Search results for: sustained anterior positivity

Authors: Sohrab Jafarpour, Hamed Farokhi, Mohammad Rahmati, Alireza Gholipour

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In the current study, a nonlinear fluid-structure interaction (FSI) biomechanical model of atherosclerosis in the left anterior descending (LAD) coronary artery is developed to perform a detailed sensitivity analysis of the geometrical features of an atheroma plaque. In the development of the numerical model, first, a 3D geometry of the diseased artery is developed based on patient-specific dimensions obtained from the experimental studies. The geometry includes four influential geometric characteristics: stenosis ratio, plaque shoulder-length, fibrous cap thickness, and eccentricity intensity. Then, a suitable strain energy density function (SEDF) is proposed based on the detailed material stability analysis to accurately model the hyperelasticity of the arterial walls. The time-varying inlet velocity and outlet pressure profiles are adopted from experimental measurements to incorporate the pulsatile nature of the blood flow. In addition, a computationally efficient type of structural boundary condition is imposed on the arterial walls. Finally, a non-Newtonian viscosity model is implemented to model the shear-thinning behaviour of the blood flow. According to the results, the structural responses in terms of the maximum principal stress (MPS) are affected more compared to the fluid responses in terms of wall shear stress (WSS) as the geometrical characteristics are varying. The extent of these changes is critical in the vulnerability assessment of an atheroma plaque.

Keywords: atherosclerosis, fluid-Structure interaction modeling, material stability analysis, and nonlinear biomechanics

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Authors: Liaqat Ali, Ehsan, Muhammad Shahzad, Nasir Orakzai

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Introduction: Internal optical urethrotomy is the main stay treatment modality in management of urethral stricture. Being minimal invasive with less morbidity, it is commonly performed and favored procedure by urologists across the globe. Although short-term success rate of optical urethrotomy is promising but long-term efficacy of IOU is questionable with high recurrence rate in different studies. Numerous techniques had been adopted to reduce the recurrence after IOU like prolong catheterization and self-clean intermittent catheterization with varying success. Mitomycin C has anti-fibroblast and anti-collagen properties and has been used in trabeculectomy, myringotomy and after keloid scar excision in contemporary surgical practice. Present study according to the best of our knowledge is a pioneer pilot study in Pakistan to determine the efficacy of Mitomycin C in preventing recurrence of urethral stricture after internal optical urethrotomy. Objective: To determine the efficacy of Mitomycin C in reducing the recurrence of anterior urethral stricture after internal optical urethrotomy. Methods: It is a randomized control trial conducted in department of urology, Institute of Kidney Diseases Hayatabad Medical Complex Peshawar from March 2011 till December 2013. After approval of hospital ethical committee, we included maximum of 2 cm anterior urethral stricture irrespective of etiology. Total of 140 patients were equally divided into two groups by lottery method. Group A (Case) comprising of 70 patients in whom Mitomycin C 0.1% was injected sub mucosal in stricture area at 1,11,6 and 12 O clock position using straight working channel paediatric cystoscope after conventional optical urethrotomy. Group B (Control) 70 patients in whom only optical urethrotomy was performed. SCIC was not offered in both the groups. All the patients were regularly followed on a monthly basis for 3 months then three monthly for remaining 9 months. Recurrence was diagnosed by using diagnostic tools of retrograde urethrogram and flexible urethroscopy in selected cased. Data was collected on structured Proforma and was analyzed on SPSS. Result: The mean age in Group A was 33 ±1.5 years and Group B was 35 years. External trauma was leading cause of urethral stricture in both groups 46 (65%) Group A and 50 (71.4%) Group B. In Group A. Iatrogenic urethral trauma was 2nd etiological factor in both groups. 18(25%) Group A while 15( 21.4%) in Group B. At the end of 1 year, At the end of one year, recurrence of urethral stricture was recorded in 11 (15.71%) patient in Mitomycin C Group A and it was recorded in 27 (38.5 %) patients in group B. Significant difference p=0.001 was found in favour of group A Mitomycin group. Conclusion: Recurrence of urethral stricture is high after optical urethrotomy. Mitomycin C is found highly effective in preventing recurrence of urethral stricture after IOU.

Keywords: urethral stricture, mitomycine, internal optical urethrotomy, medical and health sciences

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Authors: Prasad Urvashi, Wynn Yezarni, Williams Shehan, Ravindran Arun

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Introduction: Primary health services are often the first point of contact that patients with mental illness have with the healthcare system. A number of tools have been developed to increase detection of depression in the context of primary care. However, one challenge amongst many includes utilizing these tools within the limited primary care consultation timeframe. Therefore, short questionnaires that screen for depression that are just as effective as more comprehensive diagnostic tools may be beneficial in improving detection rates of patients visiting a primary care setting. Objective: To develop and determine the sensitivity and specificity of a 2-Question Questionnaire (2-QQ) to screen for depression in in a suburban primary care clinic in Ragama, Sri Lanka. The purpose is to develop a short screening tool for depression that is culturally adapted in order to increase the detection of depression in the Sri Lankan patient population. Methods: This was a cross-sectional study involving two steps. Step one: verbal administration of 2-QQ to patients by their primary care physician. Step two: completion of the Peradeniya Depression Scale, a validated diagnostic tool for depression, the patient after their consultation with the primary care physician. The results from the PDS were then correlated to the results from the 2-QQ for each patient to determine sensitivity and specificity of the 2-QQ. Results: A score of 1/+ on the 2-QQ was most sensitive but least specific. Thus, setting the threshold at this level is effective for correctly identifying depressed patients, but also inaccurately captures patients who are not depressed. A score of 6 on the 2-QQ was most specific but least sensitive. Setting the threshold at this level is effective for correctly identifying patients without depression, but not very effective at capturing patients with depression. Discussion: In the context of primary care, it may be worthwhile setting the 2-QQ screen at a lower threshold for positivity (such as a score of 1 or above). This would generate a high test sensitivity and thus capture the majority of patients that have depression. On the other hand, by setting a low threshold for positivity, patients who do not have depression but score higher than 1 on the 2-QQ will also be falsely identified as testing positive for depression. However, the benefits of identifying patients who present with depression may outweigh the harms of falsely identifying a non-depressed patient. It is our hope that the 2-QQ will serve as a quick primary screen for depression in the primary care setting and serve as a catalyst to identify and treat individuals with depression.

Keywords: depression, primary care, screening tool, Sri Lanka

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Authors: Mansour Eslami, Fereshte Habibi

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Limb length discrepancy (LLD), or anisomeric, is defined as a condition in which paired limbs are noticeably unequal. Individuals with LLD during walking use compensatory mechanisms to dynamically lengthen the short limb and shorten the long limb to minimize the displacement of the body center of mass and consequently reduce body energy expenditure. Due to the compensatory movements created, LLD greater than 1 cm increases the odds of creating lumbar problems and hip and knee osteoarthritis. Insoles are non-surgical therapies that are recommended to improve the walking pattern, pain and create greater symmetry between the two lower limbs. However, it is not yet clear what effect insoles have on the variables related to injuries during walking. The aim of the present study was to evaluate the effect of internal and external heel lift insoles on pelvic kinematic in sagittal and frontal planes and lower extremity joint moments in individuals with mild leg length discrepancy during the stance phase of walking. Biomechanical data of twenty-eight men with structural leg length discrepancy of 10-25 mm were collected while they walked under three conditions: shoes without insole (SH), with internal heel lift insoles (IHLI) in shoes, and with external heal lift insole (EHLI). The tests were performed for both short and long legs. The pelvic kinematic and joint moment were measured with a motion capture system and force plate. Five walking trials were performed for each condition. The average value of five successful trials was used for further statistical analysis. Repeated measures ANCOVA with Bonferroni post hoc test were used for between-group comparisons (p ≤ 0.05). In both internal and external heel lift insoles (IHLI, EHLI), there was a significant decrease in the peak values of lateral and anterior pelvic tilts of the long leg, hip, and knee moments of a long leg and ankle moment of short leg (p ≤ 0.05). Furthermore, significant increases in peak values of lateral and anterior pelvic tilt of short leg in IHLI and EHLI were observed as compared to Shoe (SH) condition (p ≤ 0.01). In addition, a significant difference was observed between the IHLI and EHLI conditions in peak anterior pelvic tilt of long leg and plantar flexor moment of short leg (p=0.04; p= 0.04 respectively). Our findings indicate that both IHLI and EHLI can play an important role in controlling excessive pelvic movements in the sagittal and frontal planes in individuals with mild LLD during walking. Furthermore, the EHLI may have a better effect in preventing musculoskeletal injuries compared to the IHLI.

Keywords: kinematic, leg length discrepancy, shoe insole, walking

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Authors: Janki Shankar, Shu Ping Chen

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Background: New immigrants are one of most vulnerable sections of the Canadian society. Unable to gain entry into Canada’s strictly regulated professions and trades, several skilled and qualified new immigrants take up precarious jobs without adequate occupational health and safety training, thereby increasing their risk of sustaining occupational injury and illness compared to Canadian born workers. Access to timely and appropriate support is critical for injured new immigrant workers who face additional challenges compared to Canadian born workers in accessing information and support post-injury. The purpose of our study was to explore the post-injury experiences and support needs of new immigrant workers who have sustained work-related injuries. Methods: Using an interpretive research approach and semi structured face to face qualitative interviews, 27 new immigrant workers from a range of industries operating in two cities in a province in Canada were interviewed. All had sustained work-related injuries and reported these to their work supervisors. A constant comparative approach was used to identify key themes across the worker experiences. Results: Findings reveal several factors that can shape the experiences of new immigrant workers and influence their return-to-work outcomes. Conclusion: Based on the insights of study participants, policies, practices, and potential interventions informed by their needs and preferences are proposed that can improve return to work outcomes for these workers.

Keywords: new immigrant workers, post-injury experiences, return to work outcomes, qualified

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Authors: Hasan Frookh Jamal

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This is a case of a 36-year-old Bahraini gentleman diagnosed to have Cushing's Syndrome with a large anterior mediastinal mass. He was sent abroad to the Speciality hospital in Jordan, where he underwent diagnostic video-assisted thoracoscopy, partial thymectomy and pericardial fat excision. Histopathology of the mass was reported to be an Atypical carcinoid tumor with a low Ki67 proliferation index of 5%, the mitotic activity of 4 MF/10HPF and pathological stage classification(pTNM): pT1aN1. MRI of the pituitary gland showed an ill-defined non-enhancing focus of about 3mm on the Rt side of the pituitary on coronal images, with a similar but smaller one on the left side, which could be due to enhancing pattern rather than a real lesion as reported. The patient underwent Ga68 Dotate PET/CT scan post-operatively, which showed multiple somatostatin receptor-positive lesions seen within the tail, body and head of the pancreas and positive somatostatin receptor lymph nodes located between the pancreatic head and IVC. There was no uptake detected at the anterior mediastinum nor at the site of thymic mass resection. There was no evidence of any positive somatostatin uptake at the soft tissue or lymph nodes. The patient underwent IPSS, which proved that the source is, in fact, an ectopic source of ACTH secretion. Unfortunately, the patient's serum cortisol remained elevated after surgery and failed to be suppressed by 1 mg ODST and by 2 days LLDST with a high ACTH value. The patient was started on Osilodrostat for treatment of hypercortisolism for the time being and his future treatment plan with Lutetium-177 Dotate therapy vs. bilateral adrenalectomy is to be considered in an MDT meeting.

Keywords: cushing syndrome, neuroendocrine tumur, carcinoid tumor, Thymoma

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Authors: Kristy Howells, Catherine Meehan

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This position paper presents current research findings into the proposed gap between teachers’ and practitioners’ thinking and acting about physical activity health and well-being in childhood. Within the new Primary curriculum, there is a focus on sustained physical activity within a Physical Education and healthy lifestyles in Personal, Health, Social and Emotional lessons, but there is no curriculum guidance about what sustained physical activity is and how it is defined. The current health guidance on birth to five suggests that children should not be inactive for long periods and specify light and energetic activities, however there is the a suggested period of time per day for young children to achieve, but the guidance does not specify how this should be measured. The challenge therefore for teachers and practitioners is their own confidence and understanding of what “good / moderate intensity” physical activity and healthy living looks like for children and the children understanding what they are doing. There is limited research about children from birth to eight years and also the perceptions and attitudes of those who work with this age group of children, however it was found that children at times can identify different levels of activity and it has been found that children can identify healthy foods and good choices for healthy living at a basic level. Authors have also explored teachers’ beliefs about teaching and learning and found that teachers could act in accordance to their beliefs about their subject area only when their subject knowledge, understanding and confidence of that area is high. It has been proposed that confidence and competence of practitioners and teachers to integrate ‘well-being’ within the learning settings has been reported as being low. This may be due to them not having high subject knowledge. It has been suggested that children’s life chances are improved by focusing on well-being in their earliest years. This includes working with parents and families, and being aware of the environmental contexts that may impact on children’s wellbeing. The key is for practitioners and teachers to know how to implement these ideas effectively as these key workers have a profound effect on young children as role models and due to the time of waking hours spent with them. The position paper is part of a longitudinal study at Canterbury Christ Church University and currently we will share the research findings from the initial questionnaire (online, postal, and in person) that explored and evaluated the knowledge, competence and confidence levels of practitioners and teachers as to the structure and planning of sustained physical activity and healthy lifestyles and how this progresses with the children’s age.

Keywords: health, perceptions, physical activity, well-being

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Authors: J. Herrero, D. Puigserver, I. Nijenhuis, K. Kuntze, J. M. Carmona

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In the transition zone between aquifers and basal aquitards, the perchloroethene (PCE)-pools are more recalcitrant than those elsewhere in the aquifer. Although biodegradation of chloroethenes occur in this zone, it is a slow process and a remediation strategy is needed. The aim of this study is to demonstrate that combined strategy of biostimulation and in situ chemical reduction (ISCR) is more efficient than the two separated strategies. Four different microcosm experiments with sediment and groundwater of a selected field site where an aged pool exists at the bottom of a transition zone were designed under i) natural conditions, ii) biostimulation with lactic acid, iii) ISCR with zero-value iron (ZVI) and under iv) a combined strategy with lactic acid and ZVI. Biotic and abiotic dehalogenation, terminal electron acceptor processes and evolution of microbial communities were determined for each experiment. The main results were: i) reductive dehalogenation of PCE-pools occurs under sulfate-reducing conditions; ii) biostimulation with lactic acid supports more pronounced reductive dehalogenation of PCE and trichloroethene (TCE), but results in an accumulation of 1,2-cis-dichloroethene (cDCE); iii) ISCR with ZVI produces a sustained dehalogenation of PCE and its metabolites iv) combined strategy of biostimulation and ISCR results in a fast dehalogenation of PCE and TCE and a sustained dehalogenation of cisDCE. These findings suggest that biostimulation and ISCR with ZVI are the most suitable strategies for a complete reductive dehalogenation of PCE-pools in the transition zone and further to enable the dissolution of dense non-aqueous phase liquids.

Keywords: aged PCE-pool, anaerobic microcosm experiment, biostimulation, in situ chemical reduction, natural attenuation

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Authors: J. B. Athavale, Sean Clarke

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Introduction According to ancient Indian scriptures, a person’s consciousness includes the physical body, the vital energy sheath (Pranshakti), the mental body (which includes one’s feelings and emotions), the intellectual body (which refers to one’s decision-making ability), and the Soul (which is the God Principle that resides in every person). Apart from the physical body, all the other aspects are subtle in nature. In today’s world, much attention is given to one’s physical appearance and intellectual prowess. While there have been improvements in the attention given to mental health, its complete nature is not understood, and in many cultures, mental ill health is considered taboo and looked down upon. Regarding the spiritual well-being of a person, our spiritual research has shown that people’s understanding and efforts are mostly lacking and superficial as they do not conform to Universal Spiritual Principles. Also, true well-being occurs only when all the bodies are healthy. Methodology The spiritual research team at the University has found that the spiritual aspect of a person’s life affects all the physical, psychological, and intellectual bodies of a person resulting in ill health. Cleansing these bodies at a spiritual level is essential to regain well-being. Using Aura and Energy Scanners and advanced sixth sense, we studied what causes spiritual impurity in various bodies and how to cleanse them. We measured the spiritual vibrations of a person and how they get affected due to various daily activities. For example, we studied the difference in a person’s aura before and after applying chemical-based makeup vs. natural makeup. Key Findings From the various spiritual research experiments we conducted, we found that: • All our actions and our thoughts affect our various bodies and have the potential to change the aura for the better or worse. • When there is an increase in negative vibrations around a person, negative energies from the subtle dimension are more likely to affect a person. • As the person’s spiritual level increases, the positivity in their aura also increases, and it is much easier to cleanse the various bodies spiritually. • Spiritual practice is like a general spiritual tonic that increases the positivity in one’s aura. The benefits of this are that it leads to mental stability and intellectual clarity. • Spiritual healing remedies augment any spiritual practice to obtain a faster healing effect. Conclusion Taking care of oneself spiritually has a positive halo effect on all one’s bodies. Spiritual cleansing is required regularly if one wants to attain a state of well-being. Spiritual practice and spiritual healing lead to spiritual growth, stability of mind, and less stress and reactions. Spiritually purer people affect the environment positively, and there is less unrest and more harmony between man and nature.

Keywords: body, spirituality, cleansing, consciousness

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Authors: Manoj Gupta Charan Pushparaj

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Tourism related activities are getting popular day by day and tourism has become an integral part of everyone’s life. Ecotourism initiatives have grown enormously in the past decade, and the concept of ecotourism has shown to bring great benefits in terms of environment conservation and to improve the livelihood of local people. However, the potential of ecotourism to sustain improving the livelihood of the local population in the remote future is a topic of active debate. A primary challenge that exists in this regard is the enormous costs of limiting the impacts of tourism related activities on the environment. Here we employed systems modeling approach using computer simulations to determine if ecotourism activities in the small hill town of Yercaud (Tamil Nadu, India) can be sustained over years in improving the livelihood of the local population. Increasing damage to the natural environment as a result of tourism-related activities have plagued the pristine hill station of Yercaud. Though ecotourism efforts can help conserve the environment and enrich local population, questions remain if this can be sustained in the distant future. The vital state variables in the model are the existing tourism foundation (labor, services available to tourists, etc.,) in the town of Yercaud and its natural environment (water, flora and fauna). Another state variable is the textile industry that drives the local economy. Our results would help to understand if environment conservation efforts are sustainable in Yercaud and would also offer suggestions to make it sustainable over the course of several years.

Keywords: ecotourism, simulations, modeling, Yercaud

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Authors: Christine Ysabelle G. Roman, Pauline Torres

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Background: Hypertrophic cardiomyopathy is a disease of marked heterogeneity. It is a genetically determined heart disease characterized by significant myocardium hypertrophy that results in diastolic dysfunction, left ventricular outflow tract obstruction, and an increased risk of arrhythmias. The primary treatment in patients with such conditions is negative inotropic drugs, such as beta-blockers, calcium channel antagonists, and disopyramide. However, for those who remain symptomatic and need septal reduction therapy, surgical septal myectomy or alcohol septal ablation are options. Case Summary: A 19 – year old female presented in the authors’ institution with easy fatigability. The consult was done a year prior, and 2D echocardiography was requested which showed concentric left ventricular hypertrophy, asymmetrically hypertrophied interventricular septum (IVS) with the largest diameter of 3.3cm & subaortic dynamic obstruction with a maximum gradient of 47 mmHg. A repeat echo a year later showed asymmetric septal hypertrophy (IVS measuring at 3cm) with the systolic anterior motion of anterior mitral valve leaflet and left ventricular outflow tract obstruction (peak gradient of 50mmHg). The patient then underwent alcohol septal ablation and was discharged stable after four days of admission. Conclusion: Hypertrophic obstructive cardiomyopathy, a cardiovascular genetic disease, results in various patterns of left ventricular hypertrophy and abnormality of mitral valve apparatus. The patient is managed medically initially. However, despite optimal drug therapy and significant left ventricular outflow tract obstruction, significant heart failure symptoms or syncope require invasive treatment.

Keywords: hypertrophic obstructive cardiomyopathy, left ventricular outflow tract obstruction, alcohol septal ablation, alcohol

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Authors: Recep Kesli, Huseyin Bilgin, Yasar Unlu, Gokhan Gungor

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Aim: The aim of this study, was to investigate the presence of Helicobacter pylori (H. pylori) infection by culture, histology, and RUT (Rapid Urease Test) in gastric antrum biopsy samples taken from patients presented with dyspeptic complaints and to determine resistance rates of amoxicillin, clarithromycin, levofloxacin and metronidazole against the H. pylori strains by E-test. Material and Methods: A total of 278 patients who admitted to Konya Education and Research Hospital Department of Gastroenterology with dyspeptic complaints, between January 2011-July 2013, were included in the study. Microbiological and histopathological examinations of biopsy specimens taken from antrum and corpus regions were performed. The presence of H. pylori in biopsy samples was investigated by culture (Portagerm pylori-PORT PYL, Pylori agar-PYL, GENbox microaer, bioMerieux, France), histology (Giemsa, Hematoxylin and Eosin staining), and RUT(CLOtest, Cimberly-Clark, USA). Antimicrobial resistance of isolates against amoxicillin, clarithromycin, levofloxacin, and metronidazole was determined by E-test method (bioMerieux, France). As a gold standard in the diagnosis of H. pylori; it was accepted that the culture method alone was positive or both histology and RUT were positive together. Sensitivity and specificity for histology and RUT were calculated by taking the culture as a gold standard. Sensitivity and specificity for culture were also calculated by taking the co-positivity of both histology and RUT as a gold standard. Results: H. pylori was detected in 140 of 278 of patients with culture and 174 of 278 of patients with histology in the study. H. pylori positivity was also found in 191 patients with RUT. According to the gold standard criteria, a false negative result was found in 39 cases by culture method, 17 cases by histology, and 8 cases by RUT. Sensitivity and specificity of the culture, histology, and RUT methods of the patients were 76.5 % and 88.3 %, 87.8 % and 63 %, 94.2 % and 57.2 %, respectively. Antibiotic resistance was investigated by E-test in 140 H. pylori strains isolated from culture. The resistance rates of H. pylori strains to the amoxicillin, clarithromycin, levofloxacin, and metronidazole was detected as 9 (6.4 %), 22 (15.7 %), 17 (12.1 %), 57 (40.7 %), respectively. Conclusion: In our study, RUT was found to be the most sensitive, culture was the most specific test between culture, histology, and RUT methods. Although we detected the specificity of the culture method as high, its sensitivity was found to be quite low compared to other methods. The low sensitivity of H. pylori culture may be caused by the factors affect the chances of direct isolation such as spoild bacterium, difficult-to-breed microorganism, clinical sample retrieval, and transport conditions.

Keywords: antimicrobial resistance, culture, histology, H. pylori, RUT

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Authors: Ahmadreza Bagheri, Seyyed S. Eftekhari, Shervin Rashidinia

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Background: Various stress tests have been proposed yet to assess patients with suspected coronary artery disease. However, their diagnostic properties in terms of sensitivity, specificity, and accuracy are variable and their applicability remained somewhat vague. The aim of this study is to validate per-vessel diagnostic properties of 3 types of stress myocardial perfusion scintigraphy in gated SPECT (Single-Photon Emission Computed Tomography) using either exercise or pharmacological stress testing with dipyridamole or dobutamine. Materials and Methods: Hospital records of 314 patients who referred to Imam Khomeini hospital of Tehran between September 2015 and January 2017 were completely reviewed in this study. All patients underwent coronary angiography within 3 months after stress myocardial perfusion scan. Eventually, the results were analyzed in per-vessel basis to find the proper modality for each involved vessel or scanned site. Results: The mean age of patients was 62.15 ± 4.94 years (30-85) and 35.03% were women. The overall sensitivity, specificity, and accuracy were calculated as 56.59%, 54.24%, and 55.09%, respectively. These values were 56.43% and 53.25%, 54.46% and 47.36%, 56.75% and 54.83% for dipyridamole and exercise, respectively. Ischemia of the anterior wall through exercise stress testing has the highest diagnostic accuracy in detecting LAD (Left Anterior Descending artery) involvement. Inferior wall hypokinesia and anterolateral wall ischemia during exercise stress testing have the highest diagnostic accuracy in detecting RCA (Right Coronary Artery) and LCX artery (Left Circumflex Artery) stenosis, respectively. Conclusion: Stress myocardial perfusion scan should be carried out on the basis of the findings of the preliminary investigations on suspicion of a specific coronary artery or involved myocardial wall.

Keywords: dipyridamole, dobutamine, single-photon emission computed tomography, stress myocardial perfusion scintigraphy

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Authors: Mohammed Sherzad

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The Sahara desert covers third of the total surface of Africa with a quarter of this area within the national boundaries of Algeria. Sand drift and deposition is considered one of the major factors of the desertification process in the area. It is estimated that a third of the world's hot arid lands are covered by aeolian sand deposits, forming extensive sand bedforms. The Gourrara region in the Grand Erg Occidental (west of Algerian Sahara) and the region of Souf in the Grand Erg Oriental (east of Algerian Sahara) have been chosen as case studies. These were significant cultural and trading centers for many centuries despite their remote location and their harsh desert environment particularly solar radiation and sand drift and deposition. The architecture of the sustained vernacular settlements in each of the two regions has unique design features for this environment. So do the irrigation systems used - palm groves and the foggara system for capturing and distributing groundwater. However, the ecological balance which enabled the Saharans to live with the desert has been upset. New buildings often use technology based on models imported or imposed from areas that climatically have little in common. These make the inhabitants live ‘in the desert’ rather than ‘with the desert’. This paper will describe the qualities of the vernacular architecture and demonstrate its effectiveness and adaptability to the region’s harsh desert environment in comparison with contemporary buildings. Developing design guides and approaches based on lessons from the traditional architecture is important to ensure sustained livelihoods of the inhabitants in these areas.

Keywords: vernacular architecture, desert architecture, hot climate, aeolian sand deposition

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Authors: Jiping Cai, Ningzhi Wangyang, Jun Shao

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Traumatic brain injury (TBI) is one of the major causes of morbidity and mortality that leads to structural and functional damage in several parts of the brain, such as cranial nerves, optic nerve tract or other circuitry involved in vision and occipital lobe, depending on its location and severity. As a result, the function associated with vision processing and perception are significantly affected and cause blurred vision, double vision, decreased peripheral vision and blindness. Here two cases complaining of monocular vision loss (actually temporal hemianopia) due to traumatic chiasmal syndrome after frontal head injury were reported, and were compared the findings with individual case reports published in the literature. Reported cases of traumatic chiasmal syndrome appear to share some common features, such as injury to the frontal bone and fracture of the anterior skull base. The degree of bitemporal hemianopia and visual loss acuity have a variable presentation and was not necessarily related to the severity of the craniocerebral trauma. Chiasmal injury may occur even in the absence bony chip impingement. Isolated bitemporal hemianopia is rare and clinical improvement usually may not occur. Mechanisms of damage to the optic chiasm after trauma include direct tearing, contusion haemorrhage and contusion necrosis, and secondary mechanisms such as cell death, inflammation, edema, neurogenesis impairment and axonal damage associated with TBI. Beside visual field test, MRI evaluation of optic pathways seems to the strong objective evidence to demonstrate the impairment of the integrity of visual systems following TBI. Therefore, traumatic chiasmal syndrome should be considered as a differential diagnosis by both neurosurgeons and ophthalmologists in patients presenting with visual impairment, especially bitemporal hemianopia after head injury causing frontal and anterior skull base fracture.

Keywords: bitemporal hemianopia, brain injury, optic chiasma, traumatic chiasmal syndrome.

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Authors: Martina Šutovská, Marta Jošková, Ivana Kazimierová, Lenka Pappová, Maroš Adamkov, Soňa Fraňová

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Bronchial asthma is characterized by increased bronchoconstrictor responses to provoking agonists, airway inflammation and remodeling. All these processes involve Ca2+ influx through Ca2+-release-activated Ca2+ channels (CRAC) that are widely expressed in immune, respiratory epithelium and airway smooth muscle (ASM) cells. Our previous study pointed on possible therapeutic potency of CRAC blockers using experimental guinea pigs asthma model. Presented work analyzed complex anti-asthmatic effect of long-term administered CRAC blocker, including impact on allergic inflammation, airways hyperreactivity, and remodeling and mucociliary clearance. Ovalbumin-induced allergic inflammation of the airways according to Franova et al. was followed by 14 days lasted administration of CRAC blocker (3-fluoropyridine-4-carboxylic acid, FPCA) in the dose 1.5 mg/kg bw. For comparative purposes salbutamol, budesonide and saline were applied to control groups. The anti-inflammatory effect of FPCA was estimated by serum and bronchoalveolar lavage fluid (BALF) changes in IL-4, IL-5, IL-13 and TNF-α analyzed by Bio-Plex® assay as well as immunohistochemical staining focused on assessment of tryptase and c-Fos positivity in pulmonary samples. The in vivo airway hyperreactivity was evaluated by Pennock et al. and by organ tissue bath methods in vitro. The immunohistochemical changes in ASM actin and collagen III layer as well as mucin secretion evaluated anti-remodeling effect of FPCA. The measurement of ciliary beat frequency (CBF) in vitro using LabVIEW™ Software determined impact on mucociliary clearance. Long-term administration of FPCA to sensitized animals resulted in: i. Significant decrease in cytokine levels, tryptase and c-Fos positivity similar to budesonide effect; ii.Meaningful decrease in basal and bronchoconstrictors-induced in vivo and in vitro airway hyperreactivity comparable to salbutamol; iii. Significant inhibition of airway remodeling parameters; iv. Insignificant changes in CBF. All these findings confirmed complex anti-asthmatic effect of CRAC channels blocker and evidenced these structures as the rational target in the treatment of allergic bronchial asthma.

Keywords: allergic asthma, CRAC channels, cytokines, respiratory epithelium

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Authors: D. Pogliana, A. Maso, N. Milani, D. Panzin, S. Rivaroli, J. Konin

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This case aims to identify the role of movement quality during the final stage of return to sport (RTS) in a male amateur football player 13 years old after passing the acute phase of the bilateral Osgood-Schlatter disease (OSD). The patient, after a year from passing the acute phase of OSD with the abstention of physical activity, reports bilateral anterior knee pain at the beginning of the football sport activity. Interventions: After the orthopedist check, who recommended physiotherapy sessions for the correction of motor patterns and the isometric reinforcement of the muscles of the quadriceps, the rehabilitation intervention was developed in 7 weeks through 14 sessions of neuro-motor training (NMT) with a frequency of two weekly sessions and six sessions of muscle-strengthening with a frequency of one weekly session. The sessions of NMT were carried out through free body exercises (or with overloads) with visual bio-feedback with the help of two cameras (one with anterior vision and one with lateral vision of the subject) and a big touch screen. The aim of these sessions of NMT was to modify the dysfunctional motor patterns evaluated by the 2D motion analysis test. The test was carried out at the beginning and at the end of the rehabilitation course and included five movements: single-leg squat (SLS), drop jump (DJ), single-leg hop (SLH), lateral shuffle (LS), and change of direction (COD). Each of these movements was evaluated through the video analysis of dynamic valgus knee, pelvic tilt, trunk control, shock absorption, and motor strategy. A free image analysis software (Kinovea) was then used to calculate scores. Results: Baseline assessment of the subject showed a total score of 59% on the right limb and 64% on the left limb (considering an optimal score above 85%) with large deficits in shock absorption capabilities, the presence of dynamic valgus knee, and dysfunctional motor strategies defined “quadriceps dominant.” After six weeks of training, the subject achieved a total score of 80% on the right limb and 86% on the left limb, with significant improvements in shock absorption capabilities, the presence of dynamic knee valgus, and the employment of more hip-oriented motor strategies on both lower limbs. The improvements shown in dynamic knee valgus, greater hip-oriented motor strategies, and improved shock absorption identified through six weeks of the NMT program can help a teenager amateur football player to manage the anterior knee pain during sports activity. In conclusion, NMT was a good choice to help a 13 years old male amateur football player to return to performance without pain after OSD and can also be used with all this type of athletes of the other teams' sports.

Keywords: movement analysis, neuro-motor training, knee pain, movement strategies

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Authors: Camille Charlebois-Plante, Marie-Ève Bourassa, Gaelle Dumel, Meriem Sabir, Louis De Beaumont

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To the extent of our knowledge, there has been little interest in the chronic effects of mild traumatic brain injury (mTBI) on cognition during normal aging. This is rather surprising considering the impacts on daily and social functioning. In addition, sustaining a mTBI during late adulthood may increase the effect of normal biological aging in individuals who consider themselves normal and healthy. The objective of this study was to characterize the persistent neuropsychological repercussions of mTBI sustained during late adulthood, on average 12 months prior to testing. To this end, 35 mTBI patients and 42 controls between the ages of 50 and 69 completed an exhaustive neuropsychological assessment lasting three hours. All mTBI patients were asymptomatic and all participants had a score ≥ 27 at the MoCA. The evaluation consisted of 20 standardized neuropsychological tests measuring memory, attention, executive and language functions, as well as information processing speed. Performance on tests of visual (Brief Visuospatial Memory Test Revised) and verbal memory (Rey Auditory Verbal Learning Test and WMS-IV Logical Memory subtest), lexical access (Boston Naming Test) and response inhibition (Stroop) revealed to be significantly lower in the mTBI group. These findings suggest that a mTBI sustained during late adulthood induces lasting effects on cognitive function. Episodic memory and executive functions seem to be particularly vulnerable to enduring mTBI effects.

Keywords: cognitive function, late adulthood, mild traumatic brain injury, neuropsychology

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Authors: Siziwe Monica Zuma

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The Expanded Public Works Program (EPWP) is an instrument that the South African Government uses to reduce unemployment and poverty and also stimulate economic growth. However, due to the limited budget and programs in the EPWP, the program has had challenges in reducing unemployment, poverty and stimulating economic growth. The EPWP Vuk’uphile program had positive outcomes in developing Black emerging contractors, in order for them to participate in the main stream economy far better than when the EPWP program was not introduced. The Skills component of the program particularly the EPWP Infrastructure, which is the most funded program under EPWP has had limited success in transferring appropriate skills to ensure labour participants can penetrate the labour market after participating in the EPWP. Education and skills are important attributes that can contribute to labour absorption, however, the EPWP particularly the infrastructure program needs to strengthen skills development over a longer period of time suggested a year with multi skills relevant to the labour market. Longer and more sustained employment provides a safety net and reduces poverty better that short term employment. The EPWP program can be expanded in the infrastructure sector, focusing on rural infrastructure, agricultural infrastructure, infrastructure related components like property, ownership, management, and other services. These can stimulate the Economic sector Infrastructure of EPWP, offer longer term and more sustained employment and rural enterprise development and further employment. The Expanded Public Works Program (EPWP) is an instrument that the South African Government uses to reduce unemployment and poverty and also stimulate economic growth. However, due to the limited budget and programs in the EPWP, the program has had challenges in reducing unemployment, poverty and stimulating economic growth. The EPWP Vuk’uphile program has had positive outcomes in developing Black emerging contractors, in order for them to participate in the main stream economy far better than when the EPWP program was not introduced. The Skills component of the program particularly the EPWP Infrastructure, which is the most funded program under EPWP has had limited success in transferring appropriate skills to ensure labour participants are able to penetrate the labour market after participating in the EPWP. Education and skills are important attributes that can contribute to labour absorption, however, the EPWP particularly the infrastructure program needs to strengthen skills development over a longer period of time suggested a year with multi skills relevant to the labour market. Longer and more sustained employment provides a safety net and reduces poverty better that short term employment. The EPWP program can be expanded in the infrastructure sector, focusing on rural infrastructure, agricultural infrastructure, infrastructure related components like property, ownership, management, and other services. These can stimulate the Economic sector Infrastructure of EPWP, offer longer term and more sustained employment and rural enterprise development and further employment.

Keywords: Expanded Public Works Program (EPWP), VUKÚPHILE, youth, Public Works Programs (PWP), Infrastructure Sector of EPWP (EPWP Infrastructure)

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Authors: Eli Maria Forti-Pazzianotto, Carolina Moraes Da Costa, Daniela Faleiros Berteli Merino, Maura Rigoldi Simões Da Rocha, Irineu Rasera-Junior

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There is no conclusive evidence to support the use of one type or brand of incentive espirometry over others. The decision as to which equipment is best, have being based on empirical assessment of patient acceptance, ease of use, and cost. The aim was to evaluate the effects of use of two methodologies of breathing exercises, performed by flow-oriented incentive spirometry, in the reversal of diaphragmatic dysfunction in postoperative bariatric surgery. 38 morbid obese women were selected. Respiratory muscle strength was evaluated through the nasal inspiratory pressure (NIP), and the respiratory muscles endurance, through incremental test by measurement of sustained maximal inspiratory pressure (SMIP). They were randomized in 2 groups: 1- Respiron® Classic (RC) the inspirations were slow, deep and sustained for as long as possible (5 sec). 2- Respiron® Athletic1 (RA1) - the inspirations were explosive, quick and intense, raising balls by the explosive way. 6 sets of 15 repetitions with intervals of 30 to 60 seconds were performed in groups. At the end of the intervention program (second PO), the volunteers were reevaluated. The groups were homogeneous with regard to initial assessment. However on reevaluating there was a significant decline of the variable PIN (p= < 0.0001) and SMIP (p=0.0004) in RC. In the RA1 group there was a maintenance of SMIP (p=0.5076) after surgery. The use of the Respiron Athletic 1, as well as the methodology of application used, can contribute positively to preserve the inspiratory muscle endurance and improve the diaphragmatic dysfunction in postoperative period.

Keywords: bariatric surgery, incentive spirometry, respiratory muscle, physiotherapy

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Authors: Nathalia Andrea Calderon Lesmes, Eduardo Barragan Parada, Diego Fernando Villegas Bermudez

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Spasticity in the plantiflexor muscles as a product of stroke (CVA-Cerebrovascular accident) restricts the mobility and independence of the affected people. Commonly, physiotherapists are in charge of manually performing the rehabilitation therapy known as Sustained Mechanical Stretching, rotating the affected foot of the patient in the sagittal plane. However, this causes a physical wear on the professional because it is a fatiguing movement. In this article, a mechanical device is developed to implement this rehabilitation therapy more efficiently. The device consists of a worm-crown mechanism that is driven by a crank to gradually rotate a platform in the sagittal plane of the affected foot, in order to achieve dorsiflexion. The device has a range of sagittal rotation up to 150° and has velcro located on the footplate that secures the foot. The design of this device was modeled by using CAD software and was checked structurally with a general purpose finite element software to be sure that the device is safe for human use. As a measurement system, a goniometer is used in the lateral part of the device and load cells are used to measure the force in order to determine the opposing torque exerted by the muscle. Load cells sensitivity is 1.8 ± 0.002 and has a repeatability of 0.03. Validation of the effectiveness of the device is measured by reducing the opposition torque and increasing mobility for a given patient. In this way, with a more efficient therapy, an improvement in the recovery of the patient's mobility and therefore in their quality of life can be achieved.

Keywords: biomechanics, mechanical device, plantiflexor muscles, rehabilitation, spastic hemiplegia, sustained mechanical stretching

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Authors: Milad Pirali, Sohrab Keyhani, Mohhamad Ali Sanjari, Ali Ashraf Jamshidi

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Purpose: The effect of hamstring antagonist activity on the knee extensors torque of the Anterior Cruciate Ligament reconstruction (ACLR) is not clear and persistent muscle weakness is common after ACLR. Hamstring activation when acting as antagonist is considered very important for knee strengths. Therefore the purpose of this study was to examine hamstring antagonist coactivation during maximal effort of the isokinetic knee extension in ACLR athletes with hamstring autograft. Materials and Methods: We enrolled 20 professional athletes who underwent primary ACLR (hamstring tendon autograft)with 6-24 months postoperative and 20 healthy subjects as control group. Each subjects performed maximal effort isokinetic knee extension and flexion in 60/˚ s and 180/˚ s velocities for the involved and uninvolved limb. Synchronously, surface electromyography (EMG) was recorded of vastus medialis (VM), vastus lateralis (VL), rectus femoris (RF) and biceps femoris (BF). The antagonist integrated EMG (IEMG) values were normalized to the IEMG of the same muscle during maximal isokinetic eccentric effort at the same velocities and ROM. Results: A one-way analysis of variance designs shows significantly greater IEMG coactivation of hamstring and decreased activation of Vm in ACLR when compared to uninvolved and control group leg in 60/˚ s and 180/˚ s velocities. Likewise peak torque to body weight was decreased in ACLR compared to uninvolved and control group during knee extension in both velocities (p < 0.05). Conclusions: Decreased extensors moment caused by decreased quadriceps inhibition and increased hamstring coactivation. In addition, these result indicated to decrease of motor unit recruitment in the VM (as a kinesiologicmonitore of the knee). It is appearing that strengthening of the quadriceps to be an important for rehabilitation program after ACLR for preparation in athletes endeavors. Therefore, we suggest that having more emphasis and focus on quadriceps strength and less emphasis on hamstring following ACLR.

Keywords: ACLR-coactivation, dynamometry, electromyography, isokinetic

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Authors: Samuel P. Prahlow, Anthony Sciuva, Katherine Bombly, Emily Wilson, Shiv Dhiman, Savita Arya

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A prevalence cohort study of atherosclerotic lesions within cadavers was performed to better understand and characterize the prevalence of atherosclerosis among Georgia residents within body donors in the Philadelphia College of Osteopathic Medicine (PCOM) - Georgia body donor program. We procured specimens from cadavers used for medical students, physical therapy students, and biomedical science students cadaveric anatomical dissection at PCOM - South Georgia and PCOM - Georgia. Tissues were prepared using hematoxylin and eosin (H&E) stainas histological slides by Colquitt Regional Medical Center Laboratory Services. One section from each of the following arteries was taken after cadaveric dissection at the site of most calcification palpated grossly (if present): left anterior descending coronary artery, left internal carotid artery, abdominal aorta, splenic artery, and hepatic artery. All specimens were graded and categorized according to the American Heart Association’s Modified and Conventional Standards for Atherosclerotic Lesions using x4, x10, x40 microscopic magnification. Our study cohort included 22 cadavers, with 16 females and 6 males. The average age was 72.54, and the median age was 72, with a range of 52 to 90 years old. The cause of death determination listing vascular and/or cardiovascular causes was present on 6 of the 22 death certificates. 19 of 22 (86%) cadavers had at least a single artery grading > 5. Of the cadavers with at least a single artery graded at greater than 5, only 5 of 19 (26%) cadavers had a vascular or cardiovascular cause of death reported. Malignancy was listed as a cause of death on 7 (32%) death certificates. The average atherosclerosis grading of the common hepatic, splenic and left internal carotid arteries (2.15, 3.05, and 3.36 respectively) were lower than the left anterior descending artery and the abdominal aorta (5.16 and 5.86 respectively). This prevalence study characterizes atherosclerosis found in five medium and large systemic arteries within cadavers from the state of Georgia.

Keywords: pathology, atherosclerosis, histology, cardiovascular

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Authors: Rajni Kant Panik

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The aim of the present study was to develop and evaluate mupirocin loaded nanoparticle incorporated into hydrogel as an infected wound healer. Incorporated Nanoparticle in hydrogel provides a barrier that effectively prevents the contamination of the wound and further progression of infection to deeper tissues. Hydrogel creates moist healing environment on wound space with good fluid absorbance. Nanoparticles were prepared by double emulsion solvent evaporation method using different ratios of PLGA polymer and the hydrogels was developed using sodium alginate and gelatin. Further prepared nanoparticles were then incorporated into the hydrogels. The formulations were characterized by FT-IR and DSC for drug and polymer compatibility and surface morphology was studied by TEM. Nanoparticle hydrogel were evaluated for their size, shape, encapsulation efficiency and for in vitro studies. The FT-IR and DSC confirmed the absence of any drug polymer interaction. The average size of Nanoparticle was found to be in range of 208.21-412.33 nm and shape was found to be spherical. The maximum encapsulation efficiency was found to be 69.03%. The in vitro release profile of Nanoparticle incorporated hydrogel formulation was found to give sustained release of drug. Antimicrobial activity testing confirmed that encapsulated drug preserve its effectiveness. The stability study confirmed that the formulation prepared were stable. Present study complements our finding that mupirocin loaded Nanoparticle incorporated into hydrogel has the potential to be an effective and safe novel addition for the release of mupirocin in sustained manner, which may be a better option for the management of wound. These finding also supports the progression of antibiotic via hydrogel delivery system is a novel topical dosage form for the management of wound.

Keywords: hydrogel, nanoparticle, PLGA, wound healing

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Authors: Esther O. Adebitan, Florence Oyelade

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The Millennium Development Goals (MDGs) was initiated by the UN member nations’ aspiration for the betterment of human life. It is expressed in a set of numerical ‎and time-bound targets. In more recent time, the aspiration is shifting away from just the achievement to the sustainability of achieved MDGs beyond the 2015 target. The main objective of this study was assessing how much the hotel industry within the Nigerian Federal Capital Territory (FCT) as a member of the global community is involved in the achievement of sustainable MDGs within the FCT. The study had two population groups consisting of 160 hotels and the communities where these are located. Stratified random sampling technique was adopted in selecting 60 hotels based on large, medium ‎and small hotels categorisation, while simple random sampling technique was used to elicit information from 30 residents of three of the hotels host communities. The study was guided by tree research questions and two hypotheses aimed to ascertain if hotels see the need to be involved in, and have policies in pursuit of achieving sustained MDGs, and to determine public opinion regarding hotels contribution towards the achievement of the MDGs in their communities. A 22 item questionnaire was designed ‎and administered to hotel managers while 11 item questionnaire was designed ‎and administered to hotels’ host communities. Frequency distribution and percentage as well as Chi-square were used to analyse data. Results showed no significant involvement of the hotel industry in achieving sustained MDGs in the FCT and that there was disconnect between the hotels and their immediate communities. The study recommended that hotels should, as part of their Corporate Social Responsibility pick at least one of the goals to work on in order to be involved in the attainment of enduring Millennium Development Goals.

Keywords: MDGs, hotels, FCT, host communities, corporate social responsibility

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Authors: Mohammad S. Islam

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Elections in Bangladesh are always controversial, and sometimes it becomes a violent affair when state power is combined with politics. Despite the commitment of the ruling party- the polling government to ensure free, fair, and credible elections, the participants of opposition parties and the general voters became very disappointed, terribly frustrated, and severely shocked. It happened when numerous claims of serious irregularities of vote rigging and violence came out in broad daylight during the election. This paper addresses the issues of how the ruling party created frightening and a horror situation to make people silent over electoral fraud and violent incidents, including gang rape. It also seeks to demonstrate that election-2018 was simply the deceptive action of the ruling party to legitimate their power, but not to provide a minimum opportunity for voters to exercise their fundamental right to vote. The fundamental freedom and the rule of law seemed to be ignored completely in this election process and afterwards. With the help of state machinery, the government of the ruling party violated human rights, restricted fundamental freedoms, and humiliated social protection & dignity. The contestant’s views as witnessed and relevant literatures are cited first for conceptual understanding. Then, the paper will examine how a new dimension of circumstantial social measures related to sustained protection can reduce all kinds of violence against humanity towards establishing a peaceful democratic society. Finally, this paper interprets the key findings and considers wider implications.

Keywords: electoral fraud, human rights, sustained protection, social measures, vote rigging

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Authors: S. Bouameur, S. Chirani

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The aim of this study was to evaluate the potential use of EthylCellulose in the preparation of microspheres as a Drug Delivery System for sustained release of phenobarbital. The microspheres were prepared by solvent evaporation technique using ethylcellulose as polymer matrix with a ratio 1:2, dichloromethane as solvent and Polyvinyl alcohol 1% as processing medium to solidify the microspheres. Size, shape, drug loading capacity and entrapement efficiency were studied.

Keywords: phenobarbital, microspheres, ethylcellulose, polyvinylacohol

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Authors: Recep Kesli, Huseyin Bilgin, Yasar Unlu, Gokhan Gungor

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Aim: The aim of this study was to compare diagnostic values of two different molecular-based tests (GenoType® HelicoDR ve Seeplex® H. pylori-ClaR- ACE Detection) in detection presence of the H. pylori from gastric biopsy specimens. In addition to this also was aimed to determine resistance ratios of H. pylori strains against to clarytromycine and quinolone isolated from gastric biopsy material cultures by using both the genotypic (GenoType® HelicoDR, Seeplex ® H. pylori -ClaR- ACE Detection) and phenotypic (gradient strip, E-test) methods. Material and methods: A total of 266 patients who admitted to Konya Education and Research Hospital Department of Gastroenterology with dyspeptic complaints, between January 2011-June 2013, were included in the study. Microbiological and histopathological examinations of biopsy specimens taken from antrum and corpus regions were performed. The presence of H. pylori in all the biopsy samples was investigated by five differnt dignostic methods together: culture (C) (Portagerm pylori-PORT PYL, Pylori agar-PYL, GENbox microaer, bioMerieux, France), histology (H) (Giemsa, Hematoxylin and Eosin staining), rapid urease test (RUT) (CLOtest, Cimberly-Clark, USA), and two different molecular tests; GenoType® HelicoDR, Hain, Germany, based on DNA strip assay, and Seeplex ® H. pylori -ClaR- ACE Detection, Seegene, South Korea, based on multiplex PCR. Antimicrobial resistance of H. pylori isolates against clarithromycin and levofloxacin was determined by GenoType® HelicoDR, Seeplex ® H. pylori -ClaR- ACE Detection, and gradient strip (E-test, bioMerieux, France) methods. Culture positivity alone or positivities of both histology and RUT together was accepted as the gold standard for H. pylori positivity. Sensitivity and specificity rates of two molecular methods used in the study were calculated by taking the two gold standards previously mentioned. Results: A total of 266 patients between 16-83 years old who 144 (54.1 %) were female, 122 (45.9 %) were male were included in the study. 144 patients were found as culture positive, and 157 were H and RUT were positive together. 179 patients were found as positive with GenoType® HelicoDR and Seeplex ® H. pylori -ClaR- ACE Detection together. Sensitivity and specificity rates of studied five different methods were found as follows: C were 80.9 % and 84.4 %, H + RUT were 88.2 % and 75.4 %, GenoType® HelicoDR were 100 % and 71.3 %, and Seeplex ® H. pylori -ClaR- ACE Detection were, 100 % and 71.3 %. A strong correlation was found between C and H+RUT, C and GenoType® HelicoDR, and C and Seeplex ® H. pylori -ClaR- ACE Detection (r:0.644 and p:0.000, r:0.757 and p:0.000, r:0.757 and p:0.000, respectively). Of all the isolated 144 H. pylori strains 24 (16.6 %) were detected as resistant to claritromycine, and 18 (12.5 %) were levofloxacin. Genotypic claritromycine resistance was detected only in 15 cases with GenoType® HelicoDR, and 6 cases with Seeplex ® H. pylori -ClaR- ACE Detection. Conclusion: In our study, it was concluded that; GenoType® HelicoDR and Seeplex ® H. pylori -ClaR- ACE Detection was found as the most sensitive diagnostic methods when comparing all the investigated other ones (C, H, and RUT).

Keywords: Helicobacter pylori, GenoType® HelicoDR, Seeplex ® H. pylori -ClaR- ACE Detection, antimicrobial resistance

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Authors: John E. Muñoz, Jose F. Lopez, David S. Lopez

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Attention Deficit Hyperactivity Disorder (ADHD) is a disorder that affects 1 out of 5 Colombian children, converting into a real public health problem in the country. Conventional treatments such as medication and neuropsychological therapy have been proved to be insufficient in order to decrease high incidence levels of ADHD in the principal Colombian cities. This work demonstrates a design and development of a videogame that uses a brain computer interface not only to serve as an input device but also as a tool to monitor neurophysiologic signal. The video game named “The Harvest Challenge” puts a cultural scene of a Colombian coffee grower in its context, where a player can use his/her avatar in three mini games created in order to reinforce four fundamental aspects: i) waiting ability, ii) planning ability, iii) ability to follow instructions and iv) ability to achieve objectives. The details of this collaborative designing process of the multimedia tool according to the exact clinic necessities and the description of interaction proposals are presented through the mental stages of attention and relaxation. The final videogame is presented as a tool for sustained attention training in children with ADHD using as an action mechanism the neuromodulation of Beta and Theta waves through an electrode located in the central part of the front lobe of the brain. The processing of an electroencephalographic signal is produced automatically inside the videogame allowing to generate a report of the theta/beta ratio evolution - a biological marker, which has been demonstrated to be a sufficient measure to discriminate of children with deficit and without.

Keywords: BCI, neuromodulation, ADHD, videogame, neurofeedback, theta/beta ratio

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Authors: Ibrahim M. I. Hamoda, Ahmed R. Z. Baghdadi, Mohammed K. Mohamed, Nawal A. Abu-Shady

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Background: Most of patients with vestibular dysfunction suffering from balance disorders, Abnormality in balance increase effort and exertion which affect the independency, so this study might be a guide in managing balance problem and consequently improve walking with less exertion and maximum function. Purpose: to analyze and discuss the effect of transcranial magnetic therapy on balance in patients with vestibular dysfunction. Methods: forty subjects from both sexes were classified to divided randomly into two equal groups; Group I study group: this group received transcranial magnetic therapy, with a selected physical therapy program for improving balance and vestibular disorders (Balance training, Cawthorne-Cooksey Exercises) and group II (control group): this group received a selected physical therapy program as group I without transcranial magnetic therapy. This treatment procedure will be applied three times weekly for three months. The mean age was 54.53±3.44 and 55.33±2.32 years and BMI 35.7±3.03 and 35.73±1.03 kg/m2 for group I and II respectively. The Biodex Balance System, Berge balances scale (BBS) and brain MRI were used for assessment. Assessments were conducted before and after treatment. The treatment program for group I included balance training, Cawthorne-Cooksey Exercises and pulsed magnetic therapy (Parameters used in the program of 20 minutes, Intensity 2 gausses, Frequency 1 Hz). This selected program was done in approximately one hour every other day for three month. The treatment program group II Patients received the same program as group A without transcranial magnetic therapy. Results: The One-way ANOVA revealed that there were no significant differences in BBS scores, overall balance index, Anterior / posterior balance index, Medial / lateral balance index and dynamic limits of stability between both groups. Moreover, the BBS scores increased and overall balance index, Anterior / posterior balance index, Medial / lateral balance index and dynamic limits of stability decreased significantly after treatment in group I and II compared with before treatment. Interpretation/Conclusion: Adding pulsed magnetic therapy to balance training, Cawthorne-Cooksey Exercises has no effect on static and dynamic balance in patients with balance problems due to benign positional paroxysmal vertigo.

Keywords: balance, transcranial magnetic therapy, vestibular dysfunction, biomechanic

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