Search results for: musculoskeletal graft versus host disease
3385 Evaluation of Hepatic Metabolite Changes for Differentiation Between Non-Alcoholic Steatohepatitis and Simple Hepatic Steatosis Using Long Echo-Time Proton Magnetic Resonance Spectroscopy
Authors: Tae-Hoon Kim, Kwon-Ha Yoon, Hong Young Jun, Ki-Jong Kim, Young Hwan Lee, Myeung Su Lee, Keum Ha Choi, Ki Jung Yun, Eun Young Cho, Yong-Yeon Jeong, Chung-Hwan Jun
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Purpose: To assess the changes of hepatic metabolite for differentiation between non-alcoholic steatohepatitis (NASH) and simple steatosis on proton magnetic resonance spectroscopy (1H-MRS) in both humans and animal model. Methods: The local institutional review board approved this study and subjects gave written informed consent. 1H-MRS measurements were performed on a localized voxel of the liver using a point-resolved spectroscopy (PRESS) sequence and hepatic metabolites of alanine (Ala), lactate/triglyceride (Lac/TG), and TG were analyzed in NASH, simple steatosis and control groups. The group difference was tested with the ANOVA and Tukey’s post-hoc tests, and diagnostic accuracy was tested by calculating the area under the receiver operating characteristics (ROC) curve. The associations between metabolic concentration and pathologic grades or non-alcoholic fatty liver disease(NAFLD) activity scores were assessed by the Pearson’s correlation. Results: Patient with NASH showed the elevated Ala(p<0.001), Lac/TG(p < 0.001), TG(p < 0.05) concentration when compared with patients who had simple steatosis and healthy controls. The NASH patients were higher levels in Ala(mean±SEM, 52.5±8.3 vs 2.0±0.9; p < 0.001), Lac/TG(824.0±168.2 vs 394.1±89.8; p < 0.05) than simple steatosis. The area under the ROC curve to distinguish NASH from simple steatosis was 1.00 (95% confidence interval; 1.00, 1.00) with Ala and 0.782 (95% confidence interval; 0.61, 0.96) with Lac/TG. The Ala and Lac/TG levels were well correlated with steatosis grade, lobular inflammation, and NAFLD activity scores. The metabolic changes in human were reproducible to a mice model induced by streptozotocin injection and a high-fat diet. Conclusion: 1H-MRS would be useful for differentiation of patients with NASH and simple hepatic steatosis.Keywords: non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, 1H MR spectroscopy, hepatic metabolites
Procedia PDF Downloads 3263384 Investigation of Threshold Voltage Shift in Gamma Irradiated N-Channel and P-Channel MOS Transistors of CD4007
Authors: S. Boorboor, S. A. H. Feghhi, H. Jafari
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The ionizing radiations cause different kinds of damages in electronic components. MOSFETs, most common transistors in today’s digital and analog circuits, are severely sensitive to TID damage. In this work, the threshold voltage shift of CD4007 device, which is an integrated circuit including P-channel and N-channel MOS transistors, was investigated for low dose gamma irradiation under different gate bias voltages. We used linear extrapolation method to extract threshold voltage from ID-VG characteristic curve. The results showed that the threshold voltage shift was approximately 27.5 mV/Gy for N-channel and 3.5 mV/Gy for P-channel transistors at the gate bias of |9 V| after irradiation by Co-60 gamma ray source. Although the sensitivity of the devices under test were strongly dependent to biasing condition and transistor type, the threshold voltage shifted linearly versus accumulated dose in all cases. The overall results show that the application of CD4007 as an electronic buffer in a radiation therapy system is limited by TID damage. However, this integrated circuit can be used as a cheap and sensitive radiation dosimeter for accumulated dose measurement in radiation therapy systems.Keywords: threshold voltage shift, MOS transistor, linear extrapolation, gamma irradiation
Procedia PDF Downloads 2833383 A Perspective on Emergency Care of Gunshot Injuries in Northern Taiwan
Authors: Liong-Rung Liu, Yu-Hui Chiu, Wen-Han Chang
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Firearm injuries are high-energy injuries. The ballistic pathways could cause severe burns or chemical damages to vessels, musculoskeletal or other major organs. The high mortality rate is accompanied by complications such as sepsis. As laws prohibit gun possession, civilian gunshot wounds (GSW) are relatively rare in Taiwan. Our hospital, Mackay Memorial Hospital, located at the center of Taipei city is surrounded by nightclubs and red-light districts. Due to this unique location, our hospital becomes the first-line trauma center managing gunshot victims in Taiwan. To author’s best knowledge, there are few published research articles regarding this unique situation. We hereby analyze the distinct characteristics and length of stay (LOS) of GSW patients in the emergency room (ER) at Mackay Memorial Hospital. A 6-year retrospective analysis of 27 patients treated for GSW injuries from January 2012 to December 2017 was performed. The patients’ records were reviewed for the following analyses, 1) wound position and the correlated clinical presentations; 2) the LOS in ED of patients receiving emergency surgery for major organ or vascular injuries. We found males (96.3%) were injured by guns more often than females (3.7%) in all age groups. The most common injured site was in the extremities. With regards to the ER LOS, the average time were 72.2 ± 34.5 minutes for patients with triage I and 207.4 ± 143.9 minutes for patients with triage II. The ED LOS of patients whose ISS score were more than 15 was 59.9 ± 25.6 minutes, and 179.4 ± 119.8 minutes for patients whose ISS score were between 9 to 15, respectively. Among these 27 patients, 10 patients had emergency surgery and their average ED stay time was 104.5 ± 33.3 minutes. Even more, the average ED stay time could be shortened to 88.8 ± 32.3 minutes in the 5 patients with trauma team activation. In conclusion, trauma team activation in severe GSW patients indeed shortens the ED LOS and might initially improve the quality of patient care. This is the result of better trauma systems, including advances in care from emergency medical services and acute care surgical management.Keywords: gunshot, length of stay, trauma, mortality
Procedia PDF Downloads 1313382 Treatment of Type 2 Diabetes Mellitus: Physicians’ Adherence to the American Diabetes Association Guideline in Central Region, Saudi Arabia
Authors: Ibrahim Mohammed
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Background: Diabetes mellitus is a chronic disease that can cause devastating secondary complications, reducing the quality and length of life as well as increasing medical costs for the patient and society. The guidelines recommend both clinical and preventive strategies for diabetes management and are regularly updated. The aim of the study is to assess the level of adherence of physicians to American Diabetes Association Guidelines. Method: Observational multicenter retrospective study will be conducted among different hospitals in the central region. Patient data will be collected from the records of the last three years (2017- 2020). Records will be selected randomly after a complete randomized design. The study focuses on the management of type 2 according to ADA not changed in the last three updating; those standards; all patients should be taking Metformin 1500 to 2000 mg/day as recommended dose and should be received a high dose of statin if the high risk to ASCVD or moderate statin if not at risk, patients with hypertension and diabetes should taking ACE or ARBS. Result: The study aimed to evaluate the commitment of physicians in the central region to the ADA. Out of the 153 selected patients, only 17 % were able to control their diabetes with an average A1c below 7. ADA stated that to reach the minimum benefit of using Metformin, the daily dose should be between 1500 and 2000 mg. Results showed that 110 patients were on Metformin, where 68% of them were on the recommended dose. ADA recommended the intake of high statin for diabetic patients with ASCVD risk, while diabetic patients without ASCVD risk should be on a moderate statin. Results showed that 61.5% of patients with ASCVD risk were at high statin while only 36% of patients without ASCVD risk were at moderate statin. Results showed that 89 patients have hypertension, and 80% of them are getting ACE/ARBs as recommended by the ADA. Recommendation: It is necessary to implement periodic training courses for some physicians to enhance and update their knowledge.Keywords: American Diabetic Association, diabetes mellitus, atherosclerotic cardiovascular disease, ACE inhibitors
Procedia PDF Downloads 853381 Comparative Assessment on the Impact of Sedatives on the Stress and Anxiety of Patients with a Heart Disease before and during Surgery in Iran
Authors: Farhad Fakoursevom
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Heart disease is one of the diseases which is found in abundance today. Various types of surgeries, such as bypasses, angiography, angioplasty, etc., are used to treat patients. People may receive such surgeries, some of which are invasive and some non-invasive, throughout their lives. People might cope with pre-surgery anxiety and stress, which can disrupt their normal life and even reduce the effects of the surgery, so the desired result can not be achieved in surgery. Considering this issue, the present study aimed to do a comparative assessment of people who received sedatives before surgery and people who did not receive sedatives. In terms of the purpose, this is an applied research and descriptive survey in terms of method. The statistical population included patients who underwent surgeries in the specialist heart hospitals of Mashhad, Iran; 60 people were considered as a statistical population, 30 of them received sedatives before surgery, and 30 others had not received sedatives before surgery. Valid and up-to-date articles were systematically used to collect theoretical bases, and a researcher-made questionnaire was used to examine the level of stress and anxiety of people. The questionnaire content validity was assessed by a panel of experts in psychology and medicine. The construct validity was tested using the software. Cronbach's alpha and composite reliability were used for reliability, which shows the appropriate reliability of the questionnaire. SPSS software was used to compare the research results between two groups, and the research findings showed that there is no significant association between the people who received sedatives and those who did not receive sedatives in terms of the amount of stress and anxiety. The longer the time of taking the drugs before the surgery, the more the mental peace of the patients will be. According to the results, it can be said that if we don't need to have an emergency operation and need more time, we have to use sedative drugs with different doses compared to the severity of the surgery, and also in case of a medical emergency such as heart surgery due to a stroke, we have to take advantage of psychological services during and before the operation and sedative drugs so that the patients can control their stress and anxiety and achieve better outcomes.Keywords: sedative drugs, stress, anxiety, surgery
Procedia PDF Downloads 993380 Excitation Dependent Luminescence in Cr³+ Doped MgAl₂O₄ Nanocrystals
Authors: Savita, Pargam Vashishtha, Govind Gupta, Ankush Vij, Anup Thakur
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The ligand field dependent visible as well as NIR emission of the Cr³+dopant in spinel hosts has attracted immense attention in tuning the color emitted by the material. In this research, Mg1-xCrxAl₂O₄(x=0.5, 1, 3, 5, and 10 mol%) nanocrystals have been synthesizedby solution combustion method. The synthesized nanocrystals possessed a single phase cubic structure. The strong absorption by host lattice defects (antisite defects, F centres) andd-d transitions of Cr³+ ions lead to radiative emission in the visible and NIR region, respectively. The red-NIR emission in photoluminescence spectra inferred the octahedral symmetry of Cr³+ ions and anticipated the site distortion by the presence ofCr³+ clusters and antisite defects in the vicinity of Cr³+ ions. The thermoluminescence response of UV and γ-irradiated Cr doped MgAl2O4 samples revealed the formation of various shallow and deep defects with doping Cr³+ions. The induced structural cation disorder with an increase in doping concentration caused photoluminescence quenching beyond 3 mol% Cr³+ doping. The color tuning exhibited by Cr doped MgAl₂O₄ nanocrystals by varying Cr³+ ion concentration and excitation wavelength find its applicability in solid state lighting.Keywords: antisite defects, cation disorder, color tuning, combustion synthesis
Procedia PDF Downloads 1803379 Multilevel Regression Model - Evaluate Relationship Between Early Years’ Activities of Daily Living and Alzheimer’s Disease Onset Accounting for Influence of Key Sociodemographic Factors Using a Longitudinal Household Survey Data
Authors: Linyi Fan, C.J. Schumaker
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Background: Biomedical efforts to treat Alzheimer’s disease (AD) have typically produced mixed to poor results, while more lifestyle-focused treatments such as exercise may fare better than existing biomedical treatments. A few promising studies have indicated that activities of daily life (ADL) may be a useful way of predicting AD. However, the existing cross-sectional studies fail to show how functional-related issues such as ADL in early years predict AD and how social factors influence health either in addition to or in interaction with individual risk factors. This study would helpbetterscreening and early treatments for the elderly population and healthcare practice. The findings have significance academically and practically in terms of creating positive social change. Methodology: The purpose of this quantitative historical, correlational study was to examine the relationship between early years’ ADL and the development of AD in later years. The studyincluded 4,526participantsderived fromRAND HRS dataset. The Health and Retirement Study (HRS) is a longitudinal household survey data set that is available forresearchof retirement and health among the elderly in the United States. The sample was selected by the completion of survey questionnaire about AD and dementia. The variablethat indicates whether the participant has been diagnosed with AD was the dependent variable. The ADL indices and changes in ADL were the independent variables. A four-step multilevel regression model approach was utilized to address the research questions. Results: Amongst 4,526 patients who completed the AD and dementia questionnaire, 144 (3.1%) were diagnosed with AD. Of the 4,526 participants, 3,465 (76.6%) have high school and upper education degrees,4,074 (90.0%) were above poverty threshold. The model evaluatedthe effect of ADL and change in ADL on onset of AD in late years while allowing the intercept of the model to vary by level of education. The results suggested that the only significant predictor of the onset of AD was changes in early years’ ADL (b = 20.253, z = 2.761, p < .05). However, the result of the sensitivity analysis (b = 7.562, z = 1.900, p =.058), which included more control variables and increased the observation period of ADL, are not supported this finding. The model also estimated whether the variances of random effect vary by Level-2 variables. The results suggested that the variances associated with random slopes were approximately zero, suggesting that the relationship between early years’ ADL were not influenced bysociodemographic factors. Conclusion: The finding indicated that an increase in changes in ADL leads to an increase in the probability of onset AD in the future. However, this finding is not support in a broad observation period model. The study also failed to reject the hypothesis that the sociodemographic factors explained significant amounts of variance in random effect. Recommendations were then made for future research and practice based on these limitations and the significance of the findings.Keywords: alzheimer’s disease, epidemiology, moderation, multilevel modeling
Procedia PDF Downloads 1353378 Epidemiology and Jeopardy Aspect of Febrile Neutropenia Patients by Means of Infectious Maladies
Authors: Pouya Karimi, Ramin Ghasemi Shayan
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Conclusions of the sort and setting of observational treatment for immunocompromised patients with fever are confused by the qualities of the hidden disease and the impacts of medications previously got, just as by changing microbiological examples and patterns in sedate obstruction at national and institutional levels. A few frameworks have been proposed to recognize patients who could profit by outpatient anti-infection treatment from patients who require hospitalization. Useful contemplations may choose whether the fundamental checking during the time of neutropenia can be accomplished.Keywords: microbiology, infectious, neutropenia, epidemiology
Procedia PDF Downloads 1623377 Changes in Foreign Direct Investment Policy of India and Its Impact on Economic Development
Authors: Kishor P. Kadam
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Foreign direct investment policy (FDI) is defined as an investment involving a long term relationship and reflecting a long duration interest and control of a resident entity in the home country (foreign direct investor or parent firm) in the host country. India has been one of the most translucent and open-minded FDI regimes among the emerging and developing economies. There is clear cut mentioned about the sectoral caps for foreign investment. The policy problems that have been identified by time to time surveys as acting as additional hurdles for FDI are laws, regulatory systems and government monopolies that do not have contemporary relevance. Foreign investment policies in the post-reforms period have emphasized greater encouragement and mobilization of non-debt creating private inflows for plunging reliance on debt flows. This paper will focus on how foreign direct investment policy changed from 1990-91 up to now. A time series data of 25 years is used for analysing the policy changes. It is observed that India has more liberal policy. The growth in number of Greenfield investments in India has been more impressive than the number of M&A deals whereas equity capital for incorporated bodies FDI inflows has been increased continuously 2014-15. India has made major changes in FDI Policy, and it has positive impact on economic development.Keywords: FDI, India, economic development, government
Procedia PDF Downloads 3613376 HcDD: The Hybrid Combination of Disk Drives in Active Storage Systems
Authors: Shu Yin, Zhiyang Ding, Jianzhong Huang, Xiaojun Ruan, Xiaomin Zhu, Xiao Qin
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Since large-scale and data-intensive applications have been widely deployed, there is a growing demand for high-performance storage systems to support data-intensive applications. Compared with traditional storage systems, next-generation systems will embrace dedicated processor to reduce computational load of host machines and will have hybrid combinations of different storage devices. The advent of flash- memory-based solid state disk has become a critical role in revolutionizing the storage world. However, instead of simply replacing the traditional magnetic hard disk with the solid state disk, it is believed that finding a complementary approach to corporate both of them is more challenging and attractive. This paper explores an idea of active storage, an emerging new storage configuration, in terms of the architecture and design, the parallel processing capability, the cooperation of other machines in cluster computing environment, and a disk configuration, the hybrid combination of different types of disk drives. Experimental results indicate that the proposed HcDD achieves better I/O performance and longer storage system lifespan.Keywords: arallel storage system, hybrid storage system, data inten- sive, solid state disks, reliability
Procedia PDF Downloads 4483375 An Exploratory Survey Questionnaire to Understand What Emotions Are Important and Difficult to Communicate for People with Dysarthria and Their Methodology of Communicating
Authors: Lubna Alhinti, Heidi Christensen, Stuart Cunningham
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People with speech disorders may rely on augmentative and alternative communication (AAC) technologies to help them communicate. However, the limitations of the current AAC technologies act as barriers to the optimal use of these technologies in daily communication settings. The ability to communicate effectively relies on a number of factors that are not limited to the intelligibility of the spoken words. In fact, non-verbal cues play a critical role in the correct comprehension of messages and having to rely on verbal communication only, as is the case with current AAC technology, may contribute to problems in communication. This is especially true for people’s ability to express their feelings and emotions, which are communicated to a large part through non-verbal cues. This paper focuses on understanding more about the non-verbal communication ability of people with dysarthria, with the overarching aim of this research being to improve AAC technology by allowing people with dysarthria to better communicate emotions. Preliminary survey results are presented that gives an understanding of how people with dysarthria convey emotions, what emotions that are important for them to get across, what emotions that are difficult for them to convey, and whether there is a difference in communicating emotions when speaking to familiar versus unfamiliar people.Keywords: alternative and augmentative communication technology, dysarthria, speech emotion recognition, VIVOCA
Procedia PDF Downloads 1643374 A Modified Open Posterior Approach for the Fixation of Posterior Cruciate Ligament Tibial Avulsion Fractures
Authors: Babak Mirzashahi, Arvin Najafi, Pejman Mansouri, Mahmoud Farzan
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Background: The most effective treatment of posterior cruciate ligament (PCL) tears and the consequence of untreated PCL injuries remain controversial. Objectives: The aim of this study is to assess outcomes of fixation of tibial posterior cruciate ligament (PCL) avulsion fractures via a modified technique. Patients and Methods: From January, 2009 to March, 2012, there were 45 cases of PCL tibial avulsion fractures that were referred to our hospital and were managed through a modified open posterior approach. Fixation of Tibial PCL avulsion fractures were fixed by means of a lag screw and washer placed through our modified open posterior approach. Range of motion was begun on the first postoperative day. Clinical stability, range of motion, gastrocnemius muscle strength, radiographic investigation, and patient’s overall quality of life was analyzed at final follow up visit. Results: The average of overall musculoskeletal functional evaluation scores was 15 (range 3–35). All patients achieved union of their fracture and had clinically stable knees at the latest follow-up. The mean preoperative Lysholm score for 15 knees was 62 ± 8 (range, 50-75); the mean postoperative Lysholm score was 92± 7 (range, 75-101). A significant difference in Lysholm scores between preoperative and final follow-up evaluations was found (P < .05). At first-year follow-up, 42 (93%) patients revealed a difference of less than 10 mm in thigh circumference between their injured and healthy knees. Conclusions: The management of displaced large PCL avulsion fractures with placement of a cancellous lag screw with washer by means of the modified open posterior approach leads to satisfactory clinical, radiographic, and functional results and reduces the operation time and less blood loss. Level of evidence: IV.Keywords: posterior cruciate ligament, tibial fracture, lysholm knee score, patient outcome assessment
Procedia PDF Downloads 3013373 Climate Change and Dengue Transmission in Lahore, Pakistan
Authors: Sadia Imran, Zenab Naseem
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Dengue fever is one of the most alarming mosquito-borne viral diseases. Dengue virus has been distributed over the years exponentially throughout the world be it tropical or sub-tropical regions of the world, particularly in the last ten years. Changing topography, climate change in terms of erratic seasonal trends, rainfall, untimely monsoon early or late and longer or shorter incidences of either summer or winter. Globalization, frequent travel throughout the world and viral evolution has lead to more severe forms of Dengue. Global incidence of dengue infections per year have ranged between 50 million and 200 million; however, recent estimates using cartographic approaches suggest this number is closer to almost 400 million. In recent years, Pakistan experienced a deadly outbreak of the disease. The reason could be that they have the maximum exposure outdoors. Public organizations have observed that changing climate, especially lower average summer temperature, and increased vegetation have created tropical-like conditions in the city, which are suitable for Dengue virus growth. We will conduct a time-series analysis to study the interrelationship between dengue incidence and diurnal ranges of temperature and humidity in Pakistan, Lahore being the main focus of our study. We have used annual data from 2005 to 2015. We have investigated the relationship between climatic variables and dengue incidence. We used time series analysis to describe temporal trends. The result shows rising trends of Dengue over the past 10 years along with the rise in temperature & rainfall in Lahore. Hence this seconds the popular statement that the world is suffering due to Climate change and Global warming at different levels. Disease outbreak is one of the most alarming indications of mankind heading towards destruction and we need to think of mitigating measures to control epidemic from spreading and enveloping the cities, countries and regions.Keywords: Dengue, epidemic, globalization, climate change
Procedia PDF Downloads 2333372 Characterization of the Lytic Bacteriophage VbɸAB-1 against Drug Resistant Acinetobacter baumannii Isolated from Hospitalized Pressure Ulcers Patients
Authors: M. Doudi, M. H. Pazandeh, L. Rahimzadeh Torabi
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Bedsores are pressure ulcers that occur on the skin or tissue due to being immobile and lying in bed for extended periods. Bedsores have the potential to progress into open ulcers, increasing the possibility of variety of bacterial infection. Acinetobacter baumannii, a pathogen of considerable clinical importance, exhibited a significant correlation with Bedsores (pressure ulcers) infections, thereby manifesting a wide spectrum of antibiotic resistance. The emergence of drug resistance has led researchers to focus on alternative methods, particularly phage therapy, for tackling bacterial infections. Phage therapy has emerged as a novel therapeutic approach to regulate the activity of these agents. The management of bacterial infections greatly benefits from the clinical utilization of bacteriophages as a valuable antimicrobial intervention. The primary objective of this investigation consisted of isolating and discerning potent bacteriophage capable of targeting multi drug-resistant (MDR) and extensively drug-resistant (XDR) bacteria obtained from pressure ulcers. In present study, analyzed and isolated A. baumannii strains obtained from a cohort of patients suffering from pressure ulcers at Taleghani Hospital in Ahvaz, Iran. An approach that included biochemical and molecular identification techniques was used to determine the taxonomic classification of bacterial isolates at the genus and species levels. The molecular identification process was facilitated by using the 16S rRNA gene in combination with universal primers 27 F, and 1492 R. Bacteriophage was obtained through the isolation process conducted on treatment plant sewage located in Isfahan, Iran. The main goal of this study was to evaluate different characteristics of phage, such as their appearance, range of hosts they can infect, how quickly they can enter a host, their stability at varying temperatures and pH levels, their effectiveness in killing bacteria, the growth pattern of a single phage stage, mapping of enzymatic digestion, and identification of proteomics patterns. The findings demonstrated that an examination was conducted on a sample of 50 specimens, wherein 15 instances of A. baumannii were identified. These microorganisms are the predominant Gram-negative agents known to cause wound infections in individuals suffering from bedsores. The study's findings indicated a high prevalence of antibiotic resistance in the strains isolated from pressure ulcers, excluding the clinical strains that exhibited responsiveness to colistin.According to the findings obtained from assessments of host range and morphological characteristics of bacteriophage VbɸAB-1, it can be concluded that this phage possesses specificity towards A. Baumannii BAH_Glau1001 was classified as a member of the Plasmaviridae family. The bacteriophage mentioned earlier showed the strongest antibacterial effect at a temperature of 18 °C and a pH of 6.5. Through the utilization of sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) analysis on protein fragments, it was established that the bacteriophage VbɸAB-1 exhibited a size range between 50 and 75 kilodaltons (KDa). The numerous research findings on the effectiveness of phages and the safety studies conducted suggest that the phages studied in this research can be considered as a practical solution and recommended approach for controlling and treating stubborn pathogens in burn wounds among hospitalized patients.Keywords: acinetobacter baumannii, extremely drug- resistant, phage therapy, surgery wound
Procedia PDF Downloads 933371 Molecular Identification and Genotyping of Human Brucella Strains Isolated in Kuwait
Authors: Abu Salim Mustafa
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Brucellosis is a zoonotic disease endemic in Kuwait. Human brucellosis can be caused by several Brucella species with Brucella melitensis causing the most severe and Brucella abortus the least severe disease. Furthermore, relapses are common after successful chemotherapy of patients. The classical biochemical methods of culture and serology for identification of Brucellae provide information about the species and serotypes only. However, to differentiate between relapse and reinfection/epidemiological investigations, the identification of genotypes using molecular methods is essential. In this study, four molecular methods [16S rRNA gene sequencing, real-time PCR, enterobacterial repetitive intergenic consensus (ERIC)-PCR and multilocus variable-number tandem-repeat analysis (MLVA)-16] were evaluated for the identification and typing of 75 strains of Brucella isolated in Kuwait. The 16S rRNA gene sequencing suggested that all the strains were B. melitensis and real-time PCR confirmed their species identity as B. melitensis. The ERIC-PCR band profiles produced a dendrogram of 75 branches suggesting each strain to be of a unique type. The cluster classification, based on ~ 80% similarity, divided all the ERIC genotypes into two clusters, A and B. Cluster A consisted of 9 ERIC genotypes (A1-A9) corresponding to 9 individual strains. Cluster B comprised of 13 ERIC genotypes (B1-B13) with B5 forming the largest cluster of 51 strains. MLVA-16 identified all isolates as B. melitensis and divided them into 71 MLVA-types. The cluster analysis of MLVA-16-types suggested that most of the strains in Kuwait originated from the East Mediterranean Region, a few from the African group and one new genotype closely matched with the West Mediterranean region. In conclusion, this work demonstrates that B. melitensis, the most pathogenic species of Brucella, is prevalent in Kuwait. Furthermore, MLVA-16 is the best molecular method, which can identify the Brucella species and genotypes as well as determine their origin in the global context. Supported by Kuwait University Research Sector grants MI04/15 and SRUL02/13.Keywords: Brucella, ERIC-PCR, MLVA-16, RT-PCR, 16S rRNA gene sequencing
Procedia PDF Downloads 3913370 Determinants of Market Entry Modes Used by Universities to Expand Internationally
Authors: Ali Bhayani
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The article analyses determinants of the market entry modes used by corporate firms to expand internationally and explore whether higher education institutions uses the same determinants to decide on mode adopted to enter the market. Determinants like transaction costs, location advantage, idiosyncratic capabilities, isomorphic pressure to mimic, psychic distance, uncertainty, risks, the control over academic process, previous internationalisation experience and entry to homogenous markets are considered with regards to universities. A sample consisting of 40+ branch campuses from United Arab Emirates (UAE), host to highest number of branch campuses, is selected to study the determinants of the entry modes adopted. The aim of this article is not to prescribe or offer a solution for the best-available model of market entry that can be adopted by universities but rather to act as a trigger for a critical check up on universities planning to internationalize their offering. Determinants like idiosyncratic capabilities, isomorphic pressure and control over the academic process were found to be most prevalent. However, determinants like transaction cost efficiency, internationalisation experience, psychic distance, uncertainty and risks are not significant factors.Keywords: higher education, UAE, internationalisation, market entry, international branch campuses
Procedia PDF Downloads 3493369 Dependence of the Structural, Electrical and Magnetic Properties of YBa2Cu3O7−δ Bulk Superconductor on the Sm Doping
Authors: Raheleh Hajilou
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In this study, we report the synthesis and characterization of YBa2Cu3O7-δ (YBCO) high-temperature superconductor prepared by solid-state method and doped with Sm in different weight percentages, 0, 0.01, 0.02 and 0.05 wt. The result of X-ray diffraction (XRD) analysis conforms to the formation of an orthorhombic phase of superconductivity in our samples. This is an important finding and indicates that the samples may exhibit superconductivity properties at certain conditions. Our results unequivocally point to a different structural order or disorder in SM/Y samples as compared to Sm based samples. We suggest that different site preferences of oxygen vacancies, predominantly created in CuO2 planes (CuO chains) of Y and Sm-based samples, might be responsible for the observed difference in the behavior. This contention is supported by a host of other considerations and experimental observations. The study investigated the effects of Sm doping on the YBCO system on various properties such as structural, critical temperature (Tc), scanning electron microscope (SEM), irresistibility line(IL), critical current density, jc, and flux line pinning force. It Seems the sample x=0.05 undergoes an insulator transition, which suppresses its superconducting transition temperature (Tc). Additionally, magnetization was measured as a function of temperature (M-T) and magnetic loops (M-H) at constant temperatures of 10. 20, 30, 40, 50 and 60K up to 10KG.Keywords: high-Tc superconductors, Scanning electron microscopy, X-ray scattering, Irreversibility line
Procedia PDF Downloads 153368 Developing Geriatric Oral Health Network is a Public Health Necessity for Older Adults
Authors: Maryam Tabrizi, Shahrzad Aarup
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Objectives- Understanding the close association between oral health and overall health for older adults at the right time and right place, a person, focus treatment through Project ECHO telementoring. Methodology- Data from monthly ECHO telementoring sessions were provided for three years. Sessions including case presentations, overall health conditions, considering medications, organ functions limitations, including the level of cognition. Contributions- Providing the specialist level of providing care to all elderly regardless of their location and other health conditions and decreasing oral health inequity by increasing workforce via Project ECHO telementoring program worldwide. By 2030, the number of adults in the USA over the age of 65 will increase more than 60% (approx.46 million) and over 22 million (30%) of 74 million older Americans will need specialized geriatrician care. In 2025, a national shortage of medical geriatricians will be close to 27,000. Most individuals 65 and older do not receive oral health care due to lack of access, availability, or affordability. One of the main reasons is a significant shortage of Oral Health (OH) education and resources for the elderly, particularly in rural areas. Poor OH is a social stigma, a thread to quality and safety of overall health of the elderly with physical and cognitive decline. Poor OH conditions may be costly and sometimes life-threatening. Non-traumatic dental-related emergency department use in Texas alone was over $250 M in 2016. Most elderly over the age of 65 present with at least one or multiple chronic diseases such as arthritis, diabetes, heart diseases, and chronic obstructive pulmonary disease (COPD) are at higher risk to develop gum (periodontal) disease, yet they are less likely to get dental care. In addition, most older adults take both prescription and over-the-counter drugs; according to scientific studies, many of these medications cause dry mouth. Reduced saliva flow due to aging and medications may increase the risk of cavities and other oral conditions. Most dental schools have already increased geriatrics OH in their educational curriculums, but the aging population growth worldwide is faster than growing geriatrics dentists. However, without the use of advanced technology and creating a network between specialists and primary care providers, it is impossible to increase the workforce, provide equitable oral health to the elderly. Project ECHO is a guided practice model that revolutionizes health education and increases the workforce to provide best-practice specialty care and reduce health disparities. Training oral health providers for utilizing the Project ECHO model is a logical response to the shortage and increases oral health access to the elderly. Project ECHO trains general dentists & hygienists to provide specialty care services. This means more elderly can get the care they need, in the right place, at the right time, with better treatment outcomes and reduces costs.Keywords: geriatric, oral health, project echo, chronic disease, oral health
Procedia PDF Downloads 1743367 Development of Geo-computational Model for Analysis of Lassa Fever Dynamics and Lassa Fever Outbreak Prediction
Authors: Adekunle Taiwo Adenike, I. K. Ogundoyin
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Lassa fever is a neglected tropical virus that has become a significant public health issue in Nigeria, with the country having the greatest burden in Africa. This paper presents a Geo-Computational Model for Analysis and Prediction of Lassa Fever Dynamics and Outbreaks in Nigeria. The model investigates the dynamics of the virus with respect to environmental factors and human populations. It confirms the role of the rodent host in virus transmission and identifies how climate and human population are affected. The proposed methodology is carried out on a Linux operating system using the OSGeoLive virtual machine for geographical computing, which serves as a base for spatial ecology computing. The model design uses Unified Modeling Language (UML), and the performance evaluation uses machine learning algorithms such as random forest, fuzzy logic, and neural networks. The study aims to contribute to the control of Lassa fever, which is achievable through the combined efforts of public health professionals and geocomputational and machine learning tools. The research findings will potentially be more readily accepted and utilized by decision-makers for the attainment of Lassa fever elimination.Keywords: geo-computational model, lassa fever dynamics, lassa fever, outbreak prediction, nigeria
Procedia PDF Downloads 943366 The Attitude of Second Year Pharmacy Students towards Lectures, Exams and E-Learning
Authors: Ahmed T. Alahmar
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There is an increasing trend toward student-centred interactive e-learning methods and students’ feedback is a valuable tool for improving learning methods. The aim of this study was to explore the attitude of second year pharmacy students at the University of Babylon, Iraq, towards lectures, exams and e-learning. Materials and methods: Ninety pharmacy students were surveyed by paper questionnaire about their preference for lecture format, use of e-files, theoretical lectures versus practical experiments, lecture and lab time. Students were also asked about their predilection for Moodle-based online exams, different types of exam questions, exam time and other extra academic activities. Results: Students prefer to read lectures on paper (73.3%), use of PowerPoint file (76.7%), short lectures of less than 10 pages (94.5%), practical experiments (66.7%), lectures and lab time of less than two hours (89.9% and 96.6 respectively) and intra-lecture discussions (68.9%). Students also like to have paper-based exam (73.3%), short essay (40%) or MCQ (34.4%) questions and also prefer to do extra activities like reports (22.2%), seminars (18.6%) and posters (10.8%). Conclusion: Second year pharmacy students have different attitudes toward traditional and electronic leaning and assessment methods. Using multimedia, e-learning and Moodle are increasingly preferred methods among some students.Keywords: pharmacy, students, lecture, exam, e-learning, Moodle
Procedia PDF Downloads 1643365 Age-Associated Seroprevalence of Toxoplasma gondii in 10892 Pregnant Women in Senegal between 2016 and 2019
Authors: Ndiaye Mouhamadou, Seck Abdoulaye, Ndiaye Babacar, Diallo Thierno Abdoulaye, Diop Abdou, Seck Mame Cheikh, Diongue Khadim, Badiane Aida Sadikh, Diallo Mamadou Alpha, Kouedvidjin Ekoué, Ndiaye Daouda
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Background: Toxoplasmosis is a parasite disease that presents high rates of gestational and congenital infection worldwide and is therefore considered a public health problem and a neglected disease. The aim of this study was to determine the seroprevalence of toxoplasmosis in pregnant women referred to the medical biology laboratory of the Pasteur Institute of Dakar (Senegal) between January 2014 and December 2019. Methodology: This was a cross-sectional, descriptive, retrospective study of 10892 blood samples from pregnant women aged 16 to 46 years. The Architect toxo IgG/IgM from Abbot Laboratories, which is a chemiluminescent microparticle immunoassay (CMIA), was used for the quantitative determination of antibodies against Toxoplasma gondii in human serum. Results: In total, over a period from January 2014 to December 2019, 10892 requests for toxoplasmosis serology in pregnant women were included. The age of the patients included in our series ranged from 16 to 46 years. The mean age was 31.2 ± 5.72 years. The overall seroprevalence of T. gondii in pregnant women was estimated to be 28.9% [28.0-29.7]. In a multivariate logistic regression analysis, after adjustment for a covariate such as a study period, pregnant women aged 36-46 years were more likely to carry IgG antibodies to T. gondii than pregnant women younger than 36 years. Conclusion: T. gondii seroprevalence was significantly higher in pregnant women older than 36 years, leaving younger women more susceptible to primary T. gondii infection and their babies to congenital toxoplasmosis. There will be a need to increase awareness of the risk factors for toxoplasmosis and its different modes of transmission in these high-risk groups, but this should be supported by epidemiologic studies of the distribution of risk factors for toxoplasmosis in pregnant women and women of childbearing age.Keywords: toxoplasmosis, pregnancy, seroprevalence, Senegal
Procedia PDF Downloads 1363364 White Light Emission through Downconversion of Terbium and Europium Doped CEF3 Nanophosphors
Authors: Mohit Kalra, Varun S., Mayuri Gandhi
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CeF3 nanophosphors has been extensively investigated in the recent years for lighting and numerous bio-applications. Down conversion emissions in CeF3:Eu3+/Tb3+ phosphors were studied with the aim of obtaining a white light emitting composition, by a simple co-precipitation method. The material was characterized by X-ray Diffraction (XRD), High Resolution Transmission Electron Microscopy (HR-TEM), Fourier Transform Infrared Spectroscopy (FT-IR) and Photoluminescence (PL). Uniformly distributed nanoparticles were obtained with an average particle size 8-10 nm. Different doping concentrations were performed and fluorescence study was carried out to optimize the dopants concentration for maximum luminescence intensity. The steady state and time resolved luminescence studies confirmed efficient energy transfer from the host to activator ions. Different concentrations of Tb 3+, Eu 3+ were doped to achieve a white light emitting phosphor for UV-based Light Emitting Diodes (LEDs). The nanoparticles showed characteristic emission of respective dopants (Eu 3+, Tb3+) when excited at the 4f→5d transition of Ce3+. The chromaticity coordinates for these samples were calculated and the CeF3 doped with Eu 3+ and Tb3+ gave an emission very close to white light. These materials may find its applications in optoelectronics and various bio applications.Keywords: white light down-conversion, nanophosphors, LEDs, rare earth, cerium fluoride, lanthanides
Procedia PDF Downloads 4043363 A Convolution Neural Network Approach to Predict Pes-Planus Using Plantar Pressure Mapping Images
Authors: Adel Khorramrouz, Monireh Ahmadi Bani, Ehsan Norouzi, Morvarid Lalenoor
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Background: Plantar pressure distribution measurement has been used for a long time to assess foot disorders. Plantar pressure is an important component affecting the foot and ankle function and Changes in plantar pressure distribution could indicate various foot and ankle disorders. Morphologic and mechanical properties of the foot may be important factors affecting the plantar pressure distribution. Accurate and early measurement may help to reduce the prevalence of pes planus. With recent developments in technology, new techniques such as machine learning have been used to assist clinicians in predicting patients with foot disorders. Significance of the study: This study proposes a neural network learning-based flat foot classification methodology using static foot pressure distribution. Methodologies: Data were collected from 895 patients who were referred to a foot clinic due to foot disorders. Patients with pes planus were labeled by an experienced physician based on clinical examination. Then all subjects (with and without pes planus) were evaluated for static plantar pressures distribution. Patients who were diagnosed with the flat foot in both feet were included in the study. In the next step, the leg length was normalized and the network was trained for plantar pressure mapping images. Findings: From a total of 895 image data, 581 were labeled as pes planus. A computational neural network (CNN) ran to evaluate the performance of the proposed model. The prediction accuracy of the basic CNN-based model was performed and the prediction model was derived through the proposed methodology. In the basic CNN model, the training accuracy was 79.14%, and the test accuracy was 72.09%. Conclusion: This model can be easily and simply used by patients with pes planus and doctors to predict the classification of pes planus and prescreen for possible musculoskeletal disorders related to this condition. However, more models need to be considered and compared for higher accuracy.Keywords: foot disorder, machine learning, neural network, pes planus
Procedia PDF Downloads 3613362 Piloting a Prototype Virtual Token Economy Intervention for On-Task Support within an Inclusive Canadian Classroom
Authors: Robert L. Williamson
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A 'token economy' refers to a method of positive behaviour support whereby ‘tokens’ are delivered to students as a reward for exhibiting specific behaviours. Students later exchange tokens to ‘purchase’ items of interest. Unfortunately, implementation fidelity can be problematic as some find physical delivery of tokens while teaching difficult. This project developed and tested a prototype, iPad-based tool that enabled teachers to deliver and track tokens electronically. Using an alternating treatment design, any differences in on-task individual and/or group behaviours between the virtual versus physical token delivery systems were examined. Results indicated that while students and teachers preferred iPad-based implementation, no significant difference was found concerning on-task behaviours of students between the two methodologies. Perhaps more interesting was that the teacher found implementation of both methods problematic and suggested a second person was most effective in implementing a token economy method. This would represent a significant cost to the effective use of such a method. Further research should focus on the use of a lay volunteer regarding method implementation fidelity and associated outcomes of the method.Keywords: positive behaviour support, inclusion, token economy, applied behaviour analysis
Procedia PDF Downloads 1503361 Effect of Crown Gall and Phylloxera Resistant Rootstocks on Grafted Vitis Vinifera CV. Sultana Grapevine
Authors: Hassan Mahmoudzadeh
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The bacterium of Agrobacterium vitis causes crown and root gall disease, an important disease of grapevine, Vitis vinifera L. Also, Phylloxera is one of the most important pests in viticulture. Grapevine rootstocks were developed to provide increased resistance to soil-borne pests and diseases, but rootstock effects on some traits remain unclear. The interaction between rootstock, scion and environment can induce different responses to the grapevine physiology. 'Sultsna' (Vitis vinifera L.) is one of the most valuable raisin grape cultivars in Iran. Thus, the aim of this study was to determine the rootstock effect on the growth characteristics and yield components and quality of 'Sultana' grapevine grown in the Urmia viticulture region. The experimental design was completely randomized blocks, with four treatments, four replicates and 10 vines per plot. The results show that all variables evaluated were significantly affected by the rootstock. The Sultana/110R and Sultana/Nazmieh were among other combinations influenced by the year and had a higher significant yield/vine (13.25 and 12.14, respectively). Indeed, they were higher than that of Sultana/5BB (10.56 kg/vine) and Sultana/Spota (10.25 kg/vine). The number of clusters per burst bud and per vine and the weight of clusters were affected by the rootstock as well. Pruning weight/vine, yield/pruning weight, leaf area/vine and leaf area index are variables related to the physiology of grapevine, which was also affected by the rootstocks. In general, rootstocks had adapted well to the environment where the experiment was carried out, giving vigor and high yield to Sultana grapevine, which means that they may be used by grape growers in this region. In sum, the study found the best rootstocks for 'Sultana' to be Nazmieh and 110R in terms of root and shoot growth. However, the choice of the right rootstock depends on various aspects, such as those related to soil characteristics, climate conditions, grape varieties, and even clones, and production purposes.Keywords: grafting, vineyards, grapevine, succeptability
Procedia PDF Downloads 1273360 City versus Suburb: The Effects of Neighborhood on Place Attachment and Residential Satisfaction
Authors: Elif Aksel, Çagrı Imamoglu
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This ongoing study aims to investigate the effects of neighborhood location on place attachment and residential satisfaction. Place attachment will be examined by comparing place of residence in different areas of the city. Furthermore, the relationship between neighborhood and residential satisfaction will be investigated in terms of physical and social aspects of the places influencing residential satisfaction. This study will be carried out in two different districts of Ankara which are Çankaya, located in the city center, and Sincan, a suburb. Two-hundred adult respondents will participate in this research; 100 men and 100 women aged between 18-65 years with different socio-economic status using snowball sampling. A place attachment scale and a questionnaire related with residential satisfaction, including open-ended questions and 7-point Likert type scale, will be used as instruments. Apart from these, demographic information of the participants such as gender, age, education, the length of residence will be collected. The findings of the study are expected to demonstrate that neighborhood is seen to be influential on place attachment by affecting the intensity of attachment. The level of place attachment is expected to be greater in areas far from the city compared to areas in the center of the city. Apart from this, the neighborhood is also effective in residential satisfaction. The residents living in these neighborhoods having strong physical and social opportunities will be expected to have higher residential satisfaction.Keywords: neighborhood, neighborhood satisfaction, place attachment, residential satisfaction
Procedia PDF Downloads 3173359 Neuromingeal Cryptococcosis Revealing IgA-λ Multiple Myeloma
Authors: L. Mtibaa, N. Baccouchi, S. Hannechi, R. Abid, R. Battikh, B. Jemli
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Cryptococcosis is an opportunistic fungal infection which is commonly associated with an immune-compomised state, especially HIV infection. Rare cases of cryptococcosis have been reported in patients with multiple myeloma (MM), and they are all at a late stage of the disease. However, the inaugural character of cryptococcosis revealing the MM at an early stage has never been reported to our best knowledge. We presented here a case of neuromeningeal cryptococcosis in a patient without any apparent underlying conditions, who has revealed IgA-λ MM. Early detection and treatment of cryptococcosis are essential to reduce morbidity and for a better outcome.Keywords: Cryptococcosis, Cryptococcus, hematologic, malignancy
Procedia PDF Downloads 1643358 The Effect of Psychosomatic Aspects of Endometriosis on Marital Relationships and Quality of Life: A Review Study
Authors: Farzaneh Askari, Jila Ganji, Sedigheh Hasani Moghadam
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Background and Aim: Endometriosis has been reported as one of the most common chronic gynecological conditions characterized by physical and psychological complications. Given that the impact of this disease on marital relationships and quality of life is multidimensional, the present review study aimed to reflect on the effect of psychosomatic aspects of endometriosis on marital relationships and quality of life. Materials and Methods: A narrative review methodology using keywords determined by the Medical Subject Headings (MeSH) thesaurus was adopted in this study. For this purpose, the databases of ScienceDirect, Scientific Information Database (SID), Google Scholar, and PubMed were searched by means of key terms including endometriosis, marital relationships, physical complications, psychological complications, and quality of life in English and Persian from 2005 to 2020. At the end of the search, 38 articles were retrieved, and ultimately a total number of 16 studies were recruited for this review. Results: A review of the selected articles demonstrated that endometriosis could affect marital relationships and quality of life among couples featuring in three different categories, i.e. “category I: physical health dimension” (chronic pelvic pain, dysmenorrhea, cramps but not period, reduction and loss of fertility), “category II: sexual health dimension” (no sexual intercourse, dyspareunia, lack of sexual satisfaction), and “category III: psychosocial health dimension” (negative self-esteem, low energy, sense of loneliness, depression, social isolation, insufficient sleep, marital distress, divorce and marriage breakdown, inability to work and socialize). Conclusion: In general, it is suggested to pay particular attention to psychosomatic aspects of marital problems in patients affected with endometriosis. Accordingly, implementing educational and counseling strategies to minimize the complications of this disease can provide the grounds for improving marital relationships and maintaining the quality of life in these patients.Keywords: Endometriosis, marital relationships, psychosomatic complications, quality of life
Procedia PDF Downloads 1263357 A Two Year Follow Up of Sexually Abused Children
Authors: Horesh Reinman Netta
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Early research on child sexual abuse (CSA) attempted to assess its possible effects. Researchers found that victims of CSA are prone to a host of emotional disorders, including post-traumatic stress disorder, depression, dissociative disorders, anxiety disorders and suicidality later in life. The study examined the development of symptoms over a two-year period at base line and after six months. Factors including the age at the onset of abuse, the gender of the abused child and academic achievements were also examined. Other variables examined include the complex association among self-disclosure, self-esteem, the child’s attachment and coping styles, and psychological adjustment. The abused child’s domestic environment has been found to have a relevant impact on the psychological outcomes of CSA. The study examined inter-parental conflicts, cohesion in the child’s home, parental attachment styles and psychopathology. To the best of our knowledge, no investigation of this nature has yet been performed. Hence, the study makes a major contribution to research in this field. In addition, a combined examination of abuse characteristics, child characteristics, domestic environment and therapeutic history will facilitate enhanced understanding of the interactions among CSA, mediating factors and psychological outcomes.Keywords: sexual abuse, follow up, victimization, children
Procedia PDF Downloads 753356 Head and Neck Extranodal Rosai-Dorfman Disease- Utility of immunohistochemistry
Authors: Beverly Wang
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Background: Rosai-Dorfman disease (RDD), aka sinus histiocytosis with massive lymphadenopathy, is a rare, idiopathic histiocytic proliferative disorder. Although RDD can be seen involving the head and neck lymph nodes, rarely it can affect other extranodal sites. It present 3 unique cases of RDD affecting the nasal cavity, paranasal sinuses, and ear canal. The initial clinical presentation on two cases mimicked a malignant neoplasm. The 3rd case of RDD co-existed with a cholesteatoma of the ear canal. The clinical presentation, histology and immunohistochemical stains, and radiographic findings are discussed. Design: An overview of 3 cases of RDD affected sinonasal cavity and ear canal from UCI Medical Center was conducted. Case 1: A 61 year old male complaining of breathing difficulty presented with bilateral polypoid sinonasal masses and severe nasal obstruction. The masses elevated the nasal floor, and involved the anterior nasal septum to lateral wall. It was endoscopically excised. At intraoperative consultation, frozen section reported a pleomorphic spindle cell neoplasm with scattered large atypical spindle cells, resembling a high grade sarcoma. Case 2: A 46 year old male presented with recurrent bilateral maxillary chronic sinusitis with mass formation, clinically suspicious for malignant lymphoma. Excisional tissue sample showed large irregular spindled histiocytes with abundant granular and vacuolated cytoplasm. Case 3: A 36 year old female with a history of asthma initially presented with left-sided chronic otalgia, occasional nausea, vertigo, and fluctuating pain exacerbated by head movement and temperature changes. CT scan revealed an external auditory canal mass extending to the middle ear, coexisting with a small cholesteatoma. Results: The morphology of all cases revealed large atypical spindled histiocytes resembling fibrohistiocytic or myofibroblastic proliferative neoplasms. Scattered emperipolesis was seen. All 3 cases were confirmed as extranodal sinus RDD, confirmed by immunohistochemistry. The large atypical cells were positive for S100, CD68, and CD163. No evidence for malignancy was identified. Case 3 showed concurrent RDD co-existing with a cholesteatoma. Conclusion: Due to its rarity and variable clinical presentations, the diagnosis of RDD is seldom clinically considered. Extranodal sinus RDD morphologically can be pitfall as mimicker of spindly neoplasm, especially at intraoperative consultation. It can create diagnostic and therapeutic challenges. Correlation of radiological findings with histologic features will help to reach the diagnosis.Keywords: head and neck, extranodal, rosai-dorfman disease, mimicker, immunohistochemistry
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