Search results for: clinical interpretation

Authors: Belhadi Kamilia, Bendaoud Fadhila, Zidani Abla

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Birth defects are morphological abnormalities and functionally represent the main causes of morbidity and neonatal mortality. Was to analyze a number of maternal and newborn traits, assess the main causes and risk factors of her abnormalities and describe the clinical aspects and different types of birth defects. At maternity of Batna, our rate of congenital malformations is 19% of hospitalized new-borns Mono malformations are the most common, mainly 28% neurological malformations predominated by Spina Bifida and hydrocephalus, Poly malformations and accounted for only 15% of our study. 39,61% of newborns are premature. We found a male predominance, the sex ratio of 1.33 males to one girl, most by mothers over 35; the analysis of the pathological history has shown that the diseases encountered in mothers are pregnant HTA and diabetes. These are the most common diseases, with a percentage of ( 19% and 21%) Taking medication exists with a percentage of 28%. Concerning the diagnosis, the realization that antenatal ultrasound is carried out in 12% of cases, and the mortality rate is very high; most cases die at 45%. Congenital malformations remain a problem in terms of treatment and prognosis; this will allow investigators to investigate other factors, better understand the causes of congenital malformations and develop effective prevention and treatment strategies.

Keywords: malformation, congenital, newborn, risk factors, Wilaya of Batna, Algeria.

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Authors: Robin Devillers, Chantal van Dijk

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Children face ambiguities in everyday language use. Particularly ambiguity in pronoun resolution can be challenging, whereas adults can rapidly identify the antecedent of the mentioned pronoun. Two main factors underlie this process, namely the accessibility of the referent and the syntactic cues of the pronoun. After 200ms, adults have converged the accessibility and the syntactic constraints, while relieving cognitive effort by considering contextual cues. As children are still developing their cognitive capacity, they are not able yet to simultaneously assess and integrate accessibility, contextual cues and syntactic information. As such, they fail to identify the correct referent and possibly fixate more on the competitor in comparison to adults. In this study, Dutch while-clauses were used to investigate the interpretation of pronouns by children. The aim is to a) examine the extent to which 7-10 year old children are able to utilise discourse and syntactic information during online and offline sentence processing and b) analyse the contribution of individual factors, including age, working memory, condition and vocabulary. Adult and child participants are presented with filler-items and while-clauses, and the latter follows a particular structure: ‘Anna and Sophie are sitting in the library. While Anna is reading a book, she is taking a sip of water.’ This sentence illustrates the ambiguous situation, as it is unclear whether ‘she’ refers to Anna or Sophie. In the unambiguous situation, either Anna or Sophie would be substituted by a boy, such as ‘Peter’. The pronoun in the second sentence will unambiguously refer to one of the characters due to the syntactic constraints of the pronoun. Children’s and adults’ responses were measured by means of a visual world paradigm. This paradigm consisted of two characters, of which one was the referent (the target) and the other was the competitor. A sentence was presented and followed by a question, which required the participant to choose which character was the referent. Subsequently, this paradigm yields an online (fixations) and offline (accuracy) score. These findings will be analysed using Generalised Additive Mixed Models, which allow for a thorough estimation of the individual variables. These findings will contribute to the scientific literature in several ways; firstly, the use of while-clauses has not been studied much and it’s processing has not yet been identified. Moreover, online pronoun resolution has not been investigated much in both children and adults, and therefore, this study will contribute to adults and child’s pronoun resolution literature. Lastly, pronoun resolution has not been studied yet in Dutch and as such, this study adds to the languages

Keywords: pronouns, online language processing, Dutch, eye-tracking, first language acquisition, language development

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Authors: Mehdi Tavana, Seyedeh Zeinab Peighambarzadeh

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Pyelography is used for morphologic and especially functional studies of the urinary tracts. There are many indications for excretory Pyelography in humans and animals. Intravenous Pyelography is the most practical method; other Pyelography techniques were manipulated because of difficulties for finding veins in small size of the patients. At the best of times, the combination of small veins and abundant subcutaneous tissue makes vascular access difficult or impossible, therefore, another methods of administration of contrast media is desired. This study was performed to evaluate the feasibility of intraosseous injection of iodixanol in providing a safe and diagnostic urogram in Persian squirrel. Fourteen hundred mg iodine per kilogram body weight of iodixanol was injected subcutaneously over tibial tuberosity on ten clinically healthy adult Persian squirrels with no signs of urinary system disorder. Lateral and ventrodorsal radiographs were taken every 2 minutes until the pyelogram was finished. Intraosseous injection of iodixanol was successful to show nephrogram, pyelogram, uretrogram and cystogram clearly. There were no abnormal clinical signs after one week of experiments. Biochemical and hematological profiles were in normal ranges. It is concluded that intraosseous Pyelography is an effective and reliable method for Pyelography studies in squirrel. Microscopic examinations of the kidneys and the site of injection after one week were normal.

Keywords: pyelography, intraosseous injection, iodixanol, persian squirrel

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Authors: Feng Ju Chuang, Yu Wen Wang, Tai Jung Hsieh, Shyh Ming Kuo

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Polylactic acid is a synthetic polymer with good biocompatibility and degradability, is widely used in clinical applications. In this study, we utilized Polylactic acid particles as stimulants for macrophages and the collagen synthesis of co-cultured fibroblasts was evaluated. The results indicated that Polylactic acid particles were nontoxic to cells from 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide. No obvious inflammation effect was observed (under the PLLA concentration of 1 mg/mL) after 24-h co-culture of Raw264.7 and NIH3T3 cells (from TNF-α assay). The addition of PLLA particles to the Raw264.7 and NIH3T3 co-cultures increased the synthesis of collagen, the highest collagen synthesis from the fibroblast was the 0.2 mg/mL (approximately 60% increased as compared with without addition Polylactic acid particles). Moreover, a co-axial atomization delivery device was used to percutaneously introduce Polylactic acid particles into the dermis layer and stimulating macrophages to secrete growth factors promoting fibroblasts to produce collagen. The preliminary results demonstrated the synthesis of collagen was increased mildly after the introduction of Polylactic acid particles for 28-d post implantation. The Polylactic acid particles could be successfully introduced into the dermis layer from H&E staining examination, however, the optimum concentration of Polylactic acid particles and the time-period for collagen synthesis still need to be evaluated.

Keywords: collagen synthesis, macrophage, NIH3T3 cells, polylactic acid particles

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Authors: Yongde Dai

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The recent Chinese military action blockbusters, notably known as, Wolf Warrior/Zhan Lang (2015), Operation Mekong/Mei gong he xing dong (2016), Warrior 2/Zhan Lang 2 (2017) and Operation Red Sea/Hong hai xing dong (2018), have achieved phenomenal box-office successes and in particular, Wolf Warrior 2 became China’s highest-grossing film of all time. However, their yearly presence tends to show a paradigmic shift from China’s primacy of wen manliness (soft) to wu masculinity (hard). With the increasing cinematic exposure of a more muscular image manifesting in both the Chinese heroic soldiers and China itself as a rising global power, the backlash of the Chinese public against the proliferation of the feminized masculinity influenced by the ‘pretty-boy’ pop-culture and China’s harder approach to the current Sino-US tensions have correspondingly emerged and continued to brew. Chinese masculinity imagined in these films is one of the key factors that enable a gendered interpretation of the correlation between the Chinese on-screen fantasy and off-screen reality, that is, China’s public and official discourse about the hegemonic masculinity and non-hegemonic masculinity as well as China’s international profile on cinematic appearance and in today’s Sino-US relation. By reading closely at the four megahits as visual-audio texts with Chinese masculinity studies by Kam Louie and Geng Song, this paper attempts to examine the Chinese construction of manliness with historical accounts and argue why and how the recurrent emphasis of hard/military masculinity (wu) on screen are viewed as China’s contemporary rewriting of the ‘sick-man’ history in the film form. Through this investigation, the paper finds that the rewriting of the ‘sick-man’ history in the cinematic world through heroic brawny soldiers comes to resonate a collective anxiety of China in countering the real-life increasing feminized masculinity on the public appearance, particularly on the male celebrities. In addition, the superpower fantasy about China illuminates a hypermasculine imaginary of China as a global rising power and this coincidently echoes China’s current tougher diplomatic strategy tackling the Sino-US trade war, South China sea dispute and Huawei-US lawsuits.

Keywords: Chinese masculinity, Chinese military action film, feminized masculinity, manhood and nationhood, sick man of Asia

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Authors: Atitallah Sofien, Bouyahia Olfa, Mohsen S., Boussetta Khadija, Khemiri Monia, Fitouri Zohra, Boukthir Samir

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Introduction: Megaloblastic anemia (MA) is rare in children. The diversity of its etiologies can lead to misdiagnosis and may, therefore, delay the treatment. The aim of this study was to describe the epidemiological and etiological characteristics of children followed for MA at the Tunis children's hospital. Methodology: This is a retrospective study over a period of 25 years of all cases of MA in children in the Children's Hospital of Tunis. The diagnosis of MA was confirmed by myelogram in all patients. Results: We collected 29 observations, with an incidence of 1.2 cases/year and a sex ratio of 1. Sixty percent of the children were aged between 3 months and 2 years. The consultation time was between 15 and 30 days in a third of the patients. The clinical examination showed hypotrophy in 13% of cases, hepatosplenomegaly in 6% of cases, neurological or neurosensory damage in 23% of cases, and cardiac damage in 10% of children. MA was associated with thrombocytopenia in 65% of cases and leukoneutropenia in 24% of cases. One in 5 children had pancytopenia. The etiologies were mainly thiamine deficiency, Immerslund disease (20%), nutritional deficiency (13%), and Biermer anemia (13%). One of the patients presented an MA revealing visceral leishmaniasis. The outcome under vitamin B12, the dose of which was adapted to each etiology, was favorable for all patients. Conclusion: MA is rare in children with multiple etiologies that are mainly dominated by hereditary conditions and nutritional deficiencies, mainly in vitamin B12. The association with visceral leishmaniasis seems to be a particularity in our country not reported in the literature.

Keywords: megaloblastic anemia, children, vitamin B12, anemia

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Authors: Antoine Villa, Moustapha Mohamedou, Florence Pilliere, Catherine Verdun-Esquer, Mathieu Molimard, Mohamed Sidatt Cheikh El Moustaph, Mireille Canal-Raffin

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Context: In Mauritania, the activity of the National Center of Oncology (NCO) has steadily risen leading to an increase in the handling of antineoplastic drugs (AD) by healthcare professionals. In this context, the AD contamination of those professionals is a major concern for occupational physicians. It has been evaluated using biological monitoring of occupational exposure (BMOE). Methods: The intervention took place in 2015, in 2 care units, and evaluated nurses preparing and/or infusing AD and agents in charge of hygiene. Participants provided a single urine sample, at the end of the week, at the end of their shift. Five molecules were sought using specific high sensitivity methods (UHPLC-MS/MS) with very low limits of quantification (LOQ) (cyclophosphamide (CP), Ifosfamide (IF), methotrexate (MTX): 2.5ng/L; doxorubicin (Doxo): 10ng/L; α-fluoro-β-alanine (FBAL, 5-FU metabolite): 20ng/L). A healthcare worker was considered as 'contaminated' when an AD was detected at a urine concentration equal to or greater than the LOQ of the analytical method or at trace concentration. Results: Twelve persons participated (6 nurses, 6 agents in charge of hygiene). Twelve urine samples were collected and analyzed. The percentage of contamination was 66.6% for all participants (n=8/12), 100% for nurses (6/6) and 33% for agents in charge of hygiene (2/6). In 62.5% (n=5/8) of the contaminated workers, two to four of the AD were detected in the urine. CP was found in the urine of all contaminated workers. FBAL was found in four, MTX in three and Doxo in one. Only IF was not detected. Urinary concentrations (all drugs combined) ranged from 3 to 844 ng/L for nurses and from 3 to 44 ng/L for agents in charge of hygiene. The median urinary concentrations were 87 ng/L, 15.1 ng/L and 4.4 ng/L for FBAL, CP and MTX, respectively. The Doxo urinary concentration was found 218ng/L. Discussion: There is no current biological exposure index for the interpretation of AD contamination. The contamination of these healthcare professionals is therefore established by the detection of one or more AD in urine. These urinary contaminations are higher than the LOQ of the analytical methods, which must be as low as possible. Given the danger of AD, the implementation of corrective measures is essential for the staff. Biological monitoring of occupational exposure is the most reliable process to identify groups at risk, tracing insufficiently controlled exposures and as an alarm signal. These results show the necessity to educate professionals about the risks of handling AD and/or to care for treated patients.

Keywords: antineoplastic drugs, Mauritania, biological monitoring of occupational exposure, contamination

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Authors: Pármenas Costa Macedo do Nascimento

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Periodontal disease is the most common disease in the oral cavity of felines. It starts with the accumulation of bacteria on the tooth surface supporting the tissues of the periodontal tissue, namely gums, alveolar bone, cementum, and periodontal ligament. The main clinical symptom observed by the owner is bad breath, which may lead to local and systemic consequences depending on the stage of periodontal disease, such as bleeding and bone loss. Therefore, the study is important to educate tutors to take better care of the felines oral health in order to try to prevent the disease. For this epidemiological study, the target population has been felines, located on the outskirts of Manaus, in the state of Amazonas, with a geographic area of 155.68 km², with no defined breed, from October 1st to 10th, 2021, whose samples has been randomly selected, with a detailed profile. The variables of interest for this study have been: absence or presence of periodontal disease, gender, age (delimited by age group), and condition (domiciled or homeless). Using a sample of 40 felines from 4 districts of the east side of Manaus chosen at random, an oral exam has been made to identify the studied disease. The animal's apparent age, condition, sex, and presence or absence of periodontal disease has been noted. It has been observed that 70% (28/40) of them had periodontal disease, mostly females, aged between 0 and 5 years and domiciled, totaling 30% (12/40).

Keywords: felines, oral cavity, oral exam, periodontal disease

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Authors: Asaad Alhabsi, Alyaqdan Algafri

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Aim: Reporting 83 years old man with history of left upper eyelid swelling post 4-lids blepharoplasty diagnosed based on clinical presentation and Radiological imaging with pseudoaneurysm of frontal branch of Superficial Temporal Artery post blepharoplasty. METHODS: 83 years old who presented to a Tertiary ophthalmic center with painless left upper eyelids swelling for 2 months post 4-lids blepharoplasty. Left subcutaneous, sub-brow lesion, in the supertemporal pre-septal area, large mass found and excised surgically. Then he developed recurrent larger mass twice first time treated with aspiration of blood, second time diagnosed with superficial temporal artery (STA) pseudoaneurysm of frontal branch treated with endovascular embolization. RESULTS: Pseudoaneurysm of superficial temporal artery (STA) is a rare, presenting usual post head or face trauma .literature reported few cases of such conditions post operatively, and no reported cases post blepharoplasty. CONCLUSIONS: Surgical intervention is the gold standard of treatment either directly by dissecting the aneurysmal sac and ligate both ends, or endovascular method of injecting thrombin or embolization which was done in this patient by interventional radiologist.

Keywords: superficial temporal artery, pseudoaneurysm, blepharoplasty, Oculoplasty

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Authors: Peramachi Sathiyamoorthy, Jacop Gopas, Avi Golan Goldhirsh

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Corchorus olitorius is a leafy vegetable and an industrial crop. The herb has antioxidant, anti inflammatory, and anti-cancer properties. To assay the pharmaceutical properties, aqueous extracts of leaves and seeds from C. olitorius were tested against drug resistant melanoma cell line. The test showed LC50 of the extract was 0.08µg/ml. Aqueous seed extract exhibited higher melanoma inhibiting activity than leaf extract. Dialysis of seed extract showed that the active compound is less than 12 KDa. The compound with <3 KDa MW separated by microconcentration of seed extract showed 70.5 % inhibition of melanoma cell growth. Among the two fractions obtained by Gel filtration with G10 column, the first fraction at 1:2000 dilutions exhibited 100% inhibition of melanoma growth. The compound with Rf value 0.86 (MA4) isolated by TLC separation showed about 98% cytotoxicity against melanoma at 1: 1000 dilutions. Furthermore, HPLC separation of MA4 compound with Superdex 75 column resulted in 4 compounds. Out of 4, one compound showed melanoma inhibition. The active compound is identified by reagent methods as Strophanthidin. Further toxicological and clinical studies will lead to the development of a potential drug to treat drug resistant melanoma.

Keywords: corchorus olitorius, melanoma, drug development, strophanthidin

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Authors: Ali Misaghi, Afshin Akhondzadeh Basti, Ehsan Sadeghi

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Staphylococcus aureus is a pathogen of major concern for clinical infection and food borne illness. Humans and most domesticated animals harbor S. aureus, and so we may expect staphylococci to be present in food products of animal origin or in those handled directly by humans, unless heat processing is applied to destroy them. Cuminum cyminum L. has been allocated the topic of some recent studies in addition to its well-documented traditional usage for treatment of toothache, dyspepsia, diarrhea, epilepsy and jaundice. The air-dried seed of the plant was completely immersed in water and subjected to hydro distillation for 3 h, using a clevenger-type apparatus. In this study, the effect of Cuminum cyminum L. essential oil (EO) on growth of Staphylococcus aureus in white brined cheese was evaluated. The experiment included different levels of EO (0, 7.5, 15 and 30 mL/ 100 mL milk) to assess their effects on S. aureus count during the manufacture, ripening and storage of Iranian white brined cheese for up to 75 days. The significant (P < 0.05) inhibitory effects of EO (even at its lowest concentration) on this organism were observed. The significant (P < 0.05) inhibitory effect of the EO on S. aureus shown in this study may improve the scope of the EO function in the food industry.

Keywords: cuminum cyminum L. essential oil, staphylococcus aureus, white brined cheese

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Authors: Vimarshi Sandamali Godigamuwa

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Background: Breast cancer is the leading cause of cancer mortality in women worldwide. Its incidence is increasing and young women affected more than ever. Nursing students are the future nurses who will have the opportunity to encourage and influence women to be aware of breast cancers. Objectives: To determine the level of knowledge, awareness and practices concerning of breast cancer among Sri Lankan student nurses. Methods: A descriptive cross sectional study was conducted on 150 nursing students who are in their 2nd and 3rd year studies by distributing a standard self-administered questionnaire. The completed questionnaire were retrieved, graded and scored. Results: Mean age of the respondents was 24.27; (SD=1.66) years and ranged from 20-30 years. Most of the students were female which was 85%. 32% of nursing students scored below 55% for the questionnaire and only 7.3% had good overall knowledge and awareness of breast cancer. Out of 128 female students 89.9% were answered that they know how to perform Breast Self Examination (BSE), out of which 37% of them performed BSE regularly. Only 33% were aware of recommended age for BSE and 10% were knew the recommended age for mammography. 9.3% were aware of frequency for Clinical Breast Examination on 20-39 years of age group. Of the female participants, 11.7% reported positive family history of breast cancer. Conclusion: Nursing students should explore to health educational programs on regular basis on breast cancer and its screening methods. Further studies are needed to identify reasons for not practicing BSE.

Keywords: breast cancer, student nurses, knowledge, awareness, practice, BSE

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Authors: E. Solfaroli Camillocci, C. Mancini-Terracciano, V. Bocci, A. Carollo, M. Colandrea, F. Collamati, M. Cremonesi, M. E. Ferrari, P. Ferroli, F. Ghielmetti, C. M. Grana, M. Marafini, S. Morganti, M. Patane, G. Pedroli, B. Pollo, L. Recchia, A. Russomando, M. Schiariti, M. Toppi, G. Traini, R. Faccini

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A Radio-Guided Surgery technique exploiting β− emitting radio-tracers has been suggested to overcome the impact of the large penetration of γ radiation. The detection of electrons in low radiation background provides a clearer delineation of the margins of lesioned tissues. As a start, the clinical cases were selected between the tumors known to express receptors to a β− emitting radio-tracer: 90Y-labelled DOTATOC. The results of tests on ex-vivo specimens of meningioma brain tumor and abdominal neuroendocrine tumors are presented. Voluntary patients were enrolled according to the standard uptake value (SUV > 2 g/ml) and the expected tumor-to-non-tumor ratios (TNR∼10) estimated from PET images after administration of 68Ga-DOTATOC. All these tests validated this technique yielding a significant signal on the bulk tumor and a negligible background from the nearby healthy tissue. Even injecting as low as 1.4 MBq/kg of radiotracer, tumor remnants of 0.1 ml would be detectable. The negligible medical staff exposure was confirmed and among the biological wastes only urine had a significant activity.

Keywords: ex-vivo test, meningioma, neuroendocrine tumor, radio-guided surgery

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Authors: Yahya Maeni

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It is well established that amblyopic patients have a reduced reading performance and oculomotor deficits. Word length has a significant impact on reading performance and eye movement behaviour during reading. As there no previous attempts to assess whether amblyopic eyes would be affected by word length while reading. This study aims to assess the effect of word length on amblyopic eye movement behaviour during reading including fixation duration, number of fixation and gaze duration. 21 adults with amblyopia and 21 age-matched controls participated in the study (age ± SD) (23.80 ± 4.66) for amblyopes and (24.20 ± 3.58) for Controls. Eye movement was recorded during reading binocularly using Eyelink 1000. Study was designed as 2 x 2 (amblyopia vs. control) x 2 lengths (4 letters, and 8 letters). Compared to controls, the amblyopic participants report significant longer duration of fixation, higher number of fixation and longer gaze duration for short words with far higher significant difference for long words. It could be concluded that eye movement in amblyopia during reading might be accounted for by the length of a word within a text and this could possible explanation of reduced reading performance among amblyopes. By understanding the effect of word length on amblyopia will shed light on reading deficits in amblyopia and help to determine the reading needs of amplyopes in educational and clinical settings.

Keywords: amblyopia, eye movement, reading, fixation

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Authors: Jinyan Li, Simon Fong, Raymond Wong, Mohammed Sabah, Fiaidhi Jinan

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Clinical data analysis and forecasting have make great contributions to disease control, prevention and detection. However, such data usually suffer from highly unbalanced samples in class distributions. In this paper, we target at the binary imbalanced dataset, where the positive samples take up only the minority. We investigate two different meta-heuristic algorithms, particle swarm optimization and bat-inspired algorithm, and combine both of them with the synthetic minority over-sampling technique (SMOTE) for processing the datasets. One approach is to process the full dataset as a whole. The other is to split up the dataset and adaptively process it one segment at a time. The experimental results reveal that while the performance improvements obtained by the former methods are not scalable to larger data scales, the later one, which we call Adaptive Swarm Balancing Algorithms, leads to significant efficiency and effectiveness improvements on large datasets. We also find it more consistent with the practice of the typical large imbalanced medical datasets. We further use the meta-heuristic algorithms to optimize two key parameters of SMOTE. Leading to more credible performances of the classifier, and shortening the running time compared with the brute-force method.

Keywords: Imbalanced dataset, meta-heuristic algorithm, SMOTE, big data

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Authors: Shirin Jalili, Ramin Ghasemi Shayan

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Atrial fibrillation is the foremost common arrhythmia around the world, with expanding recurrence famous with age. Thromboembolic occasions and strokes are the number one cause of mortality and morbidity. For patients who don't react to restorative treatment for rate and beat control, the maze method offers an elective treatment mediation. pharmaco-medical treatment for atrial fibrillation is pointed at the control of rate or cadence, intrusive treatment for atrial fibrillation is pointed at cadence control. An obtrusive approach may comprise of percutaneous catheter treatment, surgery, or a crossover approach. Since the maze method is recognized as the foremost successful way to dispense with AF, combining the maze strategy amid major cardiac surgeries has been received in clinical hone. the maze strategy, moreover known as Cox¬maze iii or the ‘cut¬and¬sew’ method, involves making different incisions within the atria to make an arrangement of scars that dispose of each potential zone of re¬entry. The electrical drive is constrained through a maze of scars that coordinates the electrical drive from the sinus node to the av node. By settling the headstrong period between ranges of scar, re¬entry is disposed of. in this article, we evaluate the Maze surgery method that's the surgical method of choice for the treatment of restorative atrial fibrillation.

Keywords: atrial fibrillation, congenital heart disease, procedure, maze surgery, treatment

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Authors: Divya Pathak, James Sloane

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Surgical treatment of midface fractures should ideally occur within two weeks of injury, after which bony healing and consolidation make the repair more difficult for the operating surgeon. The oral and maxillofacial unit at the Royal Surrey Hospital is the tertiary referral center for maxillofacial trauma from five regional hospitals. This is a complete audit cycle of midface trauma referrals managed over a one year period. The standard set was that clinical assessment of the midface fracture would take place in a consultant led outpatient clinic within 7 days, and when indicated, surgical fixation would occur within 10 days of referral. Retrospective data was collected over one year (01/11/2018 - 31/12/2019). Three key changes were implemented: an IT referral mailbox, standardization of an on-call trauma table, and creation of a trauma theatre list. Re-audit was carried out over six months completing the cycle. 283 midface fracture referrals were received, of which 22 patients needed surgical fixation. The average time from referral to outpatient follow-up improved from 14.5 days to 8.3 days, and time from referral to surgery improved from 21.5 days to 11.6 days. Changes implemented in this audit significantly improved patient prioritization to appropriate outpatient clinics and shortened time to surgical intervention.

Keywords: maxillofacial trauma, midface trauma, oral and maxillofacial surgery, surgery fixation

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Authors: Sultan Ayoub Meo

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Environmental pollution is a highly challenging global concern of the 21st century and is a major cause of various communicable and non-communicable diseases. We investigate the impact of air pollution on "lung function, fractional exhaled nitric oxide, and cognitive function"in a group of one hundred young students studying in a traffic-polluted school. The students wereselected based on their age, gender, height, weight, and ethnicity. After the clinical history, one hundred students were recruited from the schoolnear and away from the polluted areas. The lung and cognitive functions were recorded. The results revealed that lung and cognitive function parameters were reduced in groups of students studying in a school located in a traffic-polluted area compared to thosestudying in a schoolsituated away from the traffic-polluted area. Environmental pollution impairs students' lung and cognitive functions studying in schools located within traffic-polluted areas. The health officials and policymakers establish strategies to minimize environmental pollution and its allied health hazards. Prof. Sultan Ayoub Meo, MD, Ph.D Professor, Department of Physiology, College of Medicine, King Saud University, Saudi Arabia Email. [email protected] / [email protected]

Keywords: environmental pOllution, lung physiology, cognitive functions, air pollution

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Authors: Benjamin J. Kuo, Silvia D. Vaca, Joao Ricardo Nickenig Vissoci, Catherine A. Staton, Linda Xu, Michael Muhumuza, Hussein Ssenyonjo, John Mukasa, Joel Kiryabwire, Lydia Nanjula, Christine Muhumuza, Henry E. Rice, Gerald A. Grant, Michael M. Haglund

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Background: Traumatic Brain Injury (TBI) is disproportionally concentrated in low- and middle-income countries (LMICs), with the odds of dying from TBI in Uganda more than 4 times higher than in high income countries (HICs). The disparities in the injury incidence and outcome between LMICs and resource-rich settings have led to increased health outcomes research for TBIs and their associated risk factors in LMICs. While there have been increasing TBI studies in LMICs over the last decade, there is still a need for more robust prospective registries. In Uganda, a trauma registry implemented in 2004 at the Mulago National Referral Hospital (MNRH) showed that RTI is the major contributor (60%) of overall mortality in the casualty department. While the prior registry provides information on injury incidence and burden, it’s limited in scope and doesn’t follow patients longitudinally throughout their hospital stay nor does it focus specifically on TBIs. And although these retrospective analyses are helpful for benchmarking TBI outcomes, they make it hard to identify specific quality improvement initiatives. The relationship among epidemiology, patient risk factors, clinical care, and TBI outcomes are still relatively unknown at MNRH. Objective: The objectives of this study are to describe the processes of care and determine risk factors predictive of poor outcomes for TBI patients presenting to a single tertiary hospital in Uganda. Methods: Prospective data were collected for 563 TBI patients presenting to a tertiary hospital in Kampala from 1 June – 30 November 2016. Research Electronic Data Capture (REDCap) was used to systematically collect variables spanning 8 categories. Univariate and multivariate analysis were conducted to determine significant predictors of mortality. Results: 563 TBI patients were enrolled from 1 June – 30 November 2016. 102 patients (18%) received surgery, 29 patients (5.1%) intended for surgery failed to receive it, and 251 patients (45%) received non-operative management. Overall mortality was 9.6%, which ranged from 4.7% for mild and moderate TBI to 55% for severe TBI patients with GCS 3-5. Within each TBI severity category, mortality differed by management pathway. Variables predictive of mortality were TBI severity, more than one intracranial bleed, failure to receive surgery, high dependency unit admission, ventilator support outside of surgery, and hospital arrival delayed by more than 4 hours. Conclusions: The overall mortality rate of 9.6% in Uganda for TBI is high, and likely underestimates the true TBI mortality. Furthermore, the wide-ranging mortality (3-82%), high ICU fatality, and negative impact of care delays suggest shortcomings with the current triaging practices. Lack of surgical intervention when needed was highly predictive of mortality in TBI patients. Further research into the determinants of surgical interventions, quality of step-up care, and prolonged care delays are needed to better understand the complex interplay of variables that affect patient outcome. These insights guide the development of future interventions and resource allocation to improve patient outcomes.

Keywords: care continuum, global neurosurgery, Kampala Uganda, LMIC, Mulago, prospective registry, traumatic brain injury

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Authors: Lamia Emam

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The attractiveness of entrepreneurship education stems from its perceived value as a venue through which students can develop an entrepreneurial mindset, skill set, and practice, which may not necessarily lead to them starting a new business, but could, more importantly, be manifested as a life skill that could be applied to all types of organizations and career endeavors. This, in turn, raises important questions about what happens in our classrooms; our role as educators, the role of students, center of learning, and the instructional approach; all of which eventually contribute to achieving the desired EE outcomes. With application to an undergraduate entrepreneurship course -Entrepreneurship as Practice- the current paper aims to explore the effect of entrepreneurship education on the development of students’ general entrepreneurial tendencies. Towards that purpose, the researcher herein uses a pre-test and post-test quasi-experimental research design where the Durham University General Enterprising Tendency Test (GET2) is administered to the same group of students before and after course delivery. As designed and delivered, the Entrepreneurship as Practice module is a highly applied and experiential course where students are required to develop an idea for a start-up while practicing the entrepreneurship-related knowledge, mindset, and skills that are taught in class, both individually and in groups. The course is delivered using a combination of short lectures, readings, group discussions, case analysis, guest speakers, and, more importantly, actively engaging in a series of activities that are inspired by diverse methods for developing successful and innovative business ideas, including design thinking, lean-start up and business feasibility analysis. The instructional approach of the course particularly aims at developing the students' critical thinking, reflective, analytical, and creativity-based problem-solving skills that are needed to launch one’s own start-up. The analysis and interpretation of the experiment’s outcomes shall simultaneously incorporate the views of both the educator and students. As presented, the study responds to the rising call for the application of experimental designs in entrepreneurship in general and EE in particular. While doing so, the paper presents an educator’s perspective of EE to complement the dominant stream of research which is constrained to the students’ point of view. Finally, the study sheds light on EE in the MENA region, where the study is applied.

Keywords: entrepreneurship education, andragogy and heutagogy, scholarship of teaching and learning, experiment

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Authors: H. Merhni, A. Sbiti, I. Ratbi, A. Sefiani

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The proximal spinal muscular atrophy (SMA) is a group of neuromuscular disorders characterized by progressive muscle weakness due to the degeneration and loss of anterior motor neurons of the spinal cord. Depending on the age of onset of symptoms and their evolution, four types of SMA, varying in severity, result in a mutations of the SMN gene (survival of Motor neuron). We have analyzed the DNA of 295 patients referred to our genetic counseling; since January 1996 until October 2014; for suspected SMA. The homozygous deletion of exon 7 of the SMN gene was found in 133 patients; of which, 40.6% were born to consanguineous parents. In countries like Morocco, where the frequency of heterozygotes for SMA is high, genetic testing should be offered as first-line and, after careful clinical assessment, especially in newborns and infants with congenital hypotonia unexplained and prognosis compromise. The molecular diagnosis of SMA allows a quick and certainly diagnosis, provide adequate genetic counseling for families at risk and suggest, for couples who want prenatal diagnosis. The analysis of the SMN gene is a perfect example of genetic testing with an excellent cost/benefit ratio that can be of great interest in public health, especially in low-income countries. We emphasize in this work for the benefit of the generalization of molecular diagnosis of SMA by the technique of PCR-enzymatic digestion in other centers in Morocco.

Keywords: Exon7, PCR-digestion, SMA, SMN gene

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Authors: Adrian Sebastian, Chris Gillespie

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We describe a case of diffuse rectal involvement with cap polyposis, manifesting with a protein-losing colopathy and occurring in the setting of advanced mechanical pelvic floor dysfunction. A 59-year-old male with a 5-year history of persistent excessive flatulence, defecatory difficulties, and diarrhea. He had extensive cap polyposis of the entire rectum endoscopically. His symptoms progressed to severe fecal incontinence with mucus leakage, pelvic pain, weight loss, and hypoalbuminemia. Clinical examination exhibited severe perineal descent, a large rectocele, poor anal squeeze, and a poor defecatory technique. After a trial of nonoperative therapies addressing his defecatory dysfunction, and Helicobacter pylori eradication, surgical resection was offered due to severe symptoms with ongoing incontinence and protein loss with no other reasonable options. A robotic abdominoperineal resection with a permanent colostomy was performed, followed by an uncomplicated recovery. Our observation of coexisting mechanical pelvic floor changes in this patient lends weight to the concept of a prolapse-related phenomenon in the pathophysiology of this rare condition.

Keywords: cap polyposis, pelvic dysfunction, fecal incontinence, case report

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Authors: Farhood Rismanchian, Seong Hyeon Park, Young Hoon Lee

Abstract:

During the recent years, demand for healthcare services has dramatically increased. As the demand for healthcare services increases, so does the necessity of constructing new healthcare buildings and redesigning and renovating existing ones. Increasing demands necessitate the use of optimization techniques to improve the overall service efficiency in healthcare settings. However, high complexity of care processes remains the major challenge to accomplish this goal. This study proposes a method based on process mining results to address the high complexity of care processes and to find the optimal layout of the various medical centers in an emergency department. ProM framework is used to discover clinical pathway patterns and relationship between activities. Sequence clustering plug-in is used to remove infrequent events and to derive the process model in the form of Markov chain. The process mining results served as an input for the next phase which consists of the development of the optimization model. Comparison of the current ED design with the one obtained from the proposed method indicated that a carefully designed layout can significantly decrease the distances that patients must travel.

Keywords: Mixed Integer programming, Facility layout problem, Process Mining, Healthcare Operation Management

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Authors: Jay L. Fu

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Patients with Alzheimer's disease progressively lose their memory and thinking skills and, eventually, the ability to carry out simple daily tasks. The disease is irreversible, but early detection and treatment can slow down the disease progression. In this research, publicly available MRI data and demographic data from 373 MRI imaging sessions were utilized to build models to predict dementia. Various machine learning models, including logistic regression, k-nearest neighbor, support vector machine, random forest, and neural network, were developed. Data were divided into training and testing sets, where training sets were used to build the predictive model, and testing sets were used to assess the accuracy of prediction. Key risk factors were identified, and various models were compared to come forward with the best prediction model. Among these models, the random forest model appeared to be the best model with an accuracy of 90.34%. MMSE, nWBV, and gender were the three most important contributing factors to the detection of Alzheimer’s. Among all the models used, the percent in which at least 4 of the 5 models shared the same diagnosis for a testing input was 90.42%. These machine learning models allow early detection of Alzheimer’s with good accuracy, which ultimately leads to early treatment of these patients.

Keywords: Alzheimer's disease, clinical diagnosis, magnetic resonance imaging, machine learning prediction

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Authors: Zeena Dcosta, Junaid Ahmed, Ceena Denny, Nandita Shenoy

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In the field of dentistry, there are many conditions which warrant the requirement of three-dimensional imaging that can aid in diagnosis and therapeutic management. Cone beam computed tomography (CBCT) is considered highly accurate in producing a three-dimensional image of an object and provides a complete insight of various findings in the captured volume. But, most of the clinicians focus primarily on the teeth and jaws and numerous unanticipated clinically significant incidental findings may be missed out. Rapid integration of CBCT into the practice of dentistry has led to the detection of various incidental findings. However, the prevalence of these incidental findings is still unknown. Thus, the study aimed to discern the reason for referral and to identify incidental findings on the referred CBCT scans. Patient’s demographic data such as age and gender was noted. CBCT scans of multiple fields of views (FOV) were considered. The referral for CBCT scans was broadly classified into two major categories: diagnostic scan and treatment planning scan. Any finding on the CBCT volumes, other than the area of concern was recorded as incidental finding which was noted under airway, developmental, pathological, endodontics, TMJ, bone, soft tissue calcifications and others. Few of the incidental findings noted under airway were deviated nasal septum, nasal turbinate hypertrophy, mucosal thickening and pneumatization of sinus. Developmental incidental findings included dilaceration, impaction, pulp stone and gubernacular canal. Resorption of teeth and periapical pathologies were noted under pathological incidental findings. Root fracture along with over and under obturation was noted under endodontics. Incidental findings under TMJ were flattening, erosion and bifid condyle. Enostosis and exostosis were noted under bone lesions. Tonsillolth, sialolith and calcified styloid ligament were noted under soft tissue calcifications. Incidental findings under others included foreign body, fused C1- C2 vertebrae, nutrient canals, and pneumatocyst. Maxillofacial radiologists should be aware of possible incidental findings and should be vigilant about comprehensively evaluating the entire captured volume, which can help in early diagnosis of any potential pathologies that may go undetected. Interpretation of CBCT is truly an art and with the experience, we can unravel the secrets hidden in the grey shades of the radiographic image.

Keywords: cone beam computed tomography, incidental findings, maxillofacial region, radiologist

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Authors: Khaled Soliman, Abdullah Alrushoud, Abdulrahman Alkhalifah, Raed Albathi, Salman Altymiat

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Radiation dose received by patients undergoing Computed Tomography (CT) examination of the cervical spine was evaluated using Gafchromic XR-QA2 films and CT-EXPO software (ver. 2.3), in order to document our clinical dose values and to compare our results with other benchmarks reported in the current literature. Radiochromic films were recently used as practical dosimetry tool that provides dose profile information not available using the standard ionisation chamber routinely used in CT dosimetry. We have developed an in-house program to use the films in order to calculate the Entrance Dose Length Product (EDLP) in (mGy.cm) and to relate the EDLP to various organ doses calculated using the CT-EXPO software. We also calculated conversion factor in (mSv/mGy.cm) relating the EDLP to the effective dose (ED) from the examination using CT-EXPO software. Variability among different types of CT scanners and dose modulation methods are reported from at least three major CT brands available at our medical institution. Our work describes the dosimetry method and results are reported. The method can be used as in-vivo dosimetry method. But this work only reports results obtained from adult female anthropomorphic Phantom studies.

Keywords: CT dosimetry, gafchromic films, XR-QA2, CT-Expo software

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Authors: Mohammad Javad Zehtab, S. Alireza Mirghasemi, Ali Majlesara, Parvin Tajik, Babak Siavashi

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Objective: There are different modalities proposed for tennis elbow treatment with few randomized trials comparing them. We designed a study to compare the effectiveness of five different modalities and determine the usefulness of recently proposed extensor grip test (EGT) in predicting the response to treatment. Methods: In a randomized controlled clinical trial 92 of 98 tennis elbow patients in Sina hospital of Tehran, Iran between 2006 and 2007 fulfill trial entry criteria, among these patients 56 (60.9%) had positive EGT result. Stratified on EGT result, patients allocated randomly to 5 treatment groups: Brace (B) group, physiotherapy (P), brace + physiotherapy (BP), injection (I) and injection + physiotherapy (IP). Results: Patients who had positive result of EGT had better response to treatments: less SOC (p = 0.06), less PFFQ and patients’ satisfaction scores (p < 0.001). Among the treatment IP was the most successful, then BP, P and B, respectively; injection was the worst treatment modality. Response to treatment was comparable in all groups between EGT positive and negative patients except bracing; in which positive EGT was correlated with a dramatic response to treatment. Conclusion: In all patients IP and then BP is recommended but in EGT negatives, bracing seems to be of no use. Injection alone is not recommended in either group.

Keywords: tennis elbow, extensor grip test, physiotherapy, tennis elbow treatment

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Authors: Aiche Mohamed Amine, Mallem Leila, Yahia El Khansa, Boulakoud Mohamed Salah

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Until recently, toxicological studies focused on the effects of individual chemicals. However, humans and wildlife are exposed to a complex milieu of chemicals from different sources including food and water, personal care products and the environment. The aim of this study is to detect the toxicity of two fungicides and their mixtures in the fertility and oxidative damge induced in the rat. The male of rats (28) were used, they were divided in four groups (7 rats of each group) and one group was used as control. Rats were dosed orally with Propiconazole 60mg/Kg/day, Propinebe 100mg/Kg/day and their mixture 30mg Propiconazole/kg/day + 50mg Propineb/kg/day for 4 weeks. Animals were observed for clinical toxicity. At the end of treatment period, animals of all groups were scarified, blood was collected for hematological and biochemical’s analysis and desired organs were removed and weighted. The results indicated that the fungicide and their mixture were toxic in the treated animals. The semen study showed a decrease in the count and mobility of spermatozoa in all treated group, it was also a decrease in the weight of the testis and epidydimis in the treated group as compared with control. Reduced glutathione (GSH), Glutathione peroxidase (GPx) level was decreased in all treated groups.

Keywords: fungicides, mixtures, fertility, oxidative stress

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Authors: Ruben L. Tagare, Jr

Abstract:

This study was conducted to determine the parents’ motivating factors for their deaf and mute children to participate in physical and recreational activities. Data were collected from the 17 parents of the deaf and mute children using a specifically designed survey questionnaire as the primary instrument used in the study. Data analysis and interpretation were done with the aid of descriptive statistics, such as frequency, percentage, weighted mean and multiple responses. Most of the respondents were female with a mean average age of 38 years old. The average age of their children was 10 years old. In terms of monthly income, the respondents had an average monthly income of PhP 13,945. Furthermore, most of the respondents lived in the urban area and were all Catholic by faith or religion. As to the factors that parents used to motivate their deaf and mute children to engage in physical and recreational activities, these included the followings: First; to make my child experience and explore more meaningful things through physical and recreational activities; second; to gain other’s respect; third; to build friendship and interact with his peers; fourth; to experience the feeling of belongingness; and fifth: to learn and discover new things. On the other hand, the least chosen factors were: first; to help achieve and maintain a healthy weight; second; to reduce fats and lowering blood pressure; third; to improve balance, coordination and strength; fourth; to improve posture; and fifth; to assist the child in the development of gross motor and fine motor skills. Based on the findings of the study, it is hereby recommended that since the first factor is 'to make my child experience and explore more meaningful things through physical and recreational activities' and the other top factors are more on social aspect, the school should design extra-curricular activities such as theatrical play and other similar activities that the students will find interesting while the parents will be more motivated to engage their children into physical and recreational activities. Also, since the least chosen factors are more on physical aspect, the school should organize or conduct a seminar for the parents to be aware of the benefits of participating in physical and recreational activities for their deaf and mute children. They can also conduct an information campaign to encourage the other parents of deaf and mute children, whom they keep only inside their home to enroll in the school and let their children be exposed to the natural world. Considering that parents are the primary motivators that can best help their children become more interested in physical and recreational activities for their own development, the school should always remain motivated by creating activities for the deaf and mute children with their parents. The study also recommends conducting further study on the level of knowledge/understanding of the parents on the benefits that can be derived from participating in physical and recreational activities.

Keywords: deaf and mute, participation, physical and recreational activities, adaptive PE

Procedia PDF Downloads 172

Authors: Qasem Qananwah, Ahmad Dagamseh, Hiam AlQuran, Khalid Shaker Ibrahim

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Blood pressure helps the physicians greatly to have a deep insight into the cardiovascular system. The determination of individual blood pressure is a standard clinical procedure considered for cardiovascular system problems. The conventional techniques to measure blood pressure (e.g. cuff method) allows a limited number of readings for a certain period (e.g. every 5-10 minutes). Additionally, these systems cause turbulence to blood flow; impeding continuous blood pressure monitoring, especially in emergency cases or critically ill persons. In this paper, the most important statistical features in the photoplethysmogram (PPG) signals were extracted to estimate the blood pressure noninvasively. PPG signals from more than 40 subjects were measured and analyzed and 12 features were extracted. The features were fed to principal component analysis (PCA) to find the most important independent features that have the highest correlation with blood pressure. The results show that the stiffness index means and standard deviation for the beat-to-beat heart rate were the most important features. A model representing both features for Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) was obtained using a statistical regression technique. Surface fitting is used to best fit the series of data and the results show that the error value in estimating the SBP is 4.95% and in estimating the DBP is 3.99%.

Keywords: blood pressure, noninvasive optical system, principal component analysis, PCA, continuous monitoring

Procedia PDF Downloads 148