Search results for: head and neck
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1075

Search results for: head and neck

835 Morphological Study of Trichomes in Indigofera wightii Grah. ex Wigh & Arn., Indigo Dye Species, Traditionally Used by “Thaisongdam” Thailand

Authors: Supanyika Sengsai, Aree Thongpukdee, Chalermchai Kanchanakachain

Abstract:

The study aimed to collect morphological data of secretory structures that contribute to taxonomy of Indigofera. Detail features of trichomes occurrence in vegetative and reproductive organs of Indigofera wightii Grah. ex Wigh & Arn., a species traditionally used as source of indigo to dye “Thaisongdam” clothing were investigated. Examination through light microscopy and scanning electrom microscopy were done. Non secretory, T-shaped trichomes appeared throughout surfaces of stems, leaves, flowers and fruits. Secretory or glandular trichomes occurred in two types; one has big cylindrical head and short peduncle, distributed on adaxial surface of sepals and around the pedicel, whereas another possesses smaller cylindrical head but long peduncle. The latter was found on apical surface of immature pods. No phenolic and lipophilic compounds were detected from these glands.

Keywords: indigofera, trichome, Thaisongdam, Thailand

Procedia PDF Downloads 277
834 Bi-Axial Stress Effects on Barkhausen-Noise

Authors: G. Balogh, I. A. Szabó, P.Z. Kovács

Abstract:

Mechanical stress has a strong effect on the magnitude of the Barkhausen-noise in structural steels. Because the measurements are performed at the surface of the material, for a sample sheet, the full effect can be described by a biaxial stress field. The measured Barkhausen-noise is dependent on the orientation of the exciting magnetic field relative to the axis of the stress tensor. The sample inhomogenities including the residual stress also modifies the angular dependence of the measured Barkhausen-noise. We have developed a laboratory device with a cross like specimen for bi-axial bending. The measuring head allowed performing excitations in two orthogonal directions. We could excite the two directions independently or simultaneously with different amplitudes. The simultaneous excitation of the two coils could be performed in phase or with a 90 degree phase shift. In principle this allows to measure the Barkhausen-noise at an arbitrary direction without moving the head, or to measure the Barkhausen-noise induced by a rotating magnetic field if a linear superposition of the two fields can be assumed.

Keywords: Barkhausen-noise, bi-axial stress, stress measuring, stress dependency

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833 Morphometric Relationships of Unfarmed Puntius sophore, Collected from Chenab River, Punjab, Pakistan

Authors: Alina Zafar

Abstract:

In this particular research, various morphometric characters such as total length (TL), wet weight (WW), standard length (SL), fork length (FL), head length (HL), head width (HW), body depth (BD), body girth (BG), dorsal fin length (DFL), pelvic fin length (PelFL), pectoral fin length (PecFL), anal fin length (AFL), dorsal fin base (DFB), anal fin base (AFB), caudal fin length (CFL) and caudal fin width (CFW) of wild collected Puntius sophore were studied, to know the types of growth patterns and correlations in reference to length and weight, however, high significant relationships were recorded between total length and wet weight, as the correlation coefficient (r) possessed value of 0.989. The growth pattern was observed to be positively allometric as the value of ‘b’ was 3.22 (slightly higher than the ideal value, 3) with 95% confidence intervals ranging from 3.076 to 3.372. Wet weight and total length parameters showed high significant correlations (p < 0.001) with all other morphometric characters.

Keywords: Puntius sophore, length and weight relation, morphometrics, small indigenous species

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832 Trends of Cancer Patients Who Underwent Curative/radical Radiotherapy at Radiotherapy Center, Tikur Anbessa Specialized Hospital

Authors: Emeshaw Damtew Zebene, Edom Seife, Hagos Tesfay, Gurja Belay

Abstract:

Background: cancer incidence and mortality has grown rapidly throughout the world. Aging of the population, urbanization, physical inactivity, economic growth followed by smoking and drinking contributed a lot for the increased incidence of cancer all over the globe. Objective: the aim of this study was to assess a one-year trend of cancer patients who underwent curative/radical radiotherapy at radiotherapy center, Tikur Anbessa specialized hospital, Ethiopia. Methodology: We performed a prospective descriptive study of cancer patients treated with LINAC at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia, from April 2021- March 2022. A standardized questionnaire was used to collect sociodemographic and clinical characteristics of the patients. Descriptive statistics and chi-square results were generated using SPSS version 24. The level of significance was obtained at 0.05. Results: Sixty-four (64) curative/radical patients-44 females and 20 males were analyzed. Majority, 27(42.2%), of the patients age range from 45 to 64, and 45(70%) of them were urban residents where a group of higher gynecologic cancer was observed.78% of the patients were with locally advanced cancer, and 54(84.4%) of them had no awareness about cancer. Generally, head & neck cancer were found the most prevalent cancer 20(31.3%), and the leading cause of cancer among women was cervical cancer 17(38.6%), where about half 7(15.9%) of them were HIV positive. Conclusion: Our finding revealed that most of curative/radical patients presented at a locally advanced stage of the disease. Hence, maintaining the already available teletherapy machines and installing additional radiotherapy centers may help in treating the patients at the early stage of the disease. Since almost all of our study participants did not have information about cancer, awareness raising mechanisms should be done. Additionally, understanding differences in cancer incidence between urban and rural is important. Key words: Cancer, Curative/radical, Radiotherapy, Tikur Anbessa Specialized Hospital

Keywords: cancer, curative/radical, radiotherapy, tkur anbessa specialized hospital

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831 Mediation Analysis of the Efficacy of the Nimotuzumab-Cisplatin-Radiation (NCR) Improve Overall Survival (OS): A HPV Negative Oropharyngeal Cancer Patient (HPVNOCP) Cohort

Authors: Akshay Patil

Abstract:

Objective: Mediation analysis identifies causal pathways by testing the relationships between the NCR, the OS, and an intermediate variable that mediates the relationship between the Nimotuzumab-cisplatin-radiation (NCR) and OS. Introduction: In randomized controlled trials, the primary interest is in the mechanisms by which an intervention exerts its effects on the outcomes. Clinicians are often interested in how the intervention works (or why it does not work) through hypothesized causal mechanisms. In this work, we highlight the value of understanding causal mechanisms in randomized trial by applying causal mediation analysis in a randomized trial in oncology. Methods: Data was obtained from a phase III randomized trial (Subgroup of HPVNOCP). NCR is reported to significantly improve the OS of patients locally advanced head and neck cancer patients undergoing definitive chemoradiation. Here, based on trial data, the mediating effect of NCR on patient overall survival was systematically quantified through progression-free survival(PFS), disease free survival (DFS), Loco-regional failure (LRF), and the disease control rate (DCR), Overall response rate (ORR). Effects of potential mediators on the HR for OS with NCR versus cisplatin-radiation (CR) were analyzed by Cox regression models. Statistical analyses were performed using R software Version 3.6.3 (The R Foundation for Statistical Computing) Results: Effects of potential mediator PFS was an association between NCR treatment and OS, with an indirect-effect (IE) 0.76(0.62 – 0.95), which mediated 60.69% of the treatment effect. Taking into account baseline confounders, the overall adjusted hazard ratio of death was 0.64 (95% CI: 0.43 – 0.96; P=0.03). The DFS was also a significant mediator and had an IE 0.77 (95% CI; 0.62-0.93), 58% mediated). Smaller mediation effects (maximum 27%) were observed for LRF with IE 0.88(0.74 – 1.06). Both DCR and ORR mediated 10% and 15%, respectively, of the effect of NCR vs. CR on the OS with IE 0.65 (95% CI; 0.81 – 1.08) and 0.94(95% CI; 0.79 – 1.04). Conclusion: Our findings suggest that PFS and DFS were the most important mediators of the OS with nimotuzumab to weekly cisplatin-radiation in HPVNOCP.

Keywords: mediation analysis, cancer data, survival, NCR, HPV negative oropharyngeal

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830 Bone Mineral Density and Frequency of Low-Trauma Fractures in Ukrainian Women with Metabolic Syndrome

Authors: Vladyslav Povoroznyuk, Larysa Martynyuk, Iryna Syzonenko, Liliya Martynyuk

Abstract:

Osteoporosis is one of the important problems in postmenopausal women due to an increased risk of sudden and unexpected fractures. This study is aimed to determine the connection between bone mineral density (BMD) and trabecular bone score (TBS) in Ukrainian women suffering from metabolic syndrome. Participating in the study, 566 menopausal women aged 50-79 year-old were examined and divided into two groups: Group A included 336 women with no obesity (BMI ≤ 29.9 kg/m2), and Group B – 230 women with metabolic syndrome (diagnosis according to IDF criteria, 2005). Dual-energy X-ray absorptiometry was used for measuring of lumbar spine (L1-L4), femoral neck, total body and forearm BMD and bone quality indexes (last according to Med-Imaps installation). Data were analyzed using Statistical Package 6.0. A significant increase of lumbar spine (L1-L4), femoral neck, total body and ultradistal radius BMD was found in women with metabolic syndrome compared to those without obesity (p < 0.001) both in their totality and in groups of 50-59 years, 60-69 years, and 70-79 years. TBS was significantly higher in non-obese women compared to metabolic syndrome patients of 50-59 years and in the general sample (p < 0.05). Analysis showed significant positive correlation between body mass index (BMI) and BMD at all levels. Significant negative correlation between BMI and TBS (L1-L4) was established. Despite the fact that BMD indexes were significantly higher in women with metabolic syndrome, the frequency of vertebral and non-vertebral fractures did not differ significantly in the groups of patients.

Keywords: bone mineral density, trabecular bone score, metabolic syndrome, fracture

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829 On the Application and Comparison of Two Geostatistics Methods in the Parameterisation Step to Calibrate Groundwater Model: Grid-Based Pilot Point and Head-Zonation Based Pilot Point Methods

Authors: Dua K. S. Y. Klaas, Monzur A. Imteaz, Ika Sudiayem, Elkan M. E. Klaas, Eldav C. M. Klaas

Abstract:

Properly selecting the most suitable and effective geostatistics method in the parameterization step of groundwater modeling is critical to attain a satisfactory model. In this paper, two geostatistics methods, i.e., Grid-Based Pilot Point (GB-PP) and Head-Zonation Based Pilot Point (HZB-PP) methods, were applied in an eogenetic karst catchment and compared using as model performances and computation time the criteria. Overall, the results show that appropriate selection of method is substantial in the parameterization of physically-based groundwater models, as it influences both the accuracy and simulation times. It was found that GB-PP method performed comparably superior to HZB-PP method. However, reflecting its model performances, HZB-PP method is promising for further application in groundwater modeling.

Keywords: groundwater model, geostatistics, pilot point, parameterization step

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828 Lessons from Patients Expired due to Severe Head Injuries Treated in Intensive Care Unit of Lady Reading Hospital Peshawar

Authors: Mumtaz Ali, Hamzullah Khan, Khalid Khanzada, Shahid Ayub, Aurangzeb Wazir

Abstract:

Objective: To analyse the death of patients treated in neuro-surgical ICU for severe head injuries from different perspectives. The evaluation of the data so obtained to help improve the health care delivery to this group of patients in ICU. Study Design: It is a descriptive study based on retrospective analysis of patients presenting to neuro-surgical ICU in Lady Reading Hospital, Peshawar. Study Duration: It covered the period between 1st January 2009 to 31st December 2009. Material and Methods: The Clinical record of all the patients presenting with the clinical radiological and surgical features of severe head injuries, who expired in neuro-surgical ICU was collected. A separate proforma which mentioned age, sex, time of arrival and death, causes of head injuries, the radiological features, the clinical parameters, the surgical and non surgical treatment given was used. The average duration of stay and the demographic and domiciliary representation of these patients was noted. The record was analyzed accordingly for discussion and recommendations. Results: Out of the total 112 (n-112) patients who expired in one year in the neuro-surgical ICU the young adults made up the majority 64 (57.14%) followed by children, 34 (30.35%) and then the elderly age group: 10 (8.92%). Road traffic accidents were the major cause of presentation, 75 (66.96%) followed by history of fall; 23 (20.53%) and then the fire arm injuries; 13 (11.60%). The predominant CT scan features of these patients on presentation was cerebral edema, and midline shift (diffuse neuronal injuries). 46 (41.07%) followed by cerebral contusions. 28 (25%). The correctable surgical causes were present only in 18 patients (16.07%) and the majority 94 (83.92%) were given conservative management. Of the 69 (n=69) patients in which CT scan was repeated; 62 (89.85%) showed worsening of the initial CT scan abnormalities while in 7 cases (10.14%) the features were static. Among the non surgical cases both ventilatory therapy in 7 (6.25%) and tracheostomy in 39 (34.82%) failed to change the outcome. The maximum stay in the neuro ICU leading upto the death was 48 hours in 35 (31.25%) cases followed by 31 (27.67%) cases in 24 hours; 24 (21.42%) in one week and 16 (14.28%) in 72 hours. Only 6 (5.35%) patients survived more than a week. Patients were received from almost all the districts of NWFP except. The Hazara division. There were some Afghan refugees as well. Conclusion: Mortality following the head injuries is alarmingly high despite repeated claims about the professional and administrative improvement. Even places like ICU could not change the out come according to the desired aims and objectives in the present set up. A rethinking is needed both at the individual and institutional level among the concerned quarters with a clear aim at the more scientific grounds. Only then one can achieve the desired results.

Keywords: Glasgow Coma Scale, pediatrics, geriatrics, Peshawar

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827 Toba Batak Education Stakeholders' Perspectives towards Education of Children with Disabilities in Toba Samosir North Sumatra Indonesia

Authors: Tryastuti I. B. Manullang, Juang Sunanto

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This study aimed to find the perspectives of the Toba Batak education stakeholders towards the education of children with disabilities in Toba Samosir North Sumatra Indonesia. The education stakeholders consist of a head of the education department in Toba Samosir, head of the H foundation, two principals and three teachers from the Special Primary Schools. This study uses qualitative a descriptive approach and research data obtained through interviews. The results of this study demonstrate that the education stakeholders knowledge about disabilities needs improvement in accordance with the development of science. The cultural views towards disability and its implications, and the education services available for children with disabilities, in addition, to encountered its problem in Toba Samosir are known. The education concept considered appropriate is the special school and the CBR (Community Based Rehabilitation) strategy, also inclusive education because it represents the Toba Batak philosophy.

Keywords: community based rehabilitation, education concept, education stakeholders, inclusive education

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826 Effect of Modulation Factors on Tomotherapy Plans and Their Quality Analysis

Authors: Asawari Alok Pawaskar

Abstract:

This study was aimed at investigating quality assurance (QA) done with IBA matrix, the discrepan­cies observed for helical tomotherapy plans. A selection of tomotherapy plans that initially failed the with Matrix process was chosen for this investigation. These plans failed the fluence analysis as assessed using gamma criteria (3%, 3 mm). Each of these plans was modified (keeping the planning constraints the same), beamlets rebatched and reoptimized. By increasing and decreasing the modula­tion factor, the fluence in a circumferential plane as measured with a diode array was assessed. A subset of these plans was investigated using varied pitch values. Factors for each plan that were examined were point doses, fluences, leaf opening times, planned leaf sinograms, and uniformity indices. In order to ensure that the treatment constraints remained the same, the dose-volume histograms (DVHs) of all the modulated plans were compared to the original plan. It was observed that a large increase in the modulation factor did not significantly improve DVH unifor­mity, but reduced the gamma analysis pass rate. This also increased the treatment delivery time by slowing down the gantry rotation speed which then increases the maximum to mean non-zero leaf open time ratio. Increasing and decreasing the pitch value did not substantially change treatment time, but the delivery accuracy was adversely affected. This may be due to many other factors, such as the complexity of the treatment plan and site. Patient sites included in this study were head and neck, breast, abdomen. The impact of leaf tim­ing inaccuracies on plans was greater with higher modulation factors. Point-dose measurements were seen to be less susceptible to changes in pitch and modulation factors. The initial modulation factor used by the optimizer, such that the TPS generated ‘actual’ modulation factor within the range of 1.4 to 2.5, resulted in an improved deliverable plan.

Keywords: dose volume histogram, modulation factor, IBA matrix, tomotherapy

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825 Unsteady Numerical Analysis of Sediment Erosion Affected High Head Francis Turbine

Authors: Saroj Gautam, Ram Lama, Hari Prasad Neopane, Sailesh Chitrakar, Biraj Singh Thapa, Baoshan Zhu

Abstract:

Sediment flowing along with the water in rivers flowing in South Asia erodes the turbine components. The erosion of turbine components is influenced by the nature of fluid flow along with components of typical turbine types. This paper examines two cases of high head Francis turbines with the same speed number numerically. The numerical investigation involves both steady-state and transient analysis of the numerical model developed for both cases. Furthermore, the influence of leakage flow from the clearance gap of guide vanes is also examined and compared with no leakage flow. It presents the added pressure pulsation to rotor-stator-interaction in the turbine runner for both cases due to leakage flow. It was also found that leakage flow was a major contributor to the sediment erosion in those turbines.

Keywords: sediment erosion, Francis turbine, leakage flow, rotor stator interaction

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824 Vision and Challenges of Developing VR-Based Digital Anatomy Learning Platforms and a Solution Set for 3D Model Marking

Authors: Gizem Kayar, Ramazan Bakir, M. Ilkay Koşar, Ceren U. Gencer, Alperen Ayyildiz

Abstract:

Anatomy classes are crucial for general education of medical students, whereas learning anatomy is quite challenging and requires memorization of thousands of structures. In traditional teaching methods, learning materials are still based on books, anatomy mannequins, or videos. This results in forgetting many important structures after several years. However, more interactive teaching methods like virtual reality, augmented reality, gamification, and motion sensors are becoming more popular since such methods ease the way we learn and keep the data in mind for longer terms. During our study, we designed a virtual reality based digital head anatomy platform to investigate whether a fully interactive anatomy platform is effective to learn anatomy and to understand the level of teaching and learning optimization. The Head is one of the most complicated human anatomy structures, with thousands of tiny, unique structures. This makes the head anatomy one of the most difficult parts to understand during class sessions. Therefore, we developed a fully interactive digital tool with 3D model marking, quiz structures, 2D/3D puzzle structures, and VR support so as to integrate the power of VR and gamification. The project has been developed in Unity game engine with HTC Vive Cosmos VR headset. The head anatomy 3D model has been selected with full skeletal, muscular, integumentary, head, teeth, lymph, and vein system. The biggest issue during the development was the complexity of our model and the marking of it in the 3D world system. 3D model marking requires to access to each unique structure in the counted subsystems which means hundreds of marking needs to be done. Some parts of our 3D head model were monolithic. This is why we worked on dividing such parts to subparts which is very time-consuming. In order to subdivide monolithic parts, one must use an external modeling tool. However, such tools generally come with high learning curves, and seamless division is not ensured. Second option was to integrate tiny colliders to all unique items for mouse interaction. However, outside colliders which cover inner trigger colliders cause overlapping, and these colliders repel each other. Third option is using raycasting. However, due to its own view-based nature, raycasting has some inherent problems. As the model rotate, view direction changes very frequently, and directional computations become even harder. This is why, finally, we studied on the local coordinate system. By taking the pivot point of the model into consideration (back of the nose), each sub-structure is marked with its own local coordinate with respect to the pivot. After converting the mouse position to the world position and checking its relation with the corresponding structure’s local coordinate, we were able to mark all points correctly. The advantage of this method is its applicability and accuracy for all types of monolithic anatomical structures.

Keywords: anatomy, e-learning, virtual reality, 3D model marking

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823 Effect of Non-metallic Inclusion from the Continuous Casting Process on the Multi-Stage Forging Process and the Tensile Strength of the Bolt: Case Study

Authors: Tomasz Dubiel, Tadeusz Balawender, Miroslaw Osetek

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The paper presents the influence of non-metallic inclusions on the multi-stage forging process and the mechanical properties of the dodecagon socket bolt used in the automotive industry. The detected metallurgical defect was so large that it directly influenced the mechanical properties of the bolt and resulted in failure to meet the requirements of the mechanical property class. In order to assess the defect, an X-ray examination and metallographic examination of the defective bolt were performed, showing exogenous non-metallic inclusion. The size of the defect on the cross-section was 0.531 [mm] in width and 1.523 [mm] in length; the defect was continuous along the entire axis of the bolt. In analysis, a FEM simulation of the multi-stage forging process was designed, taking into account a non-metallic inclusion parallel to the sample axis, reflecting the studied case. The process of defect propagation due to material upset in the head area was analyzed. The final forging stage in shaping the dodecagonal socket and filling the flange area was particularly studied. The effect of the defect was observed to significantly reduce the effective cross-section as a result of the expansion of the defect perpendicular to the axis of the bolt. The mechanical properties of products with and without the defect were analyzed. In the first step, the hardness test confirmed that the required value for the mechanical class 8.8 of both bolt types was obtained. In the second step, the bolts were subjected to a static tensile test. The bolts without the defect gave a positive result, while all 10 bolts with the defect gave a negative result, achieving a tensile strength below the requirements. Tensile strength tests were confirmed by metallographic tests and FEM simulation with perpendicular inclusion spread in the area of the head. The bolts were damaged directly under the bolt head, which is inconsistent with the requirements of ISO 898-1. It has been shown that non-metallic inclusions with orientation in accordance with the axis of the bolt can directly cause loss of functionality and these defects should be detected even before assembling in the machine element.

Keywords: continuous casting, multi-stage forging, non-metallic inclusion, upset bolt head

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822 Rotor Radial Vent Pumping in Large Synchronous Electrical Machines

Authors: Darren Camilleri, Robert Rolston

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Rotor radial vents make use of the pumping effect to increase airflow through the active material thus reduce hotspot temperatures. The effect of rotor radial pumping in synchronous machines has been studied previously. This paper presents the findings of previous studies and builds upon their theories using a parametric numerical approach to investigate the rotor radial pumping effect. The pressure head generated by the poles and radial vent flow-rate were identified as important factors in maximizing the benefits of the pumping effect. The use of Minitab and ANSYS Workbench to investigate the key performance characteristics of radial pumping through a Design of Experiments (DOE) was described. CFD results were compared with theoretical calculations. A correlation for each response variable was derived through a statistical analysis. Findings confirmed the strong dependence of radial vent length on vent pressure head, and radial vent cross-sectional area was proved to be significant in maximising radial vent flow rate.

Keywords: CFD, cooling, electrical machines, regression analysis

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821 Characteristics of the Poor in Malaysia: Evidence from E-Kasih Database an Explanatory Analysis

Authors: Zunaidah Ab Hasan, Azhana Othman, Abd Halim Mohd Noor, Nor Shahrina Mohd Rafien

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This study highlights some of the factors of the poor in Malaysia by household and individual level. The discussion covers the demographic, economic and social aspects. The data is derived from the National Databank of Poverty Malaysia (eKasih) for the year of 2013. The explanatory analysis is used to analyse factor of poverty in Malaysia specifically in Malacca. The evidence confirms that male are prone to be poor. For the ethnic, majority of the poor are Malays. The number of dependency and unskilled head of household also contributes to the factors to be poor. Despite that health and physical condition condition does not affect the household head is likely to be poor. Outcome of this study hope to provide guideline that would beneficial to various stakeholders such as zakat institutions, policy makers, welfare department and other agencies related. This will lead to better standard of living as envisioned in the fourth National Key Result Areas (NKRAs).

Keywords: factors of poverty, eKasih, explanatory analysis, welfare department

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820 The Impact of the New Head Injury Pathway on the Number of CTs Performed in a Paediatric Population

Authors: Amel M. A. Osman, Roy Mahony, Lisa Dann, McKenna S.

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Background: Computed Tomography (CT) is a significant source of radiation in the pediatric population. A new head injury (HI) pathway was introduced in 2021, which altered the previous process of HI being jointly admitted with general pediatrics and surgery to admit these patients under the Emergency Medicine Team. Admitted patients included those with positive CT findings not requiring immediate neurosurgical intervention and those who did not meet current criteria for urgent CT brain as per NICE guidelines but were still symptomatic for prolonged observations. This approach aims to decrease the number of CT scans performed. The main aim is to assess the variation in CT scanning rates since the change in the admitting process. A retrospective review of patients presenting to CHI PECU with HI over 6-month period (01/01/19-31/05/19) compared to a 6-month period post introduction of the new pathway (01/06/2022-31/12/2022). Data was collected from the electronic record databases, symphony, and PACS. Results: In 2019, there were 869 presentations of HI, among which 32 (3.68%) had CT scans performed. 2 (6.25%) of those scanned had positive findings. In 2022, there were 1122 HI presentations, with 47 (4.19%) CT scans performed and positive findings in 5 (10.6%) cases. 57 patients were admitted under the new pathway for observation, with 1 having a CT scan following admission. Conclusion: Quantitative lifetime radiation risks for children are not negligible. While there was no statistically significant reduction in CTs performed amongst HIs presenting to our department, a significant group met the criteria for admission under the PECU consultant for prolonged monitoring. There was also a greater proportion of abnormalities on CT scans performed in 2022, demonstrating improved patient selection for imaging. Further data analysis is ongoing to determine if those who were admitted would have previously been scanned under the old pathway.

Keywords: head injury, CT, admission, guidline

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819 Numerical Modelling of the Influence of Meteorological Forcing on Water-Level in the Head Bay of Bengal

Authors: Linta Rose, Prasad K. Bhaskaran

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Water-level information along the coast is very important for disaster management, navigation, planning shoreline management, coastal engineering and protection works, port and harbour activities, and for a better understanding of near-shore ocean dynamics. The water-level variation along a coast attributes from various factors like astronomical tides, meteorological and hydrological forcing. The study area is the Head Bay of Bengal which is highly vulnerable to flooding events caused by monsoons, cyclones and sea-level rise. The study aims to explore the extent to which wind and surface pressure can influence water-level elevation, in view of the low-lying topography of the coastal zones in the region. The ADCIRC hydrodynamic model has been customized for the Head Bay of Bengal, discretized using flexible finite elements and validated against tide gauge observations. Monthly mean climatological wind and mean sea level pressure fields of ERA Interim reanalysis data was used as input forcing to simulate water-level variation in the Head Bay of Bengal, in addition to tidal forcing. The output water-level was compared against that produced using tidal forcing alone, so as to quantify the contribution of meteorological forcing to water-level. The average contribution of meteorological fields to water-level in January is 5.5% at a deep-water location and 13.3% at a coastal location. During the month of July, when the monsoon winds are strongest in this region, this increases to 10.7% and 43.1% respectively at the deep-water and coastal locations. The model output was tested by varying the input conditions of the meteorological fields in an attempt to quantify the relative significance of wind speed and wind direction on water-level. Under uniform wind conditions, the results showed a higher contribution of meteorological fields for south-west winds than north-east winds, when the wind speed was higher. A comparison of the spectral characteristics of output water-level with that generated due to tidal forcing alone showed additional modes with seasonal and annual signatures. Moreover, non-linear monthly mode was found to be weaker than during tidal simulation, all of which point out that meteorological fields do not cause much effect on the water-level at periods less than a day and that it induces non-linear interactions between existing modes of oscillations. The study signifies the role of meteorological forcing under fair weather conditions and points out that a combination of multiple forcing fields including tides, wind, atmospheric pressure, waves, precipitation and river discharge is essential for efficient and effective forecast modelling, especially during extreme weather events.

Keywords: ADCIRC, head Bay of Bengal, mean sea level pressure, meteorological forcing, water-level, wind

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818 The ‘Quartered Head Technique’: A Simple, Reliable Way of Maintaining Leg Length and Offset during Total Hip Arthroplasty

Authors: M. Haruna, O. O. Onafowokan, G. Holt, K. Anderson, R. G. Middleton

Abstract:

Background: Requirements for satisfactory outcomes following total hip arthroplasty (THA) include restoration of femoral offset, version, and leg length. Various techniques have been described for restoring these biomechanical parameters, with leg length restoration being the most predominantly described. We describe a “quartered head technique” (QHT) which uses a stepwise series of femoral head osteotomies to identify and preserve the centre of rotation of the femoral head during THA in order to ensure reconstruction of leg length, offset and stem version, such that hip biomechanics are restored as near to normal as possible. This study aims to identify whether using the QHT during hip arthroplasty effectively restores leg length and femoral offset to within acceptable parameters. Methods: A retrospective review of 206 hips was carried out, leaving 124 hips in the final analysis. Power analysis indicated a minimum of 37 patients required. All operations were performed using an anterolateral approach by a single surgeon. All femoral implants were cemented, collarless, polished double taper CPT® stems (Zimmer, Swindon, UK). Both cemented, and uncemented acetabular components were used (Zimmer, Swindon, UK). Leg length, version, and offset were assessed intra-operatively and reproduced using the QHT. Post-operative leg length and femoral offset were determined and compared with the contralateral native hip, and the difference was then calculated. For the determination of leg length discrepancy (LLD), we used the method described by Williamson & Reckling, which has been shown to be reproducible with a measurement error of ±1mm. As a reference, the inferior margin of the acetabular teardrop and the most prominent point of the lesser trochanter were used. A discrepancy of less than 6mm LLD was chosen as acceptable. All peri-operative radiographs were assessed by two independent observers. Results: The mean absolute post-operative difference in leg length from the contralateral leg was +3.58mm. 84% of patients (104/124) had LLD within ±6mm of the contralateral limb. The mean absolute post-operative difference in offset from contralateral leg was +3.88mm (range -15 to +9mm, median 3mm). 90% of patients (112/124) were within ±6mm offset of the contralateral limb. There was no statistical difference noted between observer measurements. Conclusion: The QHT provides a simple, inexpensive yet effective method of maintaining femoral leg length and offset during total hip arthroplasty. Combining this technique with pre-operative templating or other techniques described may enable surgeons to reduce even further the discrepancies between pre-operative state and post-operative outcome.

Keywords: leg length discrepancy, technical tip, total hip arthroplasty, operative technique

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817 The Existence of Field Corn Networks on the Thailand-Burma Border under the Patron-Client Contract Farming System

Authors: Kettawa Boonprakarn, Jedsarid Sangkaphan, Bejapornd Deekhuntod, Nuntharat Suriyo

Abstract:

This study aimed to investigate the existence of field corn networks on the Thailand-Burma border under the patron-client contract farming system. The data of this qualitative study were collected through in-depth interviews with nine key informants. The results of the study revealed that the existence of the field corn networks was associated with the relationship where farmers had to share their crops with protectors in the areas under the influence of the KNU (Karen National Union) and the DKBA (Democratic Karen Buddhist Army) or Burmese soldiers. A Mae Liang, the person who starts a network has a connection with a Thaokae, Luk Rai Hua Chai or the head of a group of farmers, and farmers. They are under the patron-client system with trust and loyalty that enable the head of the group and the farmers in the Burma border side to remain under the same Mae Liang even though the business has been passed down to later generations.

Keywords: existence, field-corn networks, patron-client system, contract farming

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816 Anatomical, Light and Scanning Electron Microscopical Study of Ostrich (Struthio camelus) Integument

Authors: Samir El-Gendy, Doaa Zaghloul

Abstract:

The current study dealt with the gross and microscopic anatomy of the integument of male ostrich in addition to the histological features of different areas of skin by light and SEM. The ostrich skin is characterized by prominent feather follicles and bristles. The number of feather follicles was determined per cm2 in different regions. The integument of ostrich had many modifications which appeared as callosities and scales, nail and toe pads. They were sternal, pubic and Achilles tendon callosities. The vacuolated epidermal cells were seen mainly in the skin of legs and to a lesser extent in the skin of back and Achilles areas. Higher lipogenic potential was expressed by epidermis from glabrous areas of ostrich skin. The dermal papillae were found in the skin of feathered area of neck and back and this was not a common finding in bird's skin which may give resistance against shearing forces in these regions of ostrich skin. The thickness of the keratin layer of ostrich varied, being thick and characteristically loose in the skin at legs, very thin and wavy at neck, while at Achilles skin area, scale and toe pad were thick and more compact, with the thickest very dense and wavy keratin layer at the nail. The dermis consisted of superficial layer of dense irregular connective tissue characterized by presence of many vacuoles of different sizes just under the basal lamina of the epithelium of epidermis and deep layer of dense regular connective tissue. This result suggested presence of fat droplets in this layer which may be to overcome the lack of good barrier of cutaneous water loss in epidermis.

Keywords: ostrich, light microscopy, scanning electron microscopy, integument, skin modifications

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815 Design and Optimization of a Small Hydraulic Propeller Turbine

Authors: Dario Barsi, Marina Ubaldi, Pietro Zunino, Robert Fink

Abstract:

A design and optimization procedure is proposed and developed to provide the geometry of a high efficiency compact hydraulic propeller turbine for low head. For the preliminary design of the machine, classic design criteria, based on the use of statistical correlations for the definition of the fundamental geometric parameters and the blade shapes are used. These relationships are based on the fundamental design parameters (i.e., specific speed, flow coefficient, work coefficient) in order to provide a simple yet reliable procedure. Particular attention is paid, since from the initial steps, on the correct conformation of the meridional channel and on the correct arrangement of the blade rows. The preliminary geometry thus obtained is used as a starting point for the hydrodynamic optimization procedure, carried out using a CFD calculation software coupled with a genetic algorithm that generates and updates a large database of turbine geometries. The optimization process is performed using a commercial approach that solves the turbulent Navier Stokes equations (RANS) by exploiting the axial-symmetric geometry of the machine. The geometries generated within the database are therefore calculated in order to determine the corresponding overall performance. In order to speed up the optimization calculation, an artificial neural network (ANN) based on the use of an objective function is employed. The procedure was applied for the specific case of a propeller turbine with an innovative design of a modular type, specific for applications characterized by very low heads. The procedure is tested in order to verify its validity and the ability to automatically obtain the targeted net head and the maximum for the total to total internal efficiency.

Keywords: renewable energy conversion, hydraulic turbines, low head hydraulic energy, optimization design

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814 Changes in Some Bioactive Content and Antioxidant Capacity of Different Brassica Herbals after Pretreatment and Herbal Infusion

Authors: Evren C. Eroglu, Ridvan Arslan

Abstract:

Over the course of herbal production, various pretreatments are performed and some of which have serious effect on the bioactive properties. Especially in the production of herbal tea from fresh herbals, it is considered that elapsed time from blending to last product may affect the bioactive properties and antioxidant contents. Herbal infusion is basically prepared by mixing herbs with hot water for 10-20 min. During the brewing of these herbs, it is supposed to be significant decrease in the antioxidant and phenolics content. The first aim of this study was to evaluate the changes of vitamin C (VitC), total phenolic content (TPC) and antioxidant contents (AO) of two brassica varieties (brussel sprouts and white head cabbage) with different holding time after blending. Second aim of this study was to understand the effect of herbal infusion on VitC, TPC and AO contents. In this study, fresh samples were subjected to 0-30 min holding time after blending. Then, samples was immediately taken to -80 °C and freeze drying process was performed. Herbal infusion was performed for 20 minutes. According to results, VitC contents in brussel sprouts was not changed significantly (p=0.12). However, there was a significant decreasing of VitC content in cabbage sample (p=0.034). 20 min of brewing caused a significant decrement in VitC of brussel sprouts by approximately 76% (1071 ppm dw), while decline in cabbage VitC content was 87% (531 ppm dw). AO and TPC values of unprocessed cabbage control sample (13791.87 ppm FeSO4·7H2O eq. dw and 5301.85 ppm gallic acid eq. dw) were higher than brussel sprouts control samples (11571.75 ppm FeSO4·7H2O dw and 5202.76 ppm, respectively). The change in AO and TPC of both brussel sprouts and cabbage samples were not statistically significant at the end of 30 minutes holding time (p=0.24 and p=0.38). After 20 minutes of brewing, AO content in brussel sprouts significantly decreased by 44% (p ˂0.05). Although, the decreasing of AO in white head cabbage was statistically important (p=0.034), decreasing was just 8%. TPC values were found to decrease by 54% in cabbage, while it was 35% in brussel sprouts after herbal infusion. It was observed that 30 min holding time had no statistically important effect on TPC values of both cabbage and brussel sprouts. As a conclusion, herbal infusion has more or less effect on VitC, TPC and AO contents of samples. Therefore, it is important to decrease brewing time. Another result was that there were no significant differences in TPC and AO content of both samples when holding samples 30 min outside after blending. However, this process had significant effect on VitC content of white head cabbage.

Keywords: Antioxidant content, brussel sprouts, herbal infusion, total phenolic content, white head cabbage, vitamin c

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813 Count Regression Modelling on Number of Migrants in Households

Authors: Tsedeke Lambore Gemecho, Ayele Taye Goshu

Abstract:

The main objective of this study is to identify the determinants of the number of international migrants in a household and to compare regression models for count response. This study is done by collecting data from total of 2288 household heads of 16 randomly sampled districts in Hadiya and Kembata-Tembaro zones of Southern Ethiopia. The Poisson mixed models, as special cases of the generalized linear mixed model, is explored to determine effects of the predictors: age of household head, farm land size, and household size. Two ethnicities Hadiya and Kembata are included in the final model as dummy variables. Stepwise variable selection has indentified four predictors: age of head, farm land size, family size and dummy variable ethnic2 (0=other, 1=Kembata). These predictors are significant at 5% significance level with count response number of migrant. The Poisson mixed model consisting of the four predictors with random effects districts. Area specific random effects are significant with the variance of about 0.5105 and standard deviation of 0.7145. The results show that the number of migrant increases with heads age, family size, and farm land size. In conclusion, there is a significantly high number of international migration per household in the area. Age of household head, family size, and farm land size are determinants that increase the number of international migrant in households. Community-based intervention is needed so as to monitor and regulate the international migration for the benefits of the society.

Keywords: Poisson regression, GLM, number of migrant, Hadiya and Kembata Tembaro zones

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812 Ultrasonographic Manifestation of Periventricular Leukomalacia in Preterm Neonates at Teaching Hospital Peradeniya, Sri Lanka

Authors: P. P. Chandrasekera, P. B. Hewavithana, S. Rosairo, M. H. M. N. Herath, D. M. R. D. Mirihella

Abstract:

Periventricular Leukomalacia (PVL) is a White Matter Injury (WMI) of preterm neonatal brain. Objectives of the study were to assess the neuro-developmental outcome at one year of age and to determine a good protocol of cranial ultrasonography to detect PVL. Two hundred and sixty four preterm neonates were included in the study. Series of cranial ultrasound scans were done by using a dedicated neonatal head probe 4-10 MHz of Logic e portable ultrasound scanner. Clinical history of seizures, abnormal head growth (hydrocephalus or microcephaly) and developmental milestones were assessed and neurological examinations were done until one year of age. Among live neonates, 57% who had cystic PVL (Grades2 and 3) manifested as cerebral palsy. In conclusion cystic PVL has permanent neurological disabilities like cerebral palsy. Good protocol of real time cranial ultrasonography to detect PVL is to perform scans at least once a week until one month and at term (40 weeks of gestation).

Keywords: cerebral palsy, cranial ultrasonography, Periventricular Leukomalacia, preterm neonates

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811 Arthroscopic Superior Capsular Reconstruction Using the Long Head of the Biceps Tendon (LHBT)

Authors: Ho Sy Nam, Tang Ha Nam Anh

Abstract:

Background: Rotator cuff tears are a common problem in the aging population. The prevalence of massive rotator cuff tears varies in some studies from 10% to 40%. Of irreparable rotator cuff tears (IRCTs), which are mostly associated with massive tear size, 79% are estimated to have recurrent tears after surgical repair. Recent studies have shown that superior capsule reconstruction (SCR) in massive rotator cuff tears can be an efficient technique with optimistic clinical scores and preservation of stable glenohumeral stability. Superior capsule reconstruction techniques most commonly use either fascia lata autograft or dermal allograft, both of which have their own benefits and drawbacks (such as the potential for donor site issues, allergic reactions, and high cost). We propose a simple technique for superior capsule reconstruction that involves using the long head of the biceps tendon as a local autograft; therefore, the comorbidities related to graft harvesting are eliminated. The long head of the biceps tendon proximal portion is relocated to the footprint and secured as the SCR, serving to both stabilize the glenohumeral joint and maintain vascular supply to aid healing. Objective: The purpose of this study is to assess the clinical outcomes of patients with large to massive RCTs treated by SCR using LHBT. Materials and methods: A study was performed of consecutive patients with large to massive RCTs who were treated by SCR using LHBT between January 2022 and December 2022. We use one double-loaded suture anchor to secure the long head of the biceps to the middle of the footprint. Two more anchors are used to repair the rotator cuff using a single-row technique, which is placed anteriorly and posteriorly on the lateral side of the previously transposed LHBT. Results: The 3 men and 5 women had an average age of 61.25 years (range 48 to 76 years) at the time of surgery. The average follow-up was 8.2 months (6 to 10 months) after surgery. The average preoperative ASES was 45.8, and the average postoperative ASES was 85.83. The average postoperative UCLA score was 29.12. VAS score was improved from 5.9 to 1.12. The mean preoperative ROM of forward flexion and external rotation of the shoulder was 720 ± 160 and 280 ± 80, respectively. The mean postoperative ROM of forward flexion and external rotation were 1310 ± 220 and 630 ± 60, respectively. There were no cases of progression of osteoarthritis or rotator cuff muscle atrophy. Conclusion: SCR using LHBT is considered a treatment option for patients with large or massive RC tears. It can restore superior glenohumeral stability and function of the shoulder joint and can be an effective procedure for selected patients, helping to avoid progression to cuff tear arthropathy.

Keywords: superior capsule reconstruction, large or massive rotator cuff tears, the long head of the biceps, stabilize the glenohumeral joint

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810 Comparison between Radiocarbon and Dendrochronology Ages Obtained on a 700 Years Tree-Ring Sequence from Northern Romania

Authors: G. Sava, I. Popa, T. Sava, A. Ion, M. Ilie, C. Manailescu, A. Robu

Abstract:

At the RoAMS laboratory in Bucharest we have looked for a head-to-head meeting between AMS radiocarbon dating and dendrochronology dating, aiming to point out and explain any differences or similarities that might appear between their output results. As a subject of this investigation, we have fixed our attention on a sequence of tree rings spanning on a period of 700 years, starting with 1000 AD. The samples were collected from the northern Romanian territory within Moldavia region, and were provided by the ‘Marin Dracea - National Institute for Research and Development in Forestry’. All the 23 single ring wood samples were radiocarbon dated using alpha-cellulose extraction, followed by graphitization in an AGE3 installation. A wiggle matching procedure was applied to reduce the radiocarbon uncertainties for the calibrated ages. The results showed a good agreement on 3 out of 4 wood cores, the age-shifting of one of the wood cores being interpreted as an uncertain dendrochronology matching, which was further corrected.

Keywords: wiggle matching, tree-ring radiocarbon dating, dendrochronology, AMS radiocarbon dating, radiocarbon dating in Romania

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809 Prevalence of Work-Related Musculoskeletal Disorder among Dental Personnel in Perak

Authors: Nursyafiq Ali Shibramulisi, Nor Farah Fauzi, Nur Azniza Zawin Anuar, Nurul Atikah Azmi, Janice Hew Pei Fang

Abstract:

Background: Work related musculoskeletal disorders (WRMD) among dental personnel have been underestimated and under-reported worldwide and specifically in Malaysia. The problem will arise and progress slowly over time, as it results from accumulated injury throughout the period of work. Several risk factors, such as repetitive movement, static posture, vibration, and adapting poor working postures, have been identified to be contributing to WRMSD in dental practices. Dental personnel is at higher risk of getting this problem as it is their working nature and core business. This would cause pain and dysfunction syndrome among them and result in absence from work and substandard services to their patients. Methodology: A cross-sectional study involving 19 government dental clinics in Perak was done over the period of 3 months. Those who met the criteria were selected to participate in this study. Malay version of the Self-Reported Nordic Musculoskeletal Discomfort Form was used to identify the prevalence of WRMSD, while the intensity of pain in the respective regions was evaluated using a 10-point scale according to ‘Pain as The 5ᵗʰ Vital Sign’ by MOH Malaysia and later on were analyzed using SPSS version 25. Descriptive statistics, including mean and SD and median and IQR, were used for numerical data. Categorical data were described by percentage. Pearson’s Chi-Square Test and Spearman’s Correlation were used to find the association between the prevalence of WRMSD and other socio-demographic data. Results: 159 dentists, 73 dental therapists, 26 dental lab technicians, 81 dental surgery assistants, and 23 dental attendants participated in this study. The mean age for the participants was 34.9±7.4 and their mean years of service was 9.97±7.5. Most of them were female (78.5%), Malay (71.3%), married (69.6%) and right-handed (90.1%). The highest prevalence of WRMSD was neck (58.0%), followed by shoulder (48.1%), upper back (42.0%), lower back (40.6%), hand/wrist (31.5%), feet (21.3%), knee (12.2%), thigh 7.7%) and lastly elbow (6.9%). Most of those who reported having neck pain scaled their pain experiences at 2 out of 10 (19.5%), while for those who suffered upper back discomfort, most of them scaled their pain experience at 6 out of 10 (17.8%). It was found that there was a significant relationship between age and pain at neck (p=0.007), elbow (p=0.027), lower back (p=0.032), thigh (p=0.039), knee (p=0.001) and feet (p=0.000) regions. Job position also had been found to be having a significant relationship with pain experienced at the lower back (p=0.018), thigh (p=0.011), knee, and feet (p=0.000). Conclusion: The prevalence of WRMSD among dental personnel in Perak was found to be high. Age and job position were found to be having a significant relationship with pain experienced in several regions. Intervention programs should be planned and conducted to prevent and reduce the occurrence of WRMSD, as all harmful or unergonomic practices should be avoided at all costs.

Keywords: WRMSD, ergonomic, dentistry, dental

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808 Impact Force Difference on Natural Grass Versus Synthetic Turf Football Fields

Authors: Nathaniel C. Villanueva, Ian K. H. Chun, Alyssa S. Fujiwara, Emily R. Leibovitch, Brennan E. Yamamoto, Loren G. Yamamoto

Abstract:

Introduction: In previous studies of high school sports, over 15% of concussions were attributed to contact with the playing surface. While artificial turf fields are increasing in popularity due to lower maintenance costs, artificial turf has been associated with more ankle and knee injuries, with inconclusive data on concussions. In this study, natural grass and artificial football fields were compared in terms of deceleration on fall impact. Methods: Accelerometers were placed on the forehead, apex of the head, and right ear of a Century Body Opponent Bag (BOB) manikin. A Riddell HITS football helmet was secured onto the head of the manikin over the accelerometers. This manikin was dropped onto natural grass (n = 10) and artificial turf (n = 9) high school football fields. The manikin was dropped from a stationary position at a height of 60 cm onto its front, back, and left side. Each of these drops was conducted 10 times at the 40-yard line, 20-yard line, and endzone. The net deceleration on impact was calculated as a net vector from each of the three accelerometers’ x, y, and z vectors from the three different locations on the manikin’s head (9 vector measurements per drop). Results: Mean values for the multiple drops were calculated for each accelerometer and drop type for each field. All accelerometers in forward and backward falls and one accelerometer in side falls showed significantly greater impact force on synthetic turf compared to the natural grass surfaces. Conclusion: Impact force was higher on synthetic fields for all drop types for at least one of the accelerometer locations. These findings suggest that concussion risk might be higher for athletes playing on artificial turf fields.

Keywords: concussion, football, biomechanics, sports

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807 Combined Cervical Headache Snag with Cervical Snag Half Rotation Techniques on Cervicogenic Headache Patients

Authors: Wael Salah Shendy, Moataz Mohamed EL Semary, Hosam Salah Murad, Adham A. Mohamed

Abstract:

Background: Cervicogenic headache is a major problem in many people suffering from upper cervical dysfunction with a great conflict in its physical therapy management. Objectives: To determine the effect of C1-C2 Mulligan SNAGs mobilizations on cervicogenic headache and associated dizziness symptoms. Methods: Forty-eight patients with cervicogenic headache included in the study; from the outpatient clinic of Faculty of Physical Therapy, Cairo University, and New Cairo outpatient clinics, were randomly assigned into three equal groups; group A ( Headache SNAG), group B (C1-C2 SNAG rotation) and group C (combined). Their mean age was (29.37 ± 2.6), (29.31 ± 2.54) and (29.68 ± 2.65). Neck Disability Index used to examine neck pain intensity and CEH symptoms. 6 Items Headache Impact test '6-HIT' scale used to examine headache severity and its adverse effects on social life and functions. Flexion-Rotation Test 'FRT' also used to assess rotation ROM at the level of C1-C2 by 'CROM' device. Dizziness Handicap Inventory 'DHI' scale was used to evaluate dizziness symptoms. Evaluation is done pre and post treatment, and comparison between groups was quantified. Correlations between the examined parameters were also measured. Headache SNAG and C1-C2 Rotation SNAGs were done separately in group (A- B) and combined in group C as a treatment intervention. Results: Group C has Significant improvement in whole parameters compared to group A and B, positive correlation was found between NDI and 6-HIT scores compared to negative correlation between NDI and DHI scores. Conclusion: SNAGs mobilizations used in the study were effective in reducing cervicogenic headache and dizziness symptoms in all groups with a noticeable improvement in the combined group.

Keywords: cervicogenic headache, cervical headache snag, cervical snag half rotation, cervical dizziness

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806 A Case of Mantle Cell Lymphoma Presenting With GI Symptoms and Noted to Have Extranodal Involvement of the Stomach and Colon on Presentation

Authors: Saba Amreen Syeda, Summaiah Asim, Syeda, Hafsa, Essam Quraishi

Abstract:

Mantle Cell Lymphoma (MCL) is a relatively uncommon type of lymphoma that comprises approximately 7 percent of non hodgkin's lymphomas (NHL), Classic MCL presents mostly in lymph nodes and occasionally in extranodal sites. About 26 % of MCL is present primarily in the Gastrointestinal tract. While both the upper GI tract and the lower GI tract could be involved, it is rare to present with concurrent upper and lower GI involvement with MCL. We present the case of a 51-year-old Asian Indian male that presented to our clinic with complaints of chronic diarrhea for the last one year, progressively worsening over the past three months. The Patient also reported black stool as well as bright red blood per rectum. Patient reported severe fatigue on minimal exertion. On a physical exam, the patient was noted to have matted lymphadenopathy in the neck. Patient was noted to be anemic with a hemoglobin to be 8 g/dl. Esophagogastroduodenoscopy and colonoscopy was performed. EGD showed a large 4 cm ulcer in the gastric antrum with thick heaped up edges. There was bleeding on contact. Colonoscopy showed a large 35 mm multilobulated polyp in the ascending colon, which was biopsied. The patient was also noted to have nodular proctitis in the mid rectum. This was localized and extended to about 5 cm. This area was biopsied as well. Biopsies from the stomach, colon, as well as the rectum, returned with findings of mantle cell lymphoma on pathology. Lymphoid cells in the biopsy were stained strongly positive for CD 20, cyclin D1, and CD 5. There was the absence of stain for CD 3 and CD 10. The IHC stain for CD 23 was negative. Biopsies from neck LAD were obtained and were also positive for MCL. The patient was referred to oncology for staging and treatment.

Keywords: mantle cell lymphoma, GI bleed, diarrhea, gastric ulcer, colon polyp

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