Search results for: severe acute respiratory distress syndrome

Authors: Disha Bhanot, Vinish Kathuria

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This study focusses on the issue of distress sale in horticulture sector in India, which faces unique challenges, given the perishable nature of horticulture crops, seasonal production and paucity of post-harvest produce management links. Distress sale, from a farmer’s perspective may be defined as urgent sale of normal or distressed goods, at deeply discounted prices (way below the cost of production) and it is usually characterized by unfavorable conditions for the seller (farmer). The small and marginal farmers, often involved in subsistence farming, stand to lose substantially if they receive lower prices than expected prices (typically framed in relation to cost of production). Distress sale maximizes price uncertainty of produce leading to substantial income loss; and with increase in input costs of farming, the high variability in harvest price severely affects profit margin of farmers, thereby affecting their survival. The objective of this study is to model the occurrence of distress sale by tomato cultivators in the Indian state of Maharashtra, against the background of differential access to set of factors such as - capital, irrigation facilities, warehousing, storage and processing facilities, and institutional arrangements for procurement etc. Data is being collected using primary survey of over 200 farmers in key tomato growing areas of Maharashtra, asking information on the above factors in addition to seeking information on cost of cultivation, selling price, time gap between harvesting and selling, role of middleman in selling, besides other socio-economic variables. Farmers selling their produce far below the cost of production would indicate an occurrence of distress sale. Occurrence of distress sale would then be modelled as a function of farm, household and institutional characteristics. Heckman-two-stage model would be applied to find the probability/likelihood of a famer falling into distress sale as well as to ascertain how the extent of distress sale varies in presence/absence of various factors. Findings of the study would recommend suitable interventions and promotion of strategies that would help farmers better manage price uncertainties, avoid distress sale and increase profit margins, having direct implications on poverty.

Keywords: distress sale, horticulture, income loss, India, price uncertainity

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Authors: A. Maciejak, M. Kiliszek, G. Opolski, D. Tulacz, A. Segiet, K. Matlak, S. Dobrzycki, G. Sygitowicz, B. Burzynska, M. Gora

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Introduction and aims: Acute myocardial infarction (AMI) is one of the most severe cardiovascular diseases affecting millions of patients each year worldwide. An early and accurate diagnosis of AMI is essential for optimal treatment. Therefore, new approaches that can complement and improve current strategies for AMI diagnosis are urgently needed. Recent studies have revealed the presence of stable circulating myocardial-derived microRNAs (miRNAs) in human peripheral blood, suggesting that such miRNAs could serve as potential biomarkers of infarction. The present study aimed to identify differentially expressed circulating miRNAs in ST-segment elevation myocardial infarction (STEMI) patients. Materials and methods: miRNA expression profile analysis was performed using Exiqon Serum/Plasma Focus microRNA PCR panel in plasma samples of n=16 patients on the first day of AMI (admission) and in samples from the same patients collected six months after AMI. Selected miRNAs were validated by RT-qPCR using serum samples from an independent set of n=14 AMI patients. Results: The profiling study identified 46 species of plasma miRNAs that were differentially expressed (p < 0.05) on admission compared to six months after AMI. The validation in the independent group of patients confirmed that miR-133b and miR-22-5p were significantly up-regulated upon AMI. Conclusions: Our results suggest that miRNA expression profiling provides better understanding of the changes that occur in the acute phase of MI in the myocardium and could be useful in determination of the potential role of extracellular miRNAs as paracrine signaling molecules. miR-22-5p represents a novel promising biomarker for the diagnosis of acute myocardial infarction.

Keywords: acute myocardial infarction, circulating microRNAs, microRNA expression profiling, miR-22-5p

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Authors: Parul Garg

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Bouveret Syndrome is a rare presentation described as Gastric Outlet Obstruction secondary to Gallstone Ileus. Here we describe the 3-year progression of disease from cholelithiasis to gallstone ileus with relevant imaging findings. The patient was treated under an Upper Gastrointestinal Surgery service with surgical intervention in the form of a laparoscopic assisted procedure with midline laparotomy. She recovered well and was discharged 1 week post operatively. No complications occurred.

Keywords: Cholelithiasis, Bouveret syndrome, Gallstone Ileus, gastric outlet obstruction

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Authors: Sherif Sabri, Nael Samir, Mohamed Ali, Ahmed ElSakhawy

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Introduction: There is growing evidence to support the hypothesis that serum matrix metalloproteinase -9 in could be an early predictor of mortality in septic patients. Aim of the work: Study the relationship of matrix metalloproteinase 9 in patients with SIRS in comparison to septic patients in day 0 and day 2. Patients and Methods: This is a prospective observational study conducted on 40 adult critically ill patients staying more than 24 hours in ICU either surgical or medical department, El Fayoum General Hospital in the period from November 2014 to March 2015. Patients met at least two of the criteria for severe inflammatory response syndrome (SIRS). Diagnostic criteria include several clinical and laboratory findings of sepsis induced tissue hypoperfusion or organ dysfunction. Samples were grouped as drawn either at admission, or at day 2 after admission. Results: Patients were divided into two groups: The non-sepsis (SIRS) group, which included 15 (37.5%) patients with no later evidence of sepsis were enrolled as controls. The Sepsis group, which included 25 patients diagnosed to have SIRS with later evidence of sepsis with positive culture. Exploring serum level of MMP-9 in non-survivors and survivors, there was significant increase in non-survivors if compared to survivors at admission p-value 0.001 (mean value in survivors 4.4mg/dl±4.1mg/dl at admission versus mean value in non-survivors 11.9mg/dl±5.8mg/dl) and after two days of admission was also significant increase p-value 0.001 (mean value in survivors 10.9mg/dl ±9.4mg/dl versus mean value in non-survivors 22.6mg/dl±10.4). Conclusion: MMP-9 levels in septic patients have a beneficial role in ICU for high-risk stratification as it is an independent marker of mortality in severe sepsis.

Keywords: matrix metalloproteinase (MMP-9), sepsis, septic shock, systemic inflamatory response syndrome

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Authors: Birendra Kumar Jha, Mingma L. Sherpa, Binod Kumar Dahal

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Background: The metabolic syndrome is emerging as a major public health concern in the world. Urbanization, surplus energy uptake, compounded by decreased physical activities, and increasing obesity are the major factors contributing to the epidemic of metabolic syndrome worldwide. However, prevalence of metabolic syndrome and its risk factors are little studied in Terai region of Nepal. The objectives of this research were to estimate the prevalence and to identify the risk factors of metabolic syndrome among adults in Terai region of Nepal. Method: We used a community based cross sectional study design. A total of 225 adults (age: 18 to 80 years) were selected from three district of Terai region of Nepal using cluster sampling by camp approach. IDF criteria (central obesity with any two of following four factors: triglycerides ≥ 150 mg/dl or specific treatment for lipid abnormality, reduced HDL, raised blood pressure and raised fasting plasma glucose or previously diagnosed type 2 diabetes) were used to assess metabolic syndrome. Interview, physical and clinical examination, measurement of fasting blood glucose and lipid profile were conducted for all participants. Chi-square test and multivariable logistic regression were employed to explore the risk factors of metabolic syndrome. Result: The overall prevalence of metabolic syndrome was 70.7%. Hypertension, increased fasting blood sugar, increased triglycerides and decreased HDL were observed in 50.7%, 32.4%, 41.8% and 79.1% of the subjects respectively. Socio-economic and behavioral risk factors significantly associated with metabolic syndrome were gender male (OR=2.56, 955 CI: 1.42-4.63; p=0.002), in service or retired from service (OR=3.72, 95% CI: 1.72-8.03; p=0.001) and smoking (OR= 4.10, 95% CI: 1.19-14.07; p=0.016). Conclusion: Higher prevalence of Metabolic syndrome along with presence of behavioral risk factors in Terai region of Nepal likely suggest lack of awareness and health promotion activities for metabolic syndrome and indicate the need to promote public health programs in this region to maintain quality of life.

Keywords: metabolic syndrome, Nepal, prevalence, risk factors, Terai

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Authors: Abdulwahab Kammon, Tan Sheau Wei, Abdul Rahman Omar, Abdunaser Dayhum, Ibrahim Eldghayes, Monier Sharif

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Infectious bronchitis virus (IBV) is a very dynamic and evolving virus which causing major economic losses to the global poultry industry. Recently, the Libyan poultry industry faced severe outbreak of respiratory distress associated with high mortality and dramatic drop in egg production. Tracheal and cloacal swabs were analyzed for several poultry viruses. IBV was detected using SYBR Green I real-time PCR detection based on the nucleocapsid (N) gene. Sequence analysis of the partial N gene indicated high similarity (~ 94%) to IBV strain 3382/06 that was isolated from Taiwan. Even though the IBV strain 3382/06 is more similar to that of the Mass type H120, the isolate has been implicated associated with intertypic recombinant of 3 putative parental IBV strains namely H120, Taiwan strain 1171/92 and China strain CK/CH/LDL/97I. Complete sequencing and antigenicity studies of the Libya IBV strains are currently underway to determine the evolution of the virus and its importance in vaccine induced immunity. In this paper, we documented for the first time the presence of possibly variant IBV strain from Libya which required a dramatic change in the vaccination program.

Keywords: Libya, infectious bronchitis, molecular characterization, viruses, vaccine

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Authors: Okan Cakir, Okan Tatli

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Acute motor and sensory axonal neuropathy (AMSAN) syndrome usually occurs following a postviral infection in two to four weeks and is a polyneuropathy characterized by axonal and sensorial degeneration as a rare variant of Gullian-Barre syndrome. In our case, we wanted to mention that a rare case of AMSAN Syndrome due to prior surgery. A 61-year-old male case admitted to emergency department with complaints of weakness in feet, numbness and incapability to walk. In his history, it was learned that endovascular aneurysm repair (EVAR) had applied for abdominal aort aneurysm two weeks ago before admission, his complaints had been for a couple of days increasingly and bilaterally, and there had been no infection disease history for four weeks. In physical examination, general status was good, vital signs were stable, and there was a mild paresis in dorsal flexion of feet in bilaterally lower extremities. No nuchal rigidity was determined. Other system examinations were normal. Urea:52 mg/dL (normal range: 15-44 mg/dL), creatinine: 1,05 mg/dL (normal range: 0,81-1,4 mg/dL), potassium: 3,68 mmol/L (normal range: 3,5-5,5 mmol/L), glycaemia: 142 mg/dL, calcium: 9,71 mg/dL (normal range: 8,5-10,5 mg/dL), erythrocyte sedimentation rate (ESR): 74 mm/h (normal range: 0-15 mm/h) were determined in biochemical tests. The case was consulted to neurology department and hospitalized. In performing electromyography, it was reported as a bilateral significant axonal degeneration with sensory-motor polyneuropathy. Normal ranges of glycaemia and protein levels were detected in lumbal punction. Viral markers and bucella, toxoplasma, and rubella markers were in normal range. Intravenous immunoglobulin (IVIG) was applied as a treatment, physical treatment programme was planned and the case discharged from neurology department. In our case, we mentioned that it should be considered polyneuropathy as an alternative diagnosis in cases admitting symptoms like weakness and numbness had a history of prior surgery.

Keywords: AMSAN Syndrome, emergency department, prior surgery, weakness

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Authors: Melissa Hachem, Maxime Loizeau, Nadine Saleh, Isabelle Momas, Lynda Bensefa-Colas

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Professional drivers are exposed inside their vehicles to high levels of air pollutants due to the considerable time they spend close to motor vehicle emissions. Little is known about ultrafine particles (UFP) or black carbon (BC) adverse respiratory health effects compared to the regulated pollutants. We aimed to study the short-term associations between UFP and BC concentrations inside vehicles and (1) the onset of mucosal irritation and (2) the acute changes in lung function of Parisian taxi drivers during a working day. An epidemiological study was carried out on 50 taxi drivers in Paris. UFP and BC were measured inside their vehicles with DiSCmini® and microAeth®, respectively. On the same day, the frequency and the severity of nose, eye, and throat irritations were self-reported by each participant and a spirometry test was performed before and after the work shift. Multivariate analysis was used to evaluate the associations between in-taxis UFP and BC concentrations and mucosal irritation and lung function, after adjustment for potential confounders. In-taxis UFP concentrations ranged from 17.9 to 37.9 × 103 particles/cm³ and BC concentrations from 2.2 to 3.9 μg/m³, during a mean of 9 ± 2 working hours. Significant dose-response relationships were observed between in-taxis UFP concentrations and both nasal irritation and lung function. The increase of in-taxis UFP (for an interquartile range of 20 × 103 particles/cm3) was associated to an increase in nasal irritation (adjusted OR = 6.27 [95% CI: 1.02 to 38.62]) and to a reduction in forced expiratory flow at 25–75% by −7.44% [95% CI: −12.63 to −2.24], forced expiratory volume in one second by −4.46% [95% CI: −6.99 to −1.93] and forced vital capacity by −3.31% [95% CI: −5.82 to −0.80]. Such associations were not found with BC. Incident throat and eye irritations were not related to in-vehicle particles exposure; however, they were associated with outdoor air quality (estimated by the Atmo index) and in-vehicle humidity, respectively. This study is the first to show a significant association, within a short-period of time, between in-vehicle UFP exposure and acute respiratory effects in professional drivers.

Keywords: black carbon, lung function, mucosal irritation, taxi drivers, ultrafine particles

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Authors: Pooja Kherudkar, Namdeo Hedaoo

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There are various causes for asphalt pavement distresses which can develop prematurely or with aging in services. These causes are not limited to aging of bitumen binder but include poor quality materials and construction, inadequate mix design, inadequate pavement structure design considering the traffic and lack of preventive maintenance. There is physical evidence available for each type of pavement distress. Distress in asphalt pavements can be categorized in different distress modes like fracture (cracking and spalling), distortion (permanent deformation and slippage), and disintegration (raveling and potholes). This study shows the importance of severity determination of distresses for the selection of appropriate preventive maintenance treatment. Distress analysis of the deteriorated roads was carried out. Four roads of urban flexible pavements from Pune city was selected as a case study. The roads were surveyed to detect the types, to measure the severity and extent of the distresses. Causes of distresses were investigated. The pavement condition rating values of the roads were calculated. These ranges of ratings were as follows; 1 for poor condition road, 1.1 to 2 for fair condition road and 2.1 to 3 for good condition road. Out of the four roads, two roads were found to be in fair condition and the other two were found in good condition. From the various preventive maintenance treatments like crack seal, fog seal, slurry seal, microsurfacing, surface dressing and thin hot mix/cold mix bituminous overlays, the effective maintenance treatments with respect to the surface condition and severity levels of the existing pavement were recommended.

Keywords: distress analysis, pavement condition rating, preventive maintenance treatments, surface distress measurement

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Authors: Sana Ilyas

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Parry-Romberg syndrome is a rare condition clinically defined by slowly progressive atrophy of the skin and soft tissues. This usually effects one side of the face, although a few cases have been documented of bilateral presentation. It is more prevalent in females and usually affects the left side of the face. The syndrome can also be accompanied by neurological abnormalities. It usually occurs in the first two decades of life with a variable rate of progression. The aetiology is unknown, and the disease eventually stabilises. The treatment options usually involve surgical management. The least invasive of these options is the management of facial asymmetry, associated with Parry Romberg syndrome, through the use of tissue fillers. This paper will review the existing literature on the management of Parry Romberg syndrome with tissue filler. Aim: The aim of the study is to explore the current published literature for the management of Parry Romberg syndrome with fillers. It is to assess the development that has been made in this method of management, its benefits and limitations, and its effectiveness for the management of Parry Romberg syndrome. Methodology: There was a thorough assessment of the current literature published on this topic. PubMed database was used for search of the published literature on this method of the management. Papers were analysed and compared with one another to assess the success and limitation of the management of Parry Romberg with dermal fillers Results and Conclusion: Case reports of the use of tissue fillers discuss the varying degrees of success with the treatment. However, this procedure has it’s limitation, which are discussed in the paper in detail. However, it is still the least invasive of all the surgical options for the management of Parry Romberg Syndrome, and therefore, it is important to explore this option with patients, as they may be more comfortable with pursuingtreatment that is less invasive and can still improve their facial asymmetry

Keywords: dermal fillers, facial asymmetry, parry romberg syndrome, tissue fillers

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Authors: Manuela Caciula, Luis Torres, Simion Tomoiaga

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Introduction: The SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), more commonly referred to as COVID-19, has wreaked havoc on all facets of higher education since its inception in late 2019. College students, in particular, significantly reduced their daily energy expenditure and increased the time spent sitting to listen to online classes and complete their studies from home. This change, in combination with the associated COVID-19 lockdown, presumably decreased physical activity levels, increased mental health symptoms, and led to the promotion of unhealthy eating habits. Objectives: The main objective of this study was to determine the current self-reported physical activity levels, mental health symptoms, and body composition of college students after the COVID-19 lockdown in order to develop future interventions for the overall improvement of health. Methods: All participants completed pre-existing, well-validated surveys for both physical activity (International Physical Activity Questionnaire - long form) and mental health (Hospital Anxiety and Depression Scale). Body composition was assessed in person with the use of an Inbody 570 device. Results: Of the 90 American college students (M age = 22.52 ± 4.54, 50 females) who participated in this study, depressive and anxious symptom scores consistent with 58% (N = 52) heightened symptomatology, 17% (N = 15) moderate borderline symptomatology, and 25% (N = 23) asymptomatology were reported. In regard to physical activity, 79% (N = 71) of the students were highly physically active, 18% (N = 16) were moderately active, and 3% (N = 3) reported low levels of physical activity. Additionally, 46% (N = 41) of the students maintained an unhealthy body fat percentage based on World Health Organization recommendations. Strong, significant relationships were found between anxiety and depression symptomatology and body fat percentage (P = .003) and skeletal muscle mass (P = .015), with said symptomatology increasing with added body fat and decreasing with added skeletal muscle mass. Conclusions: Future health interventions for American college students should be focused on strategies to reduce stress, anxiety, and depressive characteristics, as well as nutritional information on healthy eating, regardless of self-reported physical activity levels.

Keywords: physical activity, mental health, body composition, COVID-19

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Authors: James M. Geidner

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Objective: The purpose of this meta-analysis was to examine the evidence for the effectiveness of exercise interventions on reducing metabolic components in children and/or adolescents diagnosed with Paediatric Metabolic Syndrome. Methods: A computerized search was made from four databases: PubMed, PsycInfo, SPORTDiscus, Cochrane Central Register. The analysis was restricted to children and adolescents with metabolic syndrome examining the effect of exercise interventions on metabolic components. Effect size and 95% confidence interval were calculated and the heterogeneity of the studies was estimated using Cochran’s Q-statistic and I2. Bias was assessed using multiple tools and statistical analyses. Results: Thirteen studies, consisting of 19 separate trials, were selected for the meta-analysis as they fulfilled the inclusion criteria (n=908). Exercise interventions resulted in decreased waist circumference, systolic blood pressure, diastolic blood pressure, fasting glucose, insulin resistance, triglycerides, and High-Density Lipoprotein Cholesterol (HDL-C). Conclusions: This meta-analysis provides insights into the effectiveness of exercise interventions on markers of Paediatric Metabolic Syndrome in children and adolescents.

Keywords: metabolic syndrome, syndrome x, pediatric, meta-analysis

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Authors: Atlal El-Assaad

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Viruses change with time through mutations and result in new variants that may persist or disappear. A Mutation refers to an actual change in the virus genetic sequence, and a variant is a viral genome that may contain one or more mutations. Critical mutations may cause the virus to be more transmissible, with high disease severity, and more vulnerable to diagnostics, therapeutics, and vaccines. Thus, variants carrying such mutations may increase the risk to human health and are considered variants of concern (VOC). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) - the contagious in humans, positive-sense single-stranded RNA virus that caused coronavirus disease 2019 (COVID-19) - has been studied thoroughly, and several variants were revealed across the world with their corresponding mutations. SARS-CoV-2 has four structural proteins, known as the S (spike), E (envelope), M (membrane), and N (nucleocapsid) proteins, but prior study and vaccines development focused on genetic mutations in the S protein due to its vital role in allowing the virus to attach and fuse with the membrane of a host cell. Specifically, subunit S1 catalyzes attachment, whereas subunit S2 mediates fusion. In this perspective, we studied all charged amino acid mutations of the SARS-CoV-2 viral spike protein S1 when bound to Antibody CC12.1 in a crystal structure and assessed the effect of different mutations. We generated all missense mutants of SARS-CoV-2 protein amino acids (AAs) within the SARS-CoV-2:CC12.1 complex model. To generate the family of mutants in each complex, we mutated every charged amino acid with all other charged amino acids (Lysine (K), Arginine (R), Glutamic Acid (E), and Aspartic Acid (D)) and studied the new binding of the complex after each mutation. We applied Poisson-Boltzmann electrostatic calculations feeding into free energy calculations to determine the effect of each mutation on binding. After analyzing our data, we identified charged amino acids keys for binding. Furthermore, we validated those findings against published experimental genetic data. Our results are the first to propose in silico potential life-threatening mutations of SARS-CoV-2 beyond the present mutations found in the five common variants found worldwide.

Keywords: SARS-CoV-2, variant, ionic amino acid, protein-protein interactions, missense mutation, AESOP

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Authors: Rajish Shil, Mohammad Ali Houri, Mohammad Milad Ismail, Fatimah Al Kaabi

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The clinical presentation of Primary hyperparathyroidism can vary from simple asymptomatic hypercalcemia to severe life-threatening hypercalcemic crisis with multi-organ dysfunction, which can be due to parathyroid adenoma or sometimes with malignant cancer. This cascade of clinical presentation can lead to a diagnostic and therapeutic challenge for treating the disease. We are presenting a case of severe hypercalcemic crisis due to parathyroid adenoma with an emphasis on early management, diagnosis, and interventions to prevent any lifelong complications and any permanent organ dysfunction. A 30 years old female with a history of primary Infertility, admitted to Al Ain Hospital critical care unit with Acute Severe Necrotizing Pancreatitis. She initially had a 1-month history of abdominal pain on and off, for which she was treated conservatively with no much improvement, and later on, she developed life-threatening severe pancreatitis, which required her to be admitted to the critical care unit. She was transferred from a private healthcare facility, where she was found to have a very high level of calcium up to 15mmol/L. She received systemic Zoledronic Acid, which lowered her calcium level transiently and later was increased again. She went on to develop multiple end-organ damages along with multiple electrolytes disturbances. She was found to have high levels of Parathyroid hormone, which was correlated with a parathyroid mass on the neck via radiological imaging. After a long course of medical treatment to lower the calcium to a near-normal level, parathyroidectomy was done, which showed parathyroid adenoma on histology. She developed hungry bone syndrome after the surgery and pancreatic pseudocyst after resolving of pancreatitis. She required aggressive treatment with Intravenous calcium for her hypocalcemia as she received zoledronic acid at the beginning of the disease. Later on, she was discharged on long term calcium and other electrolytes supplements. In patients presenting with hypercalcemia, it is prudent to investigate and start treatment early to prevent complications and end-organ damage from hypercalcemia and also to treat the primary cause of the hypercalcemia, with conscious follow up to prevent hypocalcemic complications after treatment. It is important to follow up patients with parathyroid adenomas for a long period in order to detect any recurrence of the tumor or to make sure if the primary tumor is either benign or malignant.

Keywords: hypercalcemia, pancreatitis, hypocalcemia, hyperparathyroidism

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Authors: Mehwish Azam, Muhammad Imran, Humaira Jabeen, Sumreen Begum, Rashida Qasim

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Background: Metabolic syndrome is a cluster of metabolic risk factors including obesity, glucose intolerance, insulin resistance, dyslipidemia and hypertension. Metabolic syndrome in obese and type 2 diabetic subjects increases the risk of cardiovascular diseases (CVD). Globally, the prevalence of metabolic syndrome ranges from 10%-50% and in Pakistan ranges from 18%-46%. The objective of the present study is to estimate the prevalence of metabolic syndrome (MS) in obese type 2 diabetic subjects by using International Diabetes Federation (IDF) and National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) definitions. Methods: Obese type 2 diabetic subjects and normal healthy subjects of both genders were selected from diabetic clinics and hospitals of various localities of Karachi, Pakistan. The frequency of metabolic syndrome was estimated by the proposed definitions of IDF and NCEP-ATP III. Results: The prevalence of metabolic syndrome using International Diabetes Federation (IDF) definition in obese type 2 diabetic subjects was 85.7%. It is significantly higher (p<0.05) in females (47.1%) as compared to males (38.6%). While, using National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) definition the overall prevalence of metabolic syndrome in obese type 2 diabetic subjects was 75.7%, the prevalence is significantly higher (p<0.05) in females (45.7%) than males (30.0%). Conclusion: It is concluded that, the overall prevalence of metabolic syndrome is increasing significantly in obese type 2 diabetic subjects by using IDF and NCEP–ATP III definitions. Therefore, it is need to initiate the preventive measures by arranging public awareness programmes to highlight the significance of a healthy lifestyle and emphasis should be given to reduce weight, increase physical activity, and increase intake of healthy low-glycemic-index foods.

Keywords: metabolic syndrome, diabetes mellitus, obesity, IDF, NCEP-ATP III

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Authors: Nancy Wilson

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In utero, fetal drug exposure is prevalent amongst birthing facilities. Assessment tools for neonatal abstinence syndrome (NAS) are often cumbersome and ill-fitting, harboring immense subjectivity. This paradox often leads the clinical assessor to be hypervigilant when assessing the newborn for subtle symptoms of NAS, often mistaken for normal newborn behaviors. As a quality improvement initiative, this project led to a more adaptable NAS tool termed eat, sleep, console (ESC). This function-based NAS assessment scores the infant based on the ability to accomplish three basic newborn necessities- to sleep, to eat, and to be consoled. Literature supports that ESC methodology improves patient and family outcomes while providing more cost-effective care.

Keywords: neonatal abstinence syndrome, neonatal opioid withdrawal, maternal substance abuse, pregnancy, and addiction, Finnegan neonatal abstinence syndrome tool, eat, sleep, console

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Authors: Meryem Abi-Ayad, Biagio Arcidiacono, Eusebio Chiefari, Daniela Foti, Mohamed Benyoucef, Antonio Brunetti

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Lipoprotein Lipase (LPL) is a key enzyme for lipid metabolism; its genetic polymorphism can be a candidate for modulating lipids parameters in metabolic syndrome. The objective of the present study was to determine whether lipoproteins lipase polymorphisMetS (LPL-HindIII) could be associated with moderate hypertriglyceridemia (secondary to metabolism syndrome). The polymorphism Hind III (rs320) was assessed by PCR-RFLP in 51 MetS patients and 17 healthy controls from the hospital in Tlemcen. The logistic regression analyses showed no significant association with Hind III genotype and hypertriglyceridemia (TG ≥ 1,5g/l or TG lower treatment) (P=0,455), metabolic syndrome (P=0,455), hypertension (P=0,802) and type 2 diabetes (P=0,144). In terms of plasma biomarkers, although not statistically significant, there was a difference in TG levels (P > 0,05), which was lowest among carriers of the homogenous mutant allele (H-). In this study, there was no association between the rare allele (H-) and disease protection, and between the frequent allele (H+) and disease prevalence (hypertriglyceridemia, metabolic syndrome, hypertension, type 2 diabetes).

Keywords: moderate secondary hypertriglyceridemia, metabolic syndrome, lipids, polymorphism lipoprotein lipase, HindIII(rs320)

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Authors: Anisa Suraya Ab Razak, Izza Hayat

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Introduction: The diagnosis and management of severe hyponatremia in neuropsychiatric patients present a significant challenge to physicians. Several factors contribute, including diagnostic shadowing and attributing abnormal behavior to intellectual disability or psychiatric conditions. Hyponatraemia is the commonest electrolyte abnormality in the inpatient population, ranging from mild/asymptomatic, moderate to severe levels with life-threatening symptoms such as seizures, coma and death. There are several documented fatal case reports in the literature of severe hyponatremia secondary to psychogenic polydipsia, often diagnosed only in autopsy. This paper presents a case study of acute severe hyponatremia in a neuropsychiatric patient with early diagnosis and admission to intensive care. Case study: A 21-year old Caucasian male with known epilepsy and learning disability was admitted from residential living with generalized tonic-clonic self-terminating seizures after refusing medications for several weeks. Evidence of superficial head injury was detected on physical examination. His laboratory data demonstrated mild hyponatremia (125 mmol/L). Computed tomography imaging of his brain demonstrated no acute bleed or space-occupying lesion. He exhibited abnormal behavior - restlessness, drinking water from bathroom taps, inability to engage, paranoia, and hypersexuality. No collateral history was available to establish his baseline behavior. He was loaded with intravenous sodium valproate and leveritircaetam. Three hours later, he developed vomiting and a generalized tonic-clonic seizure lasting forty seconds. He remained drowsy for several hours and regained minimal recovery of consciousness. A repeat set of blood tests demonstrated profound hyponatremia (117 mmol/L). Outcomes: He was referred to intensive care for peripheral intravenous infusion of 2.7% sodium chloride solution with two-hourly laboratory monitoring of sodium concentration. Laboratory monitoring identified dangerously rapid correction of serum sodium concentration, and hypertonic saline was switched to a 5% dextrose solution to reduce the risk of acute large-volume fluid shifts from the cerebral intracellular compartment to the extracellular compartment. He underwent urethral catheterization and produced 8 liters of urine over 24 hours. Serum sodium concentration remained stable after 24 hours of correction fluids. His GCS recovered to baseline after 48 hours with improvement in behavior -he engaged with healthcare professionals, understood the importance of taking medications, admitted to illicit drug use and drinking massive amounts of water. He was transferred from high-dependency care to ward level and was initiated on multiple trials of anti-epileptics before achieving seizure-free days two weeks after resolution of acute hyponatremia. Conclusion: Psychogenic polydipsia is often found in young patients with intellectual disability or psychiatric disorders. Patients drink large volumes of water daily ranging from ten to forty liters, resulting in acute severe hyponatremia with mortality rates as high as 20%. Poor outcomes are due to challenges faced by physicians in making an early diagnosis and treating acute hyponatremia safely. A low index of suspicion of water intoxication is required in this population, including patients with known epilepsy. Monitoring urine output proved to be clinically effective in aiding diagnosis. Early referral and admission to intensive care should be considered for safe correction of sodium concentration while minimizing risk of fatal complications e.g. central pontine myelinolysis.

Keywords: epilepsy, psychogenic polydipsia, seizure, severe hyponatremia

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Authors: Dipanshu Sur, Ratnabali Chakravorty

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Introduction: Polycystic ovary syndrome (PCOS) is the most common metabolic abnormality such as changes in lipid profile, diabetes, hypertension and metabolic syndrome occurring in women. Hypovitaminsis D was found to be associated with the development of obesity and insulin resistance in women with PCOS. Aim: To evaluate the association of vitamin D levels in obese and non-obese patients with PCOS in an East Indian populations. Methods: A case control study was conducted. It enrolled 100 cases of PCOS based on Rotterdam criteria and 100 ovulatory normal cases matched for their age and BMI. Vitamin D levels were compared in the obese and non-obese PCOS groups and also with the controls. Results: The mean age of subjects was 29.48 ± 3.29 years in the PCOS group and 26.24 ± 2.56 years in the control group. Hypovitaminosis D was present in 75 out of 100 PCOS women (75.0%) and 25 women (25.0%) showed sufficient 25OHD levels ≥30 ng/ml. Women with PCOS had significantly lower total serum calcium (8.4 ± 0.25 mg/dl versus 9.8 ± 0.17 mg/dl in controls), and 25 OHD (21.2 ± 2.56 ng/ml versus 32.6 ± 2.23 ng/ml in control group) than ovulatory normal women. This difference remained significant for both groups after adjustment for BMI. Obese women in both groups had significantly lower concentration of calcium and 25OHD than normal weight patients in this study. Conclusion: Our study shows majority of the patients and controls had vitamin D deficiency and there was significant difference in the vitamin D levels in PCOS group and controls as well as obese and non-obese groups. This may reflect the vitamin D deficiency status of the community. Vitamin D deficiency should demands immediate attention as it is a severe problem among the East Indian population.

Keywords: vitamin D deficiency, polycystic ovary syndrome, obese, hypovitaminsis D

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Authors: Aslı Günay Bulutsuz, Mehmet Emin Yurci

Abstract:

Severe plastic deformation techniques are top-down deformation methods which enable superior mechanical properties by decreasing grain size. Different kind severe plastic deformation methods have been widely being used at various process temperature and geometries. Besides manufacturing advantages of severe plastic deformation technique, most of the types are being used only at the laboratory level. They cannot be adapted to industrial usage due to their continuous manufacturability and manufacturing costs. In order to enhance these manufacturing difficulties and enable widespread usage, different kinds of methods have been developed. In this review, a comprehensive literature research was fulfilled in order to highlight continuous severe plastic deformation methods.

Keywords: continuous manufacturing, severe plastic deformation, ultrafine grains, grain size refinement

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Authors: Muslim Idan Mohsin, Mohammed Jasim Al-Shamarti, Rusul Idan Mohsin, Ali A. Majeed

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One of the causative agents of the lower respiratory tract (LRT) is Pseudomonas aeruginosa, which can lead to severe infection associated with a lung infection. There are many cytokines that are secreted in response to bacterial infection, in particular interleukin IL-36 cytokine in response to P. aeruginosa infection. The involvement of IL-36 in the P. aeruginosa infection could be a clue to find a specific way for treatments of different inflammatory and degenerative lung diseases. IL36 promotes primary immune response via binding to the IL-36 receptor (IL-36R). Indeed, an overactivity of IL-36 might be an initiating factor for many immunopathologic sceneries in pneumonia. Here we demonstrate if the IL-36 cytokine increases in response P. aeruginosa infection that is isolated from lower respiratory tract infection (LRT). We demonstrated that IL-36 expression significantly unregulated in human lung epithelial (A549) cells after infected by P. aeruginosa at mRNA level.

Keywords: IL36, Pseudomonas aeruginosa, LRT infection, A549 cells

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Authors: Myoungsoon You, Heejung Son

Abstract:

Background: In the current study, we investigated the effects of emotions induced by an infectious disease outbreak on the various protective behaviors taken during the crisis and on the perception after the crisis. The investigation was based on two psychological theories of appraisal tendency and action tendency. Methods: A total of 900 participants in South Korea who experienced the 2015 Middle East Respiratory Syndrome outbreak were sampled by a professional survey agency. To assess the influence of the emotions fear and anger, a regression approach was used. The effect of emotions on various protective behaviors and perceptions was observed using a hierarchical regression method. Results: Fear and anger induced by the infectious disease outbreak were both associated with increased protective behaviors during the crisis. However, the differences between the emotions were observed. While protective behaviors with avoidance tendency (adherence to recommendations, self-mitigation), were raised by both fear and anger, protective behaviors with approach tendency (information-seeking) were increased by anger, but not fear. Regarding the effect of emotion on the risk perception after the crisis, only fear was associated with a higher level of risk perception. Conclusions: This study confirmed the role of emotions in crisis protective behaviors and post-crisis perceptions regarding an infectious disease outbreak. These findings could enhance understanding of the public’s protective behaviors during infectious disease outbreaks and afterward risk perception corresponding to emotions. The results also suggested strategies for communicating with the public that takes into account emotions that are prominently induced by crises associated with disease outbreaks.

Keywords: crisis communication, emotion, infectious disease outbreak, protective behavior, risk perception

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Authors: Sheikha Turki Alketbi

Abstract:

Objectives: 1. Documenting the spontaneous resolution of AML following the initiation of anti-TB therapy. 2. Presenting an uncommon type of relapse in Acute Myeloid Leukemia. 3. Highlighting the role of immune markers in the diagnosis of Leukemia cutis. 4. Exploring and highlighting the possibility of skin relapse as the exclusive manifestation, even when skin involvement is known secondary manifestation in AML. Background: Spontaneous remission of Acute Myeloid Leukemia (AML) is a rare phenomenon that has only been reported in some case reports, usually following severe infections. Some studies have described the occurrence of tuberculosis (TB) infection with AML, usually after starting chemotherapy. Spontaneous resolution of AML after starting anti TB therapy (ATT), without starting chemotherapy has never been described in the literature. Moreover, Leukemia cutis is another rare skin manifestation of Acute Myeloid Leukemia as a result of infiltration of the skin or subcutaneous tissue by leukemic cells, in which can present during, precedes, after or independently of systemic leukemia. Methods: Here, we present a case of a 13-year-old male who presented with fever, weight loss, lethargy, epistaxis, bruising and dry cough and was later diagnosed with AML. Before initiating leukemia treatment, the patient was tested for TB and was found to have active TB infection. His leukemia treatment was postponed to clear the TB infection and he was commenced on ATT. Two months later, repeat blood film and bone marrow biopsy showed resolution of his AML. The patient remained in remission for 1 month, after which he presented with symmetrical blue purple well-defined round indurated plaques on the chest and thighs. Our differentials were leukemia cutis and Kaposi sarcoma. Results: Skin Biopsy with immune markers done, showed a picture of Acute Myeloid Leukemia. Immunohistochemistry (IHC) showed neoplastic cells diffusely and strongly positive for LCA, CD2, CD31, MPO, CD117, Lysozymes and TDT, and moderately positive for CD34, CD99, CD43 and CD6 And patchy for CD68. Ki67 showed 60% proliferation index. They were negative for the remaining markers. This suggested acute myeloid leukemia (AML). Conclusion: In summary, we present a rare case of TB with AML that resolved after treatment of TB with ATT but relapsed later as leukemia cutis. While skin involvement might occur as a secondary manifestation of AML, Skin relapse could be the only one.

Keywords: Leukemia cutis, Leukemia relapse, Acute Myeloid Leukemia, spontaneous resolution of AML

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Authors: Mulusew G. Jebena, David Lindstrom, Tefera Belachew, Craig Hadley, Carl Lachat, Patrick Kolsteren

Abstract:

Background: The biological and psychosocial consequence of food insecurity on physical health and nutritional status has been reported. But, its effect on mental health during adolescence remains unexplored. Thus, the main aim of this analysis is to examine the mechanism by which food insecurity is linked to mental health among adolescents living in Jimma, Southwest Ethiopia. Methods: We used data from third round observation of Jimma Longitudinal Family and Youth Survey (JLFSY). A total of 1,521 adolescents included for the main analysis. Food insecurity was measured using 5-items scale and The Self Reporting Questionnaire (SRQ-20) was used to measure mental distress. Structural equation modeling analysis was done using maximum likelihood estimation method. Model diagnostics test was reported. All p values were two tailed and P value ≤ 0.05 was used to determine statistical significance. Results: The prevalence of mental distress was 20.8%, 95% CI: (18.8, 22.9). After adjusted for covariates, the final model depicts food insecurity was associated with adolescent mental distress (β=.324). This analysis showed 94.1% of the effect of food insecurity on mental distress is direct. By contrast, 5.9% of the food insecurity effect is mediated by physical health. In addition, Self-rated health (β=.356), socioeconomic status (β=-.078) parental educational (β= .170), living in urban (β= .193) and female headed household (β=.205) were associated with adolescent mental distress. Conclusions: This finding highlights the direct effect of food insecurity on adolescent mental distress. Therefore, any intervention aimed to improve mental distress of adolescents should consider strategies to improve access to sufficient, safe, and nutritious food. Beside this, prevention of underlying factors such as psychosomatic health illness and improving socio economic status is also very critical. Furthermore longitudinal relationship of the long term effect of food insecurity on mental health should be investigated.

Keywords: adolescent, Ethiopia, food insecurity, mental health

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Authors: Merilin Ivanova Ivanova, Kalin Dimitrov Atanasov, Stefan Petrov Enchev

Abstract:

Backgroud: Neuromyelitis optica spectrum disorder, also known as Devic’s disease, is a relapsing demyelinating autoimmune inflammatory disorder of the central nervous system associated with anti-aquaporin 4 (AQP4) antibodies that can manifest with devastating secondary neurological deficits. Most commonly affected are the optic nerves and the spinal cord-clinically this is often presented with optic neuritis (loss of vision), transverse myelitis(weakness or paralysis of extremities),lack of bladder and bowel control, numbness. APS is a core clinical entity of NMOSD and adds to the clinical representation the following symptoms: intractable nausea, vomiting and hiccup, it usually occurs isolated at onset, and can lead to a significant delay in the diagnosis. The condition may have features similar to multiple sclerosis (MS) but the episodes are worse in NMO and it is treated differently. It could be relapsing or monophasic. Possible complications are visual field defects and motor impairment, with potential blindness and irreversible motor deficits. In severe cases, myogenic respiratory failure ensues. The incidence of reported cases is approximately 0.3–4.4 per 100,000. Paediatric cases of NMOSD are rare but have been reported occasionally, comprising less than 5% of the reported cases. Objective: The case serves to show the difficulty when it comes to the diagnostic processes regarding a rare autoimmune disease with non- specific symptoms, taking large interval of rimes to reveal as complete clinical manifestation of the aforementioned syndrome, as well as the necessity of multidisciplinary approach in the setting of а general paediatric department in аn emergency hospital. Methods: itpatient's history, clinical presentation, and information from the used diagnostic tools(MRI with contrast of the central nervous system) lead us to the conclusion .This was later on confirmed by the positive results from the anti-aquaporin 4 (AQP4) antibody serology test. Conclusion: APS is a common symptom of NMOSD and is considered a challenge in a differential-diagnostic plan. Gaining an increased awareness of this disease/syndrome, obtaining a detailed patient history, and performing thorough physical examinations are essential if we are to reduce and avoid misdiagnosis.

Keywords: neuromyelitis, devic's disease, hiccup, autoimmune, MRI

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Authors: Saghar Karimi, Mohammad Saeed Ahrari Khafi, Amin Abolhasani Foroughi

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In recent decades, keeping exotic species as pet animals has become widespread. Turtles are exotic species from chelonians, which are interested by many people. Caspian pond and European pond turtles from Emydidea family are commonly kept as pets in Iran. Presence of the shell in turtles makes achievement to a comprehensive clinical examination impossible. Respiratory system is one of the most important structures to be examined completely. Presence of the air in the respiratory system makes radiography the first modality to think of; however, image quality would be affected by the shell. Computed tomography (CT) as a radiography-based and non-invasive technique provides cross-sectional scans with little superimposition. The aim of this study was to depict normal computed tomographic anatomy of the respiratory system in Caspian Pond Turtle. Five adult Caspian pond turtle were scanned using a 16-detector CT machine. Our results showed that computed tomography is able to well illustrated different parts of respiratory system in turtle and can be used for detecting abnormalities and disorders.

Keywords: anatomy, computed tomography, respiratory system, turtle

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Authors: Srikanta Tagore Sarkar, Prasanta Kumar Mandal, Dibakar Roy

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The association of a capitate fracture with a scaphoid fracture has been termed as the naviculocapitate syndrome. The existence of some nondisplaced fractures of scaphoid and capitate with or without the fracture of lunate or radius suggests that there is a spectrum of these injuries, and this confuses the terminology. With our case; we report an unusual variety of this naviculocapitate syndrome with distal radial Colles fracture in addition to the nondisplaced fractures of the scaphoid, capitate and the dorsal lip of radial fracture. When we looked at the literature there is no another Colles fracture reported together with undisplaced scapho-capitate syndrome. The coronal and sagittal images that obtained from the MDCT (Multidetector computed tomography) is useful and effective imaging modality to diagnose complex wrist fractures with more details that are not detected in X-rays.

Keywords: scaphoid, capitate, Colles’ fracture, syndrome, MDCT, unusual

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Authors: Javiera Espinosa, Patricia López, Noelia Santos, Nadia Loro, Esther Moraleda

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In recent years, there has been a notable increase in the number of investigations that establish that Down Syndrome and Autism Spectrum Disorder are diagnoses that can coexist together. However, there are also many studies that consider that both diagnoses present neuropsychological, linguistic and adaptive characteristics with a totally different profile. The objective of this research is to question whether there really can be a profile that encompasses both disorders or if they can be incompatible with each other. To this end, a review of the scientific literature of recent years has been carried out. The results indicate that the two lines collect opposite approaches. On the one hand, there is research that supports the increase in comorbidity between Down Syndrome and Autism Spectrum Disorder, and on the other hand, many investigations show a totally different general development profile between the two. The discussion focuses on discussing both lines of work and on proposing future lines of research in this regard.

Keywords: disability, language, speech, down syndrome

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Authors: Sudha Puhal, Dr Rajmala Jaiswal

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Retropharyngeal abscess occurs most commonly in children following acute upper respiratory tract and ear infection. Airway management in retropharyngeal abscess is an anesthetic challenge due to distortion of airway anatomy and the possibility of spontaneous rupture of abscess leading to aspiration or stridor due to laryngeal edema.. In this report we present a case of retropharyngeal abscess in a child, which was drained under general anaesthesia successfully without any complications.

Keywords: abscess, airway, difficult, retropharyngeal

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Authors: S. Alireza Mirghasemi, Elly Trepman, Mohammad Saleh Sadeghi, Narges Rahimi Gabaran, Shervin Rashidinia

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Bone marrow edema syndrome (BMES) is an uncommon and self-limited syndrome characterized by atraumatic extremity pain with unknown of etiology. Symptom onset may include sudden or gradual swelling and pain at rest or during activity, usually at night. This syndrome mostly affects middle-aged men and younger women who have pain in the lower extremities. The most common sites involved with BMES, in decreasing order of frequency, are the bones about the hip, knee, ankle, and foot. The diagnosis of BMES is made with magnetic resonance imaging to exclude other causes of bone marrow edema. The correct diagnosis often is delayed because of the low prevalence and nonspecific signs in the foot and ankle. This delay may intensify bone pain and impair patient function and quality of life. The goal of BMES treatment is to relieve pain and shorten disease duration. Treatment options are limited and may include symptomatic treatment, pharmacologic treatment, and surgery.

Keywords: transient osteoporosis, bone marrow edema syndrome, iloprost, bisphosphonates

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