Search results for: uterine electromyography

Authors: Engi E. I. Sarhan, Usama M. Rashad, Ibrahim M. I. Hamoda, Mohammed K. Mohamed

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Background: This study aimed to know the effect of nitrogen-based cryotherapy on the spasticity of calf muscle in stroke patients. Patients were selected from the outpatient clinic of Neurology, Al-Mansoura general hospital, Al-Mansoura University. Subjects and methods: Thirty Stroke Patients of both sexes ranged from 45 to 60 years old were divided randomly into two equal groups, a study group (A) received a nitrogen-based cryotherapy, a selective physical therapy program and ankle foot orthosis (AFO), while as patients in control group (B) received the same program and AFO only. The treatment duration was three times per week for four weeks for both groups. We assessed spasticity of calf muscle before and after treatment subjectively using modified Ashworth scale (MAS) and objectively via measuring H / M ratio on electromyography machine. We also assessed ankle dorsiflexion ROM objectively using two dimensions motion analysis (2D). Results: After treatment, there was a highly significant improvement in the study group compared to the control group regarding the score of MAS, no significant difference in the study group compared to the control group regarding the readings of H / M ratio, highly significant improvement in the study group compared to the control group regarding the 2D motion analysis findings. Conclusion: This modality considers effective in reducing spasticity in the calf muscle and improving ankle dorsiflexion of the affected limb.

Keywords: ankle foot orthosis, nitrogen-based cryotherapy, stroke, spasticity

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Authors: Gregory Chown, Benjamin Infantolino, Christopher Wise, Rachel Holmes, Samantha O'Donnell, Katelyn Pfeiffer, Victoria Ward

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Background: There is a lack of understanding of how Kinesio Tape® physiologically works. Furthermore, few studies compare Kinesio Tape® to other forms of taping. The research question is: Does Kinesio Tape® cause a difference in muscle facilitation, inhibition, and pain, between Kinesio Tape® and no tape for collegiate athletes with self-reported shoulder pain? Method: This quantitative non-randomized design used a convenience sampling method. There were eleven participants with self-reported shoulder pain who were athletes on the men’s and women’s lacrosse and tennis teams. Participants attended one 30-45 minute session for data collection. Each participant received all three taping conditions and performed four repetitions of 120 degrees of active shoulder flexion for the three separate trials (no tape, Kinesio Tape® inhibition, and Kinesio Tape® facilitation). Surface electromyography (sEMG) electrodes were placed on the anterior deltoid, supraspinatus, and lower trapezius to measure muscle facilitation and inhibition. Each participant completed the visual analogue scale (VAS) before and after each trial to measure pain. Results: No statistical significance was found for pain scores on the VAS between the taping methods of facilitation, inhibition, and no tape (p = .118). No statistical significance was found for the percentage of change in muscle function for each taping method; Anterior deltoid (p = .993), supraspinatus (p = .997) and lower trapezius (p = .922). Conclusion: Based on the results, Kinesio Tape® appears to not have an effect on muscle function or pain when utilizing the facilitation or inhibition taping method when compared to no tape.

Keywords: Kinesio tape, muscle facilitation, muscle inhibition, pain

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Authors: Oyebade K. Oyedotun

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The cardiotocogram is a technical recording of the heartbeat rate and uterine contractions of a fetus during pregnancy. During pregnancy, several complications can occur to both the mother and the fetus; hence it is very crucial that medical experts are able to find technical means to check the healthiness of the mother and especially the fetus. It is very important that the fetus develops as expected in stages during the pregnancy period; however, the task of monitoring the health status of the fetus is not that which is easily achieved as the fetus is not wholly physically available to medical experts for inspection. Hence, doctors have to resort to some other tests that can give an indication of the status of the fetus. One of such diagnostic test is to obtain cardiotocograms of the fetus. From the analysis of the cardiotocograms, medical experts can determine the status of the fetus, and therefore necessary medical interventions. Generally, medical experts classify examined cardiotocograms into ‘normal’, ‘suspect’, or ‘pathological’. This work presents an artificial neural network based decision support system which can filter cardiotocograms data, producing the corresponding statuses of the fetuses. The capability of artificial neural network to explore the cardiotocogram data and learn features that distinguish one class from the others has been exploited in this research. In this research, feedforward and radial basis neural networks were trained on a publicly available database to classify the processed cardiotocogram data into one of the three classes: ‘normal’, ‘suspect’, or ‘pathological’. Classification accuracies of 87.8% and 89.2% were achieved during the test phase of the trained network for the feedforward and radial basis neural networks respectively. It is the hope that while the system described in this work may not be a complete replacement for a medical expert in fetus status evaluation, it can significantly reinforce the confidence in medical diagnosis reached by experts.

Keywords: decision support, cardiotocogram, classification, neural networks

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Authors: Surabhi Agrawal Kohli, Sunita Gupta, Esha Khanuja, Parul Garg, P. Gupta

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Background: Adenomyosis is a common gynaecological condition that affects the menstruating women. Uterine enlargement, dysmenorrhoea, and menorrhagia are regarded as the cardinal clinical symptoms of adenomyosis. Classically it was thought, compared with ultrasonography, when adenomyosis is suspected, MRI enables more accurate diagnosis of the disease. Materials and Methods: 172 subjects were enrolled after an informed consent that had complaints of HMB, dyspareunia, dysmenorrhea, and chronic pelvic pain. Detailed history of the enrolled subjects was taken, followed by a clinical examination. These patients were then subjected to TVS where myometrial echo texture, presence of myometrial cysts, blurring of endomyometrial junction was noted. MRI was followed which noted the presence of junctional zone thickness and myometrial cysts. After hysterectomy, histopathological diagnosis was obtained. Results: 78 participants were analysed. The mean age was 44.2 years. 43.5% had parity of 4 or more. heavy menstrual bleeding (HMB) was present in 97.8% and dysmenorrhea in 93.48 % of HPE positive patient. Transvaginal sonography (TVS) and MRI had a sensitivity of 89.13% and 80.43%, specificity of 90.62% and 84.37%, positive likelihood ratio of 9.51 and 5.15, negative likelihood ratio of 0.12 and 0.23, positive predictive value of 93.18% and 88.1%, negative predictive value of 85.29% and 75% and a diagnostic accuracy of 89.74% and 82.5%. Comparison of sensitivity (p=0.289) and specificity (p=0.625) showed no statistically significant difference between TVS and MRI. Conclusion: Prevalence of 30.23%. HMB with dysmenorrhoea and chronic pelvic pain helps in diagnosis. TVS (Endomyometrial junction blurring) is both sensitive and specific in diagnosing adenomyosis without need for additional diagnostic tool. Both TVS and MRI are equally efficient, however because of certain additional advantages of TVS over MRI, it may be used as the first choice of imaging. MRI may be used additionally in difficult cases as well as in patients with existing co-pathologies.

Keywords: adenomyosis, heavy menstrual bleeding, MRI, TVS

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Authors: A-Reum Shin, Heon-Seock Cynn, Ji-Hyun Lee, Da-Eun Kim

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Round shoulder posture (RSP) is a position of scapular protraction and elevation, which may appear as scapular winging, and humeral internal rotation. Flexed posture (FP) may also affect RSP because FP is characterized by hyperkyphosis, forward head posture, and height reduction. The aim of this study was to investigate the effect of scapular posterior tilting exercise with prone trunk extension on round shoulder posture, activities of lower trapezius and serratus anterior, flexed posture, and thoracic erector spinae activity in subjects with round shoulder posture. Fifteen subjects with round shoulder posture were recruited in this study. Activities of lower trapezius, serratus anterior and thoracic erector spinae were measured during both scapular posterior tilting exercise and scapular posterior tilting exercise with prone trunk extension using electromyography, and round shoulder posture and flexed posture were measured immediately after each exercises using caliper. When the prone trunk extension was applied, the round shoulder posture and flexed posture significantly decreased, activities of lower trapezius and thoracic erector spinae significantly increased (p < 0.05) compared with the scapular posterior tilting exercise alone. There was no significant difference in serratus anterior activity between two exercises. Thus, prone trunk extension could be effective method to improve round shoulder posture during scapular posterior tilting exercise in subjects with round shoulder posture.

Keywords: flexed posture, prone trunk extension, round shoulder posture, scapular posterior tilting

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Authors: Zong Yan Cai, Wen-Chyuan Chen, Chih-Min Wu

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The purpose of this study was to investigate the acute effects of local vibration on muscle activation, metabolic and hormone responses. Totally 12 healthy, physically inactive, male adults participated in this study and completed LV exercise session. During LV exercise session, four custom-made vibrations (diameter: 20 mm; thickness: 8 mm; weight: 0.022 g) were locally placed over the belly of the thigh of each subject’s non-dominant leg in supine lying position, and subjects received 10 sets for 1 min at the frequency of 35-40Hz, with 1–2 min of rest between sets. The surface electromyography (EMG) were obtained from the vastus medialis and rectus femoris, and the subjects’ rating of perceived exertion (RPE) and heart rate (HR) were measured. EMG data, RPE values as well as HR were obtained by averaging the results of 10 sets of each exercise session. Blood samples were drawn before exercise, immediately after exercise, and 15min and 30min after exercise in each session for analysis of lactic acid (LA), growth hormone (GH), testosterone (T) and cortisol (C). The results indicated that the HR did not increase after LV (63.18±3.5 to 63.25±2.58 beat/min, p > 0.05). The average RPE values during the LV exposure were at 2.86±0.39. The root mean square % EMG values from the vastus medialis and rectus femoris were 19.02±2.19 and 8.25±2.20 respectively. There were no significant differences after acute LV exercise among LA, GH and T values as compared with baseline values (LA: 0.68±0.11 to 0.7±0.1 mmol/L; GH: 0.06±0.05 to 0.57±0.27 ng/mL; T: 551.33±46.62 to 520.42±43.78 ng/dL, p>0.05). However, the LV treatment caused a significant decrease in C values after exercise (16.56±1.05 to 11.64±1.85 nmol/L, p<0.05). In conclusion, acute LV exercise only slightly increase muscle activation which may not cause effective exercise response. However, acute LV exercise reduces C level, which may reduce the catabolic response. The probable reason might partly due to the vibration rhythmically which massage on muscles.

Keywords: cortisol, growth hormone, lactic acid, testosterone

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Authors: Luna Sequier, Florian Forelli, Maude Traulle, Amaury Vandebrouck, Pascal Duffiet, Louis Ratte, Jean Mazeas

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The study's objective is to compare the muscular activity of the flexor knee muscle in patients who underwent an anterior cruciate ligament reconstruction with hamstring autograft and the individuals who have not undergone surgery. Methods: The participants were divided into two groups: a healthy group and an experimental group who had undergone an anterior cruciate ligament reconstruction with a hamstring graft. All participants had to perform a knee flexion strength test on an isokinetic dynamometer. The medial Gastrocnemius, lateral Gastrocnemius, Biceps femoris, and medial Hamstring muscle activity were measured during this test. Each group’s mean muscle activity was tested with statistical analysis, and a muscle activity ratio of gastrocnemius and hamstring muscles was calculated Results: The results showed a significant difference in activity of the medial gastrocnemius (p = 0,004901), the biceps femoris (p = 5,394.10-6), and the semitendinosus muscles (p = 1,822.10-6), with a higher Biceps femoris and Semitendinosus activity for the experimental group. It is however noticeable that inter-subject differences were important. Conclusion: This study has shown a difference in the gastrocnemius and hamstring muscle activity between patients who underwent an anterior cruciate ligament reconstruction surgery and healthy participants. With further results, this could show a modification of muscle activity patterns after surgery which could lead to compensatory behaviors at a return to sport and eventually explain a higher injury risk for our patients.

Keywords: anterior cruciate ligament, electromyography, muscle activity, physiotherapy

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Authors: Hana Aljumayi, Mohammed Issa

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The aim of this study was to investigate the effect of the training program for professional athletes at the Saudi Archery Federation on the electrical activity of the muscles involved in pulling the bowstring, maximum muscle strength (MVC) and to identify the relationship between the electrical activity of these muscles and accuracy in shooting among female archers. The researcher used a descriptive approach that was suitable for the nature of the study, and a sample of nine female archers was selected using purposive sampling. An EMG device was used to measure signal amplitude, signal frequency, spectral energy signal, and MVC. The results showed statistically significant differences in signal amplitude among muscles, with F(8,1)=5.91 and a significance level of 0.02. There were also statistically significant differences between muscles in terms of signal frequency, with F(8,1)=8.23 and a significance level of 0.02. Bonferroni test results indicated statistically significant differences between measurements at a significance level of 0.05, with anterior measurements showing an average difference of 16.4 compared to other measurements. Furthermore, there was a significant negative correlation between signal amplitude in the calf muscle and accuracy in shooting (r=-0.78) at a significance level of 0.02. There was also a significant positive correlation between signal frequency in the calf muscle and accuracy in shooting (r=0.72) at a significance level of 0.04. In conclusion, it appears that the training program for archery athletes focused more on skill development than physical aspects such as muscle activity and strength development. However, it did have a statistically significant effect on signal amplitude but not on signal frequency or MVC development in muscles involved in pulling the bowstring.

Keywords: electrical activity of muscles, archery sport, shooting accuracy, muscles

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Authors: Joanna Maj

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Body machine interfaces (BMIs) afford users a non-invasive way coordinate movement. Vibrotactile stimulation has been incorporated into BMIs to allow feedback in real-time and guide movement control to benefit patients with cognitive deficits, such as stroke survivors. To advance research in this area, we examined vibrational discrimination thresholds at four body locations to determine suitable application sites for future multi-channel BMIs using vibration cues to guide movement planning and control. Twelve healthy adults had a pair of small vibrators (tactors) affixed to the skin at each location: forearm, shoulders, torso, and knee. A "standard" stimulus (186 Hz; 750 ms) and "probe" stimuli (11 levels ranging from 100 Hz to 235 Hz; 750 ms) were delivered. Probe and test stimulus pairs could occur sequentially or simultaneously (timing). Participants verbally indicated which stimulus felt more intense. Stimulus order was counterbalanced across tactors and body locations. Probabilities that probe stimuli felt more intense than the standard stimulus were computed and fit with a cumulative Gaussian function; the discrimination threshold was defined as one standard deviation of the underlying distribution. Threshold magnitudes depended on stimulus timing and location. Discrimination thresholds were better for stimuli applied sequentially vs. simultaneously at the torso as well as the knee. Thresholds were small (better) and relatively insensitive to timing differences for vibrations applied at the shoulder. BMI applications requiring multiple channels of simultaneous vibrotactile stimulation should therefore consider the shoulder as a deployment site for a vibrotactile BMI interface.

Keywords: electromyography, electromyogram, neuromuscular disorders, biomedical instrumentation, controls engineering

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Authors: Ena Arora, Rong Fan, Aleksandr Fuks, Kolawole Felix Akinnawonu

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Introduction: Leiomyomas are benign tumors that are derived from the overgrowth of uterine smooth muscle cells. Women with symptomatic leiomyomas who desire future fertility, myomectomy should be the standard surgical treatment. Perioperative hemorrhage is a common complication in myomectomy. We performed the study to investigate blood transfusion rate in abdominal myomectomies, risk factors influencing blood loss and modalities to improve perioperative blood loss. Methods: Retrospective chart review was done for patients who underwent myomectomy from 2016 to 2022 at Queens hospital center, New York. We looked at preoperative patient demographics, clinical characteristics, intraoperative variables, and postoperative outcomes. Mann-Whitney U test were used for parametric and non-parametric continuous variable comparisons, respectively. Results: A total of 159 myomectomies were performed between 2016 and 2022, including 1 laparoscopic, 65 vaginal and 93 abdominal. 44 patients received blood transfusion during or within 72 hours of abdominal myomectomy. The blood transfusion rate was 47.3%. Blood transfusion rate was found to be twice higher than the average documented rate in literature which is 20%. Risk factors identified were black race, preoperative hematocrit<30%, preoperative blood transfusion within 72 hours, large fibroid burden, prolonged surgical time, and abdominal approach. Conclusion: Preoperative optimization with iron supplements or GnRH agonists is important for patients undergoing myomectomy. Interventions to decrease intra operative blood loss should include cell saver, tourniquet, vasopressin, misoprostol, tranexamic acid and gelatin-thrombin matrix hemostatic sealant.

Keywords: myomectomy, perioperative blood loss, cell saver, tranexamic acid

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Authors: A. M. Bumbea, A. Musetescu, P. Ciurea, A. Bighea

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Objectives: The authors present a Parsonage Turner syndrome, a rare disease characterized by onset in apparently healthy person with shoulder and/or arm pain, sensory deficit, motor deficit. The causes are not established, could be determinate by vaccination, postoperative, immunologic disease, post traumatic etc. Methods: The authors present a woman case, 32 years old, (in 2006), no medical history, with arm pain and no other symptom. The onset was sudden with pain at very high level quantified as 10 to a 0 to 10 scale, with no response to classical analgesic and corticoids. The only drugs which can reduce the intensity of pain were oxycodone hydrochloride, 60 mg daily and pregabalinum150 mg daily. After two weeks the intensity of pain was reduced to 5. The patient started a rehabilitation program. After 6 weeks the patient associated sensory and motor deficit. We performed electromyography for upper limb that showed incomplete denervation with reduced neural transmission speed. The patient receives neurotrophic drugs and painkillers for a long period and physical and kinetic therapy. After 6 months the pain was reduced to level 2 and the patient maintained only 150 mg pregabalinum for another 6 months. Then, the evaluation showed no pain but general amiotrophy in upper limb. Results: At the evaluation in 2009, the patient developed a rheumatoid syndrome with tender and swelling joints, but no positive inflammation test, no antibodies or rheumatoid factor. After two years, in 2011 the patient develops an increase of antinuclear antibodies. This context certifies the diagnosis of lupus and the patient receives the specific therapy. Conclusions: This case is not a typical case of onset of lupus with PTS, but the onset of PTS could include the onset of an immune disease.

Keywords: lupus, arm pain, patient, swelling

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Authors: Nassima Elyebdri, Asma Boumediou, Soumia Addoun

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Traditional medicine has been part of the Algerian culture for decades. In particular, the city of Tlemcen still retains practices based on phytotherapy to the present day, as this kind of medicine fulfills the needs of its followers among the local population. The toxic plants contain diverse natural substances which supplied a lot of medicine in the pharmaceutical industry. In order to explore new medicinal sources among toxic plants, an ethnobotanical study was carried out on the use of these plants by the population, at Emir Abdelkader Square of the city of Tlemcen, a rather busy place with a high number of traditional health practitioners and herbalists. This is a descriptive and transversal study aimed at estimating the frequency of using toxic plants among the studied population, for a period of 4 months. The information was collected, using self-anonymous questionnaires, and analyzed by the IBM SPSS Statistics software used for statistical analysis. A sample of 200 people, including 120 women and 80 men, were interviewed. The mean age was 41 ± 16 years. Among those questioned, 83.5% used plants; 8% of them used toxic plants and 35% used plants that can be toxic under certain conditions. Some improvements were observed in 88% of the cases where toxic plants were used. 80 medicinal plants, belonging to 36 botanical families, were listed, identified and classified. The most frequent indications for these plants were for respiratory diseases in 64.7% of cases, and for digestive disorders in 51.5% of cases. 11% of these plants are toxic, 26% could be toxic under certain conditions. Among toxics plants, the most common ones are Berberis vulgaris with 5.4%, indicated in the treatment of uterine fibroids and thyroid, Rhamnus alaternus with 4.8% for hepatic jaundice, Nerium oleander with 3% for hemorrhoids, Ruta chalepensis with 1.2%, indicated for digestive disorders and dysmenorrhea, and Viscum album with 1.2%, indicated for respiratory diseases. The most common plants that could be toxic are Mentha pulegium (15.6%), Eucalyptus globulus (11.4%), and Pimpinella anisum (10.2%). This study revealed interesting results on the use of toxic plants, which are likely to serve as a basis for further ethno-pharmacological investigations in order to get new drug sources.

Keywords: ethnobotany, phytotherapy, Tlemcen, toxic plants

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Authors: Engida Yisma, Berhanu Dessalegn, Ayalew Astatkie, Nebreed Fesseha

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Background: The World Health Organization (WHO) recommends using the partograph to follow labour and delivery, with the objective to improve health care and reduce maternal and foetal morbidity and death. Methods: A retrospective document review was undertaken to assess the completion of the modified WHO partograph during labour in public health institutions of Addis Ababa, Ethiopia. A total of 420 of the modified WHO partographs used to monitor mothers in labour from five public health institutions that provide maternity care were reviewed. A structured checklist was used to gather the required data. The collected data were analyzed using SPSS version 16.0. Frequency distributions, cross-tabulations and a graph were used to describe the results of the study. Results: All facilities were using the modified WHO partograph. The correct completion of the partograph was very low. From 420 partographs reviewed across all the five health facilities, foetal heart rate was recorded into the recommended standard in 129(30.7%) of the partographs, while 138 (32.9%) of cervical dilatation and 87 (20.70%) of uterine contractions were recorded to the recommended standard. The study did not document descent of the presenting part in 353 (84%). Moulding in 364 (86.7%) of the partographs reviewed was not recorded. Documentation of state of the liquor was 113(26.9%), while the maternal blood pressure was recorded to standard only in 78(18.6%) of the partographs reviewed. Conclusions: This study showed a poor completion of the modified WHO partographs during labour in public health institutions of Addis Ababa, Ethiopia. The findings may reflect poor management of labour and indicate the need for pre-service and periodic on-job training of health workers on the proper completion of the partograph. Regular supportive supervision, provision of guidelines and mandatory health facility policy are also needed in support of a collaborative effort to reduce maternal and perinatal deaths.

Keywords: modified WHO partograph, completion, public health institutions, Addis Ababa, Ethiopia

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Authors: Murat Emre, Zeynep Tufekcioglu

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Objective: We describe a patient with late onset phenylketonuria which presented with rapidly progressive dementia and parkinsonism that were reversible after management. Background: Phenylketonuria is an autosomal recessive disorder due to mutations in the phenylalanine hydroxlase gene. It normally presents in childhood, in rare cases, however, it may have its onset in adulthood and may mimic other neurological disorders. Case description: A previously normal functioning, 59 year old man was admitted for blurred vision, cognitive impairment and gait difficulty which emerged over the past eight months. In neurological examination he had brisk reflexes, slow gait and left-dominant parkinsonism. Mini-mental state examination score was 25/30, neuropsychological testing revealed a dysexecutive syndrome with constructional apraxia and simultanagnosia. In cranial MRI there were bilateral diffuse hyper-intense lesions in parietal and occipital white matter with no significant atrophy. Electroencephalography showed diffuse slowing with predominance of teta waves. In cerebrospinal fluid examination protein level was slightly elevated (61mg/dL), oligoclonal bands were negative. Electromyography was normal. Routine laboratory examinations for rapidly progressive dementia and parkinsonism were also normal. Serum amino acid levels were determined to explore metabolic leukodystrophies and phenylalanine level was found to be highly elevated (1075 µmol/L) with normal tyrosine (61,20 µmol/L). His cognitive impairment and parkinsonian symptoms improved following three months of phenylalanine restricted diet. Conclusions: Late onset phenylketonuria is a rare, potentially reversible cause of rapidly progressive parkinsonism with dementia. It should be considered in the differential diagnosis of patients with suspicious features.

Keywords: dementia, neurology, Phenylketonuria, rapidly progressive parkinsonism

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Authors: Kiknadze T, Tevdorashvili G, Muzashvili T, Gachechiladze M, Burkadze G

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Uterine leiomyomas decrease the quality of life by causing significant morbidity among women of reproductive age. Histologically various types of leiomyoma's can be differentiated. We have analysed th histopathological, proliferation, apoptotic, and hormonal profile in different types of leiomyomas. Study included altogether140 cases distributed into the following groups: group I-normal myometrium (20cases), group II-classic leiomyoma (69 cases), group III-cellular leiomyoma (15 cases), group IV-bizarre cell/atypical leiomyoma (22cases), group V-smooth muscle tumors of uncertain malignancy potential (STUMP) (8 cases) and group VI-leiomyosarcoma (6 cases). Together with classic histopathological features such as nuclear atypia, cellularity, presence of mitoses, vasculature and necrosis, immunohistochemical phenotype using antibodies against Ki67,Cas3, ER, and PR were analysed. The results of our study showed that leiomyomas are charterised with variable histopathological and immunohistocthemical phenotype. Histopathological parameters mainly correlate with the degree of malignancy except for two bizarre/atypical leiomyoma and STUMP, where two distinct subgroups could be identified. In bizarre/ atipycal leiomyoma, 31% of cases are characterized with the features of classic leiomyoma, whilst the rest of the cases reveal more atipycal phenotype. In STUMP 37.5 % of cases are characterized with the features of atipycal leiomyomas. The result of the immunohistochemical study also reveald that half of bizarre/atipycal leiomyomas are characterized with the low proliferation index, high apoptotic index, and high ER and PR index, whilst another half is characterized with high proliferation index, low apoptotic index, and low ER and PR index. Similarly, part of the STUMP cases are characterized with low proliferation index, high Er, and PR index and whilst part of the cases are characterized whith high proliferation index, low apoptotic index and low ER and PR index. The results of the histopathological and immunohistochemical study indicate that these two entities represent the heterogenous group of diseases, which might be the explanation of their different prognosis. Presented histopathological and immunohistochemical features should be considered in the diagnosis of myometrial smooth muscle tumors.

Keywords: proliferation, apoptosis, bizarre cell, leiomyosarcoma., leiomyoma

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Authors: Dalia Bhattacharjee

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Motherhood as an institution is considered as sacred. Reproduction and motherhood have always been a concern of the private space of home. However, with the emergence of technologies like the Assisted Reproductive Technologies (ARTs), this intimate area has moved into the public. A woman can now become a mother with artificial insemination done by expert medical professionals in a hospital. With this development, the meanings of motherhood and childrearing have altered. Mothers have been divided into ‘ovarian mothers’ (those who provide the eggs), ‘uterine mothers’ (those who carry out the pregnancy and give birth), and ‘social mothers’ (those who raise the child). Thus, the ART business deconstructs motherhood by defining who the biological mother is and who the social mother is and who – despite contributing parts or processes of her body to the life of the child is not a mother, but merely the donor of a product, be it the egg or the womb, which is owned by those who are favoured by the contract. The industry of commercial surrogacy in India has been estimated to be of $2.3 billion as of 2012. There are many women who work as surrogate mothers in this industry for the exchange of money. It runs like a full-fledged business guided by a highly profit oriented capitalist market. The reproductive labourers are identified as mere womb renters or victims and not as active agents in such arrangements. Such a discourse undercuts the agency exercised by the women. The present study is an ethnography into the commercial surrogacy industry in India. This journey furthers the understanding of the dilemmas faced by the reproductive labourers. The paper emphasizes on the experiences of reproduction and motherhood outside the private space of the home in the commercial surrogacy industry in India, and, argues that this multiplicity of experiences need much focus and attention, where, the consumer becomes ‘the’ citizen and the women workers continue to be victims. The study draws on the narratives of the reproductive labourers, who remain at the center, and yet, at the periphery of such arrangements. This feminist ethnography is informed by the feminist standpoint theory to account for and analyse these varied experiences which further the understanding of the dilemmas faced by the reproductive labourers.

Keywords: commercial surrogacy, ethnography, motherhood, standpoint theory

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Authors: F. Saleh, F. Lyall, A. Abdulsid, L. Marks

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Background: Labour in human is a complex biological process that involves interactions of neurological, hormonal and inflammatory pathways, with the placenta being a key regulator of these pathways. It is known that uterine contractions and labour pain cause physiological changes in gene expression in maternal and fetal blood, and in placenta during labour. Oxidative and inflammatory stress pathways are implicated in labour and they may cause alteration of placental gene expression. Additionally, in placental tissues, labour increases the expression of genes involved in placental oxidative stress, inflammatory cytokines, angiogenic regulators and apoptosis. Recently, Hydrogen Sulphide (H2S) has been considered as an endogenous gaseous mediator which promotes vasodilation and exhibits cytoprotective anti-inflammatory properties. The endogenous H2S is synthesised predominantly by two enzymes: cystathionine β-synthase (CBS) and cystathionine γ-lyase (CSE). As the H2S pathway has anti-oxidative and anti-inflammatory characteristics thus, we hypothesised that the expression of CBS and CSE in placental tissues would alter during labour. Methods: CBS and CSE expressions were examined in placentas using western blotting and RT-PCR in inner, middle and outer placental zones in placentas obtained from healthy non labouring women who delivered by caesarian section. These were compared with the equivalent zone of placentas obtained from women who had uncomplicated labour and delivered vaginally. Results: No differences in CBS and CSE mRNA or protein levels were found between the different sites within placentas in either the labour or non-labour group. There were no significant differences in either CBS or CSE expression between the two groups at the inner site and middle site. However, at the outer site there was a highly significant decrease in CBS protein expression in the labour group when compared to the non-labour group (p = 0.002). Conclusion: To the best of author’s knowledge, this is the first report to suggest that, CBS is expressed in a spatial manner within the human placenta. Further work is needed to clarify the precise function and mechanism of this spatial regulation although it is likely that inflammatory pathways regulation is a complex process in which this plays a role.

Keywords: anti-inflammatory, hydrogen sulphide, labour, oxidative stress

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Authors: Norman Sinnigen, Igor Izyurov, Marina Krylova, Hamidreza Jamalabadi, Sarah Alizadeh, Martin Walter

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Background: EEG is a non-invasive brain activity recording technique with a high temporal resolution that allows the use of real-time applications, such as neurofeedback. However, EEG data are susceptible to electrooculographic (EOG) and electromyography (EMG) artifacts (i.e., jaw clenching, teeth squeezing and forehead movements). Due to their non-stationary nature, these artifacts greatly obscure the information and power spectrum of EEG signals. Many EEG artifact correction methods are too time-consuming when applied to low-density EEG and have been focusing on offline processing or handling one single type of EEG artifact. A software-only real-time method for correcting multiple types of EEG artifacts of high-density EEG remains a significant challenge. Methods: We demonstrate an improved approach for automatic real-time EEG artifact correction of EOG and EMG artifacts. The method was tested on three healthy subjects using 64 EEG channels (Brain Products GmbH) and a sampling rate of 1,000 Hz. Captured EEG signals were imported in MATLAB with the lab streaming layer interface allowing buffering of EEG data. EMG artifacts were detected by channel variance and adaptive thresholding and corrected by using channel interpolation. Real-time independent component analysis (ICA) was applied for correcting EOG artifacts. Results: Our results demonstrate that the algorithm effectively reduces EMG artifacts, such as jaw clenching, teeth squeezing and forehead movements, and EOG artifacts (horizontal and vertical eye movements) of high-density EEG while preserving brain neuronal activity information. The average computation time of EOG and EMG artifact correction for 80 s (80,000 data points) 64-channel data is 300 – 700 ms depending on the convergence of ICA and the type and intensity of the artifact. Conclusion: An automatic EEG artifact correction algorithm based on channel variance, adaptive thresholding, and ICA improves high-density EEG recordings contaminated with EOG and EMG artifacts in real-time.

Keywords: EEG, muscle artifacts, ocular artifacts, real-time artifact correction, real-time ICA

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Authors: Shih-Chieh Liao, Cheng-Yan Shuai

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"Party game" is a game mode that enables players to maintain a good social and interactive experience. The common game modes include Teamwork, Team competitive, Independent competitive, Battle Royale. Party games are defined as a game with easy rules, easy to play, quickly spice up a party, and support four to six players. It also needs to let the player feel satisfied no matter victory or defeat. However, players may feel negative or angry when the game is imbalanced, especially when they play with teammates. Some players care about winning or losing, and they will blame it on the game mechanics. What is more serious is that the player will cause the argument, which is unnecessary. These behaviors that trigger quarrels and negative emotions often originate from the player's determination of the victory and the ratio of victory during the competition. In view of this, our research invited a group of subjects to the experiment, which is going to inspect player’s emotions by Electromyography (EMG) and Electrodermal Activity (EDA) when they are playing party games with others. When a player wins or loses, the negative and positive feeling will be recorded from the game beginning to the end. At the same time, physiologic and emotional reactions are also being recorded in each part of the game. The game will be designed as telling the interaction when players are in the quest of a party game. The experiment content includes the emotional changes affected by the physiological values of game victory and defeat between “player against friend” and “player against stranger.” Through this experiment, the balance between winners and losers lies in the basis of good game interaction and game interaction in the game and explore the emotional positive and negative effects caused by the result of the party game. The result shows that “player against friend” has a significant negative emotion and significant positive emotion at “player against stranger.” According to the result, the player's experience will be affected with winning rate or form when they play the party game. We suggest the developer balance the game with our experiment method to let players get a better experience.

Keywords: party games, biofeedback, emotional responses, user experience, game design

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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: Madeleine Cox

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Objective; analyse patient choices in management of first trimester miscarriage, rates of complications including repeat procedure. Design: all first trimester miscarriages from a tertiary institution on the Gold Coast in a 6 month time frame (July to December 2021) were reviewed, including choice of management, histopathology, any representations or admissions, and potential complications. Results: a total of 224 first trimester miscarriages were identified. Of these, 183 (81%) opted to have surgical management in the first instance. Of the remaining patients, 18 (8%) opted to have medical management, and 28 (12.5%) opted to have expectant management. In total, 33(15%) patients required a repeat treatment for retained products. 1 had medical management for a small volume PROC post suction curette. A significant number of these patients initially opted for medical management but then elected to have shorter follow up than usual and went on to have retained products noted. 5 women who had small volumes of RPOC post medical or surgical management had repeat suction curette, however, had very small volumes of products on scan and on curette and may have had a good result with repeated misoprostol administration. It is important to note that whilst a common procedure, suction curettes are not without risk. 2 women had significant blood loss of 1L and 1.5L. A third women had a uterine perforation, a rare but recognised complication, she went on to require a laparoscopy which identified a small serosal bowel injury which was closed by the colorectal team. Conclusion: Management of first trimester miscarriage should be guided by patient preference. It is important to be able to provide patients with their choice of management, however, it is also important to have a good understanding of the risks of each management choice, chances of repeated procedure, appropriate time frame for follow up. Women who choose to undertake medical or expectant management should be supported through this time, with appropriate time frame between taking misoprostol and repeat scan so that the true effects can be evaluated. Patients returning for scans within 2-3 days are more likely to be booked for further surgery, however, may reflect patients who did not have adequate counselling or simply changed their mind on their preferred management options.

Keywords: miscarriage, gynaecology, obstetrics, first trimester

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Authors: Brid Dinnee, Jessica Taylor, Joseph Hartland, Michael Natarajan

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Background:The third stage of labour (TSL) can be complicated by Post-Partum Haemorrhage (PPH), which can have a significant impact on maternal mortality and morbidity. In Africa, 33.9% of maternal deaths are attributable to PPH1. In order to minimise this figure, current recommendations for the developing world are that all women have active management of the third stage of labour (AMTSL). The aim of this project was to examine TSL practice in a rural Ugandan Hospital, highlight any deviation from best practice and identify barriers to change in resource limited settings as part of a 4th year medical student External Student Selected Component field trip. Method: Five key elements from the current World Health Organisation (WHO) guidelines on AMTSL were used to develop an audit tool. All daytime vaginal deliveries over a two week period in July 2016 were audited. In addition to this, a retrospective comparison of PPH rates, between 2006 (when ubiquitous use of intramuscular oxytocin for management of TSL was introduced) and 2015 was performed. Results: Eight vaginal deliveries were observed; at all of which intramuscular oxytocin was administered and controlled cord traction used. Against WHO recommendation, all umbilical cords were clamped within one minute, and no infants received early skin-to-skin contact. In only one case was uterine massage performed after placental delivery. A retrospective comparison of data rates identified a 40% reduction in total number of PPHs from November 2006 to November 2015. Maternal deaths per delivery reduced from 2% to 0.5%. Discussion: Maternal mortality and PPH are still major issues in developing countries. Maternal mortality due to PPH can be reduced by good practices regarding TSL, but not all of these are used in low-resource settings. There is a notable difference in outcomes between the developed and developing world. At Kitovu Hospital, there has been a reduction in maternal mortality and number of PPHs following introduction of IM Oxytocin administration. In order to further improve these rates, staff education and further government funding is key.

Keywords: post-partum haemorrhage, PPH, third stage labour, Uganda

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Authors: Hsin-Chieh Lee, Fen-Ling Kuo, Jui-Chi Lin

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Background: Upper extremity functional impairment that occurs after stroke includes hemiplegia, synergy movement, muscle hypertonicity, and somatosensory impairment, which result in inefficient and inaccurate movement. Robot-assisted rehabilitation is an intensive training approach that is effective in sensorimotor and hand function recovery. However, these systems mostly focused on the proximal part of the upper limb rather than the distal part. The device used in our study was Gloreha Sinfonia, which focuses on the distal part of the upper limb and uses a dynamic support system to facilitate the whole limb function. The objective of this study was to investigate the effects of robot-assisted therapy (RT) with Gloreha device on sensorimotor, and ADLs in patients with stroke. Method: Patients with stroke (N=25) participated AB or BA (A = 12 RT sessions and B = 12 conventional therapy (CT) sessions) for 6 weeks (60 min at each session, twice a week), with 1-month break for washout period. The performance of the patients was assessed by a blinded assessor at 4 time points (pretest 1, posttest 1, pretest 2, posttest 2) which including the Fugl–Meyer Assessment-upper extremity (FMA-UE), box and block test, electromyography of the extensor digitorum communis (EDC) and brachioradialis, a grip dynamometer for motor evaluation; Semmes–Weinstein hand monofilament and Revision of the Nottingham Sensory Assessment for sensory evaluation; and the Modified Barthel Index (MBI) for assessing the ADL ability. Result: RT group significantly improved FMA-UE proximal scores (p = 0.038), FMA-UE total scores (p = 0.046), and MBI (p = 0.030). The EDC exhibited higher efficiency during the small block grasping task in the RT group than in the CT group (p = 0.050). Conclusions: RT with the Gloreha device might lead to beneficial effects on arm motor function, ADL ability, and EDC muscle recruitment efficacy in patients with subacute to chronic stroke.

Keywords: activities of daily living, hand function, robotic rehabilitation, stroke

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Authors: S. Ibrahim, D. Salilew-Wondim, M. Hoelker, C. Looft, E. Tholen, C. Grosse-Brinkhaus, K. Schellander, C. Neuhoff, D. Tesfaye

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Bovine endometrial cells appear to have a key role in innate immune defense of the female genital tract. A better understanding of molecular changes in microRNAs (miRNAs) and their target genes expression may identify reliable prognostic indicators for cows that will resolve inflammation and resume cyclicity. In the current study, we hypothesized that let-7 miRNAs family has a primary role in the innate immune defence of the endometrium tissue against bacterial infection, which is partly achieved via regulating mRNA stability of pro-inflammatory cytokines at the post-transcriptional level. Therefore, we conducted two experiments. In the first experiment, primary bovine endometrial cells were challenged with clinical (3.0 μg/ml) and sub-clinical (0.5 μg/ml) doses of lipopolysaccharide (LPS) for 24h. In the 2nd experiment, we have investigated the potential role of let-7 miRNAs (let-7a and let-7f) using gain and loss of function approaches. Additionally, tumor necrosis factor alpha (TNFα), transforming growth factor beta 1 induced transcript 1 (TGFB1I1) and serum deprivation response (SDPR) genes were validated using reporter assay. Here we addressed for the first time that let-7 miRNAs have a precise role in bovine endometrium, where LPS dysregulated let-7 miRNAs family expression was associated with an increased pro-inflammatory cytokine level by directly/indirectly targeting the TNFα, interleukin 6 (IL6), nuclear factor kappa-light-chain enhancer of activated B cells (NFκB), TGFβ1I1 and SDPR genes. To our knowledge, this is the first study showing that TNFα, TGFβ1I1 and SDPR were identified and validated as novel let-7 miRNAs targets and could have a distinct role in inflammatory immune response of LPS challenged bovine endometrial cells. Our data represent a new finding by which uterine homeostasis is maintained through functional regulation of let-7a by down-regulation of pro-inflammatory cytokines expression (TNFα and IL6) at the mRNA and protein levels. These findings suggest that LPS serves as a negative regulator of let-7 miRNAs expression and provides a mechanism for the persistent pro-inflammatory phenotype, which is a hallmark of bovine subclinical endometritis.

Keywords: bovine endometrial cells, let-7, lipopolysaccharide, pro-inflammatory cytokines

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Authors: Eman Ahmed Ahmed, Ghada Abdelmoneim Mohamed, Hamada Ahmed Hamada, Nagui Sobhi Nassif

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Impaired skeletal muscle endurance may be an important causal factor in the development of patellofemoral pain syndrome (PFPS). However, there is lack of information regarding the effect of hip versus knee muscle fatigue on isokinetic parameters, and myoelectric activity of hip and knee muscles in these patients. Purpose: The study was conducted to investigate the effect of hip abductors versus knee extensors fatigue protocol on knee proprioception, hip and knee muscle strength and their myoelectric activity in patients with PFPS. Methods: Fifteen female patients with PFPS participated in the study. They were tested randomly under two fatiguing conditions; hip abductors and knee extensors fatigue protocols. Isolated muscle fatigue of two muscles was induced isokinetically on the affected side in a two separate sessions with a rest interval of at least three days. After determining peak torque, patients performed continuous maximal concentric-eccentric contraction of the selected muscle until the torque output dropped below 50% of peak torque value for 3 consecutive repetitions. Knee proprioception, eccentric hip abductors' peak torque, eccentric knee extensors' peak torque, EMG ratio of vastus medialis obliquus (VMO) / vastus lateralis (VL), and EMG activity of gluteus medius (GM) muscle, were recorded before and immediately after each fatigue protocol using the Biodex Isokinetic system and EMG Myosystem. Results: Two-way within subject MANOVA revealed that eccentric knee extensors’ peak torque decreased significantly after hip abductors fatigue protocol compared to pre fatigue condition (p<0.05). On the other hand, there was no statistically significant difference in the eccentric hip abductors’ peak torque after admitting knee extensors fatigue protocol (p > 0.05). Moreover, no significant difference was found in knee proprioception, EMG ratio of VMO/VL, and EMG activity of GM muscle, after either hip or knee fatigue protocol (p>0.05). Conclusion: A hip focused rehabilitation program may be beneficial in improving knee function through correcting faulty kinematics and hence decrease knee loading in patients with PFPS.

Keywords: electromyography, knee proprioception, mechanical responses, muscle fatigue, patellofemoral pain syndrome

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Authors: Nupur Karmaker, Hasin Aupama Azhari, Abdul Al Mortuza, Abhijit Chanda, Golam Abu Zakaria

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Purpose: The purpose of gait analysis is to determine the biomechanics of the joint, phases of gait cycle, graphical and analytical analysis of degree of rotation, analysis of the electrical activity of muscles and force exerted on the hip joint at different locomotion during walking, running and cart pulling. Methods and Materials: Visual gait analysis and electromyography method has been used to detect the degree of rotation of joints and electrical activity of muscles. In cinematography method an object is observed from different sides and takes its video. Cart pulling length has been divided into frames with respect to time by using video splitter software. Phases of gait cycle, degree of rotation of joints, EMG profile and force analysis during walking and running has been taken from different papers. Gait cycle and degree of rotation of joints during cart pulling has been prepared by using video camera, stop watch, video splitter software and Microsoft Excel. Results and Discussion: During the cart pulling the force exerted on hip is the resultant of various forces. The force on hip is the vector sum of the force Fg= mg, due the body of weight of the person and Fa= ma, due to the velocity. Maximum stance phase shows during cart pulling and minimum shows during running. During cart pulling shows maximum degree of rotation of hip joint, knee: running, and ankle: cart pulling. During walking, it has been observed minimum degree of rotation of hip, ankle: during running. During cart pulling, dynamic force depends on the walking velocity, body weight and load weight. Conclusions: 80% people suffer gait related disease with increasing their age. Proper care should take during cart pulling. It will be better to establish the gait laboratory to determine the gait related diseases. If the way of cart pulling is changed i.e the design of cart pulling machine, load bearing system is changed then it would possible to reduce the risk of limb loss, flat foot syndrome and varicose vein in lower limb.

Keywords: kinematic, gait, gait lab, phase, force analysis

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Authors: Joanna Maj, Awais Hussain, Lyndsey Vu, Catherine Roxas

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Background: Bone injuries in babies are common conditions that arise during delivery. Fractures of the clavicle, humerus, femur, and skull are the most common neonatal bone injuries sustained from labor and delivery. During operative deliveries, zealous tractions, ineffective delivery techniques, improper uterine incision, and inadequate relaxation of the uterus can lead to bone fractures in the newborn. Neonatal anatomy is unique. Just as children are not mini-adults, newborns are not mini children. A newborn’s anatomy and physiology are significantly different from a pediatric patient's. In this paper, we describe common orthopedic trauma in newborn babies. We provide a comprehensive overview of the different types of bone injuries in newborns. We hypothesize that the rate of bone fractures sustained at birth is higher in cases of operative deliveries. Methods: Relevant literature was selected by using the PubMed database. Search terms included orthopedic conditions in newborns, neonatal anatomy, and bone fractures in neonates during operative deliveries. Inclusion criteria included age, gender, race, type of bone injury and progression of bone injury. Exclusion criteria were limited in the medical history of cases reviewed and comorbidities. Results: This review finds that a clavicle fracture is the most common type of neonatal orthopedic injury sustained at birth in both operative and non-operative deliveries. We confirm the hypothesis that infants born via operative deliveries have a significantly higher rate of bone fractures than non-cesarean section deliveries. Conclusion: Newborn babies born via operative deliveries have a higher rate of bone fractures of the clavicle, humerus, and femur. A clavicle bone fracture in newborns is most common during emergency operative deliveries in new mothers. We conclude that infants born via an operative delivery sustained more bone injuries than infants born via non-cesarean section deliveries.

Keywords: clavicle fracture, humerus fracture, neonates, newborn orthopedics, orthopedic surgery, pediatrics, orthopedic trauma, orthopedic trauma during delivery, cesarean section, obstetrics, neonatal anatomy, neonatal fractures, operative deliveries, labor and delivery, bone injuries in neonates

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Authors: Miriam Borchardt, Agata M. Ritter, Macaliston G. da Silva, Mauricio N. de Carvalho, Giancarlo M. Pereira

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This paper aims to analyze the barriers faced by social enterprises and based on that to propose a social business model framework that helps them to leverage their businesses and the social value delivered. A business model for social enterprises should amplify the value perception including social value for the beneficiaries while generating enough profit to escalate the business. Most of the social value beneficiaries are people from the base of the economic pyramid (BOP) or the ones that have specific needs. Because of this, products and services should be affordable to consumers while solving social needs of the beneficiaries. Developing products and services with social value require tie relationship among the social enterprises and universities, public institutions, accelerators, and investors. Despite being focused on social value and contributing to the beneficiaries’ quality of life as well as contributing to the governments that cannot properly guarantee public services and infrastructure to the BOP, many barriers are faced by the social enterprises to escalate their businesses. This is a work in process and five micro- and small-sized social enterprises in Brazil have been studied: (i) one has developed a kit for cervical uterine cancer detection to allow the BOP women to collect their own material and deliver to a laboratory for U$1,00; (ii) other has developed special products without lactose and it is about 70% cheaper than the traditional brands in the market; (iii) the third has developed prosthesis and orthosis to surplus needs that health public system have not done efficiently; (iv) the fourth has produced and commercialized menstrual panties aiming to reduce the consumption of dischargeable ones while saving money to the consumers; (v) the fifth develops and commercializes clothes from fabric wastes in a partnership with BOP artisans. The preliminary results indicate that the main barriers are related to the public system to recognize these products as public money that could be saved if they bought products from these enterprises instead of the multinational pharmaceutical companies, to the traditional distribution system (e.g. pharmacies) that avoid these products because of the low or non-existing profit, to the difficulty buying raw material in small quantities, to leverage investment by the investors, to cultural barriers and taboos. Interesting strategies to reduce the costs have been observed: some enterprises have focused on simplifying products, others have invested in partnerships with local producers and have developed their machines focusing on process efficiency to leverage investment by the investors.

Keywords: base of the pyramid, business model, social business, social business model, social enterprises

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Authors: Olarinde Olaniran, Oluyomi A. Sowemimo

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Toxoplasmosis is frequently misdiagnosed or underdiagnosed, and it is the third most common cause of hospitalization due to food-borne infection. Intra-uterine infection with Toxoplasma gondii due to active parasitaemia during pregnancy can cause severe and often fatal cerebral damage, abortion, and stillbirth of a fetus. The aim of the study was to investigate the prevalence of T. gondii infection in women of childbearing age in selected communities of Osun State with a view to determining the risk factors which predispose to the T. gondii infection. Five (5) ml of blood was collected by venopuncture into a plain blood collection tube by a medical laboratory scientist. Serum samples were separated by centrifuging the blood samples at 3000 rpm for 5 mins. The sera were collected with Eppendorf tubes and stored at -20°C analysis for the presence of IgG and IgM antibodies against T. gondii by commercially available enzyme-linked immunosorbent assay (ELISA) kit (Demeditec Diagnostics GmbH, Germany) conducted according to the manufacturer’s instructions. The optical densities of wells were measured by a photometer at a wavelength of 450 nm. Data collected were analysed using appropriate computer software. The overall seroprevalence of T. gondii among the women of child-bearing age in selected seven communities in Osun state was 76.3%. Out of 76.3% positive for Toxoplasma gondii infection, 70.0% were positive for anti- T. gondii IgG, and 32.3% were positive for IgM, and 26.7% for both IgG and IgM. The prevalence of T. gondii was lowest (58.9%) among women from Ile Ife, a peri-urban community, and highest (100%) in women residing in Alajue, a rural community. The prevalence of infection was significantly higher (P= 0.000) among Islamic women (87.5%) than in Christian women (70.8%). The highest prevalence (86.3%) was recorded in women with primary education, while the lowest (61.2%) was recorded in women with tertiary education (p =0.016). The highest prevalence (79.7%) was recorded in women that reside in rural areas, and the lowest (70.1%) was recorded in women that reside in peri-urban area (p=0.025). The prevalence of T. gondii infection was highest (81.4%) in women with one miscarriage, while the prevalence was lowest in women with no miscarriages (75.9%). The age of the women (p=0.042), Islamic religion (p=0.001), the residence of the women (p=0.001), and water source were all positively associated with T. gondii infection. The study concluded that there was a high seroprevalence of T. gondii recorded among women of child-bearing age in the study area. Hence, there is a need for health education and create awareness of the disease and its transmission to women of reproductive age group in general and pregnant women in particular to reduce the risk of T. gondii in pregnant women.

Keywords: seroepidemiology, Toxoplasma gondii, women, child-bearing, age, communities, Ile -Ife, Nigeria

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Authors: Fen-Ling Kuo, Hsin-Chieh Lee, Han-Yun Hsiao, Jui-Chi Lin

Abstract:

Background: Children with cerebral palsy (CP) usually suffered from mild to maximum upper limb dysfunction such as having difficulty in reaching and picking up objects, which profoundly affects their participation in activities of daily living (ADLs). Robot-assisted rehabilitation provides intensive physical training in improving sensorimotor function of the hand. Many researchers have extensively studied the effects of robot-assisted therapy (RT) for the paretic upper limb in patients with stroke in recent years. However, few studies have examined the effect of RT on hand function in children with CP. The purpose of this study is to investigate the effectiveness of Gloreha Sinfonia, a robotic device with a dynamic arm support system mainly focus on distal upper-limb training, on improvements of hand function and ADLs in children with CP. Methods: Seven children with moderate CP were recruited in this case series study. RT using Gloreha Sinfonia was performed 2 sessions per week, 60 min per session for 6 consecutive weeks, with 12 times in total. Outcome measures included the Fugl-Meyer Assessment-upper extremity (FMA-UE), the Box and Block Test, the electromyography activity of the extensor digitorum communis muscle (EDC) and brachioradialis (BR), a grip dynamometer for motor evaluation, and the ABILHAND-Kids for measuring manual ability to manage daily activities, were performed at baseline, after 12 sessions (end of treatment) and at the 1-month follow-up. Results: After 6 weeks of robot-assisted treatment of hand function, there were significant increases in FMA-UE shoulder/elbow scores (p=0.002), FMA-UE wrist/hand scores (p=0.002), and FMA-UE total scores (p=0.002). There were also significant improvements in the BR mean value (p = 0.015) and electrical agonist-antagonist muscle ratio (p=0.041) in grasping a 1-inch cube task. These gains were maintained for a month after the end of the intervention. Conclusion: RT using Gloreha Sinfonia for hand function training may contribute toward the improvement of upper extremity function and efficacy in recruiting BR muscle in children with CP. The results were maintained at one month after intervention.

Keywords: activities of daily living, cerebral palsy, hand function, robotic rehabilitation

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