Francis Eremutha   and Veronica Chizoba Gabriel   

Male contraceptive preferences in Nigeria are major pointers to acceptance, demand and sustained use of new reversible male contraceptive technologies. This study is designed to assess the willingness of Nigerian men to become actors in shared reproductive responsibility. A cross-sectional study design with mixed-methodology, which adopted both qualitative and quantitative research – using desk research, in-depth and household interviews, focus group discussions and online polls - was adopted. A total of 1,442 respondents were questioned; 801 from rural areas and 641 from urban areas. Male contraceptive use was defined by factors that influence the desire to practice contraception. 68.85% of the respondents say they would use reversible male contraceptives, if they were available; 54.27% of the respondents who were against it, said they would not use reversible male contraceptives because of the fear of adverse health risks. Our findings show that a considerable proportion of men had knowledge of family planning methods. The results show that there is a demand for reversible male contraceptives among the male population in Nigeria. It is evident that if other types of reversible male contraceptives are made available, they will be readily accepted.

Eder Annabelle   Windhager Reinhard   Pilz Veronika   Hanstein Tim   and Kühn Klaus-Dieter   

As the numbers of primary total joint replacements and following revision operations are constantly rising, there are more and more patients with severe comorbidities, which might be considered as additional risk factor for developing a periprosthetic joint infection (PJI). In this study, we analyzed patient-related risk factors, which might influence the occurrence of superficial surgical side infections (SSI) after total hip replacements. There is no study yet, focusing only on superficial SSI rather than on deep infections or PJI in general. Methods: We performed a literature research in Pubmed. Used key words were 'hip AND (arthroplasty OR replacement) AND infection'. We found 4,417 studies related to this broad definition. After exclusion by defined criteria, 10 relevant studies were left. Results: We found the following patient-related risk factors for superficial SSI: Obesity, age, ASA class >2, diabetes mellitus, HIV, hypertension, chronic obstructive pulmonary disease (COPD), previous cardiac surgery, dyspnea, corticosteroid use and hepatitis C. Gender, race and chronic kidney disease were not confirmed as risk factors for superficial SSI. Conclusions: To guarantee the best possible outcome after the surgery, it is advisable to treat these patients before performing a total hip replacement - if possible.

Raba Tatiana   

The role of proinflammatory cytokines IL-2, IL-6, and TNF-a in the pathogenesis of chronic hepatitis B and C infection was studied in 49 children ages 3 to 18 years. There has been concluded that high IL-2 and low IL-6 serum levels related to hepatic inflammatory activity did not depend on viremia levels. Slow progression of the disease was associated with an insignificant increase of IL-6 and normal TNF-a serum levels. The study results show the importance of proinflammatory cytokines as diagnostic and prognostic indicators in the pathogenesis of chronic hepatitis B and C in children.

M. F. Uddin   M. M. Ahasan   R. Khatun   S. Akter   H. M. Jamil   A. N. Monika   and M. A. Rahman   

High energy medical linac from Varian Medical Systems of model Clinac iX is installed in Bangladesh Atomic Energy Commission with dual photon energies (15 MV and 6 MV) and five electron energies upto 18 MeV. This machine is used to treat cancer patients either in electron or photon mode depending on the position of the malignant tissue. As the particles energies are in MeV range, special measures are taken into account for designing linac bunker. In this study, maximum photon energy is considered for shielding design. Other two particles i.e., electron and neutron are not considered due to their low penetration depth. As physicists the aim for us is to consider and calculate the shielding so that to protect the people and the stuff. Protection is required against three types of radiation such as, primary radiation (from the patient), scattered radiation (from the patient) and leakage radiation (from the linac head). To save the radiation worker from these three types of radiations, primary wall and secondary wall thickness, primary wall width and roof thickness are calculated. These calculations are done by empirical equations known as NCRP calculations using data in tabular form. These empirical equations are similar to those developed by Mutscheller. The primary and secondary barrier thickness for 15 MV and 6 MV photons are 2.84 m, 2.31 m and 0.93 m, 0.83 m respectively. Radiation survey reports are found to be below 10 µSvhr^-1 at six different locations for different gantry positions. This paper reveals what measures have been taken to protect the occupational workers and public from linac radiation hazards.

Anuja Sharma   and Ravinder Kaur   

The present study was undertaken to compare the role of direct microscopy with microscopy after cytocentrifugation during diagnosis of fungal infections. Also, the role and usefulness of different media like Sabouraud Dextrose Agar (SDA), Emmons Sabouraud Dextrose Agar (ESDA) and Inhibitory Mold Agar (IMA) for the growth of different fungi were compared to determine the most effective primary medium to be used in routine. Out of the total number of observations, 11.25% showed 2 folds increase, 28.75% showed 3 folds increase, 20% showed 4 folds increase and 40% showed 5 folds or more increase in cell density after cytocentrifugation. Also there were 3.75% of negative observations during direct microscopy while positive results were obtained on microscopy of same samples after cytocentrifugation. On studying the effect of various primary media on isolation and growth of different fungi, a total of 27 fungal isolates were recovered on culture media and identified. These isolates represented six important genera of fungi namely Candida, Penicillium, Trichophyton, Aspergillus, Cryptocococcus and Rhizopus. Out of a total of 27 fungal isolates, 66.66% fungal isolates were isolated on all the three media, 11.11% on SDA alone, 7.40% on Emmons SDA alone and 14.81% on IMA alone.

Prachi Kala   Vidya Bhargavi   Rohini Avantsa   and Geeta Narayan   

Objectives: To investigate the possibility of DWI as an imaging bio marker and evaluate its role in prediction and monitoring of chemoradiotherapy response in cervical carcinoma. Methods: 30 carcinoma cervix patients undergoing radiation for Carcinoma Cervix were examined with routine pelvic MRI and DWI before chemoradiation, following EBRT and on completion of brachytherapy. Based on the response on conventional MRI patients were categorized into complete, good and partial response groups. Analysis of variance (ANOVA) and Student t test (two tailed, independent) were used to compare the ADC, size and volume parameters between response groups and therapeutic times. Pearson's correlation test was calculated between ADC parameters and tumor size and volume response. Results: Cervical cancer demonstrated serial increase in tumor ADC values with corresponding decrease in tumor diameters and volumes during the therapy (all p values <0.001). significant and moderate positive linear correlation was found between the tumor ADC values and final size and volume responses at pre-treatment, post EBRT and post-treatment. Tumors with high diffusion values responded better to therapy than with low diffusion values. Patients with greater post EBRT tumor ADC changes and greater size and volume responses responded better to therapy. The pretreatment tumor ADC values, post EBRT ADC changes were found to be correlating well with the final outcome. However ADC mapping was less useful in predicting the extension and staging of carcinoma. Conclusion: DWI and its quantitative parameter, ADC has a potential role in the prediction, assessment and monitoring of cervical cancer treatment response to chemo radiation therapy.

Rajada Khatun   Masud Rana   Monjur Ahasan   Shirin Akter   Fakhar Uddin   Ashrafun Nahar Monika   and Md Ohiduzzaman   

Radiotherapy is a multidisciplinary area which uses complex equipment and radiation sources for treatment. Radiotherapy programme is mainly run on site planning, constructing and staffing the radiotherapy facility by skilled people. Medical Physicists play a vital role in radiotherapy such as treatment plan verification, machine calibration, patient positioning etc. There is a lack of qualified medical physicist in Bangladesh. Considering this situation, Bangladesh Government has initiated an "Institute of Nuclear Medical Physics (INMP)" under the umbrella of Bangladesh Atomic Energy Commission. Linear Accelerator (LINAC) is the major equipment of this Institute. The main motto of this Institute is to provide educational opportunity and, training of the medical physics professionals as well as patient service. The location and siting of a radiotherapy facility within the hospital environment requires careful consideration due to the role of radiation oncology in multidisciplinary cancer management, including the needs for diagnosis, corresponding medical appointment and long term follow-up of patients. The specialized bunkers (shielded rooms) for housing the treatment equipment is technically an engineering challenge and needs professional oversight to ensure long term structural integrity. A standard design is imperative to provide future requirements and advances in technology. This study provides a basis for site planning of a newly installed radiotherapy facility (LINAC) construction.

Aline Hamade   Fadia Najjar   and Tracy Dagher   

Objectives: Urine analysis, a simple and inexpensive test, is the cornerstone in the evaluation of the kidney function and may reflect some pathophysiologies. Materials: A cross sectional study was carried out in Lebanese University of Lebanon. One hundred asymptomatic students and stuff were enrolled in this study. Urine samples were obtained from students and stuff and were tested by dipstick method and trypan blue for urine cell count. Results: Among all the samples, leukocyturia and hematuria were the most common abnormalities found with a prevalence of 39% and 24% respectively, followed by proteinuria (13%), nitrituria (8%) and glycosuria (8%). Urinary abnormalities were more common in females than in males. Number of living urine cells was associated to the presence of glucose, proteins and leucocytes in urine (p=0.001, p=0.049 and p=0.027 respectively). Urine viable cells were also significantly correlated with the gender (p=0.000), alcohol and theine consumption (p=0.023, p=0.034 respectively) and smoking status (p=0.003). Conclusion: Asymptomatic urinary abnormalities might be detected by urine screening. Our results confirm that gender and environment factors might affect urine composition.

Jean-Paul A. Joris   and René Van Tiggelen   

This review is a tentative historical survey of what could be called 'Neuroradiology' meaning any radiological approach of what concerns the skull content i.e. the brain and its envelope and the vertebral column (spine). The celebration of the 100 years of WWI by the International Society for the History of the Neurosciences (ISHN) (Brussels 1^st of July 2014) gave the opportunity for a speech about the 'Neuroradiology in the trench-coat' and for the official international presentation of the book published about this topic.

K. Shakeyev   M. Zhanasova   G. Stepanenko   G. Tastanova   E. Darmenov   and M. Muratbekov   

Correction of malnutrition with enteric fistula is a problem that is caused by difficulties in the normalization of fluid and electrolyte balance and protein balance. Effective way of correcting violations trophological is transfistula enteral nutrition that helps to stabilize the condition of patients, respectively, and reduce the number of poor results in 1.8 times.

Shumilovich B.R.   Sushenko A.V.   and Morozov A.N.   

A system of finished Componeer composite veneers is a unique and having no analogy in the world elaboration of the Swiss company Coltene/Whaledent, an outcome of almost half a century experience of the company working in a field of composite materials. It combines the best features of direct and indirect restoration methods. The system is fulfilled of nano-composite Synergy D6 that has high mechanical strength, convenience for workable consistency, color stability and a system of halftone shades, which facilitates color matching. All this allows achieving excellent aesthetic results in minimal time. Application of an original standard scale gives possibility effectively assess optical properties of dental hard tissues and develop an implementation strategy of restoration before work started. Formation of Componeer form, polymerization and polishing at factory allow a practitioner fully utilize effect of "fluorescence" inherent to the material. All this allows us to position the Componeer system as a serious alternative to non-direct methods of restoration with the possibility of both high aesthetic and cosmetic reconstruction reliability.

L. Sukupova   D. Vedlich   and F. Jiru   

The position of the patient highly influences the functioning of the ATCM in CT imaging. The effect of different mis-centerings on the CTDIvol dose was determined during PMMA and water phantom simulations, which were also used for noise assessment. The results show that a 50 mm mis-centering (with the phantom placed above the isocenter) can cause an increase of the CTDIvol by 47 % associated with the lower standard deviation of the HU signal, whilst a -50 mm mis-centering (with the phantom placed below the isocenter) leads to a decrease of the CTDIvol by 35% and is associated with a noisier image. A mean value of the mis-centering determined for 473 patients was -43 mm. A total of 470 of 473 patients were mis-centered below the X-ray tube, which shows an inclination of radiographers to place patients below the isocenter. This inclination was more significant for smaller patients.

Svend Richter   and Sigfus Thor Eliasson   

Objectives: The importance of the Icelandic Sagas as a source of information on the way of life and diet habits in Iceland and possibly other Nordic countries 1000 years ago is obvious. Extensive tooth wear in archaeological human skull material worldwide has been blamed on coarse diet. Near volcano Hekla, 66 skeletons dated from before 1104 were excavated from a graveyard. The purpose of this study was to determine the main causes of tooth wear in Icelanders 1000 years ago. Materials and methods: Available were 49 skulls for research. Two methods were used to evaluate tooth wear and seven for age estimation. An attempt was made to determine main causes of tooth wear in the light of likely diet and beverage consumption according to a computer search on food and drink customs described in the Icelandic Sagas. Results: Extensive tooth wear was seen in all groups, increasing with age. The first molars had the highest score with no difference between sexes. It had all the similarities seen in wear from coarse diet. In some instances it had similar characteristics as seen in erosion in modern Icelanders consuming excessive amounts of soft drinks. According to the Sagas, acidic whey was a daily drink and used for preservation of food in Iceland until recently. Conclusions: It is postulated that consumption of acidic drinks and food in addition to a coarse and rough diet, played a significant role in the dental erosion seen in ancient Icelanders.

Evah Maina   Dennis Butto   and Mary Murigi   

Understanding predisposing factors to homosexuality is important in formulating behavioural interventions targeted to men having sex with men (MSM) who form part of key populations as defined by World Health Organization. A descriptive cross-sectional study utilizing snowballing sampling methodology was conducted to determine predisposing factors to homosexuality in Kilifi town council. The study, which carried out between the months of August and December 2015, included both self-identified and non-self-identified MSM in Kilifi town. Data was collected through self-administered questionnaires, focused group discussions and key informant interviews drawn from healthcare institutions and law enforcement agencies that ensure the safety of MSM in the community. Data was thereafter analysed by descriptive statistics. The findings of this study demonstrated that homosexuality is as a result of socialization rather than biological causes. 66.6% of respondents cited choice as the reason they were homosexuals. They further described homosexuality as a lifestyle, meaning it's a decision they made. Peer pressure, parental upbringing, family set up, watching pornography, physical and sexual abuse when growing up were other factors mentioned by the respondents. Community involvement and sensitization would be important in reducing the number of boys who convert to homosexuality at some point in life.

Kachua Ndewa   Charles M. Kihamia   Marycelina Mubi   and George Semango   

Background: Malaria diagnosis continues to be the foremost among the challenge in malaria control strategies in Sub-Saharan countries including Tanzania. The World Health Organization changed malaria treatment Guidelines in 2010 to restrict the use of antimalarial drugs to parasitologically confirmed malaria cases in response to the overuse of antimalarial drugs. Malaria rapid diagnostic tests (mRDTs) are presented as a mean to implement the new guidelines for malaria parasitologically confirmed cases prior to initiating antimalarial drug therapy for mRDT positive patients. Methods: A hospital-based cross-sectional study among patients with fever and malaria-like symptoms was done between May and June, 2014 in Korogwe district hospital in a convenient manner. Data were cleaned and analysed in Epi-Info version 3.5.4 computer software, Chi-square test was used to compare proportions between two groups with P-value set at 0.05. Results: Results revealed that sensitivity, specificity, positive predictive value and negative predictive value of mRDT at 95% CI was 97.6%, 97.4%, 91.0% and 99.3% respectively. All patients with positive mRDT were treated with antimalarial drugs, while patients with negative mRDT results were treated with either antimalarial (P-value = 0.001) or antibiotics (P-value = 0.005) at 95% CI. The results of patients with negative mRDT results were less likely to be further investigated at 95% CI (P-value = 1.000). Conclusion: The mRDT had good sensitivity and specificity if compared with blood slide microscopy. Clinicians adhered to the 2010 World Health Organization guidelines adopted by the National Malaria Control Programme for patients with positive mRDT result; however, they did not adhere to malaria diagnosis and management guidelines in case of negative mRDT results.

John G. Stowe   and Kathleen M. Curran   

The purpose of the research was to develop an automated program incorporating a predictive artifact correction technique (PACT) to correct for the signal deviations from metal beam hardening artifacts in Computed Tomography (CT) detector raw data. Thin-slice sequential CT scans were performed on a dosimetry head phantom using a Somatom Sensation 16 scanner to establish a ground truth image. Metal pins were then affixed to either side of the phantom at the three and nine o’clock positions to cause streak artifact in detector raw data and a subsequent streak image. The program automatically detected the extent of the overlap peaks in the detector raw data causing the artifact. It profiled a correction using adjacent projections so that the peak error could be corrected rather than simply being removed or smoothed by interpolation. The PACT algorithm modified raw data was then reconstructed on a SYNGO CT reconstruction workstation. This image was then compared against ground truth and that produced by commercially available metal artifact reduction projection completion and also a research based iterative technique. Qualitative results illustrate superior suppression of streak artifact in images using PACT when compared directly to tested projection completion methods but inferior to iterative reconstruction. Recovery of voxel data underlying the streak is also demonstrated to be quantitatively superior with PACT when referenced to the original ground truth image. Limitations were however detected with the threshold technique for initial localisation of the streak sources. The work still demonstrates the feasibility of this predictive artifact correction technique in correcting beam hardening affected voxel data without recourse to expensive additional options such as iterative reconstruction or dual energy that are not so commonly available in the clinical setting.

M. F. Uddin   S. M. M. Islam   M. N. Khan   R. Khatun   T. A. Biman   M. M. Ahasan   S. Akter   and A. N. Monika   

Dual Energy X-ray Absorptiometry (DXA) has long been and remains the most widely used technique for Bone Mineral Densitometry (BMD) measurement. Several manufacturers developed their performance of DXA with various types of measurement software but still not a unique data processing system which can ensure the unique measurement for the patients. The aim of this article is to show the precision level of BMD in DXA machine GE (Model: DPX Lunar) installed at INMAS, Mymensingh and to measure background radiation consistency during acquisition. A rectangular shape QA phantom of variable density for precision measurement and survey meter (Austral Rad Mini 8 in 1) for radiation monitoring were used. Coefficient of Variation for BMD values was 0.37% and always ranges from 0.32% to 0.38%. Radiation survey meter reading always showed the values ranges from 0-3 µSv/hr. It can be concluded that these good QC are not the conformity of exact measurement because there some reference values involved in T-score or Z-score measurement. These reference values were taken from healthy adult Caucasian women which are different from Bangladeshi population.

M. Mizandari   and N. Habib   

Purpose: Spectrum of PV patency and integrity percutaneous restoration techniques is presented. Material and methods: Total twenty patients with portal hypertension due to PV patency & integrity problem; among them percutaneous recanalization was attempted in fifteen patients with PV tumor thrombus using a novel endoluminal bipolar radiofrequency device. The procedure was completed in twelve of fifteen RFA cases; RFA was followed by balloon angioplasty (six cases) or vascular stent placement (six cases). In two cases catheter directed local thrombolysis was performed to acutely manifest fresh PV thrombosis, caused by thrombophylia and HCC. In two cases of pancreatitis induced PV thrombosis & stricture and one case of pancreatitis induced PV thrombosis & stricture and porto-biliary fistula, PV stenting was performed. The PV tributary was percutaneously accessed under US guidance and 5G guide catheter was manipulated through the obstruction using guidewire technique under DSA guidance. In case of thrombolysis thrombolytic agent was injected directly distal to the thrombus, the stenting procedure was completed by self-expanding vascular stent placement. Results: The technical success rate was 85.0%; in three cases (15.0%) wire conduction through the organized thrombus was impossible. Posprocedure portography documented significantly improved portal vein blood flow in all patients, to whom the procedure was completed. Porto-biliary fistula was successfully managed by percutaneous stenting. In three cases postprocedure bleeding was documented, which led to multiorgan failure and death in one case. Conclusions: The management of PV patency and integrity problems by percutaneous stenting or endoluminal RFA and stenting is an effective technique; it should be suggested as a treatment option for otherwise incurable patients and might be used as a bridge for further treatment. Post-procedure intraperitoneal bleeding is a possible life-threatening complication which should be prevented by procedure track ablation or embolization.

Jesenko Michael   Windhager Reinhard   Kontekakis Antonis   Hanstein Tim   and Kuehn Klaus-Dieter   

Total hip arthroplasty (THA) is a very successful and effective operation for the restoration of the hip function. The number of operations is steadily climbing and is going to reach new heights in the future. The most feared and devastating complication is the periprosthetic joint infection (PJI) and has in most cases to be treated with a total revision of the prostheses. The risk factors for a PJI are playing a very important role in the preoperative assessment of the patient and for the type of antibiotic treatment. There are many risk factors described in the literature, which are associated with the development of a PJI. Our goal was to analyze and find the relevant risk factors, which matter most in joint replacement surgery. We searched the database "PubMed" and "Embase" with the keywords: „ ((hip AND infection) AND (arthroplasty OR replacement))". With the help of check lists and limits we extracted the most viable studies for our research. Risk factors associated with a deep periprosthetic joint infection included the BMI (Body mass index), male gender, prolonged duration of surgery, diabetes mellitus type 2, the ASA (American society of anesthesiologists) score, the Charlson score and the NNIS (National Nosocomial Infections Surveillance System) risk index score. Female gender, age and the diagnosis of rheumatoid arthritis were not associated with a higher risk of periprosthetic joint infections. Patients with risk factors should be assessed and informed preoperatively and should receive an appropriate prophylactic antibiotic treatment, to reduce the risk of a PJI. With the reduction of their weight and adjustment of the diabetes, patients can reduce the risk for PJI by their own. Total hip replacement is still a very safe and effective operation and therefore should not be withheld from patients.

Bedru Jemal   Million Tesfaye   and Mengistu Alemu   

Knowledge about a type of Anesthesia to be used for cesarean section is not well investigated in developing countries. Knowing types and complications of anesthesia for Caesarean section will help mothers to have less stress and decide on their anesthetic choice. This study aimed to assess perception, knowledge and attitude of pregnant mothers towards Anesthesia for Cesarean section. A hospital-based cross-sectional study was conducted to assess knowledge and attitude of pregnant mothers attending antenatal care at Jimma University specialized hospital. Convenience sampling method was used to select participants from May 5 up to June 5, 2014. Chi-square and p-values were also calculated, and P- value < 0.05 was considered as significant association. 147 (69.7%) women in our survey were found totally unaware about various options of anesthesia technique. Fear of seeing things (60.3%) and previous experiences (7.94) were the main reasons for choosing general anesthesia in our population. The women who wanted to see their baby at birth, which accounts 12.6% and wants to be awakened during operation, which accounted to 6.54%, considered regional anesthesia as a safer technique. Most of the studied population is unaware of the existence of different anesthesia technique. The major source information about anesthesia was from experience, and most of the patient has no knowledge about importance of pre-operative evaluation.

Norbert Leitgeb   

It is well known from everyday life that communication is difficult. However, it is an even greater challenge to communicate sensitive or controversial issues such as risks in particular in emotional situations. Consequently, risk communication is much more than just talking about an issue. It requires specific knowledge, tailoring and targeting information to the patient's needs and abilities, and observing communication rules. The most frequent mistake is underestimating the need for specific skills and ignoring the pitfalls and dos and don'ts of risk communication. The basic information is given and demonstrated by various examples.

Ivy Tonnu-Mihara   Tara Matsuda   Jeff McCombs   Sammy Saab   Patricia Hines   Gilbert L’Italien   Timothy Juday   and Yong Yuan   

Background and Aims: New Hepatitis C [HCV] drugs are expensive but highly effective but have created an overwhelming ‘cash flow' problem for payers facing a large bolus of infected patients. Health plans are developing ‘watchful waiting' strategies to safely defer treatment for low risk patients. This study identifies five laboratory tests which predict increasing risk of liver related events and documents that delaying treatment until after an abnormal lab test diminished effectiveness of treatment with interferon alpha plus ribavirin. Methods: Patients from the Veterans Administration's clinical registry of HCV patients [1999-2010] were screened for a detectable viral load at baseline and a recorded baseline genotype. The primary outcomes were time to death and time to time to a composite clinical event. Cox proportional hazards models were estimated with time dependent independent variables for initial treatment and first abnormal laboratory test. Results: 128,769 patients met all inclusion criteria. Abnormal values for five laboratory were associated with increased risk for the composite outcome/death: 1.35/1.84 for the AST/ALT ratio > 1; 2.35/5.01 for albumin < 3 g/Dl; 1.58/1.15 for GGT > 195 IU/L; 3.85/1.55 for platelet count < 100 k/mm² and 4.48/2.39 for alpha fetoprotein > 144 ng/mL. Delaying drug therapy until after an abnormal lab test significantly reduced treatment effectiveness. Discussion: Five tests predict liver complications for HCV patients which can be used to develop "watchful waiting" protocols which monitor untreated HCV patients over time and defer access to expensive new drug regimens to those patients most at risk adverse liver-related events.

Anuj Patel   Chad Silverberg   David Becker-Weidman   Christopher Roth   and Sandeep Deshmukh   

Familiarity with how MRI sequences can distinguish different tissues when coupled with an understanding of pathology aids in narrowing differentials or making a specific diagnosis. Utilizing specific MRI pulse sequences allows for identification of key tissue substances such as fat, paramagnetic substances, protein, fibrous tissue, or free or bound water. The identification of these tissue substances allows the radiologist to form narrow or specific diagnoses efficiently. A tissue-based approach to understanding MRI sequences allows the radiologist to both systematically and effectively interpret MRIs despite the large number of pulse sequences particularly in basic MRI body protocols.

Szeto Ching Ho   

Chest tube drainage is a simple system to manage pneumothorax. It is inserted at the safety triangle after local anesthesia. Due to the positive intrapulmonary pressure and the negative intrapleural pressure during inspiration, air in the pleural space will be forced out into the chest drain bottle with underwater seal. The resorption of pneumothorax is further enhanced by oxygen therapy, which displaces the nitrogen inside the pneumothorax. Out of our expectation, there are cases with peculiar response to chest tube drainage. We should consider the following in the root cause analysis. 1. Chest drain system integrity: The chest drain should be placed in the pleural cavity, rather than sub-cutaneous or intra-abdominal cavity. The tubing should not be kinked or disconnected and the connection site should not be masked by dressing. 2. Anatomy of the pneumothorax: The anatomy of the pneumothorax should be on CXR or preferably contrast CT thorax. Any loculation, endobronchial obstruction, trapped lung due to old inflammatory process, lung entrapment due to persistent active inflammatory process should be noted. 3. Clinical assessment: It includes pleural fluid analysis, if present, and pleural manometry with air aspiration. In case of persistent air-leak seen in the chest drain bottle, suspect alveolopleural or bronchopleural fistula especially when patient is on positive pressure ventilation. Alternating or persistent bilateral pneumothorax without air-leak suggests interpleural communication (Simultaneous Bilateral Spontaneous Pneumothorax). The observed phenomena can be explained by considering the pressure change between various intra-thoracic compartments accounts for the observed phenomena, although confirmation of the communication during thoracoscopy is preferred.

Naveen Mohan   Gireesh Kumar K. P   Ajith Kumar. J   Sreekrishnan T. P   Ajith. V   Bharath Prasad. S   Krupanidhi Karunanithi   Arun Kumar. K   Vishnu Manohar   and Nandu. M   

Background and objectives: Hypoglycemia in the body is controlled by counter regulatory hormones. Serum cortisol is one among them not subjected to extensive study, in Type 2 diabetes mellitus cases. Cortisol responses among non diabetics and type 1 diabetics have been studied to a certain extent. The primary objective of our study was to identify the serum cortisol levels in hypoglycemic patients with or without type 2 diabetes and to find out the correlation between the mean cortisol responses in the two groups. Methodology: A total population of 51 symptomatic hypoglycemic patients meeting Whipple's criteria were studied in the ER of a medical college hospital at Kochi. Forty patients were diabetic and 11 non diabetic. Previous history, present illness, comorbidities, medical history and reasons for hypoglycemia were considered. Laboratory investigations on RFT, 7 AM serum cortisol and RBS were made and the results analysed applying standard statistical methods and SPSS II software. Results and discussion: Male female ratio in the diabetic and non diabetic groups was 3:1 and 10:1 respectively. Hypoglycemia was more among males, especially in the diabetic group due to decreased food intake(49%) or concurrent illness(51%),the mean age being 65.7 years in these cases. Hypoglycemia was more frequent in those on sulfonylurea (61.9%), and in habitual insulin users (42.5%). In non diabetic patients, hypoglycemia was caused by renal failure(27.27%), insulinoma(27.27%) or sepsis(18.18%). The mean serum cortisol among the diabetic group was subnormal(17.47), and in the non diabetic group it was 28.56. Age, sex, serum creatinine, GCS, period of stay and condition at discharge showed no correlation with serum cortisol levels. RBS, period of stay and condition at discharge showed no correlation with diabetic status. Conclusion: Diabetic patients with acute symptomatic hypoglycemia demonstrated a subnormal serum cortisol response as compared to non diabetic hypoglycemic patients.

Krupanidhi Karunanithi   Ajith V   Ajith Kumar. J   Naveen Mohan   Arun Kumar   Elson Kuriakose   Deepan Kumar   S. Kavitha   Sreekrishnan T. P   and Gireesh Kumar   

Background and objective: Although the benefits of systemic corticosteroids in pneumonia are not clear, their use is frequent in clinical practice. We described the patients' characteristics, demographics and the effect of steroids in Influenza pneumonia Hemagglutinin Type 1 and Neuraminidase Type 1 (H1N1) patients in terms of length of hospital stay. METHODS: The study design was a retrospective observational study, which consisted of patients presenting with H1N1 infection to the department of Emergency medicine at tertiary referral centre. We investigated all cases admitted with diagnosis of H1N1 pneumonia, confirmed by collecting throat swabs and doing Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) for H1N1 infection during July 2009 to February 2011. RESULTS: Of the 115 patients, 30 patients have been administered steroids. Within those 30 patients 20 have stayed in ICU with mean 7.45 ± 5.7 days. In that group of 20 patients, 10 patients have stayed in ICU alone, 10 patients have stayed in ICU and ward with mean 10.3±6.5 and 13.6±7.4 days respectively. 10 patients have stayed only in ward with mean days of 4.8±1.9. The overall mean hospital stay is 9.8±6.6 days. It is found that there is a significant statistical relationship between corticosteroid administration and reduced hospital stay (P=0.000).

Naveen Mohan   Gireesh Kumar K. P   Sreekrishnan T. P   Ajith Kumar. J   Ajith. V   Bharath Prasad. S   Krupanidhi Karunanithi   and Arun Kumar. K   

The study aims to identify the correlation between arterial and venous blood gas variables, in patients with metabolic acidosis secondary to renal failure and/or diabetic ketoacidosis(DKA). Paired arterial and venous blood samples of 100 patients, with metabolic acidosis resultant to renal failure and/or diabetic ketoacidosis during 2009-2011, were analyzed and the correlation between the variables were assessed using SPSS software, applying Pearson's product moment correlation coefficient, Linear regression, Statistical parameter R² and Chi-square test. Results: Mean ABG values for pH, HCO3, pCO2 and lactate were (7.29 +/- 0.448, 12.12 +/- 2.61, 25.2 +/- 4.0 and 5.39 +/-1.95 respectively) and mean VBG values for the same were (7.292 +/- 0.0451, 12,23 +/- 2.55, 27.8 +/- 3.9, and 5.19 +/- 1.81). Pearson product moment coefficient for pH, HCO3, pCO2 and lactate were 0.919, 0.967, 0.966 and 0.924 , with p <0.001 . Percentage variation in ABG as explained by VBG for pH = 84.4%, HCO3 =93.6%, pCO2 = 93.2% and lactate = 85.4%. Regression equations to predict arterial from venous values:-Arterial pH = 0.631 +0.913 x venous pH (R²=0.844), Arterial HCO3 = 0.990 x venous HCO3 (R²=0.936), Arterial pCO2 = -2.546 + 0.997 x venous pCO2 (R²=0.932), Arterial lactate = 0.993 x venous lactate (R²=0.854). Arterial and venous blood gas values showed significant correlation coefficient for pH, HCO3, pCO2 and lactate. Hence, VBG may be used as an alternative to ABG in the initial management metabolic acidosis secondary to diabetic ketoacidosis and/or renal failure.

Ajith Kumar J   Vivek Nambiar   Vaidynathan   Gireesh Kumar K. P.   Sreekrishnan T. P.   Ajith V.   and Naveen Mohan   

Early neurological deterioration following stroke is quiet common and is associated with significant morbidity. Etiology for stroke is very well understood, whereas etiology behind neurological worsening is not clear and is different. In our study we found posterior circulation infarct, left hemisphere & bihemispheric infarct are associated with significant neurological worsening. Our study also demonstrated that large artery disease and cardioembolic mechanisms are associated with neurological worsening in the acute phase of stroke.

Sana Ullah   Muhammad Imtiaz Aqdas   Nasrullah Khan   Ghulam Nabi   and Tariq Aziz   

The present study was undertaken at District Lower Dir, Khyber Pakhtunkhwa, Pakistan in order to assess the knowledge and perceptions of schools teacher regarding autistics, in public and private schools. This cross sectional study was conducted through purposive sampling among 240 teachers using self-administered questionnaire. The questionnaire was having questions for investigating teachers' knowledge and perception about autism. The collected data was analyzed by using SPSS (Version 20). The results of the present study showed that 47.5% (114) teachers know about autism through media (64.04% (73) through print media and 35.96% (41) through electronic media) while 8.75% (21) teachers know of it through trainings. Of the total 17.50% (21) public and 10.83% (13) private schools' teacher were of the opinion that autism is curable. A major portion, 42.92% (103) of the recruited teachers (46.67% (56) public and 39.17% (47) private schools' teachers) said that there should be separate schools for autistics while 57.08% (137) of the total teachers (60.83% (73) public and 53.33% (64) private schools' teachers) were of the opinion that managing autistics comes with prior training. The current study concluded that there is a lack of awareness regarding autism among teachers from both the sectors, yet public schools' teachers were better aware. School implemented proper training, workshops and seminars are suggested to train teachers for autism diagnosis and teaching autistics accordingly.

Chia-Hung Lin   Wei-Ling Chen   Chung-Dann Kan   and Yi-Chun Du   

Early clots and thrombosis to the progress of stenosis leading to arteriovenous shunt dysfunction occurs at the venous anastomsis site or the outflow vein. To prevent vascular access complications, such as inflow or outflow stenosis, this study proposes a computerized decision support system combining feature extraction methods and a non-cooperative game (NCG)-based decision-making model to evaluate arteriovenous shunt stenosis in clinical usages. Feature extraction methods, including the Burg autoregressive (AR) method and the fractional-order self-synchronization error formulation, are used to estimate the characteristic frequencies and to quantify the differences between the reference data and the routine examination data, in terms of the degree of stenosis (DOS). For 42 long-term follow-up patients, a less parameterized NCG model is then used to identify the possible level of stenosis. A novel screening model might be further built on an embedded system, for portable medical screening applications.

Ghulam Nabi   Imran Ali Khan   Sardar Ali   Yousaf Khan   and Sami Ullah   

The objectives of this study were to investigate the effects of long term strong electromagnetic field on fertility and offspring sex ratio in grade stations occupants. Fifty grade stations (132 kV and 500 kV) occupants and fifty control peoples were recruited randomly from district Dir, Swat and Peshawar (Pakistan). A special questionnaire was filled from all study participants about, age, job history, exposure time, protective clothing, addictions, fertility and number and sex of children. It was found that in exposed group, infertility both primary (n=5/50) and secondary (n=5/50) was common as compared to control group. Similarly the numbers of female children were significantly (< 0.0001) higher while the numbers of male children were significantly (< 0.0001) lowered in exposed group as compared to control group. In conclusion, long term strong electromagnetic field exposure decreases fertility and alters offspring sex ratio.

Raafat Hegazy   and Abdelmonem Hegazy   

To evaluate the changes in estrogen (ER) and progesterone (PR) receptors in oviducts, their immunohistochemical expression was investigated using albino rats in estrous cycle and after administration of depot-medroxy progesterone acetate (DMPA). Materials and methods: Twenty rats underwent this study were classified into groups, five rats were sacrificed in the morning of first day (follicular stage); another five rats were sacrificed in the morning of the second day (luteal stage); and ten rats were injected with 12.5 mg subcutaneous DMPA in the first day of cycle, then sacrificed in the next day to show changes in ER and PR. Paraffin-embedded blocks were prepared from the ampullae of oviducts. Then, immunohistochemical staining was performed for each block. Results: ER immunoreactivity mainly nuclear was expressed in the glands, pseudoglands, stromal cells and vascular endothelia in the follicular phase; becoming cytoplasmic in the luteal phase, expressed mainly in the cytoplasm of luminal epithelial cells, and nearly the same picture after DMPA injection. PR immunoreactivity mainly nuclear was expressed in the glands, pseudoglands and stromal cells in the follicular phase; becoming moderately expressed in the luteal phase, but reached a maximum after DMPA injection. Conclusions: DMPA injection caused increased expression of PR but not affecting ER expression.

Faydhi A   Mohidin S.   and Al Eidarous S   

This article reporting on a case study 21 years old lady diagnosed with acute pancreatitis secondary to hypertriglyceridemia was treated with series of plasmapheresis as treatment modality. The patient came with high triglycerides and cholesterol level, deteriorated and admitted to ICU for ventilation support. Three series of plasmapheresis was done on the consecutive days in ICU. Laboratory results show remarkable changes on both total cholesterol and triglyceride levels reduction by -11% to 33.6% and 20.8% to 51.8% respectively. The patient's general condition improve significantly patient was extubated and haemodinamically stable. Patient was transferred to general ward on day 5^th of ICU and discharge on the day 13^th of hospital admission. Plasmapheresis was proved to be treatment modality for patients with hypertriglyceridemia.

Paras Singh   Mradula Singh   Manpreet Bhalla   Rupak Singhla   Phani kumar Gumma   Devika Tayal   Vithal Prasad Myneedu   and Rohit Sarin   

Background: Toll-like receptor 4 (TLR4) is an essential component of the innate immune response to various microorganisms. Genetic polymorphisms in TLR4 are often associated with susceptibility to mycobacterial infection. Objective: The present study examines the influence of TLR4 896 A/G (Asp299Gly) and 1196 C/T (Thr399Ile) polymorphism in the susceptibility to develop pulmonary tuberculosis (PTB) in Indians. Materials & Methods: Single nucleotide polymorphisms (SNPs) of the TLR4 gene were genotyped using PCR-RFLP and sequenced in 198 patients with PTB and 60 healthy controls.Results: The frequency of mutant allele 299Gly and 399Ile of the TLR4 gene (14.4%; p < 0.048; RR=1.919; OR=2.074 & 14.6%; p < 0.020, RR=2.197; OR=2.402) was predominant in PTB patient as compared to healthy controls (7.5% & 6.7%), respectively. Data was further analysed under the dominant model [CT+TT (Thr/Ile + Ile/Ile)] at 399 position revealed preponderance of mutant allele in PTB patients (25.8%; p < 0.045; OR=2.555). On the other hand, combined evaluation of polymorphisms showed heterozygous/heterozygous (AG299+CT399) genotype was higher (16.2% vs 6.7%; p=0.063) in PTB patients than in control subjects. However homozygous/homozygous (GG299+TT399) genotype was observed only in PTB patients (3%).Conclusion: The current observation suggests the contribution of mutant allele ‘Gly' & ‘Ile' towards the increased risk of development of tuberculosis in North Indian population. As per our knowledge, this is first Indian study indicating the synergetic effect of two mutant (Asp299Gly and Thr399Ile) / alleles influencing the PTB infection. Further investigation on association of TLR-4 as an innate immunity biomarker with tuberculosis diseases need to be evaluated.

Caroline Akinyi   Jeremie Nzanzu   and Dan Kaseje   

In Kenya, Maternal Mortality Rate remains high at 488 deaths per 100,000 live births and the scenario is even worse in rural areas. Community Health Workers (CHWs) are integral in community mobilization to reduce maternal mortality, which is far more dependent on specific facility based interventions. This study's main objective was to determine effectiveness of CHWs in promotion of maternal health services in Butere District (intervention site) and Mumias District (non intervention site) in Kenya. This was a quantitative nested study with quasi-experimental study design for the secondary data collected in 2011. Statistical Package for Social Sciences 16 was used for data analysis. Inferential Statistics were used to estimate effectiveness of CHWs. There was a significant increase in the proportion of women who had Focused Antenatal Care (FANC) from 53% to 66% and Health Facility delivery from 35% to 48% and a moderate positive relationship between these indicators in Butere District. A woman in Butere was three times likely to deliver in a Health Facility with higher odds as compared to a woman in Mumias. CHWs are effective in promotion of maternal health services and their utilization should be up scaled especially in rural population with poor health seeking behaviours.

Sherif Sultan   Edel P Kavanagh   Michel Bonneau   Chantal Kang   and Niamh Hynes   

This study tested the hypothesis that the Multilayer Flow Modulator (Cardiatis, Isnes, Brussels) can treat aortic aneurysms through intra-arterial hemodynamic modulation, without substantial parent or small branch artery compromise, using 8 porcine models. The animals were euthanized and devices explanted upon completion of the study for examination. Results of the delivery system evaluation showed that there were no difficulties during navigation of the device through the arteries. An overall trend of reduction in aneurysm size was recorded. The opening of the aneurysm was nearly occluded with thrombus in 2 of the explants. The visceral arteries covered by the device remained patent, and it adhered to the arterial wall with endothelialization clearly visible. The MFM was therefore placed without intra-arterial compromise, and the aneurysms were stabilized while adequate blood flow to the collateral arteries was preserved.

Caroline Akinyi   Jeremie Nzanzu   Dan Kaseje   and Rose Olayo   

Cost-effectiveness analysis is a type of economic evaluation used to determine the best use of money available for medical care for informed decision making. This study carried out a cost-effectiveness analysis of using Community Health Workers (CHWs) as an integral part of Community Health Strategy implementation to promote uptake of maternal health services in Butere District, rural western Kenya. The main objective was to determine incremental cost-effectiveness ratio of utilization of CHWs in promotion of maternal health services in Butere District (intervention site) in selected Community Health Units. The costs and consequences of promoting maternal health services at the community level with CHWs were identified, measured, valued while using a quasi experimental study design. Annual cost incurred in utilizing CHWs to promote maternal health services in Butere District in 2011 was US$ 30,124, effectiveness of utilization of CHWs was 1,205 yearly DALY averted. The incremental cost-effectiveness ratio was US$25 per yearly DALY averted.Utilization of CHWs to promote maternal health services is a cost effective strategy in Butere District. Community Health Strategy should be up scaled as it is a cost effective intervention to promote uptake of maternal health services especially in the rural population where health seeking behaviours are low.

Samuel Jerry Odindo   Constant Loum   John Alwar   Rose Olayo   Aaron Mwayi   and Henry Oyugi   

Introduction: This was a nested study in which 2011 data from a baseline study conducted by Great Lakes University of Kisumu, supported with funds from UNICEF Kenya. Findings was analyzed and used to describe practices of exclusive breastfeeding among lactating mothers with children under-5 years of age in Nyanza province. Methods: A multi-stage cluster sampling technique was used to select 2,805 households. Descriptive statistics were used to determine the coverage of exclusive breastfeeding practice. Frequencies were run using SPSS and Chi –square test was used to determine the association. Findings: The practice of exclusive breastfeeding in Siaya County is found at 29.9%; with unemployed mothers presenting at 36.1%, while working class mothers performed poorly at 21.4%.On the level of education: - respondents on none level of education reported the highest at 46.2%, while post Secondary level reported the lowest at 26.1%.All had a p-value 0.008 significant at the 5% level. This could be due to connection that education has with employment. Conclusion: Source of income and level of education has an association with exclusive breastfeeding. Recommendation. Need for further research to find out why uneducated mothers breastfeed more than educated mothers.

Sahar EM El-Deek   Mohamed Aboel-Kassem F Abdelmegid   Mona M Soliman   and Amr A Youssef   

Background: Adipo¬cytokines may play role in pathogenesis of atherosclerosis. The association of the novel adipocytokines, vaspin and visfatin, with atherosclerosis coronary artery disease (CAD) is still obscure. Objectives: To investigate the relationship of vaspin and visfatin adipocytokines with the existence as well as the severity of CAD. Patients and Methods: A total of 87 patients who underwent coronary angiography due to symptoms of stable angina were enrolled in the study. They were divided into two groups; CAD group who have at least single vessel disease and normal group who have normal coronary arteries. The severity of CAD was assessed using coronary angiography by estimation the number of vessels affected and Gensini score. Results: Serum levels of vaspin were significantly lower and inversely, serum levels of visfatin were significantly higher in CAD group than normal (1.51 ± 0.99 μg/L versus 4.54 ± 0.69 μg/L for the former and 22.86 ± 4.68 μg/L versus 13.43 ± 1.1 μg/L for the later; p<0.0001 for each). Decreased vaspin and increased visfatin levels were correlated with CAD severity (p<0.0001 for each). There was a negative correlation between vaspin and the Gensini score and positive correlation between visfatin and Gensini score (r= -0.727, p<0.00001 and r= 0.798, p< 0.00001, respectively). Conclusion: Patients with CAD showed reduced vaspin and increased visfatin serum levels. Moreover, low vaspin and high visfatin levels were significantly correlated with CAD severity suggesting a link between atherosclerosis and adiposity.

Nzanzu Jeremie   Dan Kaseje   Rose Olayo   and Caroline Akinyi   

Information should form the backbone of decisions that effect change in all areas. It is therefore paramount in health, for information to be used for decision making. In effect this will bring about equity in health resource allocation. The development of comprehensive community based health information systems is increasingly becoming important for measuring and improving the quality of health services. Many developing countries including Kenya have made efforts to strengthen their national health information systems to provide information for decision-making in managing health care services. The purpose of this paper is to explore how data collected at the community level is utilised by various stakeholders within the community in order to produce actionable information for decision making. This was a descriptive, cross sectional study. The qualitative aspects of data collection involved key informant interviews and focused group discussions with the health service providers; potential health services users, and community health workers. Findings indicated that strong local ownership of data developed at the community. The main perspectives of service providers included joint ownership of health intervention programs at the community level, the community owned their health and aimed to improve it and community health workers to champion on health and development issues to bring about change.

Nzanzu Jeremie   and Caroline Akinyi   

The main aim of the study was to understand issues surrounding access and use of information in rural Butere, and how women and health workers perceived and interpreted these issues. An interview schedule that consisted of open questions and one relating to health information critical incidents was used. A holistic inductive paradigm was adopted with a grounded theory analysis. The findings highlight a model of information behavior that was driven by the value and impact of information unlike previous information models, which have been driven by information needs. The value and effect of information on PHC was as experienced and reported by the interviewees. For example, information was valuable in the prevention and detection of diseases, management of illnesses, decision-making, improving knowledge and promoting health, administration, behavioral change, and community support. The need for and value of information in rural Kenya led to the institution of an informal mechanism of health information provision. It was, therefore, recommended that the local capacity should be built or strengthened to enable it to sustain health information provision; a participatory approach involving all stakeholders was suggested, more repackaging of information to suit the needs of rural health workers and the community.

Gabriela Balf Soran   Rani Hoff   and Paula Zimbrean   

Objective: The Authors Examined The Perceived Adequacy Of Current Training In Transplant Psychiatry (TP). Methods: An anonymous web-based survey was distributed to all US Psychiatry Residency programs (N=182) and Psychosomatic Medicine Fellowship programs (N=46). Results: Sixty one (33.5%) Psychiatry Residency Directors and 24 (52%) Directors of Psychosomatic Medicine completed the survey. Sixty eight percent of Psychiatry Residency programs do not provide specific TP training and 79.4% of residents had never performed a TP evaluation. Among the Psychosomatic Medicine Programs, 91.3% provide TP training; however only 14.3% of fellows are involved in TP evaluations. Giving the news of a negative determination of eligibility was listed as a main source of anxiety about TP. 68.6% of the PRD considered more training in TP necessary, specifically regarding medication interactions and substance abuse issues. Conclusions: Given this perceived need, psychiatry and psychosomatic medicine residency and fellowship programs should consider supplementing their existing curricula with more TP-related training.

Sang-Yeon Park   and Eung Ho Choi   

Background: Oral lichen planus (OLP) is a chronic inflammatory disease involving the oral mucosa that induces pain and burning sensations, thus decreasing a patient’s quality of life. Although its etiology has not yet been clearly defined, infection has been suggested to be associated with OLP. We tried to clarify the relevance of herpes simplex virus (HSV) infection in OLP, since HSV infection is the most common infection in the oral mucosa of adults with characteristics of recurrence due to psychological and physical stress. Methods: We enrolled thirty subjects diagnosed with OLP by clinical manifestation and pathologic findings. We tested serum IgG levels against HSV-1 and 2, and performed PCR testing of biopsy specimens for HSV. Additionally, we assessed the treatment effect of an oral anti-viral agent for OLP. Results: Serum HSV-1, 2 IgG levels were markedly elevated in the OLP subjects. HSV DNA was not found in the PCR biopsy specimens. Eight out of thirteen subjects(61.5%) who took oral acyclovir improved in subjective symptoms and objective lesion manifestations. OLP patients treated with conventional treatments showed improvement in 58.8%.Conclusions: Although we did not observe decisive findings, such as a positive HSV-PCR result, to establish a link between HSV and OLP, we did observe an increase in HSV IgG levels and a therapeutic response to oral acyclovir in subjects with OLP.

Mathew Folaranmi Olaniyan   Folorunso Olabiyi   and Adebisi .A. Ademuyiwa   

Background: Anthropometric indices, plasma albumin, uric acid and packed Cell Volume(PCV) are good markers of malnutrition and the associated disorders. Aim and Objective: This work aimed to evaluate the anthropometric indices, plasma albumin, uric acid and packed cell volume in tertiary institution students. Materials and Methods : Anthropometric indices, plasma albumin, uric acid and packed cell volume (PCV) were evaluated in 200 students of two tertiary institutions in Owo-Nigeria which include Achievers University and Rufus Giwa polytechnic, Owo, Ondo state-Nigeria (comprising of 95 males and 105 females). Anthropometric measurements including weight, height, and waist and hips circumference were measured. Body mass index and waist-hip ratio were also calculated. Plasma uric acid, and albumin were estimated biochemically by spectrophotometry while PCV was determined by capillary tube method. Results: The results showed a statistically higher significant difference in the values of mid arm circumference obtained from Achievers University (10.48±0.72) than the values obtained in the students of Rufus Giwa Polytechnic Owo (9.72±1.14) with P < 0.05. The values of plasma albumin were also statistically significantly higher (P< 0.05) in students of Achievers University, Owo (47.84±4.5) than the values obtained in the students of Rufus Giwa Polytechnic Owo (42.36±4.89) with P < 0.05. There was also a significant gender difference in the values of mid arm circumference and plasma albumin obtained from the students of the two institutions with p<0.05. Conclusion: We therefore recommend routine measurements of anthropometric indices, Packed Cell Volume and biochemical parameters (Serum Uric acid and Albumin) are hereby suggested for early detection of malnutrition and its associated disorders among students of tertiary institutions due to significant alterations in the level of the parameter.

John H. Newman   

Universities have been organized into Schools and Departments focused on specific disciplines. This has led to a “silo” type of research. There is a new model for research known as "convergence” that merges the disciplined design approach and technical tools of hard science into the research process in other sciences. This model, put forth by the Massachusetts Institute of Technology (MIT) in 2000, calls for rethinking how research is conducted in order to achieve an integrated approach contributing the advancement of several different fields. It applies the technical tools of engineering to life science research. Convergence research can promote innovation by enabling the intersection of scientific disciplines and promoting a cross-disciplinary expertise in the fields of science, technology, engineering, and math (STEM). A current STEM project requires the expertise dispersed among multiple Schools within Coppin State University (CSU). These include the School of Business, the School of Nursing, the School of Arts and Sciences (SAS) and the School of Natural Sciences. Convergence research is being used create a knowledge base that includes constructs from medical practice, computer science, system analysis and design, and other fields.

Isaev V.A.   and Simonenko S.V.   

The people having dysbacteriosis, becomes more increasing, covering nearly a half of the population of a planet. And the combination of a syndrome of angry intestines to atherosclerosis is a harbinger of such terrible forms of an illness, as a heart attack, a stroke, etc. Now there was a first of a series developed combined bifidopreparatov. This is Bifeynol containing both a microbic protivodisbakteriozny component (bifid bacteria), and the PNZhK treatment-and-prophylactic complex of the class ω-3 (Eikonol). The assessment of clinical efficiency and Bifeynol's safety at patients with SRK and an accompanying hypercholesterolemia is carried out. 20 patients with SRK with prevalence of locks are surveyed. Efficiency of carried-out therapy was estimated by means of microbiological (epidemiology and microbiology GDTs scientific research institute laboratory of GI. Gabrichevsky) and koprologichesky research a calla, the clinical and biochemical analysis of blood with definition of a lipidic range, the general analysis of blood and urine. It is established that reduction or full elimination of clinic of SRK is noted at 85% of patients. The quantity стафилококков decreased more than by 3 times, the drozhzhepodobnykh of mushrooms – by 4 times, a haemolytic intestinal stick – almost twice. Against Bifeynol's application full elimination of yodofilny flora was noted. In blood decrease in the content of urea, the general bilirubin, Alat, Asat was noted. After a four-week course of therapy Bifeynol revealed reduction of the content of the general cholesterol due to decrease in the XC LPNP whereas concentration of the XC LPVP increased.

Ashfaq Ul Hassan   Aijaz Malik   and Ghulam Hassan   

The anatomical localization of inguinal region is important especially to pediatric surgeons and General Surgeons. A thorough understanding of groin anatomy is essential to successful inguinal hernia treatment. Conservative management of asymptomatic inguinal hernias is usually acceptable and Elective repair of inguinal hernias can be undertaken using a laparoscopic or open approach .Laparoscopic inguinal hernia repair results in less pain and faster recovery, yet requires specialized training and equipment. Without the knowledge of surgical anatomy surgeon can damage many vital structures in this region. The incidence of complications of inguinal hernia surgery is about 10 percent in United states and recent data from India suggests complication rates of order of 20-25 percent in Hospital settings which can increase to about 30-35 percent in District Hospitals will ill equipped theatres and lack of Full Expertise.

P. Finazzi   P. Brambillasca   D. Corbella   F. Coccolini   D. Codazzi   L. Ansaloni   and V. Sonzogni   

We present a case of an 11-years old child who underwent several plastic procedures for massive skin necrosis of the right forearm. Pain control was achieved combining a thoracic epidural and a continuous brachial plexus block. The patient was successfully weaned from chronic opiates. Possible advantages (i.e. improved graft perfusion, speeded opiates weaning) and disadvantages (i.e. local anesthetic toxicity) of this combined approach are briefly discussed.

Patricia Jo   David A Leswick   Derek A Fladeland   Robert Otani   and Hyun J Lim   

The purpose of this study is to prospectively compare image quality and radiation dose using 100- and 120-kVp techniques for carotid CT angiography. Forty consecutive patients were alternated between the 100 kVp group and 120 kVp group while all other scanning parameters were kept constant. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated for locations along the carotid artery, vertebral artery and circle of Willis. Three radiologists independently assessed subjective image quality including confidence of visualization using a five-point scale. Effective dose was calculated using the dose length product (DLP). CNR and SNR were either similar or better when using 100 kVp for all vessels. Subjective image quality was similar between techniques. Mean effective dose was 36% lower for the 100 kVp than the 120 kVp technique. This study demonstrated that using 100 kVp technique provides 36% dose reduction with significantly higher objective image quality and nonsignificantly higher subjective image quality compared to the 120 kVp technique.

Youfu Ke   Chun Xiang Li   and Junxian Zheng   

Objective: To evaluate the efficacy and safety of Wuling Powder and Modified Shengmai Powder on treating chronic cardiac insufficiency. Methods: 42 cases of chronic cardiac insufficiency patients with heart function ranging from NYHA class II to IV took Wuling Powder and Modified Shengmai Powder for 2 weeks to treat chronic cardiac insufficiency without changing former medication. NYHA heart function, systolic pressure, diastolic pressure, heart rate, and 6-minute walk test were evaluated before and after treatment. Results: Wuling Powder and Modified Shengmai Powder decreased systolic pressure, diastolic pressure, heart rate, and increased the 6-minute walk distance significantly(P<0.01). Total effective rate was 92.9%. There was no serious side effect. Conclusion: Using samples from outpatients, this study shows Wuling Powder and Modified Shengmai Powder is effective and safe to treat chronic cardiac insufficiency.

Ehab AM Albanna   Hanan S Ahmed   and Hanan AA   

Background: the proper zinc and copper levels seem very important to our immune system. Due to the association of copper and zinc in many enzymes structures, and also the important role of them in the immune system most of the evaluations have considered copper and zinc together. Objective: To evaluate serum copper and zinc levels in children suffering from pneumonia and its relation to CD34+ cell. Study design: 37 patients (21 males and 16 females)with proven diagnosis of pneumonia these patients were selected as one every three cases admitted to chest unit of Pediatric Department, Zagazig University Hospital during the year 2012,their ages ranging from 6 months to 5 years and 37 healthy children(19 males and 18 females) were studied as control group. Results: WBCs, platelets, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), neutrophils and lymphocytes were highly significantly higher in patients than controls while hemoglobin, zinc, copper, CD34+ levels were highly significantly lower. There were highly significant positive correlation between CD34 and both copper and zinc levels.Conclusion: Low serum copper and zinc levels may be a contributing factor to the pathophysiology of community acquired pneumonia through its effect on the immune system.

Raafat A. Hegazy   Abdelmonem A. Hegazy   Hesham R. Abdel-Aziz   Anan F. Mohamed   and Abdelhafez M. Mohamed   

The Wnt/β-catenin pathway plays an important role in the genesis of familial adenomatous polyposis, the most common form of inherited colorectal carcinoma (CRC). Also, the inflammatory bowel diseases (IBDs) predispose to cancer development; and cyclooxygenase 2 (COX-2) seems to be pivotal in their pathogenesis. This study aimed to investigate the relationship between the expression of COX-2 protein and β-catenin in colorectal cancer. The study enrolled 45 patients, all of whom underwent surgery and immunohistochemical staining of tissue specimens for COX-2 and β-catenin was done. Correlation between the two modulators and their relationship with clinicopathological features were examined. In 34 cases (75.56%) of the tumor samples; β-catenin immunoreactivity was found in the cytoplasm and/or membrane compartment. On the other hand, COX-2 immunoreactivity was weakly and/or strongly positive in 32 cases (71.11%) and negative in 13 (28.89%). Positivity was detected in the cytoplasm and in the perinuclear area. Increased expression of β-catenin was correlated to Duke stage (P=0.009). Furthermore, nuclear β-catenin localization showed a correlation to the Duke stage (P=0.029) and insignificant correlation with distant metastases (P = 0.336). Positive COX-2 expression showed a significant relation to, liver metastases (P = 0.042), and Duke stage (P = 0.011) and insignificant correlation to lymph node invasion (P=0.25). These data indicate that cytoplasmic/membrane β-catenin over-expressions as well as positive COX-2 expressions are associated with a more aggressive behavior of the disease.

Seyed Ali Rahimi   and Shokrolae Salar   

During different studies on 1.5 Tasla equipments it was possible to obtain proper images with different values for different parts of limb. To date no research of such kind has been done in Iran and angiography of lower limbs is not done at present. In this study, it was tried to proper images of lower limbs considering the capabilities of designed protocol system.1.5 Tasla MRI equipment with optimized parameters for different positions calculated on the volunteers, patients and phantom was used. SNR and CNR images were compared, and categorized by radiologist based on diagnostic values. First stage of recovery current, a lower, mobile pre saturated pulses, NSA=1, matrix size 128 to 180 at direct phase and 256 direct frequency were selected. The qualitative value of the images 3 at pelvis area; 3 at femoral and knee areas; and 4 for knee was obtained. Total time required for imaging of lower limb was 45 minutes. This technique is useful particularly for the patients who can not go under conventional angiography. The value of the MR images using contrast drug is higher than the images obtained by this method, however this method is cheaper.

Shaban Almouahed Chafiaa Hamitouche Eric Stindel and Christian Roux 

The main purpose of this paper is to summarize the results of our research to develop a new generation of instrumented knee implant. The proposed implant is supposed to provide the clinician with significant information on the tibiofemoral force distribution during normal walking in order to assess the ligament imbalance and correct it as needed. The electronics embedded into the implant to achieve this task should be miniaturized enough to fit the limited space available inside it. These electronics should also be self-powered to eliminate the need for periodic replacement of a rechargeable battery or the need for an external source of electric power. Therefore, the possibility to use the piezoceramics not only as imbalance sensors but also as energy harvesters within the tibial baseplate of knee implant has been investigated by means of theoretical modeling and experimental trials.

Emad Y. Moawad 

The goal of this work is to determine the role of the autoimmune cells in Rheumatoid arthritis (RA) induction and the immunomodulatory mechanism of therapy with Tyrosine Kinase Inhibitors (TKIs) in RA attenuation. B cells were isolated from naive DBA/1 mouse spleens and stimulated for 72 hours with LPS as a positive control forming a mouse model of RA in the presence or absence of 1–5 μM imatinib. B cell staging were assessed by adding 1 μCi of [³H] thymidine for measuring proliferation in the final 18 hours of the stimulation, and a Beta plate scintillation counter was used to quantitate incorporated radioactivity. Samples of C1.MC/57.1 mast cells were stimulated with 100 ng/mL of Self Cell Factor (SCF) as a positive control of a mouse model of RA in the absence or presence of 1-5 μM of imatinib. Tumour Necrotic Factor (TNF) levels in culture supernatants from C1.MC/57.1 mast cells were measured by ELISA. The histologic grade (H_G) and the level of TNF of the mouse model of RA were 1/10 and 10 times respectively those in the control one. This inverse proportion clarifies that RA disease is the result of big increase in TNF level perpetuating local inflammation and joint destruction leads to a major decrease in with the same ratio. The addition of 1 and 5 μM doses of imatinib increased by 200% and 300% respectively while decreased TNF level to be 12.5% and 10% respectively of that in the mouse model of RA restoring rate of TNF level of normal tissue. This demonstrates that effective mitigation of symptoms of RA is the result of a significant increase in H_G because of the cell cycle arrest resulting from the treatment of TKIs which leads to a significant reduction in the level of TNF but with a different ratio to increase H_G unlike happened in incidence of RA.

Thomas M. Halaszynski 

Background: There has been an increase in the number of elderly patients undergoing surgery. This particular patient population have unique age related comorbidities that lead to an increase in postoperative complications involving the neurological, pulmonary, cardiac and endocrine systems. Despite advances in anesthesia and analgesia, mono-therapy with opioids continues to be the mainstay for treatment of post-op pain, which often times leads to inadequate pain control, or gastrointestinal and respiratory compromise. Regional anesthesia and multimodal analgesic regimens are promising alternatives to reduce high doses and dependence of opioids and the adverse effects that accompany. Methods: The authors searched the following databases for relevant published trials: the Cochrane Central Register of Controlled Trials and PubMed. Textbooks and meeting supplements were also utilized. The authors assessed trial quality and extracted data. Conclusions: Incorporating perioperative regional techniques and multimodal drug therapy can be a very effective approach to perioperative pain management in the elderly and cognitively impaired. Regional anesthesia can often reduce postoperative neurological, pulmonary, cardiac and endocrine complications. It has not been completely proven to improve long-term morbidity, but does improve immediate post-operative pain control. Multimodal drug therapy utilizes a variety of analgesic medications (non-opioids) in order to minimize dosages and adverse effects from opioids while maximizing analgesic effect and benefit.

Emad Y. Moawad 

The aims of this study are to interpret elemental transmutations occurring in biological cell in terms of its growth energy, to classify risks of their signaling pathways from normal cell to carcinoma, and to investigate effects of recommended dose levels of medical treatments on human cell. As nitrogen-containing bisphosphonates alendronate and risedronate inhibits cell phosphorylation and arrests cell cycle which are the most common effects of all cancer causes, this approach involves experimental proof that interprets phosphorylation status of normal human epidermal keratinocytes in term of cell growth energy (CGE) to be compared to its critical levels. For transmutation occurrence in biological cell, energy of such transmutation should be less than that of the cell. CGE could express phosphorylation statuses of cells or cell cycle arrest successfully to predict the cancer/normal tissue of individual samples according to levels of CGE. Furthermore, applications of man uses, and medical treatments that may lead to raise CGE can be tested to check whether their effects induce cancer or not. CGE regulates elemental transmutation occurs inside the cell, where mechanism of the transmutation in biological cultures and interpreting it in terms of CGE, gives us a complete figure for cancer occurrence. Cancer is a matter of energy balances, under the natural circumstances; low CGE doesn’t allow harmful or lethal transmutations. While it’s increasing due to the exposure to long term effects of low radioactive doses or any type of excitation, stimulates harmful transmutations and consequently different kinds of cancerous tumors. This new concept provides the possibility to investigate all effects of cancer causes, further more it is recommended that a test for CGE can play a major role in targeting an earlier interception for cancer.

Hemalata Singh S. K. Rathi and A. S. Verma 

In this paper we present a simple method for the calculation of mass stopping power (in MeV cm²/g) of protons from 0.5 Mev to 200 MeV energy range in biological human body substances such as water, bone, muscle and tissue. The proposed relations have been described in terms of energy of proton and mean (< Z/A >) of atomic number (Z) and atomic weight (A). A fairly good agreement has been found between our simplified values for mass stopping power of protons for water, bone, muscle and tissue and that of Mukherjee calculated values.

Sabina Cerimagic 

This journal paper is a literature review which aims to take a closer look at how different ethnicities/races, cultures and socioeconomic status affect both patients and their families and how those factors influence patients' medical decision-making. Both culture and socioeconomic status have been shown to influence the stage at which an individual is diagnosed, how that individual copes with their diagnosis and what medical decisions the patient will make. Hence, it is of utmost importance that more research in the area of cross-cultural and socioeconomic influences on urological cancer patients is conducted. Additionally, medical practitioners must take into consideration patients' cultural and socioeconomic backgrounds when treating them if the treatment is to be effective and efficient. A lack of cultural and socioeconomic understanding by doctors may lead to misperceptions and misunderstandings, which in turn can lead to poor interaction between patients and doctors as well as unwanted or inappropriate clinical outcomes.

Raafat A. Hegazy and Abdelmonem A. Hegazy 

Aim of the study: To highlight the importance of cell-block study in combination with FNAC in the diagnosis of different thyroid lesions. Patients and methods: This study was a retrospective study of 85 Egyptian patients with thyroid swellings, coming to cytopathology unit, faculty of medicine, Zagazig U:niversity. FNAC and cell-blocks were performed for each case. Cytological results of FNAC were compared to the cell-block histopathological picture. Results: FNAC findings were diagnosed as follows: 52 (61%) as colloid goiter, 5 (5.8%) as Hashimoto thyroiditis, 2 (2.3%) as branchial cleft cyst, 1.0 (1.1%) thyroglossal cyst, 5 (5.8%) follicular neoplasm without atypia, 2 (2.3%) as follicular neoplasm with atypia, 2 (2.3%) as suspicious of malignancy, 10 (11.7%) papillary thyroid carcinoma, and 1.0 (1.1%) thyroid carcinoma of undefined category. Insufficient cases were 5 in number. The sensitivity of FNAC in comparison with histopathological results of cell-blocks was 91.6% and specificity was 97.2%. Conclusion: It is advised to perform cell-block for each case of FNAC of thyroid lesions to decrease the pitfalls and to improve the diagnosis and management of thyroid lesions.