01/30/2017
Research Article

Predictive Psychological Factors of Problematic Alcohol use in University Students

Hatice Demirbas*

The objective of this study is to determine prevalence of alcohol-substance use among university students, and to investigate the correlation between the childhood abuse, suicide probability and anger expression styles in students who have drinking problems. A survey was carried out among randomly selected students from the Faculty of Education in Baskent University in Turkey. Study sample consists of 399 university students. Childhood Trauma Questionnaire (CTQ), Trait Anger and Anger Expressions Scales (T-Anger-Anger EX), and Suicide Probability Scale (SPS) were used. The CAGE questionnaire was applied to identify the problems of alcohol use. Probable presence of an alcohol use disorder is indicated by a score of 1+, whereas a score of 2+ was taken as the cut-off point for assessing presence of clinically significant alcohol use problems. Data were analyzed using with t test and multiple binary logistic regression. Of the whole sample 36.9% reported that they had ever tried drinking alcohol. The overall prevalence of alcohol use problems according to CAGE 1+ was 14.4% and CAGE 2+ was 7.3%. Sexual abuse and Anger-In were predictors of CAGE 1+, suicide probability was predictor of CAGE2+. Childhood trauma experiences especially, sexual abuse, suicide probability, trait anger, the anger expressed inside and outside were main factors to identify alcohol use problems. Professionals and parents must pay attention to childhood traumatic experiences, suicide and anger expression styles in youths with alcohol use problems.

01/30/2017
Mini Review

Novel Challenges for the Therapeutics of Depression: Pharmacological Modulation of Interaction between the Intracellular Signaling Pathways Mediated by Ca2+ and cAMP

Afonso Caricati-Neto and Leandro Bueno Bergantin*

Depression is a psychiatric disease resulting mainly by dysfunction of serotoninergic and monoaminergic neurotransmission in central nervous system (CNS). Due to the multifaceted nature of depression and our limited understanding on its etiology, depression is difficult to be treated with currently available pharmaceuticals. Then, new therapeutic strategies for depression have been proposed. Since 1975, several clinical studies have reported that L-type Ca2+ channel blockers (CCBs), used in anti-hypertensive therapy, produce increase of plasma catecholamine levels and tachycardia, typical symptoms of sympathetic hyperactivity. Despite these adverse effects of CCBs have been initially attributed to adjust reflex of arterial pressure, during almost four decades these enigmatic phenomena remained unclear. In 2013, we discovered that this paradoxical sympathetic hyperactivity produced by CCBs results from the increase of catecholamines release from sympathetic nerves, and adrenal chromaffin cells, due to its modulatory action on the interaction between intracellular signaling pathways mediated by Ca2+ and cAMP (Ca2+/cAMP signalling interaction). Then, the pharmacological modulation of this interaction by combined use of L-type CCBs, and cAMP-enhancer compounds, could be a more efficient (and safer) therapeutic strategy to produce increase of serotoninergic and monoaminergic neurotransmission in the CNS due to enhance of serotonin and monoamines release, thus attenuating clinical symptoms of depression in humans.

01/30/2017
Case Report

Tumours of the Uterine Corpus: A Histopathological and Prognostic Evaluation Preliminary of 429 Patients

Jorge F Cameselle-Teijeiro*, Javier Valdes-Pons, Lucia Cameselle-Cortizo, Isaura Fernandez-Perez, MariaJose Lamas-Gonzalez, Sabela Iglesias-Faustino, Elena Figueiredo Alonso, María-Emilia Cortizo-Torres, María-Concepcion Agras-Suarez, Araceli Iglesias-Salgado, Marta Salgado-Costas, Susana Friande-Pereira and Fernando C Schmitt

A histopathological review preliminary of 429 patients diagnosed with tumours of the uterine corpus (TUC) cancer between 1984- 2010 in the Vigo University Hospital Complex (Spain) were evaluated prospectively for over 5 years. Of these 403 (93.9%) were epithelial tumours: 355 (82.7%) were adenocarcinomas of the endometrioid type, 5 (1.1%) mucinous adenocarcinoma, 10 (2.3%) serous adenocarcinoma, 17 (3.9%) clear cell carcinomas, 11 (2.5%) mixed adenocarcinoma, 4 (0.9%) undifferentiated carcinomas and 1 (0.2%) squamous cell carcinomas. A total 20 (4, 6%) were mesenchymal tumours: 4 (0.9%) endometrial stromal sarcoma, 7 (1.6%) Leiomyosarcoma, 9 (2%) Mixed endometrial stromal and smooth muscle tumour. A total 1 (0.2%) were mixed epithelial and mesenchymal tumours: (0.2%) Adenosarcoma 1. And 5 (1.1%) were Metastases from extragenital primary tumour (3 carcinomas of the breast, 1 stomach and 1 colon). The mean age at diagnosis from total series were 65, 4 years (range 28-101 years). Age was clearly related to histologic type: Endometrial stromal sarcoma 46.0 years, Leiomyosarcomas 57.1 years, Adenocarcinomas of the endometrioid type 65.4 years, Clear cell carcinomas 70.1 years and mixed endometrial stromal and smooth muscle tumours 71.2 years. Five-year disease-free survival rates for the entire group were: Endometrial stromal sarcoma 50%, Leiomyosarcomas 28.6%, Adenocarcinomas of the endometrioid type 83.7%, Clear cell carcinomas 64.7% and mixed endometrial stromal and smooth muscle tumours 44.4%. The 5-year disease-free survival rates of patients with Adenocarcinomas of the endometrioid type tumors were 91.4% for grade 1 tumors, 77.5% for grade 2, and 72.7% for grade 3.

In conclusion, we describe 5-year histological and disease-free survival data from a series of 429 patients with TUC, observing similar percentages to those described in the medical literature. The only difference we find with other published series is a slightly lower percentage of serous carcinomas (ESC) that the Western countries but similar to the 3% of all ESC in Japan. Our investigation is focus at the moment on construct genealogical trees for the possible identification of hereditary syndromes and to carry out germline mutation analysis.

01/30/2017
Case Report

Recurrent Peripheral Ameloblastoma of the Mandible: A Case Report

Angela Jordao Camargo*, Mayara Cheade, Celso Martinelli and Plauto Christopher Aranha Watanabe

Ameloblastoma is the second most common odontogenic tumor being back only for the odontoma. An unusual case of recurrent peripheral ameloblastoma in the mandible from the site of previous occurrence, reducing oropharyngeal space due compression by lesion. Panoramic radiography not showed presence of lesion, except one step in left side of mandible angle. Multislice CT scans revealed presence of hypoattenuated image, well-defined, histopathological exam suggesting Ameloblastoma Follicular.

01/30/2017
Clinical Image

Pulmonary Infarction Mimicking An Aspergilloma In A Heart Transplant Recipient

Antonacci F*, Belliato M Bortolotto C, Di Perna D, Dore R, Orlandoni G and D’Armini AM

This patient (male, 59 years old) underwent cardiac re-transplantation for chronic rejection. Prior to re-transplantation, the patient was in NYHA class IV, with a clear chest x ray. On 14th postoperative day, he presented hemoptysis. On chest x-ray, a left lower lobe opacity was seen. Therefore, a chest CT scan was done and it showed a round mass within a pulmonary cavity surrounded by airspace in proximity of the pulmonary artery. The radiologist strongly suspected a pulmonary lesion similar to an aspergillum’s disease. The radiological appearance together with the immunocompromised status of the patient made the diagnosis of aspergillosis possible. Considered the high risk of a devastating hemoptysis due to the aspergillum vascular invasiveness, a left lower lobectomy was performed. The following course was characterized by a difficult weaning from mechanical ventilation and the patient was discharged on 45th postoperative day post lobectomy. Surprisingly pathological examination showed an abscessual cavity in an area of pulmonary infarction.

We focused on aspergillosis in view of the above-mentioned aspects, nevertheless a differential diagnosis of pulmonary infarction could have been considered because of the prolonged bed rest and recent surgery. Lung lobectomy appeared to be the correct treatment since, both in case of aspergilloma and in case of pulmonary infarction, the left inferior lobe would have never recovered a normal function.

01/20/2017
Case Report

Cystic Micronodular Thymoma. Report of a Case

Mona Mlika*, Adel Marghli and Faouzi Mezni

Micronodular thymoma is a rare subtype of thymoma with less than 20 cases published in the English literature. These tumours have been reported with thymoma or thymic cyst. The authors describe a new case of micronodular thymoma in a 68-year-old-patient which is well documented and particular by its cystic degeneration which hasn’t been described yet. Micronodular thymoma is a rare variant of thymoma with a challenging diagnosis. Clinicians must be aware of this entity in order not to confuse it with a thymic cyst.

01/25/2017
Research Article

A Further Example Showing Efficiency of a Modeling Method Based on the Theory of Dynamic Systems in Pharmacokinetics

Maria Durisova*

Aims: To present a further example showing an efficiency of a modeling method based on the theory of dynamic systems in pharmacokinetics.

Study design:The goals of the current study were twofold: to present (1) a further example showing efficiency of a modeling method based on the theory of dynamic systems in pharmacokinetics, an to perform (2) a next step in tutoring the use of computational and modeling tools from the theory of dynamic systems in pharmacokinetics.

The data available in the study by Plusquellec et al. published in the October Issue of the Journal Medical Engineering & Physics were used to exemplify the method considered here. For modeling purpose an advanced mathematical modeling method was employed. Modeling was performed using the computer program named CTDB described in the study by Dedík et al. published in September 2007 issue of the Journal Diabetes Research and Clinical Practice.

Main outcome: Modeling results revealed that computational and modeling tools from the theory of dynamic systems can be successfully used in the development of a mathematical model of such a complicated process as is a multiple sites discontinuous gastrointestinal absorption.

01/24/2017
Research Article

Kinematics and Electromyographic Analysis of Gait with Different Footwear

Carlos Alberto Kelencz*, Ingrid Solange Sepulveda Munoz, Paulo Rui de Oliveira, Bruno Mazziotti and Cesar Ferreira Amorim

Kinematic analysis and surface electromyography are tools being used as important methods to evaluate the human gait and to analyze different types of footwear aiming modifications and adaptations to the human locomotor system, especially of the feet. The aim of the present study was to analyze through electromyography (EMG) the muscles tibialis anterior (TA) and gastrocnemius lateralis (GL) and gastrocnemius medialis (GM) and to capture digital images of the human gait in four different footware situations, barefoot with tennis, platform shoes and high heels. Twenty healthy women with a mean age of 22.6 years took part in this experiment, which was performed on a treadmill at a speed of 3.8 m/s. The results showed that shoes that do not allow a normal movement of the tarsal bones caused changes in the trajectory of the gait, which promotes a greater muscular movement. This study concluded that shoes closer to a normal position and allow greater mobility of the feet, decrease muscular demands, which in everyday situations cause less localized muscular fatigue.

01/25/2017
Research Article

Associations of Burnout, Secondary Traumatic Stress and Individual Differences among Correctional Psychologists

Irina G. Malkina-Pykh*

Objective: The aim of the present study was to examine associations between secondary traumatic stress (ST), job burnout (BO) and several psychological variables such as world assumptions and locus of control in correctional psychologists.

Methods: This study utilized information provided by 87 currently prac¬ticing correctional mental health providers (psychologists) in the correctional settings across Russia in St.Petersburg, Belgorod, Vladimir, Kaluga, Ryazan, etc. The sample included 51 men, 36 women. The mean age of participants was 34.9±6.9 (ranging from 25 to 48 years). Participants reported working a mean of 6.23 ± 3.5 years (ranging from 3 months to 15 years) in a correc¬tional setting. Subjects were assessed with Maslach Burnout Inventory-Human Services Survey (MBI-HSS), Secondary Traumatic Stress Scale (STSS), World Assumption Scale (WAS) and Locus of Control (LC) Scale. Three sets of statistical analysis were provided: ANOVAs between- group comparisons with STS and BO as factors and Spearman correlation analyses.

Results: The results of our study reveal that burnout and secondary traumatic stress in correctional psychologists are significantly positively related and thus may be exacerbated by each other. BO is significantly negatively associated with WAS benevolence scale and the WAS self worth scale and STS is significantly negatively associated with WAS benevolence scale and the WAS meaningfulness scale. However, LC and its components are negatively associated with BO, but not with STS.

Conclusion: The main future direction of our research is to construct nonlinear model of burnout with STS, WA and LC components as predictors, identify its parameters and make its validation.

01/19/2017
Review Article

WMW: A Secure, Web based Middleware for C4I Interoperable Applications

Nida Zeeshan*

Modern-day enhancements in Enterprise Architectures (EA) has increased the interoperability issues in almost all domains; these issues are increasing day-by-day as organizations are spanning and information is being exchanged between different platforms. Command Control Computer Communication and Intelligence (C4I) complex systems are also facing the interoperability issues due to highly classified and sensitive information being exchanged. In this paper we have discussed the integration of different C4I applications running under heterogeneous platforms by allowing them to communicate using a secure and ciphered web based middleware named as Web Middleware (WMW). This middleware is a client-server based web adaptor to achieve clean, systematic, secure and reliable communication. The main feature among many is the simple HTTP browser based customization that do not require any specific or special add-ons and controls to be installed on the client machine. Architecture usage, and initialization of the WMW middleware is discussed with security and performance discussion.

01/09/2017
Research Article

Poly-dopamine-Beta-Cyclodextrin Modified Glassy Carbon Electrode as a Sensor for the Voltammetric Detection of L-Tryptophan at Physiological pH

Mohammad Hasanzadeh*, Nasrin Shadjou, Sattar Sadeghi, Ahad Mokhtarzadeh and Ayub karimzadeh

The main purpose of this report was to develop application of poly-dopamine-beta-cyclodextrin modified glassy carbon electrode (PDA-β-CD-GCE) towards electrooxidation and determination of L-Tryptophan (L-Trp) and also the evaluation its kinetic parameters. In continuation of our efforts to use PDA-β-CD-GCE for amino acids detection, our objective in the present work was to expand application of this sensor for the determination of L-Trp which is very sensitive.

01/23/2017
Case Report

Cytology and DNA Analysis of Ameloblastoma - A Case Report

Karmen Trutin Ostovic*, Berislav Rozman, Ivica Luksic, Miso Virag, Dalibor Franceski, Zorana Lipsanski1, and Spomenka Manojlovic

Ameloblastoma is a benign odontogenic tumour that may have aggressive biological behavior with local recurrence and metastasis after the surgical resection. We report a case of cytology of recurrent ameloblastoma. The first tumour was diagnosed in the left mandible in 57-yers-old woman thirteen years ago. The patient was operated on, the tumour was enucleated, pathohistological diagnosis of ameloblastoma was put and DNA analysis by flow cytometry of the tumour was performed. DNA analysis showed that the tumour was diploid but proliferative. Two years after the operation, a new tumour appeared on the scar. Fine needle aspiration cytology with ultrasound guidance of the tumour was performed; cytological diagnosis of recurrent ameloblastoma was put and confirmed by pathohistology. Until now the patient is well without any new recurrent ameloblastoma.

01/09/2017
Case Report

Impact of Diabetes on the Nutritional Status of CKD Patients

Amalu B. Mathew*, Kundhala Ravi and Gopalan TR

Background: Prevalence of malnutrition in Chronic Kidney Disease (CKD) patients is due to their lower appetite level. Diabetic patients experience polyphagia. Hence it is necessary to understand the impact of diabetes on the nutritional status of CKD patient.

Aim: To compare the nutritious status between the CKD patients with and without diabetes.

Objectives: To find out the impact of diabetes on the nutritional status of CKD patients.

Method and Materials: A prospective random sampling method was adopted to select the subjects. Eighty CKD patients were divided equally into two groups. Tool which has been used to collect the data was SOAP format.

Results: While comparing BMI between group 1(CKD without diabetes) and group 2(CKD with diabetes) it was noticed that the percentage of normal nourished subjects in group 2 were greater than that of group1. About 63% and 25% of subjects with CKD in group1 had normal BMI and grade 1 undernourished respectively. In group 2, about 75% and 10% of patients had normal BMI and grade 1 over nourished respectively. About 80% of subjects in group 2 were on insulin treatment. About 88% of subjects in group1 were anorexic and about 55% and 25% of subjects in group 2 had polyphagia and normal appetite respectively. The difference in the energy and protein intake between the two groups was statistically significant at p<0.01 level.

Conclusions: It can be concluded from the above study that a better nutritional status was found in the CKD patients with Diabetes Mellitus (DM) than the CKD patients without DM which may be due to their normal appetite/ polyphagia, hence allowing a better food intake among group2 subjects. Weight gain in CKD with DM patients may be due to increase in fat mass which is subsequent to lipogenic effect of insulin.

01/03/2017
Case Report

Bouveret Syndrome in an Elderly Female

Zvi H. Perry*, Udit Gibor, Shahar Atias, Solly Mizrahi, Alex Rosental and Boris Kirshtein

Introduction: A gastric outlet obstruction secondary to a gallstone ileus is known as Bouveret syndrome. Herein we present a case of an elderly woman with an impacted gallstone in duodenum and discuss its’ management.

Patient description: A 96-year-old woman was admitted to our department due to a gastric outlet obstruction. Initial gastroscopy revealed a gastric bezoar. An attempt for its extraction failed. She underwent a laparotomy in which a cholecystoduodenal fistula and a large impacted stone were found. Separation of the fistula, including closure of the duodenum side, cholecystectomy and removal of the obstructing gallstone were performed. Additional stones were found and retrieved during common bile duct (CBD) exploration. Surgery was finalized by duodenoplasty, closure and T-tube drainage of the CBD. Post-operative course was prolonged and uneventful.

Discussion and Conclusions: Bouveret syndrome is a rare cause of gastric outlet obstructions. In this case, unsuccessful endoscopic treatment necessitated surgery for removal of impacted gallstone in the duodenum.

01/02/2017
Review Article

Laparoscopic Adrenalectomy; A Short Summary with Review of Literature

Mushtaq Chalkoo*, Naseer Awan, Hilal Makhdoomi, Syed Shakeeb Arsalan and Waseem Raja

We present a review article on adrenal glands, with a special reference to their anatomy, physiology, evaluation, laparoscopic operative techniques with a short summary of review of literature.

01/20/2017
Research Article

Ethical Dimensions of Population Genetic Research in the Caucasus

Ramaz Shengelia* and Theodore G Schurr

The emergence and establishment of anthropological genetics as an interdisciplinary science is primarily, associated with the development of new genomic technologies. Precision genetic testing on the one hand, and the rapidly increasing number of genetic investigations on the other, have created a set of bioethical dilemmas for genetic and epidemiology research. Such research deals with persons who have the right to the protection of their personal information and confidentiality, and also concerns collective (village, region, ethnic group, state) consciousness, ethnic identity, and traditional culture, i.e., so called “ethnic pride”. In this regard, taking into consideration the results of ongoing field research, we make some recommendations for better management of relationships with individuals and communities and the preparation of questionnaires and informed consent forms that will facilitate similar research projects, especially in such an ethnically, linguistically and culturally diverse region such as the Caucasus.

01/09/2017
Short Review

Endothelial Repair and Endothelial Cell-Derived Secretome

Alexander E. Berezin*

Growing evidence supports the hypothesis that endothelial cell-derived microparticles (MPs) might contribute to the pathogenesis of cardiovascular (CV) disease. Endothelial cell-derived MPs play a pivotal role in the regulation of the endogenous repair system, thrombosis, coagulation, inflammation, immunity and metabolic memory phenomenon. There is evidence that the MPs are secreted actively accompanied to other regulatory molecules. All these actively synthetizing and secreting factors include proteins, adhesion and intercellular signal molecules, peptides, lipids, free DNAs, microRNAs, and even microparticles (MPs) are defined as cellular secretome. The proteomic profile of secretome is under tightly control of genetic and epigenetic mechanisms, which may altered a secretion of the proteins involved into MPs’ organization. Finally, this may contribute the modification of MP’s after their secretion and throughout transfer to the target cells. As a result, communicative ability of endothelial cell-derived MPs may sufficiently worse. Subsequently, cross talk between some components of secretome might modulate delivering cargos of MPs and their regenerative and proliferative capabilities via intercellular signaling networks. The aim of the review is to discuss the effect of various components of secretome on MP-dependent effects on endothelium.

01/27/2017
Research Article

The Outcome of an ADHD Parenting Group Training Programme (APEG) In the Peterborough Neurodevelopmental Service (NDs)

Hani Ayyash*, Michael O Ogundele, Ruth Wisbey, Emma Weisblatt, Lorraine Cuff and Venkat Reddy

ADHD is the most common neurodevelopmental disorder in children and adolescents with prevalence ranging between 5% and 12% in developed countries. There is ample evidence that carefully structured enhanced behavioural parenting programmes are useful in the management of ADHD.

We assessed the outcome of an ADHD group parenting training programme (APEG) offered between 2014 and 2015 by the Peterborough Neurodevelopmental Service (NDS) in improving the knowledge and skills of carers using a pre-/post-training intervention study.

APEG follows a Parent Advisor Model, consisting of a 6-session programme of evidence-based parenting training.

A total of 27 parents completed the 53 pre- and post-course questionnaires. The knowledge and understanding of the parents increased significantly about all aspects of ADHD diagnosis and management in response to all the 5 questions. The difference between the scores of 0 to 3 and 4 or 5 pre- and post-intervention was statistically significant (chi square 239, df 1, p value <0.01).

The study suggests that provision of a psychosocial intervention programme for parents of ADHD children through the APEG parenting training proved to be effective in significantly improving the level of knowledge and understanding of parents regarding several aspects of ADHD diagnosis, symptom identification and behaviour control.

01/19/2017
Case Report

Bilateral Parasymphyseal Osteoma

Akanksha Gupta, Sangeeta Singh Malik, Swati Gupta and Ravi Prakash SM*

Osteoma is a benign osteogenic tumor arising from the proliferation of cancellous or compact bone. In the facial bones, both central and peripheral osteomas have been described in the literature. Peripheral type of osteoma is the most common variant in the mandible, which occurs on the cortical bone surface. We present a case of a fourteen year old boy who had swelling on right and left parasymphyseal region. Radiographs revealed radiopacity having onion-peel appearance and histopathology gave the final diagnosis of osteoma. Periosteal reaction giving rise to onion peel appearance on the radiograph has been reported in Ewing sarcoma, Garre’s osteomyelitis and infantile cortical hyperostosis in the literature but our case shows that similar appearance can be there in osteoma as well.

01/21/2017
Short Communication

Sex Differences in Hypertension: A Question worth Asking?

Mario Lombardi, Paolo Severi, Andrea Mazza, Maria Grazia Bendini, Elisa Caldarone, Massimo Armeni, Stefania DEmidio and Massimo Leggio*

Hypertension is a complex disorder involving multiple organ systems and the primarily modifiable risk factor for heart disease, which is the leading cause of death among both men and women in the World. Although both men and women develop hypertension, distinct gender differences in the incidence and severity of hypertension are well established where men have a higher incidence of hypertension compared with women of the same age until the sixth decade of life [1,2]. Despite gender differences in human hypertension, the treatment guidelines do not differ by gender [3]. Even if the causes of hypertension are complex and are related to genetic factors, lifestyle, diet structure, and environmental factors including air pollution [4], coupled with the potential determinants of hypertension, sex differences in hypertension-which exist in human populations-are attributed to both biological and behavioural factors. The biological factors include sex hormones, chromosomal differences, and other biological sex differences that are protective against hypertension in women. These factors become prominent in adolescence and persist through adulthood until women reach menopause. Behavioural risk factors for hypertension include high body mass index, smoking, and low physical activity.

01/30/2017
Short Communication

Role of Carcinoma Associated Fibroblasts in Anoikis Resistance in Oral Squamous Cell Carcinoma –need of the hour

Anjali Ganjre*

Anoikis resistance (AR) is a favorable attribute exhibited by cancer cells for metastasis. Carcinoma associated Fibroblasts (CAFs) plays a crucial role in AR in various cancers. It was proved in array of studies in different cancers that there was definite interrelationship between CAFs and AR. But its role in OSCC is ambiguous. It is the need of the time to reveal the correlation of CAF and oral squamous cell carcinoma (OSCC) in relation with anoikis. Molecular pathways which affects the AR via CAFs in various cancers has been highlighted in this communication. Divulging the importance of CAF in cancer will aid in designing customized novel chemoprevention therapy and thus will help in enhancing the prognosis of patient in OSCC.

01/31/2017
Case Report

Atopic Conjunctivitis in Children: Influence of Treatment with Topical Cyclosporin 0.05% in the Quality of Life

Carlos Alberto Sanchez Salguero and Alvaro Isidro Sanchez Chacon

Introduction:Forty-six per cent children have allergic rhinoconjunctivitis (Allergologica 2005).

Working hypothesis:Ocular topical cyclosporine improves the quality of life for these patients.

Material, methods, design:2-year prospective study (2015-16), 40 patients with topical corticosteroids without improvement, followed 20 and 20 switched to corticosteroids cyclosporine 0.05%. Interview with Quality of Life Questionnaire in Children with rhinoconjunctivitis (PRQLQ) before and at the end of treatment. Mean age of 10.3 years with 60% male-40% female. Treatments were applied from January to March. There were 15 questions divided into two blocks. Children responded using a card with responses rated from zero (not bothered at all) to 6 (quite upset).

Results: Before the 100% reported that, the itching was very bothersome. In the group of 40 children, 80% showed symptoms of epiphora and 60% showed symptoms of ocular inflammation. 100% complained of significant discomfort in rubbing their eyes, 30% did not like to take medications. Headaches affected 20%. 100% stated that they cannot play normally. 80% showed decreased concentration in class.

Continuing with corticosteroids did not show statistically significant changes.

Patients with cyclosporine improved the results by 3 points, with decreased itching, tearing, swelling, pain, eye rubbing, medication and headaches. In the 2nd questionnaire there was limited variation in the results related to fatigue, malaise, and irritability but with substantially improved balance of sleep, insomnia and concentration at school.

Conclusion: Cyclosporine A is a cyclic polypeptide calcineurin inhibitor developed from the fungus Tolypocladium inflatum. The first dilution was 2% but it is currently used at a dilution of 0.05% and recent publications suggest nanosuspensions. Our study showed improvement in parameters related to symptoms, especially itching and lower improvement of psychological aspects, this achieves a better quality of life for children and more willingness to adhere to the treatment.

01/27/2017
Case Report

Pulsed Shortwave Diathermy and Joint Mobilizations Restore a Twice Fractured Elbow with Metal Implants to Full Range of Motion

David O. Draper* and Emily Veazey

A 21-y-old recreationally active male lacking the last 30° of elbow extension from a fractured and dislocated elbow sustained while wakeboarding came to our clinic November of 2015. A regimen was applied of 20-minutes of pulsed shortwave diathermy (PSWD) treatments delivered at 100 watts to heat the affected tissue prior to approximately 40°C followed by 10 minutes of joint mobilizations.This was followed by application of an ice pack to the area for 30 minutes. Measurements and treatments were given on Nov 3,5 and 10. The changes in AROM extension were as follows: Nov 3, from 30° to 20°; Nov 5, from 24° to 10°; Nov 10, from 10° to 0°. Over the course of the treatment the PSWD/ joint mobilizations improved extension AROM of the elbow 30° (full AROM) in just 3 treatments. There was also no post-treatment pain.

01/20/2017
Research Article

Effects of Fast-Walking on Muscle Activation in Young Adults and Elderly Persons

Camila Fonseca de Oliveira*, Denise Paschoal Soares, Michel Christian Bertani, Leandro Jose Rodrigues Machado and Joao Paulo Vila-Boas

Coactivation of agonist and antagonist muscles participates in the regulation of joint stiffness and postural instability. Alterations on muscle activity have been revealed as an important falling risk factor. It is unclear the effects, and age-related differences, of a prolonged demanding task on the muscular coactivation levels.We compared muscle activation amplitude and coactivation of the vastus medialis, biceps femoris, tibialis anterior, and gastrocnemius medialis from surface EMG in 16 young adults (age 21-33) and 8 elderly adults (age 66-72) while fast-walking at 70% of their maximum heart rate. Overall, the elderly demonstrated higher coactivation indexes than the young individuals. Ankle coactivation decreased in the first half of the swing phase, while coactivation at the knee increased in the latter half of the swing phase in our elders. Alterations of muscle activation and coactivation on the knee and ankle were more prominent close to landing and in the swing phase. Our results suggest that these alterations may suggest potential concerns with respect to the risk of falls.

01/23/2017
Case Report

Congenital Quadricuspid Aortic Valve, a Rare Cause of Aortic Insufficiency in Adults: Case Report

Cyrus Kocherla* and Kalgi Modi

Quadricuspid aortic valve (QAV) is rare congenital malformation of the aortic valve with estimated prevalence of 0.013% to 0.043% [1-4]. QAV is most commonly associated with aortic insufficiency (AI), which is found in almost 75% of cases [5].QAV can also be associated with other cardiac defects such as ventricular or atrial septal defects, patent ductus arteriosus, subaortic fibromuscular stenosis, malformation of the mitral valve, and coronary anomalies [3]. Up to 40% of all patients with QAV undergo aortic valve replacement surgery most commonly due to progressive AI in 88% of case [2,3,6]. Here we report a case from our institution of a woman with QAV with severe AI and anomalous origin of the right coronary artery.

01/20/2017
Case Report

Intermittent Left Bundle Branch Block: What is the Mechanism?

Hussam Ali* and Riccardo Cappato

A 73-year-old male underwent cardiologic evaluation for an incidental electrocardiographic finding of left bundle branch block (LBBB). He was asymptomatic and had no relevant cardiac history. Physical examination and transthoracic echocardiogram revealed no abnormalities.

12-lead Holter ECG showed constant sinus rhythm, preserved AV conduction (PR at the upper normal limit) and no brady/tachyarrhythmias. Complete LBBB was observed during prolonged phases of the recording, but occasionally it was intermittent (Figure 1). What is the most likely mechanism of the intermittent LBBB showed in this figure?

01/09/2017
Review Article

Primary Cutaneous Lymphomas and Interferon Treatment

Ajda ERSOY GUNES, Melda COMERT OZKAN*, Fahri SAHIN and Guray SAYDAM

Primary cutaneous lymphomas (PCLs) are the second most common group of extranodal non-Hodgkin lymphomas (NHL) with an estimated annual incidence of 1/100.000. Interferons (IFNs) are used in mono or combination therapy for cutaneous lymphomas especially for cutaneous T-cell lymphomas (CTCL) for years. IFN-α is the most widely-used type for cutaneous lymphomas. IFN-α has been shown to be a highly active agent in CTCL with response rates ranging from 40% to 80%. In this review, the current information about PCLs and IFNs treatment is summarized.

01/21/2017
Case Report

Submitral Ventricular Pseudoaneurysm: Unusual and Late Complication of Cardiac Surgery

Marzia Cottini*, Amedeo Pergolini, Giordano Zampi, Vitaliano Buffa, Paolo Giuseppe Pino, Federico Ranocchi, Riccardo Gherli, De Marco Marina, Carlo Contento*, Myriam Lo Presti, Francesco Musumeci

Despite the background of advances in cardiac surgery procedures for higher risk population, the postoperative complication has already been a challenge for cardiac surgeon and Heart-Team. Future perspectives to exceed this challenge could be periodically patient’s follow up and advance diagnostic workup. We describe the diagnosis of a large sub mitral left Ventricle Pseudoaneurysm that was identified in a 59-year-old woman 17 years after she underwent aortic and mitral valve replacement for rheumatic valvular disease. 

01/09/2017
Review Article

A Multidisciplinary Approach to the Assessment and Management of Pre-school Age Neuro-developmental Disorders: A Local Experience

Michael O Ogundele*

Background: Early and effective identification of childhood neurodevelopmental disorders remains a critical task of all pediatric healthcare professionals, which is critical to the well-being of children and their families.

Methods: A retrospective review of medical records of all preschool children referred to a Child Development Centre (CDC) in North-West England, over a six-month period between Sept 2014 and Feb 2015 was conducted. The local multi-professional approach to the clinical assessment and management of preschool children was described and the published literature on this topic was reviewed.

Results: Twenty four different categories of professionals spanning the whole range of primary, secondary, and tertiary healthcare, social care and educational services were involved in the management of the patients. The largest group of professionals was the primary healthcare specialists. The ten different primary care professionals managed an average of 42% of the patients.

The secondary healthcare providers were involved in the care of an average of 17%, tertiary care providers 10%, educational specialists 25% and social care professionals were involved with 5% of all the patients.

The commonest diagnostic disorders were Speech/Language delay (56%), Global developmental delay (33%), Behavior difficulties (26%), Social communication concerns (21%) and Autistic spectrum disorder (19%).

Conclusion: The high number and specialties of various healthcare professionals at all levels of care indicates the high social and economic investment required in managing the affected preschool children in the region. Childhood neurodevelopmental disorders in the preschool age represents a high level of public health significance.

01/27/2017
Research Article

Empirical formulae for calculating γ-ray detectors effective solid angle ratio

Ahmed. M. El Khatib, Mohamed. S. Badawi*, Mohamed. A. Elzaher, Mona. M. Gouda, Abouzeid. A. Thabet, Mahmoud. I. Abbas and Kholud. S. Almugren

Determination of the detector efficiency using volumetric cylindrical sources is very important in various scientific and industrial fields, especially in the field of quantitative analysis. To calculate the absolute activity of any sample, the full-energy peak efficiency (FEPE) of the detector is needed.By applying the efficiency transfer method, the FEPE of the detector would be determined easily without using the standard sources. This approach depends on two main factors. The first one, is the reference efficiency of the reference source, which is determined experimentally, and the second one, is the calculation of the effective solid angle ratio between the sample and the reference source geometries. This work introduces an empirical formula for calculating the second factor for using two different sizes of NaI(Tl) detectors. The validity of this empirical formula was successfully demonstrated by comparing the calculating values with the experimental values.

01/11/2017
Research Article

Removal of Chromium from Aqueous Solution by Thermally Treated Mgal Layered Double Hydroxide

Enkhtur Otgonjargal, Byambasuren Nyamsuren, Enkhtuul Surenjav, Gunchin Burmaa, Jadambaa Temuujin and Dashkhuu Khasbaatar*

MgAl based layered double hydroxide (MgAl-LDH) was used as adsorbent for the removal of chromium oxyanion from an aqueous solution. MgAl-LDH was synthesized successfully using co-precipitation method, and was characterized by X-Ray Diffractometer (XRD), Scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM-EDX). MgAl-LDH was thermally treated for improving the chromium adsorption. Samples were treated at 220°C and 450°C. A negligible difference of total chromium adsorption capacities was observed between MgAl-LDH000 and MgAl-LDH220 as 12.56 mg/g and 11.01 mg/g. The maximum chromium adsorption capacity of MgAl-LDH was 88.07 mg/g at 500g/l chromium concentration for MgAl-LDH which has been thermally treated at 450°C (MgAl-LDH450). The results indicated that memory effects of thermally treated MgAl-LDH at certain temperatures were retained and enhanced chromium removal efficiency.

01/20/2017
Case Report

“Bulls Eye For Bulls Teeth” - Endodontic Management of Taurodontism Using CBCT as A Diagnostic Tool- 2 Rare Case Reports

Sapna Sonkurla, Manoj Mahadeo Ramugade*, Shubha Hegde, Gopal Tawani

Taurodontism is a rare dental anomaly presented with an aberration of teeth that lacks the constriction at the level of the cemento-enamel junction (CEJ). It is characterized by elongated pulp chambers and apical displacement of bifurcation or trifurcation of the roots, forming a rectangular shape. Whilst, it appears most frequently as an isolated anomaly, its association with several syndromes and abnormalities has also been reported in the literature. Although permanent molars are most commonly affected, this anomaly could also be seen in deciduous dentition, unilaterally or bilaterally, and in any combination of teeth or quadrants. These morphological anomalies pose various challenges to the dentist during their endodontic treatment. Modern diagnostic tools such as Cone beam computed tomography (CBCT), loupes and Dental operating microscopes (DOM) help in achieving better treatment outcome in such cases. The presented article elaborates diagnosis and successful management of 2 rare cases of taurodontism in permanent molars.

01/09/2017
Research Article

Postural Stability Induced by Supervised Physical Training may improve also Oxygen Cost of Exercise and Walking Capacity in Post-Menopause, Obese Women

Fernanda Velluzzi, Massimiliano Pau, Andrea Loviselli, Raffaele Milia, Daniela Lai, Daniele Concu, Gianmarco Angius, Abdallah Raweh, Andrea Fois and Alberto Concu*

We utilized the training impulses method to numerically quantify the volume of physical exercise to be prescribed to postmenopausal obese women in such a way of obtain the best possible improvement of their health-related quality of life.Nine women (57±4 years, 89±2 kg, 157±9 cm) carried out 3-months of exercise training (3 session/week each lasting 80 min) under the supervision of skilled operators which indirectly calculated the volume of physical exercise by assessing heart rate values while patient exercised and making sure that the workload corresponded to 50-60% of their maximum oxygen uptake. Before and after training anthropometric, functional and biomechanical variables were assessed. After training patients shoved statistically signifi cant (P<0.05) reduction in body mass (-2%) and body mass index (-4%), waist circumference (-4%), total (-6%) and LDL (-26%) serum cholesterol and glycaemia (-8%), diastolic arterial blood pressure (-14%), and oxygen cost (-14%) at the maximum workload during incremental cardiopulmonary test, the sway area from unipedal stance (right leg) of 20 s on a pressure platform (-49%), while increased both free fat body mass percentage (+3%) and space covered during the six minute walk test (+11%). It was concluded that, when an exercise protocol is carried out by postmenopausal obese women and the volume of exercise is instrumentally controlled by experienced operators, it could result in an effective benefi t on the quality of life of these patients since they ameliorate some critical anthropometric and functional parameters.

01/02/2017
Research Article

New Approach for Analysing the Discrepancy of Pretherapeutic Tc-99m and Intra-therapeutic I-131 uptake in Scintigraphies of Thyroid Autonomies using a Parametric 3D Analysis Program

Maaz Zuhayra, Marlies Marx, Ulrich Karwacik, Yi Zhao and Ulf Lützen*

Introduction: Radioiodine therapy is a standard procedure in thyroid autonomy treatment. Discrepancies in the visual comparisons of the scintigraphies prepared for this purpose using Tc-99m-O4- and I-131 have been known for years.In this study a new method is used to calculate and perform a quantitative comparison of both uptakes using subtraction analysis and 3D imaging. The results and their causes are discussed together with practice-relevant conclusions for better clinical results.

Material and Methods: The new method was used in 38 patients with thyroid autonomies for the subtraction analysis of standardized pretherapeutic and intratherapeutic scintigraphies. The parametric distribution of activity was calculated absolutely and as a percentage and displayed three-dimensionally. These results were compared with the visual assessment of the different scintigraphies by the experts. Inclusion criteria were pretherapeutic and intratherapeutic hyperthyroidism without medication affecting the thyroid. The time difference between acquiring the scintigraphies was 28 days maximum.

Results: Activity distribution was visually discrepant in 39.5% of cases. 60.5% displayed comparable uptake. The calculated values showed reversed results after applying the new method. The results using our method show a higher rate of calculated discrepancies compared with visual analysis.

Conclusion: Accurate functional imaging of the thyroid is next to further aspects very important in establishing the diagnosis and deciding about the therapy activity for thyroid treatment. In combination with clinical symptoms and laboratory values, Tc-99m-O4 - scintigram can be used for an orientated, preliminary assessment of functional disorders of the thyroid. But because of the higher rate of found discrepancies, the solely use of Tc-99m-O4 - scintigram is not always capable for exact and reliable diagnosis. The known reason for this is most probably due to the different biokinetics of both radiopharmaceuticals, which can be imaged more sensitively with this method. Consequently, a scintigram should be performed in the pretherapeutic radioiodine uptake test. Despite higher costs and radiation exposure, alternatively, pretherapeutic use of other diagnostic iodine isotopes like I-123 or -124 should be discussed, because they could overcome the limitation of the different biokinetics. Following this approach the preliminary assessment using Tc-99m-O4 - scintigraphy can be precised and double checked to improve diagnostic confi dence and treatment results for a better outcome of the patients.

 
 
Results: Activity distribution was visually discrepant in 39.5% of cases. 60.5% displayed comparable uptake. The calculated values showed reversed results after applying the new method. The results using our method show a higher rate of calculated discrepancies compared with visual analysis.