09/20/2017
Research Article

Rehabilitation of proximal humerus fractures: An environmental scan of Canadian physiotherapy practice patterns

Lowell L Kwan and Norma J MacIntyre*

Background: Proximal humerus fractures (PHFs) are common injuries particularly in older adults. Evidencebased protocols for PHF rehabilitation are lacking and physiotherapists use a variety of interventions.

Purpose: To determine practice patterns and perceptions of physiotherapists who treat adults with PHF in Ontario, Canada.

Method: A paper and pencil survey asking about respondent demographics and management of Neer Group 1 (minimally/nondisplaced) and complex (displaced 3- and 4-part) PHF was mailed to 875 randomly selected physiotherapists who were registered with the College of Physiotherapists of Ontario in 2013/2014 and working in practice areas likely to be accessed by adults with PHF.

Results: The response rate was low (10%); 83 physiotherapists completed the survey - 80% had experience managing PHF. Respondents treated 1-5 individuals with PHF annually; more treated Neer Group 1 PHF (89%) than complex PHF (68%). Most individuals with PHF were older than 60 years (64%), female (76%) and accessed physiotherapy through a doctor’s referral (91%) more than 1 month post injury (33%).

Main findings: Physiotherapists manage PHF using multi-component interventions and a minimum of 76% include the following elements: education and progression of passive, active assisted, active range of motion exercises and muscle retraining to build coordination and strength. Use of other elements was variable. The main factors influencing the treatment plan were the ability of the individual with PHF to comply, bone quality, and fracture type. Most respondents were unsure that there is sufficient PHF rehabilitation literature to guide treatment.

Conclusions:This environmental scan is the first North American study to document practice patterns and attitudes of physiotherapists providing PHF rehabilitation. Elements used by physiotherapists in Ontario treating small numbers of individuals with Neer Group 1 or complex PHFs each year align well with the limited PHF rehabilitation literature available.

Potential implications:Multi-disciplinary collaborations to design and conduct large, high quality, multi-centre prognostic studies and RCTs that evaluate the effectiveness of key aspects of non-surgical PHF rehabilitation in various patient groups are needed. Meanwhile, consensus guidelines should be developed in the context of region-specific physiotherapy service models to inform best practice in PHF rehabilitation management.

 
 
 
 
09/25/2017
Short Communication

Kummoona Chondro-Ossous Graft for Reconstruction of the Temporomandibular Joint in Children

Raja Kummoona*

There are a lot of controversy about the usage of graft for reconstruction of the TMJ, many researchers tried in the past different technique to be applied in the TMJ [1], for restoration of growth and all failed and some of these techniques may be used for one trial without success.

The Chondro-Ossous graft is the most valuable graft been advocated since 1986 for reconstruction of the temporomandibular joint (TMJ). There is two successful graft been used for reconstruction of the TMJ in children, the Costo-Chondral graft and Chondro-Ossous graft, Costo-Chondral graft been studied clinically by Kennett 1973 and experimentally on Mecaca Iris Monkeys 1974 by Poswillo to assess the viability of the graft [2,3], his work was a breakthrough in research and in reconstruction with restoration of growth of TMJ and this graft been widely used for reconstruction of the TMJ for few decades [4].

09/27/2017
Case Report

Gastric Mucosal Calcinosis

Vedat Goral*, Irem Ozover and Ilknur Turkmen

Gastric mucosal calcinosis is a very rare pathology of the gastric mucosa. It may develop secondary to several diseases but may also be idiopathic in some cases. In this case, gastric mucosal calcinosis was diagnosed with endoscopic biopsy performed for a patient who presented to our clinic with heartburn and abdominal discomfort. This case involves a very rare gastric pathology, and is being studied here with reference to literature data.

09/27/2017
Review Article

Ra-223 dichloride management in a Nuclear Medicine Unit: experience of a referral institution

Giulia Anna Follacchio*, Viviana Frantellizzi, Francesco Monteleone, Giuseppe De Vincentis and Mauro Liberatore

Ra-223 dichloride is a first-in-class alpha-emitting radiopharmaceutical recently introduced into clinical practice for treatment of men with Castration-Resistant Prostate Cancer (CRPC) and symptomatic bone metastases.Due to the proven benefit on Overall Survival and the favorable toxicity profile, Ra-223 therapy is gaining widespread use in both US and Europe. In this article, we describe the routinary management of patients undergoing Ra-223 treatment in our Institution.

Currently, Ra-223 therapy is indicated for 6 intravenous injections (55 kBq per kg of body weight) administered every 28 days. In comparison to other radiopharmaceuticals, Ra-223 handling and administration do not need any additional training for authorized users. Due to the minimal external dose rate emission, Ra-223 dichloride can be delivered in an outpatient setting. Moreover, no particular precautions other than standard hygiene measures must be taken by patients’ family members or caregivers. Ra-223 therapy is associated to a favorable hematologic toxicity profile, while non-hematologic adverse events are generally mild and easy to manage.

Given the favorable toxicity profile of this treatment, clinical trials are currently ongoing to evaluate efficacy and safety of Ra-223 treatment in combination or sequence with recently approved drugs such as abiraterone acetate, enzalutamide and sipuleucel-T. In addition, the recent interest in Ra-223 bone lesion dosimetry could open the way to a dosimetric-based therapeutic approach with Ra-223. In this new scenario, results of these promising clinical trials may help clarifying the optimal sequencing of new therapeutic possibilities for metastatic CRPC and the appropriate eligibility criteria for Ra-223 treatment in oncologic patients.

09/28/2017
Mini Review

A decade of targeted therapy for non-small cell lung cancer

Khalid Abu Ajaj*

Chemotherapy is one of the main treatment options for cancer. However, chemotherapeutic agents usually suffer from poor pharmaceutical properties that restrict their use. Targeted therapy drugs have been developed to specifically target changes in cancer cells that help these cells to grow. Such drugs often work when standard chemotherapeutic drugs do not, they often have less severe side effects and they are most often used for advanced cancers. The objective of this article is to give an overview about the 16 FDA-approved targeted therapy drugs to treat non-small cell lung cancer.

09/27/2017
Research Article

Fluticasone furoate/Vilanterol 92/22 μg once-a-day vs Beclomethasone dipropionate/Formoterol 100/6 μg b.i.d. in asthma patients: a 12-week pilot study

Claudio Terzano* and Francesca Oriolo

Two of the most recent LABA/ICS combinations for treatment of persistent asthma are Fluticasone furoate/Vilanterol 92/22 μg (Ellipta) and Beclomethasone dipropionate/Formoterol 100/6 μg (Nexthaler).

Objective: To compare once-daily Fluticasone/ Vilanterol combination with twice daily Beclomethasone/ Formoterol association in moderate asthma, in terms of quality of life and lung function.

Methods: Fourty patients with moderate asthma treated with Beclomethasone/Formoterol 100/6 µg or Fluticasone/Vilanterol 92/22 µg. We revalued patients in terms of lung function and Asthma Control Test, at 4, 8 and 12 weeks to assess any differences between the two groups. After 4 weeks, thirty-one of the fourty patients were evaluated in terms of respiratory function at predetermined time intervals.

Result: In patients treated with beclomethasone/formoterol FEV1 presented a mean value of 78% at the third visit and of 79.1% during the final check, compared with 74.5% and to 75.8% in patients in treatment with fluticasone/vilanterol (p 0.01). Mean values of IC and MMEF25-75% were higher in patients treated with beclomethasone/formoterol compared with fluticasone/vilanterol. For the dyspnea it was a difference at the third observation. For the nocturnal symptoms and the use of rescue drug there was a significant difference, except at the beginning. For the perception of control by patients, there was a difference in the two groups at the beginning, after 4 and 8 weeks. Total ACT score showed a significant difference after 4, 8 and 12 weeks. In the group treated with beclomethasone/formoterol FEV1 value was significantly higher at a distance of four hours after drug administration (p 0.04) and after the second dose (p 0.02) compared with the group treated with fluticasone/vilanterol.

Discussion: Patients in treatment with beclomethasone/formoterol showed improved asthma control and nocturnal symptoms and more stable respiratory function compared with patients receiving fluticasone/vilanterol.

 
 
Result: In patients treated with beclomethasone/formoterol FEV1 presented a mean value of 78% at the third visit and of 79.1% during the final check, compared with 74.5% and to 75.8% in patients in treatment with fluticasone/vilanterol (p 0.01). Mean values of IC and MMEF25-75% were higher in patients treated with beclomethasone/formoterol compared with fluticasone/vilanterol. For the dyspnea it was a difference at the third observation. For the nocturnal symptoms and the use of rescue drug there was a significant difference, except at the beginning. For the perception of control by patients, there was a difference in the two groups at the beginning, after 4 and 8 weeks. Total ACT score showed a significant difference after 4, 8 and 12 weeks. In the group treated with beclomethasone/formoterol FEV1 value was significantly higher at a distance of four hours after drug administration (p 0.04) and after the second dose (p 0.02) compared with the group treated with fluticasone/vilanterol.
 
09/27/2017
Mini Review

Joint Functional Screening for Older Adults: Clinical Prevention of Accidental Fall

Balwant S Bains*

As people get older, chronic diseases become an important reason of disability while a decline in physical functions is related to aging among the elders, which may lead to dependency and isolation of the older adults.Body asymmetry and imbalance body alignment can bring added stress to the joint structures that can cause dysfunction of the joint, ligaments, tendons, bursas, and related muscles, which in return brings about problem while walking or during activities of daily living. Joint Functional Screening (JFS) is a systemic clinical examination with clinical reasoning of the entire human joints body, with or without causative limitation to derive a holistic analysis of musculoskeletal system. JFS profile helps to assess body disorder of older people. This clinical screening include documentation of balance of the body, lower and upper body strength, joints flexibility, body composition, and body alignment. This is an innovation build to profile a normal musculoskeletal state to decode any anomaly in an otherwise a normal subject, who might be preparing to take up any activities in one’s lifespan that could elicit an injury which could be prevented. JFS could be a useful tool for physiotherapists, exercise therapist or even the personal trainers to screen a body prior to rehabilitative or an exercise program; and this clinical screening is presently a best guidance to prevent risk of fall or injury among individual healthy people and older adult.

09/27/2017
Research Article

Evaluation of genetic diversity in germplasm of paprika (Capsicum spp.) using random amplifi ed polymorphic DNA (RAPD) markers

Renganathan P, Ruiz-Alvarado C, Hernandez-Montiel LG, Prasath Duraisamy and Rueda-Puente EO*

Capsicum spp. is one of the most important economical horticulture crops due to its high consumption either by fresh vegetable or dried spice. Molecular genetic markers offer a number of applications in the genetic improvement of crop plants, which plays an important role in the areas of plant classification and breeding programs.The polygenetic characters of rare species, which are difficult to analyze by traditional methods can, be analyzed easily and classified by using molecular markers. In our study, genetic relationships of twenty-two paprika species were examined to estimate their genetic variations/similarities and to detect the polymorphism present within and among the paprika species by using RAPD-PCR markers. The results revealed that the maximum similarities among the 16 ICBD lines were 100%. The ICBD 03 had 76% similarity compared with other ICBD lines. The CC01 had comparatively low similarity with ICBD forms (30%), followed by EC01 (28%), EC02 (33%), CC02 (35%), and Kt.Pl-19 (60%). The similarity between EC01 and EC02 were 54%. Kt.Pl-19 showed different similarities compared to CC01 (41%), CC02, EC01 (38%), EC02 (29%) and ICBD 03 (40%). The different combinations were tried to optimize the RAPD-PCR profile, which helped to assessing the polymorphism/similarities within and among the Paprika germoplasms were studied.

09/26/2017
Case Report

CT signs of pressure induced expansion of paranasal sinus structures

Peter AR Clement* and Stijn Halewyck

Several articles have been written about hyper inflated sinus structures. Never before, however, a complete overview of all possible pressure induced variations of sinus anatomy have been published. The aim of this study was to make an inventory of the most common CT signs of hyper inflated paranasal sinus structures. During a period of 2 years all CT-scans of the paranasal sinuses made in an ENT-department were studied and the most typical shapes of hyper inflated sinus structures were recorded.

The authors documented 9 different anomalies of the anterior paranasal sinus complex (frontal sinus, frontal and supra-orbital recess and anterior ethmoid), 8 of the ethmoid and 1 of the sphenoidal sinus. These hyper inflated paranasal sinus structures can only be generated by high positive intranasal pressures. The nose blowing manoeuvre is the only manoeuvre that generates extremely high pressures and as such it might be the driving force in the generation of these hyper inflated paranasal structures and consequently play a role in the pathophysiology of chronic sinusitis.

Pneumatisation of the sinuses starts at birth and is a lifelong process. Sometimes, however, pneumatisation can be extreme and will result in facial deformities. Pneumosinus dilatans, is such a condition, characterized by an abnormal dilatation of a paranasal sinus cavity, containing air only. Most reports describe pneumosinus dilatans of the frontal sinus, but also other sinuses can show this phenomenon: maxillary sinus and in one case a unilateral pneumosinus dilatans of nearly all sinuses (maxillary, ethmoid, and sphenoid sinus) was described.

Recently Kalavagunta et al., described a less dramatic expansion of the maxillary sinus and named it “Extensive Maxillary Sinus Pneumatisation” (EMSP). They were surprised to see that EMSP has received little attention in the literature. Neuner et al., described 9 different atypical pneumatisation abnormalities of the paranasal sinus anatomy.

Most of deformities of the sinus pneumatisation are growth deformities of the thick bones that make up the frame of the sinuses. Only a few articles, deal with specific deformities of thinner bone structures such as “wavy orbital floor” and “frontal cells”. Never before, however, an article was published that studied all possible deformities due to increased pressures and tried to make a classification. So the aim of this study was to make an inventory of the most obvious pressures related deformities that can be seen on CT-scans of patients with rhinosinusitis.

09/22/2017
Research Article

Unrecognized myocardial infarction in the elderly

Haakon H Eilertsen, Peer K Lilleng, Bjorn Maehle and Inge Morild*

This study presents the frequency of old myocardial infarctions (OMI), and the frequency of unrecognized myocardial infarction (UMI) in elderly people in a forensic material. It was also examined if predisposing factors of UMI could be identified. Of special interest was also to investigate the value of the police's records as a source for medical information in a forensic setting. The study is based upon medico-legal autopsies of persons above the age of 60 at the time of death during the period 1999-2003. The study included 325 cardiovascular deaths. Of these, 166 died from OMI. UMI accounted for 123 of these (74%). Most UMI were located in the interventricular myocardial septum and left anterior wall (>60%), but no significant differences could be found between UMI and recognized MIs (RMI). No obvious reason could be found as to why the UMI remained unrecognized. Police records were inferior to the hospitals records, regarding medical information to the pathologist, with information about cardiac disease in about 60%, and with information about OMI in 11-17%. Hospital records supplying information about OMI were found in half the cases. It is concluded that unrecognized myocardial infarction is not uncommon among elderly persons, and with a high risk of sudden death. More emphasis should be put in recognizing OMI in ECGs to attempt to reduce the risk of sudden cardiac death.

09/26/2017
Thesis

Retrosynthesis analysis; a way to design a retrosynthesis map for Pyridine and pyrimidine ring

Samar S Fatahala*

Pyridine and pyrimidines are amongst the most important, well known heteroaromatic rings, owning to their bioactive importance. Herein, an idea about how to design the synthetic pathway for these rings using retrosynthesis analysis techniques.

09/26/2017
Research Article

Synthesis of some new Schiff bases of Pharmaceutical Interest

Ajay Kumar, Shweta Verma, Arun K Mishra and Sushil Kumar*

A series of Schiff bases of diphenylamine derivatives have been synthesized and evaluated in vitro for their antibacterial activity against pathogenic both Gram-positive bacteria B. subtilis and Gram-negative bacteria E. coli using ciprofloxacin as standard drug at conc. of 50 µg/ml and 100 µg/ml. The structures of these compounds were established on the basis of IR and 1H-NMR spectral analysis. The compound (3d) displayed potent antibacterial activity against Bacillus subtilis (17 and 15mm) and Escherichia coli (19 and 17mm) by disc diffusion method.

09/25/2017
Research Article

The master regulator gene PRDM2 controls C2C12 myoblasts proliferation and Differentiation switch and PRDM4 and PRDM10 expression

Di Zazzo Erika, Bartollino Silvia* and Moncharmont Bruno

The Positive Regulatory Domain (PRDM) protein family gene is involved in a spectrum variety of biological processes, including proliferation, differentiation and apoptosis: its member seem to be transcriptional regulators highly cell type and tissue peculiar, towards histones modifications or recruitment of specific interaction patters to modify the expression of target genes. In this study we analyzed the expression profile of different member of PRDM gene family focusing our attention on the role of PRDM2, PRDM4 and PRDM10 genes in mouse C2C12 cell line, during the differentiation of myoblasts into myotubes and speculate about the role of the protein Retinoblastoma protein-interacting zinc finger protein 1-RIZ1, coded by PRDM2 gene, as a regulator of the proliferation/differentiation switch.

Results showed a reduction of PRDM2, PRDM4 and PRDM10 expression level during the commitment of the differentiation of myoblasts into myotubes. The RIZ1 silencing stimulated myoblasts differentiation, similar to the effect of serum deprivation on these cells, associated with an increase of Myogenin expression level, which is considered to be involved in the differentiation of myoblasts into multinucleated myotubes. As demonstrated by chromatin immunoprecipitation experiments, RIZ1 is associated with Myogenin promoter in proliferation condition and after 24h from differentiation induction, negatively controlling therefore Myogenin expression. Moreover RIZ1 silencing induced a reduction in PRDM4 and PRDM10 expression levels leaving us to speculate that the PRDM genes have a redundant role and they are hierarchically organized.

09/20/2017
Case Report

Evolution of anaesthesia in transapical aortic valve implantation Running head: Anaesthesia and transcatheter valve

Marzia Cottini*, Lappa A, Donfrancesco S and Francesco Musumeci

The Transcatheter Aortic Valve Implantation (TAVI) had emerged more and more in the last twenty years. According to the scientific literature, this is an approved, suitable and alternative therapeutic choice to conventional surgery for aortic valve disease in high risk patients. The most of patients are octogenarians or nonagenarians, with multiple comorbidities (neurological,vascular,oncologic, haematological, etc). The evolution of TAVI techniques and its devices have improved the quality of results and reduced the peri- and post-procedural complications. Cardiac anaesthesia and analgesia in TAVI patients is very important and fundamental to a quickly and complete clinical restoring after the procedure. An optimal balance of drugs and peri-procedural management could reduce the neurological events (such as delirium), the days of hospitalization and the admission of intensive care unit. According to our experience in transapical approach, the low dose of propofol and desflurane allowed to optimal cardiac anaesthesia and rapid mechanical ventilation weaning in complex patient undergone to transcatheter valve implantation with transapical approach. Moreover, our protocol reduced considerably the incidence of perioperative delirium.

09/25/2017
Research Article

Effects of Site Factors on the Clonal Growth of Phyllostachys bambusoides f. shouzhu Yi

Lijuan Chen, Xia Zhang, Cuibin Tang and Xiaohong Gan*

In order to provide theoretical foundation for forestation of Phyllostachys bambusoides f. shouzhu Yi, the site factors, and the morphological character and biomass of standard bamboo were investigated in 16 sample spots of bamboo forest in Liangping county, Chongqing City, and then the effects of site factors on the clonal growth was discussed.Three site factors as the slope position, altitude, species diversity, had significant effects on the clonal growth of the bamboo. The effects of the gradient, slope aspect, humus thickness, and soil thickness were little, but that of slope aspects was not significant. The altitude of above 800 m, the upper slope, the steep slope and slope, and the thin soil were not suitable for its clonal growth. The results showed that (1) the main site factors affecting the growth of P. bambusoides f. shouzhu were slope position, soil thickness and humus thickness; (2) The forestation site of P. bambusoides f. shouzhu should be selected at the flat ground and the gentle slope of the hills below altitude of 800 m, and the slope position of the forestation site should be selected at the mid and lower position of a hill; (3) Soil thickness and humus thickness should be kept at a suitable level; (4) The diversity of plant species in the bamboo forest should be kept at a suitable level for keeping its growth environment.

09/25/2017
Review Article

Spiritual and religious Islamic perspectives of healing of posttraumatic stress disorder

Mevludin Hasanovic*, Izet Pajevic and Osman Sinanovic

It is known today that psycho-trauma and PTSD cause different levels of mental and social dysfunction. Human spirituality and capacity to meet further life difficulties become severely damaged. There is wide accepted attitude today that in holistic approach in process of healing PTSD and psycho-trauma is necessary to include other professionals from community resource regarding needs of trauma victims. In Bosnia and Herzegovina after very severe war (1992-1995) as mental health professionals, we are faced with increasing number of different mental health disorders as result of severe trauma experiences. Regarding community based care orientation it is necessary to include and religion professionals. According national and religious background of majority of our population in Tuzla Canton that is Muslim, we meet spiritual needs of our clients as needs for Islamic explanation of life and death meaning. Our clients need to talk about spiritual issues in daily therapy and to practice daily religious rituals. Regarding that in this paper we tried to interface Islamic principles and it’s beneficial toward psycho-trauma and PTSD, as well as Muslim perspectives in attempt to apply spiritual practice in therapeutic tools for better efficacy in spiritual healing of mental dysfunction’s of believers who survived severe trauma, especially war trauma.

09/20/2017
Research Article

Intravitreal Ranibizumab/ Lucentis (IVTL) injections in Glaucoma patients-Intraocular Pressure (IOP) elevation and the use of Anterior Chamber Paracentesis (ACP)

EA Ansari* and H Huraira

Purpose

• To assess the short term effects of intravitreal Lucentis (IVTL) on intraocular pressure in patients with ocular hypertension and glaucoma.

• To determine rate of anterior chamber paracentesis (ACP) required post-injection according to departmental protocol.

Methods

This was a prospective, observational study carried out between August 2011 and February 2012 in the Department of Ophthalmology, Maidstone Hospital. 24 participants (13 female, 11 male) with established ocular hypertension (OHT) or glaucoma were chosen from a cohort of patients receiving intravitreal (IVTL) Ranibizumab (Lucentis) treatment for wet age related macular degeneration (wARMD). Apraclonidine 1% was given pre-injection, and baseline IOP was measured 30 min. after this, just before IVTL. IOP was measured at baseline, within 1 min of injection, 5 min, 15 min, 30 min up to 60min following a single IVTL treatment.

Anterior paracentesis was performed if:

• Immediate post injection IOP > 50mm Hg and OHT.

• Immediate post injection IOP > 40 mm Hg and there was evidence of disc damage only.

• Immediate post injection IOP > 30mm Hg with evidence of disc damage and visual field loss.

• Immediate post injection IOP > 30mm Hg with evidence of disc damage and visual field loss
09/20/2017
Research Article

Non-hemodynamic factors associated to the risk of developing hypertensive cardiopathy

Alexis Alvarez-Aliaga*, Julio Cesar Gonzalez-Aguilera, Liliana del Rosario Maceo-Gomez, Lic David del Llano Sosa, Raul Leyva-Castro and Rosa Ojeda-Vazquez

Introduction: Hypertensive cardiopathy is the target organ lesion caused by arterial hypertension (HTN) that exhibits the highest morbidity and mortality rates. Although the importance of hemodynamic overload exerted by HTN on the onset of cardiopathy is well established, several non-hemodynamic factors may contribute significantly to its development. 

Objective: To evaluate the influence of different non-hemodynamic risk factors in the development of hypertensive cardiopathy.

Methods: A prospective cohort study was carried out in hypertensive patients assisted at the specialized arterial hypertension physicians’ office of the “Carlos Manuel de Céspedes” Specialty Policlinic attached to the General University Hospital, Bayamo Municipality, Granma Province, Cuba from January 5, 2006 to December 31, 2015. The study included 18-to-55-year-old hypertensive patients with a stage 1 arterial hypertension diagnosis for less than a year1.

Results: The multivariate analysis showed a significant and independent relation among the majority of the factors studied and the risk of developing cardiopathy. The major factor was C-reactive protein (HR: 5.020; IC 95%: 3.383-7,448; p<0.005) followed by microalbuminuria (HR: 2.649; IC 95%: 1.932-3.631; p<0.005). The area under the model ROC curve was 0.887 (p<0,005).

Conclusions: The results showed that it is possible to estimate the risk of developing hypertensive cardiopathy with the application of the regression model to major risk factors.

09/20/2017
Case Report

Kikuchi’s disease in a young Scandinavian woman

Sannia Mia Sveningsen Sjostedt*, Eva Hebbelstrup Rye Rasmussen, Anette Bygum and Line Kanstrup Springborg

A 21 year-old woman presented with cervical lymphadenopathy and night sweats. Initially, lymphoma was suspected and one of the enlarged lymph nodes was excised in order to make a diagnosis. Histopathological examination revealed Kikuchi’s disease, which is usually a benign syndrome with spontaneous resolution. The disease is very rare, particularly in Caucasian populations. A higher incidence is seen in patients of Asian descent.

The patient had persistent swelling of cervical lymph nodes over several months and further lymph nodes were removed as malignant transformation was suspected. However examinations showed only Kikuchi’s disease. There was given no specific treatment. Follow-up appointments were performed biannually and the patient is currently awaiting removal of yet another swollen lymph node on suspicion of relapse of her Kikuchi’s disease.

09/20/2017
Thesis

Impedance audiometry: Stapedial reflex eliciting conditions

Mojmir Lejska*

The work is an attempt to create a complete system of conditions which influence genesis, existence, and response characteristics of stapedial reflex in impedance audiometry. The author divides the conditions into the internal-reflex arc integrity, temporal acoustic summation, mixed-external auditory meatus and middle ear, and internal-side of stimulation and energy content of the stimulus. The system of conditions that influence stapedial reflex is based on a criterion, that stapedial reflex depends on energy, which is percepted by the inner ear as subjective loudness. The system of conditions stated in this work is based mainly on the author’s own experiments and measurements, which are herein also documented. At the same time, these results are in accordance with data in literature as quoted. This system is not closed-it potentially may be completed using the basic criterion and further knowledge.

09/20/2017
Mini Review

The use of Allergoids and Adjuvants in Allergen Immunotherapy

Celso Eduardo Olivier*

Allergen immunotherapy (AIT) is the unique curative treatment to help allergic patients to get over their allergies. With a personalized approach, AIT is the best example of precision medicine. After a century of intensive studies and innovative discoveries, allergists have in their hands many tools to orchestrate the best strategy to re-educate the hypersensitive immune systems that decrease the quality of life of their patients. This review describes both the historical and the promising acquisitions in this field, focusing the biochemical and Bioengineering tools that render an allergen more suitable for a secure, convenient and effective immunotherapy.

09/22/2017
Clinical Image

Andy Gump deformity

Pirabu Sakthivel*, Chirom Amit Singh, and Suresh Chandra Sharma

A 63 year old gentleman presented with ulcer over the lower alveolus for the past 4 months duration. The patient also had pain, loose lower central incisors and occasional bleeding from the ulcer while brushing. On examination an ulceroproliferative growth was seen involving lower alveolus along with adjoining mucosa of the lower lip with mobile central incisors. There was associated bilateral submandibular area lymphadenopathy. Histopathological examination of the ulcer revealed moderately differentiated squamous cell carcinoma. The patient underwent wide local excision with central arch resection of mandible with bilateral modified neck dissection and pectoralis major myocutaneous flap for reconstruction followed by postoperative radiotherapy. During the follow up, patient developed severe “Andy Gump deformity” [Figure 1]. Surgical reconstruction was offered to the patient but denied consent for further intervention.

09/22/2017
Research Article

How Bruguiera gymnorhizza seedlings respond to climate change induced salinity rise?

Prosenjit Pramanick, Subrata Trivedi, Sufia Zaman and Abhijit Mitra*

A study was undertaken during August 2017 to evaluate the effect of salinity on chlorophyll a, chlorophyll b, total chlorophyll, and carotenoid and proline contents of hydroponically grown seedlings of Bruguiera gymnorhizza. The primary aim was to observe its tolerance to changing salinity. The selected seedlings were exposed to five different salinity levels (2,5,10,15 and 20psu) for a period of 30 days and observations were done at a regular interval of 7,14,21 and 30 days respectively. The concentrations of chlorophyll exhibited significant positive correlations with salinity (p<0.01). The chlorophyll a:b ratio in the plant varied between 2.39 to 3.71 throughout the period of investigation. The salinity fluctuation did not affect the carotenoid level and proline content in the leaves of the species as evidenced from the insignificant r values. The results show that Bruguiera gymnorhizza of Indian Sundarbans region can tolerate and adapt to high saline condition as witnessed in the central sector of the deltaic complex around the Matla River.

09/15/2017
Case Report

A new heart: portraying the physiologic anatomo-functional reconstruction in ischemic cardiomyopathy

Marco Cirillo*, Marco Campana, Anna Bressanelli and Giovanni Troise

Fiber-based model of the left ventricle is known since 1628 but the complex 3D structure of myocardial fibers has not taken into account in normalcy or in disease until the last decade. We here present the case of a 60-year-old female patient affected by ischemic cardiomyopathy and severe left ventricular dysfunction. Left ventricle was reconstructed according to a novel surgical technique aimed at rebuilding an elliptical ventricular chamber and redirecting myocardial bundles of fibers in a near-normal orientation, by means of an original suturing technique. Left ventricular torsion was restored, proving the reorientation of myocardial fibres’ bundles. The restored physiologic shape was maintained along the years, gradually improving global ejection fraction and diastolic indices, showing a positive remodeling induced by the optimised geometrical and functional parameters.

The unexpected and never proven before renewal of ventricular torsion is an adjunctive element of ventricular efficiency, mainly in ventricles that work at a critical mechanics. A new fiber-based reading of heart function could improve clinical and functional outcomes and address some unsolved issues in the surgical treatment of ischemic cardiomyopathy as well as in medical approaches to the diseased myocardium.

09/21/2017
Case Report

Nicotinamide as a treatment option of Age-Related Macular Degeneration

Yuchen Lin, Peter F. Zipfel and Christine Skerka*

Age related macular degeneration is a severe disease of mainly elderly people and leads to central vision loss because of the degeneration of the retinal pigment epithelium [1]. Genetic and environmental factors are responsible for the accumulation of extracellular material and deposit formation near the retinal pigment epithelial (RPE) layer, which leads to loss of photoreceptors and induction of chronic inflammation.The deposits are composed of lipids and proteins including many complement proteins, indicating the involvement of the complement system in the degenerative process and chronic inflammation [2]. So far there is no treatment for the dry form of AMD, except nutritional supplementation with antioxidants and vitamins [3]. Combined with a prolonged lifetime expectation in developed countries, AMD is developing to a social and economic burden. Therefore, there is an urgent need for a treatment of AMD that can delay disease manifestation and progression for several years.

In a recent manuscript, Saini and colleagues analyzed a vitamin B derivate, nicotinamide (NAM), as a potential treatment strategy of AMD [4]. The anti-inflammatory activity of NAM is not entirely new and may have inspired the investigators to look in detail at the effect of this drug for AMD treatment. In 2008, Temple and her group reported about the treatment of 3 x Tg-AD mice, a mouse model for Alzheimer’s disease (AD), with NAM. Their work suggested that NAM treatment selectively reduces a phosphorylated species of tau associated with microtubule depolymerization and implicated in AD. Treatment of mice restored cognitive decline related to AD pathology indicate a readily available therapeutic for the treatment [5]. Collectively NAM was identified as a cytoprotectant that blocks cellular inflammatory cell activation, early apoptotic phosphatidylserine exposure, and late nuclear DNA degradation [6]. Therefore, NAM supplementation was suggested for the treatment of chronic diseases with an immune system dysfunction as seen in diabetes and age-related diseases.

Sinai et al. [4], investigated the effects of NAM in a human induced pluripotent stem cell (iPSC) model of AMD which they they previously established. The advantage of this model is evident. The investigators used cells from AMD patients with or without a specific ARMS2/HTRA1 risks haplotype as well as from control people to generate iPSCs and to compare the effects of NAM. The authors showed that iPSC cells express a broad panel of drusen like deposits and AMD associated molecules. Also, iPSC-RPE from all AMD patients studied, demonstrated an increased expression of inflammatory and complement factors as compared to controls. The expression of complement genes C3 and CFI was significantly enhanced in patient cell lines carrying the homozygous ARMS2/HTRA1 risk alleles. Interestingly, the expression of the classical complement components C1s and C1r was enhanced in AMD derived iPSC-RPE, thus indicating a role of the classical pathway in AMD.

09/07/2017
Research Article

Arid3a regulates mesoderm differentiation in mouse embryonic stem cells

Melissa Popowski, Bum-kyu Lee, Cathy Rhee, Vishwanath R Iyer and Haley O Tucker*

Research into regulation of the differentiation of stem cells is critical to understanding early developmental decisions and later development growth. The transcription factor ARID3A previously was shown to be critical for trophectoderm and hematopoetic development.Expression of ARID3A increases during embryonic differentiation, but the underlying reason remained unclear. Here we show that Arid3a null embryonic stem (ES) cells maintain an undifferentiated gene expression pattern and form teratomas in immune-compromised mice. However, Arid3a null ES cells differentiated in vitro into embryoid bodies (EBs) significantly faster than control ES cells, and the majority forming large cystic embryoid EBs. Analysis of gene expression during this transition indicated that Arid3a nulls differentiated spontaneously into mesoderm and neuroectoderm lineages. While young ARID3A-deficient mice showed no gross tissue morphology, proliferative and structural abnormalities were observed in the kidneys of older null mice. Together these data suggest that ARID3A is not only required hematopoiesis, but is critical for early mesoderm differentiation.

09/18/2017
Case Report

Preservation of Haemostasis with Anti-thrombotic Serotonin Antagonism

Mark IM Noble* and Angela J Drake-Holland

An enquiry into the lack of attention awarded to serotonin antagonism in the treatment of arterial thrombosis revealed that the mode of action of serotonin and its platelet receptor antagonists was an action upon thrombus growth, and not, as with other anti-platelet drugs upon the initiation of thrombosis. This lack of effect could explain why this approach has been considered not to be effective. However under conditions of arterial stenosis in which there is platelet activation by increased shear stress, and during the growth phase of arterial thrombi, serotonin 5HT2A antagonism has been demonstrated to have great potentcy in dispersing thrombotic obstruction to blood flow. This mode of action, the lack of participation of serotonin in haemostasis, and the absence of serotonin in wounds accounts for the proven lack of effect of effect of pure specific 5HT2A antagonists (i.e., not those with other actions) on operative bleeding and skin bleeding times. This lack of effect on haemostasis solves the dosing problem encountered with other anti-thrombotic drugs, with which drug concentration cannot be controlled with single fixed doses, leading to the association between increased anti-thrombotic efficacy and increased bleeding complications. Thus 5HT2A antagonism appears to be the preferred approach, from the point of view of safety and lack of bleeding risk; this consideration applies particularly to thrombosis therapy in the context of traumatic accidents, surgical operations and invasive procedures such as angioplasty.

09/12/2017
Case Report

Cytomegalovirus pneumonia and Cryptogenic organizing pneumonia following pediatric stem cell transplantation for leukemia

Zuhre Kaya*, Tuba Sismanlar, Ayse Tana Aslan, Oznur Konus Boyunaga, Isıl Fidan Balcı, İdil Yenicesu and Ulker Kocak

Background: Knowledge of pulmonary complications (PCs) in children after hematopoetic stem cell transplantation (allo-HSCT) is limited; most data are from adult studies.

Case: We describe a 8 year old girl with high risk acute myeloid leukemia who developed graft versus host disease (GVHD) on Day 20, Cytomegalovirus (CMV) pneumonia on Day 50 and Cryptogenic organizing pneumonia (COP) on Day 170 after allo-HSCT.

Case: We describe a 8 year old girl with high risk acute myeloid leukemia who developed graft versus host disease (GVHD) on Day 20, Cytomegalovirus (CMV) pneumonia on Day 50 and Cryptogenic organizing pneumonia (COP) on Day 170 after allo-HSCT.
 
Discussion: Cryptogenic organizing pneumonia is a rare noninfectious PCs that can be idiopathic or have several risk factors as a secondary causes, such as viral respiratory infections, drugs, GVHD and allo-HSCT. Viral respiratory infections and alloimmune lung syndromes have been reported in a few patients who have undergone transplantation.
 
Conclusion: Transplant physicians should be kept in mind for the development of alloimmune lung syndrome in the form of COP following CMV pneumonia in patients after allo- HSCT

Discussion: Cryptogenic organizing pneumonia is a rare noninfectious PCs that can be idiopathic or have several risk factors as a secondary causes, such as viral respiratory infections, drugs, GVHD and allo-HSCT. Viral respiratory infections and alloimmune lung syndromes have been reported in a few patients who have undergone transplantation.

Conclusion: Transplant physicians should be kept in mind for the development of alloimmune lung syndrome in the form of COP following CMV pneumonia in patients after allo- HSCT

 
Discussion: Cryptogenic organizing pneumonia is a rare noninfectious PCs that can be idiopathic or have several risk factors as a secondary causes, such as viral respiratory infections, drugs, GVHD and allo-HSCT. Viral respiratory infections and alloimmune lung syndromes have been reported in a few patients who have undergone transplantation.
 
Conclusion: Transplant physicians should be kept in mind for the development of alloimmune lung syndrome in the form of COP following CMV pneumonia in patients after allo- HSCTCase: We describe a 8 year old girl with high risk acute myeloid leukemia who developed graft versus host disease (GVHD) on Day 20, Cytomegalovirus (CMV) pneumonia on Day 50 and Cryptogenic organizing pneumonia (COP) on Day 170 after allo-HSCT.
 
Discussion: Cryptogenic organizing pneumonia is a rare noninfectious PCs that can be idiopathic or have several risk factors as a secondary causes, such as viral respiratory infections, drugs, GVHD and allo-HSCT. Viral respiratory infections and alloimmune lung syndromes have been reported in a few patients who have undergone transplantation.
 
Conclusion: Transplant physicians should be kept in mind for the development of alloimmune lung syndrome in the form of COP following CMV pneumonia in patients after allo- HSCT
09/08/2017
Case Report

Sinking Skin Flap Syndrome

Liew BS*, Rosman AK and Adnan JS

A previously healthy 26-year-old gentleman, referred from a state hospital with history of alleged fall from 10 feet height at a construction site on the same day. Glasgow coma scale (GCS) at that hospital was E2 V2 M5. He was brought in to our Emergency Unit, Hospital Kuala Lumpur with GCS of E1 V2 M4 (7/15). Pupils were 5mm+ /3mm+. He sustained left ear bleed. Otherwise vital signs were stable, with no other extracranial injury. Computed tomography (CT) scan brain (Figure 1) showed right frontotemporal acute subdural hematoma with left frontotemporoparietal acute subdural hematoma, with underlying subarachnoid hemorrhage, mass effect and midline shift to left side more than 0.5cm and obliteration of basal cistern.

09/07/2017
Case Report

Unusual presentation of a bilateral basilar stroke: Bradycardia

Zidouh S*, Jidane S, Nabhani T, Chouaib N, Sirbou R, Belkouch A and Belyamani L

We report a case of 79-year-old man who presented to our emergency department (ED) for lipothymia. The patient developed significant bradycardia with hypotension. His EKG objectified a slow atrial fibrillation .the patient rapidly installed a coma. A non-contrast CT brain scan showed a bilateral vertebrobasilar ischemic stroke.

09/15/2017
Case Report

Dieulafoy’s Lesion related massive Intraoperative Gastrointestinal Bleeding during single Anastomosis Gastric Bypass necessitating total Gastrectomy: A Case Report

Ashraf Imam, Khalayleh Harbi*, Miller Rafael, Khoury Deeb, Buyeviz Victor, Guy Pines and Sapojnikov Shimon

Introduction: Immediate postoperative gastrointestinal bleeding following bariatric bypass surgery is a major complication, and usually results from staple line hemorrhage or conventional gastro-esophageal causes. Dieulafoy`s lesion is a rare cause of gastrointestinal bleeding and is usually managed by endoscopic means. Herein we present a case of massive intraoperative bleeding resulting from gastric Dieulafoy`s lesion single anastomosis gastric bypass surgery necessitating resection of the gastric pouch. This is the first description of this complication, and the difference of such a lesion from the sporadic ones is discussed.

Discussion: Gastric bypass saurgery is an effective procedure for morbid obesity. The approach we have adopted for massive upper GI hemorrhage in the immediate postoperative period should be distinguished from delayed bleeding after gastric bypass. In these latter cases, marginal ulceration is more common than bleeding from the remnant gastric pouch. It is also likely that bleeding from a Dieulafoy`s lesion following gastric bypass surgery represents a different disease compared to other Dieulafoy's cases.

Conclusion: This is the first description of an intraoperative Dieulafoy's lesion bleeding during the conduct of a single anastomosis gastric bypass procedure which required gastric pouch resection. Such a lesion differs from sporadic Dieulafoy`s cases, and must be considered in every case of intraoperative bleeding during gastric bypass.

09/11/2017
Letter to the Editor

Exploring the Debate on Vaccines

D. John Doyle*

A thought-provoking debate in the popular literature concerning vaccination has blossomed in recent years [1-6]. While “traditionalists” support universal immunization against a variety of infectious diseases, many influential individuals hold that vaccinations do far more harm than good.The web sites vactruth.com and anhinternational.org are typical web sites to visit to understand their concerns.  More details on the debate, offering commentary on both sides of the issue, can be explored at wikipedia.org/wiki/Vaccine_controversies. In essence, however, those arguing for the universal use of vaccines point to the many millions of lives saved since mass immunization programs were introduced and further argue that resistance to routine vaccination is almost always based on false information. Those arguing against the routine use of vaccines usually either contend that the vaccines are unsafe (often maintaining that vaccine components such as formaldehyde or thimerosal are highly toxic) or alternately argue that governments simply do not have the moral authority to encroach on an individual’s freedom to make medical decisions for themselves or for their children.

I would like to offer my sociological analysis of this debate. I believe that central to the debate are two competing belief systems concerning what kinds of evidence can be used to establish an informed opinion on clinical matters. The traditionalists hold that the way to truth is through the method of scientific investigation, which includes studies in basic immunological mechanisms at the cellular level, experiments on animals, and clinical trials on humans. They hold that the resulting publications in the peer-reviewed scientific literature are the “canon of truth” from which opinion on clinical matters must be established.
 
But not everyone is a believer in this approach. Individuals in this second community are suspicious of the scientific method on several grounds. Some argue that “big pharma” or the medical profession at large, in their own self-interest, has been suppressing valuable “alternative” approaches to treating patients.  They further argue that any formal clinical trials that members of this alternative clinical community have conducted are rejected from publication from mainstream scholarly journals (these journals forming the canon referred to above) purely because of self-interest and bias. As a result, they are forced, they argue, to make their results available to the public by alternative means: web sites, personal communication, “alternative” health fairs, articles in the popular press, and books. This is not to suggest that mainstream medical journals do not discuss complications from vaccination; potentially serious, even lethal, complications do exist, especially in immunologically compromised individuals. Some individuals obviously should not be vaccinated.
 
Of interest, one particularly noteworthy publication on the harmful effects of vaccinations came from The Lancet, a particularly well-respected medical journal [7]. This study was true canon material. Unfortunately, the study was completely fraudulent [8,9] and the first author of the study (Andrew Wakefield) even lost his medical license after an investigation found that he had acted “dishonestly and irresponsibly” [10].
 
In the case of the vaccine debate the potential consequences are critically important. Some arguments against vaccination have succeeded in reducing vaccination rates in certain communities, leading to increased outbreaks of preventable, and sometimes lethal, childhood illnesses [11].But even accepting that vaccines are safe and effective, another debate centers around whether society has the right to mandate vaccinations to protect society at large. Like the debate on seatbelts for car occupants and helmets for motorcyclists, the question as to what interventions the government should enforce will likely continue for some time.
I would like to offer my sociological analysis of this debate. I believe that central to the debate are two competing belief systems concerning what kinds of evidence can be used to establish an informed opinion on clinical matters. The traditionalists hold that the way to truth is through the method of scientific investigation, which includes studies in basic immunological mechanisms at the cellular level, experiments on animals, and clinical trials on humans. They hold that the resulting publications in the peer-reviewed scientific literature are the “canon of truth” from which opinion on clinical matters must be established.
 
But not everyone is a believer in this approach. Individuals in this second community are suspicious of the scientific method on several grounds. Some argue that “big pharma” or the medical profession at large, in their own self-interest, has been suppressing valuable “alternative” approaches to treating patients.  They further argue that any formal clinical trials that members of this alternative clinical community have conducted are rejected from publication from mainstream scholarly journals (these journals forming the canon referred to above) purely because of self-interest and bias. As a result, they are forced, they argue, to make their results available to the public by alternative means: web sites, personal communication, “alternative” health fairs, articles in the popular press, and books. This is not to suggest that mainstream medical journals do not discuss complications from vaccination; potentially serious, even lethal, complications do exist, especially in immunologically compromised individuals. Some individuals obviously should not be vaccinated.
 
Of interest, one particularly noteworthy publication on the harmful effects of vaccinations came from The Lancet, a particularly well-respected medical journal [7]. This study was true canon material. Unfortunately, the study was completely fraudulent [8,9] and the first author of the study (Andrew Wakefield) even lost his medical license after an investigation found that he had acted “dishonestly and irresponsibly” [10].
 
In the case of the vaccine debate the potential consequences are critically important. Some arguments against vaccination have succeeded in reducing vaccination rates in certain communities, leading to increased outbreaks of preventable, and sometimes lethal, childhood illnesses [11].But even accepting that vaccines are safe and effective, another debate centers around whether society has the right to mandate vaccinations to protect society at large. Like the debate on seatbelts for car occupants and helmets for motorcyclists, the question as to what interventions the government should enforce will likely continue for some time.
 
I would like to offer my sociological analysis of this debate. I believe that central to the debate are two competing belief systems concerning what kinds of evidence can be used to establish an informed opinion on clinical matters. The traditionalists hold that the way to truth is through the method of scientific investigation, which includes studies in basic immunological mechanisms at the cellular level, experiments on animals, and clinical trials on humans. They hold that the resulting publications in the peer-reviewed scientific literature are the “canon of truth” from which opinion on clinical matters must be established.
 
But not everyone is a believer in this approach. Individuals in this second community are suspicious of the scientific method on several grounds. Some argue that “big pharma” or the medical profession at large, in their own self-interest, has been suppressing valuable “alternative” approaches to treating patients.  They further argue that any formal clinical trials that members of this alternative clinical community have conducted are rejected from publication from mainstream scholarly journals (these journals forming the canon referred to above) purely because of self-interest and bias. As a result, they are forced, they argue, to make their results available to the public by alternative means: web sites, personal communication, “alternative” health fairs, articles in the popular press, and books. This is not to suggest that mainstream medical journals do not discuss complications from vaccination; potentially serious, even lethal, complications do exist, especially in immunologically compromised individuals. Some individuals obviously should not be vaccinated.
 
Of interest, one particularly noteworthy publication on the harmful effects of vaccinations came from The Lancet, a particularly well-respected medical journal [7]. This study was true canon material. Unfortunately, the study was completely fraudulent [8,9] and the first author of the study (Andrew Wakefield) even lost his medical license after an investigation found that he had acted “dishonestly and irresponsibly” [10].
 
In the case of the vaccine debate the potential consequences are critically important. Some arguments against vaccination have succeeded in reducing vaccination rates in certain communities, leading to increased outbreaks of preventable, and sometimes lethal, childhood illnesses [11].But even accepting that vaccines are safe and effective, another debate centers around whether society has the right to mandate vaccinations to protect society at large. Like the debate on seatbelts for car occupants and helmets for motorcyclists, the question as to what interventions the government should enforce will likely continue for some time.
09/14/2017
Review Article

Anxiety and depression as an effect of birth order or being an only child: Results of an internet survey in Poland and Germany

Jochen Hardt*, Lisa Weyer, Malgorzata Dragan and Wilfried Laubach

Background: Various studies examined the effect of birth order. First born children show usually better cognitive performance than their later born siblings. Studies on emotional aspects yield heterogeneous results, sometimes in favour of first born, sometimes in favour of later born children. Studies comparing only-children with children with siblings are rare.

Method: An internet survey was performed in 508 Polish and 500 German subjects. Only-children, first born, middle born and latest born children were compared regarding body mass index, depression, anxiety and partnership.

Results: No differences among first born, middle born and latest born children were detected. Only-children reported significantly less symptoms of social phobia than first born children (z=0.50, p< 0.01).

Conclusions: Except for suicidality, the results of this study question the sense of further investment in studying effects of birth order. In contrast, examining differences between only-children vs. children having siblings seems to have the potential to yield interesting and new results. Optimally, such research would combine self-report measures with reports from others, such as parents, teachers or clinicians.

09/19/2017
Case Report

Frequency specific microcurrent resolves chronic pain and adhesions after ulnar transposition surgery

Jodie Adams* and Carolyn McMakin

Frequency specific microcurrent (FSM) has been used to treat myofascial pain syndrome [1,2] fibromyalgia associated with spine trauma [3], delayed onset muscle soreness [4], acute and chronic neuropathic pain [5] and chronic scarring in burn patients [6].In this case, its use was modified to include not only the treatment of neuropathic pain but the treatment of neural adhesions in a patient with a ten year history of pain at rest and painful restricted range of motion following an ulnar nerve anterior transposition surgery in 2001. Eleven standard physical therapy sessions including augmented soft tissue mobilization using plastic tools, and muscle strengthening exercises and stretching failed to resolve symptoms. Three sessions of frequency specific microcurrent produced complete resolution of pain and symptoms. Patient remained symptoms free at one-year follow up.

09/08/2017
Case Report

The efficacy of complex Decongestive Physiotherapy in patients with Bilateral Primary Lower Extremity Lymphedema and Untreatable multiple health conditions: A Case Report

Humeyra Kiloatar PT*

Background: Primary lymphedema occurs as a result of genetic abnormalities of the lymph system. Currently, complex decongestive therapy is accepted as the standard treatment of the lymphedema. In this case presentation, we described the management of bilateral primary lower extremity lymphedema and the use of complex decongestive therapy.

Case Report: A 62 years old female patient had stage III primary lymphedema on her left lower extremity and stage II primary lymphedema on her right lower extremity. The patient, who had morbid obesity, also had untreatable sleep apnea, urinary incontinence, umbilical hernia and hypertension controlled by drugs. She had stage 4 gonarthrosis according to Kellgren – Lawrence classification in her both knees. The patient received complex decongestive therapy as an outpatient.

After 27 sessions of complex decongestive therapy, edema reduced in both lower extremities. Before the treatment started, the patient couldn’t go up and down stairs, get out and had difficulty mobility in the home. But after the treatment, the patient could go up and down 16 stairs by holding the railing, get out by two walking sticks and had less difficulty mobility in the home. However, due to gonarthrosis in her knees, her pain did not diminish.

Conclusion: Complex decongestive therapy is effective in the management of bilateral primary lower extremity lymphedema, which progressed with multiple health conditions.

09/18/2017
Mini Review

Mechanism-related Teratogenic, Hormone Modulant and other Toxicological effects of Veterinary and agricultural surfactants

Andras Szekacs*

Veterinary and agricultural surfactants are supposed to be inert additives, yet these substances commonly exert biological side-effects, in given cases synergistic with those of the active ingredients of these preparations. This is explicitly seen in altered toxicity of veterinary or pesticide formulations compared to their active ingredients alone. Neither the individual effects of these excipients, nor such combination effects are well-studied in toxicology, and therefore, possible toxicity consequences are occasionally not being considered at sufficient significance in the authorization, use and control of these substances. Risk assessment of these substances should cover all hazards they may represent, and corresponding levels of exposure. Surfactants used in veterinary and pesticide formulation enter the environment either by direct dispersion or by indirect release through excrement, leaching, sewage waters or sludge, and in turn, create potential exposure to a number of non-target organisms. Biochemical and (eco)toxicological hazards recently identified regarding certain agricultural surfactants include cytotoxicity (on cell lines of epithelial, neural and other tissues, as well as stem cells and tumor cells), endocrine disrupting effects, as well as aquatic ecotoxicity. This Mini Review summarizes toxicological effects identified in our studies in aquatic toxicity tests, in cell viability and cytotoxicity tests, in estrogenic activity assays, correlated with biochemical analysis of the surfactants and their decomposition. The conclusions are hoped to facilitate environmentally precautious revision of surfactants widely used in agriculture.

09/06/2017
Research Article

Investigation on Theileria lestoquardi infection among sheep and goats in Nyala, South Darfur State, Sudan

Osman TM, Ali AM*, Hussein MO, El Ghali A and Salih DA

This study was conducted in Nyala, South Darfur State, Sudan during August-September 2015 to study the seroprevalence of ovine and caprine theileriosis and to identify the tick infesting sheep and goats. For this purpose, total of 150 samples (ticks, blood smear and sera) were collected from sheep (n=61) and goats (n=89) of different age groups, breed and both sex. Three age groups were included: less than one-year-old, one-two years-old and more than two-year-old. Two diagnostic techniques were used, blood smears, and indirect fluorescent antibody test (IFAT). Out of 150 samples, 9 (6%) were positive for Theileria spp. piroplasms in blood smears, and 81 (54%) were positive for Theileria lestoquardi antibodies. Out of 61 sheep, 3 (4.9%) were positive for Theileria spp. piroplasms, and 25 (41%) were positive for T. lestoquardi antibodies. Out of 89 goats, 6 (6.7%) were positive for Theileria spp. piroplasms, and 56 (62.9%) were positive for T. lestoquardi antibodies. The highest prevalence of T. lestoquardi was recorded among sheep and goats more than two-year-old. Two genera and 4 species of ticks were infested sheep and goats. These included Rhipicephalus evertsi evertsi, R. s. sanguineus, Amblyomma variegatum and A. lepidum. The study concluded that the malignant ovine theileriosis is endemic in Nyala town.

09/18/2017
Case Report

Osteogenic Accelerated OrthodonticsTM for treatment of a Skeletal Class II patient with moderate crowding

Armando Montesinos F and Marisol Perez Gasque B

Introduction: A 17 years old male patient was treated at the University orthodontic department. He had the chief complaint of unaesthetic  appearance of his teeth, mostly for anterior crowding. The pretreatment records showed a Class II skeletal relation, moderate upper and lower anterior crowding, 0.5mm of overbite and 2mm of overjet.

Materials and Methods: It was suggested Osteogenic Accelerated Orthodontics (OAOTM), the treatment option was very attractive to the patient although it required a surgical procedure and a more expensive type of treatment.

Results: The overall treatment time was 6 months, facial balance was improved and the final occlusal relationships from the functional and aesthetics perspective were good.

Conclusion: OAOTM is a good alternative to reduce extractions rate as it increases the scope of tooth movement and strengthen the periodontal tissues thru bone grafting, although these claims require more scientific data to be validated.

09/05/2017
Research Article

Anemia response to Methoxy Polyethylene Glycol-Epoetin Beta (Mircera) versus Epoetin Alfa (Eprex) in patients with chronic Kidney disease on Hemodialysis

Alaa K Dhayef*, Jawad K Manuti and Abdulwahab S Abutabiekh

Objective: Anemia, a common complication of chronic kidney disease, usually develops because of erythropoietin deficiency. Maintaining target hemoglobin (Hb) with minimal variability is a challenge in hemodialysis (HD) patients. The aim of this study is to compare the long- and short-acting erythropoietin erythropoietin stimulating agents such as Mircera and Eprex in achieving these targets.

Results: The response rate in the evaluation period was higher in patients treated with methoxypolyethylene glycol-epoetin beta (Mircera) than with epoetin (Eprex) alfa: 36 of 50 (72%) mean Hb concentration (10.51g/dl) versus 29 of 50 (58%) mean Hb concentration (9.81), with statistically significant p-value <0.0001.

Conclusion: Treatment with (Mircera) administered intravenously once monthly was superior to treatment with (Eprex) administered subcutaneously three times weekly for maintaining haemoglobin concentrations in patients with chronic kidney disease on hemodialysis.

09/05/2017
Research Article

Organic compositional analysis of propellant powders using monolithic material sorption extraction (MSSE)-a feasibility study

Ellen Goudsmits, George P Sharples and Jason W Birkett*

The application of monolithic material sorption extraction, specifically MonoTrapTM, to the extraction of organic gunshot residue (OGSR) compounds from unburnt propellant powders is described. Four different MonoTraps were assessed for their capability to extract OGSR compounds from two different ammunition types. Extracts were analysed using gas chromatography-mass spectrometry. Results indicated that the carbon disc was suitable for the extraction of OGSR compounds from unburnt propellant powders. Quantities for major compounds were comparable to methanol extractions. The method was successfully used to detect a wide range of OGSR compounds, including nitrotoluenes, nitroglycerin, diphenylamines and centralites and is expected to be applicable to a wide range of ammunition types.