Case Report

A rare case: Congenital Megalourethra in prune belly syndrome

Ismail Selvi, Numan Baydilli* and Emre Can Akınsal

Introduction: Prune Belly syndrome is a disease characterized by abdominal muscle defect, bilateral cryptorchidsim and urinary system anomalies (reflux megaureter, hydronephrosis, etc.). Pulmonary, cardiac, and gastrointestinal anomalies may also be present. Management of these rare cases is very important. In this case, the clinical course of a patient with Prune Belly syndrome with megaurethra is presented.

Case: The patient from the first gestation and parturition with birth weight of 2500 g and 38 weeks was hospitalized because of the bilateral hydronephrosis. His physical examination revealed undescended testicles and a large penis. The abdominal muscles were not very atrophic. The size of the kidney was small, bilateral hydroureteronephrosis and wide posterior urethra on the ultrasound. Renal function tests were progressively disturbed and the patient underwent cystourethroscopy for diagnostic purposes in terms of posterior urethral valve. A large diverticulum was found in anterior urethra. Prune Belly Syndrome was thought because the orifices were in appearance of reflux. The vesicostomy was applied. After vesicostomy the renal function tests got better but he was hospitalized due to urosepsis two times. In cystoscopic examination, the diverticulum in the urethra was filled with urine and the drainage was very slow. Phimosis was opened with dorsal slit technique. Cutaneous urethrostomy was proximal to the anterior diverticulum.

Conclusion: Prune Belly syndrome should be considered in patients with megaurethra and postrenal or renal insufficiency although there are no obvious clinical findings. In Prune Belly cases, via a large penis with obstruction signs, anterior urethral diverticulum should be considered.

Research Article

Comorbidity of alcohol dependence with attention-defi cit/hyperactivity disorder and the role of executive dysfunctions

Gloria Tosi, Giovanni Vittadini, Ines Giorgi, Caterina Pistarini*, Elena Fiabane and Paola Palladino

Background: This study aims to retrospectively investigate the comorbidity of ADHD multiple symptoms (behavioral) with alcohol addiction in a sample of adult alcohol-dependent patients and to test their current attentional skills (behavioral and cognitive).

Methods: Thirty-two adult alcohol-dependent patients were examined for ADHD using a semi-structured interview and the Mini Mental State Examination to evaluate attention and inhibition functions. Brown ADD Scales were used to specifically examine ADHD syndrome. Patients were compared with thirty matched control participants selected from healthy population in few measures of attentional control and working memory.

Results: 50% of patients showed evidence of primary ADHD symptoms: specifically, 28.12% showed criteria for ADHD highly probable, 12.50% for ADHD probable but not certain and 9.38% for ADHD possible but not likely. Patients also revealed several deficits in the selective visual attention, interference control and verbal working memory compared to the control group.

Conclusions: These results revealed that adult alcohol-dependent patients had retrospectively high comorbidity with ADHD and significant current deficits of the executive functions. These findings suggest the importance of early diagnosis and treatment of ADHD in order to prevent the development of alcohol dependence.


Indian spices and Caffeine treatment for Obesity and Cardiovascular disease

Ian James Martins*

The global obesity epidemic that was previously reported [1,2] is now to worsen with obesity to double in 73 countries around the world [3,4]. Improving the health of obese individuals by dietary restriction, anti-obese foods and increased physical activity [1] has not reduced the global obesity epidemic. Obesity is linked to nonalcoholic fatty liver disease (NAFLD) [5,6] with complications relevant to the metabolic syndrome and cardiovascular disease [7]. Appetite control has become critical to endocrinology and metabolism with the apelinergic pathway and nuclear receptor Sirtuin 1 (Sirt 1) now connected to the endocrine system [8] and critical to metabolism. The apelin-Sirt 1 interaction involves nitric oxide (NO) [9] that is now considered as the defect [10] in the interaction between the peptide apelin and calorie sensitive gene Sirt 1 involved in NO imbalances in the adipose tissue, liver and the brain.


For professionals working on the topic of cochlear implantation: Opinions of readers of “Instruction” and participants of MIMIC

Petrov SM*

To facilitate understanding some issues of cochlear implantation for new beginners we wrote 1- “The Instruction for audiologists and cochlear implanted patients” and created 2-Demo-program MIMIC. Here are opinions of readers of “The Instruction” and participants of MIMIC. All the ratings are from positive to enthusiastic.

Letter to the Editor

Alcohol-related poisonings in Russia: Obfuscated facts

Sergei V Jargin*

The problem of the alcohol misuse in Russia is well known; but there is a tendency to exaggerate it, which seems to be used to disguise shortages of the healthcare and public assistance.In this way, responsibility for the relatively low life expectancy is shifted onto the patients, who are supposed to drink excessively. In parallel, there is a tendency to exaggerate successes of the anti-alcohol campaign (1985-1989) and to trivialize the harm caused by the campaign e.g. mass consumption of surrogates [1]. The bias can be illustrated with the example of papers by Yuri Razvodovsky [2-5]. Yuri asked me per e-mail to write a “friendly” letter to the Editor referring to his article. An excerpt from the correspondence is presented here as documentary evidence (Figure 1). In reply, I cited the phrase: “The official statistical data do not support the claims that the… аnti-alcohol campaign contributed to the dramatic growth in fatal poisonings by non-beverage alcohol surrogates” [4] and commented that I witnessed mass poisonings with window cleaner in 1988. Considering the large scale of the window cleaner sales, it was knowingly tolerated by authorities. Poisonings with methanol and organochlorides (used e.g. in dry cleaning) were known to occur as well. Yuri replied that “there are two realities: one, which we both witnessed, and another-official statistics” (Figure 1). Obviously, Razvodovsky should have discussed in his articles the “realities we both witnessed”, i.e. common knowledge and observations, otherwise his papers are misleading.

Research Article

The impact of two different doses of Dexmedetomidine to Local Anesthetic Mixture on the quality of single injection Peribulbar Block in Vitreoretinal operations

Nagat S EL-Shmaa*, Mohamed El-Kashlan and Eman Ramadan Salama

Objective: To evaluate the impact of adding two different doses of dexmedetomidine to local anesthetic mixture on the quality of single injection peribulbar block in vitreoretinal operations.

Design: A prospective, double-blinded and randomized study.

Setting: carried out in operating room of our university hospital.

Patients: The study included 120 patients with viteroretinal diseases who were scheduled for vitreoretinal operations during the period from April 2016 to March 2017.

Interventions: 120 patients were randomly allocated to three groups of 40 patients each. Group I (the control group) received 5-7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase, group II received5- 7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase +15 µgdexmedetomidine, and group III received5- 7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase + 30 µg dexmedetomidine.

Measurements: The primary outcome was to evaluate the impact of adding two different doses of dexmedetomidine on the onset of globe anesthesia and akinesia. Secondary outcomes were the duration of globe anesthesia and akinesia, overall patient satisfaction and surgeon satisfaction.

Results: The onset of globe anesthesia was significantly shorter in group II and III in comparison with group I. Adding dexmedetomidine to the local anesthetic mixture prolonged the duration of globe analgesia, and this difference was statistically significant in group II and III in comparison with the group I.

Conclusion: Adding dexmedetomidine to a mixture of lidocaine 2% and levobupivacaine/hyaluronidase mixture in single injection peribulbar block shortened sensory and motor block onset, extended the analgesia period and the motor block duration with high patient and surgeon satisfaction.

Research Article

Evaluation of Desmin, α-SMA and hTERT expression in pulmonary fibrosis and lung cancer

Farahnaz Fallahian*, Seyed Ali Javad Moosavi, Frouzandeh Mahjoubi, Samira Shabani, Pegah Babaheidarian and Tayebeh Majidzadeh

Background: Pulmonary fibrosis is a clinical problem with an enigmatic etiology with no effective therapy. Current therapies for lung fibrosis are ineffective for progression of lung fibrosis and preventing respiratory failure.

Objectives: The aim of this study is to explore the expression of Desmin, α-smooth muscle actin (α-SMA) and the telomerase subunit: human telomerase reverse transcriptase (h-TERT) in a spectrum of lung tissue samples consist of lung fibrosis, lung cancer, and healthy controls.

Materials and Methods: The expression of Desmin, α-SMA and hTERT were studied in samples of 15 pulmonary fibrosis samples, 16 samples of lung cancer and 14 healthy controls investigated. We evaluated Desmin, α-SMA as well as the expression of components of telomerase (TERT), by methods: RNA Extraction and cDNA synthesis, Real-Time quantitative PCR, Immunohistochemistry, all prepared from lung tissue paraffin blocked.

Results: α-SMA marker detected 1(8.3%) of healthy control and 11(91.7%) of lung fibrosis samples. The difference between groups was significant (p<0.001). Also the difference between healthy control 1(6.7%) and lung cancer 14 (93.3%) for α-SMA marker was a significant (P<0.001). It was a significant difference between healthy control and lung cancer for TERT expression (P=.005). TERT was not positive in any sample of neither healthy control nor lung fibrosis. For TERT, it was a significant difference between lung fibrosis and lung cancer by Fisher’s Exact Test (P=.004). Expression of TERT and α-SMA between small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) was not statistically significant (P=.700, P=0758), respectively.

Conclusions: We recommend more investigation to regard α-SMA, Desmin in patients with lung fibrosis and follow them for possible cancer risk. Also, more study is needed to regard TERT as a marker in lung cancer. Assessment of these markers may have future implication to explain the same way of pathogenesis and carcinogenesis of fibrosis and cancer and for prevention or treatment

Short Communication

Heart disease new hypothesis: under endogenous toxicological aspect

luisetto M*, Behzad Nili-Ahmadabadi and Ghulam Rasool Mashori

In order to suggest new pathogenetic hypotesys in some heart disease we think is interesting to observe some biomedical literature: Can we think some endogenus toxicologic movens in some heart pathologies?

Activated platelet can trigger coronay artery spasm in some patients, and in SCD many patients not show Anatomic abnormalities and this can be involved sudden vigorous exertion untrained subjects (also in young) in seems to show an inadeguate methabolic response. Also severe artmia can be due by electrolyte umbalance.

Short Communication

Stem cells in heart failure some considerations

Federico Benetti*, Natalia Scialacomo and Bruno Benetti

Stem cell treatments depend not only on the type of cell to be used but also on the different implantation techniques. Intravascular cell injections are known to rapidly separate from the vessels On the other hand, it is also well known that direct injection into the myocardium provides better coupling within the heart muscle.That were the cases of Embriofetal stem cell (HFDSC) or Autologous stem cells (ABMSC) in our experience focused on direct approaches. When we have to deal with different stimuli, such as parietal stress or direct myocardial injury leading to hemodynamic overload, the heart responds with hypertrophy, able to initially compensate for loss of function. Later, and over a long subclinical period, progressive dilation continues to be compensated for by varying degrees of hypertrophy.

In the final stage, as described by Meerson et al. [1], dilatation overcomes hypertrophy and changes in cellular organization appear, such as: 1) myofibrillar lysis; 2) Increased lysosomes; 3) Distortion of the sarcoplasmic reticulum; 4) replacement of myocardial cells by fibrous tissue. Simultaneously, capillary density and contractile reserve decrease, and diffuse myocyte necrosis is a characteristic of both idiopathic and ischemic dilated cardiomyopathy [2,3]. Therefore, idiopathic dilated cardiomyopathy can be described from a pathological point of view [4], as a dilated heart with hypertrophied walls; macroscopically the dilatation exceeds hypertrophy. Microscopically the heart is invaded by areas of interstitial and perivascular fibrosis, adjacent to necrotic areas and myocytes that may be atrophic or hypertrophic, with loss of the extracellular matrix. Cell therapy in these patients is directed at restoring and repopulating the myocardium, thus restoring lost function by supplying cells that are able to differentiate into myocardial cells.

The use of mesenchymal or stromal cells as precursors of non-hemopoietic tissues was first attempted by the German pathologist Conheim in 1867 [5]. It was later demonstrated in tissue cultures that they were able to form various tissues, such as bone, cartilage, muscle, ligaments, tendons, etc., and to intervene in tissue repair [6]. An extremely interesting study showed that stromal stem cells treated with 5 Azacytidine a week formed interconnected with micro-tubuli cardiomyocytes. After 2 weeks they begin to beat and this contraction becomes synchronous after three weeks develop natriuretic peptide and stained with antibodies against actin and myosin and have a potential for action of cardiac cells [7]. Trans-differentiation in the cardiac phenotype requires an adequate microenvironment. It depends on the cellular interconnection for the generation of cardiac transcription factors (GATA-4 and myocyte factor 2 that was also observed) [8]. This was also confirmed by other investigators, emphasizing the importance of intercellular integration of cardiomyocytes with trans-differentiated cells [9]. Among the various cell types studied, stromal stem cells were shown to have the ability to differentiate into muscle and vascular cells and produce angiogenesis.This work was conducted by Weisel and Lee of the University of Toronto in 1999 [10]. This differentiation in the myogenic lineage with the development of actin, myosin and tropomyosin was demonstrated, as well as the presence of Conectin 43, a protein responsible for cellular interconnection.

Review Article

The bio-energy transport in the protein molecules and its experimental validations of correctness

Pang Xiao-Feng*

The bio-energy released by the hydrolysis of adenosine triphosphate, which relate to plenty of life activities and is transported in a solution, and its theory of transport are first stated and built in helix protein molecule. In order to confirm and verify the correctness of the transported theory we here systematically summarized and reviewed a great number of experimental investigation and evidences obtained by us and other researchers in past 30 years, involving the real existences of the solution and its features and lifetimes. In this survey we outlined and presented concretely the features of infrared spectra of absorption, Raman spectra and specific heat of the molecular crystal-acetanilide collagen, bivine serum albumin, myoglobin proteins and E.Coli. cell as well as the lifetimes of the solution in acetanilide and myoglobin measured by using pump-probe techniques and free-electron laser experiment, in which we give not only experimental data but also their comparisons with theoretical results. These experimental data and evidences provided here are enough to verify and affirm the true existences of the new solution, which can complete itself functions of bio-energy transport in the lifetime, and the correctness of the new theory of bio-energy transport in the acetanilide and protein molecule. Thus we can affirm the correctness of theory of the bio-energy transport in helix protein molecule, which can greatly promote the development of molecular biology.

Research Article

Management of Popliteal Artery aneurysms: Experience in our center

Michiels Thirsa and Vleeschauwer De Philippe*

Background: Popliteal artery aneurysms (PAAs) are rare, but the diagnosis should not be missed because of the limb and life threatening complications. The purpose of this study was to reach a consensus about the management of PAA based on our own experience and the available literature.

Materials and Methods: This is a retrospective analysis of all patients who underwent an open surgical PAA repair at our institution from January 2015 to December 2016. Demographic data, risk factors, clinical presentation, aneurysm characteristics, type of repair and results were reviewed. Results include patency and major complications.

Results: Seven patients underwent an open surgical PAA repair (six men). Median age was 72 years. A posterior approach (PA) was chosen four times and a medial approach (MA) was chosen three times. We performed six resections with interposition of a graft and only one ligation with a bypass. Five patients recovered well, did not develop any complication and did not need a second intervention to guarantee patency. These patients underwent a resection of the aneurysm and interposition of a graft (four via a PA and one via a MA). One patient treated by resection and interposition of a Dacron graft via a MA underwent an above-the-knee amputation at postoperative day 14. This patient had a preoperatively dysfunctional leg since several months with no patent outflow vessels. Our patient treated by ligation and bypass via a MA, developed an acute ischemia four months postoperatively because of an extreme flexion of the knee during several hours while watching TV. After unsuccessful trombolysis, he underwent a femorotibial bypass and a partial forefoot amputation. No long-term results are yet available.

Conclusions: In our opinion, open surgical repair of PAAs by resection of the aneurysm and interposition of a venous graft has the best results. Depending on the relation to the knee joint and thus the accessibility of the aneurysm, a posterior approach is preferred. We are not convinced of endovascular techniques in the treatment of popliteal artery aneurysms


Chemo-cytokines network is main target for control of Allergic asthma

Seyyede Masoume Athari and Seyyed Shamsadin Athari*

Asthma is a chronic respiratory disease which characterized by recurrent air flow obstruction, wheezing, chest tightness and coughing. Management of allergic asthma especially in children, is main problem for industrial world. Immunological factors have critical role in pathogenesis of allergic asthma.

Research Article

Body mass index in a group of security forces (policemen). Crosssectional study

Guillermo Padron Arredondo*

Introduction: Most police officers work long hours in day and night shifts and this exposure can harm your health.

Objective: Know the Body Mass Index (BMI) of a group of policemen of both sexes chosen at random to calculate the degree of overweight / obesity of the observed population.

Material and Method: An cross-sectional study was carried out on 75 elements of the municipal police of sexes, obtaining age, height, and weight with which the corresponding Body Mass Index was obtained. Descriptive statistics were used.

Results: Measurements were taken at 75 (100%) policemen of both of them sexes, 60 (80%) male and 15 (20%) female. And the following results were obtained: ideal weight 5 (6.6%), overweight 21 (28.0%) elements and obesity 49 (65.3%).

Discussion: Obese workers are prone to getting sick, missing work, disability and early retirement when compared to non-obese workers. Obesity can be a predictor of early mortality; therefore, with a BMI of 30-35, life expectancy decreases from 2 to 4 years and with a BMI of 40-45 it decreases from 8 to 10 years. In our study we found 70 (93.3%) policemen were overweight and obese BMI> 25).

Conclusions: Our findings recommend the implementation of diverse programs for the improvement of the health of this labor group with a multidisciplinary team as well as the adequate physical spaces for the practice of the corresponding activities.


Research Article

Treating Blood Hypertension in a Brazilian Community: Moving from Reactive Homeostatic Model to Proactive Allostatic Healthcare

Roberto Carlos Burini*, Mariana Santoro Nakagaki, Edilaine Michelin and Franz Homero Paganini Burini

The responsiveness of hypertensive subjects to different types of physical exercises and length of intervention, has been investigated in samples of our dynamic cohort study (“Move for Health” program) based on spontaneous demand for healthy lifestyle with supervised exercises and dietary counseling. After clinical selection and baseline assessments they were spontaneously assigned to exercise protocols of strength (PAc) isolated or combined with endurance (walking) exercises (PMi) daily or in alternated days(PMiA), hydrogymnastics(PHy) and tread mill high- intensity exercises(PHit), applied during 10(experiment 1) and 20(experiment 2) weeks of intervention. Baseline demographic, socioeconomic, anthropometric and physical activity and fitness characteristics were similar among protocols. Ten-week training improved VO2max. Similarly in all protocols while hand grip increased only in PAc. In average, there was a 16% reduction rate of hypertension rate from baseline with both, SBP and DBP, reduced by PHy and only SBP by the PMi. After adjustments hypertension was more reduced by PAc, PMi and PHy. In the 20-week experiment, higher SBP was similarly reduced by PAc or PMiA and DBP by PMiA, after adjustments. Hence, so far, our generated data suggest physical exercises as an effective tool for hypertension reduction, from 10 weeks to 3 year-long supervised protocols composed by surface or aquatic activities with strength or endurance exercises. PAc takes longer and short-period responsiveness can be achieved by either combined (strength-endurance) or hydrogymnastic exercises. Thus, exercise training is a time-and type-dependent tool, feasible, costless and scientific-based rheostatic-allostatic alternative for the current “sick-care” drug-dependent homeostatic approach to hypertension med care.

Case Report

Ultrasound conjugated with Laser Therapy in treatment of osteoarthritis: A case study

Ana Elisa Serafim Jorge, Michele Luise de Souza Simao, Ana Carolina Fernades, Aline Chiari, Antonio Eduardo de Aquino Junior*, Anderson Luis Zanchin and Vanderlei Salvador Bagnato*

Osteoarthritis of the hand is a chronic condition that involves hand joints, but receives less attention. Few studies have investigated the use of ultrasound therapy and laser therapy for the treatment of hand osteoarthritis.The objective was to evaluate the effect of the conjugated treatment of therapeutic ultrasound and laser therapy on the pain and joint function of a patient with hand osteoarthritis. The is case of a woman, 57 years old, with a diagnosis of osteoarthritis on hand for 3 years, presenting constant pain and worsening after manual activities. The pain and function were evaluated, respectively, by Visual Analog Scale (VAS) and Australian Canadian Osteoarthritis Hand Index questionnaire (AUSCAN). After 12 sessions using ultrasound and laser therapy application, there was an expressive improvement in the pain and functional indexes of the patient. The combined application of therapeutic ultrasound and laser therapy, through the unified field action of the therapies used, proved to be efficient in reducing pain and improving the functionality.

Research Article

Correlate alcohol and toxicology analysis with Urinary Bladder Distension on Post-mortem Computed Tomography (PMCT): A Validation Study

Lai Poh Soon*, Mohamad Helmee Mohamad Noor, Nor Fadhilah Madon, Mohd Hilmi Saidin, Mansharan Kaur Chainche Singh and Kunasilan Subramaniam

Urinary bladder distension is traditionally regarded as a sign of intoxication at autopsy, however, to date there is very little literature available to support this hypothesis. The purposes of our study were to correlate alcohol and/or toxicological analysis with calculated urinary bladder volumes and its sensitivity as well as to test the validity by using the radiologically calculated urinary bladder volumes (UBVs) from CT images. The study population was all the postmortem cases involving with blood and/or urine samples sent for alcohol and/or toxicology analysis in 2016 at the Kuala Lumpur Hospital. Out of that 485 cases, there were 127 postmortem cases retrieved with positive alcohol and/or toxicology results Positive toxicology results in this study was referring to drug of abuse (DoA) including amphetamine type stimulants, opiates, cannabis and ketamine.


Unveiling the gut virome in human health and diseases

Tao Zuo*

Due to the advances in high-throughput sequencing technologies, the gut vriome is increasingly being perceived as one important component of the gut microbiome, where the number of viral biological entities is believed to far outcompetes that of the bacterial populations [1,2]. The human virome are primarily composed of bacteriophages, animal-cell viruses, endogenous retroviruses and viruses causing persistent and latent infections. Collectively they contains a more diverse genetic entity than the gut bacteria [3,4]. While the composition of them in the gut is precipitately being revealed, their roles in human health remain largely unexplored. It is undeniable that certain gut viruses are deleterious to human health. Interestingly, enteric viruses however, in some cases, can recapitulate the beneficial effects of commensal bacteria through different mechanisms, including modulating the innate and adaptive immunity of the host [5-7].

Letter to the Editor

Importance of prevention-A letter to the editor

Rathi A

Over 50% of all deaths are because of chronic diseases, that we call lifestyle diseases. It means, 50% of the deaths can be prevented by lifestyle modifications. Even 40% of cancer, the disease which is the dreaded the most, can be prevented through healthy lifestyle. According to the World Health Organization (2005), the estimated loss in India’s national income due to heart diseases, stroke and diabetes in 2005 was US $9 billion. These losses are projected to exceed US $200 billion in the next decade, unless preventive measures are taken in which case, an accumulated economic growth of US $15 billion can be expected [2].
Such is the power of prevention. People need to be made aware of the risk factors and healthy lifestyles and it can remove a big burden from the healthcare system of the country. On an individual level too, it will help a great deal as people will be empowered to lead a healthy life.
It’s high time we give preventive health care its log due respect and make this world a healthier and happier place.
As the saying goes “prevention is better than cure…”, but such is the wrath of chronic diseases that the saying should be rephrased into “prevention is better than NO cure at all”.

Research Article

Evaluation of the effects of Leech Salivary Extract (LSE) on Haematological parameters in Rats

Hausatu Babayi*, Ojo Olufunmilola Praise, Labake Fadipe Ajoke, Israel Kayode Olayemi, Elisha Baba and Oladosun Oluwale Peter

The effects of Leech Salivary Extract (LSE) on some haematological, immunological and organ weight parameters in rats, during a twenty eight days oral administration of 25, 50 and 100 mg/kg body weight doses, was investigated. LD50 and sub chronic toxicity was determined using standard methods. The oral LD50 was above 5000mg/kgbw. Oral administration of LSE (25mg/kgbw, 50mg/kgbw, 100mg/kgbw) for 28days had no significant (p>0.05) effect on the differential white blood cells (lymphocytes, monocytes, basophils, neutrophils, eosinophils), red blood cell indices (RBC count, PCV, HB, platelets, MCHC and MCH), feed intake, body weight gain and relative organ weight of lung, heart, liver, kidney, spleen and stomach of rats. However, the LSE evoked a significant (p>0.05) increase in the level of MCV in treated rats compared to the control. These results, indicating low toxicity and no negative significant effects of LSE on haemato-immunological indices in rats, suggest that the extract is safe for development and use as therapeutic for managing clinical conditions.

Research Article

Status of protection against Hepatitis B infection among healthcare workers (HCW) in a tertiary healthcare center in India: results can’t be ignored!

Pandey Prashant, Agarwal Nitin*, Das Suryasanta and Dharmendra Kumar

Background and Aims: the Aim of the study was to find the level of protection among the healthcare workers (nurses, doctors, housekeeping staff and general duty assistants) by doing Anti-HBsAb titer and vaccinate those who were not properly immunized against HBV infection.

Materials and Methods: The study was approved by the Institutional review board of the Hospital. The study group included doctors, nurses, technical staff and lab attendants. Anti-HBs antibody titer was done on Vitros 3600 (OCD, USA). Tests were performed according to manufacturer’s instruction. Vaccine provided was Engerix B (GSK Glaxo, Belgium). Vaccination was provided to all employees had titer below 10 miu/ml.

Results: 489 of 794(61.5%) HCW had no history of previous vaccination and only 293 (36.9%) subjects had complete vaccination. Only 60.8 % (482/794) of the total subjects had titer above 10 miu/ml and were protected against Hepatitis B. Around 80.6% (246/305) of those who were fully vaccinated and 40.8% (237/489) of those who were not vaccinated previously had protective anti-HBs titers(>10 miu/ml). Majority (86.8%, 271/312) who had titer below 10 miu/ml were unvaccinated. Two of eight employees who had history of needle stick injury in past were found non-immune to Hepatitis-B infection.

Conclusion: Despite being involved in the procedures with high chances of infections through needle stick or other exposures, only one third of health care workers were vaccinated against hepatitis B. We recommend that all the HCWs should be vaccinated for Hepatitis B and their anti-HBs levels determined at regular intervals.

Conclusion: Despite being involved in the procedures with high chances of infections through needle stick or other exposures, only one third of health care workers were vaccinated against hepatitis B. We recommend that all the HCWs should be vaccinated for Hepatitis B and their anti-HBs levels determined at regular intervals.
Results: 489 of 794(61.5%) HCW had no history of previous vaccination and only 293 (36.9%) subjects had complete vaccination. Only 60.8 % (482/794) of the total subjects had titer above 10 miu/ml and were protected against Hepatitis B. Around 80.6% (246/305) of those who were fully vaccinated and 40.8% (237/489) of those who were not vaccinated previously had protective anti-HBs titers(>10 miu/ml). Majority (86.8%, 271/312) who had titer below 10 miu/ml were unvaccinated. Two of eight employees who had history of needle stick injury in past were found non-immune to Hepatitis-B infection.
Conclusion: Despite being involved in the procedures with high chances of infections through needle stick or other exposures, only one third of health care workers were vaccinated against hepatitis B. We recommend that all the HCWs should be vaccinated for Hepatitis B and their anti-HBs levels determined at regular intervals.

Research Article

Analysis of Pyogenic Liver Abscesses

Eva Barreiro Alonso*

Background: Pyogenic liver abscesses (PLA) are frequent in immunosuppressed patients. We review the characteristics of patients with PLA at a tertiary academic Spanish hospital in Asturias.

Methods: A retrospective observational study for 10 years, between 2006-2015. Epidemiological, clinical, analytical characteristics, treatment and hospital stay of the patients with PLA were analyzed.

Results: 99 patients, 62 (62.6%) men, with age ≥65 years (72.7%). The most frequent etiology was: Biliary (40%), postsurgical (15%) and intestinal origin (11%). The most frequent clinical signs were fever, showing significant differences, abdominal pain (p=0.001) and nausea (p=0.02) between biliary PLA and the rest of the PLA. Microbiological results were confirmed in 63% (62 cases). All were treated with antibiotic therapy, along with percutaneous drainage (44.4% (44 cases)); and surgical drainage (12.1% (12 cases)). The overall mean stay was 23.1 days without significant differences between those treated with percutaneous drainage or surgical drainage.

Conclusion: PLA predominate in patients ≥65 years. Biliary PLA are the most frequent, diagnosed at an older age than the intestinal PLA (p=0.005).

- The treatment is based on systemic antibiotherapy and percutaneous drainage, especially in PLA only >5cm (p=0.019).

- There are no significant differences in average stay of patients treated with percutaneous drainage or surgical drainage.

Research Article

Growth Promoting Potential and Colonization Ability of Probiotics (Bacillus coagulans and Bacillus subtilis) on the Freshwater Prawn Macrobrachium rosenbergii Post-Larvae

Karthik M, Saravana Bhavan P* and Manjula T

The probiotic effects of Bacillus coagulans and Bacillus subtilis were studied on survival, growth, concentrations of basic biochemical constituents, activities of digestive enzymes, and their colony establishments in the gut of Macrobrachium rosenbergii post-larvae (PL). Eleven groups of PL (2.03±0.05 in length and 0.18±0.01g in weight), each consists of 35 individuals maintained in 25 L of ground water and fed ad libitum with five serially diluted concentrations, 10-1, 10-3, 10-5, 10-7 and 10-9 of B. coagulans, and B. subtilis incorporated diets containing 40% protein, for 45 days. Diet without incorporation of any of these probiotics was served as control. These probiotics were found to be alive in the respective feed even on day-15 after their formulations. Significant improvement in survival, nutritional indices (weight gain, specific growth rate, food conversion ratio and protein efficiency ratio), contents of basic biochemical constituents (total protein, amino acid, carbohydrate and lipid) and activities of digestive enzymes (protease, amylase and lipase) were observed (P<0.05), particularly in 10-7 concentration of B. coagulans, and B. subtilis incorporated diets fed PL when compared with control. The biochemical confirmation tests revealed that presence of Escherichia coli, Acetonobacter sp., Salmonella sp., and Pseudomonas sp., in the gut of control PL. In the gut of PL fed with B. coagulans incorporated diet, Acetonobacter sp., Salmonella sp., and Pseudomonas sp., were found to be competitively excluded, whereas, in the gut of PL fed with B. subtilis incorporated diet, Acetonobacter sp., and Salmonella sp., only were found to be excluded competitively. Actually, colonies of Bacillus sp., and Lactobacillus sp., were found to be establishment in the gut of PL fed with B. coagulans, and B. subtilis incorporated diets. Overall, these probiotics incorporated diets produced better growth and survival due to better FCR and activities of digestive enzymes, which in turn led to better nutritional profile. Therefore they are recommended as feed additives for sustainable culture of M. rosenbergii.

Short Communication

Erectile Dysfunction and Coronary Artery Disease: Two manifestations, one same underlying mechanism

Jonathan Cardona-Velez* and Laura Ceballos-Naranjo

Erectile dysfunction (ED) is a common disorder whose prevalence increases with age. Over time a strong correlation between erectile dysfunction and cardiovascular disease has been established as the result of the same pathophysiological process: endothelial dysfunction and atherosclerosis. Because small vessels of the penis can be affected by atherosclerotic plaque earlier than coronary arteries, carotids or femoral arteries, men often have symptoms of ED long before the signs of cardiovascular disease appear. For this reason, ED can act as a marker of early atherosclerosis that predicts the onset of cardiovascular disease at a later time.

Case Report

Implications of entomological evidence during the investigation of five cases of violent death in Southern Brazil

Patrícia J Thyssen*, Marina FK Aquino, Natane CS Purgato, Edmilson Martins, Alexandre A Costa, Carolina GP Lima and Claudemir R Dias

In homicide cases, knowledge about time of death is important as it directs police investigation towards the discovery of authorship, including or excluding suspects of a crime, and determining nature of death. In Brazil, entomological evidence is still neglected by official forensic organizations and for this reason cases using insects to estimate post-mortem interval (PMI) are still rare. Dipteran specimens collected and analyzed by the staff of Criminalistics Institute (CI) from São Paulo State, Brazil, made it possible to elucidate circumstances of the death, including suspects to the crime scene, in five occurrences involving discovery of cadavers. In all cases, blowflies were collected and were identified as belonging to species Chrysomya albiceps (Wiedemann, 1819), Chrysomya megacephala (Fabricius, 1794), Chrysomya putoria (Wiedemann, 1830), Hemilucilia semidiaphana Rondani, 1850 and Lucilia eximia (Wiedemann, 1819) (Diptera: Calliphoridae), while only in one case Sarcophagidae (Diptera) flies were also collected. PMI estimate was calculated taking into account laboratorial developmental rate data of mentioned species on the environmental temperature on which bodies and insects were exposed, along with comparisons to field research previously conducted in those areas. Based on larval age and behavior, the course of the investigation had changed, pointing to the crime author (case I), as well as the nature of the crime (cases I-III) and associated suspects to the criminal act (cases IV-V). Results show how promising is the use of entomological evidence during investigations of violent deaths.

Review Article

Open bite malocclusion: An overview

Mohamed Abdul Wajid, Pratik Chandra, Rohit Kulshrestha*, Kamlesh Singh, Ramji Rastogi and Vinay Umale

The term open bite is referred as no contact between anterior or posterior teeth. The complexity of open bite is attributed to a combination of skeletal, dental and habitual factors. Etiology of open bite can be attributed to genetics, anatomic and environmental factors.However, the tendency toward relapse after conventional or surgical orthodontic treatment has been indicated. Therefore, open bite is considered one of the most challenging dentofacial deformities to treat. The aim of this article is to emphasize that early etiological diagnosis, dentofacial morphology and classification are essential to the successful outcome of the technical intervention. Failure of tongue posture adaptation subsequent to orthodontic and/or surgical treatment might be the primary reason for relapse of open bite. Prolonged retention with fixed or removable retainers is advisable and necessary in most cases of open bite treatment. The treatment of open bite remains a tough challenge to the clinician; careful diagnosis and timely intervention with proper treatment modalities and appliance selection will improve the treatment outcomes and long-term stability.

Review Article

Fixed functional Appliances in Orthodontics-A review

Devinder Preet Singh* and Ramanpreet Kaur

Correcting class II malocclusion has always challenged an orthodontist owing to the complex and multifactorial aetiology. Age of patient and selection of the appliance plays an important role in the outcome of the treatment. Growth modification using functional appliances achieves stable results in class II patients. An orthodontist has wide variety of fixed and removable appliances for addressing a class II malocclusion. In this review article an attempt has been made to compile various available fixed functional appliances.

Case Report

Role of Helicobacter pylori in causing repeated Reinfection from Oral cavity in Chronic Prostatitis

Pankaj Garg*

Introduction: The refractoriness in treatment of chronic prostatitis (CP) could be due to repeated infection. This reinfection could be caused by Helicobacter Pylori present in human saliva.

Methods: The oral cavities seem to be the important reservoirs for the reinfection. The transmission from these reservoirs could be stopped by avoiding contact between male urethera and saliva.

Results: Three patients suffering from refractory symptoms of CP were advised to avoid contact between their urethera and saliva and were prescribed antibiotics. All patients had complete response.

Conclusions: The oral cavity serve as reservoir of microorganisms (H.Pylori) which infects patient’s urethera repeatedly in patients of CP.

Research Article

Diabetes and red blood parameters

Md. Sadikuj Jaman*, Md. Sohanur Rahman, Rubaiya Rafique Swarna, Joyanto Mahato, Md. Milon Miah and Mosa. Ayshasiddeka

Type 2 diabetes is a common disease in these days and day by day it is arising. The main focus of the study was to investigate association of packed cell volume (PCV), Mean Corpuscular Volume (MPV), Mean Corpuscular Hemoglobin Concentration (MCHC), Red Cell Distribution Width (RDW) with glycemic marker HbA1c. So that PCV, MPV, MCHC, RDW could be used as a predictor of glucoregulation in type 2 diabetes instead of HbA1c value. This study included 87 DMT2 patients, which divided into two groups, A (n=41, presence in diabetics≤6.5-6.9%) and B (n=46, target in diabetes≥7.0%), according to HbA1c values. Spearsman correlation co-efficients were calculated to evaluate the relationship between RBC count, MCHC, RDW with random blood sugar (RBS) and PCV, MCV, MCHC with HbA1c value. Binominal logistic regression analysis was performed to estimate the relationship between glycemic control, as dichotomous outcome of MCHC, RDW, PCV, and MCV as the main prognosticator. MCHC and RDW were significantly higher in the group B compared to the group A. RDW and MCHC may be applied as the auxiliary indicators of deterioration of glucoregulation.

Research Article

Effect of foot posture on foot-specific health-related quality of life

Bahar Kulunkoglu*, Yasemin Akkubak and Afra Alkan

The purpose of this study was to determine the relationship between Navicular drop (ND) and Hallux valgus (HV) angles and their effects on foot-specific health related quality of life. Sixty female patients with bilateral HV aged between 32-60 participated in this study. The patients with the HV deformity degree of “2” or “3” according to the Manchester scale were included.

HV angle were obtained from standing (weight bearing) bilateral antero-posterior radiographs. HV angle (A angle), intermetatarsal angle (B angle), hallux interphalangeal angle (C angle) were measured. Subtalar pronation was measured the navicular drop (ND) test. ND test were performed for both feet and recorded in millimeters. Foot-specific health related quality of life was measured using the Manhester-Oxford Foot Questionnaire (MOFQ).

There was a strong positive correlation between the ND qtest and the angles A, B, and C for the right foot (rho=0.749, 0.761 and 0.749 p<0.001, respectively,). There was a strong positive correlation between the MOFQ subscales and the angles A, B, and C for the right foot (p<0.001). There was a strong positive correlation between the MOFQ subscales and the angles A, B, and C for the right foot (p<0.001).

In conclusion, there were relationship between ND, HV angular severity and foot-specific health related quality of life. As the HV angular severity increased, there was greater drop in the navicula and reduction in quality of life.

In conclusion, there were relationship between ND, HV angular severity and foot-specific health related quality of life. As the HV angular severity increased, there was greater drop in the navicula and reduction in quality of life.

Research Article

Injuries of the shoulder sustained by Surfboard riders

Simon Dimmick*, Jillian Patterson, Patrick Sheehan, Suzanne Anderson and Graeme MacDougal

Background: To determine the spectrum of shoulder pathologies suffered by surfers.

Methods: Prospective descriptive study. Surfers with shoulder injuries who were referred to a sub-speciality orthopaedic shoulder private practice situated on the Northern beaches of Sydney (Australia) were recruited over a three-year period.

Results: 42 shoulders in 37 subjects were included-12 acute injuries (29.3%), 9 acute on chronic (22%) and 20 chronic injuries. Average age 48 years (range 20-72 years). Seventeen subjects (46%) had manual occupations and 20 subjects (54%) had office-based occupations. Spectrum of pathologies included rotator cuff tendon tears, long head of biceps tendon pathology, labral tears, acromioclavicular and glenohumeral joint osteoarthritis.

Discussion: There is a wide spectrum of acute and chronic shoulder injuries sustained by surfers. The most common presentation was for chronic pathology. The average age of 48 suggests that age may play a role in attritional/degenerative change and therefore an increased likelihood of injury.

Case Report

Physical Therapy for Transverse Myelitis: A Case Report

Allison Buchanan, Kelli J Wilkerson and Han-Hung Huang*

Background and Purpose: Transverse myelitis (TM) is a rare neurological diagnosis found in 1-4 per million people. Rehabilitation is recommended secondary to steroid treatment.There is limited clinical research on physical therapy (PT) for TM. The purpose of this case report is to present PT examination and management strategies for a patient with TM.

Case Description: A 25-year-old female patient diagnosed with TM was referred to PT. She presented foot drop causing ataxic gait, decreased sensation in bilateral lower extremities, significant fatigue, and low back pain. The patient required significant rest time between all tests and measures due to severely increased fatigue. PT plan of care was focused on therapeutic exercises per patient tolerance, passive range of motion (ROM) administered by the therapist, and gait training when activity tolerance was increased.

Outcomes: The patient was able to tolerate bouts of exercise as prescribed through home exercise program. She responded very well to passive ROM treatment during breaks between exercises to maintain ROM and decrease rigidity. Active ROM exercise was used to build activity tolerance while being mindful of limited ability due to fatigue. Upon increased activity tolerance, the patient was able to tolerate gait training with multiple breaks and maintain corrected gait when addressed during treatment.

Discussion: PT intervention was helpful for this patient with TM. Breaking down functional activities based on patient tolerance is important when treating people with TM. More experimental research is needed to support the benefits of PT for TM.

Research Article

Diazepam Withdrawal Expression is related to Hippocampal NOS-1 Upregulation

Emilce Artur de la Villarmois, Maria Florencia Constantin, Claudia Bregonzio and Mariela Fernanda Perez*

Background: Benzodiazepines are usually prescribed for anxiety and sleep disorders in a long-term fashion that may cause drug dependence. Discontinuation after prolonged administration may lead to withdrawal expression, being anxiety the most predominant sign. It has been described that a context-dependent associative learning process underlies diazepam dependence. Nitric oxide is a crucial player in learning and memory processes, hippocampal transmission, as well as in benzodiazepines withdrawal. Considering that previous results from our laboratory showed an increase in hippocampal functional plasticity only in diazepam dependent rats, the aim of the present investigation is to determine whether diazepam dependence could alter neuronal nitric oxide synthase enzyme (NOS-1) expression within the hippocampus, by using western blot.

Results: chronic diazepam-treated animals that developed dependence showed increase in NOS-1 expression in dorsal, but not in ventral hippocampus, while no-dependent or control animals presented similar NOS-1 protein levels.

Conclusion: withdrawal from long-term diazepam exposure could be associated to increased nitric oxide neurotransmission within dorsal hippocampus induced by NOS-1 over-expression. This mechanism could underlie the improved hippocampal synaptic transmission previously observed in diazepam withdrawn animals. Confirmatory experiments need to be addressed to determine the mechanisms by which nitric oxide participates in benzodiazepines withdrawal in order find new molecular targets to develop pharmacological tools to prevent the withdrawal syndrome.


What can Mathematics say about unsolved problems in Medicine?

Marco P Soares dos Santos*

Nobody doubts that mathematics plays a crucial role in medical achievements. It is certain that is being mainly used in statistics and physics for biomedical problems [1]. For sure that we have already heard about how mathematics can improve the anticancer arsenal [2].Quantitative genetics have triggered a giant potential in medical care [3,4]. And mathematical algorithms, provided by artificial intelligence, continuously boost new therapeutic paradigms [5,6]. Nonetheless, one cannot ignore the ability of mathematics for analyzing ideas. One can see that when Soares dos Santos and colleagues [7] wondered what mathematics is able to say about how to optimize the performance of implantable medical devices, they wondered about the optimality of their research projects in the first place. What mathematics says about how to design “optimal” devices? It says that current devices are not able to ensure such performance. Will new or improved surgical techniques solve device failures? Mathematics also says «no». Will new or improved materials solve device failures? Mathematics says «it is possible, but it will be harder». Harder than what? Mathematics says: «Harder than instrumented active devices. Medical devices can perform optimal performances if they are active, i.e., if they are able to monitor their own state and the physiological states of the tissues surrounding the device, and if they are able to apply therapeutic actuations to such tissues so that the failure state is conducted to a without-failure state» [7-11]. And mathematics also says that this analysis can be applied to the overall implantable medical devices [7]. One cannot deny that mathematics is a powerful tool to identify what are the key challenges that must be addressed for unsolved problems in medicine. Thanks to mathematics, the universe of concepts is not apart from the clinical practice. However, medical research is being conducted by considering the paradoxicality of mathematics in medicine [1] as an assumption-the first challenge must be to question mathematics about the real accomplishments that our research projects can achieve.

Review Article

Studies of Grafts in vegetables, an alternative for agricultural production under stress conditions: Physiological responses

Jose Bernal Alzate, Edgar Omar Rueda Puente*, Onecimo Grimaldo Juarez, Daniel Gonzalez Mendoza, Lourdes Cervantes Diaz and Alejandro García Lopez

Vegetable production by grafting is a technique which it has made possible to resume agricultural soils which previously could not be produced due to stress generated by various abiotic factors, like a lack of water,stress by high or low temperatures, and or heavy metal contamination, among them. It has been documented and defined a number of graftings which they are tolerant to different factors; however, when it comes to auscultating information related to understand the molecular responses and observe what are the biochemical changes and physiological responses of grafted plants, it is dispersed. The current paper attempts to provide basic information documented on technique, addressing the molecular, biochemical and physiological responses, and thus get a clear perspective on the use of grafts, making this practice be used with most frequently by all its advantages.

Mini Review

Common transcriptional regulation of ABA and ethylene

Ravi Valluru*

Plant hormones are versatile chemical regulators of plant growth. The concept of hormone ‘interaction’ [1] has gained much importance and several key players of hormonal network are uncovered for major plant hormones.The fact that hormones are structurally unrelated and their interaction elicits different genomic and non-genomic responses suggest hormone interaction involve co-regulation at multiple levels [2]. Recent studies suggest that hormonal interaction involves control over biosynthesis genes [3-6], key components of signalling pathways [7,8], hormone distribution [9,10], and interaction at the level of gene expression [11-13]. The spatial and temporal changes in hormone sensitivity add further complexity as they are developmental stage-dependent [14]. Understanding how these mechanisms are integrated would allow us to manipulate hormone interaction-regulated growth response under environmental changes. One such prominent emerging hormone interaction is ethylene and abscisic acid (ABA) in several growth processes. In this short review, I discuss some of the common transcriptional regulators of ethylene and ABA.

Review Article

Progresses of the Badminton equipment relate to exercise: Some training aspects

Zhi Qiang Liang and Jian She Li*

Background: With the development of sports science and badminton equipment, the roles of badminton shoes, such as to alter lower - extremity biomechanical parameters, prevent sports injuries and enhance performance, were confirmed by a mass of studies.

Methods: In this study, a serial of methods including literature review, visualization analysis, mathematical statistics, are used to describe the progresses of the badminton shoes relate to exercise in some training aspects, which can be searched by CNKI and SCOPUS databases.

Results: Among the exiting research, most mainly focused on evaluation and design of badminton shoes, sports injuries and performance, some have tested and verified the roles mechanism of badminton shoes. However, there are still some disadvantages to can’t ignore, such as the quantities of studies the designed level and the mechanism exploration.

Conclusions: To sum up, the roles of the badminton shoes in sports training still need to be explored and confirmed.


Research Article

Effectiveness of Soft Tissue Mobilisation as an adjunct to the Conventional Therapy in patients with Ankylosing Spondylitis

Patitapaban Mohanty*

Introduction: The HRMT (Human Resting Myofasial Tone) factor plays an important role to initiate the trigger the inflammation at the disease site in Ankylosing spondylitis (AS) as in all spondyloarthropathies. The incidence of fibromyalgia is higher in AS and a limiting factor to undergo the exercise program.

Aim of the study: To know the effectiveness of soft tissue mobilisation in patients with Ankylosing Spondylitis when it used as an adjuncts to the conventional exercises.

Methodology: 40 subjects were randomly assigned in to experimental and conventional group. Experimental group (n=20) received conventional exercises along with soft tissue mobilisation and the conventional group (n=20) received only conventional exercises (flexibility exercises, aerobic exercise and breathing exercise) for a period of 4 weeks, 5days/week.

Results: The result of the study showed that both the conventional and experimental groups improved significantly in stiffness, pain and physical function aspects after treatment. However the experimental group had a greater change as compared to conventional group.

Conclusion: The study demonstrates that soft tissue mobilisation has an effect when it used before the conventional exercise in patients with ankylosing spondylitis.


Mini Review

ABC and MFS Transporters: A reason for Antifungal drug resistance

Neelabh* and Karuna Singh

Fungi cause a variety of diseases and are difficult to treat owing to their eukaryotic nature resulting in dearth of antifungal targets at hand. This problem is further elevated many folds due to the resistance mechanisms of fungi through which they circumvent the antifungal drugs administered for therapeutic purposes. Fungi have a variety of strategies for obtaining these resistances, amongst them pivotal role is played by the ABC and MFS transporters. This article encompasses the important genes and their respective roles of both the classes of the transporters in different species of fungi.