10/26/2018
Case Report

Preventing Peri-implantitis with a proper Cementation Protocol and with the consideration of alternatives to Cement-Retained Implant Restorations

Tony Daher*, Robert G Mokbel and Vahik P Meserkhani

Successful implant restoration is depending on an adequate surgical and prosthetic protocol. In the last few years an increase in Peri-Implantitis has been attributed, in part, to the excess cement left around the implant collar and threads, leading in many cases to bone loss and even the complete failure of the implant treatment [1-5].

This article will attempt: 1. To describe a proper cementation protocol for cement-retained implant restorations to reduce cement induced implant failures, and 2. To review the alternative implant restorative options to cement-retained crowns such as screw-retained restorations, screwless and cementless implant restorations, screw-retained-cemented implant crown, angulated screw channel restorations, the lingual locking screw-retained restorations and the multi-unit abutment restorations.

10/29/2018
Review Article

Endogenous sensitizer of beta-adrenergic receptors (ESBAR) and its analogs (review)

Victor Tsirkin*, Alexander Nozdrachev, Elena Sizova, Tatyana Polezhaeva, Svetlana Khlybova, Marina Morozova, Andrew Trukhin, Julia Korotaeva and Grigory Khodyrev

The results of the 20 years studies of the presence in blood serum and other body fluids of endogenous modulators of adrenergic and M-cholinergic impact as a component of humoral link of autonomic nervous system. The article is devoted to the endogenous sensitizer of beta-adrenergic receptor (ESBAR) - water-soluble low molecular weight substances, analogs of which are histidine, tryptophan, tyrosine, mildronat and preductal. It is shown, that separate dilutions of human serum and animal (as a source of ESBAR) and analogs of ESBAR ways to enhance the effectiveness of activation of beta-adrenoceptors (AR) of smooth muscle (uterus, coronary and renal arteries, trachea, stomach), myocardium, erythrocytes and platelets (respectively influenced of histidine and tryptophan). It is reported that content of ESBAR in human serum (according to the titers of its dilution) depends on the sex and the presence of somatic diseases, and at women are also on the stage of reproduction and obstetric complications It is discussed possible mechanisms of ESBAR action, its physiological role, including as a component of beta-adrenoceptor inhibitory mechanism for myometrium, as well as the prospect of the use of analogs of ESBAR, including for the prevention of preterm labor, and for the treatment of bronchial asthma, coronary heart disease, hypertension and heart failure.

10/23/2018
Research Article

Assessing the Neurocognitive function effects of ketamine in Cardiac Surgical patients

Demet Dogan Erol*

Background: Despite remarkable progress in surgical,cardiopulmonary bypass (CPB) and anesthetic tecniques, neurocognitive damage still remains an important cause of postoperative morbidity in cardiac surgery. The aetiology of neurocognitive damage is likely to be multifocal; including macro and microemboli, cerebral hypoperfusion, inflammation and nonpulsatile flow. N-methyl-D-asparticAcid (NMDA) receptors play an important role during neurocognitive damage. Ketamine is a non-competitive antagonist to the phencyclidine site of NMDA receptor for glutamate and directly suppresses proinflammatory cytokine production. The aim of the present study was to evaluate whether ketamine has neuroprotective effects during open-heart surgery through the use of neurocognitive tests.

Methods: We considered all patients aged between 58-76 years who were referred to a single cardiothoracic surgical team for elective, primary coronary revascularization. Patients were excluded from the study for the following reasons: a history of neurological, psychiatric, gastrointestinal, hepatic, renal, hematologic and clotting systems disorder and repeat procedures. Undergoing CPB were randomized 2 groups: Group1 (ketamine)(n=25) or Group2 (propofol)(n= Patients 25) In the propofol group, anesthesia was induced with 3mg/kg propofol, 1µg/kg remifentanyl, 0.1mg/kg vecuronium. Remifentanyl 0.5-1μg/kg/min was infused intravenously throughout the whole procedure. In the ketamine group, anesthesia was induced with 1-2mg/kg propofol, 1-2mg ketamin, 0.1mg/kg vecuronium. Ketamin 1mg/kg/hour was infused intravenously. Pressors, inotropic agents and antiarrhythmics were used as needed. The Mini-Mental State Examination(MMSE) was administered the day before surgery and three days later. The change in scores for MMSE was calculated for each patient and all the group. The results were compared statistically with paired simple t-test.

Results: The mean age, CBP duration, lowest temperature was not statistically significant (Table1). Peroperative and postoperative blood pressures and pulse rates showed differences between groups. There were no preoperative differences between the groups on any of the mean MMSE score (Table2). The ECG monitoring revealed that most patients remained in sinus rhythm, with no difference between groups.

Conclusions: We could not demonstrate that intraoperatively administered ketamine resulted in greater neuroprotective effects compared with propofol. Ketamine in combination with propofol during cardiac surgery is associated with a stable hemodynamic profile. Propofol may reduce the delivery of microemboli to the cerebral circulation by decreasing the cerebral blood flow. Propofol has a direct neuroprotective effect in vitro, although Roach et al. could not demonstrate a protective effect of propofol during open-heart surgery. Propofol enhances the antiinflammatory response to surgery by several mechanisms. This might have masked a neuroprotective effect of ketamine because propofol was administered in both groups in our study.

10/02/2018
Review Article

Urine Leak Following Kidney Transplantation: An Evidence-based Management Plan

Shafiq A Chughtai, Ajay Sharma and Ahmed Halawa*

Care of kidney transplant recipient remains complex and long-term graft survival is not seen in every transplant recipient. Due to reduced supply and increased demand of human organs, more transplants are carried out using marginal grafts on emergency lists. Transplant recipients have altered physiology due to known end-stage renal disease, recent surgery and the use of potent analgesic and immunosuppressive medications. Amongst the known surgical complications, urine leak remains the most common. It can result from poor graft preparation due to excessive peri ureteric or lower pole dissection or damage to lower polar artery resulting in ischemic necrosis. In addition, poor surgical technique, bladder outflow obstruction, iatrogenic injury to bladder or renal pelvis may contribute to urine leak. Ongoing urine leak may manifest itself as swelling, pain, high drain output, sepsis, ileus and eventual graft loss. Early identification, localisation and quantification of leak remain essential in management of these patients. In addition, sepsis should be identified and treated promptly as these patients are highly susceptible to infections. Early recognition of this complication can significantly reduce hospital stay, improve quality of life and reduce graft loss and mortality. In this article, we aim to develop an evidence-based management approach to a patient with urine leak using a clinical scenario.

10/29/2018
Review Article

Current anesthesıa for Cesarean Sectıon

Demet Dogan Erol* and Ismail Aytac

The choice of anesthesia for cesarean section should depend on the urgency of the procedure, in addition to the condition of the mother and fetus. It is widely accepted that regional anesthesia for cesarean section is preferable to general anesthesia. Regional techniques have several advantages. They lessen the risk of gastric aspiration, avoid the use of depressant anesthetic drugs and allow the mother to remain awake during delivery. The most common type of regional anesthesia for cesarean section is spinal anesthesia because of its simplicity, cost-effectiveness and speed of onset. It is suitable for cases of an emergent cesarean delivery. Hypotension during spinal anesthesia is a common that is associated with morbidity for both mother and fetus. Epidural anesthesia is preferred when physicians want to minimize the maternal hypotension or when intense motor blockage of the thoracoabdominal segments is not desired. General anesthesia still leads to a higher maternal mortality and should be reserved for absolute emergencies and cases where neuroaxial blockade is contraindicated.

10/31/2018
Research Article

Clinico-epidemiological characteristics and survival outcome of patients with hypertensive crisis at Kassala Hospital, Eastern Sudan

TajEldin M Abdallah*, Abdalazeem A Ibrahem, Ezeldein A Ali, Elbashir G Ahmed and AbdelAziem A Ali

Introduction: Hypertensive crisis (HC) is recognized consequence of inadequate blood pressure (BP) control. A hypertensive crisis is further divided into hypertensive emergency (HT-E) and hypertensive urgency (HT-U).

Method: Using a cross-sectional hospital-based study design, patients who had been diagnosed as having HC between January and October 2017 were consecutively recruited in the study. The criteria proposed by the Seventh Joint National Committee were used for the definition of HC.

Result: A total of 81 (.81%) patients newly diagnosed as having HC were enrolled in the study. Of these patients, 50 (61.7 %) patients met criteria for HT-E, while 31 (38.3%) patients had HT-U. Renal impairment (16%), stroke (30.8%), acute coronary syndrome (13.6%) and heart failure (22.2%) were predominant complications associated with HT-E. Out of 81 study subjects, 13 (16%) patients died. Although there was no significant difference in residence, history of smoking, Diabetes mellitus and history of alcohol consumption between groups, old age (P=.o22), male gender(.046), history of hypertension(.007), history of non-governmental employee(.003), poor compliance (p=.002) and high case fatality rate (p=.041) were significantly associated with hypertensive emergency (HT-E).

Conclusion: This study showed that HT-E has high case fatality rate among patients admitted with hypertensive crisis at kassala teaching Hospital. Therefore early detection of hypertension and appropriate management are the main stay for reducing morbidity and mortality among patients with hypertensive crisis.

10/27/2018
Short Communication

Ontario wait time strategy to solve long waiting problem

Satyajit Patra*

The Ontario government has been battling with the issue of extensive wait times in hospitals for several years. Although there are many complex reasons that stem off of the issues of wait times, such as available in patient beds and bed blockers (patients who stay in the hospitals for long periods of time after sustaining a massive injury), the primary cause is concentrated as a system wide problem in access to care [1]. Through numerous reforming and restructuring plans, the Ontario government devised a Wait Time Strategy plan to monitor, manage and improve access to health care services including surgeries and time spent in the ER. The strategy was also devised to enhance the efficiency and effectiveness of healthcare provision. The information derived from the results of the Ontario Wait Time Strategy (OWTS) was to be made public to citizens and providers to ensure that everyone is well aware of the results. Yet, it is quite difficult to implement such a strategy if the leadership challenges within the hospital are not addressed [2].

10/26/2018
Review Article

A Review on filaricidal activity of phytochemical extracts against filariasis and the Parasites Genomic Diversity

AM Gumel* and MM Dogara

Filariasis is one of the Neglected Tropical Diseases (NTDs) known to be of serious public health importance and pose devastating socio-economic burden especially among the poor people in tropical and subtropical countries of the world. The parasite is responsible for lymphatic filariasis affecting about 1.3 billion people in 72 countries worldwide. The major parasitic agents of the infection are three closely related nematodes of clade Onchocercidaei namely Wuchereria bancrofti, Brugia malayi and B. timori that are transmitted to human through bites by mosquitoes of genera: Aedes, Anopheles, Culex and Mansonia. The disease is targeted by the World Health Organization (WHO) for elimination by 2020 through the use of chemically synthesized drugs used as therapeutic agents to cure the disease but there are some setbacks. Phytochemical extracts are viewed as alternative therapy in the management of the disease. Additionally, the species have many ecological variants and are diversified in terms of their genetic fingerprint. This diversification in terms of genomic sequences as well as rapid infection rate warrant the lymphatic filarial parasites to respond differently to diagnostic and therapeutic interventions. Thus understanding the genomic diversity of the parasite will help in efficient therapeutic management of the disease, thereby eliminating it to prevent unnecessary suffering and contribute to the reduction of poverty. In this review, we have highlighted on the used for phytochemical extracts in the therapeutic management of the lymphatic and the molecular genetic diversity of the parasite was delineated.

10/30/2018
Review Article

Gravitation - Flat Power Field

Orlov SA

A new principle of origin and the nature of the action of gravity forces are proposed. Forces of universal attraction have plane-symmetrical directions. On this basis, it becomes possible to reconsider certain regularities in natural science. The new principle of gravitation will allow to explain physical paradoxes, to improve methods of scientific research and some technological processes.

10/30/2018
Review Article

Application of the Pyphagor’s Theorem for Correction of Ki and Ka constants of enzyme inhibition and activation

VI Krupyanko* and PV Krupyanko

The analysis of dependence of the length projection of Li vectors of biparametrical inhibited and activated (La) enzymatic reactions from the length projection of vectors of monoparametrical inhibited and activated enzymatic reactions on the basic σ0 plane in three-dimensional coordinate system, allows to deduct the quadratic forms of equations for the correction of the constants of inhibition (ki) and activation (Ka) of enzymes. Examples of correction of constants are given.

10/29/2018
Research Article

Preclinical studies for a cationic liposome formulation containing Il-2 Intended for the treatment of Human Tumors

Maria Teresa Corona-Ortega*, Arturo Valle-Mendiola, Leonor Aguilar-Santelises, Araceli Garcia del Valle, Rosalva Rangel-Corona and Benny Weiss-Steider

Human cervical cancer tumours expressing the IL-2 receptor (IL-2R) were induced in the peritoneal cavity of nude mice. The tumours were significantly reduced by the i.p. administration of either free IL-2 or liposomes containing this growth factor. No toxicity was observed in the mice even at the highest doses of IL-2 in liposomes. We did not detect any IL-2 in the blood plasma pointing to a strong retention of the liposomes on the cavity. We concluded that this preclinical study for the treatment of tumours expressing IL-2R in the peritoneal cavity is effective and safe. The liposomes were stable and their IL-2 active for up to one year when kept at -14oC in a cryopreservation media approved by the FDA for human use.

10/27/2018
Opinion

COPD and low plasma vitamin D levels: Correlation or causality?

Luca Gallelli*, Erika Cione, Stefania Zampogna and Gino Scalone

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death and its prevalence and incidence is also related to smoking behavior [1]. COPD is still a chronic inflammatory and progressive disease caused by multifactorial agents including environmental pollutants [2].Besides that, it is emerging that endogenous epigenetic factors induced by lifestyle and environment [3] could play a role in the etiopathogenesis of the disease [4].

In the last years, several authors suggested that low vitamin D levels seem to be related with the increase of COPD manifestations [5]. Moreover, a multicentre, double-blind, randomised controlled trial documented that vitamin D supplementation protects against moderate or severe exacerbation of the disease, but not by upper respiratory infections [6]. However, low levels of vitamin D can be extended to many other diseases, including multiple sclerosis, diabetes, colon rectal cancer, headache or drug use [7-11]. Moreover, it is also important to remember that Vitamin D deficiency is common in high latitude regions, such as northern Europe, New Zealand, northern USA, and Canada where weaker ultraviolet B rays is not able to produce enough vitamin D. Finally, methodological factors (using low sensitivity methods) could contribute to misleading evaluation of circulating vitamin D levels. In any case, here we shall remind that vitamin D has a fundamental role in immunity [12]. In particular, it has been reported that vitamin D is able to shift the pro-inflammatory T-helper cell 1 to anti-inflammatory T-helper cell 2 [13]. Therefore, benefits of vitamin D supplementation in chronic diseases which directly or indirectly affect immune system are obvious. Today, the burden of COPD in never smokers is higher than previously believed. Therefore, more research is needed to unravel the characteristics of non-smokers COPD [1]. Notably, vitamin D levels are reported to be significantly lower in smoker’ssubjects than in non-smokers ones [14]. Therefore, low plasma vitamin D levels in COPD seems to be more a causality than a correlation.

10/26/2018
Short Communication

Synthesis and Biological Evaluation of Fluorescein-Tagged 1-Methyl-o-carborane for Boron Neutron Capture Therapy

Lucas A Kuzmanic, Lauren E Zuidema, Jason A Misurelli, Kazuko Uno, Sherine F Elsawa*, Masao Takagaki* and Narayan S Hosmane*

Fluorescein was conjugated with 1-methyl-o-carborane and the resulting bioconjugate was biologically evaluated through microscopic and flow cytometric studies in pancreatic cancer and squamous cell carcinoma cell lines. The uniform distribution of this bioconjugate, as well as its moderate cytotoxicity and higher boron content relative to present boronated delivery agents sodium borocaptate (BSH) and boronophenylalanine (BPA), provide justification for its further evaluation as a potential delivery agent for BNCT.

10/31/2018
Mini Review

Advances in research of the structural gene characteristics of the aflatoxin biosynthetic gene cluster

Qi-Zhang Li and Zhu-Mei He*

Aflatoxins, produced by Aspergillus spp., are strongly toxic and carcinogenic fungal secondary metabolites. Aflatoxin biosynthesis is a complex process and involves at least 30 genes clustered within an approximately 75 kB gene cluster.In this paper, we reviewed current status of the researches on the characterized structural genes involved in aflatoxin biosynthesis and their roles in aflatoxin-producing fungi, especially in A. flavus and A. parasiticus, which will improve our understanding of the mechanism of aflatoxin biosynthesis and regulation and provide reference for further study.

10/24/2018
Research Article

Factors affecting physical activity of recuperating alcoholics in Asumbi- Homabay rehabiliation center, Kenya

Lucy Amanya Mutuli*, Peter Bukhala and Gordon Nguka

Background: Alcoholism is a widespread problem in Kenya and is associated with severe impacts on health and quality of life of the individual. Physical activity is an affordable and sustainable adjunct treatment option for recuperating alcoholics; however its’ rarely used in rehabilitation of alcoholics in Kenya.

Objective: This qualitative study sought to elicit facilitators and barriers that influence the practice of physical activity amongst recuperating alcoholics under rehabilitation.

Methods: A focus group guide was utilized to gather views and perceptions of 15 alcoholics and 5 health professionals through focus group discussions. Constant comparative approach was used to analyze verbatim transcripts obtained from in-depth interviews. This analysis entailed three stages including open, axial and selective coding.

Results: Recuperating alcoholics’ recognized various forms of physical activity to promote mental and physical health during their rehabilitation. Health professionals and significant others considerably supported the recuperating alcoholics to practice physical activity however physical activity facilities and facilitation was lacking in Asumbi rehabilitation center.

Conclusions: The rehabilitation centres should have physical activity experts and facilities that can offer individualized physical activity services and support needed by the recuperating alcoholics.

10/23/2018
Case Report

Septic arthritis of left shoulder in pregnancy following minor hand injury

Neelam Agrawal, Rhoughton Clemmey and Shamma Al-Inizi*

Septic arthritis of the shoulder joint is rare and might affect around 3% of the general population [1]. A delay in diagnosis may increase morbidity and lead to bone and cartilage destruction [2]. Septic arthritis is an unusual complication of pregnancy and can progress to permanent arthropathy and disability [3].

Septic arthropathy in pregnancy requires multidisciplinary team involvement for prompt recognition and treatment to improve both maternal and fetal outcomes. High index of suspicion is vital when clinical and laboratory findings suggest septic arthritis. There are multiple predisposing factors reported previously for septic arthritis of the shoulder in pregnancy such as medical conditions, pyelonephritis and trauma. We report a 37 year old lady who presented at 26 weeks gestation with acute left shoulder pain and high temperature following minor left palm trauma. She also had left mastectomy with axillary clearance ten years earlier. She underwent arthroscopic wash out of her left shoulder joint and was covered with antibiotics with rapid improvement and recovery. We reinforce the importance of early multidisciplinary involvement when septic arthritis of the shoulder in pregnancy is suspected especially in women who have had previous mastectomy and axillary clearance which could be a predisposing factor for such a rare and serious joint condition in pregnancy.

10/19/2018
Review Article

Does Veterinary Science have a future in Australia?

Maxwell JAL

Although the veterinary art has been practiced since antiquity, the modern era began in the 18th century with the establishment of the discipline of “Veterinary Science” at universities. In the 19th century, veterinary education began in Australia with Kendall’s private veterinary school in 1888 [1].In 1909, a Veterinary Faculty was established at the University of Melbourne and Kendall’s school was incorporated into it. In 1910, a second faculty was established at the University of Sydney and in 1936, a third was established at the University of Queensland [2-4]. A fourth school was established at Murdoch University in Western Australia (WA) in 1974 [5].

In the first decade of the 21st century, three new veterinary schools were established; one at Charles Sturt University (2005), a second at James Cook University (2006) and the third at the University of Adelaide (2008). Australia now has more veterinary schools per capita of any Western Nation [6-8]. In Australia, veterinary science graduates serve in private practice, government service, academia and industry. Those in practice serve the animal-owning public and charge a fee-for-services rendered, whilst the others serve the purpose of the institution employing them and receive a salary for doing so.

10/16/2018
Review Article

Finite-time thermodynamics: Realizability domains of thermodynamic systems and P. Salamon’s problem of efficiency corresponding to maximum power output of the system

Tsirlin AM, Sukin IA

The  paper  analyses  performance  boundaries  of  systems  converting  the  heat  energy  into  the  mechanical  or  separation  work.  Authors  approach  this  problem  from  the  view-point  of  the  finite-time thermodynamics. Using thermodynamic balance equations, authors provide the algorithm for calculation of  realizability  domain  for  such systems.  The  paper  shows  that  the  performance  of  these  systems is  the  upper  bounded  function  of  the  heat  flux,  assuming  that heat  and  mass  transfer  coefficients  are given.  Authors  present  sufficient  conditions  under  which  the  efficiency  (specific  heat flux  per  unit  of  the useful flux) of the system does not depend on kinetic coefficients when operating in the maximum performance mode. The paper shows how to use these conditions to optimally choose the separation order for multicomponent distillationfor multicomponent distillation.

10/17/2018
Case Report

Actinomycosis of the appendix

Lucas Wheatley*, Michael Lonne, James Bennnet and Bhavik Patel

A 40 year old woman presented to the emergency department with acute on chronic abdominal pain in her right iliac fossa. On history her pain had been present for over 6 months and had previously been investigated with ultrasound, CT and a diagnostic laparoscopy several months prior to presentation. Her pain had acutely worsened over the preceding two weeks. This was associated with two days of diarrhoea but nil other systemic symptoms. Her medical history was significant for immunosuppression with tacrolimus, azathioprine and prednisone post renal transplant for IgA nephropathy [1].

10/17/2018
Case Report

Intra-abdominal testicular tumour--A case report

Sardar Rezaul Islam*, Shafiqur Rahman, Shahalam Sarkar and Debabrata Paul

A 35-year-old man presented with swelling in the lower abdomen for 2 months. He was found to have left undescended testis. An ultrasound scan showed a solid floating pelvic mass. His chest x-ray and tumour markers for testicular cancer were normal. Exploratory laparotomy revealed the left intra-abdominal testicular tumour. Intra-abdominal left orchiectomy was performed. The patient made an uneventful recovery. Histology showed immature seminoma. A mass in the lower abdomen with a cryptorchidic testis strongly points towards the diagnosis of malignancy in abdominal testis. To prevent this complication all undescended testis gets orchiopexy before 2nd year or orchiectomy in post-adolescent life. But some cases remain unnoticed, which leads to this kind of presentation. So, we decided to present this rare and interesting case of intra-abdominal testicular tumour.

10/17/2018
Research Article

Trypanosoma dionisii as an experimental model to study anti-Trypanosoma cruzi drugs: A comparative analysis with benznidazole, posaconazole and amiodarone

Barrias ES, Borges TR, De Souza W

Chagas disease is a public health problem in Latin America and its treatment is based on the use of benznidazole or nifurtimox compounds. Both present problems such as resistance, inefficiency in chronic infection and cytotoxic effects. New compounds such as posaconazole and amiodarone have been tested against T. cruzii and shown to be effective. In addition, new molecules have been synthesized and tested against T. cruzii. Because this protozoan is highly pathogenic, even with a number of cases of accidental laboratory infections, few laboratories located outside Latin America are authorized to work with its infective developmental stages. On the other hand, Trypanosoma dionisii is a non-pathogenic protozoan phylogenetically related to T. cruzii and that shares similar strategies to complete its life cycle in mammalian cells in vitro. Here, we describe a comparative analysis of the sensitivity of both parasites to benznidazole, posoconazole and amiodarone. We also analyzed the morphological effects of these compounds on both Trypanosoma species using electron microscopy. Our results show that T. dionisii is more sensitive to the compounds tested than T. cruzii. They also support a previous suggestion that it may constitute an excellent model for large scale screening of compounds against T. cruzii.

10/17/2018
Case Report

Challenges in the diagnosis and management of severe Pneumocystis jirovecii pneumonia in a non-HIVinfected patient - A case report

Mark Taubert, Lorenz Weidhase, Sirak Petros and Henrik Rueffert*

A 64-year-old woman was referred to our hospital due to progressive dypnoea for the past week, combined with fever and type 1 respiratory failure. White blood cell count and procalcitonin level were normal. The Chest X-ray showed bilateral disseminated pulmonary infiltrates. Within the next 24 hours the patient developed a severe ARDS. A first diagnostic work-up for typical and atypical pathogens as well as serological tests for CMV, RSV, HIV and HSV were negative. Analysis of a second bronchoalveolar lavage fluid revealed Pneumocystis jiroveci DNA. The patient was successfully treated with trimethoprim-sulfamethoxazole and off label use with caspofungin. The cause of the infection was a six week treatment with dexamethasone. The patient developed a toxic epidermal necrolysis during further course, but completely recovered.

Pneumonia with Pneumocystis jirovecii must also be taken into account in non-HIV patients, whenever there are any indications that cellular immunity may be depressed

10/15/2018
Case Report

Novel Complication of Nusinersen Treatment: Hyponatremia

Yasemin Coban*

There are variations in therapeutic regimens of different liver diseases. The accurate diagnosis ensNusinersen treatment is a novel therapy for spinal muscular atrophy (SMA) type 1; consequently, the adverse reactions of the therapy, have not been well known, yet. The present study is a case report that declares a hyponatremia development after the nursinersen therapy. Since the therapy is quite new one and has limited practice, we hope that this rare complication will contribute to the scientific literature.

10/15/2018
Opinion

Effectiveness of the lifestyle modifications in prevention and control of sexually transmitted diseases (STDs): Focus on Islamic lifestyle

Mohammad Rabbani Khorasgani*

The advancement of human researches and scientific activities in the field of diseases prevention and treatment, has not diminished the importance of sexually transmitted diseases (STDs). Despite the continuous efforts for prevention and control of them, many peoples suffers from STD with very considered wasted expenses for anybody and for community [1,2].

It is necessary to be mentioned that one of the most important factors influences STD development and spreading, is human lifestyle especially sexual relationship lifestyle [3,4].

Lifestyle is an important and very effective agent in human being life especially in the interactions between them [5]. It affects the different human relationships and therefore, the survival of infectious agents in the body and environment and the rate of infection development. Also, the quantity and quality of sex relationships, beginning age, different types, freedom or limitations of sex connections is related to human lifestyle.

 
Lifestyle is an important and very effective agent in human being life especially in the interactions between them [5]. It affects the different human relationships and therefore, the survival of infectious agents in the body and environment and the rate of infection development. Also, the quantity and quality of sex relationships, beginning age, different types, freedom or limitations of sex connections is related to human lifestyle.
10/12/2018
Case Report

Novel Non-invasive Management of Chronic Groin Pain from Fibrosed Contracted Inguinal Ligament

A Lokeshwar Raaju and N Ragunanthan*

A 34-year-old male patient presented with the complaint of chronic pain in the left groin following left side testicular vein ligation for varicocele. Ilio-inguinal neurectomy and cremaster muscle division was done in another hospital for the pain but with no relief of pain. Patient on examination showed point tenderness in the left groin at the pubic tubercle. Finger Invagination test in the left was painful with severe tenderness. Investigation showed fibrosed contracted left distal inguinal ligament. Percutaneous Ultrasonographic (USG) guided inguinal ligament release and Platelet-Rich Plasma (PRP) injection relieved the pain completely. Post-procedure patient showed significant improvement of pain.

10/11/2018
Case Report

Endocrine abnormalities in two siblings with Rothmund Thomson Syndrome

Nagehan Aslan* and Ozgur Pirgon

Rothmund-Thomson syndrome is a rare autosomal recessive disorder characterized by poikiloderma (skin atrophy, telangiectasia, hyper- and hypopigmentation), congenital skeletal abnormalities, short stature, premature aging, and increased risk of malignant disease.

10/10/2018
Research Article

Effects of Balanites Aegyptiaca (del) Seed Cake on Growth and Carcass Performance of Growing Rabbit

Ogori AF, Makinde JO, Ogori J

A study on growth and carcass performance was conducted to evaluate the effect of Balanites aegyptiaca seed cake meal (BASCM) as a substitute for groundnut cake in the diet of growing rabbit. Five experimental diets were formulated representing the following treatments: T1, T2, T3, T4 and T5 respectively. T1 (0% BASCM) was served as the control diet, while T2, T3, T4 and T5 contained 25%, 50% 75% and 100% BASCM respectively. A total of 100 weaner rabbits of mixed breeds were purchased from the National Animal Production Research Institute (NAPRI), Zaria, Nigeria. The rabbits were fed the control diet during the one week of adjustment period. They were given vitalyte as anti-stress and were dewormed using ivermectin, at the end of one week of adjustment; the rabbits were housed in different hutches and fed their respective experimental diet for one month. Each treatment contained 20 rabbits and these treatments’ (T1-T5) each were replicated in four portions and each portion had five rabbits each. Results showed that all the parameters were significantly different (P<0.05) among the treatment groups. Balanites aegyptiaca seed cake meal can replace groundnut cake at 25% level inclusion without adverse effect on the rabbit physiology.

10/12/2018
Research Article

Percentage of Positive Biopsy Cores Predicts Presence of a Dominant Lesion on MRI in Patients with Intermediate Risk Prostate Cancer

Jason M Slater, William W Millard, Samuel M Randolph, Thomas J Kelly and David A Bush*

Background: Biopsy findings of percentage of positive biopsy cores, percentage of cancer volume, and maximum involvement of biopsy cores have been shown to have prognostic value and correlate with magnetic resonance imaging (MRI) findings of extracapsular extension and seminal vesicle invasion.he relationship of these prognostic biopsy factors to MRI findings of the presence of a dominant lesion, has not yet been investigated.

Methods: Sixty-five patients with intermediate risk prostate cancer were included in a retrospective cohort. MRI was acquired using either 1.5 Tesla (T) with endorectal coil or a 3 T MRI unit. Findings of extracapsular extension, seminal vesicle invasion, and presence and number of dominant lesions were noted. T-test and Cox regression statistical analyses were performed.

Results: Patients with one or more dominant lesions on MRI had a significantly higher mean percentage of positive biopsy cores (56.7% vs 39.8%, p=0.004), percentage of cancer volume (23.5% vs 14.5%, p=0.011) and maximum involvement of biopsy cores (62.9% vs 47.3%, p=0.027) than those without a dominant lesion on MRI. On multivariate analysis, only percentage of positive biopsy cores remained a statistically significant predictor for a dominant lesion on MRI (Hazard Ratio 1.06 [95% CI 1.01-1.12; p=0.02]), whereas prostate-specific antigen, clinical T-stage, Gleason score, percentage of cancer volume, and maximum involvement of biopsy cores were not significant predictors of a dominant lesion on MRI. Receiver-operator characteristic analysis was done and a cutoff value of >=50% was chosen for percentage of positive biopsy cores, >=15% for percentage of cancer volume, >=50% for maximum involvement of biopsy cores.

Conclusion: Percentage of positive biopsy cores was found to be a significant predictor for the presence of a dominant lesion on MRI. This finding is hypothesis-generating and should be confirmed with a prospective trial.

 
 
10/23/2018
Editorial

Knowledge or Money: Which One is More Important?

Narayan S Hosmane*

When I asked the students in my general Chemistry class whether grade is more important than knowledge, a majority of them opted for grades over knowledge and this answer did not surprise me a bit as the smart phones are available for them to think while their brains are corrupted or unused for most of the time. This brings one to the Einstein’s prediction that technology will develop to the point where there is no human interaction, which will be the day a new generation of idiots will emerge, and we are witnessing everywhere, including in the classrooms all over the world.

10/23/2018
Research Article

Final solution in femoroacetabular impingement - Threaded cups in hip revision surgery 2002-2012

Stepan Magersky*

Purpose: Here, we report the complications of endoprosthesis with threaded cups according to our application in cases of complicated acetabulum (hip revisions and femoroacetabular impingement (FAI)).

Methods: A total of 504 patients was analyzed, including 189 men and 315 women. For re-implanted patients (n = 49), the mean time to re-implantation was 6.3 years and the average age at re-implantation was 54.7 years. For censored patients (n = 455), the mean time to censoring was 5.5 years and the average age of the implant was 55.7 years. Among the patients that were censored, 77 died and 378 patients did not experience an event necessitating re-implantation.

Results: For the total study population, the Kaplan-Meier estimate of 5 year survival is 0.94 and of 10 year survival is 0.85. 90% of the implants survived 7 years, 80% of the implants survived almost 12 years and 70% of implants survived almost 15 years. Kaplan-Meier survival analysis suggests that men have higher survival than women. Age of the patient at the time of implant was not a statistically significant factor for re-implantation (p value = 0.21) but sex was (p value = 0.02). Women had 2.25 times more risk of being re-implanted than men.

Conclusions: In our case series, the failure rate, as a result of aseptic loosening, was 7.4% (n = 51). More than half the failure cases (56%) required re-implantation. Over one-third (37%) of the primary arthrosis cases, were found to be FAI, lessening the frequency of diagnosis of the former. In our clinic, the threaded cup seems to be indispensable in hip revision surgery and in treating FAI.

 
10/17/2018
Research Article

An observational study of the occurrence of anxiety, depression and self-reported quality of life 2 years after myocardial infarction

Catrin Henriksson, Mona-Lisa Wernroth and Christina Christersson

Background: Patients with myocardial infarction (MI) often experience anxiety, depression and poor quality of life (QoL) compared with a normative population. Mood disturbances and QoL have been extensively investigated, but only a few studies have examined the long-term effects of MI on these complex phenomena.

Aims: To examine the levels and associated predictors of anxiety, depression, and QoL in patients 2 years after MI.

Methods: This was a single center, observational study of patients with MI (n=377, 22% women, median age 66 years). Two years after MI (2012-2014), the patients were asked to answer the Hospital Anxiety and Depression Scale (HADS) and EuroQol 5-dimension (EQ-5D-3L) questionnaires.

Results: Most patients experienced neither anxiety (87%, 95% confidence interval [CI]: 83-90%) nor depression (94%, 95% CI: 92-97%) 2 years post-MI. Elderly patients experienced more depression than younger patients (p=0.003) and women had higher anxiety levels than men (p=0.009).

Most patients had “no problems” with any of the EQ-5D-3L dimensions (72-98%), but 48% (95% CI: 43%-53%) self-reported at least “some problems” with pain/discomfort. In a multiple logistic regression model (EQ-5D-3L) higher age (p<0.001) and female sex (p<0.001) were associated with more pain/discomfort. Female sex (p=0.047) and prior MI (p=0.038) were associated with anxiety/depression. History of heart failure was associated with worse mobility (p=0.005) and problems with usual activities (p=0.006). The median total health status of the patients (EQ-VAS) was 78 (95% CI: 75-80).

10/19/2018
Research Article

Analysis of static, dynamic, and pelvic stability in junior badminton players of South Asia

Manan Vora*, Digpal Ranawat, Apoorva Tiwari and Manit Arora

Badminton is a sport that requires a player to perform while being still, as well as in motion. Stability is the ability to maintain or control joint movement or joint position, in the static as well as dynamic state. Improvement in stability could help maintain body control and proper posture positions during play. Accordingly, the study was proposed to analyze stability in junior badminton players and understand its importance. A total of 106 players from South Asia between the ages of 8 and 15 years were analyzed. Prokin 252N and Balance trunk MF systems of Tecnobody Italy were used in the assessment and static, dynamic, and pelvic stability was recorded. The variables used were gender, age, body mass index, and experience in years, level at which they play, current pain, and clicks & catches in the past 1 year. Our study showed that there was significant difference in pelvic stability in terms of age and level at which players compete. There were a variety of other factors which do not affect stability. There needs to be a greater focus on stability training as part of the development of junior badminton players.

10/11/2018
Research Article

What is the Cost of Measuring a Blood Pressure?

Steven A Yarows*

Rationale: Blood Pressure measurement has transitioned to the oscillometric method in most hospitals in the United States, however out-patient offices mainly use the auscultatory technique.

Objective: To determine time taken to measure blood pressure by an automatic oscillometric device compared to an auscultatory measurement device and to determine what each measurement costs.

Methods: Blood Pressures were measured in a single primary care office by medical assistants (MA) for patients seen for office visits. Timed measurements were performed using an automated oscillometric Welch Allyn Connex Vital Signs Monitor (WA) and manually using a Tycos device. A minimum of 400 readings were taken with each method.

Results: The average time to manually measure BP was 58.6 seconds, whereas the WA average was 39.8 seconds, 18.8 seconds faster (p<0.05). There was an improvement in measurement time with MA experience with the WA device (p<0.05). The average MA cost to measure a single BP using the manual method was $0.35 vs. the WA method ($0.24) or a savings of $0.11 per measurement. The improvement with experience of WA method reduced cost to $0.17 per measurement.

Conclusion: The oscillometric method saved 17cents per measurement potentially saving $1,119 per year for our primary care practice.

10/11/2018
Opinion

Use of Rivaroxaban and Apixaban, Two Non-Vitamin K Antagonist Oral Anticoagulants (NOACs), in Renally Impaired Patients - the limits of our knowledge

Kenneth T Moore* and Maria Langas

Patients with chronic kidney disease are at increased risk of thromboembolic complications and are therefore often managed with anticoagulation therapy [1]. While these patients are traditionally treated with Vitamin K antagonists (VKAs), the Non-Vitamin K antagonist oral anticoagulants (NOACs), such as rivaroxaban and apixaban are being used with increasing frequency. Relatively new to the anticoagulant treatment arsenal, both compounds are direct Factor Xa inhibitors and represent an alternative to traditional VKA treatments, such as warfarin. However, because these compounds are at least partially renally eliminated, achieving safe and effective anticoagulation in this vulnerable population has proven to be a challenge [2,3].

10/13/2018
Clinical Image

A rare case of Diabetic Foot in male of middle age has been shown Diabetic foot

Sujit K Bhattacharya*

A rare case of Diabetic Foot in male of middle age has been shown.

Diabetes mellitus is a chronic disease due to complete absence of its hormone, Insulin, or has the hormone which is ineffective. This disease affects individuals of all ages and both sexes. When the disease affects individuals below 40 years of age and there is complete absence of Insulin (autoimmune reaction), the disease is known as type 1 Diabetes mellitus. On the other hand the disease when it affects individual above the age of 40 years and there is partial deficiency of insulin, it is known as type 2 Diabetes mellitus. However, this age division is no longer used; instead it is called Mutuality Onset Diabetes mellitus in Adults (MODY). The accompanying picture shows a diabetic foot with a big blister full of blood. This type of presentation of Diabetic foot is relatively rare. Upon incision of the swelling, reddish pus came out. Draining of the pus and debridement of dead tissue was done under antibiotic coverage along with Insulin. The patient had a slow recovery. Strict control of diabetic status was done. Culture of the pus yielded staphylococcus aureus sensitive to amoxyclav, gentamycin and oflaxacin. Antibiotic treatment was continues for 10 days. Although this time the patient recovered, he was advised to take scrupulous care of the feet and control blood sugar

10/15/2018
Editorial

Endogenous Ligands of Toll Like Receptors: A Danger Signal to the Brain Memory at High Altitude

KP Mishra* and Shashi Bala Singh

Sojourn to high altitude may affect various human systems if proper acclimatization
not followed. If acclimatization failed, sojourners may suffer with high altitude sickness such as acute mountain sickness (AMS), high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE).Although a sojourner’s tolerance to high altitude hypoxia varies according to differences in physiology and physical conditioning. Acute mountain sickness may cause headache, insomnia, dizziness, nausea, vomiting and fatigue. While HACE is more serious stage where brain swelling occurs and it is potentially fatal. A sojourner with HACE may experience confusion, amnesia, delusions, and loss of consciousness. Staying in high altitude (above 9000 feet) environment poses low oxygen supply (hypobaric hypoxia) to the different body organs including brain.

Brain is the organ that reacts sensitively to oxygen deprivation, which leads to inflammation, oxidative stress and cognitive function impairment. Our previous studies have reported that exposure to hypoxia leads to neurodegeneration and memory impairment also hypoxia exposure upregulated NALP3 mediated IL-1 beta and NF-kB expression [1-3]. Recently our laboratory has reported that suppression of scavenger receptor Mac-1 attenuates microglial phenotype switching and working memory impairment following hypoxia [4].

 
 
Brain is the organ that reacts sensitively to oxygen deprivation, which leads to inflammation, oxidative stress and cognitive function impairment. Our previous studies have reported that exposure to hypoxia leads to neurodegeneration and memory impairment also hypoxia exposure upregulated NALP3 mediated IL-1 beta and NF-kB expression [1-3]. Recently our laboratory has reported that suppression of scavenger receptor Mac-1 attenuates microglial phenotype switching and working memory impairment following hypoxia [4].
10/05/2018
Research Article

Amyotropyc Lateral Sclerosis and Endogenous -Esogenous Toxicological Movens: New model to verify other Pharmacological Strategies

Mauro Luisetto*, Behzad Nili-Ahmadabadi, Nilesh M Meghani, Ghulam Rasool Mashori, Ram Kumar Sahu, Kausar Rehman Khan, Ahmed Yesvi Rafa, Luca Cabianca, Gamal Abdul Hamid and Farhan Ahmad Khan

In 1874 J.M. Charcot was the first to describe ALS amyotrophic lateral sclerosis, a disease with an high non response therapy rate also to the actual therapy.

ALS is not clearly associate to only single etio-patogenetic movens but many process seem involved.

Also the strange geographic diffusion of different forms contribute to a complex syndromic pathology.

Also the strange geographic diffusion of different forms contribute to a complex syndromic pathology.

In this work the different neuronal damage movens and new therapeutic strategies are analyzed to produce a Unic global response to the pathologic process useful in next clinical application.

Genetic factors must be considered also added to environmental movens but also to the endogenous microenvironment of motoneuron involved.

A toxicological-biochemical-imunological approach can be useful tool to find new therapeutic strategies.

Or to improve local availability of pharmacological molecules.

10/05/2018
Review Article

Vigour of CRISPR/Cas9 Gene Editing in Alzheimer’s Disease

Jes Paul*

Ailment repairing regiments has turn out to be arduous, despite a plenty of understanding and knowledge acquired in the past relating to the molecular underpinnings of Alzheimer’s disease (AD. Umpteen clinical experiments targeting the fabrication and accumulation have been turned fruitless to fit potency standards.The tests aiming beta-amyloid hypothesis also turned futile making it exigent for further handling tactics. The new emanation of a comparably candid, economical, and punctilious system known as gene editing have showed light in path of cure for AD by CRISPR/Cas9 gene editing. Being a straight approach this procedure has already shown assurance in other neurological disorders too such as Huntington’s disease. This review standpoint the immanent service of CRISPR/Cas9 as a remedial option for AD by aiming on specific genes inclusive of those that induce early-onset AD, as well as those that are substantial risk components for late-onset AD such as the apolipoprotein E4 (APOE4) gene.

10/04/2018
Review Article

Validation of HPLC-UV method for determination of amoxicillin Trihydrate in capsule

Sendanyoye Marcel*, Uwambajineza Tito, Ineza Ines and Nahimana Jean Pierre

The intention of the present work is to validate an easy, better and reasonable approach for estimation of amoxicillin trihydrate in tablet formulation by opposite segment(reverse phase) HPLC –UV with advanced conditions and parameters for habitual use in Rwanda well known board in pharmaceutical laboratory in order to check if no substandard or counterfeit amoxicillin has entered in our country that can result in antimicrobial resistance, treatment failure which can be a chief difficulty on public health. an easy, selective, precise, speedy, specific, and correct reverse phase HPLC UV-seen technique has been verified for the dedication of amoxicillin, in addition that is a cost-effective technique for the established method, monobasic potassium phosphate (KH2PO4) used as buffer and methanol and had been used as a mobile section in the ratio 95:5 respectively. The elution turned into finished in an isocratic mode at a go with the flow rate of 1.5ml/minute proposed method became demonstrated as according to ICH guiding principle refereeing additionally to USP necessities for amoxicillin capsule. linearity range of amoxicillin and was evaluated inside the variety of 20–160 g/ml. the correlation coefficient r2 changed into 0.9998 and the relative well known deviation between six replicates injection was always much less than 2%. The retention time was found 3.5±0.02. the high percentage of healing of amoxicillin is 100.6±4% indicates that the proposed method is exceptionally correct and precise trueness of with the trueness of 100.06±1.2% .the statistical evaluation proved that the demonstrated method is appropriate for analysis of amoxicillin as the majority drug and pharmaceutical formula with none interference from excipients .with the aid of considering the efficiency of the drug samples, all analyzed pattern were within the variety of 90-120 % of percentage of labeled amount, but the efficiency had been distinctive amongst samples. The have a look at located that no counterfeit, no substandard product turned into amongst all batches of amoxicillin samples throughout the c programming language of the look at.

10/02/2018
Research Article

Bacillus amyloliquefaciens as a plant growth promoting bacteria with the interaction with of grass salt Distichlis palmeri (Vasey) under field conditions, in desert of Sonora, Mexico

Ruiz Alvarado Cristina, Jesus Borboa Flores, Victor Cardenas Salazar, Soto Ortiz Roberto, Lourdes Díaz Cervantes and Rueda Puente Edgar O*

The halophyte Distichlis palmeri (Vasey) is a plant resource with high potential to be harvested in the coastal areas of northwestern Mexico; enlarge the knowledge and domestication for its incursion into the agricultural sector, plays an important role for arid areas with saline intrusion problems. However, its productivity depends on the supplementary supply of nitrogen, as well as other essential macro and micronutrients. The microorganisms considered beneficial are an alternative to chemical fertilization, highlighting those Plant Growth Promoting Bacteria (PGPB). In the present study, the inoculation of the Bacillus amyloliquefaciens (B.a.) as a halobacterium PGPB was evaluated to know the response in seeds of Distichlis spicatai obtained from natural population from colorado river in Delta north of the Gulf of California. Wild seed was collected and germinated previously inoculated with B. a., and sowed in germinated beds. Later, seedlings were planted under field and salinity conditions in the coast of Hermosillo, Sonora. Three treatments were examined (T1: B.a., T2: Chemical fertilization, T3: Negative control), with four repetitions each treatment. Each repetition consisted of experimental plots of 5 x 5 m, with a separation of 1 m between them. The harvest was carried out 600 days after sowing. The results indicate that treatments inoculated with halobacteria B.a., showed significant results in crude protein, non-protein nitrogen, neutral detergent fiber and acid detergent fiber, as well as spike length and number of seeds. The results obtained suggests the feasibility of biofertilizers where biomass and seed production are significant compared to non-inoculated controls.