Monday, 31 December 2018

Prevalence of Frailty Syndrome and Associated Risk Factors in Old Adults in Ciudad Juarez, Chihuahua


Theprevalence and incidence of frailty is variable, with percentages between 33-88%. The prevalence in Latin America is between 30-48% in women and 21-35% in men. The prevalence in Mexico is 39%, more frequently in women than in men. Fragility is a physiological syndrome characterized by reduced reserves and reduced resistance to stressors as a result of the cumulative decline of multiple physiological systems that increase vulnerability for adverse health outcomes. Some authors distinguish primary frailty as that caused by multiple physiological decline associated only with aging and secondary frailty that is associated with diseases or even disability. 

Older adults are vulnerable mainly to chronic diseases, sensory medical alterations such as vision, hearing, malnutrition, polypharmacy, cognitive deterioration, depression, dependence on basic and instrumental activities of daily life, alteration in walking and deficiency in social support; it is frequent that the older adult does not express all his discomforts, due to shame or because of the type of attention in the classic consultation, where the time for medical attention is decreasing; all this makes it difficult to recognize diagnostics. Within the syndrome of frailty one of the risks that exist are falls, which are cause of increase in morbidity and mortality in older adults. The incidence of falls and the severity of complications increases after the age of 60; in developed countries, accidental falls are listed as the fifth cause of death in older adults, after cardiovascular diseases, cancer, stroke and lung disorders. 

Amongthe systems involved in the frailty syndrome is the cardiovascular, neuroendocrine, metabolic, immune system and skeletal muscle system. There are two physical changes associated with aging and may be the main cause of frailty: sarcopenia and osteopenia. The loss of muscle mass and power is a universal loss, occurs over the years, even in people who regularly perform moderate physical exercise. The muscle mass decreases by 3-8% per decade from the age of 30. This produces a progressive decrease in strength and contributes to the disability and loss of independence of the elderly. Fragility and sarcopenia overlap, most frail elderly people have sarcopenia and many of the elderly with sarcopenia are fragile.

Thursday, 27 December 2018

Forensic Chemistry of Alkaloids: Presumptive Color Test


Evidence collected from crime scenes often includes unknown powders, pills, and tablets, many of which are illicit drugs difficult to identify visually. Presumptive color tests help with the on-scene recognition of drug materials via rapid color changes. Most of these tests are based on qualitative chemical reactions and have since been standardized. Although simple and rapid, qualitative tests provide only preliminary analytical data. Nevertheless, these tests are still important components of crime scene investigations, and government authorities deploy them to detect illicit drugs in the field. Understanding the chemistry behind presumptive color tests makes it possible to predict reactions to known drug standards. However, in the presence of cutting agents and other chemicals, the results of presumptive color tests may not be predictable due, in part, to interference by contaminating chemicals. Most described presumptive tests are developed for ‘classic’ drugs, such as opiates, amphetamines, and cocaine, but new psycho-active substances and cutting agents emerge every day on the market. Among them, alkaloids (e.g., lobeline, caffeine, piperine) can be purchased easily and legally via the Internet or in local shops and are often utilized to lace or cut drugs. This study is the first to predict and document the results on 7 of the most common presumptive color tests with various alkaloid standards.

Weassessed these tests with mixtures of alkaloids to ascertain interference, if any, in the color results. We performed presumptive color tests on various popular cutting agents and, finally, tested several mixtures of drugs/alkaloids/cutting agents potentially similar to samples seized in the field. The results showed that color prediction worked well with pure standards, but color tests could not be predicted for mixtures in most cases. Also, alkaloid cutting agents often interfere with presumptive color test results, affecting outcomes. Better understanding of presumptive color tests, coupled with better populated databases of color results involving cutting agents, will help in reducing false positives and false negatives, thereby improving initial testing of seized evidence.

Wednesday, 26 December 2018

Secrets in Cricotracheal Resection for Benign Laryngotracheal Stenosis


Thecauses of adult laryngeal and upper tracheal stenosis vary between traumatic, idiopathic, chronic inflammatory disease, collagen vascular disease, benign and malignant neoplasms. The most common cause is iatrogenic internal injury. Patients typically present with months to years of exertional dyspnea or cough, which has often been misdiagnosed as asthma. Others are diagnosed in intensive care with failure of weaning of endotracheal tube. An endotracheal cuff pressure greater than 30mm Hg exceeds the mucosal capillary perfusion pressure, causing mucosal ischemia, which may lead to ulceration and chondritis of the tracheal cartilages. These circumferential lesions heal with fibrosis, leading to a progressive tracheal stenosis.

In1994, Myer-Cotton System modified the original Cotton System in 1984. He classified the horizontal stenosis into 4 grades; depending on the percentage of narrowing of the lumen. McCaffrey designed another clinical staging depending on the vertical length and the location of the stenotic segment. Monnier et al. designed another staging system with considering the co-morbidities and glottis involvement that can affect the prognosis.

Surgicaloptions for laryngotracheal stenosis are closed or open techniques. In closed operation, dilatation, endoscopic laser ablation or laryngotracheal stents can be used. In the open approach, different procedures are used such as cricoid splitting procedures, Laryngotracheaplasty (LTP), vascularized myo-osseus flap, slide tracheoplasty, tracheal transplantation, Cricotracheal Resection (CTR). The standard technique used in the curative treatment of laryngotracheal stenosis is the segmental resection and anastomoses, by means of tracheotracheal anastomsis through the Küster operation and cricotracheal resection through the Pearson operation. The Rethi operation is reserved for cases of glottic and subglottic stenosis. During the 1980s and 1990s, it became apparent, notably through the work of Grillo, and Laccourreye, that resection of laryngotracheal stenosis with primary anastomotic reconstruction could achieve decannulation rates up to 97%.

Tuesday, 25 December 2018

Climate Change and Child Health in Developing Countries: An Alarming Issue


Climatechange is a change in the statistical distribution of weather patterns when that change lasts for an extended period of time. Certain human activities have been recognized as primary reasons of ongoing climate change, regularly referred to as global warming.

Climatechange affects everyone, however certain populations go through disproportionately, one being children, particularly in creating developing countries like Bangladesh. According to the Economist Intelligence Unit (EIU) annual global survey, Dhaka the capital city of Bangladesh currently obtained the unflattering tag of being listed as the second least livable metropolis in the world. The threat to human health in Bangladesh is one of the most important risks bobbing up from climate change and children are prone by using nature. First socially, they rely on a caregiver and have difficulties expressing themselves. Also, biologically, they have weaker immune systems and poor temperature regulation. According to the World Health Organization, more than eighty percentage of the contemporary health burden due to altering climate occurs in children younger than five years old. These health impacts include the large outcomes of weather disasters, exacerbated allergic and asthmatic diseases, meals and water insecurity, and heat-related deaths. As local weather change accelerates, children will continue to suffer disproportionately.

Theexposures to local weather change influence children’s health begin earlier than conception-reflecting parents’ diets and different environmental exposures (Maternal dietary popularity can have an effect on lifetime threat of many continual diseases) and proceed via being pregnant (Extreme warmth all through pregnancy is associated to lower birth weight) childhood Breast-feeding practices are affected by means of extreme climate occasions Diarrheal illness is already a main cause of dying in young children and adolescence. The impacts climate change has on health can be considered into primary, secondary, and tertiary ranging from injury, pollution, or meals and water shortages, respectively. Now, increase these health hazards through the lack of authorities, resource terrible infrastructure and ordinary poverty of developing nations.

Tuesday, 18 December 2018

Lung Ultrasound and Septated Posterior Pneumothorax in Patients with the B’-Profile of the BLUE-Protocol


TheB’-profile of the BLUE-protocol describes abolished lung sliding with lung rockets at the anterior chest wall. It indicates pneumonia or ARDS. We explain abolished lung sliding by pleural symphysis. In such patients, if a pneumothorax occurs, it can be septated. We experienced a case of pneumonia with a B’-profile and a sudden worsening of respiratory function due to a posterior pneumothorax. The ultrasound signs were limited to a “posterior A’-profile” (the term A’-profile implies that abolished lung sliding with complete absence of B-line is detected at the anterior wall). There was no lungpoint, a frequent finding in these septated pneumothoraces occurring on pathological lungs. In conclusion, in patients with a B’-profile, a pneumothorax can occur elsewhere than the anterior, classical location. Conversely, we assume that an anterior lung sliding indicates a free movement of the lung against the parietal pleura, and should logically rule out posterior, septated pneumothorax.

Monday, 17 December 2018

A Brief Overview to the Beginning of the Human Embryologic Development


Humandevelopment begins when a male gamete or sperm unites with a female gamete or ovum to form a single cell called a zygote. Gametogenesis process involving the chromosomes and cytoplasm of the gametes, prepares these cells for fertilization. During gametogenesis, the chromosome number is reduced by half and the shape of the cells is altered. Gametes develop in the gonads (sex cells). In males, its name is spermatogenesis, formation of sperm. In females, its name is oogenesis, formation of oogonesis. The process of gametes formation that occurs in the gonads (ovary or testis). It is defined as a process by which diploid or haploid cells undergo cell division and differentiation to form mature haploid gametes. Spermatogenesis and oogenesis are both forms of gametogenesis, in which a diploid gamete cell produces haploid sperm and egg cells.

Primordialgerm cells are the progenitor cells that give rise to the gametes. Primordial germ cells migrating from the vitellus sac to the reproductive organ developmental zone are distributed among the cells in the region. After a while, changes start in the male testes. The differentiation in primordial germ cells, which started in the third month of uterine life in female, but it, starts in puberty in male. A newborn males, sex cord’s shape are like a column. In this case, all of the primordial germ cells are seated on the basal membrane of the sex cord and are mixed with the modified cell that Sertoli cells (Sustentaculer). Along with the formation of the lumen, the primordial germ cells turn into spermatogoniums. At the meiosis cleavage stages they enter into a tight relationship with the Sertoli cell. Sertoli cells, the structural cells of the reproductive epithelium of the sex cord, perform vital tasks such as supplementing, feeding, hormone secretion, mitosis and regeneration. Sertoli cells are nurse cells.

Spermatogenesisis a complex period that relies on coordinated cell proliferation and apoptosis. Spermatogenesis is a temporal event during which a relatively undifferentiated diploid cell called spermatogonium slowly evolves into a highly specialized haploid cell called spermatozoon. The main aim of spermatogenesis is to produce a genetically unique male gamete that can fertilize an ovum and produce offspring. Spermatogenesis can be divided into three stages.

Biofilm Adhesiveness is a Reliable Proxy for the Effect Assessment of Silver Nanoparticles on the Functionality of Freshwater Biofilms


Freshwaterbiofilms have great ecological relevance and are essential for aquatic habitats. The biofilm microbes not only constitute the base of the aquatic food web, the benthic pelagic feedback loop and the microbial loop make different nutrient available for other larger organisms such as makrophytes. Moreover, benthic biofilms play a significant role in the process of auto purification and can function as a trap for persistent contaminations and pollutants. Even more, during the process of biostabilization benthic biofilms can significantly increase the stability of fine sediments and thus prevent a re-suspension of legacies.

Dueto this variety of important ecosystem functions and an even greater number potential stressors which can impact these biofilm services, research into the reaction of benthic systems and biofilms after disturbance is increasingly expedited. As examples, the development of biofilms after an exposure to stressors such as desiccation or antibiotics was investigated. Furthermore, different survival strategies of biofilm microbes were studied in more detail such as morphological changes in bacteria due to stress [9] or different stages of dormancy in case of nutrient deficiency in bacteria that do not form spores. There are also first insights into the resilience of the microbial community of a drinking water system and how stress can induce changes in the community composition. However, reliable and measurable markers for the functionality of the biofilm system and its ecosystem services were hardly addressed. The investigation of Weaver et al. Assessing the resilience of the enzyme activity of ground water biofilms constitutes a suitable example of this required new comprehensive perspective as microbial enzyme activity can be essential for ground water quality and the total habitat. The adhesiveness of the biofilm constitutes another example of an essential ecosystem function: it significantly influences the development of the biofilm matrix and shapes the rate of attachment and detachment of particles and flocs, and thus the mass balance in the system of biofilm and fine sediment. Furthermore, the process of biostabilization is depending on biofilm stability and adhesiveness which is directly measurable using the MagPI-IP.

Thursday, 13 December 2018

Comparison of Oral Iron Chelation Therapy Versus the Injectable Once for the Decrease Some Endocrinopathy in β-Thalassemia Major Patients


β-thalassemiamajor is a hereditary hemoglobinopathy due to defect in the production of β-globulin chain. The most common manifestations of disease are anemia and hepatospelenomegaly (due to extramedullary hematopoiesis). The mainstay of treatment of the β-major thalassemia is frequent blood transfusion that leads to iron overload in the critical organs include; liver, heart and endocrine glands. Iron chelators for attenuated of iron overload in body are used in two ways: injectable (subcutaneous deferoxamine) and recently oral once (Deferiprone; L1). Deferiprone is well inserted into the cell and removes iron, so is more effective than defroxamine in reducing endocrine complications and cardiac iron overload. Endocrinopatheis is one of the most common complications due to iron overload and approximately, 60% patients have at least one endocrine organ involvement.There are a few studies compare efficacy of oral and injectable iron chelator for decrease endocrine complications in β-thalassemia major patients. Here, we compared some endocrinopathies include: IGT (impared glucose tolerance), DM (diabetes mellitus), hypoparathyroidism (clinical and subclinical) and hypothyroidism in the patients with β-thalassemia major who received oral chelators against the injectable once.

Seventytwo patients with homozygote β-thalassemia major were included to this study. The patients were treated at the Children’s Medical Center Hospital, Tehran, Iran, from April 1997 to August 2017. Β-thalassemia major was diagnosed in the early of life by standard methods of peripheral blood smear and hemoglobin electrophoresis. Individual characteristics and type of used iron chelator were collected in the specific questionnaire. All of the patients were divided into two group 1(received oral iron chelator; Deferiprone or L1) include; 39 patients (38.46% male and 61.53% female) with age average of 19.5 years and group 2 (received injectable iron chelator; deferoxamine) include; 33 patients (60.6% male and 39.3% female) with mean age of 21.3 years. Deferiprone therapy was started 6 to 65 months (mean 29.9 ± 11.2 months) after receiving deferoxamine therapy from early age. The endocrine functions were evaluated for all the patients before and after of Deferiprone therapy. Fasting plasma glucose levels 110-125 mg/dl or 140-199 mg/dl after OGTT (oral glucose tolerance test 2 hours) was considered IGT (impaired glucose tolerance). Fasting blood glucose levels greater than 126 mg/dL or OGTT more than 200 mg/dl or presence of the symptoms of diabetes and plasma glucose concentrations greater than 200 mg/dL, were regarded to have diabetes mellitus. Hypoparathyroidism was defined as low serum calcium, high serum phosphate and low PTH. Clinical or subclinical hypothyroidism was defined according to Evered criteria.

Wednesday, 12 December 2018

A New Approach for Reduction of Anterior Mandibular Dislocation: Semi-Sitting Technique


I read the published article by Heidari with title: “The new technique for reduction of bilateral mandibular dislocation” with great interest. In this study has been explained a new technique for reduction of bilateral anterior mandibular dislocation. This technique wasperformed on one patient that ordinary approach failed. Temporomandibular joint (TMJ) dislocation is an uncommon presentation to the emergency department (ED) and may occur in up to 5% of the population during their lifetime. Anterior dislocation is the most common type seen in clinical practice. In the traditional method described for reduction of bilateral TMJ dislocation, the operator stands in front of the patient and inducts intraoral bilateral inferior-posterior downward force on the patient's molar occlusal surfaces. In this new technique (semi-sitting approach), the patient Placed on a bed in semi-sitting position and the operator stands behind the patient. Then, the physician places both thumbs bilaterally posterior to the patient's last molar teeth, on the retro-molar gum along the ramus of mandible. Then, bilateral inferior-anterior downward force in this position was given. The benefits of this technique are that the bilateral inferior-anterior downward force provides a levering action on the mandible, which reduction with lower force than traditional methods accomplished, and that it increases the chance of successful reduction of bilateral mandibular dislocations. In addition, working with this technique is easier than conventional methods for operators. It looks that will be done for unilateral or posterior mandibular dislocation but however, further studies need to be done in this case.

Contribution to the Knowledge of the Blidinje Lake Sediment


Lake sediments are considered as an archive of physical, chemical and biological conditions in lakes and their drainage basin. Under relative steady sedimentation process and in the absence of bio-turbation, depositional sequence of lake sediments provide a temporal composition pattern, therefore the onset, rate and variations in present and past environmental conditions could be assessed. In this sense, environmental impacts caused by human activities, mainly those related to the release of persistent pollutants, can be identified by appropriate analyses of sediment archives.

Lake Blidinje with area of some 2.5 km2 (on average) is the biggest mountain lake in Bosnia and Herzegovina. It is located at an altitude of 1185 m (N 43o36`; EO 17o29`), between Čvrsnica and Vran mountains. The lake is very shallow with an average depth of about 0.5 m, and under the strong influence of meteorological conditions. The lake has variable volume and surface area. Lake Blidinje is an integral part of the Nature Park “Blidinje” founded in 1995. Nature Park “Blidinje” (364 km2) includes the Čvrsnica massif (2228 m), the Vran Mt. (2074 m), the valley Dugo polje and the western part of the mountain ridge Čabulja named Debelo brdo, (1500 m).

Geologicalbase is very heterogeneous, made up of limestone from upper and middle Triassic, and has a young Jurassic limestone, werfenian layers of red sandstone, sandy shale, limestone plate marl, porous limestone and dolomite. On the surface most of the Nature Park “Blidinje” lithosphere breaks through the ground and form a single larger or smaller blocks to the tops form a rocky massif.

Tuesday, 11 December 2018

Splenic Abscess


A 66- year old man, who has undergone open prostatectomy three months earlier presented to the abdominal department with general malaise, left upper abdominal pain, and intermittent fever. On physical examination, he was noted that these symptoms have started three weeks after open prostatectomy. The physical examination of the abdomen was normal. At the admission erythrocyte sedimentation was 140 mm/h (normal value 3 mm/h), C-reactive protein was 128 mg/L (normal value 1.0-6.0 mg/L), leukocytes were 13.2 X 10³/μL (normal value 4.0- 10.0 X 10³/μL), and creatinine was 156 mmol/L (normal value 70-108 mmol/L).

The CT- scan of the abdomen revealed splenomegaly (17 X 8 cm), suspicious splenic infarction and suspicious splenic abscess in progression (Figure 1). After the admission, we have started to treat a patient by imipenem- cilastatine, a broad-spectrum antibiotic. Three days after admission patient underwent surgery with the aim to remove the septic source and the diseased organ. About 90% of spleen parenchyma was destructed due to abscess. Spleen was like bag filled with pus, and an open splenectomy was performed (Figure 2). From splenic abscess has been isolated enterococcus faecalis. The patient was discharged on the seventh postoperative day. Fourteen days after splenectomy, a patient has been vaccinated by pneumococcal, meningococcal, and Haemophylus Influence (Hib) vaccines. A month after splenectomy patient was in very good condition.

Splenic abscess is a rare entity, with high mortality rate, up to 47%. The most common causes of splenic abscesses are haematogenous spread originating from an infective focus elsewhere in the body, urinary tract infection, infective endocarditis, pneumonias, pelvic infections etc. Splenic infarction resulting from systemic disorders such as hemoglobinopathies (especially sickle cell disease), leukemia, polycythemia, or vasculitis, can become infected and evolve into splenic abscess. Splenic abscess can be treated by percutaneous drainage or surgical interventions open or laparoscopic splenectomy.

Monday, 10 December 2018

Psychometric Properties of Malay Version of Summary of Diabetes Self-Care Activities Measures among the Malay Adults with Type 2 Diabetes Mellitus in Kelantan, Malaysia


Self-managementis defined as the knowledge and skills necessary for an individual to take care of oneself, manage crises, and change lifestyle to manage illness successfully. Self-management is an important part of daily life for people with diabetes. It has been reported that approximately 95% of diabetes care is self-treatment or self-management. To control diabetes, individuals must monitor their daily lifestyle behaviour, and often they must change long-held habits. Therefore, although self-management is vital in people with type 2 diabetes mellitus (T2DM), it is not always as effective as health professionals would like. Thus, it is important that individuals adhere to self-management, to prevent further complications associated with diabetes to maintain or achieve a positive quality of life.

Ina clinic-based study on diabetes self-management in Malaysia, about 99% of the respondents were practising at least two out of four diabetes regimens, which were regular exercise, healthy diet, monitoring blood glucose and monitoring body weight. However, only about half of the respondents (56%) were practicing all these four regimens. Besides, it is common for people withT2DM to have difficulty practicing all the self-care recommended by their health practitioner. People with T2DM must comply with demanding requirements of their treatment regimens, and this can create the fear of failure. These regimens can involve daily behavioral tasks, such as changes in habits on diet and exercise, which people with diabetes should comply for the rest of their life.

Practicessuch as diet, exercise, smoking cessation, and yearly check-ups will help to prevent the incidence of diabetes and delay the progression of its complications in people who are already known to have diabetes. Handley et al. reported that the majority of the 228 participants (75%) from San Francisco, California, with coronary heart disease risk factors, including those diagnosed with diabetes, were carrying out an action plan that focused on diet or exercise for self-management of their illness condition. Moreover, in a qualitative study, the researchers demonstrated that most people with diabetes had selected diet and or exercise for their behavior change. The study that examined people with diabetes attending a Malaysian clinic showed that 94% of these individuals were following a healthy diet. Besides, Anderson et al., suggested that diabetes self-management, such as diet planning, requires a life-long commitment. This can only be sustained with the genuine internalisation of the purposes and the value of good diabetes self-care.

Wednesday, 5 December 2018

Anti-Candida Activity of the Essential Oil From Elionurus Muticus: A Preliminary Study


Therapeuticoptions for the treatment of candidiasis are mainly azole, polyene and echinocandin type antibiotics. Unfortunately, the clinical use of these agents has been limited due to their toxicity and resistance factors, contributing to high rates of morbidity and mortality. In recent decades, research on medicinal plants has been an alternative in the discovery of new biocomponents for various applications in folk medicine. The use of essential oils extracted from different types of plants, showed several indications, as antiseptic, antifungal and antibacterial actions.

Thegenus Elionurus presents approximately 45 species. It occurs in Africa, Asia, North America and South America. Elionurus muticus is a grass of the Brazilian pampas known as Brazilian lemongrass. This has aroused considerable interest in the phytochemical industry. It presents antioxidant activity related to the content of its phenolic compounds. It is notable for containing antiseptic, sudoriferous and febrile properties. Produces essential oil in all its extension: in the aerial part, leaves and inflorescences, as in the roots. However, both the composition and the yield are variable according to the region of cultivation and the seasonality.

Despite this, this essential oil may be rich in citral, which is a mixture of two geometric isomers known as geranians and nerals. Some pharmacological properties of citral have been reported in the literature, including antitumor, bronchodilator, antiprotozoal and antimicrobial effects. Based on the literature data, the objective of this work was to evaluate the in vitro antimicrobial activity of Elionurus muticus essential oil on the Candida spp. Strains by determining the Minimum Inhibitory Concentration (MIC) and Minimum Fungicidal Concentration (CFM).

Tuesday, 4 December 2018

White Spot Lesions: Whose fault it is?


Fixedorthodontic treatment has many side-effects associated with it, especially Demineralization with a very poor oral hygiene. Demineralization of enamel occurs because of the subsequent release of acidic byproducts of the bacteria in the plaque which leads to the formation of White Spot Lesions (WSL). Caries is another side effect leading to poor esthetics, patient dissatisfaction and legal complications. For an orthodontic point of view, the formation of these white spot lesions is very discouraging as the main goal of orthodontics is to improve the esthetics in the dento facial region.

Orthodonticattachments make oral hygiene maintenance the most difficult job as the small size of these attachments on teeth like brackets, bands, arch wires, ligatures and other orthodontic devices leads to prolonged plaque accumulation and appearance of WSL. So, before starting orthodontic treatment and initiating other preventive measures, one has to assess the saliva, oral hygiene status and caries rate. Patients should be properly educated about the importance of maintaining good dietary compliance and excellent oral hygiene regime.

Clinically,these white spots can be seen around orthodontic attachments within 4 weeks of starting of treatment and their prevalence can be as high as 96%. The most frequently affected area is the labio-gingival area of the lateral incisors and the maxillary posterior segments are the least affected sites with a tendency to be seen in males than in females. A critical evaluation of oral hygiene is recommended during the initial periods as the number of white spot lesions increases in the beginning and keep on increasing at a slower rate.

White spot lesions are not only the result of demineralization, however, as fluorosis, hypomineralization /hypomaturation and hypoplasia can also cause lesions. Management of white spots includes the methods of prevention, demineralization and methods used for remineralization of lesions that are already formed. Remineralization is the process of restoring minerals in the form of mineral ions in dental enamels. Demineralization is the process of removing minerals, in the form of mineral ions, from dental enamel.

Monday, 3 December 2018

Physical Medicine and Rehabilitation Surmounting the Hiatus between Disease and Health Related Quality of Life


Theultimate goal of management of all critical illnesses are to rehabilitate the patient up to optimum functional level and achieving quality of life and quality adjusted life years. Quality health care can be defined as providing the best possible outcome, safety and service. Quality patient care should be the first priority of every rehabilitation specialist. Physiatrist or specialty of physical medicine and rehabilitation has been recognized as a method that can restore the functional capabilities of patients with disabilities or chronic diseases to become participants in their home and community. Successful rehabilitation to the level at which the individual can participate in the society provides is the basis for the restoration of hope and aspiration for creativity. Medicine has been making highly significant progress in providing better health services. Acute medical and surgical services have successfully decreased mortality and extended life expectancy. 

As the success of surgical and medical care’s increases, the proportions of patients survive to aged population group increases. Most of the aged people survive with chronic disease and disability, which require more rehabilitation. With the growing of geriatric population, the health care delivery system will be burdened with patients suffering from chronic diseases of musculoskeletal and neurological system. At the same time physiological reserves also declines in aged population. Due to physiological constraints of kidney, liver and many other organs in aged people, the role of pharmacological agents in ameliorating the symptoms has also become limited. Different modalities of physical treatment including exercise used in physical medicine helps the patients in alleviating pain and disability as well as reduce the vulnerability to detrimental effects of drugs in old age.

Sunday, 2 December 2018

Understanding the Role of microRNAs in the Pathogenesis of Intracranial Aneurysms


Treatmentoptions for the management of intracranial aneurysms (IA) remain associated with significant morbidity and mortality. As a result, there is a need to identify biochemical markers predictive of the presence of IAs and the risk of rupture. Genetic factors play a key role in IA pathogenesis, as evidenced by the increased susceptibility to IA formation and rupture in the familial form of the disease. microRNAs (miRNAs), which modulate gene expression, have been demonstrated to be differentially expressed in multiple disease states. To date, little data exists pertaining to miRNA expression and IAs. We review the literature examining miRNA expression and IA formation, progression, and rupture. The relationship between miRNA expression profiles and the specific molecular and cellular processes driving IA genesis are examined. The potential clinical relevance of miRNA is also discussed, as it relates to improving the means by which the risk of rupture is estimated.

IntracranialAneurysms; miRNA: microRNA; aSAH: aneurysmal Subarachnoid Hemorrhage; mRNA; messenger RNA; miRISC: RNA-Induced Silencing Complex; UTR: Untranslated Region; ECM: Extracellular Matrix; TGF-β: Tissue Growth Factor-β; VSMC: Vascular Smooth Muscle Cell; NF-κB: Nuclear Factor-kappa B; IL-6: Interleukin 6; IL-8: Interleukin 8; ICAM-1: Intercellular Adhesion Molecule-1; VCAM-1: Vascular Cell Adhesion Molecule; MMPs: Matrix Metalloproteinases; TIMPs: Tissue Inhibitors of Matrix Metalloproteinases; VEGF: Vascular Endothelial Growth Factor; NF-κB: Nuclear Factor kappa-B; TNF-α: Tumor Necrosis Factor-α; IL-1β: Interleukin-1β; MCP-1: Monocyte Chemo Attractant Protein-1; qPCR: Quantitative PCR; AAA: Abdominal Aortic Aneurysms.

Intracranialaneurysms (IAs) affect 3-6% of the general population and have an annual rupture rate of 1-3%, resulting in approximately 27,000 aneurysmal subarachnoid hemorrhages (aSAH) in the United States each year. The morbidity and mortality of aSAH remains high, with as many as 50% of cases resulting in death, and up to 50% of survivors suffering significant permanent disability. Current microsurgical and endovascular treatment of IAs remains associated with significant risk, which may exceed the annual risk of rupture. Thus, there is a need for both an improved understanding of factors contributing to rupture and the development of noninvasive means by which to identify those aneurysms with a higher risk of rupture.

Thursday, 29 November 2018

Measurements of Electroencephalogram (EEG), Galvanic Skin Resistance (GSR) and Heart Rate Variability (HRV) during the Application of a System that Gives Simultaneously tVNS and Brain Entrainment on Subjects Affected by Depression and Anxiety


Thedevice that we have used, is a system realized by the NuCalm  designed with the purpose to treat subjects affected by depression, anxiety, stress. The whole system consists of four components that leverage biochemistry, neurophysiology, and physics to obtain and maintain parasympathetic nervous system dominance. Previously, we have performed an HRV analysis just on tVNS only. Let us express how the four components work together. First, NuCalm topical cream is applied to the carotid on the neck and it is designed to act counteracting adrenaline. It includes structured, nutrient-sourced building blocks (Active ingredients are PharmaGABA, Lactium (Casein Tryptic Hydroylsate), L-Theanine and L-Tyrosine) that rapidly create a natural relaxation response. Second, the system uses the micro current stimulation patches, a tVNS system that is placed behind each ear at the Mastoid Process. Research has shown that this device induces an increase of parasympathetic response. Next, a noise- dampening headphones.

are used to deliver proprietary nonlinear oscillating neuroacoustic software to bring the brain wave pace to the pre-sleep stages (12Hz -4Hz) via brain entrainment. Finally, Light-blocking eye masks are used to negate visual stimuli. The aim of the present paper is to study the combination of these four components in subjects having Psychological Disorders (P.D.) as depression and anxiety. We have studied the Electroencephalogram (EEG), the Galvanic Skin Resistance (GSR) level and the HRV during the complete treatment in subjects affected by anxiety and/ or depression.

Solace Lifesciences, Inc., of Wilmington, Delaware, USA, furnished the NuCalm device. 100 young subjects affected by anxiety, or depression were examined. To test the subjects each potential participant was given a nonstructured interview following the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Participants selected for the study showed symptomatology of anxiety or depression.

Wednesday, 28 November 2018

Social Pathology of Drug Abuse, Addiction and the Possible Problems Generated


Anydeviation from the permissible acts in any society is an abnormal behavior. If these abnormal acts are pronouncedly deviant and pose threat to communal peace and order, then they are known as crimes. Therefore, crime may be defined as an act inimical to social peace and harmony. So, crimes are hurtful to social stability, and are more expected to appear in larger cities. To be able to control and prevent crimes, we need to study the various causes and roots of crimes in a systematic manner. However, the discipline involved in such a systematic investigation is known as criminology.

Oneof the increasing vulnerabilities observed in megacities at present is addiction in general within the young cohort which often leads to prostitution by the female youth. When any female allows use of her body for sexual relation against payment of some money to many persons, this is an immoral activity and poses a threat to the society. Prostitution is considered immoral and unsocial because it commercializes and degenerates love, and asserts the supremacy of bodily values over social and moral.

The scope of criminology is quite vast and wide. It is relates to all social classes and structures. However, criminologists have tried to limit its scope so as to be able to study the subject scientifically and systematically. To elaborate it, here are the viewpoints of some notable criminologists: According to the science of criminology “includes within its scope the process of making laws, of breaking laws, and of reacting towards the breaking of laws”. According to Sutherland’s description of the scope of criminology, we can divide it into departments: The sociology of law, criminal etiology and penology.

Tuesday, 27 November 2018

Immediate Load Implants: Systematic Review on the Clinical Success Assessment and Follow Up


Earlyloading was identified as a critical factor and therefore, several waiting times were attempted until the establishment of a period of at least three months for the mandible and five to six months for the maxilla. The first studies of implant follow-up constituted the scientific basis of modern implantology. Both a two-stage surgical protocol and a single surgical procedure protocol required a waiting time for osseointegration (OI) to occur.

Thisconcept of a healing period, before the implants were submitted to functional load, was based on the existing knowledge related to bone repair of fractures and osteotomies that required a period of 3 to 6 months before the functional loads could be gradually applied. With the advancement of the researches, even considering the high clinical success rates of the late loading techniques, some researchers began to question the possibility of reducing the time for the implants to be submitted to the load, since the loading by itself would not impede the process of healing. Therefore, Immediate loading (IL) was defined as “installation of a prosthetic element on implant without OI.

As a recentliterature support, a total of 378 implants were placed in 56 patients. Forty upper and lower arches were restored and 16 patients received bimaxillary rehabilitation. The mean duration of follow-up was 50 months, and the patient’s prevalence of implant and peri-implantitis was 14.3% and 50.0 %, respectively. The mucosa affected 56.9% of the implants and 50.0% of the patients. The survival rate was 96.4% per patient, but reached 99.5% in the implant-based analysis and the success rate was 95.5% for implants and 80.4% for patients. Full loaded full arch restorations immediately have an acceptable result after 1 to 9 years of follow-up. However, the incidence of peri-implant diseases is high, and further research is needed to confirm whether these can compromise the predictability of prostheses in the long term.

Monday, 26 November 2018

Dermatoscopy can Impact Biopsy Method


Dermatoscopyhas impacted diagnostic accuracy for skin malignancy to the extent that this now has the potential to influence choices of surgical biopsy procedures for the benefit of patients. For this potential to be realised dermatoscopy and surgical decision-making need to be integrated. This can happen in dermatology, primary care and surgical practice. This editorial will consider what is possible by applying recent advances in dermatoscopy to optimise decisions on biopsy method in the management of all suspected skin malignancies, both melanocytic and non-melanocytic.

Dermatoscopyis a relatively recent non-invasive diagnostic tool only having made an impact on the management of skin malignancy in the last 30 years. It was shown to significantly improve diagnostic accuracy for pigmented melanocytic lesions as early as 2001 and for pigmented non-melanocytic lesions in 2010 but it was not until 2018 that dermatoscopy was shown to improve diagnostic accuracy for non-pigmented skin lesions in general. In Australia and New Zealand, the countries with the highest incidence of skin cancer in the world, dermatoscopy has been standard of care with respect to the management of pigmented skin lesions since 2008. Parallel to the compelling evidence for its efficacy the uptake of dermatoscopy is increasing as evidenced by membership of the International Dermoscopy Society, now exceeding 14,000 individuals from 168 countries.

Dermatoscopyuse varies world-wide which is understandable with technology which did not exist when senior dermatologists, surgeons and general practitioners (GPs) were trainees. A cross sectional study in the USA in 2010 reported that 79% of dermatologists had used a dermatoscope. In a survey in the UK in 2012, 98.5% of respondents, mainly consultant dermatologists and registrars reported regular dermatoscopy use. A survey on dermatoscopy use by Australian dermatologists published in 2011 reported a rate of 98% compared to 33% for Australian GPs in 2007.

Sunday, 25 November 2018

Endodontic Treatment and Restoration of a Mandibular First Premolar Type IV Wiene’s Root Canal Configuration with IPS E.Max CAD Technology: A Case Report


Knowledgeof the complexity of root canal anatomy and common variants is necessary for the success of root canal treatment. Clinically, it is important to know that a root has a single root canal at the pulp chamber floor that splits into multiple root canals at a certain point of the root canal length; it is also important to determine the level of the root canal where the separation occurs. Root canal spitting in the middle and apical root canal sections may go unnoticed, is more difficult to manage and may affect the cyclic fatigue of endodontic instruments. Weine’s classification system of root canal configuration has long history of use and classified the root canals into four types. Type I is one continuous root canal with one orifice and one exit. Type II is a canal with two orifices which combines into one before reaching the portal of exit. Type III refers to two distinct canals which has two distinct orifices and two distinct portal of exit. Type IV refers to canal which has one orifice and diverges into two canals which has separate portal of exit.

Themain objective of root canal therapy is thorough shaping and cleaning of all pulp spaces and its complete obturation with an inert filling material. The presence of an untreated canal may be a reason for failure. A canal may be left untreated because the dentist fails to recognize its presence. The mandibular premolars are difficult to treat as they have a high flare-up and failure rate. It may be due to the extreme variations in root canal morphology. Normally the root canal system of the mandibular second premolar is wider buccolingually than mesiodistally with two pulp horns. At the cervical line the root and canal are oval; this shape tends to become round as the canal approaches the middle of the root. If two canals are present, they tend to be round from the pulp chamber to their foramen. Another anatomic variation is that a single, broad root canal may bifurcate into two separate root canals. Direct access to the buccal canal is usually possible, whereas the lingual canal may be very difficult to find. The lingual canal tends to diverge from the main canal at a sharp angle. In addition, the lingual inclination of the crown tends to direct files buccally, making location of a lingual canal orifice more difficult.

Wednesday, 21 November 2018

Dietary Patterns and Oncological Morbidity in European and Mediterranean Countries


NCD:Chronic Noncommunicable Diseases; Euro: European countries; Med: Mediterranean Countries; BMI: Body Mass Index; BH: Blood Cholesterol Level; BG: Blood Glucose; BP: Blood Pressure; GDP: Per Capita Income; EEI: Ecological Efficiency Index; HDI: Human Development Index; QR: Interquartile Range; FAO: Food and Agriculture Organization of the United Nations.

Eachyear, 15 million people die from a Chronic Noncommunicable Diseases (NCD) between the ages of 30 and 69 years; over 59% of these followed by cancers (8.8 million), which pose a threat to human longevity. Cancer is the main cause of morbidity and mortality in developed countries.

It is shown that in the Mediterranean countries the incidence of breast cancer and Alzheimer’s disease are lower. The authors point out the protective effect of the Mediterranean diet, with low share of animal protein containing products and high share of unsaturated fatty acids. It is shown that eating disorders in prenatal period can contribute to predisposition to non-infectious chronic diseases (NCD) at an older age. Diets with high share of fats and calories are risk factors for cancer. There is little information about the risk of high-calorie diets with different sources of calories (fats, proteins, carbohydrates). We have shown that a risk factor for breast cancer may be a Western diet that contains the same level of total energy as the Mediterranean diet, but a different source of Proteins and Fat. It is shown that food behavior, the regulation of which is complicated, may be a risk factor for obesity and breast cancer, as well as other cancer types. But food is a modifiable factor. Therefore, the negative impact of nutrition on NCD can be reduced by developing safe, low-immune diets.

Tuesday, 20 November 2018

Sudden Cardiac Arrest during Treadmill Test Secondary to Slow Coronary Flow


Slowcoronary flow is an attractive phenomenon, has been investigated for years. Clinical features of slow coronary flow changes from just angina pectoris to sudden cardiac death. It was first described by Tambe et al, in 1972. In this case, we reported 41 years-old patient with no history of chronic disease, was asked to perform treadmill test due to his family’s high cardiovascular risk factors. Sudden cardiac death secondary to ventricular arrhythmia was also reported before. In our case there was interestingly just cardiac asystole without ventricular arrhythmia.

A51 years-old man was admitted to outpatient clinic for cardiac screening. When medical anamnesis was deepened, we learned that he applied to cardiology clinic because of high family cardiovascular risk factor. There was no exertional chest pain and no history of medical drug usage in his anamnesis. Resting Electrocardiogram (ECG) was totally normal. He underwent treadmill test on Bruce protocol in order to induce coronary ischemia. In second minutes of the treadmill test new left bundle branch block also extreme bradycardia appeared. Sudden cardiac arrest occured Figure 1 After five minutes of cardiac resuscitation heart rhythm was provided. 3 mg of atropine was intravenously given to patients in five minutes in order to prevent the bradycardia.

Thepatient was immediately taken to the catheter laboratory. Coronary Angiography (CAG) was performed, Left Anterior Descending artery (LAD) and Left Circumflex Artery (LCX) were totally normal whereas there was extremely slow blood flow in the Right Coronary Artery (RCA). CAG showed slow dye opasification and delayed distal vessel clearance during selective injection in right coronary artery. To standardize the degree of slow antegrade filling, TIMI frame count method was used. Antegrade filling in the LAD and LCX was normal with TIMI 3 flow. In contrast the patient had TIMI 2 flow in RCA, TIMI frame count was found to be 60.

An Evaluation of the Role of fMRI in Patients with Lower Urinary Tract Dysfunction

                                        Patientswith Lower Urinary Tr...