info

Wednesday 28 February 2018

Macroscopic Balance Equations for Spatial or Temporal Scales of Porous Media Hydrodynamic Modeling

                                  http://austinpublishinggroup.com/hydrology/currentissue.php



We focus on thefirst author’s previous work addressing macroscopic balance equations developed for different spatial and temporal scales. We elaborate on previous findings so as to orient the reader to fundamental concepts with which the mathematical formulations are developed. The macroscopic balance Partial Differential Equations (PDE’s) are obtained from their microscopic counterparts by volume averaging over a Representative Elementary Volume (REV), considering a non-Brownian motion. The macroscopic quantity of phase/component intensive quantities product, is the premise of two concurrent decomposed macroscopic balance PDE’s of the corresponding extensive quantity. These are concurrently valid at the primary REV order of length and at a significantly smaller secondary length. The hydrodynamic characteristic at the smaller spatial scale was found to always be described by pure hyperbolic PDE’s, the solution of which presents displacement of sharp fronts. Reported field observations of condensed colloidal parcels motion, validate the suggestion of hyperbolic PDE’s describing fluid momentum and components mass balance at the smaller spatial scale. Controlled experiments supplemented by numerical predication can yield the hydrodynamic interrelation between the two adjacent spatial scales.

Further, we focus on the first author past developments concerning dominant macroscopic balance PDE’s of a phase mass and momentum and a component mass following an onset of abrupt pressure change. These account for the primary REV order of length and for evolving temporal scales. Numerical simulations were found to be consistent in excellent agreement with experimental observations. During the second time increment and in view of the aforementioned developments, we presently elaborate on new findings addressing theoretically the efficiency of expansion wave for extracting solute from a saturated matrix. Simulations comparing between pumping using an approximate analytical form based on Darcy’s equation and numerical prediction addressing the emitting of an expansion wave, suggest that the latter extracts by far more solute mass for a spectrum of different porous media.

Application of spatial averaging rules, referring to a REV, leads to the formulation of the macroscopic balance equations addressing phase interactions such as fluids carrying components and a deformable porous matrix. Further elaborations by Sorek et al. Sorek and Ronen  and Sorek et al.  prove that the phases and components macroscopic balance PDE’s can be decomposed into a primary part that refers to the REV length scale and, concurrently, a secondary part valid at a length scale smaller than that of the corresponding REV length. The secondary macroscopic balance equation always conforms to a hyperbolic PDE. Geometrical patterns of different spatial scales that prevail in various porous media are exemplified. Such patterns support the notion of the need to implement macroscopic balance equations addressing different spatial scales. Observations verify that the hydrodynamic characterization of colloidal transport comply with the developed fluid and component macroscopic balance equations for the smaller spatial scale.

Local Understanding and Responses to Deliberate Transmission of HIV: Experiences from Persons Receiving Antiretroviral Treatment in Rural Northeastern Tanzania




As access to Antiretroviral Therapy (ART) in Tanzania has been steadily improving in recent years, there has been concern that availability of Antiretroviral Drugs (ARV) could fuel HIV transmission due to deliberate unprotected sexual practices of persons receiving antiretroviral treatment. There has been a debate about the need to enforce some institutional measures to help manage and control what has been described as the deliberate spread of HIV. However, there is no widespread consensus about what constitutes ‘deliberate transmission’.
Drawing on in-depth interviews with a sample of people receiving ART and health workers providing care in a rural setting, this article examines the context in which deliberate HIV transmission is defined and the ways through which it can be controlled. The article demonstrates that people on ART face the dilemma of reducing risk of spreading HIV and a desire to maintain socially acceptable sexual and reproductive lives. Although many participants reportedly remained sexually abstinent, they also revealed that some people on treatment from within and beyond the study area were engaging in sexual behaviours perceived to amount to deliberate spread of HIV.
Despite some reservations, formal sanctions to control deliberate HIV transmission were generally highly approved by participants. The article strongly recommends for a careful examination of needs of persons on treatment and strengthened prevention in order to manage unintended consequences of ART for individuals living with HIV/AIDS and uninfected population.

Tuesday 27 February 2018

Looking Beyond Liver! Cirrhotic Cardiomyopathy: Pathophysiology, Clinical Presentation and Management Strategies

                                    http://austinpublishinggroup.com/glpd/currentissue.php


Cardiac dysfunction in cirrhosis of liver remains dormant due to hyperdynamic circulatory state even with the severe stage of cirrhosis. This in actuality is worsening of the cardiac functions. The decline in diastolic functions, inotropic and chronotropic functions and cardiac hypertrophy all occur simultaneously in the setting of an absent organic cardiac disease. The Cirrhotic cardiomyopathy has pertinent findings in its loop comprising of impaired contractile reaction to stress stimuli and electrophysiological abnormalities along with prolonged QT interval. The disruption in β-adrenergic receptor signalling, altered composition of cardiomyocyte membrane lipids plus biophysical properties, ion channel defects and enhanced cardiodepressant factors attributed to hormones are the pathogenic assailants. The hindrance to diagnose cirrhotic cardiomyopathy mainly lies in unavailability of a stark specific diagnostic test nevertheless; an echocardiogram is favourably used to follow deteriorating diastolic functions and the E/e′ ratio thus giving insight to the progression of disease. The severity of cirrhosis is linked in parallel with ensuing cirrhotic cardiomyopathy which substantially impairs arterial blood volume. So, in case of any hemodynamic stress, a heart bearing cirrhotic cardiomyopathy retorts with diminished cardiac response which may cause renal hypoperfusion leading to renal failure. The management is mainly symptomatic where only the liver transplantation could play an imperative role in correction of the cardiac functions.

CCM: Cirrhotic Cardiomyopathy; QTc: Corrected QT interval; SNS: Sympathetic Nervous System; RAAS: Renin Angiotensin Aldosterone System; CAIDS: Cirrhosis-Associated Immune Dysfunction Syndrome; NO: Nitric Oxide; CO: Carbon monoxide; LV: Left Ventricle; SVR: Systemic Vascular Resistance; BDL: Bile Duct Ligation; PWCP: Pulmonary Wedge Capillary Pressure; PRAL: Plasma Renin Activity; TGF β: Transforming Growth Factor Β; IVRT: Increased Isovolumic Relaxation Time; DT: Deceleration Times; TDI: Tissue Doppler Imaging; CAMP: Cyclic Adenosine Monophosphate; PKA: Protein Kinase; ECS: Endocanabinoid System; iNOS: inducible Nitric Oxide Synthase; L-NMMA: N Omegamonomethyl-larginine; NGL: Nitro-arginine Methyl Ester; HO: Haem Oxygenase; CGMP: Cyclic Guanosine Monophosphate; MAPKs: Mitogen-Activated Protein Kinase; HRS: Hepatorenal Syndrome; ANP: Atrial Natriuretic Peptide; BNP: B Type Natriuretic Peptide; GLS: Global Longitudinal Strains.

Cirrhosis is a chronic state of liver caused by various aetiologies characterized by altered parenchyma and distorted hepatic vascular architecture consequent to chronic tissue fibrosis and regenerative nodules. Globally, cirrhosis has become an emergent cause of mortality. Apart from the known complications of cirrhosis like ascites, hepatic encephalopathy, upper GI bleeding and Coagulopathy, cardiac involvement in the form of Cirrhotic Cardiomyopathy (CCM) has recently gained attention as the commonest cause of post liver transplant mortality.







Friday 23 February 2018

Periportal Schwannoma: Two Case Reports and Review of Periportal Mass



Schwannomas arebenign tumors that arise from Schwann cells of peripheral nerve myelin sheaths. Initially reported in 1988 by Daimaru et al. gastrointestinal schwannomas have an excellent prognosis after surgical resection. Patients with periportal schwannomas can present with abdominal pain or concerning features such as weight loss, jaundice or anorexia raising suspicion for a malignant tumor. Schwannomas characteristically undergo cystic degeneration due to vascular thrombosis and subsequent necrosis. Computed Tomography (CT) scan shows a well-defined, hypodense, heterogeneous mass with peripheral enhancement  making the differentiation from a malignant tumor even more difficult. Only 15 cases of periportal schwannomas have been described in the literature, and preoperative diagnoses could not be made in any of them. All of these patients underwent open surgical resection.

laparoscopically. The first patient underwent laparoscopic resection of a periportal schwannoma arising from the proper hepatic artery. To our knowledge, this is the first reported case of laparoscopic resection of periportal schwannoma. The second patient underwent a diagnostic laparoscopy, and the periportal mass was confirmed as a benign schwannoma by intraoperative frozen section. The tumor was encased around the extrahepatic biliary tree, so it was left in-situ to avoid unnecessary extensive biliary surgery.


A 55-year-old Caucasian female presented with six months of severe abdominal pain, early satiety, bloating, steatorrhea and a fifteen-pound weight loss. Past surgical history was significant for laparoscopic cholecystectomy. Her laboratory studies (complete blood count, liver function test) and tumor markers including Carcino Embryonic Antigen (CEA) and Cancer Antigen 19-9 (CA 19-9) were within normal limit. Both upper and lower endoscopies were normal. Abdominal CT showed a 5cm well-defined hypodense mass in the porta hepatis (Figure 1a). No enlarged hilar lymph nodes were identified. This was confirmed on an MRI as a 5cm complex, septated cystic mass, hyperintense on T2 signal, adjacent to porta hepatis but separate from the pancreas and biliary tree (Figure 1b). There was no intra or extra-hepatic bile duct dilatation. A decision was made to pursue laparoscopic resection of the periportal mass based on the extent to which the symptoms affected the patient’s quality of life. Intraperitoneal access was gained through a Hasson cannula and abdomen was insufflated with CO2 pneumoperitoneum to a pressure of 12mmHg. Four 5-mm trocars were placed in the upper abdomen (Figure 2). After introduction of the laparoscope (KARL STORZ, Tuttlingen, Germany), the mass was easily identified posterior to the hepatic artery (Figure 3a and 3b).











Thursday 22 February 2018

Frequency of Congenital Heart Defects in Indian Children with Down Syndrome

http://austinpublishinggroup.com/genetics-genomic-research/fulltext/ajggr-v3-id1016.php



CongenitalHeart Diseases (CHD) are commonly associated with Down Syndrome (DS) infants. Our study aimed at determining the occurrence and pattern of CHD in association with DS among patients in Indian subjects. A total of 60 patients with clinical features suggestive of DS were recruited. Echocardiography, standard karyotype and QF-PCR (Quantitative – Flourescent PCR) studies were performed in all patients in order to confirm DS. CHDs were detected in the 50% of children with DS. The commonest type of CHD reported in Indian subjects was atrioventricular septal defect (50%). The second most type of CHD present was ventricular septal defect (26.6%). Other type of CHD included in our study was atrial septal defect, tetralogy of fallot and patent ductus arteriosus with the frequency of 10 %, 6.6 % and 6.6% respectively. Our findings showed that CHDs are common in Indian DS children. These results suggest that a routine echocardiography should be mandatory in DS patients.
Down Syndrome (DS) or trisomy 21 is a chromosomal disorder associated with a varied combination of morphological and structural birth defects. These defects include congenital mental disability, hypotonia, characteristic body features, congenital heart defects, Hirschsprung’s diseases and others. The frequency and severity of these morphological and functional defects vary significantly among affected individuals. DS affects about one in 700 live births.
Congenital heart defect disorder or CHD is a common defect among newborn infants which can be caused by environmental or genetic factors. About 50% of babies with DS are born with CHD, which is a much higher percentage compared to the number of children without DS who are born with CHD which is approximately 1%. The most common CHD seen in infants with DS is an Atrioventricular Septal Defect (AVSD), or AV canal. Other heart defects seen in infants with DS include Ventricular Septal Defects (VSD), Atrial Septal Defects (ASD), Tetralogy of Ffallot (TOF) and Patent Ductus Arteriosus (PDA). However, the exact etiology of CHD in DS remains poorly understood. Few decades ago the frequency of CHD in DS was estimated to be approximately 20%, but now with the use of better diagnostic tool, the frequency estimated has increased to 50%. The most common CHD in the western literature is atrioventricular septal defects.



Wednesday 21 February 2018

Risk Factors of Surgical Recurrence after Resection for Crohn's Disease

                  http://austinpublishinggroup.com/gastroenterology/currentissue.php



The surgery is required in more than 80% of patients with Crohn’s disease. Crohn’s disease is associated with high rates of postoperative recurrence. The aim of the study was to identify, the risk factors of postoperative ‘surgical recurrence’ after the first resection for Crohn’s disease.

We report a retrospective study from January 1998 to September 2010 that studied 226 patients originated only from Tunisia (in North Africa), operated on for MC. We had been interested to the risk factor of surgical recurrence of Crohn’s disease.

Mean age was 33 years. The average time between the onset of the disease and the surgical procedure was 31 months. The diagnosis of CD was established preoperatively in 213 patients (94%). The diagnosis was made intraoperatively because of an acute complication in 5 cases (2.2%) and postoperatively in 8 cases (3.5%). The most common location was the ileocecal junction in 184 cases (81.4%). The most common type of lesion was the mixed form (stricture and fistula) in 123 cases (54.4%). Operative mortality was 0.04% (n=1). Specific morbidity was 8.4% (n=19). In long term, a surgical recurrence was noted in 18 patients (8%). In multivariate analysis, independent risk factors for recurrence were: smoking (p=0.012, ORs=3.57) and post-operative medical treatment (p=0.05, ORs=2.6).

Our series is unique for a lower rate of the postoperative recurrence (8%). The two risk factors of recurrence are smoking and the necessity of postoperative medical prophylaxis.

Pleomorphic Sarcoma of the Head and Neck Region

                  http://austinpublishinggroup.com/head-neck-oncology/currentissue.php



Pleomorphic Sarcoma or Malignant Fibrous Histiocytoma is commonest soft tissue sarcoma but is rare in Head and neck. Commonest site in Head and neck being Nasal cavity and para nasal sinuses. It is more common in male. Tumor is diagnosed histologically consisting of both histiocytes and fibroblast cells. Pleomorphic Sarcoma is classified into primary and secondary types with mean age of presentation between 6th and 7th decade. The treatment of choice for this tumor is surgery with clear margins and adjuvant Radiotherapy. Prognosis remains poor even after surgery with local and distant metastasis seen commonly.

Soft Tissue Sarcoma encompasses (STS) a broad array of malignant tumors that are derived from cells of mesenchymal origin at any anatomical site. The originating tissue is diverse that includes bones, cartilage, muscular, fibrous, vascular, fatty and neural tissue.  Of all the soft tissue sarcomas only 5-20% occurs in the head and neck region. The most common STS of the head and neck region are Rhabdomyosarcoma followed by Malignant fibrous Histiocytoma, Fibrosarcoma and Neuro-fibrosarcoma. The incidence of MFH seems to be the highest among various types of adult malignant soft tissue sarcomas.  Pleomorphic Sarcoma or Malignant Fibrous Histiocytoma (MFH) is a rare primitive mesenchymal tumor showing both fibroblastic and histiocytic differentiation. We report a case of Pleomorphic Sarcoma/ MFH and the review of literature in relation to Pleomorphic Sarcoma.

A 40 year old male presented with the chief complaint of gradually progressive, painless, irregular swelling over the right side of the face for the past 6 months. On examination it was a 10 x 8 x 8 cm large firm mass of the right parotid region with no evidence of intra oral lesion. There were no palpable neck glands. On radiological evaluation, CT scan revealed a 98 x 113x 106 mm enhancing soft tissue lesion over the right parotid region. Lesion showed area of necrosis within. Lesion reaches up to the skin and involves the masseter muscle. Right submandibular gland is not seen separately from the lesion. Presence of few lymph nodes at level IA, II, III with the largest at IA measuring 20 x17 mm. No evidence of mandible erosion.

Tuesday 20 February 2018

HLA-G 14 bp Polymorphism and Risk of Pre-Eclampsia




Pre-eclampsia belongs to one of very serious complication during pregnancy. It is a multisystem disorder that is manifested by hypertension, proteinuria and abnormal blood clotting. Advanced clinical symptoms include seizures, renal failure, IUGR (Intrauterine Growth Restriction) and/or HELLP (Hemolysis, Elevated Liver Enzymes and Low Platelets) syndrome. Finally the generalized damage of the maternal endothelium, kidneys and liver can develop leading to increased mortality of mother as well as foetus. The clinical symptoms of pre-eclampsia can be observed in the second or the third trimester in pregnancy and are the most common in primiparas. Clinical features of PE are studied by Doppler flowmetry not only in foetal and foetoplacental circulation as well as in maternal organs, i.e. uterine  cerebral ophthalmic and renal vessels. Stiffness metabolic syndrome and risk of CVD are other clinical research topics.
Despite many research studies, the pathology of pre-eclampsia is not fully understood. One cause may originate in an insufficiently developed placenta, referred to as poor placentation. It is characterized by impaired remodeling of spiral arteries of the uterus (endothelial dysfunction) caused by an imbalance of circulating angiogenic factors. High circulating levels of soluble Fms like tyrosine kinase 1 (sFlt1) and soluble endoglin (sEng), a circulating receptor or TGFbeta, (both anti-angiogenic factors) and low levels of circulating Vascular Endothelial Growth Factor (VEGF) and Placental Growth Factor (PlGF) (both pro-angiogenic factors) have been described.
There are also immunological factors that can induce pregnancy disorders including pre-eclampsia. One of the immune molecules that play a beneficial role in the pregnancy is the Human Leukocyte Antigen G (HLA-G). HLA-G is a non-classical HLA class I protein that exerts various immunosuppressive functions. The molecule is mainly expressed on trophoblast cells in the foetal placenta and induces the immune tolerance of foetus. Immunosuppressive activity of HLA-G molecule is mediated through its interaction with inhibitory receptors of immune cells: ILT-2 present on B, APC and some T, NK cells, ILT-4 on APC and KIR2DL4 expressed by NK and some T cells. Thus HLA-G mediates inhibition of cytotoxic activity of uterine and peripheral blood NK cells and CD8+ T cells, inhibition of all proliferative response of CD4+ T cells; inhibition of Dendritic cells maturation and activates regulatory T cells.

Monday 19 February 2018

Gender Disparity in Hepatitis: A New Task in the Challenge Against Viral Infection




Gender/sex-specific medicine is still a neglected field of investigation, which is devoted to the analysis of the disparity between men and women in disease pathogenesis and prevention, in the detection of clinical signs or symptoms, in the prognosis and response to therapy as well as in psychological and social determinants of morbidity. For instance, it is well documented that incidence and outcome of several human diseases, such as cardiovascular diseases, tumors, degenerative diseases, or some respiratory and neurological disorders display a significant disparity between males and females [1-4]. In addition, it is now emerging that men and women also experience a different susceptibility to some virus infections, often with a different outcome. In addition, even the prevention or the response to antiviral treatments can display significant differences between male and female patients.

Hepatitis B (HBV) and C viruses (HCV) are responsible of chronic liver disease and are the major risk factors for development of hepatocellular carcinoma (HCC) [6]. It is estimated that 240 million people worldwide are chronically infected with HBV and at risk of serious illness, like cirrhosis and HCC. One hundred seventy million people are estimated to be chronically infected with HCV, whose infection prevalence is about 3% in the developed countries whereas, only in Europe, about 4 million people are HCV carriers [7,8]. Beside these epidemiological data, sex disparity in the natural history of HBV and HCV infections and in the evolution and progression of the associated liver disease in different geographic areas of the world [9] have been reported since many.

A number of studies are available regarding gender differences in HBV infection, whereas HCV infection appears studied in less detail. After the initial knowledge that men are more likely than women to become chronic carriers for HBV [11], it has been recognized that the serum prevalence of HBV surface antigen (HBsAg) and the DNA virus titers are higher in serum of men than women [12,13]. Both these viral factors probably contribute to the increased risk to develop HCC in male with respect to female. 

Friday 16 February 2018

Hodgkin Lymphoma Presenting with Dural Involvement





HodgkinLymphoma (HL) is a B-cell neoplasm that rarely presents with central nervous system (CNS) extranodal manifestation. This presentation can occur as relapsed disease as well as at initial diagnosis. In this report, we present a patient with dural involvement of HL. Systemic chemotherapy with ABVD (doxorubicin, bleomycin, vinblastine, and decarbazine) in addition to intrathecal therapy (IT) with intrathecal chemotherapy may be a treatment option for patients with isolated dural involvement with CNS HL. There is no current consensus for treatment modality of CNS HL, however, our patient with dural disease was successfully treated with ABVD systemic chemotherapy and IT MTX and ARA-C and is now >12 months in an ongoing remission. The role of CNS penetrating agents for isolated dural involvement is unclear given it is not protected by the blood brain barrier (BBB). As evidenced by this case with appropriate therapy patients can achieve complete remission (CR) in CNS HL.

Hodgkin Lymphoma (HL) is a B-cell neoplasm that typically presents with enlarged lymph nodes and “B” symptoms. Many patients at presentation will have advanced disease and some will develop extranodal lesions. Central nervous system (CNS) involvement is an extremely rare extranodal manifestation of HL occurring at a frequency of 0.02-0.7% in patients. Although rare, there have been several cases describing CNS HL. The current knowledge of CNS HL and treatment approach is mostly derived from these case reports. Treatment has often included radiation, systemic chemotherapy, surgical resection, and combined modality therapy; however, no consensus has been reached about the best treatment option. Despite aggressive treatments, overall prognosis in patients with CNS HL is poor. In our case, we describe a patient with HL presenting with dural involvement.
A 38 year old male presented with a 5 week history of new onset headache. 

The patient underwent a magnetic resonance imaging (MRI) brain scan which demonstrated dural thickening, and enhancement along the anterior falx and the right tentorium (Figure 1A and D). Imaging was concerning for an infectious, inflammatory, or neoplastic process. He had a lumbar puncture, which was negative for infection and malignancy by flow cytometry and cytology. A bone marrow biopsy demonstrated hypocellularity with normal karyotype with no evidence of malignancy. The patient then underwent a computed tomography (CT) neck/chest/abdomen/pelvis and positron emission tomography (PET) scan, which demonstrated a single enlarged FDG-avid supraclavicular node (Figure 1G). The node was excised, and pathology demonstrated a lymph node with effaced architecture and nodules surrounded by thick collagen bands. These nodules were comprised of small lymphocytes with interspersed large mono- or binucleated Reed-Sternberg cells with prominent eosinophilic nucleoli and abundant light eosinophilic cytoplasm. There was focal retraction artifact present around the large cells, as well as scattered “mummified” cells. The Reed-Sternberg cells were CD15+ and CD30+, weakly PAX-5+, CD3-, CD20-, and CD45- . Background lymphocytes were composed of CD3+ T-cells and CD20+ B-cells. The excised lymph node pathology was diagnostic for nodular sclerosis classical HL (Figure 2). The patient was referred to oncology.

Thursday 15 February 2018

Macroscopic Balance Equations for Spatial or Temporal Scales of Porous Media Hydrodynamic Modeling

                               http://austinpublishinggroup.com/hydrology/currentissue.php


Wefocus on the first author’s previous work addressing macroscopic balance equations developed for different spatial and temporal scales. We elaborate on previous findings so as to orient the reader to fundamental concepts with which the mathematical formulations are developed. The macroscopic balance Partial Differential Equations (PDE’s) are obtained from their microscopic counterparts by volume averaging over a Representative Elementary Volume (REV), considering a non-Brownian motion. The macroscopic quantity of phase/component intensive quantities product, is the premise of two concurrent decomposed macroscopic balance PDE’s of the corresponding extensive quantity. These are concurrently valid at the primary REV order of length and at a significantly smaller secondary length. The hydrodynamic characteristic at the smaller spatial scale was found to always be described by pure hyperbolic PDE’s, the solution of which presents displacement of sharp fronts. Reported field observations of condensed colloidal parcels motion, validate the suggestion of hyperbolic PDE’s describing fluid momentum and components mass balance at the smaller spatial scale. Controlled experiments supplemented by numerical predication can yield the hydrodynamic interrelation between the two adjacent spatial scales.

Further, we focus on the first author past developments concerning dominant macroscopic balance PDE’s of a phase mass and momentum and a component mass following an onset of abrupt pressure change. These account for the primary REV order of length and for evolving temporal scales. Numerical simulations were found to be consistent in excellent agreement with experimental observations. During the second time increment and in view of the aforementioned developments, we presently elaborate on new findings addressing theoretically the efficiency of expansion wave for extracting solute from a saturated matrix. Simulations comparing between pumping using an approximate analytical form based on Darcy’s equation and numerical prediction addressing the emitting of an expansion wave, suggest that the latter extracts by far more solute mass for a spectrum of different porous media.

Application of spatial averaging rules, referring to a REV, leads to the formulation of the macroscopic balance equations addressing phase interactions such as fluids carrying components and a deformable porous matrix. Further elaborations by Sorek et al. Sorek and Ronen and Sorek et al. prove that the phases and components macroscopic balance PDE’s can be decomposed into a primary part that refers to the REV length scale and, concurrently, a secondary part valid at a length scale smaller than that of the corresponding REV length. The secondary macroscopic balance equation always conforms to a hyperbolic PDE. Geometrical patterns of different spatial scales that prevail in various porous media are exemplified in Figure 1. Such patterns support the notion of the need to implement macroscopic balance equations addressing different spatial scales. Observations verify that the hydrodynamic characterization of colloidal transport comply with the developed fluid and component macroscopic balance equations for the smaller spatial scale.

Wednesday 14 February 2018

Local Understanding and Responses to Deliberate Transmission of HIV: Experiences from Persons Receiving Antiretroviral Treatment in Rural Northeastern Tanzania



As access to Antiretroviral Therapy (ART) in Tanzania has been steadily improving in recent years, there has been concern that availability of Antiretroviral Drugs (ARV) could fuel HIV transmission due to deliberate unprotected sexual practices of persons receiving antiretroviral treatment. There has been a debate about the need to enforce some institutional measures to help manage and control what has been described as the deliberate spread of HIV. However, there is no widespread consensus about what constitutes ‘deliberate transmission’.
Drawing on in-depth interviews with a sample of people receiving ART and health workers providing care in a rural setting, this article examines the context in which deliberate HIV transmission is defined and the ways through which it can be controlled. The article demonstrates that people on ART face the dilemma of reducing risk of spreading HIV and a desire to maintain socially acceptable sexual and reproductive lives. Although many participants reportedly remained sexually abstinent, they also revealed that some people on treatment from within and beyond the study area were engaging in sexual behaviours perceived to amount to deliberate spread of HIV.
Despite some reservations, formal sanctions to control deliberate HIV transmission were generally highly approved by participants. The article strongly recommends for a careful examination of needs of persons on treatment and strengthened prevention in order to manage unintended consequences of ART for individuals living with HIV/AIDS and uninfected population.


Tuesday 13 February 2018

Management of Endoscopy Patients’ Hydration Status during National Shortage of Intravenous Fluidss


                                  http://austinpublishinggroup.com/glpd/currentissue.php


Traditionally Patients are started on Intravenous (IV) fluids prior to the colonoscopy & Endoscopy at the Ambulatory Surgical Centres (ASC). However, with a recent dire national shortage of IV fluids, this routine practice was changed at many ASCs and patients received Keep Vein Open (KVO) IV cannula without IV fluids.
With this change of the practice, it was observed that our patients had frequent episodes of temporary/transient hypotension during the peri-procedure period at the endoscopy centre. IV bolus fluids had to be given to the patients and occasionally IV ephedrine as well to restore the blood pressure. No adverse sequences were noted. These patients recovered without any adverse consequences and were discharged home in good condition. However, this observation of frequent hypotension episodes became a concern to our quality control committee as to the patient’s optimal care during the perioperative period. This was investigated further to estimate the incidence and identifies the high risk patients for hypotension. At our ASC, the Endoscopy nursing staff reviewed charts for three months (09 /01/14 –11/30/14). A total of 514 charts were analyzed. 27 patients had relatively persistent low blood pressure peri- operatively and received IV fluids with or without ephedrine to restore the IV fluids. The incidence was 5.2%.
To identify the incidence of hypotension before the practice of KVO IV, a total of 478 Charts were reviewed from 1/1/13- 3/30/13 (when all the patients routinely received IV fluids) and four patients were found to have to receive ephedrine for episodes of hypotension. This incidence rate is 0.89%. Thus a six fold increase in the incidence of hypotension was noted when IV fluids are not routinely given.
The individual charts of patients who had hypotension requiring IV fluids ± Ephedrine were analyzed. We identified the following characteristics as risk factors for peri-operative hypotension. 1. Elderly patients (>70 years). 2. Base line systolic blood pressure < 100mm H. 3. Procedures began after 11.00AM (i.e. longer duration of NPO). 4. BMI of less than 20. These patients were at a higher risk of hypotension when routine IV fluids were not given. With the ongoing national shortage of IV fluids it was decided to start IV fluids prior to the procedures on the high risk patients we identified as above. We restudied the episodes of hypotension for three months, 1/1/15- 3/31/15. 537 patient’s records were reviewed. Five patients had low blood pressure requiring IV fluids ± ephedrine. The rate was 0.93% and this is in consistent with the normal range for our centre when all patients received IV fluids.

Monday 12 February 2018

Periportal Schwannoma: Two Case Reports and Review of Periportal Mass


                          http://austinpublishinggroup.com/gastrointestinal-cancer/currentissue.php



Schwannomas arebenign tumors that arise from Schwann cells of peripheral nerve myelin sheaths. Initially reported in 1988 by Daimaru et al. Gastrointestinal schwannomas have an excellent prognosis after surgical resection. Patients with periportal schwannomas can present with abdominal pain or concerning features such as weight loss, jaundice or anorexia raising suspicion for a malignant tumor. Schwannomas characteristically undergo cystic degeneration due to vascular thrombosis and subsequent necrosis. Computed Tomography (CT) scan shows a well-defined, hypodense, heterogeneous mass with peripheral enhancement making the differentiation from a malignant tumor even more difficult. Only 15 cases of periportal schwannomas have been described in the literature, and preoperative diagnoses could not be made in any of them. All of these patients underwent open surgical resection.

We present two cases of periportal schwannomas approached laparoscopically. The first patient underwent laparoscopic resection of a periportal schwannoma arising from the proper hepatic artery. To our knowledge, this is the first reported case of laparoscopic resection of periportal schwannoma. The second patient underwent a diagnostic laparoscopy, and the periportal mass was confirmed as a benign schwannoma by intraoperative frozen section. The tumor was encased around the extrahepatic biliary tree, so it was left in-situ to avoid unnecessary extensive biliary surgery. 55-year-old Caucasian female presented with six months of severe abdominal pain, early satiety, bloating, steatorrhea and a fifteen-pound weight loss. Past surgical history was significant for laparoscopic cholecystectomy. Her laboratory studies (complete blood count, liver function test) and tumor markers including Carcino Embryonic Antigen (CEA) and Cancer Antigen 19-9 (CA 19-9) were within normal limit. Both upper and lower endoscopies were normal. Abdominal CT showed a 5cm well-defined hypodense mass in the porta hepatis (Figure 1a). No enlarged hilar lymph nodes were identified. This was confirmed on an MRI as a 5cm complex, septated cystic mass, hyperintense on T2 signal, adjacent to porta hepatis but separate from the pancreas and biliary tree.

 There was no intra or extra-hepatic bile duct dilatation. A decision was made to pursue laparoscopic resection of the periportal mass based on the extent to which the symptoms affected the patient’s quality of life. Intraperitoneal access was gained through a Hasson cannula and abdomen was insufflated with CO2 pneumoperitoneum to a pressure of 12mmHg. Four 5-mm trocars were placed in the upper abdomen. After introduction of the laparoscope (KARL STORZ, Tuttlingen, Germany), the mass was easily identified posterior to the hepatic artery. It was dissected carefully from surrounding structures using an ultrasonic dissector (SonoSurg, Olympus, Tokyo, Japan). A network of peripheral nerves was seen to be entering the tumor. The mass appeared to arise from the proper hepatic artery. The cystic duct stump from prior cholecystectomy was identified by the presence of surgical clips . An intraoperative cholangiogram (IOC) through the cystic duct demonstrated normal filling of the bile duct and no communication with the periportal mass.

Friday 9 February 2018

Geriatric Women Sexuality Challenges Affecting Libido: A Case Study




Hispanicgeriatric woman sexuality and libido are affected by hormonal imbalances; for example, low estrogen level causes physiological concerns such as, vaginal atrophy and vaginal dryness, among other symptoms. Also, comorbidities, such as diabetes, vascular diseases, hypertension, and hyperlipidemia are common diseases in the Hispanic menopausal woman. Another important aspect affecting libido is the psychological issue the Hispanic geriatric women population suffers, including depression, anxiety, or partner’s pressure for intercourse. In addition to physiological and psychological issues, medications’ side effects can also decrease the woman’s libido. Healthy lifestyles as well as controversial treatments have been shown to improve geriatric women sexual dysfunction and decreased libido.

Commonly,in all races the number of ageing woman is increasing. This is directly associated with life expectancy due to innovative treatments and the modern lifestyle. Ageing women usually out number older men; however, their sexuality and libido at menopause is still a taboo in the 21st century society. According to Bauer et al., it is clear that sexuality is an important component of quality of life for many older people and can be just as fulfilling as it is for younger people. Geriatric women sexual dysfunction is a symptom that a majority of geriatric women 65 years old or older complains about it in the outpatient setting. According to Abernethy et al., the prevalence of sexual dysfunction in postmenopausal women is even higher, with rates between 68% and 86.5%. Some women express their menopausal symptoms as vaginal dryness, low or not sexual desire, depression, anger, and/or anxiety due to partner pressure for intercourse.

This case study is based in a geriatric Hispanic woman suffering menopausal symptoms. It would cover physical factors such as, vaginal dryness and psychological factors corresponding to depression affecting women geriatric population. According to Watters et al., being able to remain sexually active often indicates greater self-worth, prevents social disengagement and avoids depression. Vaginal dryness and depression cause geriatric women sexual dysfunction. In addition to the mentioned causes, there are many other factors that can affect the changes in sexual desires in this population. For instance, socio-cultural factors, stress, traumas, and medications adverse effects are some reasons of women decrease libido. Attitudes toward sex are a cause of social and sexual experiences.

Thursday 8 February 2018

Postradiogenic Atypical Vascular Lesion of the Vulva in a Young Woman after Treatment for Cervical Cancer - Case Report and Review of the Literature

                           http://austinpublishinggroup.com/gynecology-case-reports/


A 43-year-old caucasian women suffers from an extensive and painful vulvar lesions. Prior to this presentation the patient was treated for cervical cancer with surgical treatment and radio chemotherapy seven years ago. A malignant and infectious cause of these lesions was excluded and Atypical Vascular Lesion (AVL) of the vulva was diagnosed by histopathology. AVL is defined as benign vascular proliferation with widened atypical vessels interepidermal and in the deeper dermis. These lesions cause multiple small papules and are mainly located in the radiation field after cancer treatment.
AVL embraces a histological spectrum that ranges from banal appearing lesions closely resembling a lymphangioma circumscriptum to capillary vascular proliferations with nuclear atypia resembling an angiosarcoma. The patient was treated with a radical skinning vulvectomy for a complete resection of the altered tissue. The patient did not relapse under a close follow up and her quality of life improved, significantly.
AVL is a rare disease that can be acquired especially after radiation for cervical cancer therapy induced lymphedema. It presents with multiple cutaneous papules that may cause pain along with other discomforting symptoms. The differential diagnoses are infectious diseases such as genital herpes but also malignant tumours such as angiosarcoma or cutaneous metastasis of a prior cancer.

A 43-year-old caucasian patient presented with a lesion of the vulva, declining over the last four years. She suffered from itching, burning and swelling of the vulva. The clinical examination revealed multiple small, wetted papules covering the complete vulva. The lesions were most prominent confined to the labium majus but had also emerged on the labia minora. 

Wednesday 7 February 2018

Frequency of Congenital Heart Defects in Indian Children with Down Syndrome



CongenitalHeart Diseases (CHD) are commonly associated with Down Syndrome (DS) infants. Our study aimed at determining the occurrence and pattern of CHD in association with DS among patients in Indian subjects. A total of 60 patients with clinical features suggestive of DS were recruited. Echocardiography, standard karyotype and QF-PCR (Quantitative – Flourescent PCR) studies were performed in all patients in order to confirm DS. CHDs were detected in the 50% of children with DS. The commonest type of CHD reported in Indian subjects was atrioventricular septal defect (50%). The second most type of CHD present was ventricular septal defect (26.6%). Other type of CHD included in our study was atrial septal defect, tetralogy of fallot and patent ductus arteriosus with the frequency of 10 %, 6.6 % and 6.6% respectively. Our findings showed that CHDs are common in Indian DS children. These results suggest that a routine echocardiography should be mandatory in DS patients.
Down Syndrome (DS) or trisomy 21 is a chromosomal disorder associated with a varied combination of morphological and structural birth defects. These defects include congenital mental disability, hypotonia, characteristic body features, congenital heart defects, Hirschsprung’s diseases and others. The frequency and severity of these morphological and functional defects vary significantly among affected individuals. DS affects about one in 700 live births.
Congenital heart defect disorder or CHD is a common defect among newborn infants which can be caused by environmental or genetic factors. About 50% of babies with DS are born with CHD, which is a much higher percentage compared to the number of children without DS who are born with CHD which is approximately 1%. The most common CHD seen in infants with DS is an Atrioventricular Septal Defect (AVSD), or AV canal. Other heart defects seen in infants with DS include Ventricular Septal Defects (VSD), Atrial Septal Defects (ASD), Tetralogy of Ffallot (TOF) and Patent Ductus Arteriosus (PDA). However, the exact etiology of CHD in DS remains poorly understood.


Monday 5 February 2018

Risk Factors of Surgical Recurrence after Resection for Crohn’s Disease



Thesurgery is required in more than 80% of patients with Crohn’s disease (CD). The aim of surgery is to treat complicated lesions. The most important principle of the surgery is to perform an intestinal resection as limited as possible. Crohn’s disease is associated with high rates of postoperative recurrence. At 10 years after surgery, 75% of patients suffer recurrence and 45% of these require re-intervention. The aim of the study was to identify, the risk factors of postoperative ‘surgical recurrence’ after the first resection for Crohn’s disease.

This is a retrospective study, with prospective collection of data, conducted from January 1998 to September 2010, which included all patients undergoing surgery for primary CD. All patients born and living in Tunisia in North Africa. The diagnosis of CD was confirmed in all cases by histological examination of endoscopic biopsies or specimen after bowel resection. We excluded from this study, patients initially operated in another center and patients operated on for isolated anoperineal lesions of CD. The management was multidisciplinary and standardized for all patients.

All of the potential risk factors studied were divided in four groups. Factors related to the patient (cigarette smoking), to the disease (duration of disease, anatomical site of disease, type of disease: stricturing, penetrating, mixte or inflammatory disease), to the type of surgery (extend of bowel resection, the type of anastomosis and the involvement of section margins) and to the pharmacological treatment after surgery.


A protocol was established to ensure regular monitoring during the postoperative period. Patients were followed both by the surgical team than gastroenterology. All results of clinical, biological and endoscopic have been noted and transcribed on patient records.

Assessment of Consumption Habits and Attitude Regarding Sports Drinks, Sugar Sweetened Beverages and Aerated Soft Drinks in Children Involved in Organized Sports in New Delhi



Good oralhealth is crucial for successful performance in sports and for the overall well being of the child. Children who participate in strenuous sports require the highest levels of nutrition to meet the energy demands of their activities. Dental erosion is defined as the irreversible loss of dental hard tissues caused by a chemical process not involving bacteria. Over the last two decades, tooth erosion has become a significant clinical problem. Dental erosion in children involved in Sports is a growing concern due to the frequent ingestion of sports drinks. Sports drinks are acidic drinks, like fruit juices and carbonated drinks, most of which have pH below 5.5, the critical pH for enamel demineralization to occur. Additionally, they also have free sugars thus having potential to cause dental caries also. They are used primarily by athletes to provide carbohydrates, electrolytes and for fluid replacement. Sports drinks are becoming increasingly popular in children and adolescents to quench their thirst and provide extra energy to improve their performance in sports. Increased consumption of sports drinks, aerated soft drinks and other Sugar Sweetened Beverages (SSBs) puts children at increased risk of dental erosion. The frequent intake of sports drinks and carbonated mineral water has been implicated in tooth erosion. Unusual drinking habits such as swishing or holding acidic drinks in the mouth for prolonged periods have also been linked to dental erosion. Apart from oral health risks, consumption of these acidic beverages has been linked to obesity, diabetes, cardiac problems and gout as well.
Uninhibited advertising, promotion and unawareness of these Acidic drinks pose a big public health hazard. The marketing of these drinks has become a lucrative money minting industry. Easy availability of food vending machines and fast food restaurants further catalyze the uninterrupted intake of these harmful beverages. Children and adolescents engaged in organized sports are especially vulnerable to external influences due to lack of adequate knowledge.

There is limited literature on knowledge and consumption habits of acidic drinks in children involved in organized sports, especially in India. Few studies have examined the effect of consumption pattern (frequency, method and timing of consumption) of these drinks on dental erosion. In light of the lacunae in literature, the objectives of the present study were to (i) to assess the knowledge regarding sports drinks in children involved in organized sports; (ii) to evaluate the consumption habits of various acidic beverages and (iii) to investigate the relationship between consumption patterns of acidic drinks and dental erosion.
















Thursday 1 February 2018

Monogenic, Polygenic and Multifactorial Obesity in Children: Genetic and Environmental Factors



Obesityis a chronic disease that has increased alarmingly in recent years. It is considered a risk factor for the development of diseases such as type 2 diabetes, cardiovascular diseases, dyslipidemia, and some types of cancer. Two genetic profiles have been described: monogenic obesity, in which a single gene is mutated, usually leading to loss-of-function or haploinsufficiency, and polygenic obesity, which involves several polymorphic genes with complex interactions between genes and environmental factors. In the latter case, the frequency of polymorphisms can be very high, depending on the population analyzed. In both cases, the genes of interest are associated with changes in body composition through different mechanisms, including hyperphagia, energy expenditure, adipocyte differentiation and lipolysis. However, most studies have analyzed genes associated with obesity in other populations, and the results are often inconsistent, so it is important to study the context of obesity, such as genetics, biochemical biomarkers and environmental factors. Environmental factors include physical activity, nutritional status, and an intake of foods rich in fats and carbohydrates that favor obesity in children. In addition, several chemical compounds have been described as potential endocrine disruptors that increase BMI and produce obesity, and some biological agents can alter the homeostasis of adipose tissue. In this review, we analyzed the genetic and environmental factors that influence obesity, particularly in children.

OECD: Organization for Economic Cooperation and Development; BMI: Body Measured Index; LEP: Leptin; LEPR: Leptin Receptor; POMC: Proopiomelanocortin; PCSK1: Prohormone convertase 1/3; MC4R: Melanocortin 4 Receptor; SIM1: Single Minded Homologue 1; GWAS: Genome Wide Association Studies; PPARG: Peroxixome Proliferator-Activated Receptor γ; ADIPOQ: Adiponectin; FTO: Fat-Mass and Obesity Associated Gene; SNP: Single Nucleotide Polymorphism; CED: Chemical Endocrine Disrupters; DDE: Diphenyl-dichloro-Ethylene (DDE); BPA: Bisphenol A.

Obesity is a chronic disease of diverse etiology. In the genetic context, monogenic obesity is associated with loss-of-function mutations in a single gene. These mutations are very rare and are in some cases unique to a patient or several members of a family; in some populations with high rates of consanguinity, the mutations are more frequent. In polygenic obesity, there is an interaction between several polymorphic genes; in this case, the frequency is greater than 1% and varies by the population analyzed. In this type of obesity, the risk that is attributed to each allele is generally small, but the additive effect of several risk alleles can considerably increase susceptibility to obesity. Multifactorial obesity refers the involvement of other environmental factors, or the obesogenic environment.

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

                                                 https://www.austinpublishinggroup.com/urology/ Patientswith Lower Urinary Tr...