Nontuberculous Mycobacteria in Critical Care

                                                      http://austinpublishinggroup.com/tuberculosis/

Recentstudies inpatients, who are hospitalized in Intensive Care Unit (ICU), show that 51% of them have infections, and 71% are given treatment. Bacterial and some fungal infections, as opportunistic microorganism are the primary concern. Hospitalizing in ICU is associated with increasing in mortality rate and excess expenses. Pharmacokinetics, absorption, distribution, metabolism, and excretion of drugs experience many changes in critical illness.

NTM, are a group of mycobacteria which is not a causative organism of tuberculosis or leprosy, so they called as Mycobacteria Other Than Tuberculosis (MOTT). NTM bacteria are a family of small, rod-shaped bacilli which have more than 150 species. Atypical mycobacteria have different favor in choosing their environment and are identified as environmental mycobacteria. NTM are the causative organisms in pulmonary diseases like tuberculosis, lymphadenitis, skin disease, or disseminated disease. Major clinical manifestations of NTM Infections are presented in Table 1. In 1950s, they were accepted as human pathogens. Unlike tuberculosis and leprosy, spreading NTM infections from one person to another person is rare. Environmental exposure is the major way of contagion. The risk of getting infected by a particular species of NTM is dependent on pathogenicity of microorganism, the method of exposure and frequency of exposure. In the last decade, (NTM) infections have worldwide increasing in incidence and mortality. The reasons for this increase are not obvious. But increasing incidence of acquired immune compromised syndrome, cancer, diabetes mellitus, chronic lung injuries, and continues supportive ventilation could be causative.

A retrospective study in medical center of Taiwan from January 1999 to June 2007 was planned to evaluate medical ICU patients whose respiratory specimens were positive for NTM. They defined tree group of patients, one group with NTM pulmonary infection, the other with NTM colonization and a control group who have culture negative samples for mycobacteria. Clinical sign, symptoms and outcomes were compared. Their finally result was that, increment in mortality rate in patients who have NTM pulmonary. Suitable treatment against NTM would followed by better result.

Urban-Rural Disparities in Female Cancer Incidence and Mortality in Trivandrum, South India

                                      http://austinpublishinggroup.com/translational-medicine/

Significant differences in cancer incidence between urban and rural women have been reported and for the same type of cancer, rural women are generally diagnosed at a later stage and have decreased survival rates as opposed to their urban counterparts. This has been shown for cancers such as breast, colo-rectum in both developed and developing countries. Rural women may suffer significant inequalities in terms of access to medical care and health awareness and these women tend to be less educated with lower economic means. Poorer hygienic conditions tend to aggravate physical threats in rural areas. Conversely, mechanized life-style, stress and air pollution are more widespread in urban environment.

Currently, lifestylehomogenization, particularly in developed countries, and the increased opportunities to healthcare access in rural population, has led to a minimal difference in cancer pattern. However, within Asia, large differences in cancer pattern are found between urban and rural population. Incidence rates of cancers such as cervix uteri, esophagus, stomach etc. are generally low in urban than rural population. In contrast to this, cancers such as breast, corpus uteri, ovary, colo-rectum etc. incidence rates are higher in urban than rural.

Cancer incidence particularly breast cancer among women in Kerala, South India, is a growing threat to public health. In urban Trivandrum other cancers such as corpus uteri, colo-rectum and kidney are also reported as the highest in the country (NCRP 2016). In Kerala, urban-rural difference according to education among women is minimal (literacy rate: 84.6% urban vs. 81.6% rural) (Census of India 2011) and the distances by road between the main oncology centers in Trivandrum and the rest of the regions are small. It is therefore possible to hypothesize that urban-rural differences in health care access is minimal. However, the magnitude and pattern of cancer incidence and mortality may differ by type of residence due to the difference in socio-demographic and life-style factors.

Atrial Fibrillation in a Patient with Subacute Thyroiditis

                                           http://austinpublishinggroup.com/thyroid-research/

Thyrotoxicosiscaused by subacute thyroiditis is self-limited and results from the subacute release of preformed thyroid hormone. Our data showed that the hyperthyroid state may last for 1 or 2 months as the stored thyroid hormone is depleted. It may be followed by a hypothyroid phase in approximately 60% of the cases, but 91% of them return to the euthyroid state and the remaining 9% remained hypothyroid, as presented in Figure.

Atrial fibrillation occurs in up to 15% of patients with hyperthyroidism compared to 4% of people in the general population and more common in men. But the case report of subacute thyroiditis with atrial fibrillation is rare. We report the case of a 54-year-old man with subacute thyroiditis who had unexpected atrial fibrillation.

A 54-year-old man presented to our observation in November 2017 with 10 days of neck pain, high fever, chills, fatigue, sweating, dysphagia, odynophagia, palpitation, and an 8kg weight loss. A recent history of upper respiratory tract infection was not evident. Bilateral thyroid pain and tenderness were noted. Past medical history was not significant. Family history was pertinent for his niece with hyperthyroidism. On physical examination, the patient had a temperature of 39.9^oC, blood pressure of 110/70 mmHg, and weight of 55kg. There was no proptosis, lid lag, conjunctiva; redness, periorbital edema, or erythema. His thyroid gland was enlarged to 48g (normal range 15-35g) estimated by ultrasonography without palpable nodules or lymphadenopathy. Both sides of the anterior thyroid gland were tender to palpation.

Review of Lavender Aromatherapy: Past, Present, and Future

                                       http://austinpublishinggroup.com/therapeutics/index.php

Complementary and Alternative Medicine (CAM) is a practice that incorporates unconventional medical therapies such as aromatherapy, acupuncture, and massage in order to alleviate medical problems. CAM practice is a huge undertaking in the United States, in a 1993 report in the NEJM 1 out of 3 Americans used CAM therapies. It was estimated at that time that $13.7 billion dollars per year were spent on CAM therapies and that three quarters were paid out of pocket. In 2007 it was determined that 4 out of 10 adults in the U.S. used CAM therapies, which is a significant increase since the prior study [2], and the National Center for Complementary and Integrative Health reported that $33.9 billion were spent on CAM therapies. It was further determined that when there was concern about the cost of conventional care, individuals were more likely to use CAM therapy. 

Aromatherapy is commonly defined as therapy through the use of aromatic plant extracts and essential oils through various methods (inhalation, oral, massage, baths). The physiologic effects of aromatherapy have been recognized in folk medicine for many years. In particular, lavender oil has been attributed to have mood enhancing and analgesic properties by aromatherapists. As alternative medicine continues to grow, aromatherapy is at the forefront of this growth [6]. Interest in lavender oil in particular has increased, not just in retail but also in the medical community. Lavender oil in vapor form is purported to have multiple beneficial effects in humans including: relief of anxiety, analgesia, sleep improvement, pain relief, and decreased restlessness. Many recent clinical trials have supported these claims and suggest that lavender aromatherapy can be a useful adjunct to standard care.

An Unusual Presentation of Nocardiosis - A Report of Two Cases

                                        http://austinpublishinggroup.com/tropical-medicine/index.php

Nocardiosisis an opportunistic infection more common in immune compromised hosts. Disseminated nocardiosis has a poor outcome. We report a case of disseminated nocardiosis with nocardaemia (case-1) which is an extremely rare finding even in immune compromised subjects. In case-2 we found pulmonary abscess caused by nocardia in a patient of sarcoidosis on steroids. Vascular thrombosis complicating nocardiosis is not recognized. We report two cases of nocardiosis with arterial thrombosis.

Nocardiaspecies are saprophytic aerobic actinomycetes and are common worldwide in soil causing decay of organic matter. It is an opportunistic pathogen causing significant morbidity and mortality in human beings. It predominantly affects lung with pre-existing structural defects and also with co-existing mycobacterial infection. Disseminated nocardiosis occurs through haematogenous spread to distant organs including brain (commonest), bone, soft-tissues and kidney; whereas peritoneum and heart valves only rarely affected. Isolating nocardia in blood culture (nocardaemia) is extremely rare. Endovascular foreign body e.g. prosthetic heart valve is a unique risk factor for nocardaemia but our patient (case I) did not posses any such foreign body. Nocardia bacteraemia is also associated with simultaneous infection with other bacterial pathogens, especially Gram negative organisms in 30%. First patient had concomitant Klebsiella infection [Extended-Spectrum Beta-Lactamase (ESBL) producer in lung. Surprisingly in both the cases vascular thrombosis complicated the picture-thrombosis in pulmonary trunk was in case- 1 and lacunar infarcts of brain found in case-2. Nocardiosis and vascular thrombosis may be causally related.

A 52 yr old gentleman presented to our clinic with fever and dry cough for 15 days. He also complained of chest tightness and exertional breathlessness for the same duration. His fever was low grade, intermittent in nature and subsided only on taking antipyretics. It was associated with cough without expectoration, hemoptysis or chest pain.

Registration of Road Traffic Injuries at Emergency Departments in the Netherlands

                      http://austinpublishinggroup.com/trauma-treatment/onlinefirst.php

In the Netherlands, direct medical costs of road traffic accidents resulting in an ED-visit or hospital admission are high, comprising €400 million. This is 21% of the total direct medical costs in the Netherlands (€1,9 milliard). Understanding causes and risk groups provides important information for improving road safety and reducing high costs of health care. For several authorities, but especially at regional and local level, acquiring road traffic accident data is an important issue. It is known that the Registered Crashes database - containing the Dutch police data - does not provide sufficient data. The Dutch Injury Surveillance System (DISS) of the Consumer Safety Institute registers the number of injury-related ED-visits in the Netherlands due to different causes, such as occupational –and road traffic injuries. The goal of this study was to establish risk groups and risk factors for road traffic accidents.

The Dutch Injury Surveillance System (DISS) registers data of individuals who visit Emergency Departments (EDs) of a selection of 13 hospitals in the Netherlands, injured due to an accident, an act of violence or self-harm. These hospitals form a representative sample of the general and university hospitals in the Netherlands providing a 24 hour accident and emergency service. This enables extrapolation of the recorded injury cases and of subsets of cases to national estimates. The quotient-estimate method is used, for extrapolation, given the auxiliary variable ‘number of ED-visits in the Netherlands.

In DISS a variety of variables is registered, for example demographic characteristics, referral to the ED and circumstances of the accident. In terms of road traffic injuries, the most important variables are ‘mechanism of transport accident’, ‘mode of transport victim’, ‘transport function victim’, ‘injury mechanism’ and ‘type of injury’. In addition to these variables DISS registers a description of accident circumstances and location, if present. In the participating hospitals ED staff registers the data for every injury patient in the Electronic Medical Record (EMR). To minimize the workload of the ED staff, existing data (e.g. gender, age, admission date and referral to the ED) of the EMR are used as much as possible. More specific variables like ‘means of transport’ require an additional registration of the ED staff in the EMR. The ‘injury mechanism’ (e.g. collision with an obstacle) and ‘type of injury’ (e.g. bone fracture) are filtered out from an open-text field by an automatic text processor. In order to obtain the best possible quality and completeness of data, the ED staff is instructed by the Consumer Safety Institute about encryption and how to fill in the open-text fields. In order to ensure the patients privacy an opt-out procedure is part of the data collection procedure.

6 Year Old Boy with a Right Posterior Thoracic Mass

                                         http://austinpublishinggroup.com/surgical-oncology/

Bronchogenic cysts result from the abnormal or late budding of the ventral lung bud or the tracheobronchial tree during the process of the development. Primary Bronchogenic cysts of cardiac origin or extension are rare. Bronchogenic cysts can be detected in fetus or in stillbirths and it is well recognized in babies or infants. Bronchogenic cysts are rare lesions which originate from primitive tracheobronchial tree. They are primarily located in the thorax. Extrathoracic locations may be either in the immediate vicinity of the thoracic cage or more remote periscapular location which is extremely rare. The clinical presentations are usually releated to trancheal and tracheobronchial compressions. Typical localization of bronchial cysts has been reported for esophageal, pericardial, dermal cervical, diaphragmatic or intradural spaces, but such localizations are very rare.

A 6-years old male with presented with chest typical chest pain, discomfort, paroxysmalpalpitations continuing, for one month, cough, fever was admitted in our department with bronchogenin cyst extending to the right atrial wall. Physical examination, chest radiography, and blood analysis were found to be normal. The computed tomography (CT) confirmed giant cystic mass with a diameter of 6,5 x 5,5 x 5,5cm. Following standard a right posterolateral thoracotomy, we performed tumor enucleation and managed to resect the cyst from the atrial wall with the use of a side-biting clamp on the right atrial wall, which was repaired with continuous 4-0 polypropylene sutures (Ethicon, Somerville, NJ, USA). The patient was taken to the intensive care unit and weaned off mechanical ventilation in 6 hours. He was taken to the ward next day and discharged from the hospital on the postoperative 5th day. Microbiologic examination ended sterile and Bronchogenic cyst diagnosis was confirmed with detailed histopathologic examination. Grossly, the excised tumor measured 6,5 x 5,5 x 5,5cm and had multi-cystic features with turbid contents. Microscopically the tumor consisted of thin-walled multiple cysts attached to the respected myocardium. The inner cavities were lined with pseudo-stratified ciliated columnar epithelium and cartilages, which are characteristic features similar to those of normal bronchi and confirm a pathologic diagnosis of Bronchogenic cyst.

Relationship between Total Percurred Distances in High Intensity with Physical Weariness on Soccer Athletes

                                        http://austinpublishinggroup.com/sports-medicine/

There are several http://austinpublishinggroup.com/sports-medicine/eccentric muscle actions during the match, such as jumping and sudden stops. According  the eccentric actions cause increased muscle damage and an increased number of micro lesions, complicating the recovery. It should also be considered different workloads due the positions and roles in the field (goalkeepers, center backs, full backs, holding midfielders, midfielders and strikers), respecting the training specificity principle.

It important being able to assess and identify the variables: Intensity, volume, effectiveness and frequency of competitive actions, individually (biological individuality), contribute on making technical, tactical and strategic decisions for soccer players in training and in competitive actions. Specifically in the competitive actions, knowing the covered distance in each position and their different intensities, contribute on building adequate and specific training models, consequently improving performance during game play.

For this purpose, various methods are investigated over time in order to minimize training mistakes, such as the use of lactate analysis, electromyography and Mechanomyography (MMG), with the intend of evaluate variations that occur in muscle before and during fatigue installation. Recently the plasma concentrations of Creatine Kinase (CK) has been described and used as a marker for muscular fatigue due the low cost and peak release that occurs between 24 and 48 hours after physical exercise session.

Inflammatory Stenosis of Ascending Colon: Differential Diagnosis between Granulomatous Disorders

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

We present a case of 36 years old woman investigated in the emergency department because of intermittent abdominal pain in Right Iliac Fossa (RIF) associated with distension of the abdomen and nausea. The clinical report reveals a history of diarrhea, weight loss in the last six months and appendectomy performed 3 months before. Histological exam of appendix resulted suspicious for Crohn’s disease (Figure 1-2). In addition the patient reported close contact with TB affected patient (her mother) in the last year. The blood tests reveal poorly inflammatory index (CRP 2.11mg/dl) and a mild impairment of liver tests (AST 53 UI/L, ALT 60UI/L, ALP 279 U/L, ϒ-GT 129 UI/L). Furthermore serology reveals a positive QuantiFERON-Tb Gold test that confirmed the positivity of Mantoux reaction. Coproculture and urinoculture were negative for BK.

Colonoscopy characterized stenosis of right colon with severe inflammatory response suggestive for Crohn’s Disease (Figure 3-4). A total-body CT scan performed has shown thickness and oedema of the last tract of ascending colon that involved part of ileum. In addiction paracolic and lateral neckcaseous lymphadenitis is described (Figure 5-6). We perform Fine Needle Aspiration Cytology (FNAC) on lateral neck nodes (Figure 7) but Ziehl-Neelsen staining methods and RT-PCR resulted negative.

definitive histopathological examination revealed the presence of granulomatous inflammation with typical granulomas with localized caseous necrosis properties of TB (Figure 8-9). The Lowenstein-Jensen culture was positive for KB after 8^th week. The patient underwent anti-TB therapy with resolution of symptoms. The endoscopic control after 4 months describes normal results of right hemicolectomy without any sign of inflammation.

Study of Biological Parameters of Schizophrinics During 6 Months of Different Anti Psychotics Treatment

                                               http://austinpublishinggroup.com/stem-cells/

Objective: The aim is to study the impact of antipsychotics on schizophrenic’s metabolic parameters in 6 months.

Methods: Blood glucose, lipid profile, liver enzymes weight & waist circumference were assessed for 160 schizophrenia patients; at the beginning and after 6 months of continuous use of antipsychotics. Patients with who used antipsychotics in the past 3 months or have family history of diabetes or obesity were excluded.

Results: Except for white blood count and High-Density Lipoproteins (HDL); all the studied parameters showed significant elevation after 6 months of antipsychotic treatment. The relation between the type of antipsychotic and the studied parameters showed that the lipid profile was the only parameter of significance in relation to drug type. Because not only the lipid profile but also other parameters increased after six months we used analysis of covariance [ANCOVA] which showed that the value of any studied parameters at the beginning of the study was significantly determine the values at the end of the study, in addition, the type of drug used in treatment is significantly influences the triglyceride level and interaction of sex, drug used, and the history of drug treatment could significantly determine the serum cholesterol and LDL levels.

Conclusion: The study demonstrated elevated metabolic parameters in patients with schizophrenia treated with antipsychotics. The burden of each antipsychotic was explored. More research is needed to confirm our findings which are limited by the short duration of the study, the fewer number of studied antipsychotics and sample size

Keywords: Antipsychotics; Schizophrenia; Metabolic

Study of Biological Parameters of Schizophrinics During 6 Months of Different Anti Psychotics Treatment

                              http://austinpublishinggroup.com/schizophrenia/index.php

Objective: The aim is to study the impact of antipsychotics on schizophrenic’s metabolic parameters in 6 months.

Methods: Blood glucose, lipid profile, liver enzymes weight & waist circumference were assessed for 160 schizophrenia patients; at the beginning and after 6 months of continuous use of antipsychotics. Patients with who used antipsychotics in the past 3 months or have family history of diabetes or obesity were excluded.

Results: Except for white blood count and High-Density Lipoproteins (HDL); all the studied parameters showed significant elevation after 6 months of antipsychotic treatment. The relation between the type of antipsychotic and the studied parameters showed that the lipid profile was the only parameter of significance in relation to drug type. Because not only the lipid profile but also other parameters increased after six months we used analysis of covariance [ANCOVA] which showed that the value of any studied parameters at the beginning of the study was significantly determine the values at the end of the study, in addition, the type of drug used in treatment is significantly influences the triglyceride level and interaction of sex, drug used, and the history of drug treatment could significantly determine the serum cholesterol and LDL levels.

Conclusion: The study demonstrated elevated metabolic parameters in patients with schizophrenia treated with antipsychotics. The burden of each antipsychotic was explored. More research is needed to confirm our findings which are limited by the short duration of the study, the fewer number of studied antipsychotics and sample size

Keywords: Antipsychotics; Schizophrenia; Metabolic

Verschraegen C*, Rehman H, Kalof A, Lemos D, Anker CJ, Leavitt B and Lisle J

                                              http://austinpublishinggroup.com/sarcoma/

Soft Tissue Sarcomas (STS) represent a very heterogeneous family of tumors derived from mesenchymal cells. Despite a variety of cells of origin, most STS are treated with the same chemotherapy regimens, although there are some exceptions. For example alveolar, soft part sarcoma is now treated with tyrosine kinase inhibitor in first line. Treatment of sarcomas is multidisciplinary, but the approach to the management of high risk primary STS remains controversial. While the combination of surgery and radiotherapy prevents local recurrence, the role of adjuvant or neoadjuvant chemotherapy to reduce the risk of metastatic disease or to reduce tumor size to facilitate an R0 resection is not established. Over 50% of patients with very high risk STS will eventually develop metastatic disease. Additional curative options must be identified in appropriate patients. The definition of high risk STS is also somewhat controversial. For the purpose of this clinical trial, we considered any high grade STS greater than 5cm in the greatest dimension, for which chemotherapy could be indicated in the first line setting. Although doxorubicinbased regimens are favored in first line for metastatic disease, the new combination of docetaxel and gemcitabine might have greater activity in some STS subtypes with less long term toxicity especially when administered on an every two-week schedule.

VascularEndothelial Growth Factor (VEGF) is a potent tumorproduced angiogenic factor whose overexpression is usually associated with an adverse outcome in most STS. Median pretreatment serum VEGF levels are significantly raised in patients with grade 2 and grade 3 sarcomas compared with concentrations in patients with benign lesions. Serum VEGF expression correlates with grade in soft tissue sarcoma and reflects response to treatment. The tyrosine kinase inhibitor, pazopanib, is now approved for recurrent or metastatic STS, with good clinical benefit. Health-related quality of life does not improve with pazopanib, but the improvement in progressionfree survival without impairment of quality of life was considered meaningful. When administered as a single agent, side effects are manageable and include hypertension, diarrhea, nausea, liver inflammation, mild myelosuppression, and hair de-pigmentation. In combination with chemotherapy, however, there is a synergistic effect on the toxicity profile and combination with multi-agent chemotherapy is not tolerable (Table 1). This study proposes to combine the least toxic chemotherapy regimen with intermittent pazopanib administration to avoid pharmacokinetics synergy, to be tested in the neoadjuvant setting for patients with high risk STS.

Perioperative Pulmonary Embolism Prevention and Treatment

                                                       http://austinpublishinggroup.com/spine/

Massiveperioperative Pulmonary Embolism (PE) is an uncommon event but significant cause of morbidity and mortality. It is estimated that PE is responsible for between 150,000 and 200,000 deaths per year in the United States. 30% of the deaths from PE take place during the perioperative period. PE is the third most common cardiovascular disease after myocardial infarction and cerebrovascular accident (stroke). Several studies have reported mortality rates ranging from 15% to 30%, while mortality rates in a massive PE can reach 30% to 50%. A recent review of more than 3000 massive intraoperative thromboembolic events revealed an overall mortality of 41%.

Surgery increases the risks for perioperative PE. Healthcare providers, including anesthesiologists, are responsible for the diagnosis and treatment of perioperative PE. During surgery, PE often first presents with hemodynamic instability and if progressing quickly, can lead to death. It is important that healthcare providers recognize perioperative PE and know prevention and treatment options. Prompt diagnosis and treatment can save patient lives. In this review, we will focus on perioperative acute PE treatment and prevention.

Diagnosis of a PE in the perioperative period can be a challenge, but early detection can reduce morbidity. The American Heart Association (AHA) classified and defined PE into three classes: massive PE, submassive PE, and low-risk PE. Acute PE with sustained hypotension (systolic blood pressure <90 mm Hg for at least 15 minutes or requiring isotropic support, not due to a cause other than PE, such as arrhythmia, hypovolemia, sepsis, or Left Ventricular (LV) dysfunction), pulselessness, or persistent profound bradycardia (heart rate<40 bpm with signs or symptoms of shock).

Spirituality in Medicine/Surgery: Time for a New Awareness?

                                           http://austinpublishinggroup.com/annals-surgery/

Asphysicians/surgeons, we cannot “understand” (on a metaphysical level) why people suffer or die. Despite our advanced training in modern technological advances on the frontiers of immunology, gene therapy or minimally invasive surgical techniques, individually we remain steadfastly and unchangingly human, and often struggle with both anguish and misery in the lives of patients and families we serve (as well as our own). We also wrestle with questions like, “How can a loving and all-powerful God permit the suffering of an innocent child from an aggressive cancer?” In my career as a pediatric surgeon, I have often been asked similar questions from grieving parents whose lives have suddenly imploded with the shattering news of their child’s affliction. They- and I as well- seek through the tears, some reassurance in our faith that begs answers, even understanding, of the unknowable.

Can it be thatadvances in modern science and technology have made the concept of “suffering” itself a kind of “predictable storm,” at least for the most part- one which should be seen off in the horizon to be safely avoided, or at least prepared for well in advance; or one that attacks in distant places, to unseen populations- safely at a distance from our “all too comfortable” lives. At least until we, or those close to us, are suddenly blindsided- by a terrible accident or critical health concern, and are left asking, “Why me (them)? What on earth could have happened? How could this be? This is just so sudden and unexpected”. Furthermore, “It just doesn’t seem fair. Isn’t our God a deity of love? Surely it cannot be his wish that such misery could happen to an undeserving child of his. Isn’t his plan to protect and nurture (each of) us so we can carry on with our daily lives in obedience and service to him? How did everything we believe go wrong”?

In reality, in our human existence, that anguish and misery we struggle to understand are necessary parts of life, unavoidable and oftentimes painfully real- and always have been.

Unenhanced Chest Computerized Tomography Assisted Sentinel Lymph Node Biopsy Could be a Highly Reliable Option for Only Methylene Blue Available Breast Cancer Patients

                                            http://austinpublishinggroup.com/surgery/index.php

Background: Blue dye and radioisotope (RI) combined SLNB is the “best” protocol. However, RI is not available worldwide. This study is to evaluate the feasibility of unenhanced chest Computerized Tomography (CT) with three criteria for suspicious nodal metastasis assisted SLNB using only methylene blue (MB) as an alternative reliable option.

Patients and Methods: A total of 1771 consecutive patients with clinically node negative breast cancer were enrolled. For limiting FNR and surgical complications, the number of removed Sentinel Lymph Nodes (SLNs) was suggested to be 3~5. Unenhanced chest CT is mandatory to locate SLNs, which were graded from 1 to 3 according to suspicious criteria for metastasis. Three doctors adopted three SLNB methods. Periareolar sub-dermal injection using 4ml of 0.5% MB alone or in combination with a radioisotope was individually employed by two doctors. The third doctor used 2ml of 1% MB to inject into parenchyma to map SLNs.

Results: Both FNR and outcomes of patients showed no difference between three methods. We also confirmed that Lymph Vascular Invasion (LVI) and CT grade were both significantly correlated with SLN status (coefficients were0.68 and 0.25, p<0.001). Although there was no difference found in complications, but parenchymal injection did never cause skin necrosis.

Conclusion: Unenhanced chest CT could be are liable assistance to improve SLNB using only MB via parenchymal injection. This technique might be the safest and convenient option for SLNB in the study and RI could be safely spared.

Keywords: Breast cancer; Sentinel lymph node biopsy; Methylene blue; Computerized tomography

Cardiotoxicity Proceeding Stem Cell Transplantation

                         http://austinpublishinggroup.com/stemcell-research-transplantation/

HSCT is a process in which there is intravenous infusion of progenitor cells and hematopoietic stem cells to revive normal hematopoiesis. When stem cells are taken from patient’s own body, this is called autologous HSCT. When stem cells are taken from identical twin of the patient, this is called syngeneic HSCT. When stem cells are taken from body other than patient (siblings), this is called allogeneic HSCT.

During the procedure, autologous or allogeneic stem cells are infused into veins in order to restore normal hematopoietic function. Evaluation of health status: It involves following steps (complete history and physical exam, Evaluation of your psychological and emotional strengths, HLA tissue typing, Blood tests, such as a complete blood count, blood chemistries, and screening for viruses like hepatitis B, CMV, and HIV, CT (computed tomography) scan or MRI (magnetic resonance imaging), ECG or echocardiogram, chest x-ray and PFTs (pulmonary function tests).

Conditioning treatment: It is also known as bone marrow preparation, is treatment with high-dose chemo and/or radiation therapy. It’s the first step in the transplant process and usually it takes a couple of weeks. Infusion of stem cells: Infusion of cells is done through central venous catheter, much like a blood transfusion. If frozen stem cells are taken, patient might get some drugs before the stem cells are given. These drugs are used to prevent the reaction to the preservatives that are used when freezing the cells.

Stem cell transplantation is curative in a number of otherwise fatal hematological diseases.

In an autologous transplant, stem cells are collected from the patient themselves, harvested, frozen and stored, then given back to the patient after intensive therapy. An autologous stem cell transplant is different from an allogeneic stem cell transplant, which uses stem cells from a matching donor.

Austin Statistics

                                      http://austinpublishinggroup.com/statistics/index.php

Austin Statistics is an open access, peer reviewed, scholarly journal dedicated to publish articles in all areas of statistics.

The aim of the journal is to provide a forum for scientists, academicians and researchers to find most recent advances in the field statistics.

Austin Statistics accepts original research articles, review articles, case reports and rapid communication on all the aspects of statistics.

Physical Therapy and Migraines

http://austinpublishinggroup.com/sleep-disorders/

The study ofeffective techniques for migraines is justified by its high prevalence; a systematic review (Woldeamanuel and Cowan, 2017) concluded that it affects 1 out of 10 individuals worldwide, with preference in gender for females in comparison with males, in a ratio 2:1.

One of the reasons that promotes the use of physical therapy in the treatment of these patients is the concurrence of musculoskeletal dysfunctions in the neck in patients with migraines; a recent study concluded that 89% of the patients with migraines included in the study reported local or referred pain in the head during the realization of pressure on the high cervical segment. In a study about the prevalence of neck pain in patients with migraines observed it was of 76% during the year of the study.

In the most recent study about this topic findings from the exploration of the cervical spine in patients with migraine and controls were compared and concluded that significant differences existed in the number of active trigger points, in the flexion-rotation test, joint mobility in the high cervical segment, in the crane cervical test and in the reproduction and resolution of symptoms during sustained pressure; also, 93% of the patients with migraine presented at least three cervical musculoskeletal dysfunctions .

The neurophysiologic relation between the cervical spine and headaches in migraines is found at the Trigeminal-Cervical Complex (TCC). This complex is in charge of transmitting sensorial, visceral and nociceptive information of the head and orofacial region to superior centers like the thalamus, hypothalamus, and the primary sensorial cortex this complex receives afferent nociceptive signals from cervical structures; this convergence of nociceptive signals seems to be the cause of the central and peripheral sensitization phenomenon present in migraine. The concurrence of peripheral nociceptive mechanisms and the central sensitization can justify the results from Watson & Drummond (2014); in this study, 20 patients with migraine received sustained pressure on C1 and C2; in 19 cases it reproduced the symptoms of their migraine.

ADAM10 is Elevated in Microscopic Polyangiitis and is Involved in Inflammation

                                      http://austinpublishinggroup.com/austin-rheumatology/

                                               

Background: A disintegrin and metalloproteinase (ADAM) 10 has been reported to be involved in certain autoimmune diseases, such as rheumatoid arthritis. In this study, we demonstrate that ADAM10, which is a member of the ADAM family, is expressed in angiitis, and we examine its relationship to this condition using clinical data.

Materials and Methods: The ADAM10 levels in serum from microscopic polyangiitis (MPA) patients and healthy controls were measured using enzyme-linked immunosorbent assay. The clinical data were collected from Showa University cohort data. The relationship between the ADAM10 level in the sera and the clinical data was evaluated using Spearman’s rank correlation.

Results: No significant differences were observed in the mean age or gender ratio between the MPA patients and the healthy controls. The ADAM10 level in MPA serum (n=10) was significantly elevated compared with that in healthy control serum (n=7) (450 ± 44 pg/ml and 85 ± 33 pg/ml, respectively). The ADAM10 level in MPA serum was also significantly negatively correlated with myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) titer, but not with the C-reactive protein level.

Discussion: ADAM10 is elevated in MPA patients and might be involved in their inflammation. On the other hand, ADAM10 is negatively correlated with MPO-ANCA. These results indicate that ADAM10 might be involved in inflammation other than MPO-ANCA.

A disintegrin and metalloproteinases (ADAMs) are a family of proteinases that are known to be involved in ectodomain cleavage and in the regulation of the intramembrane proteolysis of transmembrane proteins. ADAM10 and 17 are the major proteases that cleave some membrane-bound proteins, and have extensive overlap with and compensate for several substrates, including epidermal growth factor receptor ligands, tumor necrosis factor (TNF), TNF receptor, and interleukin (IL)-6 receptor. ADAM17 is also known as TNF-α converting enzyme (TACE) and was identified as the primary protease responsible for the proteolytic processing of TNF-α. ADAM17 is expressed in numerous human tumors and is associated with invasion and metastasis. ADAM10 is also involved in the shedding of many substrates that play roles in cancer progression, allergic responses and inflammatory diseases. We previously showed that ADAM10 is involved in angiogenesis and the inflammation associated with rheumatoid arthritis (RA). However, the role of ADAM10 in other autoimmune diseases has not been examined. Here, we describe the expression and possible implications of ADAM10 in angiitis.

Nephroprotection Regimen to Combat the Global Challenge of ESRD (End Stage Renal Disease) and RRT (Renal Replacement Therapy)

                                   http://austinpublishinggroup.com/austin-renal-disorders/

Kidney disorders are increasing with fast pace and emerged as major health challenge in recent decades. It has been emphasised in various studies published in reputed journals to take serious preventive measures about alarming situation of prevalence of kidney diseases leading to acute or chronic renal failure, (ESRD) end stage renal disease thereby resulting in kidney transplantation. The epidemiological evidence at present indicates that nephrotoxicity leading to acute and chronic renal failure has a substantial financial burden on the society.

Being the main organ of excretion for many endogenous metabolites and waste products, and also various exogenous substances like chemicals and drugs that are used to treat different ailments of the body, kidney always remains in contact with substances of aversive nature. This makes the kidney vulnerable to toxicity and injury. Secondly, the effect of occupational or therapeutic exposure to metals on kidney is well established; furthermore, a number of drugs which are frequently used in the management of various diseases cause significant degree of nephrotoxicity even at normal therapeutic dose levels. There are several chemicals which cause such nephropathies, which remain unrecognized for quite some time. These include toxicities caused by cadmium and other heavy metals, anti cancer drugs, cyclosporins, analgesics, antibiotics etc. and recently reported nephropathies caused by plant drugs containing aristolochic acid. 

The specific physiologic characteristics of kidney are localized to specific cell types, which further makes it susceptible to and targets for chemicals. Furthermore, kidney remains under tremendous pressure to maintain the homeostasis of the body in several pathophysiological conditions like edema, obesity, CHF and other diseases that adversely affect the kidney function and produce oxidative changes leading to cellular injury. The nephron, that performs a variety of physiological functions; also bioconverts chemicals and metabolically activates a variety of compounds. Not with standing there is a substantial capacity within the kidney for repair, but there are also several circumstances where damage may be irreversible.

Gait Adaptive Robotic Leg

                                      http://austinpublishinggroup.com/robotics-automation/

The paper is in the field of Bio Medical Engineering. It is focused on rehabilitation of above knee amputees through the implementation of a design that is simple enough to facilitate them carry out their daily routine tasks (walk, sit and stand) with ease. A working model of the gait adaptive robotic leg was developed using the various techniques of bio medical and mechatronics engineering. Amongst the phases of human gait the swing phase posture was modeled for working out the kinematics of robotic leg.

The technology now-a-days has sufficiently benefited the developed countries as they made it so as to fill the mould of their lifestyle, quiet fair for them as they worked hard for achieving that. On the other hand, this boom of technology has not only comforted the researchers of the developed countries but has also provided the developing countries with readymade products. This is showing an alarming situation and therefore, needs a wakeup call for the researchers of the developing countries to come up with at least what they can by utilizing the available resources, otherwise the technology gap will continue to rise. 

This research deals with active and passive prosthetic limb designs. Though both the approaches address the operating characteristics of a particular structure under study but the difference lies in the way they replicate the structure. The structure designed in active prosthetic limb design is quiet close to real structure as compared to the passive prosthetic limb design and this fact makes the implementation of former type expensive whereas the later approach stands inexpensive instead. This paper reflects a mixture of both the limb design approaches and tends to motivate the researchers of the developing countries to unveil the creative ideas of their mind and try to design a product within the resources available to them.