Panafrican Medical Journal

PAMJ, 3 - 7 Dec 2018

RESEARCH Menstrual hygiene management practices among primary school girls from a pastoralist community in Kenya: a cross sectional survey Eleen Korir et al. Pubescent girls from developing countries are confronted with diverse menstrual hygiene management (MHM) challenges, especially at school. Girls from rural pastoralist communities experience insurmountable MHM barriers. Inadequate coping strategies adopted result in sub-optimal school performance, absenteeism and physical problems. Outcomes of tunneled internal jugular venous catheters for chronic haemodialysis at the University College Hospital, Ibadan, Nigeria Yemi Raheem Raji et al.  Vascular access is an important aspect of haemodialysis treatments and determinant of patient outcomes. Arteriovenous (AV) fistula has been described as the preferred haemodialysis vascular access for patients on chronic dialysis. IMAGES IN CLINICAL MEDICINE Une cataracte inhabituelle: régressive à noyau pétaloïde Ahmed Bennis et al. Nous rapportons le cas d'une patiente de 38 ans, sans antécédents médico-chirurgicaux, victime d'un traumatisme contusif de l'œil droit par coup de pierre il y a 20 ans, avec baisse de l'acuité visuelle progressive depuis 10 ans. Formes évolutives postérieures de la persistance de la vascularisation fœtale bilatérale à l'hôpital régional de Gao Ibrahima Conaré et al.  La persistance de la vascularisation fœtale (PVF) est une anomalie de la résorption du système vasculaire hyaloïdien. Formes évolutives postérieures bilatérales de la persistance chez un garçon âgé de 2 ans qui a consulté pour une leucocorie de l'œil droit.  CASE REPORTS Perforation cæcale néonatale inaugurale du diagnostic d'un mégacôlon congénital Abdoulaye Diallo Harouna et al. Les perforations intestinales spontanées sont rares chez un nouveau-né à terme. Nous rapportons le cas d'un nouveau-né issu d'une grossesse de 41 semaines d'aménorrhée, qui avait présenté à trois jours de vie, un pneumopéritoine inaugural d'un mégacôlon congénital. Corps étranger intra urétral inhabituel chez un adolescent schizophrène: à propos d'un cas Mustapha Ahsaini et al.  L'auto insertion d'un corps étranger s'observe généralement chez les patients ayant une psychose chronique dans le but d'automutilation ou érotique. Le diagnostic est parfois difficile s'il est rapporté tardivement ou si le patient est non coopérant, d'où l'intérêt d'un bilan d'imagerie complémentaire.

Indian Journal of Occupational and Environmental Medicine (Indian J Occup Environ Med) 2018 | September-December | Volume 22 | Issue 3

Occupational health surveillance Damodar Vishnu Lele Indian Journal of Occupational and Environmental Medicine 2018 22(3):117-120, Occupational health surveillance Damodar Vishnu Lele Indian Journal of Occupational and Environmental Medicine 2018 22(3):117-120 The untold story of fluoridation: Revisiting the changing perspectives Maitreyee P Unde, Raju Umaji Patil, Persis P Dastoor Indian Journal of Occupational and Environmental Medicine 2018 22(3):121-127 The discovery of fluoride in dentistry has revolutionized treatment modalities with a new aspect of prevention and conservation of tooth structure coming into foreplay. Since then, there has been a lot of research on both topical and systemic fluoridation in an overzealous attempt to control the most debilitating dental problem of caries. Although topical fluoride is still being widely used as a preventive measure for dental caries, systemic administration of the same has gained major criticism worldwide due to the low margin of safety of fluoride and no control over the amount of individual intake when administered on a community level. This problem is more prevalent in countries with presence of natural fluoride belts that extend from Turkey to China and Japan through Iraq, Iran, and Afghanistan increasing the chances of both dental and skeletal fluorosis and hence increasing the focus toward defluoridation. This historical review highlights the distribution of fluoride worldwide and in India and also discusses about the various claims of the antifluoride lobby.  Occupational and environmental exposure to lead and reproductive health impairment: An overview Sunil Kumar Indian Journal of Occupational and Environmental Medicine 2018 22(3):128-137 Lead is a heavy metal. It is used in lead-acid battery, as a coloring agent, paints, and metal alloyed as shielding materials, smelters, printing press, and so on. It is a toxic metal affecting various organs, and developing fetus and young children are more vulnerable to toxicity of lead. This overview is based on the information of toxic potential of lead to human reproduction and reproductive outcome. Exposure to lead may affect libido, semen quality by declining sperm count, motility, viability, integrity, elevation in morphological abnormalities, and sperm DNA integrity. These alterations led to reducing fertility potential and chances of miscarriages, preterm birth, and so on in a partner. Lead exposure impairs hormonal synthesis and regulations in both sexes. Lead exposure also affects female reproduction by impairing menstruations, reducing fertility potential, delaying conception time, altering the hormonal production, circulation, affecting pregnancy and its outcome, and so on. At present, the safe dose of lead cannot be advocated as more and more data are generated in recent years which indicate the toxic potential of lead to human reproduction at a low level that was previously thought not to have such effect. Hence, use of lead should be stopped/avoided or restricted to safeguard human reproduction.  Upper extremity muscular strength in push–pull tasks: Model approach towards task design Joydeep Majumder, Sanjay M Kotadiya, Lokesh Kumar Sharma, Sunil Kumar Indian Journal of Occupational and Environmental Medicine 2018 22(3):138-143 Background: Pushing and pulling in workplaces are common actions. Repetitive forceful exertions in long-duration works lead to increased risk of musculoskeletal disorders and injuries. Aim: To investigate the upper extremity strength in generic push–pull modes while using hand tools and forecasting the limits of the workers while frequent or continuous operation. Settings and Design: The study was conducted among men workers in Ahmedabad city, India, and the design was cross-sectional study. Materials and Methods: In all, 100 men were recruited (Group 1: 18–39 years and Group 2: 40–60 years). Upper extremity muscular strength (isometric mode) testing of the preferred hand during push–pull type of manual hand-tool operations was carried out for 60 s. Forecasting of strength to generate predictions for future events (120 s) based on known past events (measured 60 s) was carried out using Holt–Winters time-series model. Statistical Analysis: Descriptive statistics was used for analysis. For prediction model evaluation, WEKA 3.8.2 was used. Results: Anthropometric parameters of both groups were similar, having no effect on generated strength. Largely, pull strength was recorded to be higher than push strength, wherein Group 2 men generated slightly higher strength. Seated strength was also higher than standing exertion. Forecasting reveals steady strength values for Group 1 men, whereas steep decline among Group 2 men with increasing duration of trial. Conclusion: The strength data generated would aid in work schedule design. Strength forecasting model would assist in developing engineering guidelines in the design of tools at workplace.  Effects of occupational heat exposure on traffic police workers in Ahmedabad, Gujarat Amee Raval, Priya Dutta, Abhiyant Tiwari, PS Ganguly, LM Sathish, Dileep Mavalankar, Jeremy Hess Indian Journal of Occupational and Environmental Medicine 2018 22(3):144-151 One of the most concerning environmental effects of climate change is rising levels of extreme heat, which already poses serious risks in many parts of the world. In June and July 2015, we collected weekly heat exposure data using area and personal temperature monitoring in Ahmedabad, Gujarat. The study was conducted at four different traffic junctions with a cohort of 16 traffic police. For information on health effects, we administered a baseline survey at the start of the study and prospectively followed up with the officers on prevalence of heat-related symptoms. Wet bulb globe temperature (WBGT) levels ranged from 28.2°C to 36.1°C during the study period. Traffic police workers who participated in this study were exposed to WBGT levels higher than the recommended threshold limit value as per American Conference of Governmental Industrial Hygienists guidelines even beyond the hottest months of the season. Our findings suggest that airport measurements by the Indian Meteorological Department may not accurately capture heat exposures among individuals who work in and alongside high-density traffic junctions. Based on our temperature estimates, traffic police are at risk for heat stress. India is likely to experience warmer temperatures and increased heat waves in the coming decades, fueled by climate change. Therefore, it is important to reduce current and future heat-related risks for traffic police workers and similar occupational risk groups by establishing protection strategies. The protocol established in this study for occupational heat exposure assessment could be applied to a larger cohort.  The exposure to pollutants of the auto repair workers: Monitoring their oxidative stress Roberto Menicagli, O Marotta, L Menicagli Indian Journal of Occupational and Environmental Medicine 2018 22(3):152-155 Background and Aim: Auto repair workers are exposed to multiple pollutants, each of them potentially risks, dangerous for several target organs. The aim of this study is to identify their possible overall effect, by monitoring the concentration of salivary malondialdehyde, index of oxidative stress. Materials and Methods: Malondialdehyde of 25 male workers, smokers and non-smokers, further divided into two subgroups relatively to the amplitude of their working place, was monitored, in the saliva, with the Thiobarbituric acid method. The control group consists of 12 and 13 male smokers, and 13 non-smokers. Univariate (UVA) and Multivariate (MVA) analysis methods were used to analyze the results. Results: No variable is significant (P ≥ 0.05) for the control group using UVA, while age and smoking significantly increase the levels of MDA (P ≤ 0.05) using MVA. For workers group, the age and the place of work increase the MDA (P ≤ 0.05) using UVA analysis, while only the place of work remains significant (≤0.05) using MVA analysis. MVA analysis reveals that, besides the type of work, also the age and smoking significantly increase the level of MDA, as a result of a higher exposure to pollutants. Conclusions: You can check the cumulative effect of pollutants on auto repair workers, by monitoring the salivary malondialdehyde.  Impact of school air quality on children's respiratory health Peter Fsadni, Frank Bezzina, Claudia Fsadni, Stephen Montefort Indian Journal of Occupational and Environmental Medicine 2018 22(3):156-162 Background: Asthma is common in children with indoor pollutants influencing the development of the disease. Since children spend most of their time outside their homes within the school environment, school indoor air quality can directly influence their respiratory health. Aims: This study aims to analyze the indoor and outdoor air quality of Maltese schools and if an association exists between indoor pollutants and respiratory health in children. Settings and Design: Five primary schools were selected with 9- to 11-year-old students participating. Materials and Methods: Standardized health questionnaires and lung function tests were utilized. Indoor and outdoor air sampling together with traffic counts were carried out. Statistical Analysis Used: SPSS version 21 was used and the Chi-squared, logistic regression, and Pearson's correlation were used. Results: The mean indoor PM 2.5 level of 17.78 μg/m3 and CO (9.11 ppm) exceeded World Health Organization thresholds. Indoor ozone levels exceeded the mean European school's indoor ozone concentration of 8 μg/m3. High exposure to formaldehyde, NO2, and ozone was associated with atopy in children. Heavy vehicles passing near the schools were associated with current wheezing (P < 0.001) but not nocturnal cough (P = 0.34). Conclusions: School indoor and outdoor environment has a direct impact on children's respiratory health. This study has identified significant associations between high exposures to indoor air pollutants, school characteristics, and upper and lower airway inflammation.  Work related musculoskeletal disorders and postural stress of the women cultivators engaged in uprooting job of rice cultivation Amitava Pal, Prakash C Dhara Indian Journal of Occupational and Environmental Medicine 2018 22(3):163-169 Aims: A large number of workers including women are involved in the informal sector in India. A majority of them are engaged in agricultural sectors. The agricultural workers have to perform their jobs by putting manual labor and are exposed to different occupational stresses. The present study was aimed to evaluate postural stress and prevalence of musculoskeletal disorder (MSD) of women cultivators engaged in uprooting job of rice cultivation. Settings and Design: This cross-sectional study was conducted on 166 women cultivators from different districts of West Bengal state, India. Materials and Methods: Prevalence and intensity of MSDs of the cultivators were evaluated by Nordic questionnaire and 10-point body part discomfort scale. Work rest pattern and postural pattern were studied by direct observation method. Postural stress was assessed by OVAKO Working Postures Analysis System (OWAS), Rapid Entire Body Assessment (REBA), Rapid Upper Limb Assessment (RULA), and Quick Exposure Checklist (QEC) methods and as well as by measuring center of gravity. Results and Conclusions: MSD was highly prevalent among the study participants. Lower back, hip, wrist, shoulder, and knee were highly affected. Higher prevalence of MSDs among the cultivators may be because of prolonged working hours and awkward postures. The women cultivators had to start their day before dawn to finish off their household chores such as cooking, cleaning, washing clothes and dishes, etc., before they moved off to the fields, which altogether impose them under additional stress. It may be suggested that ergonomic interventions such as modifying work-rest schedules, improving work postures, and introducing new design hand tools should be considered for improving work condition of the women cultivators.  A comparative study of byssinosis in jute industries Asim Saha, Anirban Das, Bhaskar Prasad Chattopadhyay, Jane Alam, Tilak Kanti Dasgupta Indian Journal of Occupational and Environmental Medicine 2018 22(3):170-176 Background: Byssinosis is an acute respiratory difficulty that is caused usually following exposure to cotton and hemp dust. Occurrence of such similar acute symptoms had been reported following exposure to jute dust/fiber also. With passage of time, Jute industries have modernized themselves for increased quality and productivity, which has lessened workforce and thereby provided more working space. However, occupational health benefit due to such changes has rarely been explored. This study was initiated to understand whether this modernization can protect the health of workers. Methodology: This study was carried out in two jute mills manufacturing jute clothes, jute bags, and so on. Interview of the workers for their occupational and morbidity details, medical examinations, as well as pre-shift and post-shift pulmonary function tests was carried out. Results: It was observed that chest tightness was significantly more in the industry with old technologies. Breathlessness was also more in this industry. As far as pulmonary function status is concerned, it was noted that greater than 5% cross-shift change in forced expiratory volume in one second was more common in the industry with old technology. Obstructive feature on lung function test was also observed in workers of both industries. Conclusion: The study concluded that exposure to jute dust has contributed to both acute and chronic respiratory health effects in the jute industry workers. Modernized industry showed lesser prevalence of acute symptoms and changes related to byssinosis. Modernization of processes in jute industries may prove fruitful in lowering the respiratory problems of workers.  Nipah virus: South India in panic mode Jasmine Shanthi Kamath, Shruthi Hegde, Vidya Ajila Indian Journal of Occupational and Environmental Medicine 2018 22(3):177-178

The untold story of fluoridation: Revisiting the changing perspectives Maitreyee P Unde, Raju Umaji Patil, Persis P Dastoor Indian Journal of Occupational and Environmental Medicine 2018 22(3):121-127 The discovery of fluoride in dentistry has revolutionized treatment modalities with a new aspect of prevention and conservation of tooth structure coming into foreplay. Since then, there has been a lot of research on both topical and systemic fluoridation in an overzealous attempt to control the most debilitating dental problem of caries. Although topical fluoride is still being widely used as a preventive measure for dental caries, systemic administration of the same has gained major criticism worldwide due to the low margin of safety of fluoride and no control over the amount of individual intake when administered on a community level. This problem is more prevalent in countries with presence of natural fluoride belts that extend from Turkey to China and Japan through Iraq, Iran, and Afghanistan increasing the chances of both dental and skeletal fluorosis and hence increasing the focus toward defluoridation. This historical review highlights the distribution of fluoride worldwide and in India and also discusses about the various claims of the antifluoride lobby.

Occupational and environmental exposure to lead and reproductive health impairment: An overview Sunil Kumar Indian Journal of Occupational and Environmental Medicine 2018 22(3):128-137 Lead is a heavy metal. It is used in lead-acid battery, as a coloring agent, paints, and metal alloyed as shielding materials, smelters, printing press, and so on. It is a toxic metal affecting various organs, and developing fetus and young children are more vulnerable to toxicity of lead. This overview is based on the information of toxic potential of lead to human reproduction and reproductive outcome. Exposure to lead may affect libido, semen quality by declining sperm count, motility, viability, integrity, elevation in morphological abnormalities, and sperm DNA integrity. These alterations led to reducing fertility potential and chances of miscarriages, preterm birth, and so on in a partner. Lead exposure impairs hormonal synthesis and regulations in both sexes. Lead exposure also affects female reproduction by impairing menstruations, reducing fertility potential, delaying conception time, altering the hormonal production, circulation, affecting pregnancy and its outcome, and so on. At present, the safe dose of lead cannot be advocated as more and more data are generated in recent years which indicate the toxic potential of lead to human reproduction at a low level that was previously thought not to have such effect. Hence, use of lead should be stopped/avoided or restricted to safeguard human reproduction.

Upper extremity muscular strength in push–pull tasks: Model approach towards task design Joydeep Majumder, Sanjay M Kotadiya, Lokesh Kumar Sharma, Sunil Kumar Indian Journal of Occupational and Environmental Medicine 2018 22(3):138-143 Background: Pushing and pulling in workplaces are common actions. Repetitive forceful exertions in long-duration works lead to increased risk of musculoskeletal disorders and injuries. Aim: To investigate the upper extremity strength in generic push–pull modes while using hand tools and forecasting the limits of the workers while frequent or continuous operation. Settings and Design: The study was conducted among men workers in Ahmedabad city, India, and the design was cross-sectional study. Materials and Methods: In all, 100 men were recruited (Group 1: 18–39 years and Group 2: 40–60 years). Upper extremity muscular strength (isometric mode) testing of the preferred hand during push–pull type of manual hand-tool operations was carried out for 60 s. Forecasting of strength to generate predictions for future events (120 s) based on known past events (measured 60 s) was carried out using Holt–Winters time-series model. Statistical Analysis: Descriptive statistics was used for analysis. For prediction model evaluation, WEKA 3.8.2 was used. Results: Anthropometric parameters of both groups were similar, having no effect on generated strength. Largely, pull strength was recorded to be higher than push strength, wherein Group 2 men generated slightly higher strength. Seated strength was also higher than standing exertion. Forecasting reveals steady strength values for Group 1 men, whereas steep decline among Group 2 men with increasing duration of trial. Conclusion: The strength data generated would aid in work schedule design. Strength forecasting model would assist in developing engineering guidelines in the design of tools at workplace.

Effects of occupational heat exposure on traffic police workers in Ahmedabad, Gujarat Amee Raval, Priya Dutta, Abhiyant Tiwari, PS Ganguly, LM Sathish, Dileep Mavalankar, Jeremy Hess Indian Journal of Occupational and Environmental Medicine 2018 22(3):144-151 One of the most concerning environmental effects of climate change is rising levels of extreme heat, which already poses serious risks in many parts of the world. In June and July 2015, we collected weekly heat exposure data using area and personal temperature monitoring in Ahmedabad, Gujarat. The study was conducted at four different traffic junctions with a cohort of 16 traffic police. For information on health effects, we administered a baseline survey at the start of the study and prospectively followed up with the officers on prevalence of heat-related symptoms. Wet bulb globe temperature (WBGT) levels ranged from 28.2°C to 36.1°C during the study period. Traffic police workers who participated in this study were exposed to WBGT levels higher than the recommended threshold limit value as per American Conference of Governmental Industrial Hygienists guidelines even beyond the hottest months of the season. Our findings suggest that airport measurements by the Indian Meteorological Department may not accurately capture heat exposures among individuals who work in and alongside high-density traffic junctions. Based on our temperature estimates, traffic police are at risk for heat stress. India is likely to experience warmer temperatures and increased heat waves in the coming decades, fueled by climate change. Therefore, it is important to reduce current and future heat-related risks for traffic police workers and similar occupational risk groups by establishing protection strategies. The protocol established in this study for occupational heat exposure assessment could be applied to a larger cohort.

The exposure to pollutants of the auto repair workers: Monitoring their oxidative stress Roberto Menicagli, O Marotta, L Menicagli Indian Journal of Occupational and Environmental Medicine 2018 22(3):152-155 Background and Aim: Auto repair workers are exposed to multiple pollutants, each of them potentially risks, dangerous for several target organs. The aim of this study is to identify their possible overall effect, by monitoring the concentration of salivary malondialdehyde, index of oxidative stress. Materials and Methods: Malondialdehyde of 25 male workers, smokers and non-smokers, further divided into two subgroups relatively to the amplitude of their working place, was monitored, in the saliva, with the Thiobarbituric acid method. The control group consists of 12 and 13 male smokers, and 13 non-smokers. Univariate (UVA) and Multivariate (MVA) analysis methods were used to analyze the results. Results: No variable is significant (P ≥ 0.05) for the control group using UVA, while age and smoking significantly increase the levels of MDA (P ≤ 0.05) using MVA. For workers group, the age and the place of work increase the MDA (P ≤ 0.05) using UVA analysis, while only the place of work remains significant (≤0.05) using MVA analysis. MVA analysis reveals that, besides the type of work, also the age and smoking significantly increase the level of MDA, as a result of a higher exposure to pollutants. Conclusions: You can check the cumulative effect of pollutants on auto repair workers, by monitoring the salivary malondialdehyde.

Impact of school air quality on children's respiratory health Peter Fsadni, Frank Bezzina, Claudia Fsadni, Stephen Montefort Indian Journal of Occupational and Environmental Medicine 2018 22(3):156-162 Background: Asthma is common in children with indoor pollutants influencing the development of the disease. Since children spend most of their time outside their homes within the school environment, school indoor air quality can directly influence their respiratory health. Aims: This study aims to analyze the indoor and outdoor air quality of Maltese schools and if an association exists between indoor pollutants and respiratory health in children. Settings and Design: Five primary schools were selected with 9- to 11-year-old students participating. Materials and Methods: Standardized health questionnaires and lung function tests were utilized. Indoor and outdoor air sampling together with traffic counts were carried out. Statistical Analysis Used: SPSS version 21 was used and the Chi-squared, logistic regression, and Pearson's correlation were used. Results: The mean indoor PM 2.5 level of 17.78 μg/m3 and CO (9.11 ppm) exceeded World Health Organization thresholds. Indoor ozone levels exceeded the mean European school's indoor ozone concentration of 8 μg/m3. High exposure to formaldehyde, NO2, and ozone was associated with atopy in children. Heavy vehicles passing near the schools were associated with current wheezing (P < 0.001) but not nocturnal cough (P = 0.34). Conclusions: School indoor and outdoor environment has a direct impact on children's respiratory health. This study has identified significant associations between high exposures to indoor air pollutants, school characteristics, and upper and lower airway inflammation.

Work related musculoskeletal disorders and postural stress of the women cultivators engaged in uprooting job of rice cultivation Amitava Pal, Prakash C Dhara Indian Journal of Occupational and Environmental Medicine 2018 22(3):163-169 Aims: A large number of workers including women are involved in the informal sector in India. A majority of them are engaged in agricultural sectors. The agricultural workers have to perform their jobs by putting manual labor and are exposed to different occupational stresses. The present study was aimed to evaluate postural stress and prevalence of musculoskeletal disorder (MSD) of women cultivators engaged in uprooting job of rice cultivation. Settings and Design: This cross-sectional study was conducted on 166 women cultivators from different districts of West Bengal state, India. Materials and Methods: Prevalence and intensity of MSDs of the cultivators were evaluated by Nordic questionnaire and 10-point body part discomfort scale. Work rest pattern and postural pattern were studied by direct observation method. Postural stress was assessed by OVAKO Working Postures Analysis System (OWAS), Rapid Entire Body Assessment (REBA), Rapid Upper Limb Assessment (RULA), and Quick Exposure Checklist (QEC) methods and as well as by measuring center of gravity. Results and Conclusions: MSD was highly prevalent among the study participants. Lower back, hip, wrist, shoulder, and knee were highly affected. Higher prevalence of MSDs among the cultivators may be because of prolonged working hours and awkward postures. The women cultivators had to start their day before dawn to finish off their household chores such as cooking, cleaning, washing clothes and dishes, etc., before they moved off to the fields, which altogether impose them under additional stress. It may be suggested that ergonomic interventions such as modifying work-rest schedules, improving work postures, and introducing new design hand tools should be considered for improving work condition of the women cultivators.

A comparative study of byssinosis in jute industries Asim Saha, Anirban Das, Bhaskar Prasad Chattopadhyay, Jane Alam, Tilak Kanti Dasgupta Indian Journal of Occupational and Environmental Medicine 2018 22(3):170-176 Background: Byssinosis is an acute respiratory difficulty that is caused usually following exposure to cotton and hemp dust. Occurrence of such similar acute symptoms had been reported following exposure to jute dust/fiber also. With passage of time, Jute industries have modernized themselves for increased quality and productivity, which has lessened workforce and thereby provided more working space. However, occupational health benefit due to such changes has rarely been explored. This study was initiated to understand whether this modernization can protect the health of workers. Methodology: This study was carried out in two jute mills manufacturing jute clothes, jute bags, and so on. Interview of the workers for their occupational and morbidity details, medical examinations, as well as pre-shift and post-shift pulmonary function tests was carried out. Results: It was observed that chest tightness was significantly more in the industry with old technologies. Breathlessness was also more in this industry. As far as pulmonary function status is concerned, it was noted that greater than 5% cross-shift change in forced expiratory volume in one second was more common in the industry with old technology. Obstructive feature on lung function test was also observed in workers of both industries. Conclusion: The study concluded that exposure to jute dust has contributed to both acute and chronic respiratory health effects in the jute industry workers. Modernized industry showed lesser prevalence of acute symptoms and changes related to byssinosis. Modernization of processes in jute industries may prove fruitful in lowering the respiratory problems of workers.

Nipah virus: South India in panic mode Jasmine Shanthi Kamath, Shruthi Hegde, Vidya Ajila Indian Journal of Occupational and Environmental Medicine 2018 22(3):177-178

Prescribing Therapy for Hypothyroidism: Influence of Physician Characteristics

Thyroid, Ahead of Print.


https://ift.tt/2GC87Sb

Iodine Status of Pregnant Women and Women of Reproductive Age in the United States

Thyroid, Ahead of Print.


https://ift.tt/2R2joiv

A New Highly Thyrotropin Receptor-Selective Small-Molecule Antagonist with Potential for the Treatment of Graves' Orbitopathy

Thyroid, Ahead of Print.


https://ift.tt/2GmFXu4

Differential expression of immune markers in the patients with obstructive sleep apnea/hypopnea syndrome

Abstract

Purpose

To evaluate phenotypic changes of various immune cells in the peripheral blood in the patients with sleep apnea/hypopnea syndrome (OSAHS).

Methods

This is a case–control study. The peripheral venous blood was collected. A subset of T cells, B cells, natural killer cells, and dendritic cells was analysed using various markers and flow cytometry. Regression curve analysis was made to examine the correlation between the change of immune cells and aponea hypoxia index (AHI) and oxygen desaturation.

Results

The percentage of CD3⁺/CD4⁺ T lymphocytes (P < 0.001) and CD19⁺ B cells (P < 0.001) and the CD4⁺/CD8⁺ ratio (P < 0.001) in the OSAHS patients were significantly increased compared with those in the control group without OSAHS, and CD4⁺/CD8⁺ ratio positively correlated with aponea hypoxia index (r = 0.37, P < 0.001) but negatively correlated with the lowest SaO₂ (r = − 0.2, P < 0.001), whereas a greater reduction in the percentage of CD3⁺/CD8⁺ T cells (P < 0.001). Moreover, the ratios of CD3⁺/CD16⁺/CD56⁺ natural killer (NK)-like T cells (P < 0.05) and CD3⁻/CD16⁺/CD56⁺ NKT cells (P < 0.001) were significantly lower in the OSAHS group than those in the control group. However, no significant difference was observed in the percentage of CD3⁺ total T cells, CD8⁺/CD28⁺ T cells, CD8⁺/CD28⁻ T cells, DC1, DC2, and DC1/DC2 dendritic cells between the OSAHS and control groups.

Conclusion

Our study showed differential responses of various types of immune cells in the peripheral blood in patients with OSAHS and their correlation with severity of oxygen desaturation.

https://ift.tt/2rGoSB9

Exclusively plant, whole-food diet for polypharmacy due to persistent atrial fibrillation, ischaemic cardiomyopathy, hyperlipidaemia and hypertension in an octogenarian

Polypharmacy is common and associated with negative health outcomes in the elderly. We report the case of an 82-year-old man with a history of polypharmacy due to coronary artery disease, myocardial infarction, ischaemic cardiomyopathy, hyperlipidaemia, hypertension and persistent atrial fibrillation who presented with memory loss, cognitive impairment, fatigue and weakness. His treatment plan included an exclusively plant, whole-food diet and moderate physical activity which resulted in a rapid reduction of hyperlipidaemia and high blood pressure and the discontinuation of statin, antihypertensive and beta blocker drug therapy. The patient also reported reversal of impaired cognition and symptoms associated with atrial fibrillation and ischaemic cardiomyopathy, including light-headedness, fatigue and weakness. This case demonstrates that dietary and lifestyle modifications have the potential to improve symptoms of cardiovascular disease and reduce polypharmacy along with associated negative consequences in the elderly.

https://ift.tt/2QFRPfB

Citrobacter freundii sepsis in an immunosuppressed patient with pemphigus vulgaris

Pemphigus vulgaris is an autoimmune bullous disease that involves the skin and mucous membranes. Current therapies aim to decrease antibody production by means of the use of systemic corticosteroids, immunosuppressive agents and, recently, rituximab, an anti-CD20 monoclonal antibody. However, the chronic immune suppression could entail complications, like infections and secondary malignancies. We describe a case of a patient with pemphigus who developed a sepsis due to Citrobacter freundii infection.

https://ift.tt/2BtUkXE

Rare complication of central venous catheter placement: bilateral hydrothorax

Central venous catheters (CVCs) are very useful tools in clinical medicine. It is important not only for the administration of medications or fluids but also the measurement of haemodynamic variables, especially in intensive care patients. CVC placement is a relatively safe procedure but may occasionally be associated with complications, such as pneumothorax, haemothorax, cardiac tamponade, sepsis and thrombosis. We aim to report an extraordinary case of bilateral hydrothorax due to CVC placement.

https://ift.tt/2QFRHwD

Levator palpebrae superioris nuclear palsy in a child with artery of Percheron infarction

https://ift.tt/2BndEpE

Fungal endocarditis of native valves

https://ift.tt/2QDda9v

Diffuse large B cell lymphoma: cutaneous presentation

https://ift.tt/2BpT9Zw

Misconceptions surrounding pregnancy-associated breast cancer

This case report describes a 31-year-old woman who presented with a right painless breast lump. A mammogram and ultrasound scan showed the lump was suspicious of cancer. Core biopsy and immunohistochemistry of the lump confirmed a triple negative, poorly differentiated, invasive ductal carcinoma of the right breast. One week following her diagnosis, the patient found out she was pregnant. The patient was worried about what the implications this diagnosis would have on both her baby and her own cancer treatment.

https://ift.tt/2QFRzgD

Tilting the balance: hemidiaphragm paralysis leading to right to left cardiac shunt

Patent foramen ovale (PFO) is a congenital abnormality present in 25%–30% of healthy adults and rarely leads to any sequelae.^{1 2} It is associated with a left-to-right shunt which usually does not lead to any haemodynamic compromise. Occasionally, the shunt can get reversed; that is, right-to-left shunt occurs due to worsening pulmonary hypertension and can lead to persistent hypoxia. It is rare for the shunt reversal to happen in the absence of pulmonary hypertension. Here, we present an exceedingly rare case in a 61-year-old man presenting with hypoxia, was found to have shunt reversal due to unilateral diaphragmatic paralysis. He was successfully treated with PFO closure. The purpose of this report is to consider rare possibilities of PFO shunt reversal when the right-sided heart pressure is normal and to highlight that a simple chest X-ray can be a clue to the diagnosis.

https://ift.tt/2BpT34b

Genotype‐phenotype correlations in Brazilian patients with Hereditary Angioedema due to C1‐ inhibitor deficiency

https://ift.tt/2S7qiAm

Table of contents

https://ift.tt/2R5GFAg

Masthead

https://ift.tt/2GpaxDq

“Five‐point eight‐line” anatomic flap design for precise hemitongue reconstruction

Abstract

Background

Reconstruction of hemiglossectomy defects requires careful flap design to avoid adverse functional and aesthetic outcomes.

Methods

Hemitongue specimens were obtained from minipigs to study the three‐dimensional anatomy and to define anatomic landmarks for precise measurements of flap requirement. The concept developed in animal models was then applied to hemiglossectomy reconstruction in clinical practice. Sixty‐one patients were randomly enrolled into the following two groups: a "five‐point eight‐line segment" (FIPELS) flap design group (28 patients) and a conventional group (33 patients). Functional and aesthetic outcomes were compared between the two groups.

Results

All flaps designed with the FIPELS technique matched the hemiglossectomy defects without the need for flap trimming, thus reducing the operating time (P = .03). Swallowing functions, speech intelligibility, and aesthetic outcomes were superior in the FIPELS group than that in the conventional group (P < .05).

Conclusions

The FIPELS flap design for hemiglossectomy reconstruction yields improved functional and aesthetic outcomes compared to a conventional flap design.

https://ift.tt/2QCiOZl

Evaluation of 4-amino 2-anilinoquinazolines against Plasmodium and other apicomplexan parasites in vitro and in a P. falciparum humanized NOD-scid IL2R{gamma}null mouse model of malaria [Experimental Therapeutics]

A series of 4-amino 2-anilinoquinazolines optimized for activity against the most lethal malaria parasite of humans, Plasmodium falciparum, were evaluated for activity against other human Plasmodium parasites and related apicomplexans that infect humans and animals. Four of the most promising compounds from the 4-amino 2-anilinoquinazoline series were equally as effective against the asexual blood stages of the zoonotic P. knowlesi suggesting they could also be effective against the closely related P. vivax, another important human pathogen. The 2-anilinoquinazoline compounds were also potent against an array of P. falciparum parasites resistant to clinically available anti-malarial compounds although slightly less so than the drug sensitive 3D7 parasite line. The apicomplexan parasites Toxoplasma gondii, Babesia bovis and Cryptosporidium parvum were less sensitive to the 2-anilinoquinazoline series with an EC₅₀ generally in the low micromolar range suggesting the yet to be discovered target of these compounds is absent or highly divergent in non-Plasmodium parasites. The 2-anilinoquinazoline compounds act as rapidly as chloroquine in vitro and when tested in rodents displayed a half-life that contributed to the compound's capacity to clear P. falciparum blood stages in a humanized mouse model. At a dose of 50 mg/kg adverse effects to the humanized mice were noted and evaluation against a panel of experimental high-risk off targets indicated some potential off target activity. Further optimization of the 2-anilinoquinazoline antimalarial class will concentrate on improving in vivo efficacy and addressing adverse risk.

https://ift.tt/2URLwnt

Emergence of OXA-232 carbapenemase-producing Klebsiella pneumoniae that carries a pLVPK-like virulence plasmid among elderly patients in China [Mechanisms of Resistance]

This study reported the clonal dissemination of OXA-232-producing ST15 carbapenem-resistant K. pneumoniae among elderly patients in China. All patients were immunocompromised, suffered from multiple underlying diseases, and hospitalized for a prolonged period; yet they slowly recovered upon antimicrobial therapy. The bla_OXA-232 gene was in a 6.1 Kb ColKP3-type non-conjugative plasmid. The strains displayed multidrug resistance phenotype and were not hypervirulent despite harboring a virulence plasmid. Active surveillance should be enforced to control the further transmission.

https://ift.tt/2PKy1lJ

Changing molecular markers of antimalarial drug sensitivity across Uganda [Epidemiology and Surveillance]

The potential spread of antimalarial drug resistance to Africa, in particular for artemisinins and key partner drugs, is a major concern. We surveyed Plasmodium falciparum genetic markers associated with drug sensitivity on 3 occasions at ~6 month intervals in 2016-17 at 10 sites representing a range of epidemiological settings in Uganda. For putative drug transporters, we found continued evolution toward wild type sequences associated with increased sensitivity to chloroquine. For pfcrt K76T, by 2017 the prevalence of wild type was >60% at all sites, and >90% at 6 sites. For the pfmdr1 N86Y and D1246Y alleles, wild type prevalence ranged from 80-100%. We found low prevalence of K13 propeller domain mutations, which are associated with artemisinin resistance in Asia, but one mutation previously identified in northern Uganda, 675V, was seen in 2.0% of samples, including 5.5% from the 3 northernmost sites. Amplification of the pfmdr1 and plasmepsin2 genes, associated elsewhere with decreased sensitivity to lumefantrine and piperaquine, respectively, was seen in <1% of samples. For the antifolate targets pfdhfr and pfdhps, 5 mutations previously associated with resistance were very common, and the pfdhfr 164L and pfdhps 581G mutations associated with higher-level resistance were seen at multiple sites, although prevalence did not clearly increase over time. Overall, changes were consistent with the selective pressure of the national treatment regimen, artemether-lumefantrine, with increased sensitivity to chloroquine, and with poor efficacy of antifolates. Strong evidence for resistance to artemisinins was not seen. Continued surveillance of markers that predict antimalarial drug sensitivity is warranted.

https://ift.tt/2UR0ZUW

Isavuconazole in the Treatment of Coccidioidal Meningitis [Clinical Therapeutics]

Patients with coccidioidal meningitis require life-long antifungal therapy. Cumulative toxicity and lack of antifungal efficacy requires salvage therapy in the treatment of some patients. In a retrospective review of nine patients with coccidioidal meningitis treated with isavuconazole, successful therapy was seen in 3/9 patients and stable disease confirmed in 6/9. Isavuconazole may be a useful addition to the therapeutic choices currently available for coccidioidal meningitis.

https://ift.tt/2PMAyMx

Bone and Joint Tissues Penetration of the Staphylococcus-Selective Antibiotic Afabicin in Patients Undergoing Elective Hip Replacement Surgery [Clinical Therapeutics]

Afabicin (formerly Debio 1450, AFN-1720) is a prodrug of afabicin desphosphono (Debio 1452, AFN-1252), a novel antibiotic in development which targets the staphylococcal enoyl-acyl carrier protein reductase (FabI), and exhibits selective potent antibacterial activity against staphylococcal species, including methicillin-resistant Staphylococcus aureus.

As part of clinical development in bone and joint infections, a distribution study in bone was performed in 17 patients who underwent elective hip replacement surgery. Patients received 3 doses of 240 mg afabicin orally (q12h) at various time points before surgery. Afabicin desphosphono concentrations were measured by LC-MS/MS in plasma, cortical bone, cancellous bone, bone marrow, soft tissue and synovial fluid collected during surgery at 2, 4, 6, or 12 hours after the third afabicin dose.

The study showed good penetration of afabicin desphosphono into bone tissues with mean AUC ratios for cortical, cancellous, bone marrow, soft tissue and synovial fluid to total plasma concentrations of 0.21, 0.40, 0.32, 0.35 and 0.61, respectively. When accounting for the free fraction in plasma (2%) and synovial fluid (9.4%), the mean ratio was 2.88 which is indicative of excellent penetration, and showed that afabicin desphosphono concentration was beyond MIC90 of S. aureus over the complete dosing interval.

These findings, along with preclinical efficacy data, clinical efficacy data in skin and soft tissue staphylococcal infection, availability of both IV and oral formulations, and potential advantages over broad-spectrum antibiotics for the treatment of staphylococcal bone or joint infections, support the clinical development of afabicin in bone and joint infections.

https://ift.tt/2UOB3cF

Oxazolidinones Can Replace Clarithromycin in Combination with Rifampin in a Mouse Model of Buruli Ulcer [Experimental Therapeutics]

Rifampin (RIF) plus clarithromycin (CLR) for 8 weeks is now the standard of care for Buruli ulcer (BU) treatment, but CLR may not be an ideal companion for rifamycins due to bidirectional drug-drug interactions. The oxazolidinone linezolid (LZD) was previously shown to be active against Mycobacterium ulcerans infection in mice but has dose- and duration-dependent toxicity in humans. Sutezolid (SZD) and tedizolid (TZD) may be safer than LZD. Here, we evaluated the efficacy of these oxazolidinones in combination with rifampin in a murine BU model. Mice with M. ulcerans-infected footpads received control regimens of RIF plus either streptomycin (STR) or CLR or test regimens of RIF plus either LZD (1 of 2 doses), SZD, or TZD for up to 8 weeks. All combination regimens reduced the swelling and bacterial burden in footpads after two weeks of treatment compared with RIF alone. RIF+SZD was the most active test regimen, while RIF+LZD was also no less active than RIF+CLR. After 4 and 6 weeks of treatment, neither CLR nor the oxazolidinones added significant bactericidal activity to RIF alone. By the end of 8 weeks of treatment, all regimens rendered footpads culture negative. We conclude that SZD and LZD warrant consideration as alternative companion agents to CLR in combination with RIF to treat BU, especially when CLR is contraindicated, intolerable, or unavailable. Further evaluation could prove SZD superior to CLR in this combination.

https://ift.tt/2PMAwEp

Mass Balance and Drug Interaction Potential of IV Eravacycline Administered to Healthy Subjects [Pharmacology]

Eravacycline is a novel, fully-synthetic fluorocycline that is undergoing clinical development for treating serious bacterial infections due to multidrug-resistant pathogens. We report results from three studies in healthy subjects that investigated the distribution, metabolism, and excretion of intravenous (IV) eravacycline and the effect of a CYP3A4 inhibitor (itraconazole) and inducer (rifampin) on the pharmacokinetics (PK) of IV eravacycline. In the mass balance study, the majority of total radioactivity from [14C]-eravacycline was recovered in the feces, suggesting biliary/fecal elimination is the major route of excretion for eravacycline and its metabolites after IV administration. The volume of distribution (217 L) was greater than extracellular fluid, which suggests distribution beyond the central compartment. In the drug-drug interaction studies, mean AUC_0-t and half-life were increased approximately 30%-40% after a concomitant dose of IV eravacycline and itraconazole and clearance was decreased. A reduction in total eravacycline exposure (AUC) of approximately 25%-35% and an increase in CL of approximately 50% occurred with concomitant eravacycline and rifampin. The dose of eravacycline should be increased to 1.5 mg/kg Q12H when coadministered with a strong CYP3A inducer.

https://ift.tt/2UR0Oce

Detection of echinocandin-resistant Candida glabrata in blood cultures spiked with different percentages of FKS2 mutants [Susceptibility]

Infections caused by the co-existence of C. glabrata echinocandin-resistant- and echinocandin-susceptible cells may be possible and the detection of FKS mutants when the proportions of FKS mutants are underrepresented poses a problem. We assessed the role of EUCAST and methods directly performed on positive blood cultures – Etest (ET_DIR) and anidulafungin-containing agar plates – for detecting resistance in C. glabrata isolates containing different amounts of echinocandin-susceptible/resistant Candida glabrata isolates.

We studied ten pairs of C. glabrata involving parental echinocandin-susceptible and isogenic echinocandin-resistant FKS mutant isolates. Three inocula per pair (1-5 x 10³, 1-5 x 10², and 10-50 CFU/mL) were prepared spanning suspensions with different amounts of susceptible/resistant isolates (9/1, 5/5, and 1/9). Suspensions were spiked in BACTEC bottles and incubated until positive and compared the three methods.

The EUCAST showed echinocandin resistance when the bottles were spiked with resistant isolates at 5/5 and 1/9 proportions; the suspensions with a 9/1 proportion of resistant isolates resulted susceptible in three pairs. We observed with the ET_DIR, resistance to both echinocandins in all pairs (resistance to micafungin and anidulafungin, MICs ≥ 0.064 mg/L and ≥ 0.125 mg/L, respectively) and a double ring of growth inhibition in two pairs. The anidulafungin-containing plates showed fungal growth in the 90 spiked blood cultures at 48 hours. Testing of echinocandin susceptibility with the ET_DIR directly on blood positive bottles is a reliable and rapid method to detect echinocandin resistance in C. glabrata. On the other hand, resistance can be missed with the EUCAST method when resistant-isolates are underrepresented.

https://ift.tt/2PMApst

Spironolactone as an antischistosomal drug capable of clinical repurposing: in vitro and in vivo studies [Experimental Therapeutics]

Schistosomiasis is a parasitic flatworm disease that infects over 200 million people worldwide, especially in poor communities. Treatment and control of the disease rely on just one drug, praziquantel. Since funding for drug development for poverty-associated diseases is very limited, drug repurposing is a promising strategy. In this study, from a screening of 13 marketed diuretics, we identified that spironolactone, a potassium-sparing diuretic, had potent antischistosomal effects on Schistosoma mansoni in vitro and in vivo in a murine model of schistosomiasis. In vitro, spironolactone at low concentrations (< 10 µM) is able to alter worm motor activity and the morphology of adult schistosomes, leading to parasitic death. In vivo, oral treatment with spironolactone at a single dose (400 mg/kg) or daily for five consecutive days (100 mg/kg/day) in mice harbouring either patent or pre-patent infections significantly reduced worm burden, egg production, and hepato- and splenomegaly (P<0.05 to P<0.001). Taken together with the safety profile of spironolactone, supported by its potential to affect schistosomes, these results indicate that spironolactone could be a potential treatment for schistosomiasis and make it promising for re-purposing.

https://ift.tt/2ULUenc

The Hypothetical Impact of Accelerate Pheno (ACC) on Time to Effective Therapy and Time to Definitive Therapy for bloodstream infections due to drug-resistant Gram-negative bacilli. [Clinical Therapeutics]

Background

Strategies are needed to improve time to optimal therapy in patients with bloodstream infections (BSI) due to resistant Gram-negative (GN) pathogens. Accelerate Pheno™ (ACC) can provide antimicrobial susceptibility results within 7 hours of a positive culture and may more rapidly optimize therapy.

Objectives

The primary objective was to evaluate the hypothetical impact of ACC on time to effective therapy (TTET) and time to definitive therapy (TTDT) among patients with BSI due to resistant GN pathogens.

Methods

ACC was performed on resistant GN BSI isolates and results were not available to clinicians in real time. Potential benefit of having ACC on TTET or TTDT was determined if modifications to antimicrobial regimens could have been made sooner with ACC. Comparisons on the impact of ACC in the presence or absence of Verigene GN-BC were performed.

Results

61 patients with resistant GN BSI were evaluated. The median actual TTET and TTDT in the cohort was 25.9 hours (h) (interquartile (IQR) 18.5, 42.1) and 47.6 h (IQR 24.9, 79.6), respectively. Almost half of the patients had potential improvement in TTET and/or TTDT with ACC. In patients who would have had a benefit the median potential decreases in TTET and TTDT were 16.6 h (IQR 5.5 – 30.6) and 29.8 h (IQR 13.6 – 43), respectively. The largest potential improvements were seen in patients where Verigene results were not available.

Conclusions

Among patients with resistant GN BSI in a setting where other rapid diagnostic technologies are utilized, ACC results could have further improved TTET and TTDT.

https://ift.tt/2PMAjB7

Pharmacokinetic/Pharmacodynamic Evaluation of a Novel Aminomethylcycline Antibiotic, KBP-7072, in the Neutropenic Murine Pneumonia Model against S. aureus and S. pneumoniae [Experimental Therapeutics]

KBP-7072 is a novel aminomethylcycline antibiotic in clinical development for community-acquired pneumonia. The goal of present studies was to determine which pharmacokinetic/pharmacodynamic (PK/PD) magnitude correlated with efficacy in the murine pneumonia infection model against Staphylococcus aureus and Streptococcus pneumoniae. KBP-7072 pharmacokinetic measures were performed in plasma and epithelial lining fluid (ELF) at 4-fold increasing doses from 1-256 mg/kg subcutaneously. Pharmacokinetic parameters were calculated using a noncompartmental model and were linear over the dose range. Penetration into ELF ranged from 82 to 238% when comparing ELF drug concentrations to plasma free drug concentrations. Twenty-four-hour dose-ranging efficacy studies were then performed in the neutropenic murine pneumonia model against 5 S. aureus (3 MRSA, 2 MSSA) and 6 S. pneumoniae (2 Tet^R, 2 Pen^R) strains. KBP-7072 demonstrated potent in vivo activity resulting in a 3-5 log₁₀ kill in CFU burden compared to the start of therapy for all strains. The PK/PD index AUC/MIC corelated well with efficacy (R² 0.80-0.89). Net stasis was achieved at a plasma 24-h free drug AUC/MIC values of 1.13 and 1.41 (24-h ELF AUC/MIC values of 2.01 and 2.50) for S. aureus and S. pneumonia, respectively. One-log₁₀ kill was achieved at 24-h plasma AUC/MIC values of 2.59 and 5.67 (24-h ELF AUC/MIC values 4.22 and 10.08) for S. aureus and S. pneumonia, respectively. A 2-log₁₀ kill was achieved at 24-h plasma AUC/MIC values of 7.16 and 31.14 (24-h ELF AUC/MIC of 8.37 and 42.92) for S. aureus and S. pneumonia, respectively. The results of these experiments will aid in the rational design of dose-finding studies for KBP-7072 in patients with community-acquired bacterial pneumonia (CAP).

https://ift.tt/2UUiR1k

Clinical Thyroidology® for the Public – Highlighted Article

From Clinical Thyroidology^® for the Public: Higher iodine intake in the mother during pregnancy is associated with higher child IQ. Read More…

We welcome your feedback and suggestions. Let us know what you want to see in this publication.

Feedback & Suggestions

The post Clinical Thyroidology^® for the Public – Highlighted Article appeared first on American Thyroid Association.

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Dear Dr. Dermatoethicist: Credit Card on File

https://ift.tt/2ST7tRu

Two cases of Tullio phenomenon in which oval and round window reinforcement surgery was effective

To report the effect of oval and round window reinforcement surgery performed in two patients with the Tullio phenomenon. Case 1: A male with bilateral superior canal dehiscence syndrome. Downbeat nystagmus with leftward horizontal eye movement was recorded in an electronystagmogram using a pure-tone sound of 110dB at 2000 or 4000Hz in the right ear. Case 2: A female who had undergone stapes surgery. Computed tomography revealed an ossicular prosthesis in the vestibule. An audiogram indicated mild to moderate hearing impairment in the right ear.

https://ift.tt/2EoCHff

Scrofuloderma with disseminated tuberculosis in an Ethiopian child: a case report

Cutaneous tuberculosis represents only 1–2% of extrapulmonary forms of tuberculosis. Scrofuloderma is an endogenous form of cutaneous tuberculosis and can present as isolated or coexist with pulmonary and diss...

https://ift.tt/2S11UAe

Tislelizumab in Combination With Chemotherapy as First-Line Treatment in Adults With Inoperable, Locally Advanced or Metastatic Gastric, or Gastroesophageal Junction Carcinoma

Condition:   Gastric, or Gastroesophageal Junction Adenocarcinoma
Interventions:   Drug: Tislelizumab (BGB-A317) combined with oxaliplatin and capecitabine or Tislelizumab (BGB-A317) combined with Cisplatin and 5-FU;   Drug: Placebo combined with oxaliplatin and capecitabine or Placebo combined with Cisplatin and 5-FU
Sponsor:   BeiGene
Not yet recruiting

https://ift.tt/2QYxOA3

Cold Weather Injuries | Keeping Your Kids Warm

How cold is too cold for your child to be playing outside? In this episode, our team braves the cold and answers your questions about cold-related dangers like hypothermia and frostbite. We'll also go over some of the ways you can minimize the risk of a fall, for you and your child, when it's icy outside.

The post Cold Weather Injuries | Keeping Your Kids Warm appeared first on ChildrensMD.

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A semi-mechanistic model describing the influence of light and temperature on the respiration and photosynthetic growth of Chlorella vulgaris

https://ift.tt/2S0GdjM

Increased levels of systemic LPS-positive bacterial extracellular vesicles in patients with intestinal barrier dysfunction

https://ift.tt/2A1EyDK

Autoimmune pancreatitis in children: The impact of immune system in a challenging disease

Publication date: Available online 17 December 2018

Source: Autoimmunity Reviews

Author(s): Danilo Pagliari, Rossella Cianci, Donato Rigante

https://ift.tt/2rH438D

Airborne sound insulation in terms of a loudness model

Neubauer, RO; Kang, J; (2014) Airborne sound insulation in terms of a loudness model. Applied Acoustics , 85 pp. 34-45. 10.1016/j.apacoust.2014.03.024 . Green open access

https://ift.tt/2UYavWq

The SUMMA platform prototype

Liepins, R; Germann, U; Barzdins, G; Birch, A; Renals, S; Weber, S; Van Der Kreeft, P; ... Mitchell, J; + view all Liepins, R; Germann, U; Barzdins, G; Birch, A; Renals, S; Weber, S; Van Der Kreeft, P; Bourlard, H; Prieto, J; Klejch, O; Bell, P; Lazaridis, A; Mendes, A; Riedel, S; Almeida, MSC; Balage, P; Cohen, S; Dwojak, T; Garner, P; Giefer, A; Junczys-Dowmunt, M; Imran, H; Nogueira, D; Ali, A; Miranda, S; Popescu-Belis, A; Werlen, LM; Papasarantopoulos, N; Obamuyide, A; Jones, C; Dalvi, F; Vlachos, A; Wang, Y; Tong, S; Sennrich, R; Pappas, N; Narayan, S; Damonte, M; Durrani, N; Khurana, S; Abdelali, A; Sajjad, H; Vogel, S; Sheppey, D; Hernon, C; Mitchell, J; - view fewer (2017) The SUMMA platform prototype. In: (Proceedings) Proceedings of the EACL 2017 Software Demonstrations. (pp. pp. 116-119). Association for Computational Linguistics: Valencia, Spain.

https://ift.tt/2UYaFNw

Interactions between ultra-high-energy particles and protogalactic environments

Owen, ER; Jacobsen, IB; Wu, K; Surajbali, P; (2018) Interactions between ultra-high-energy particles and protogalactic environments. Monthly Notices of the Royal Astronomical Society , 481 (1) pp. 666-687. 10.1093/mnras/sty2279 . Green open access

https://ift.tt/2LoNtTW

Spectral Analysis of the Spin-Boson Hamiltonian with Two Photons for Arbitrary Coupling

Ibrogimov, OO; (2018) Spectral Analysis of the Spin-Boson Hamiltonian with Two Photons for Arbitrary Coupling. Annales Henri Poincaré 10.1007/s00023-018-0725-z . (In press). Green open access

https://ift.tt/2Lmq0Tr

Environmental law in the United Kingdom post Brexit

Macrory, RB; (2018) Environmental law in the United Kingdom post Brexit. ERA Forum 10.1007/s12027-018-0531-6 . (In press). Green open access

https://ift.tt/2UQYodF

Designing digital displays and interactive media in today’s cities by night. Do we know enough about attracting attention to do so?

Zielinska-Dabkowska, K; Fatah gen. Schieck, A; (2018) Designing digital displays and interactive media in today's cities by night. Do we know enough about attracting attention to do so? Conscious Cities (In press).

https://ift.tt/2LoNmru

Resolving the Discrepancy in Tortuosity Factor Estimation for Li-Ion Battery Electrodes through Micro-Macro Modeling and Experiment

Usseglio-Viretta, FLE; Colclasure, A; Mistry, AN; Claver, KPY; Pouraghajan, F; Finegan, DP; Heenan, TMM; ... Smith, K; + view all Usseglio-Viretta, FLE; Colclasure, A; Mistry, AN; Claver, KPY; Pouraghajan, F; Finegan, DP; Heenan, TMM; Abraham, D; Mukherjee, PP; Wheeler, D; Shearing, P; Cooper, SJ; Smith, K; - view fewer (2018) Resolving the Discrepancy in Tortuosity Factor Estimation for Li-Ion Battery Electrodes through Micro-Macro Modeling and Experiment. Journal of The Electrochemical Society , 165 (14) A3403-A3426. 10.1149/2.0731814jes . Green open access

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How Well Can We Predict Hypernyms from Word Embeddings? A Dataset-Centric Analysis

Ivan Sanchez Carmona, V; Riedel, S; (2017) How Well Can We Predict Hypernyms from Word Embeddings? A Dataset-Centric Analysis. In: Proceedings of the 15th Conference of the European Chapter of the Association for Computational Linguistics: Volume 2, Short Papers. (pp. pp. 401-407). Association for Computational Linguistics: Valencia, Spain.

https://ift.tt/2LoNcQU

Influence of mesoscale urban morphology on the spatial noise attenuation of flyover aircrafts

Hao, Y; Kang, J; (2014) Influence of mesoscale urban morphology on the spatial noise attenuation of flyover aircrafts. Applied Acoustics , 84 pp. 73-82. 10.1016/j.apacoust.2013.12.001 . Green open access

https://ift.tt/2URA7UQ

Earthquake Damage Data Collection Using Omnidirectional Imagery

Stone, H; Putrino, V; D'Ayala, D; (2018) Earthquake Damage Data Collection Using Omnidirectional Imagery. Frontiers in Built Environment , 4 (51) 10.3389/fbuil.2018.00051 . Green open access

https://ift.tt/2LoN43S

The blood-brain interface: a culture change

Galea, I; Perry, VH; (2017) The blood-brain interface: a culture change. Brain, Behavior, and Immunity , 68 pp. 11-16. 10.1016/j.bbi.2017.10.014 . Green open access

https://ift.tt/2UULlbh

Spinocerebellar ataxia: an update

Sullivan, R; Yau, WY; O'Connor, E; Houlden, H; (2018) Spinocerebellar ataxia: an update. Journal of Neurology 10.1007/s00415-018-9076-4 . (In press). Green open access

https://ift.tt/2LmjEnd

Improving RNN with atention and embedding for adverse drug reactions

Pandey, C; Ibrahim, Z; Wu, H; Iqbal, E; Dobson, R; (2017) Improving RNN with atention and embedding for adverse drug reactions. In: Proceedings of the 2017 International Conference on Digital Health: DH 17. (pp. pp. 67-71). ACM: London, United Kingdom. Green open access

https://ift.tt/2UQYn9B

Finding common ground between UK based and Chinese approaches to earthen heritage conservation

Richards, JCJ; Wang, Y; Orr, SA; Viles, H; (2018) Finding common ground between UK based and Chinese approaches to earthen heritage conservation. Sustainability , 10 (9) , Article 3086. 10.3390/su10093086 . Green open access

https://ift.tt/2LqhBi8

The use of human neurons for novel drug discovery in dementia research

Vargas-Caballero, M; Willaime-Morawek, S; Gomez-Nicola, D; Perry, VH; Bulters, D; Mudher, A; (2016) The use of human neurons for novel drug discovery in dementia research. Expert Opinion on Drug Discovery , 11 (4) pp. 355-367. 10.1517/17460441.2016.1154528 . Green open access

https://ift.tt/2LqhKlG

Progressive Ventricles Enlargement and Cerebrospinal Fluid Volume Increases as a Marker of Neurodegeneration in Patients with Spinal Cord Injury: A Longitudinal Magnetic Resonance Imaging Study

Seif, M; Ziegler, G; Freund, P; (2018) Progressive Ventricles Enlargement and Cerebrospinal Fluid Volume Increases as a Marker of Neurodegeneration in Patients with Spinal Cord Injury: A Longitudinal Magnetic Resonance Imaging Study. Journal of Neurotrauma 10.1089/neu.2017.5522 . (In press). Green open access

https://ift.tt/2UQB7so

Major Wind Energy & the Interface of Policy and Regulation: A Study of Welsh NSIPs

Natarajan, L; (2018) Major Wind Energy & the Interface of Policy and Regulation: A Study of Welsh NSIPs. Planning Practice and Research 10.1080/02697459.2018.1548216 . (In press). Green open access

https://ift.tt/2UQMeBp

Treatment and long-term outcome in primary distal Renal Tubular Acidosis

Lopez-Garcia, SC; Emma, F; Walsh, SB; Fila, M; Hooman, N; Zaniew, M; Bertholet-Thomas, A; ... Bockenhauer, D; + view all Lopez-Garcia, SC; Emma, F; Walsh, SB; Fila, M; Hooman, N; Zaniew, M; Bertholet-Thomas, A; Colussic, G; Burgmaier, K; Levtchenko, E; Sharma, J; Soliman, NA; Ariceta, G; Basu, B; Murer, L; Tasic, V; Tsygin, A; Decramer, S; Gil-Pena, H; Koster-Kamphius, L; La Scola, C; Gellermann, J; Konrad, M; Lilien, M; Francisco, T; Tramma, D; Trnka, P; Yuksel, S; Caruso, MR; Chromek, M; Ekinci, Z; Gambaro, G; Kari, JA; Konig, J; Taroni, F; Thumfart, J; Trepiccione, F; Windin, L; Wuh, E; Agbas, A; Belkevich, A; Vargas-Poussou, R; Blanchard, A; Conti, G; Boyer, O; Dursun, I; Pinarbasi, AS; Melek, E; Miglinas, M; Novo, R; Mallett, A; Milosevic, D; Szczepanska, M; Wente, S; Cheong, HI; Sinha, R; Gucev, Z; Dufek, S; Iancu, D; Kleta, R; Schaefer, F; Bockenhauer, D; - view fewer (2019) Treatment and long-term outcome in primary distal Renal Tubular Acidosis. Nephrology Dialysis Transplantation (In press).

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High-frequency, functional HIV-specific T-follicular helper and regulatory cells are present within germinal centers in children but not adults

Roider, J; Maehara, T; Ngoepe, A; Ramsuran, D; Muenchhoff, M; Adland, E; Aicher, T; ... Leslie, A; + view all Roider, J; Maehara, T; Ngoepe, A; Ramsuran, D; Muenchhoff, M; Adland, E; Aicher, T; Kazer, SW; Jooste, P; Karim, F; Kuhn, W; Shalek, AK; Ndung'u, T; Morris, L; Moore, PL; Pillai, S; Kløverpris, H; Goulder, P; Leslie, A; - view fewer (2018) High-frequency, functional HIV-specific T-follicular helper and regulatory cells are present within germinal centers in children but not adults. Frontiers in Immunology , 9 , Article 1975. 10.3389/fimmu.2018.01975 . Green open access

https://ift.tt/2UQB4gc

In vivo phase imaging of human epiphyseal cartilage at 7 T

Dymerska, B; Bohndorf, K; Schennach, P; Rauscher, A; Trattnig, S; Robinson, SD; (2018) In vivo phase imaging of human epiphyseal cartilage at 7 T. Magnetic Resonance in Medicine , 79 (4) pp. 2149-2155. 10.1002/mrm.26858 . Green open access

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Cell Death and Differentiation

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  Sphingolipid-mediated inflammatory signaling leading to autophagy inhibition converts erythropoiesis to myelopoiesis in human hematopoietic stem/progenitor cells

  Posted:2018-12-13

  Sphingolipid-mediated inflammatory signaling leading to autophagy inhibition converts erythropoiesis to myelopoiesis in human hematopoietic stem/progenitor cells

  Sphingolipid-mediated inflammatory signaling leading to autophagy inhibition converts erythropoiesis to myelopoiesis in human hematopoietic stem/progenitor cells, Published online: 13 December 2018; doi:10.1038/s41418-018-0245-x

  Sphingolipid-mediated inflammatory signaling leading to autophagy inhibition converts erythropoiesis to myelopoiesis in human hematopoietic stem/progenitor cells

• Author Correction: Eosinophil differentiation in the bone marrow is promoted by protein tyrosine phosphatase SHP2

  Posted:2018-12-13

  Author Correction: Eosinophil differentiation in the bone marrow is promoted by protein tyrosine phosphatase SHP2

  Author Correction: Eosinophil differentiation in the bone marrow is promoted by protein tyrosine phosphatase SHP2, Published online: 13 December 2018; doi:10.1038/s41418-018-0247-8

  Author Correction: Eosinophil differentiation in the bone marrow is promoted by protein tyrosine phosphatase SHP2

• Post-translational modifications of Beclin 1 provide multiple strategies for autophagy regulation

  Posted:2018-12-13

  Post-translational modifications of Beclin 1 provide multiple strategies for autophagy regulation

  Post-translational modifications of Beclin 1 provide multiple strategies for autophagy regulation, Published online: 13 December 2018; doi:10.1038/s41418-018-0254-9

  Post-translational modifications of Beclin 1 provide multiple strategies for autophagy regulation

• Author Correction: ATF4 regulation of mitochondrial folate-mediated one-carbon metabolism is neuroprotective

  Posted:2018-12-13

  Author Correction: ATF4 regulation of mitochondrial folate-mediated one-carbon metabolism is neuroprotective

  Author Correction: ATF4 regulation of mitochondrial folate-mediated one-carbon metabolism is neuroprotective, Published online: 13 December 2018; doi:10.1038/s41418-018-0253-x

  Author Correction: ATF4 regulation of mitochondrial folate-mediated one-carbon metabolism is neuroprotective

• By reducing global mRNA translation in several ways, 2-deoxyglucose lowers MCL-1 protein and sensitizes hemopoietic tumor cells to BH3 mimetic ABT737

  Posted:2018-12-11

  By reducing global mRNA translation in several ways, 2-deoxyglucose lowers MCL-1 protein and sensitizes hemopoietic tumor cells to BH3 mimetic ABT737

  By reducing global mRNA translation in several ways, 2-deoxyglucose lowers MCL-1 protein and sensitizes hemopoietic tumor cells to BH3 mimetic ABT737, Published online: 11 December 2018; doi:10.1038/s41418-018-0244-y

  By reducing global mRNA translation in several ways, 2-deoxyglucose lowers MCL-1 protein and sensitizes hemopoietic tumor cells to BH3 mimetic ABT737

• The proneural gene <i>ASCL1</i> governs the transcriptional subgroup affiliation in glioblastoma stem cells by directly repressing the mesenchymal gene <i>NDRG1</i>

  Posted:2018-12-11

  The proneural gene ASCL1 governs the transcriptional subgroup affiliation in glioblastoma stem cells by directly repressing the mesenchymal gene NDRG1

  The proneural gene <i>ASCL1</i> governs the transcriptional subgroup affiliation in glioblastoma stem cells by directly repressing the mesenchymal gene <i>NDRG1</i>, Published online: 11 December 2018; doi:10.1038/s41418-018-0248-7

  The proneural gene ASCL1 governs the transcriptional subgroup affiliation in glioblastoma stem cells by directly repressing the mesenchymal gene NDRG1

• Mutant p53 as a guardian of the cancer cell

  Posted:2018-12-11

  Mutant p53 as a guardian of the cancer cell

  Mutant p53 as a guardian of the cancer cell, Published online: 11 December 2018; doi:10.1038/s41418-018-0246-9

  Mutant p53 as a guardian of the cancer cell

• A DHX9-lncRNA-MDM2 interaction regulates cell invasion and angiogenesis of cervical cancer

  Posted:2018-12-05

  A DHX9-lncRNA-MDM2 interaction regulates cell invasion and angiogenesis of cervical cancer

  A DHX9-lncRNA-MDM2 interaction regulates cell invasion and angiogenesis of cervical cancer, Published online: 05 December 2018; doi:10.1038/s41418-018-0242-0

  A DHX9-lncRNA-MDM2 interaction regulates cell invasion and angiogenesis of cervical cancer

Egyptian Rheumatology and Rehabilitation (Egypt Rheumatol Rehabil) 2019 | January-March | Volume 46 | Issue 1

Intra-articular injection of platelet-rich plasma and therapeutic exercise in knee osteoarthritis Mona E. M Badr, Eman A. R Hafez, Atif I El-Ghaweet, Heba M El-Sayed Egyptian Rheumatology and Rehabilitation 2019 46(1):1-10 Context There is no definite treatment strategy capable of decreasing destruction of cartilage and enhancing its healing. Intra-articular injection of platelet-rich plasma (PRP) provides a lot of growth factors that are capable of stimulating regeneration of cartilage and is supposed to be a future solution to patients with osteoarthritis (OA). Aim To detect the efficacy of intra-articular injection of PRP or therapeutic exercise (Ex) alone as well as a combination of both in the treatment of idiopathic knee OA. Settings and design A prospective randomized controlled clinical study was conducted. Patients and methods A total of 60 patients, 44 to 65 years of age, having idiopathic unilateral knee OA were included in the study and were divided into three groups: PRP group included 20 patients and were treated with intra-articular PRP injection, Ex group included 20 patients and were treated with only therapeutic Ex, and PRP and Ex group included 20 patients who were treated with both PRP intra-articular injection and therapeutic Ex. Evaluation of all patients was done by visual analogue scale, tenderness, range of motion, thigh circumference, and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores at baseline and 1 and 6 months later. Objective evaluation was done through MRI of osteoarthritic knee at baseline and 6 months later. Statistical analysis Statistical analyses were performed using SPSS for windows, version 20.0. Results Baseline WOMAC score differences among the three groups were not statistically significant but were significant 6 months after treatment. In PRP and Ex groups, there was a significant improvement after treatment, whereas a highly significant improvement in PRP+Ex group. MRI grading differences among the three groups were not significant before or after treatment, with no improvement in all three groups after treatment. Conclusion A combination of intra-articular injection of PRP and therapeutic Ex resulted in significantly lesser visual analogue scale, WOMAC score, and joint tenderness compared with PRP or Ex alone.

Association of rheumatoid arthritis disease activity, severity with electrocardiographic findings, and carotid artery atherosclerosis Samia M Abd El-Monem, Ahmed Y Ali, Nashwa I Hashaad, Ahmed M Bendary, Hend A.F Abd El-Aziz Egyptian Rheumatology and Rehabilitation 2019 46(1):11-20 Aim The aim was to detect specific ECG changes in rheumatoid arthritis (RA) patients as well as to study atherosclerotic changes of the carotid arteries as an indicator of cardiovascular system risk factors and to correlate findings with disease activity and severity parameters to elucidate possible associations between these variables. Patients and methods This study included 30 RA patients, 30 age-matched and sex-matched systemic lupus erythematosus patients and 30 age-matched and sex-matched healthy volunteers as control groups. The patients were subjected to clinical examination, assessment of disease activity score-28 (DAS28), functional disability Health Assessment Questionnaire, and laboratory and radiological assessments. ECG and measurement of the carotid intima media thickness (CIMT) by carotid ultrasound scan was also done. Results Ten (33.3%) RA patients had ECG abnormalities, with ST or T-wave abnormality being the most common abnormality present. RA patients had the highest frequencies of ECG abnormalities. Most ECG changes occurred in RA patients using steroids (90%). ST or T-wave abnormality in RA occurred more in patients with a higher swollen joint count, higher DAS28, and a higher patients’ global health assessment. RA patients had the highest mean. The mean CIMT was significantly higher in RA patients with ECG abnormalities. There were significant positive correlations of average CIMT with DAS28, Health Assessment Questionnaire, and Simple Erosion Narrowing Score. There were significant positive correlations of mean CIMT with the level of triglycerides, cholesterol, high-density lipoprotein, erythrocyte sedimentation rate, and a highly significant correlation between mean CIMT and C-reactive protein. CIMT at a cut-off point of 0.75 mm can predict ECG abnormalities with high sensitivity and specificity. Conclusion ECG changes were present in 33.3% of RA patients. Increased CIMT was observed in RA patients and correlated well with disease activity and severity parameters.

The therapeutic application of functional electrical stimulation and transcranial magnetic stimulation in rehabilitation of the hand function in incomplete cervical spinal cord injury Shereen Fawaz, Fatma Kamel, Ahmed El Yasaky, Heba El Shishtawy, Ahmed Genedy, Reda M Awad, Lobna El Nabil Egyptian Rheumatology and Rehabilitation 2019 46(1):21-26 Background Functional electrical stimulation (FES) therapy has a potential to improve voluntary grasping and induce plastic changes among individuals with tetraplegia secondary to traumatic spinal cord injury (SCI). Also, evidence suggests that the use of high frequency repetitive transcranial magnetic stimulation (rTMS) to increase corticomotor excitability improves hand function in persons with cervical SCI. Purpose Our randomized controlled trial was carried out to compare the two rehabilitation programs, the first applied to FES and real rTMS whereas the second applied to FES and sham rTMS, with repect to hand function in chronic traumatic incomplete cervical SCI patients, and also with respect to changes in cortical excitability, and its relation to hand function before and after the rehabilitation programs. Patients and methods Our study included 22 patients with chronic traumatic incomplete SCI. Patients were randomly assigned into two groups, 11 patients each. Group I patients received FES for 12 weeks with an additional real rTMS therapy for the last two weeks, at 10 Hz frequency, subthreshold intensity for a total of 1500 pulse per session for 10 sessions. Whereas group II patients received FES for 12 weeks with an additional sham rTMS therapy for the last two weeks. All were followed by an intensive hand training program. Patients were assessed: using hand function tests (action research arm test, modified Sollerman hand function test, nine-hole pegboard scale, and finger tapping test) and corticomotor excitability tests (using amplitude of motor evoked potential). Conclusion Our study showed statistically significant improvements in hand function tests in group I, who received FES in addition to real rTMS therapy in comparison with group II, who received FES in addition to sham rTMS at 12-week assessment. This could support the evidence of the additional benefit of real rTMS therapy for 10 sessions/2 weeks in improving hand function and motor recovery following SCI.

Electromyographic study to predict functional outcome of transforaminal epidural steroid injection in lumbosacral radiculopathy Hussein Sultan, Tamer H Shehata, Wafaa S El-Emary, Shehad M Fakhry Egyptian Rheumatology and Rehabilitation 2019 46(1):27-34 Context Epidural steriod injections (ESIs) are commonly used for managment of lumbosacral radiculopathy (LSR). Predicting outcomes after ESIs could be another valuable application of needle electromyography (EMG) in these patients. Aim The aim was to determine if EMG study can predict the functional outcome of transforaminal ESIs in patients with LSR. Materials and methods The study included 20 patients with clinical diagnosis of LSR. Peripheral nerve conduction study, late responses, somatomsensory evoked potentials, and needle EMG were performed in both lower limbs followed by transforaminal ESI under fluoroscopic guidance. The functional outcome was evaluated using visual analog scale for pain and Oswestry disability index (ODI) that were performed before and after injections. Results There were statistically significant decrease in pain severity (visual analog scale; P=0.022) and in ODI (improvement in functional score; P=0.029) after injection in patients with symptom duration less than 3 months compared with patients with longer duration of symptoms. In patients with negative EMG findings, there was a significantly greater reduction in pain severity (P<0.01) and ODI score (P<0.01) after injection compared with patients with positive findings. Regression analysis showed that negative needle EMG findings were significant predictors of pain reduction (P=0.001) and functional improvement (P=0.002) in patients with LSR after ESI. Conclusion This study supports the notion that EMG studies can be used for prediction of functional outcome in patients with LSR performing transforaminal ESI.

Body, wrist, and hand anthropometric measurements as risk factors for carpal tunnel syndrome Mohamed H Imam, Marwa M Hasan, Rehab A ELnemr, Riham H El-Sayed Egyptian Rheumatology and Rehabilitation 2019 46(1):35-41 Aim The aim of this study was to identify cut-off values for body, hand, and wrist measurements in order to correctly identify individuals with increased risk of carpal tunnel syndrome (CTS). Patients and methods This study included 30 patients with clinically diagnosed and electrophysiologically confirmed idiopathic CTS and 30 age-matched and sex-matched healthy volunteers as the control group. Both groups performed sensory and motor conduction studies of the median nerve. Body, hand, and wrist anthropometric measurements were taken including weight, height, waist circumference, hip circumferences, wrist depth/width, third digit length, palm length/width, and hand length. Obesity indicators and hand/wrist ratios were calculated. Area under the ROC curve (AUC), confidence intervals, cut-off values, sensitivity, and specificity were calculated separately for each measured parameter. Results There were statistically significant differences among the studied participants regarding all measured anthropometric parameters (P<0.001). As a result, all studied patients had squarer wrists and shorter hands than healthy participants. The AUC values for all studied measurements showed high accuracy (AUC<95) except for hip circumference, waist-to-hip ratio, palm length, third digit length, and digit index which showed moderate accuracy. In the studied patients there were positive significant correlations between BMI, wrist depth, wrist ratio, and shape index with an electrophysiological severity grading of CTS of the studied patients; on the other hand, there were negative significant correlations between palm length, hand length, and hand ratio with electrophysiological severity grading of CTS. Conclusion The cut-off values for body, wrist, and hand anthropometric measurements are useful tools to assess the risk factors for CTS.

Importance of patient education in management of patients with rheumatoid arthritis: an intervention study Soha H Senara, Wafaa Y Abdel Wahed, Shimaa E Mabrouk Egyptian Rheumatology and Rehabilitation 2019 46(1):42-47 Background People living with chronic diseases such as rheumatoid arthritis (RA) are extremely in need of patient education (PE) to adapt and cope with the effects of the disease and treatments. PE comprises all educational activities provided for patients, including aspects of therapeutic education, health education, and health promotion. Objective The aim of this study was to evaluate the effect of PE program following the eight evidence-based EULAR-2015 recommendations in the management of patients with RA. Patients and methods A randomized controlled clinical trial with two parallel arms was carried out at the Department of Rheumatology and Rehabilitation, Faculty of Medicine, Fayoum University, Egypt. One hundred patients (both sexes) having RA were included in the study, and their mean age was 39.23±11.28 years, with range from 19 to 71 years. Patients were randomly allocated into two comparable groups: group I received health education through designed PE program and group II did not receive PE program. Disease activity and disability were assessed at the start of study and at two visits later, that is, after 3 months and 6 months, by using the 28 joint disease activity score 28 and the Health Assessment Questionnaire disability index. Results On comparing laboratory investigation and outcome scores at follow-up visits, although there were no significant differences between the two study groups regarding laboratory investigation, disease activity score 28 and Health Assessment Questionnaire scores at the start of the study, comparative differences were reported in the follow-up visits. Significant decreases in the laboratory values and scores were reported in group I, whereas no difference was reported in group II. Conclusion PE interventions in patients with RA documented significant improvements in behavior, pain, and disability among these patients.

Depression in patients with chronic low back pain N Nassar, N Assaf, D Farrag, D Ibrahim, A Al-Sheekh Egyptian Rheumatology and Rehabilitation 2019 46(1):48-54 Background Low back pain is a common health issue affecting at least 80% of individuals during their lifetime. It is usually recurrent and develops into chronic low back pain (CLBP). In chronic pain, psychosocial risk factors become relevant, and may explain how individuals respond to pain. CLBP is often comorbid with depression. Aim The aim of this study was to detect if there is an association between depression and functional disability in patients with CLBP. Patients and methods This cross-sectional, descriptive preliminary study included 50 patients with CLBP. Pain intensity was measured using visual analogue scale (VAS), functional disability was measured using the Oswestry Disability Index (ODI), and depression assessment was done using Beck depression inventory (BDI) questionnaire II. Results The mean age of the patients was 43.66±13.96 years. Mean scores for VAS, ODI, and BDI were 5.38±2.42, 18.66±7.26, and 22.40±9.20, respectively. A strong positive correlation was found between VAS and each of ODI and BDI (r=0.797 and 0.515, respectively; P=0.000). Similarly, a positive significant linear relation was detected between degree of disability by ODI and severity of depression by BDI (P=0.039). Conclusion Depression strongly influences pain intensity and degree of disability in patients with CLBP. Screening and early management of depression is essential for reducing pain and disability associated with CLBP.

Comparative study between platelet-rich plasma injection and steroid injection in mild–moderate shoulder osteoarthritis and their relation to quality of life Dalia Salah Saif, Deena Mamdouh Serag, Mohamed Ahmed El Tabl Egyptian Rheumatology and Rehabilitation 2019 46(1):55-61 Context Osteoarthritis (OA) is a degenerative joint disorder that causes joint pain and stiffness. Platelet-rich plasma (PRP) is considered a recent effective line of management of OA. Aims To compare the effect of local injection of PRP versus steroid in shoulder OA and their relation to quality of life. Patients and methods This study included 50 patients with mild–moderate OA shoulder diagnosed according to Samilson and Prieto grading system of shoulder OA and were recruited from the outpatient clinic of physical medicine, and rehabilitation, Faculty of Medicine, Menoufia University Hospital, in the period between 2017 and 2018. The study included both sexes. Group I included 25 patients who were injected intra-articularly with PRP in the affected shoulder, and group II included 25 patients who were injected with triamcinolone acetate. They were evaluated by Western Ontario Osteoarthritis Shoulder index and visual analogue scale before and after injection. Statistical analysis A descriptive and analytic study by SPSS, version 16, on IBM compatible computer was done. Results There was a highly statistical significant difference between preinjection and postinjection parameters regarding Western Ontario Osteoarthritis Shoulder score and visual analogue scale in both groups, with more improvement in the PRP group. Conclusion Intra-articular injections with PRP and steroids are effective less-invasive lines of shoulder OA treatment, with superiority to PRP owing to more persistence of its effects.

Comparison between the roles of musculoskeletal ultrasound and magnetic resonance imaging in detection of joint inflammation and destruction in rheumatoid arthritis Sherihan M Salama Egyptian Rheumatology and Rehabilitation 2019 46(1):62-69 Background Detection of early signs of synovitis and bone erosions by modern radiological techniques such as musculoskeletal ultrasound (US) and MRI has gained a great interest, as early diagnosis and treatment to target for patients of rheumatoid arthritis (RA) has its impact on disease control. Aim The aim of the following study is to detect the ability of US compared with MRI for the early detection of joint synovitis and bone erosion in RA patients. Patients and methods Six hundred joints (second to fifth metacarpophalangeal joints and second to fifth proximal interphalangeal joints) were examined in 50 patients with RA diagnosis. Clinical assessment, noncontrast MRI, US, and conventional radiography were performed for synovitis and bone erosion evaluation. Results and conclusion We concluded that both US and MRI had high ability to detect inflamed joints with close agreement but favoring the US, especially with the added value of power Doppler US where it can reflect increased vascularity associated with inflammation and also with higher scores for these affected joints than that shown by MRI. On the other hand, the study has found that although both US and MRI had high ability to detect erosions with close agreement, the MRI favorably had higher scores for joint erosions compared with the scores shown by US.