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A total of one hundred (100) matured rabbit of 4 – 6 month of age comprising of New Zealand White (NZW) and Dutch (DUT) breeds were used in the study. They comprised of forty nine (49) New Zealand White, thirteen (13) males and thirty six (36) females, Fifty one (51) Dutch breed comprising of twenty one (21) males and thirty (30) females. The experiment was conducted at the Livestock Teaching and Research Farm, University of Maiduguri, Borno State. Maiduguri. The management system used was intensive system and semi intensive system. By housing them in a cage based on breed and sex. Each rabbit is housed in a cage measuring 33cm x 38cm x 45cm and the cages were tagged for easy identification, measurement and weighing. The cages were slightly raised above the ground for cross ventilation and to facilitate cleaning.Body weight was measured with a digital weighing scale in kilograms and the body measurements were measured using tailor tape calibrated in centimeters. The data measured are body weight (BW), body length (BL), nose to shoulder length (NSL), heart girth (HG), height at withers (HW), ear length (EL), leg length (LL), tail length (TL) and height of the rabbit (HR). Results obtained showed that sex had no significant effect on all the morphometric data measured. Significant effect of genotypes on morphometric traits were observed on NSL, HG, HW, EL and TL with their corresponding values of 10.83, 13.57, 13.37, 14.73, 10.95 in Dutch breed and corresponding values in

Two hundred adult men between 36 and 55 years were selected for the assessment of their nutritional status. Information pertaining to socio economic status, anthropometric measurement, clinical profile and dietary pattern was collected using interview schedule. Energy costs of the activities were also collected. Information on the dietary nutrient intake was collected using 3-day dietary recall method. Anthropometric measurements namely height, weight, BMI and waist hip ratio were analyzed using standard procedures. Data was statistically analyzed. Results show that a greater percentage of the selected adult men were involved in moderate activity and belonged in middle income group. The educational qualification showed that 66% have completed school. The greater percentages of the selected subjects were from nuclear family. Most of the subjects were of normal height when compared with reference value. BMI revealed that forty nine percent were normal, 30% were overweight and 21% were obesity. Most of the selected subjects had WHR greater than 1. The food habits showed that majority of them were non vegetarians. Consumption of green leafy vegetables and fruits was less. On the contrary rice, wheat, red gram dhal were consumed daily. Most of the selected subjects mean nutrient intake was deficit when compared to RDA. The results of energy balance study showed that mean positive energy balance was 2098.2±90 kcal in the selected subjects. Nutrition education was given by power point, charts, pamphlets and a low energy snack was formulated and demonstrated used in the nutrition education programme. Results of paired t-test done shows that the nutrition education was effective (t = 3.84) and helped in improving the nutrition knowledge. The formulated product contains high amount of fibre. There is a need for educating these subjects on the right type and quantity of foods, higher intake of fibre rich foods, as well as the importance of regular physical activity to combat obesity.

A sample of 120 children with acute diarrhoea was divided into two equal study groups. There was no difference between groups in pre-intervention and post-intervention findings during the acute phase of diarrhoea. Upon discharge, Group A patients were supplied weekly with sufficient milk formula and cereal together with adequate nutritional advice while Group B patients were supplied with food or nutritional advice only if requested by the mothers. Forty nine patients from each group were followed each week for four weeks. Group B infants showed a higher incidence of recurrent diarrhoeal attacks and a significantly longer duration of recurrent diarrhoea than Group A infants. Moreover, Group A infants scored a significantly higher weight increment than Group B ones after four weeks of follow up

Objective: To assess the presence of anemia in epileptics presenting at neurology department of Pak Emirates Military Hospital Rawalpindi. Study Design: Comparative cross sectional study. Place and Duration of Study: Neurology department, Pak Emirates Military Hospital Rawalpindi, from Oct to Dec 2018. Methodology: One hundred and eighteen patients were included in this study. Diagnosis of epilepsy was made by the routine international guidelines by the consultant neurologist. Iron deficiency anemia was diagnosed on the basis of hemoglobin and ferritin levels. Gender of the patient, age, duration of epilepsy, education and poly-pharmacy were correlated with of iron deficiency anemia among the epileptics included in our study during the period of study. Results: A total of 118 patients were included in the study. Forty nine (41.5%) patients were male while 69 (58.5%) epileptics were females in this study. Most common type of seizures was generalized followed by the partial seizures. Out of 118 patients of epilepsy, 44.9% showed the presence of iron deficiency anemia while 55.1% had no anemia. Duration of illness and poly-pharmacy were correlated significantly (p-value

Foraminiferal and sedimentological analysis was carried out using ditch cutting samples from intervals 2700 ft. - 10,185 ft. in AE-1 well. The samples were composited at 60 ft. into ninety four (94) ditch cutting samples. The standard micropaleontological sample procedures to recover the foraminiferal biofacies assemblages was utilized, followed by analysis and interpretation of the obtained results. The sedimentological analysis reveals five lithofacies - sandstone, sandy shale, shaly sand, mudstone and sandy clay which constitute part of the Agbada Formation of the Niger Delta. The foraminiferal fauna recovered from the samples studied comprised of twenty four species grouped into nineteen genera from niniteen families and nineteen subfamilies. A few number of miscellaneous microfossils such as Ostracoda, Holothuroidea and Echinoderm remains were recovered. The total count of foraminiferal defined from this well is four hundred and nineteen (419). The planktic foraminiferal count was two hundred and forty two (242) (57.8 % of the total count) while the benthics foraminiferal count was one hundred and seventy seven (177) (42.2 % of the total count). Among the benthic forms, the calcareous consists of one hundred and forty nine forms (149) (33.4 % of the total benthic count) while the agglutinating benthic forms were thirty seven (37) (8.8 % of the total benthic count). One (1) planktic (Chiloguembelinacubensis) and three (3) benthic (Eponidesberthelotianus, Hanzawaiastratonii and Nonionellaauris) informal foraminiferal zones were established in the well. The age of the AE-1 well sediments has been interpreted to belong to Early Oligocene - Early Miocene in comparism with foraminiferal markers species whose stratigraphic ranges are well established in the Niger Delta and globally. This inferred the presence of the Rupelian - Burdigalian sediments in the Niger Delta. Keywords: Foraminiferal, Biozone, Age, Rupelian, Burdigalian.

BACKGROUND: The primary objective of this study was to evaluate the quality of life following limb lengthening surgery in patients with achondroplasia. The complications and different lengthening techniques have and effects on mid-term results were also investigated. METHODS: We performed a retrospective, multicenter study by evaluating the records of patients with achondroplasia operated in our clinic between 1999 and 2014 for limb lengthening with a minimum follow-up of 3 years. Forty nine patients were underwent bilateral lower limb lengthening surgery and 21 of 49 patients underwent bilateral humerus lengthening surgery. Patients were evaluated by the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales to assess the health-related quality of life (HRQOL) of children. Twenty patients with achondroplasia who had no lengthening surgery history were also evaluated with the PedsQL score as the control group. RESULTS: The average age at the time of first surgery was 6.17 years. The average follow-up period was 100.2 months. The average age at the time of study 14.70 ± 2.44 (11–18) years. There were significant differences between the patients with humeral lengthening and patients who did not undergo humeral lengthening in all scores. Transient complications had minimal effects on scores. Although all scores in the operated group were higher than non-operated patients with achondroplasia, there were no significant differences. CONCLUSION: Quality of life was significantly improved as a result of humerus lengthening surgery of patients with achondroplasia, despite minor complications compared with Lower limb lengthening surgery. LEVEL OF EVIDENCE: Level III, case control study.

Purpose Image guided musculoskeletal MSK biopsy could afford initial and ultimate judgment and lead choices to the best treatment Nonsurgical intervention grants less complication rate than surgical intervention It is rapid harmless and decisive procedure yields accuracy in diagnosis up to Ultrasound and computed axial tomography represent the key procedures in performing MSK intervention Numerous needles and procedures are existing for helping the physician accomplishing this procedure without harm This study was accepted in order to evaluate ultrasound and computed tomography CT guided core needle biopsies CNB of musculoskeletal lesions accurateness and medical worth in the management plan nbsp Materials and methods Fifty patients with MSK lesions underwent image guided Ultrasound or CT guided CNB for deeply located musculoskeletal pathology Radiological Pathological and clinical data were recorded and analysed nbsp Results Of fifty CNBs forty nine were adequate to obtain pathological diagnosis while one CNB seemed to be inadequate Of the fifty CNBs forty eight patients were correctly diagnosed while two patients were misdiagnosed and this gives an overall accuracy rate of nbsp Conclusion The image guided CNB of MSK lesions signify the decisive and harmless method for gaining a final histopathological decision

BACKGROUND: Hypertension is a global health issue among the adult population with high morbidity and mortality rates. Poor adherence to medication is associated with bad outcome of the disease and wastage of health resources. Therefore, this study aims to determine the role of patient education in medication adherence among hypertensives attending tertiary hospitals in Ekiti State, South Western, Nigeria.METHODS: This is a descriptive cross-sectional study involving 420 participants attending Family Medicine Department Clinic of Federal Medical Centre (FMC), Ido-Ekiti. Relevant data were collected using semi-structured questionnaire.RESULTS: The mean age of respondents was 60.97 ± 11.28 years, and a slight female preponderance (male: female = 1:1.7 over male). Three hundred and forty nine (83.1%) were married, 273(65.0%) were from a monogamous family and 375(89.2%) had family sizes of more than 4. Ninety four (22.4%) had good knowledge about hypertension, and 257(61.2%) were adherent to their medication. Increased medication adherence proportion was observed as knowledge about hypertension improves. The odds of adherence to treatment among subjects with good knowledge is 2 times (OR = 2.320, 95%CI = 1.164, 4.626) higher than among subjects with poor knowledge.CONCLUSION: The proportion of respondents with good knowledge about hypertension is low. However, the adherence among them to medication is higher and statistically significant. Patient education about the disease and its treatment by primary care physicians can help to improve adherence to medication.

Objective: Study aimed to identify the prevalence of falls and associated contributory factors among older Malaysians.Methods: A cross sectional study among community dwelling older adults aged 50 years and above. Self-administered questionnaires on history of falls in the previous 12 months, physical assessment and computerized and clinical measures of balance were assessed on a single occasion.Results: Forty nine (31.0%) participants fell, with 4.4% reported having multiple falls within the previous 12 months. Slips were the most prevalent cause of falls, accounting for 49% of falls. More than half (54.5%) of falls occurred in the afternoon while participants walked inside the home (32.7%), outside home (30.6%), and 36.7% were in community areas. More than half of respondents were identified as having turning instability. Step Test, turn sway, depression, physical activity level and edge contrast sensitivity were significantly worse for fallers (p < 0.05). Multiple logistic regression analysis showed that turning performance, visual acuity and back pain were significantly associated with falls risk, accounting for 72% of the variance of risk factors for falls among studied population.Conclusion: Falls are common among community dwelling older Malaysians. The findings provide information of falls and falls risk factors among community dwelling older adults in Malaysia. Future intervention studies should target locally identified falls risk factors. This study has highlighted the importance of instability during turning as an important fall risk factor.

For centuries almost nothing could be done for untreated congenital dislocation of the hip in adults. At thebeginning ofthe 20th century procedures such as self operation, inominate osteotomy, osteotomy of the proximal femur,fusion, Girdlestone, etc. were performed as treatment for CDH but the results were not satisfactory.At the early 70s the development of total hip arthroplasty, seem to give an answer to this difficult problem butat the beninning the results were disappointing. The reason of the disappointing results was mainly the insufficient bonestock at the place of the acetabulum. To overcome this problem several techniques, were developed: a. Reconstractionof the acetabulum using the femoral head to Augment the cup, b. placement of the cup to the false acetabulum andc. K. Stamos, cotyloplasty techniqueThe K. Stamos cotyloplasty technique involves medial advancement of the acetabular floor of the tme acetabulum by the creation of a controlled comminuted fracture of the medial wall, autogenous bone- grafting and the implantation of a small acetubular component with or without cement.This procedure was performed in sixty six patients (eighty six hips). Forty nine of the hips had high dislocation,thirty one had low dislocation and six were dysplastic. The mean age at the time of the operation was forty seven years(range 23-70). Two to fifteen years (mean seven years) after the operation the clinical and radiographical results wereevaluated. Eighty one (94%) of the eighty six hips had a good or excellent clinical result. The cummulative rate of successfor the acetabular componet was 100% at five years and 93.2% at ten years. The radiographic results were also satisfactory. Two (2%) of the eighty six acetabular components had migrated (displaced more than two millimeters). FYogressiveradiolucent lines (indicating aseptic loosening) were found in two also. There was radiographic incorporation (union) ofall of the bone grafts.These results show that Total hip artrhoplasty combined with K. Stamos Cotyloplasty techinque provides the bestpossible solution to the problem of untreated congenital dislocation of the hip in Adults.%%%%Για πολλούς αιώνeς η Θeραπeία του παραμeλημe'νου συγγeνούς eξαρθρήματος του ισχίου στους eνήλικeςήταν ανέφικτη. Στις αρχές του 20ου αιώνα διάφορeς eπeμβάσeις όπως η eγχeίρηση στe'γης, η οστeοτομία τουανωνύμου, η οστeοτομία του eγγύς μηριαίου, η αρθρόδeση, η Girdlestone, κλπ. δοκιμάστηκαν σαν θeροστeία του ΣE]αλλά τα αποτeλέσματα δeν ήταν ικανοποιητικά.Στις αρχές της δeκαeτίας του 70 η ανάπτυξη της ολικής αρθροπλασπκής φάνηκe να ήταν η λύση τουπροβλήματος αλλά τα οπτοτeλέσματα στις πρώτeς προσπάθeιeς ήταν απογοητeυτικά. Ο λόγος τωναπογοητeυτικών αποτeλeσμάτων ήταν βασικά η ανeπαρκής οστική μάζα στην πeριοχή της κοτύλης. Για ναξeπeραστeί το πρόβλημα αυτό αναπτύχθηκαν διάφορeς τeχνικe'ς: α. Ανακατασκeυή της κοτύλης χρησιμοποιώνταςτην μηριαία κeφαλή ως δομικό μόσχeυμα για την κάλυψη της προθέσeως, β. Τοποθέτηση της προθe'σeως στηνψeυδοκοτύλη και γ. Η κοτυλοπλαστική Κ. Στάμου.Η κοτυλοπλαστική Κ.…

Frequently, the kidney stones are treated without determining the root cause of kidney stones which leads to recurrence of the kidney stones. This is a case report of a forty nine years old male who developed nephrolithiasis secondary to parathyroid adenoma. This tumor was removed through a modern and an efficient technique called minimal invasive parathyroidectomy which proved to be more efficient and safe compared to the old techniques.

This article examines Joseph Bryennios’ Forty-Nine Chapters, a text that has been hitherto explored mostly for the information on social practices in late Byzantium. The analysis of the text's rhetorical techniques indicates that Bryennios departed significantly from other contemporary collections of kephalaia which relied on the inherited wisdom of gnomologia. I argue that the pervasiveness of figurative language and vivid analogies in the Forty-Nine Chapters shaped his specific didacticism and unveiled the author's acquaintance with the technique of rhetorical amplification.

Objective The aim of this work is to correlate between endodontic case complexities and treatment quality outcomes. Methods Three hundred and forty nine radiographs of patients who had received endodontic treatment at a postgraduate dental institute in Dubai were retrieved from the Institute's data base. The majority of the cases were referred by in house general dental practitioners (GDPs). Unreadable radiographs were all excluded. From the original sample of 349,in total 51 radiographs were discarded. The final sample thus consisted of 298 root canal fillings of 211 patients treated by the endodontic postgraduate students. All radiographs were individually evaluated following the American Association of Endodontic Case Difficulty Assessment Form. Based on this, the technical quality of the root filling was evaluated for each individual case. Results The sample consisted of 53% high,35% moderate and 12% minimal difficulty cases. Adequate homogeneity of root canal fillings were found in 93% of the cases. This compared with 90% of cases with adequate length of root fillings. There were statistically significant differences between the length of root canal filling and level of difficulty (p = 0.016) but, no statistically significant difference between homogeneity of root canal filling and case difficulty (p = 0.794). Conclusion Eighty four percent (0.93 × 0.90 = 0.84) of the cases treated proved to be adequate in terms of length and homogeneity which is in line with published work of Endodontic treatment carried out by specialists. Clinical Significance GDPs require robust guidelines to help with appropriate referral of patients to Endodontic specialists.

The use of medicines in unlicensed and off-label manner for adults is less common with limited research compared to children. This research was carried out t o characterise unlicensed and off-label use of medicines in adult intensive care patients of a hospital in Malaysia . Data on medications prescribed to patients were collected from the patients’ medical records and the unlicensed and off-label status for each medicine were determined . Forty nine (73.1%) and 20 (29.9%) patients from a total of 67 patients received at least one medicine in an unlicensed and off-label manner, respectively. The most common reason for off-label use of medicines was higher than the licensed dosing frequency (29.6%). The most common unlicensed and off-label medicine used was amlodipine tablet (5.8%) and IV metoclopromide (11.1%), respectively. Length of stay in the ICU was a significant predictor for unlicensed use of medicines (OR 1.219; 95% CI 1.022-1.456; p=0.028) and number of medication prescribed was a significant predictor for off-labelled use of medicines (OR 1.130; 95% CI 1.010-1.263; p=0.032). There was substantial prescribing of unlicensed medicines compared to off-label medicines in the adult ICU highlighting the need for more research to be carried out considering the critical condition of the patients. DOI : http://dx.doi.org./10.17576/JSKM-2019-1701-03

Objective: The aim of this study was to analyze the survivorship and clinical outcome of Cementless Spotorno (CLS) stem in young patients. Methods: A total of 99 consecutive hip arthroplasties using CLS stem were performed on 84 patients younger than 50 years of age between 1993 and 2001. 63 patients were available for final follow-up (mean age: 39 ± 7.8 (range: 22–50)). Patients' Harris Hip Scores (HHS) and survivorship estimates were calculated. Radiographs were analyzed for acetabular implant status, canal fill index (CFI), stem alignment, osteolysis, and stress shielding. Results: Mean follow-up time was 18 years (13–3), and mean HHS was 88.7 (58–100). Patients with femoral neck fracture had a more favorable functional outcome (p = 0.027), while those with stems in varus had lower scores (p = 0.017). 31 stems (49%) were undersized and 30 hips (47%) had perifemoral osteolysis. Acetabular impairment was strongly associated with osteolysis in Gruen zones 1 and 7 (p

Introduction: Since time immemorial man has tried to improve upon teaching methods so that students can become more proficient. Biopsy slides of pathology have been difficult for medical students to understand and comprehend since a long time. The introduction of projection microscope for teaching biopsy slides would go a long way in simplifying the whole process. Methodology: The authors compared the two teaching methods for identifying pathologic lesion in biopsy slides. Ninety nine fourth semester undergraduate students were divided into two groups with group A having fifty students and group B having forty nine students. The period of our study of four months was divided into two, two month period. In the first two months group B was made the test group and taught biopsy slides using projection microscope and group A was made control group and was taught by conventional method (atlas, chalk and board). To avoid any form of bias, in the second two months their roles were reversed so that group A was made the test group and group B was made the control group. Result: After each two month OSPE was held and marks recorded. At the end of four month period a survey was taken from students and faculty in a feedback form based on Likert scale. In this survey it was found that ninety percent (90%) of the students and faculty were of the view that visual aided method of teaching was superior to conventional method of teaching biopsy slides. In the OSPE the group which underwent visual method of teaching scored higher than the group which underwent conventional method of teaching even after swapping of their roles after two months. Discussion: Teaching tools using two or more senses is superior to teaching with one sense only. This is specially true while using visual and auditory method of teaching which accounts for 88% of our learning. Here we have made good use of visual aid in form of projection microscope to teach and explain the morphologic features of pathologic lesion in a biopsy slide.

Regularly participating in physical activity is known to improve quality of life and body composition in elderly with stroke. However, comparatively less physical activity is performed by the stroke survivors. The factors related to inactivity in elderly female stroke survivors have not been elucidated. Therefore, this study aims to compare the quality of life factors and limb compositions between the active and inactive elderly female stroke survivors. Forty nine subjects between the ages of 65 to 75 years were selected from the KNHANES data between the years 2009 to 2011. In addition, 186 age-matched healthy peers were also selected for limb composition comparisons. The subjects were groups based on walking days per week: walkers; 3 days or more, non-walkers; less than 3 days per week. BMI and waist circumference were within the obesity ranges for both the non-walkers and walkers. As results, the trend for greater fat (±10%) and lean mass (±30%) differences were observed for non-walker and walkers, respectively. Significantly greater reasons for function limitation by stroke and hypertension were reported with significantly greater self-care difficulty was shown by the walkers. In conclusion, elderly female stroke survivals may require customized motivation and continuous support to participate in physical activity regularly.

To study the incidence, clinical risk factors and outcome of thrombotic events in pediatric age group of 1 mo-12 y. This prospective observational study was conducted in a tertiary care institute from September 2015 through October 2017. Forty nine children with thrombosis from 1 mo-12 y were enrolled. Out of 49 cases, 30 (61.2%) were due to venous thromboembolism (VTE) and 19 (38.8%) were of arterial thromboembolism (ATE). The cumulative average annual incidence for VTEs was found to be 38.2 (n = 30) and for ATEs it was found to be 24.2 (n = 19) per 10,000 hospital admissions over 2 y of study period. With total of 19 (38.7%), catheters were the leading cause of thrombosis followed by infection numbering to 10 cases (20.4%). Total 42.8% cases (n = 21) achieved complete resolution. Partial resolution was noted in 53.2% of cases (n = 26) and no resolution in 4% cases (n = 2). Total seven (14.3%) deaths were recorded during the study period. The present study showed that thrombosis is an emerging problem in tertiary care setting adding to both mortality and morbidity in children. Central venous catheters followed by infection were the leading cause of thrombosis in this study.

Background: Neurosurgery has developed as a separate specialty and neurosurgical patients are some of the most common admitted in the intensive care unit. The objective of the study was to study the profile of neurosurgical patients admitted in level III mixed, medical-surgical intensive care unit in a tertiary level teaching hospital in Nepal with the view to identify the causes of intensive care unit admission, types of neurosurgery performed, outcome of the patients, in terms of intensive care unit stay, mechanical ventilation days and mortality.Methods: A retrospective study was designed and all neurosurgical patients admitted to the intensive care unit of our center between 13 April 2017 and 13April 2018 (1st Baisakh 2074 to 30th Chaitra 2074) were enrolled in this study.Results: A total of 813 patients were admitted in ICU over a period of one year (2074 B.S.) of which 199 (24.48 %) were neurosurgical cases. Among these 170 (85.42%) cases were post-surgical, with 29 (14.58%) being pre-operative patients. One hundred forty nine patients (74.9%) were on mechanical ventilation. One hundred and thirty two (66.3%) patients improved and were transferred to a step down ward. Forty-three (22.5%) died in the intensive care unit, 14 (7.03%) left the hospital against medical advice and 9 (4.5%) patients expired after withdrawal of life support.Conclusions: Despite improved care over the recent years the mortality and morbidity of neurosurgical patients is high.Keywords: Intensive care unit; mortality; neurosurgery; outcome.

BACKGROUND AND AIMS: The success of the COVID-19 vaccination program is dependent on people's knowledge and attitude regarding the vaccination program. Higher vaccine acceptance can be ensured by strengthening the facilitators and limiting the barriers being observed among the general population. MATERIAL AND METHODS: Indexed study is a cross-sectional web-based survey using a pre-validated questionnaire to assess knowledge, barriers and facilitators of COVID-19 vaccine and vaccination programme administered on adults across India using a Google online survey platform. RESULTS: A total of 1294 responses (age: 38.02 ± 13.34 years) were collected. Most of the participants had limited knowledge regarding the eligibility of vaccines in vulnerable population groups such as people with allergies (57.89%) and immune-compromised patients (62.98%), pregnant and lactating women (41.89%) and patients with chronic illness (34.78%). Older participants (>45 years) were more willing to take the COVID-19 vaccine (p

Background Nutrition and good health are two dependent parallel axes; female’s health at different ages in general and at the time of menopause in particular has received a lot of attention last several years. The objective of this experimental study was to evaluate the effect of consuming food supplement versus lifestyle modification in the dietary habit on menopausal symptoms in perimenopausal Egyptians females. Results Forty seven females in the perimenopausal stage of life with mean age 46.04 ± 5.88 years participated on the food supplement consumption group, they consumed 75 g per day of a rusk (prepared from corn flour, wheat flour 72%, full cream milk powder, flaxseed oil, wheat germ, clove and cinnamon powder) for 2 months. They were compared with the control group (forty nine females with mean age 46.91 ± 5.39 years) who changed their foods habits to a healthy life style. Menopause rating scale and the biochemical analysis were comparable on day 1 and on day 60. The total menopause rating scale and its three subscales (psychological, urogenital and somatic), waist circumference, serum follicle stimulating hormone and estradiol in the corn rusk supplement group showed a statistically significant improvement. No significant difference was noted in the control group apart of the psychological subscale and waist circumference. Conclusions Corn Rusk enriched with clove and cinnamon as a food supplement snake is promising to relief menopausal symptoms and should be considered on the diet of menopausal females.

Sarcoidosis is a multisystem inflammatory condition with occasional cardiac involvement (CS), which may be associated with risk of venous thromboembolism (VTE). As data on VTE in CS are sparse and corticosteroid therapy has not been previously examined, we aim to determine the association between CS, corticosteroid treatment for CS, and VTE. Patients referred to our institution with concern for sarcoidosis and underwent a positron emission tomography (PET) scan were retrospectively assessed. Chi-squared and multivariate regression analyses were conducted to determine the association between a diagnosis of sarcoidosis, CS, corticosteroid use, and VTE events. Six hundred and forty nine patients were split into 3 categories: 235 with no sarcoidosis (NS), 91 with extra-cardiac sarcoidosis only (ECS), and 323 with CS (isolated CS and/or CS with extra cardiac sarcoid). Thirty nine CS, 7 ECS, and 9 NS patients developed PE while 44 CS, 3 ECS, and 18 NS patients developed DVT. On multivariate regression, neither CS nor ECS was an independent risk factor for VTE (p0.05) but corticosteroid use was independently associated with VTE (HR 3.06, p = 0.007 for PE, HR 6.21, p0.0001 for DVT). On logistic regression analysis, corticosteroid dose was found to be independently associated with both PE (p = 0.001) and DVT (p = 0.007). Optimal threshold for defining VTE risk with corticosteroid therapy was a prednisone-equivalent dose of 17.5 mg. In conclusion, contrary to previous studies, this current study found that neither sarcoidosis nor CS is an independent risk factor for VTE. Rather, corticosteroid therapy was associated with an increased risk of VTE.

As we enter the year 2021 our journal, Avian Pathology, approaches an important landmark. Starting the 50th volume here, we are now planning towards our 50th anniversary year in 2022. Volume 1 was ...

In this paper, we introduce the concept of ‘societal emotional environment’: the emotional climate of a society (operationalized as the degree to which positive and negative emotions are expressed in a society). Using data collected from 12,888 participants across 49 countries, we show how societal emotional environments vary across countries and cultural clusters, and we consider the potential importance of these differences for well-being. Multilevel analyses supported a ‘double-edged sword’ model of negative emotion expression, where expression of negative emotions predicted higher life satisfaction for the expresser but lower life satisfaction for society. In contrast, partial support was found for higher societal life satisfaction in positive societal emotional environments. Our study highlights the potential utility and importance of distinguishing between positive and negative emotion expression, and adopting both individual and societal perspectives in well-being research. Individual pathways to happiness may not necessarily promote the happiness of others. info:eu-repo/semantics/publishedVersion

Introduction Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is an uncommon congenital malformation characterised by agenesis or hypoplasia of the vagina and uterus. Here, we describe the treatment of patients with MRKH syndrome in a tertiary hospital. Methods This retrospective study included patients with MRKH syndrome attending the Paediatric and Adolescent Gynaecology Clinic in a tertiary hospital. Their clinical manifestations, examinations, and methods for neovagina creation were recorded. Among patients who underwent vaginal dilation (VD), therapy duration, vaginal width and length at baseline and after VD, complications, and sexual activity and dyspareunia outcomes were evaluated. Results Forty nine patients with MRKH syndrome were identified. Their mean age at presentation was 17.9 years; 69.4% and 24.5% of patients presented for primary amenorrhoea treatment and vaginoplasty, respectively. Forty eight patients had normal renal imaging findings and 46 XX karyotypes. Seventeen (34.7%) patients underwent VD as first-line therapy; three did not complete the therapy. Two had surgical vaginoplasty, whereas five achieved adequate vaginal length by sexual intercourse alone; 25 had not yet requested VD. The mean duration of VD was 16±10.2 (range, 4-35) weeks. The widths and lengths of the vagina at baseline and after VD were 1.1±0.28 cm and 1.3±0.7 cm, and 3.1±0.5 cm and 6.9±0.9 cm, respectively. The overall success rate of VD was 92.3%. Vaginal spotting was the most common complication (21%); only one patient reported dyspareunia. Conclusions Mayer-Rokitansky-Kuster-Hauser syndrome is an uncommon condition that requires multidisciplinary specialist care. Vaginal dilation is an effective first-line approach for neovagina creation.

ObjectivesThe current COVID-19 pandemic needs unconventional therapies to tackle the resulted high morbidity and mortality. Convalescent plasma is one of the therapeutic approaches that might be of benefit.MethodsForty nine early-stage critically-ill COVID-19 patients residing in RCU of three hospitals in Baghdad, Iraq were included, 21 received convalescent plasma while 28 did not receive, namely control group. Recovery or death, length of stay in hospital, and improvement in the clinical course of the disease were monitored clinically along with laboratory monitoring through SARS-CoV-2 RNA detection via PCR, and SARS-CoV-2 IgG and IgM serological monitoring.ResultsPatients received convalescent plasma showed reduced duration of infection in about 4 days, and showed less death rate, 1/21 versus 8/28 in control group. In, addition, all of the patients received convalescent plasma showed high levels of SARS-CoV-2 IgG and IgM 3 days after plasma transfusion. Plasma from donors with high levels of SARS-CoV-2 IgG and donors with positive SRAS-CoV-2 IgM showed better therapeutic results than other donors.ConclusionsConvalescent plasma therapy is an effective mode of therapy if donors with high level of SARS-Cov2 antibodies are selected and if recipients were at their early stage of critical illness, being no more than 3 days in RCU.

Patients with diffuse large B-cell lymphoma (DLBCL) who fail to complete planned treatment with R-CHOP due to toxicity are sparsely described. We investigated the extent of failure to complete treatment (six cycles or more, or three cycles + RT for patients with stage I disease) with R-CHOP for reasons unrelated to non-response, the determinants of such failure and the outcome among these patients. Three thousand one hundred and forty nine adult DLBCL patients who started primary treatment with R-CHOP were identified through the Swedish lymphoma register 2007-2014. Of these, 147 (5%) stopped prematurely after 1-3 cycles of R-CHOP for reasons unrelated to non-response, 168 (5%) after 4-5 cycles and 2639 patients (84%) completed planned treatment. Additionally, 195 (6%) patients did not complete treatment due to non-response or death before treatment end. In a multivariable logistic regression model, age > 75 years, poor performance status, extranodal disease and Charlson Comorbidity Index >= 1 were significantly associated with failure to complete planned R-CHOP treatment for other reasons than non-response. Non-completion of treatment strongly correlated with survival. Five-year overall survival for patients who received 1-3 cycles was 26% (95% CI: 19%-33%), 49% (95% CI: 41%-57%) for 4-5 cycles and 76% (74%-77%) for patients who completed treatment. Failure to complete planned R-CHOP treatment is an important clinical issue associated with inferior survival. Old age and poor performance status most strongly predict such failure. These results indicate a need for improved treatment tailoring for patients with certain baseline demographics to improve tolerability and chance for treatment completion.

Background In this study, we analyzed the impact of pulmonary valve-sparing techniques on early and midterm postoperative results of tetralogy of Fallot repair. Methods A total of 64 patients diagnosed with tetralogy of Fallot, who underwent total correction operation by the same surgeon between November 2010 and September 2015 were included in this retrospective study. Mean age of the patients was 20.0±14.2 months (5.5-96 months). Forty patients (62.5%) were male. Thirty two of the patients (50%) were under one year of age. Pulmonary valve-sparing techniques were performed in 29 patients (Group 2), while transannular patch was applied in the remaining 35 patients (Group 1). Pericardial monocusp valve was constructed in 15 patients in Group 1. In Group 2, pulmonary valve-sparing techniques were transatrial repair in nine patients; transatrial-transpulmonary in eight, infundibular patch in eight, and infundibular-pulmonary patch in four patients. Results There was no early postoperative mortality in Group 2. Five patients (14.2%) in Group 1 died in the early postoperative period (p=0.058). Pulmonary monocusp insertion was performed in 2 (13.3%) of these patients (p=1). The causes of mortality were sudden cardiac arrest (n=2), multiorgan failure (n=1), low cardiac output (n=1), and neurological complications (n=1). Five patients in Group 1 required extracorporeal membrane oxygenation support (ECMO). Three of them were separated from ECMO and two of the patients that were separated were discharged uneventfully. Total postoperative morbidity rate was significantly higher in Group 1 (51.4% vs. 6.8%) (p=0.0001). Morbidity rate was significantly lower in patients with pulmonary monocusp insertion than patients in the same group without a monocusp (p=0.0176). Forty nine (83%) of the patients were followed up for a median of 6.5 (1-24) months. While free pulmonary regurgitation was detected in all non-monocusp patients in Group 1, pulmonary regurgitation was absent or mild in Group 2. Twelve (80%) of the patients in Group 1 who had monocusp insertion were followed up. Only two of these patients had free pulmonary regurgitation (16.6%). The rest of them had mild (n=6) or mildmoderate pulmonary regurgitation (n=4). Conclusion Mortality and morbidity rates are lower when pulmonary valvesparing techniques are used in repair of tetralogy of Fallot. Monocusp pulmonary valve insertion may improve results in patients who require transannular patch repair. It is suggested that every effort should be made to achieve a competently working pulmonary valve during repair.

Background: To evaluate the response of the modern bladder-preservation treatment modality; trimodal therapy (TMT) in muscle-invasive bladder cancer (MIBC). Aiming at bladder preservation in MIBC, TMT was to offer a quality-of-life advantage and avoid potential morbidity and mortality of radical cystectomy (RC) without compromising oncologic outcomes.Aim of Study: To investigate the TMT as a treatment option for muscle-invasive bladder cancer confirmed by cancer specific and overall survival rates in two different institutes.Material and Methods: The study included 64 consecutive patients between 2008 and 2013, and was conducted in National Institute of Urology and Nephrology, Cairo, Egypt, Al-Azhar University, Girls Div., Urology Dept., Cairo, Egypt and National Cancer Institute, Cairo University, Cairo, Egypt. Forty nine patients were males and 15 were females. Mean age was 61±9 years (range, 34-82 years). Sixty nine percent of patients (44) were below 65 years old while 31% (20) were above 65. Sixty six percent (42 patients) were fit for surgery but refused RC as first line of treatment and 34% (22 patients) were unfit for surgery. Results: One third of patients (20) failed TMT and under went RC. Five years overall survival (OS) was 57% and disease specific survival (DSS) was 61%. There was no significant difference observed in OS or DSS between different age, sex or surgical fitness patients groups. Tumor stage showed significant statistical difference between T2 and T3 (p

BACKGROUND: To compare the effectiveness of Natural Honey with Triamcinolone acetonide (0.1%) on the healing of Oral ulcers. METHODS: Seventy four oral ulcers (forty nine recurrent aphthous stomatitis, sixteen aphthous like ulcers in Oral submucous fibrosis and nine traumatic ulcers) were evaluated and each half of them were advised to apply honey and triamcinolone acetonide. Pain score (visual analog scale), ulcer size (measured by William’s Periodontal Probe), erythema level was evaluated on first day and after drug application. Statistical Analysis was done and tabulated by SPSS software. RESULTS: Natural honey showed significant reduction in pain score and ulcer size (p

In response to increases in emergency surgical admissions, the Royal College of Surgeons of England (RCSE) published guidelines on ways to separate inpatient emergency and elective surgery with the creation of the surgical assessment unit (SAU). This study aimed to evaluate the impact of a new SAU on acute surgical patient pathways in a busy district general hospital and compare it with the RCSE standard for emergency care. Data were retrospectively extracted from records for all patients attending the SAU over an 8-week period. Patient demographics, methods of referral, rate of discharge, time spent in the SAU, imaging, diagnosis and the requirement for emergency surgical intervention were looked at. During the period studied there were 956 attendees, who spent an average time of 5 hours 48 minutes in the unit. Forty nine percent were admitted and of these, 41% required emergency surgery, with a further 18% of patients (60) re-attending the next day for emergency surgery. A total of 316 radiological investigations were conducted on the SAU patients. The average waiting time for a scan was 5 hours and 3 minutes. The majority of referrals were from GPs (38.5%). The SAU at Watford hospital is meeting the majority of the RCSE's guidelines, however there are several areas in which the unit can continue to improve. With hospitals under increasing pressures, this unit highlights a service where patients can be diverted from A&E to a dedicated assessment area, which is key to the future efficiency of emergency surgical care.

The principal purpose of this investigation is to study the effect of robotic cooperative learning methodologies on middle school students’ critical thinking, and STEM interest. The semi-experimental inquiry consisted of ninety four six-grade students (forty nine students in the experimental group, forty five students in the control group), chosen by their principals. A critical thinking test was administered to evaluate the cognitive skills and STEM interest of the students. Instruction was implemented in two formats: cooperative learning and problem-based learning. The experimental group utilized robotic cooperative learning while the control group utilized problem-based learning. After four sessions of both instruction types with both groups the findings reveal that critical thinking of students is enhanced significantly by robotic cooperative learning (P

Aim: To determine knowledge, attitude and practice of patients with glaucoma and to analyze the quality of life of patients with glaucoma using the GQL-15 questionnaire. Materials and Methods: 62 patients with a known diagnosis of glaucoma and started on medical management were included in the study. On the first visit patients were counseling about the nature of the disease, dose, duration and frequency of medications, were informed of side effects and technique of instillation. On the second visit patients were assessed with a validated KAP questionnaire and GQL-15 quality of life questionnaire. The questions were administered in the local language by trained optometrists and health care personnel. Results: The inter item correlation between knowledge, attitude and practice was found to be 0.897, 0.877 and 0.765 there by validating the questionnaire. Forty nine (87.5%) of patients were found to have adequate knowledge regarding disease, drug, dose , frequency and proper method of instillation of eye drops. Forty one (73.32%) of patients were found to have a positive attitude towards usage of eye drops and the remaining 15(26.78%) negative attitude. Safe practice was followed by 49 ( 87.5%) of patients and unsafe with 7( 12,57%) GQL-15 questionnaire applied at the time of second visit showed 40 (71.42%) of patients with low GQL score. Conclusion: Our study highlights that awareness and dissemination of information on basic eye drop instillation technique improves patient knowledge awareness and practice patterns of this asymptomatic disease and can help patients adhere to management.

To evaluate the indications, outcomes, and complications of scleral buckle removal over the past decade and compare to previously published data.Forty nine eyes of 49 patients who underwent scleral buckle removal and had at least 6 months of follow-up were included in this retrospective study. Recorded parameters included demographic information, history of the retinal detachment, details of the scleral buckling surgery, indication for scleral buckle removal, time from scleral buckle placement to removal, culture results, length of follow up, visual acuity (VA) throughout the follow up, and the occurrence of any complications or need for additional surgery after scleral buckle removal.The overall rate of scleral buckle removal over the last decade was 5.7% (85/1493). Indications included buckle extrusion (57.1%), infection (8.2%), both (26.5%) eyes, and strabismus and diplopia (8.2%). The median time from scleral buckle placement to removal was 35 months, but in 22.4% of cases the buckles were removed after less than 6 months, and in an additional 22.4% of cases after more than 10 years. The rate of recurrent retinal detachment after scleral buckle removal was 8.2%, with half of the cases occurring within 3 months of the removal.Removal of scleral buckles is associated with a 8.2% risk for redetachment. Redetachment can occur many years following the removal and long-term follow up in these patients is warranted.

Background Our tertiary paediatric centre has approximately 8300 admissions a year. Bronchiolitis is a common illness requiring admission but only 10% require high dependency care (HDU). Is there a difference between those patients requiring HDU and those who do not? Aims To complete a retrospective comparative case analysis comparing demographics and features of illness between the two groups to determine any relationships to HDU admission. Methods All bronchiolitis admissions (n=509) from September 2016 to April 2017 were identified in patients up to 14 months of age. There were 53 admissions to HDU. Forty nine had complete electronic clinical records available to review. Fifty admissions receiving ward level care were randomly selected for comparison. Statistical analysis was completed using descriptive statistics, the Independent T test and Pearson’s Chi Squared. Results Table one shows the comorbidities. A significantly greater number of patients with a cardiac abnormality required admission to HDU. Admission to hospital earlier (days of coryza), higher respiratory rate and the need for oxygen were statistically significantly related to HDU admission. There was no viral aetiology that related to HDU admission when compared with the ward cohort. Conclusion The only comorbidity identified that was related to HDU admission was a cardiac abnormality. There was no statistical relationship with prematurity, chronic lung disease, home oxygen or neuromuscular conditions identified. Earlier admission in illness, higher respiratory rate and oxygen requirement could all be used as surrogate markers for disease severity and were more prominent in the HDU group.

Catheterization and cardiovascular interventions 9, 1-8 (2019). doi:10.1002/ccd.28582, Published by Wiley Interscience, New York, NY

This study aimed to examine the level of language proficiency of college students. This study used the descriptive correlation research since it describes the phenomena being studied.The researcher employed purposive sampling. Out of the twenty seven (27) batches enrolled in semester 1 and 2 eleven (11) batches were utilized as respondents which composed of three hundred forty nine (349) respondents.Result showed that identifying errors, writing, correct usage, reading and listening skills were significantly affected by the respondents‟ profile. However, speaking and vocabulary skills show that they are not significantly. The level of their language proficiency in terms of listening, reading and writing are above average while speaking, vocabulary, identifying of errors and correct usage are average. The relationship between the profile of the respondents and their level of proficiency showed that their listening, reading, writing, identifying of errors, and correct usage skills is highly significant while speaking and vocabulary skills is not significant.

Introduction Traditional Chinese medicine (TCM) is used to treat mental illnesses but attitudes to its use may vary. This study aimed to explore the attitude towards, and practice of, TCM among leading Chinese psychiatrists, and to explore the possibility of future TCM-psychiatry cooperation. Methods Psychiatrists who were committee members of two major academic and professional associations considered to be leading psychiatrists were sent an online questionnaire which focused on their attitudes towards and their practice of using TCM. Results A total of 49 responses (a 50% response rate) were received. Many leading psychiatrists had prescribed TCM and had recommended TCM to junior psychiatrists. The respondents showed a mild positive attitude of TCM. Being used as an adjunct therapy (t = 7.65, P 0.05). Respondents who recommended TCM to junior psychiatrists showed a significantly more positive attitude than those who did not (t = 5.42, P Conclusions Future TCM-biomedicine cooperation in China is potentially feasible because the leading psychiatrists hold a broadly positive attitude towards the use of TCM in psychiatry. However, more quality evidence and academic exchange are needed.

Background: Diabetes mellitus (DM) and depression are common chronic disease states of public health importance with huge burden and the potential to impact many aspects of life. They are said to be related though this relationship is not fully understood. The presence of depression among patients with DM is associated with poor glycemic control, complications, and poor self-care. Method: This was a descriptive cross-sectional study conducted at the Diabetes Clinic of the Jos University Teaching Hospital. Three hundred and ten (310) patients with diabetes mellitus were recruited consecutively. The depression module of the Mini International Neuropsychiatric Interview (M.I.N.I.) version 5.0 was used to ascertain depression among these patients. Other demographic data were obtained using a questionnaire. Blood pressure, weight, and height were also measured and the body mass index (BMI) calculated. Results: One hundred and eighty four (59.35%) of the study population were females and the mean age (SD) of the study population was 54 ± 12 years. The mean age (SD) of the females was 53 ± 11 years and that of the males was 54 ± 12 years with no significant statistical difference (P = 0.35). Two hundred and forty nine (80.32%) of the study population were urban dwellers with 140 (45.16%) earning less than N500, 000 (794 USD) yearly. Current major depression was found in 35 (11.3%) patients, among whom 7 (2.3%) had recurrent depression. The presence of DM complications (OR: 3.50, 95% CI 1.16–10.61) and a positive family history of depression (OR: 4.03, 95% CI 1.32–12.29) were found to be correlates of current major depression. Conclusion: The prevalence of current major depression among patients with diabetes mellitus in this study is high. We recommend that all patients with DM should be screened for depression and treated appropriately to reduce its consequences.

Background The progressive cardiomyopathy that develops in boys with Duchenne and Becker muscular dystrophy (DMD/BMD) is presumed to be a secondary consequence of the fibrosis within the myocardium. There are only limited data on using parametric imaging in these patients. The purpose of this study was to assess native T1 and extracellular volume (ECV) values in DMD patients. Methods The Czech population of males with DMD/BMD was screened. All eligible patients fulfilling the inclusion criteria were included. Forty nine males underwent cardiac magnetic resonance (MR) examination including T1 native and post-contrast mapping measurements. One DMD patient and all BMD patients were excluded from statistical analysis. Three groups were compared – Group D1 - DMD patients without late gadolinium enhancement (LGE) (n = 23), Group D2 - DMD patients with LGE (n = 20), and Group C – gender matched controls (n = 13). Results Compared to controls, both DMD groups had prolonged T1 native relaxation time. These results are concordant in all 6 segments as well as in global values (1041 ± 31 ms and 1043 ± 37 ms vs. 983 ± 15 ms, both p

Background Neonatal intubation is a stressful procedure taught to trainees. This procedure can attract additional observers. The impact of observers on neonatal intubation performance by trainees has not been studied. Our objective was to evaluate if additional observers present during neonatal mannequin endotracheal intubation (NMEI) by junior trainees, affects their performance and their stress levels. Methods A randomized cross over trial was conducted. First year residents with no experience in neonatal intubation were assigned to NMEI condition A or B randomly on day 1. Subjects were crossed over to the other condition on day 2. Condition A: Only one audience member was present Condition B: Presence of an audience of 5 health care providers. Differences in the time to successful NMEI was recorded and compared between conditions. A portable heart rate monitor was used to measure peak heart rate above baseline during NMEI under both conditions. Results Forty nine residents were recruited. 72% were female with a median age of 25 years (IQR: 24–27). Time to successful intubation was comparable under both conditions with a mean difference of − 3.94 s (95% CI: -8.2,0.4). Peak heart rate was significantly lower under condition A (mean difference − 11.9 beats/min, 95% CI -15.98 to − 7.78). Conclusion Although the time required to NMEI did not increase, our results suggest that presence of observers significantly increases trainee stress. The addition of extraneous observers during simulation training may better equip residents to deal with such stressors. Trial registration Date of registration: March 2016, NCT 02726724. Electronic supplementary material The online version of this article (10.1186/s12909-018-1338-4) contains supplementary material, which is available to authorized users.

Purpose: A cross sectional study was done to determine the factors associated with caries and periodontal condition of pregnant women.Material and Methods: One hundred and forty nine women were examined in the city of Bucaramanga in a period of time between February to May, 2001. Sociodemographic variables in regard to gestation, diet, beliefs and oral health practices were evaluated as independent variables. The outcome was defined by COP index and CPITN index. Simple and multiple logistic regression were applied to evaluate the possible association by Odds Ratio (OR) and their 95% confidence interval.Results: The adjusted OR for COP was: age OR: 1.27 95% CI (1.15-1.41), social security OR: 0.04 CI 95% (0.006-0.27) and week of pregnancy OR: 0.93 CI 95% (0.87-0.99). The model for CPITN was: Hypertension OR: 11.8 CI 95% (1.14-121.3), deficient oral hygiene OR: 4.19 CI 95% (1.63-10.8), social security OR: 0.19 CI 95% (0.05-0.7) and high risk pregnancy OR: 0.27 CI 95% (0.07-0.98).Conclusions: These findings provide clear guidelines for the proposal of attendance programs, prevention of oral diseases programs and promotion of oral health programs for pregnant women. Objetivo: Determinar los factores asociados a caries y a enfermedad periodontal en la mujer gestante.Materiales y Métodos: Se realizó un estudio de corte transversal en 149 mujeres entre febrero y mayo de 2001, en la ciudad de Bucaramanga. Se estudiaron variables sociodemográficas, relacionadas con la gestación, dieta, creencias y prácticas saludables e higiene oral. Como variables dependientes se definieron: el índice de dientes cariados, obturados y perdidos (COP) y el Índice Periodontal Comunitario y de necesidades de tratamiento (CPITN). Para el análisis se aplicaron modelos de regresión logística simple y múltiple con el fin de estimar las razones relativas, Odds Ratio, (OR) y determinar los factores asociados a COP y CPITN utilizando el software Stata 6.0 con un a = 0.05.Resultados: Los OR ajustados paro COP fueron: edad OR: 1.27, IC 95% (1.15 y 1.41), seguridad social OR: 0.04, IC 95% (0.006 y 0.27) y semana de gestación OR: 0.93, IC 95% (0.87 y 0.99). Para CPITN se detectaron: signos y síntomas sugestivos de HTA, OR: 11.8, IC 95% (1.14 y 121.3), Índice Cuantificado de Placa OR: 4.19, IC 95% (1.63 y 10.8), seguridad social OR: 0.19 y embarazo de riesgo OR: 0.27, IC 95% (0.05 y 0.7) y (0.07 y 0.98), respectivamente.Conclusiones: Estos hallazgos proporcionan información valiosa para desarrollar programas de atención odontológica, prevención de la enfermedad y promoción de la salud bucodental en la mujer gestante en nuestro medio.[Chacón AF, Gutiérrez A, Montañez JA, Villamizar A, Pieschacón MP, Camargo DM. Factores asociados a caries y enfermedad periodontal en mujeres gestantes, Bucaramanga, 2001. Ustasalud 2002; 1: 33 - 41]

Objective To determine the frequency of dietary supplement use for children with Down syndrome, and to obtain additional descriptive data regarding the age of initial treatment, cost, perceived benefits, and disclosure of use to the pediatrician. Study design An anonymous questionnaire in English and Spanish was created for parents of children under age 18 years with Down syndrome. Surveys were completed in our clinic, or accessed on a number of Down syndrome-related websites. Results A total of 1167 responses were completed and analyzed. Forty nine percent of responders currently/previously gave their child supplement(s). The average child received 3 supplements (ranging from 1-18). Although Nutrivene, curcumin, and green tea extract were most common, over 150 different products were reported. Supplementation began most often in infancy, generally between age 4 and 6 months. Average cost was $90.53/month. Overall, 87% of users noted improvement, mainly in speech, immunity, and attention; 17% reported side-effects, predominantly gastrointestinal disturbance. Lack of improvement and cost were the main reasons for discontinuation. Most parents learned of supplements through a parent group or friend. In almost 20%, the pediatrician was unaware of the supplement use. Conclusions Almost one-half of parents surveyed administer or have administered supplement(s) to their children with Down syndrome. Many of the supplements have concerning ingredient profiles and are given to children too young to articulate potential ill effects. Providers need to be aware of these products and question families about their use.

Background. The management of choledocholithiasis has evolved from open common bile duct exploration (OCBDE) to therapeutic endoscopic retrograde cholangiopancreatography (ERCP) to laparoscopic common bile duct exploration (LCBDE). Each entails a degree of difficulty. Aim. To review 5-year results of bile duct exploration in an UGI unit. Methods. Common bile duct explorations (CBDEs) performed between January 2008 and January 2013 were identified from a prospectively collected clinical audit system and results reviewed retrospectively. Results. 216 CBDEs were performed, 119 (55%) as an emergency and 52 (24%) following failed ERCP. Open CBDE (OCBDE) was performed primarily in 34/216 (16%) patients and attempted laparoscopically in 182 (84%). Fifty nine (32%) Laparoscopic CBDEs (LCBDEs) were converted to OCBDE. Of the remaining 123 LCBDEs, 51 (41%) primary choledochotomies and 72 (59%) primary transcystic CBDEs (TC-CBDEs) were performed. Forty nine (68%) TC-CBDEs were considered successful and 23 (32%) failed. Fifteen failed TC-CBDEs were converted to a successful laparoscopic choledochotomy. Ductal clearance was achieved in 187/216 (87%) patients and retained stones were identified in 20/123 (16%) LCBDEs. Complications occurred in 52/216 (24%) patients. There were 8/216 (4%) bile leaks requiring further intervention. Postoperative ERCP was carried out in 32/216 (15%) patients and 9/216 (4%) required relaparoscopy/laparotomy. No patient died. Conclusions. Successful management of choledocholithiasis requires a breadth of laparoscopic and endoscopic expertise.