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Despite the fact that the tablets are the most widely used dosage form, they are not suitable for young children and patients with swallowing difficulties, especially the elderly. Orodispersible films (ODFs) dissolve rapidly in the mouth and deliver an accurate amount of the active ingredient, which makes them an easy-to-use dosage form that can improve drug acceptability and, therefore, treatment adherence. The findings of the 4 studies that we discussed in this review prove that ODFs have experimentally-proven good acceptability in all age groups and that they are clinically superior to tablets and syrups in terms of acceptability. Therefore, despite some limitations, ODFs are still an innovative and patient-centered dosage form that can contribute to improving drug acceptability and treatment adherence particularly in children and elderly patients. Pharmaceutical companies should focus on developing more ODF-based drugs and also other innovative dosage forms that can make the drug-taking experience even-easier.

Diabetes mellitus is a chronic disease that occurs when the pancreas is unable to produce enough insulin. Indonesia is the 7th most DM sufferer in the world. Patients when diagnosed with DM experience psychological stress, anxiety because they are no longer like normal people, causing depression. The way to reduce depression is to do physical activity such as gymnastics. The purpose of this study was to determine the effect of diabetic exercise on the reduction of depression scores at Persadia RSI Klaten. This study used a quasy experimental pre post test design with a cross sectional approach. The study population was type II DM patients who joined Persadia Islamic Hospital Klaten. The sampling technique was purposive sampling with a total of 30 respondents. The data collection instrument used the PHQ questionnaire. Bivariate data analysis using the Wilcoxon test. The results of the research on the characteristics of respondents were dominated by women as many as 23 (76.7%). The average age of the respondents was 49 years. The ethnic group is dominated by Javanese as many as 28 (93.3%). Most of the respondents' occupation is Labor 12 (40.0%). The average score for depression before the intervention for diabetic exercise was 7,400 and after the intervention for diabetic exercise decreased to 2.166. The results of the Wilcoxon test showed that there was a significant effect of diabetes exercise on the reduction of depression scores in type II diabetes mellitus patients at Persadia RSI Klaten values ??(p = 0.000, Z = -4.813). Conclusion based on the results of the study, the average depression score in Type II DM patients before diabetes exercise was 7,400. Meanwhile, the average depression score after diabetes exercise was 2.166. The results of statistical tests showed that there was an effect of diabetes exercise on depression scores in Type II DM patients with a p value of 0.000.

Chronic obstructive pulmonary disease is a progressive lung disease characterized by chronic obstruction of the lung airflow that interferes with normal bleeding and is not fully reversible. Chronic smoking is the most common risk factor for COPD causing severe cough, wheezing, labored breathing and reduced functionality. COPD not only exerts pulmonary symptoms but also has a spill over the extra pulmonary effects. Owing to the impact of the disease, it may lead to conditions like osteoporosis, cardiovascular complications as well as to psychological effects such as depression and anxiety. Such comorbidities are hidden and are not effectively treated. Depression, one of the most common hidden comorbidities is known to be present but never diagnosed. Various scales like HAM-D and Bode Index can be used to diagnose the extent of depression. Our review mainly focuses on the various studies conducted worldwide and comparing the results of the same. Based on the worldwide analysis, depression is known to affect a COPD patient at later stages and requires immediate diagnosis and appropriate treatment.

Neurocysticercosis (NCC) is a rare central nervous system infection that is preventable and is caused by the Taenia solium tapeworm larval stage. This disorder is the world’s most common cause of acquired epilepsy and a significant cause of neurological morbidity. This disease is pleomorphic due to several complex factors such as cysticerci characteristics, stages of development, and many more which leads to difficulties in inaccurate diagnosis and adequate stage-wise care. The introduction of cystidical medications, however, has led to a stronger prognosis of NCC-affected patients with an increase in the patient’s clinical course of the disease. After diagnosis most seizure patients do not experience epilepsy. Since Neurocysticercosis remains a neglected tropical disease, the management, and prevention of T. so ilium transmission and strategies for eradicating NCC from endemic areas should be highlighted and prioritized in global healthcare to minimize the significant burden on healthcare and the economy.

Objective The purpose of this case report was to create awareness among scientific fraternity and those who are in the regular usage of the yellow phosphorous compound. Yellow phosphorus is an inorganic element that is poisonous to humans (yellowish, waxy, crystal-clear solid with a pungent odor). Case presentation The patient treatment chart was reviewed and the patient’s condition was evaluated daily. Consumption of toxic doses causes shock and cardiovascular failure within 2–3 h of ingestion, and peak levels are reached when distributed to all tissues after absorption. Here, we report a case of self-harm with the ingestion of rat killer paste, and the patient suffered internal bleeding and acute liver failure. Conclusion Rodenticides remain the primary cause of morbidity and mortality, internal bleeding is the major risks of rodenticide poisoning.

Introduction: Psychological factors including depression and anxiety are the most critical risk factors in the treatment and prognosis of heart failure which should be addressed in treatment and care programs. The purpose of this study was to examine the effect of cognitive-behavioral training (CBT) on depression severity and self-care ability of patients with heart failure. Methods: This study was a randomized clinical trial that carried out on 80 patients with heart failure who had been hospitalized in 2018. The participants were divided into the CBT group (n= 40) and the conventional training (CT) group (n= 40), randomly. Data were collected using Beck Depression Inventory (BDI) and the Self-Care of Heart Failure Index (SCHFI) version 6.2 before and 8 weeks after the educational interventions. Data were analyzed in SPSS 21 using paired t-test, independent t-test, chi-square test, and covariance analysis. Results: The mean score of self-care in the CBT group turned out to be significantly higher than the CT group after receiving the intervention. Also, the mean depression score of the CBT group 26.95 (5.53) after intervention was significantly lower than the CT group 36.04 (8.45). Conclusion: Cognitive-behavioral intervention, compared with conventional training, had a greater positive impact on improving self-care and alleviating the severity of depression symptoms. Therefore, it is recommended that the principles of cognitive-behavioral therapy be integrated into routine educational programs.

PURPOSE: This study aimed to evaluate biphasic calcium phosphate coating (BCPC) on the secondary stability of dental implants compared to sand-blasted and acid-etched (SLA) implants. MATERIALS AND METHODS: This is a split-mouth study. Thirty subjects (20 males and ten females) underwent a dental implant procedure to replace mandibular first or second molars bilaterally. The subjects were randomly assigned to BCPC or SLA groups. The resonance frequency analysis measurements were performed two, four, six, and eight weeks after the implant placement. RESULTS: Sixty implants were placed in the two groups (30 implants per group). The mean ISQ was 52.26 ± 3.73 in group 1 and 50.21 ± 2.59 in group 2 on day 14 after the implant insertion, 63.20 ± 2.76 in group 1 and 58.80 ± 2.14 in group 2 on day 28, 72.30 ± 3.15 in group 1 and 64.53 ± 3.19 in group 2 on day 42, and 78.70 ± 1.56 in group 1 and 71.63 ± 3.22 in group 2 on day 56. The data analysis demonstrated significant differences between the two groups in terms of the mean ISQ at various evaluation times. CONCLUSION: Regarding ISQ measurements, the secondary stability in BCPC implants may be higher compared to SLA implants in two months after implant insertion.

The aim of this study was to investigate the frequency of anti-N-methyl-D-aspartate receptor (anti-NMDAR) antibody positivity in patients presenting with transverse myelitis (TM) and/or optic neuritis (ON), to describe their neurologic and radiological characteristics, and to compare these characteristics with those reported in previous studies. This study included 179 patients (ON: 96, TM: 74, ON and TM: 9) who visited Isfahan Multiple Sclerosis Center from January 2017 to September 2019, for approximately 32 months. The respective neurological examinations were performed. Demographic data of the patients, as well as findings from radiological and serological investigations were obtained. Frequencies of anti-NMDAR seropositivity in patients with TM, ON, and concurrent TM and ON were approximately 3.4%, 1.4%, and 11.1%, respectively. None exhibited any psychiatric symptoms. Based on the frequency of seropositivity for anti-NMDAR antibody in our patients, positivity for this antibody appears to be more frequent than previously anticipated in patients presenting with these conditions. We recommend that the anti-NMDAR antibody presence in CSF/serum be checked and considered in addition to the routine examinations performed upon confronting demyelinating conditions such as TM and ON. We suggest considering the term “NMDAR spectrum disorder” to more clearly distinguish the potentially overlapping conditions with different etiologies in patients with CNS disorders.

Pre-Eclampsia was recorded as a cause of maternal death in Indonesia in 2017, which was 28.8%. Hypertension is a sign of pre-eclampsia. Murattal Therapy Letter Yusuf is a non-pharmacological therapy that can be used to reduce blood pressure. The purpose of this study is to determine the effect of Murattal Therapy in reducing blood pressure in pregnant women with pre-eclampsia. The design of this study used the Quasy Experiment design with One Group Pretest and Posttest Design. As the population are pregnant women who are diagnosed with pre-eclampsia. 15 respondents were selected using purposive sampling. Data collection tool with an observation sheet and tensimeter. The data collection technique was carried out using the respondent placed in a conditioned room, then listening to the letter of Joseph for 15 minutes using a tape recorder and then his blood pressure was measured. From the 15 respondents after Murotal therapy, the result of a decrease in blood pressure with a statistical test using a paired t-test obtained a p-value of systolic blood pressure of 0,000 and diastolic blood pressure of 0,000. Murattal therapy can stimulate a controlled autonomic nerve and cause secretion of epinephrine and norepinephrine by the controlled adrenal medulla. Control hormones epinephrine and norepinephrine will inhibit the formation of angiotensin which can reduce blood pressure. Surah Yusuf's Murattal Therapy can reduce the blood pressure of pregnant women with pre-eclampsia.

Inherited hemorrhagic telangiectasia (HHT or Osler–Weber–Rendu syndrome) is a hereditary condition characterized by malformations of multiple blood vessels (vascular dysplasia), which may lead to bleeding (hemorrhaging). Chronic nosebleeds are often the first warning, and malformations in various blood vessels can lead to abnormalities in the lungs, brain, spinal cord, and liver. There are a number of therapies available for various aspects of HHT to improve the quality of life and avoid life-threatening complications. Individuals with HHT have an almost average life expectancy. HHT is inherited as a dominant autosomal trait. We have done this review to enlighten the scientific fraternity about HHT. In this review, we have tried to explain about HHT and its related management.

BACKGROUND Introducing a non-invasive method for determining disease activity is important in patients with ulcerative colitis (UC). So in this study, we aimed to assess the association between disease activity index and microalbuminuria in patients with UC. METHODS In the present cross-sectional study, 84 patients with UC were selected. The disease activity was calculated by the partial Mayo clinic score. Microalbuminuria was assessed using the immunoturbidimetric method in a first-voided sample in the morning in two consecutive days and the mean of these two measurements was reported as urinary microalbumin level. Serum C reactive protein (CRP), erythrocyte sedimentation rate (ESR), and fecal calprotectin were measured respectively using conventional turbidimetric immunoassay, Westergren method, and ELISA methods. RESULTS The mean age of the participants was 40.01 ± 12.85 years, 60.8% of them were female and 53.5% had microalbuminuria. The frequency of microalbuminuria was significantly higher in patients with active compared with inactive inflammatory bowel disease (IBD). There were significant differences between the patients with active and inactive disease regarding CRP, ESR, and calprotectin (p < 0.001). Moreover, there was a strong correlation between microalbuminuria and CRP (r = 0.89, p < 0.001), ESR (r = 0.92, p < 0.001), and calprotectin (r = 0.91, p < 0.001). CONCLUSION Microalbuminuria could be used as a non-invasive marker of disease activity in patients with UC.

Objective: To assess the attitudes, experiences, training levels, and interest in future education regarding the use of hypnosis by dentists working in Dental Clinic of Monastir, Tunisia . Material and Methods: A cross-sectional study was conducted among 330 dentists working in Dental Clinic of Monastir in November 2019. Students, internship, residents, and professors were randomly selected. This was a survey with a structured questionnaire mailed to all dentists. The questionnaire was pre-fabricated, simple, and close-ended. Data were analyzed using SPSS 24.0 statistical software. Results: A total of 202 dentists respond to this survey. 54% of the participants were interns with a female predominance (66.5%). Findings revealed that beliefs toward hypnosis in the sample were generally positive. Using a visual analogue scale, dentists reported having moderate acknowledge in hypnosis (3.4). 60% of the participants in our study consider that hypnosis is useful in dentistry and, more particularly, in pediatric dentistry. 78.2% of respondents want to follow training courses in hypnosis . Conclusion: Our survey highlights the weak knowledge of participants in hypnosis and reveals certain misconceptions about this procedure. More efforts are required to better educate dentists about hypnosis's benefits in their practice.

Recurrent thrombosis is a common complication in various pathologies and is part of the definition of antiphospholipid syndrome. We report an observation in which the patient presented with repeated thrombosis, due not only to an antiphospholipid syndrome with partial thromboplastin time with normal activator, but also to a resistance to active protein C linked to the existence of the Leiden factor mutation V. This observation confirms the most often multifactorial nature of thromboses and therefore encourages the search for resistance to activated protein C before an evocative clinic, especially if the routine coagulation assessment is normal.

Albinism is a hereditary disorder that causes decreased pigmentation (coloring) in the body. As a consequence, albinism individuals are mostly fair-skinned with light hair known as oculocutaneous albinism. Skin, hair and color of the eye may vary, however, as some people with albinism may have dark brown hair and green or hazel / blue eyes. In both cases, poor vision and varying degrees of nystagmus (uncontrolled side-to-side eye movements) are observed. Everyone with HPS has albinism but not all people with albinism have HPS. We recorded a case with multiple comorbidities of a 37-year-old female patient with Hermansky-Pudlak syndrome (HPS) here

Background: Due to the importance of spiritual health in patients with thalassemia and its positive and significant effects on improving the treatment process and mental, psychological and social conditions of these patients and according to the results of previous studies, patients with thalassemia have high spiritual health. The lack of studies in this field, the present study was conducted to determine the spiritual health of adolescents with thalassemia major. Methods: This descriptive-analytical study was performed on 100 adolescents with thalassemia major. Sampling was done by available means. Patients' spiritual health was measured using the Poltzin and Ellison spiritual health questionnaire. Data were analyzed using descriptive statistics tests and the relationship between mean spiritual health and mean age of patients with Pearson correlation coefficient test, its relationship with gender and place of residence with independent t-test and its relationship with economic status with ANOVA. Results: The mean and standard deviation of patients' spiritual health score was 74.23 ± 11.45, which showed a moderate level of spiritual health. 12% of patients (12 patients) reported low spiritual health, 84% (84 patients) reported moderate spiritual health and 4% (4 patients) reported high spiritual health. There was no significant relationship between spiritual health and demographic characteristics (p value > 0.05). Conclusion: According to the results of this study which showed that adolescents with thalassemia have a moderate level of spiritual health and due to the high importance of spiritual health in improving treatment, adherence to treatment regimen, life expectancy and mental health of patients, It is necessary to take appropriate measures to improve the spiritual health of these patients.

Background: Staphylococcus aureus is one of the important bacteria causing nosocomial infections. Nowdays, because of overuse of antibiotics, resistance is increasing and this problem has caused anxiety all over the world. The aim of this study was to evaluation of antibiotic resistance pattern in S.aureus isolates from urinary tract infections in Shahid Beheshti educational and therapeutic center in Maragheh city. Methods: In this cross sectional study, 100 S. aureus isolates were collected from patients suffering from urinary tract infections. After doing the biochemical tests for diagnosis of S. aureus, these isolates were identified as S.aureus with proliferation of thermonuclease species-specific gene (nuc) by polymerase chain reaction (PCR) method. Kirby-Bauer method was used for investigation of antibiotic resistance patterns in S. aureus isolates. Results: No significant difference in genotype frequencies was observed between the T2DM patients and normoglycemic controls. The rs7903146 (C/T) polymorphism odds ratios for CC and TC genotypes were 1.75 (95% CI, 0.63 to - 4.88; p=0.28) and 0.94 (95% CI, 0.49 to - 1.79; p = 0.84) compared with the TT genotype, respectively. The rs46522 (C/T) poly-morphism odds ratios for TT and TC genotypes were 1.41 (95% CI, 0.58 to - 3.42; p = 1.41) and 1.22 (95% CI, 0.64 to - 2.35; p = 1.22) compared with the CC genotype, respectively. Conclusion: Results of current study showed high antibiotic resistance in nosocomial S. aureus isolates. Therefore, antibiotics consumption should be avoided without proper prescription and unnecessary usage of routine antibiotics for showed be prevented.

Introduction: Breastfeeding is a physiological task for postpartum mothers. At the postpartum the condition of the body, especially the breast and hormonal system are prepared to support the lactation process. Not all mothers however can carry out this new task smoothly. Many complaints experienced by the mothers at the beginning of the lactation process including breast milk not coming out, breast milk in small amount, nipple blisters and so on. One of the factors that influences milk production is hormonal factors, namely prolactin and oxytocin. Breast care will stimulate the breast and affect hypopise to release more progesterone, estrogen and oxytocin hormones. The oxytocinhormone will cause contractions in other cells around the alveoli so that milk flows down towards the nipples. Methodology: This type of research is a quasi-experiment using the pre post test design with control group. Results: The study showed that there was an increase in the mean value of oxytocin hormone in the mothers after receiving the Oketani massage intervention and pressure on the jianjing GB-21 acupressure point. Discussion: Massage can help reducing daily stress, improve the immune system and generally make people feel healthier and more relaxed. Massage has been shown to facilitate increased release of natural oxytocin. Acupressure technique at Jianjing point GB-21 is a point to stimulate let down reflexes which can stimulate lactogen hormone secretion and can increase blood circulation in the breast (Betts, 2003). Relaxation conditions experienced by the mother will increase comfort so that it increases the let down reflex and increases levels of the prolactin and oxytocin hormones (Rahayu, et al., 2015).

Antimicrobial resistance is a global public health challenge, which has accelerated by the overuse of antibiotics worldwide. Increased antimicrobial resistance is the cause of severe infections, complications, longer hospital stays and increased mortality. Steps must be taken to reverse the damage that has already been done and prevent further resistance from developing. This work will examine the context and societal situations that led to this acceptance of antibiotic overuse and misuse seen in both health care professionals and the public, the biochemical and genetic pathways that allow a microbe to develop drug resistance, the consequences that could follow if this trend of antibiotic overuse is allowed to continue and the various methods and solutions that have been suggested to prevent and reverse this problem.

Epidural myeloid sarcoma revealing chronic myeloid leukemia is scarce. Herein, we describe a patient that presented with back pain and bilateral sciatica secondary to root compression due to epidural deposition of leukemic cells. The magnetic resonance imaging showed epidural masses, causing a slight restriction of the spinal canal with bilateral L5 root compression. Laboratory examinations showed hyperleukocytosis (white blood cell count: 83 × 109/L, absolute neutrophil count: 60 × 109/L). The bone marrow cytology and immunophenotypic findings confirmed the diagnosis of myeloid leukemia. The diagnosis of spinal myeloid sarcoma revealing chronic myeloid leukemia during the blast phase was established. The patient underwent induction chemotherapy. Then, bone marrow cytology revealed less than 3% of blasts, which correspond to cytological remission. Three months later, MRI showed complete disappearance of the epidural masses. A literature review was conducted by searching PubMed using these terms: “Leukemia, Myeloid” AND “Spine” AND “Sarcoma, Myeloid”. We emphasize clinical and radiological findings of spinal myeloid sarcoma. This diagnosis should be considered when the MRI reveals epidural mass lesion. The early management of this disease is necessary, and the treatment of myeloid sarcoma is not codified. Our case highlighted that chemotherapy treatment could be sufficient to lead to the disappearance of myeloid sarcoma and the remission of leukemia.

Menurut Badan Penelitiandan Pengembangan Kesehatan dalam Riset Kesehatan Dasar 2013 tercatat jumlah balita di Indonesia sebanyak 26,7 juta. Dari jumlah tersebut 17,9% atau 4,7 juta balita menderita gizi kurang dan 5,4% atau 1,3 juta balita menderita gizi buruk. Gizi kurang berdampak langsung terhadap kesakitan, kematian dan juga berdampak terhadap pertumbuhan, perkembangan intelektual dan produktivitas.. Dampak lain dari gizi kurang adalah menurunkan produktivitas yang diperkirakan antara 20-30%. Penelitian ini bertujuan untuk meneliti hubungan faktor pengetahuan ibu tentang gizi seimbang dengan status gizi balita. Penelitian ini merupakan penelitian deskriptif korelatif dengan pendekatan crossectional . Penelitian dilaksanakan bulan Juni-Agustus 2019 di wilayah Desa Gogik, Kec. Ungaran Barat Kab. Semarang. Sampel dipilih dengan teknik Prposif sampling sebesar 80 ibu dan 80 balita berumur 13-60 bulan. Variabel bebas: pengetahuan. Variabel terikat: status gizi. Teknik pengumpulan data menggunakan kuesioner . Analisis data yang digunakan adalah Chi square . Hasil penelitian menunjukkan karakteristik subjek penelitian sebagian besar dalam kategori usia reproduksi sehat yaitu 68 (85%), sebanyak 53 (66%) adalah bekerja, sebanyak 39(48,8%) memiliki tingkat pendidikan dasar dan sebanyak 44 (55%) memiliki pendapatan kurang dari UMR. Sebanyak 39 (48,8%) subjek penelitian memiliki tingkat pengetahuan tentang gizi balita dalam kategori baik, sebanyak 58 (72.5%) subjek penelitian memiliki status gizi dalam kategori normal. Secara statistik terdapat hubungan signifikan antara pengetahuan ibu tentang gizi dengan status gizi balita dengan nilai p = 0.000 < dari 0.05. Sebagian besar subjek penelitian memiliki tingkat pengetahuan dalam kategori baik, dan sebagian besar subjek penelitian memiliki status gizi dalam kategori normal. Terdapat hubungan signifikan antara pengetahuan ibu tentang gizi dengan status gizi balita. Kata Kunci : Pengetahuan, Gizi seimbang, Status Gizi, Balita

Spotting blood in urine can be alarming. In many instances the cause is harmless, but blood in urine can indicate a serious disorder. Haematuria can be categorized into two categories, such as gross haematuria and microscopic haematuria. Gross haematuria is visible with naked eyes, and easily identifiable, whereas microscopic haematuria can be identified after doing a urine test under a microscope. It is important to know the primary cause of bleeding. It can be either due to medications, kidney disorders, urinary tract infections or strenuous exercise's. Here we report a case series of gross haematuria for three patients where it has been caused by anticoagulant drug heparin. Our case series illustrates a strong causal relation with heparin causing gross haematuria.

Non-steroidal anti-inammatory drugs (NSAID) are regularly utilized for pain relieving and are among the most often medications in this world. The adverse effects of NSAID on the upper gastrointestinal tract are very much portrayed. Evidence shows that NSAID can be unsafe to the small intestine tract. The prevalence of NSAID-induced enteropathy is insecure. The utilization of NSAID has been related with little intestinal strictures, ulcerations, perforations, diarrhoea and villous atrophy. The reports of NSAID abuse and NSAID use issue are exceptional. In contrast to stomach, NSAID-induced lower gastrointestinal wounds are not brought about by concealment of prostaglandin union because of restraint of cyclooxygenase (COX) action. The pathogenesis of NSAID- induced enteropathy is unpredictable and not clearly understood. Until now, no new drugs have been developed for the treatment of NSAID-induced enteropathy. This case report portrays an investigation on the mechanism of NSAID induce enteropathy with comorbid condition.

Introduction: Oketani massage and oxytocin is one of the breast care methods that do not cause pain. Massage can stimulate oketani pectoralis muscle strength to increase milk production and make the breasts become more soft and elastic so meumudahkan baby to suck milk. Massage oketani will also provide a sense of relief and an overall comfortable on respondents, improving the quality of breast milk, to prevent mastitis and nipple blisters and can fi x / reduce lactation problems caused by putting a fl at (fl at nipples), nipples that enter into (inverted). Method: This research was a quasi experimental with post test only design. Result: The results showed that there are different breastfeeding frequency, frequency of bowel, bladder frequency of respondents who do massage and oxytocin oketani. Discussion: one milk production assessment is to assess the frequency and volume of urine bladder baby. Normal babies will urinate 6-8 times a day, with a clear yellow color of urine is urine volume between 30-50 mg daily. This result is consistent with research conducted by Budiarti (2009) and Mardianingsih (2010) which states that the milk production can be judged from the frequency of micturition babies as many as 6-8 times a day Key words: oketani massage, oxytocin massage, milk production

Phenytoin is an antiepileptic drug and is commonly prescribed for generalized tonic-clonic seizure. It blocks the voltage gated sodium channel and produce the action. It has a narrow therapeutic index. Adverse effects are very common with phenytoin but idiopathic ataxia is rarely observed. We report a case of a 30-year-old male patient who had chief complaints of ataxia, giddiness and vomiting. He had past medical history of epilepsy for which he was adherent to phenytoin from past four years. Key words: Phenytoin, Ataxia, Male, Epilepsy, Adverse drug reaction.

An adverse drug reaction is a causal relationship between a drug and an event. Alcohol consumption remains a huge threat to the global health. A seizure is an event accompanied with loss of motor activity and alterations in the patients EEG. Phenytoin is one of the most commonly employed anti-seizure medications. Manifestations of chronic phenytoin use may induce phenytoin toxicity and psychosis. Here we report a case of a 45 year old male patient with probable phenytoin induced psychosis while being treated for seizures in the in-patient ward. The long term use of phenytoin may manifest psychotic symptoms in certain population. There is a definite need of more evidence in this field and proper diagnostic and management approaches. Key words: Adverse drug reaction, Alcohol, Phenytoin, Probable, Psychosis, Seizures.

Objective: A poison can be any substance that can be taken through any means with net production of toxicity, which may result into death and coma as well. The evolution of rodenticides through history, witnesses the large-scale use of the first and the second-generation rodenticides those are commonly found with many of the household items meant for pest control. Psychosis is a mental health issue associated with episodes of hallucinations and delusions. This leads to the patient’s misinterpretation of the surrounding environment. Few literatures have been reported regarding the use of rodenticides in psychotic patients. Manifestations of rodenticide poisoning includes gastric irritations, flank pain, gastric distension etc. The management focus of rodenticide poisoning should be more prominently based on most recent updated guidelines and dose titration should be monitored on the laboratory outcomes. Monitoring is the key to remission. Key words: Adverse Drug Reactions, Psychosis, Poison, Rodenticides, Self-Harm.

Bayi dengan Berat Badan Lahir Rendah (BBLR) merupakan penyebab ke dua kematian bayi di Jawa tengah. Bayi yang lahir dengan BBLR perlu mendapatkan penanganan yang serius, karena pada kondisi tersebut bayi mudah sekali mengalami gangguan. Bayi dengan BBLR memiliki resiko untuk mengalami gangguan pertumbuhan dan perkembangan dimasa depan (Kemenkes RI, 2016 ; Dinkes Jateng, 2016; Surami, 2003). Tujuan penelitian ini untuk mengetahui hubungan berat badal lahir dengan pertumbuhan dan perkembangan balita. Penelitian ini menggunakan desain analitik observasional dengan pendekatan cross sectional. Penelitian dilaksanakan tanggal 11 Juli -21 Agustus 2019 diwilayah kerja Puskesmas Ungaran, Leyangan dan Banyubiru. Sampel penelitian ini adalah balita usia 0 – 5 tahun yang berjumlah 137 responden.Teknik pengumpulan data dengan pengukuran pertumbuhan dan perkembangan balita. Hasil Penelitian dianalisis bivariat menggunakan uji chi Square. Hasil penelitian menunjukkan responden dengan riwayat berat lahir normal 86 (62,8%), riwayat berat lahir rendah 51 (37,2%). Status pertumbuhan Normal 83 (60.6%), sangat pendek 45 (32,8%), dan pendek 9 (6,6%) responden. Status perkembangan dengan kategori normal 78 (56,9%) dan kategori suspect 59 (43,1%) responden. Berdasarkan hasil analisis statistik dengan chi square didapatkan hasil bahwa terdapat hubungan antara berat badan lahir dengan pertumbuhan balita dengan p value = 0.025 dan OR = 0.415, dan terdapat hubungan secara statistik antara berat badan lahir dengan perkembangan balita dengan p value = 0.000 dan OR = 4.880. Terdapat hubungan antara berat badan lahir dengan pertumbuhan balita. Terdapat hubungan yang kuat dan signifikan antara berat badan lahir dengan perkembangan balita. Penelitian ini menyarankan kepada orang tua untuk lebih maksimal dalam melakukan stimulasi perkembangan anak dan bagi petugas kesehatan untuk melakukan deteksi dini prenatal untuk mencegah terjadinya BBLR. Kata Kunci : Berat badan lahir, pertumbuhan, perkembangan

Mosquitoes are the most important vectors of some human diseases in tropical countries. In particular, Aedes aegypti is the main vector for Chikungunya, Dengue, and Zika viruses in Brazil (Scavuzzo, 2018). The infection causes flu-like symptoms, and sometimes evolves into a life-threatening condition called severe dengue or hemorrhagic dengue. It is a widespread infection that occurs in all regions of the planet's tropical climate, and now because of the climate change, it may expand to some other regions. In recent years, transmission has increased predominantly in urban areas and has become a major public health problem.Recently, there has been an increasing trend on GeoHealth studies by use of remotely sensed data for mapping health risk and monitoring vector-borne diseases. Thus, the aim of this work is to generate risk maps integrating those environmental and climate indicators with adaptive capacity factors to define regions with high risk of vector-borne diseases in Brazil. Consequently, we present a multi-indicator study, similar to the one already developed in Vietnam by Nguyen and Liou (Nguyen and Liou, 2018) for the Aedes Albopictus, but the present study is in Brazil for the Aedes aegypti and adding the information of the Soil Moisture (SM) from the Barcelona Expert Center (BEC). Then, the study combines climatological data (e.g. soil moisture, temperature and precipitation), and demographic and socioeconomic data over the Brazilian territory for the 2013-2018 period. Dengue episodes distribution data for this period have been obtained from the Notifiable Diseases Information System (SINAN), developed by Ministry of Health.

Background: Platelets can activate B cells and stimulate them for the production of antibodies. Since platelet microparticles (PMPs) originate from platelets, they may have the same virtue. In the present study, the effect of PMPs was investigated on the production of human leukocyte antigen (HLA)-specific antibody from B cells in vitro. Materials and Methods: In this experimental study, HLA-DR antigen was solubilized from the immortalized B lymphocytes (Daudi cell line) and purified using the affinity chromatography. Antigen properties were determined by the ELISA technique. PMPs were isolated from platelet concentrate bags by centrifugation. Fresh blood products were prepared from the Innovation Center of Iranian Blood Transfusion Organization (IBTO) and B lymphocytes were purified by the MACS method. B cells were exposed with PMPs and HLA-DR antigens in the culture medium. On the third day of culture, the culture supernatant was examined in terms of antibody production using the ELISA test. The results were analyzed using paired sample T-test and P-value

Penyebab AKB di Kabupaten Semarang tahun 2016 bila dilihat dari umur kematian bayi, kasus kematian terbanayk pada usia 7 hari (77 bayi), usia 8-28 hari (31 bayi), dan usia 29 hari – 11 bulan (43 kasus). Dengan penyebab terbesar AKB adalah BBLR (44 kasus), asfiksia (29 kasus), dan sisanya (78 kasus) karena infeksi, kelainan kongenital, aspirasi, tetanus, dan lain-lain. Berbagai upaya yang telah dilakukan untuk menekan Angka Kematian Bayi antara lain dengan pemberian makanan tambahan pada ibu hamil, pemberian informasi tentang perawatan BBL (Profil Kesehatan Kabupaten Semarang, 2016). Akan tetapi untuk informasi tentang tanda bahaya bayi baru lahir belum ada program khusus.Untuk Menganalisis Pengetahuan Ibu Nifas Tentang Tanda Bahaya Bayi Baru Lahir Di Wilayah Kabupaten SemarangPenelitian Penelitian menggunakan desain analitik observasional dengan pendekatan cross sectional. Jumlah sampel dalam penelitian ini adalah 76 responden dengan pengambilan sampel menggunakanPurposive sampling. Analisis bivariat menggunakan uji chi Square. Dengan hasil tidak ada hubungan yang signifikan antara kepemelikan buku KIA (p=1.000), membaca buku KIA (p=0,980), Mendapat informasi (p=0,951), Usia ibu (p=0,422), pendidikan ibu (p=0,349) dengan pengetahuan ibu nifas tentang tanda bahaya bayi baru lahir, dan terdapat hubungan yang signifikan antara penjelasan nakes (p=0.002) dengan pengetahuan ibu nifas tentang tanda bahaya bayi baru lahir. Tenaga kesehatan hendaknya selalu memberikan penjelasan tentang tanda bahaya bayi baru lahir baik pada waktu kunjungan antenatal maupun saat kunjungan post natal dan lebih memberikan dukungan pada ibu untuk membaca buku KIA yang berkaitan dengan tanda bahaya bayi baru lahir.

Nail disorders have always remained a therapeutic challenge for the dermatologist. Deformed and unhealthy nails give a psychological setback and may have significant adverse effects on a patient’s daily life, social functioning, and mental health and, hence, the quality of life. So, nails form a vital part of the individual’s personality. A wide range of topical and systemic modalities have been used for treating various nail disorders, but response is often not satisfactory due to various reasons: poor drug delivery, slow growth of nails, and systemic toxicities of drugs. The author discusses various modalities used for nail disorders with special emphasis on injection therapy in nail disorders. This chapter discusses various drugs, namely triamcinolone acetonide, methotrexate, and cyclosporine, which can be used as intramatricial therapy. This chapter also emphasizes upcoming use of injection etanercept for nail disorders. Nail matrix injections are easier than nail bed injections. However, the nail bed disease is less responsive to intramatricial injections. This chapter discusses various indications, contraindications, methods, and complications of injection therapy in nail disorders. Injection therapy has been proven to be a safe, economical, simple, and effective modality in the management of nail disorders. Hence, keeping in mind its low cost, fewer treatment visits and minimal side effects, injection therapy is the best promising option for nail disorders.

Sixty suprarenal glands (both right and left) of different gestational age groups were studied to see the cytoarchitecture of the normal and anencephalic fetuses. The present study was carried out in the Department of Anatomy, Government Medical College & Hospital, Chandigarh. The material for the study consisted of 60 spontaneously aborted human fetal specimens from 12th to 28th weeks of gestational ages (30 – normal fetuses, 30 – anencephalic fetuses). The suprarenal glands were taken from fetal specimens for histological study. The staining was done by hematoxylin and eosin. Histologically, it was observed that suprarenal gland has a superficial narrow zone of darkly stained cells underneath the capsule, which was the permanent cortex and a deeper lighter zone called the fetal cortex. The changes were seen in thickness of capsule, medulla and the layers of the cortex and these layers were compared with the anencephalic suprarenal gland. The study will establish the micro development of suprarenal gland inhuman fetuses in North-West Indian population. The arrangement of cells in the permanent cortex changed from the discrete cells and clusters to well formed glomerulus like structure with increasing gestational period. Fasciculoreticular zone of the fetal cortex decreased in thickness as gestation advanced. The cells were arranged in columns extending deeper into the cortex toward medulla. Sinusoidal vessels increased in number and were 34 μm wide at 11–15 weeks and decreased to 15 μm at >25 weeks gestation. In the medulla, the ganglionic cells were 3–4/field initially which increased to 25–30/field in later gestation period. Few cells showed vacuolization at 11–15 weeks and there was presence of fibrous zone in the medulla consisting of collagen fibers with fibroblasts at >15–20 weeks suggesting early degenerative changes whereas in anencephalic fetuses the medulla was observed to be bulkier as compared to permanent cortex. The fetal cortex was observed till 20 weeks of gestation but after 20 weeks fetal cortex diminished.

Paraquat is one of the most commonly used lethal herbicide. Even the small amount of paraquat is hazardous to human beings. Poisoning by paraquat is most commonly happening in agricultural based economical country. This poison is a threat to public health and its high mortality rate is responsible for a significant number of death. We hereby report a case of 38-year-old male with a history of accidental paraquat ingestion. He works as a gardener which contributes to the ease in availability of the poison. He had the post accidental paraquat consumption complaints of lip sores, swallowing difficulty and hypersalivation in more amount. The patient was admitted in the Casualty and underwent the supportive treatment. Laboratory investigations were found to be normal except WBC count which was elevated. Early diagnosis and proper management can reduce the mortality rate and even small amount of paraquat can lead to some major fatal outcomes. At present there is no specific antidote available so there is a need to focus more on the prevention and management of paraquat poisoning.

Angka kematian ibu (AKI) di Indonesia merupakan salah satu tolak ukur kualitas pelayanan kebidanan dan salah satu indikator penting derajat kesehatan masyarakat. Faktor penyebab kematian ibu diantaranya adalah perdarahan nifas sekitar 26,9%, eklampsia saat bersalin 24%, perdarahan 28%, infeksi 11%, komplikasi puerpurium 8%, trauma obstetrik 5%, emboli obstetrik 3 %, aborsi 5 % dan lain-lain 11 % (DepkesRI, 2015). AKI Kabupaten Semarang mengalami penurunan dari tahun 2014 sebesar 144,31 per 100.000 KH menjadi 120,34 per 100.000 KH pada tahun 2015, adapun penyebab kematian ibu di Kabupaten Semarang tahun 2015 yaitu preeklamsi-eklamsi sebesar 29%, perdarahan sebesar 23%, penyakit jantung sebesar 17%, infeksi sebesar 5% dan lain-lain sebesar 23%, dengan demikian preeklamsi/eklamsi merupakan penyebab terbesar kematian ibu di Kabupaten Semarang (Profil Kesehatan Provinsi Jawa Tengah, 2015; Profil Kesehatan Kabupaten Semarang, 2015). Untuk Mengetahui Hubungan Stress Dan Pekerjaan Dengan Preeklampsia Di Wilayah Kabupaten Semarang. Penelitian menggunakan desain analitik observasional dengan pendekatan case control. Jumlah sampel dalam penelitian ini adalah 110 responden dengan perbandingan 1:4 antara kasus dan kontrol, untuk kasus 22 responden dan untuk kontrol 88 responden. Analisis bivariat menggunakan uji chi Square. Pekerjaan ibu tidak memiliki hubungan yang signifikan dengan kejadian preeklampsia p=0.918, ibu dengan stress sedang memiliki hubungan yang signifikan dengan pre eklampsia p=0.001. Terdapat hubungan yang signifikan antara stress dengan kejadian preeklampsia. Tenaga kesehatan terutama bidan dapat memberikan pendampingan ibu hamil secara menyeluruh termasuk psikologi untuk dapat meminimalkan terjadinya stress yang sedang dan berat saat kehamilan.

Background: The empowerment of the community through health workers is expected to help decrease the occurrence of pneumonia in children under five years old. The health workers need to be given the training about the management of children with cough and breathing difficulties to improve their knowledge, attitude and skills. This research aims to know the impact of training on the management of children’s cough toward the health workers’ knowledge, attitude and skills in the management of children with cough and breathing difficulties. Methods: It was a quasi experimental study with pre-post with control group design. The research is conducted to community health workers where the intervention group (n=40) and the control group (n=37) with purposive sampling. The intervention group has the training by the methods of lectures, simulations, case studies and demonstrations using audiovisual media and modules, whereas the control group does so by reading modules. Results: After 14 days, there is an increase in the value of knowledge (p 0.05) and a decrease in the value of skills (p >0.05). Conclusions: Training on the management of children’s cough can improve the health workers’ value of knowledge, but not value of attitude and skills after the training.

// Ibtissem Djaafri 1,2,* , Farah Khayati 1,2,3,* , Suzanne Menashi 4 , Jorg Tost 5,6 , Marie-Pierre Podgorniak 3 , Aurelie Sadoux 1,3 , Antoine Daunay 6 , Luis Teixeira 7 , Jean Soulier 2,8 , Ahmed Idbaih 9,10 , Niclas Setterblad 1,2 , Francoise Fauvel 1,2 , Fabien Calvo 1,2 , Anne Janin 2,11,12 , Celeste Lebbe 2,13,14 and Samia Mourah 1,2 1 Inserm UMR-S 940 Paris, France 2 Institute of Hematology (IUH), U niversite Paris-Diderot, Sorbonne Paris Cite, Paris, France 3 AP-HP, Hopital Saint-Louis, Laboratoire de Pharmacologie-Genetique, Paris, France 4 Universite Paris Est Creteil, CNRS-UMR; Creteil, France 5 Laboratory for Epigenetics, Centre National de Genotypage, CEA-Institut de Genomique, Evry, France 6 Laboratory for Functional Genomics, Fondation Jean Dausset - CEPH, Paris, France 7 AP-HP ; Hopital Saint-Louis, Service d’oncologie medicale, Paris, France 8 Hematology Laboratory APHP, Saint-Louis Hospital, Paris, France 9 AP-HP, Groupe Hospitalier Pitie-Salpetriere, Service de Neurologie 2-Mazarin, Paris, France 10 Inserm U 975, Paris, 75013 France, CNRS, UMR, Paris, France 11 Inserm, U728, Paris, France 12 AP-HP, Hopital Saint-Louis, Laboratoire de Pathologie, Paris, France 13 AP-HP, Hopital Saint-Louis, Departement de Dermatologie, Paris, France 14 Inserm U976, Paris, France * These Authors contributed equally to this work Correspondence: Samia Mourah, email: // Keywords : Tumor suppressor gene, Kindlin-3, Invasion/Migration, metastasis, Integrins Received : May 26, 2014 Accepted : June 18, 2014 Published : June 20, 2014 Abstract Kindlin-3 (FERMT-3) is known to be central in hemostasis and thrombosis control and its deficiency disrupts platelet aggregation and causes Leukocyte Adhesion Deficiency disease. Here we report that Kindlin-3 has a tumor suppressive role in solid cancer. Our present genetic and functional data show that Kindlin-3 is downregulated in several solid tumors by a mechanism involving gene hypermethylation and deletions. In vivo experiments demonstrated that Kindlin-3 knockdown in 2 tumor cell models (breast cancer and melanoma) markedly increases metastasis formation, in accord with the in vitro increase of tumor cell malignant properties. The metastatic phenotype was supported by a mechanism involving alteration in β3-integrin activation including decreased phosphorylation, interaction with talin and the internalization of its active form leading to less cell attachment and more migration/invasion. These data uncover a novel and unexpected tumor suppressor role of Kindin-3 which can influence integrins targeted therapies development.

The aim of the present study was to evaluate the periodontal regenerative capacity of demineralized freeze-dried bone allograft (DFDBA) alone or used with local lincomycin.In the present single-blind, randomized, controlled clinical trial, 20 subjects 26 years old or older, requiring extraction of bilateral third molars (M3s), were included. Each subject was randomly assigned to receive either DFDBA or DFDBA plus lincomycin therapy. Within the subjects, 1 M3 site was randomly selected to be the experimental site and the contralateral served as the control and was permitted to heal without intervention. The primary variables were changes in the probing depth (PD), clinical alveolar bone levels (ABLs), and radiographic alveolar bone density (ABD) on the distal aspect of second molar between baseline (immediately postoperatively) and 26 weeks postoperatively (T26). Appropriate sample sizes and descriptive, bivariate, and multivariate statistics were computed.For both treatment and control sites, between T0 and T26, statistically significant improvements were seen in the ABLs and ABD (P.05). Within-subject comparisons showed no significant differences in PD, ABL, or ABD between the treatment and control M3 sites at T0 or T26 (P.05). Also, no significant differences were found in the PD, ABL, or ABD between the 2 treatment M3 sites at T26 (P.05).The results of the present study have revealed that the PD, ABL, and ABD improved after M3 removal in subjects 26 years old or older, irrespective of the treatment or control group. Reconstructive procedures (e.g., DFDBA with or without lincomycin therapy) did not offer predictable benefits compared with a no-treatment protocol in patients younger than 30 years old.

Latar Belakang : Pre Eklamsia merupakan komplikasi pada kehamilan yang mendominasi (21 %) Angka Kematian Ibu (AKI) di Indonesia. Pre eklamsia ditandai dengan peningkatan tekanan darah ( hipertensi ) di usia >20 minggu disertai gangguan salah satu organ. Peningkatan tekanan darah yang terjadi secara terus menerus akan menimbulkan komplikasi pada ibu dan janin bahkan kematian pada salah satu atau keduanya. Kondisi ini perlu dilakukan upaya pencegahan dan pengobatan, baik secara farmakologi maupun non farmakologi. Salah satu upaya penurunan tekanan darah secara non farmakologi adalah rendam kaki menggunakan rebusan jahe merah. Tujuan penelitian : Mengetahui pengaruh rendam kaki dengan rebusan jahe merah terhadap tekanan darah pada ibu hamil dengan preeklamsi. Metode penelitian : Rancangan penelitian quasi experiment Pre-Posttest one group design . Penelitian ini dilakukan pada 15 Februari- 15 Maret 2019 di wilayah kerja puskesmas Mranggen dan Karangawen dengan menggunakan sampel 15 orang. Hasil penelitian : Didapatkan nilai P untuk tekanan sistolik sebesar 0.000 dengan uji statistik Paired t-test dan hasil uji Wilcoxon untuk tekanan diastolik didapatkan nilai P sebesar 0.001 Simpulan : Ada pengaruh rendam kaki dengan jahe merah terhadap tekanan darah pada ibu hamil dengan preeklamsi. Kandungan gingerol membuat sensasi hangat pada kulit yang merangsang pembukaan pori-pori sehingga zat gingerol dapat meresap dan masuk ke pembuluh darah sehingga membuat pembuluh darah melebar ( vasodilatasi ). Pelebaran pembuluh darah membuat tekanan perifer menurun sehingga dapat menurunkan tekanan perifer pembuluh darah dan memperlancar sirkulasi darah keseluruh tubuh akibatnya terjadi penurunan tekanan darah. Saran : Rendam kaki dengan rebusan jahe merah dapat diterapkan pada ibu hamil yang mengalami preeklamsi sehingga mencegah terjadinya eklamsia dan Intra Uterine Fetal Death (IUFD).

Kejang demam adalah kejang yang terjadi pada anak usia 6 bulan hingga 5 tahun yang mengalami peningkatan suhu tubuh yang tidak disebabkan oleh proses tersebut. Kejang demam dapat dikendalikan dengan meningkatkan pengetahuan orang tua. Penting untuk melakukan pendidikan kesehatan bagi orangtua dengan metode dan media yang tepat. Penelitian ini bertujuan untuk mengukur pengaruh pendidikan kesehatan dengan media flip pada tingkat pengetahuan orangtua tentang perkembangan anak-anak dengan kejang demam. Penelitian ini adalah penelitian eksperimental semu dengan desain one pretest posttest group dan menggunakan teknik purposive sampling. Subjek penelitian adalah 16 orang tua dari anak-anak yang mengalami kejang demam. Instrumen menggunakan kuesioner dan intervensinya adalah pendidikan kesehatan menggunakan media lembar balik. Hasil Uji Homogenitas Marginal menunjukkan bahwa ada pengaruh pendidikan kesehatan dengan media lembar balik terhadap peningkatan pengetahuan orangtua dengan nilai p=0,005 (α = 0,05). Dianjurkan untuk menggunakan media lembar balik untuk pendidikan kesehatan bagi orangtua dengan kejang demam.Kata kunci: perkembangan anak, kejang demam, lembar balik, pendidikan kesehatan, pengetahuan orang tuaThe Effect of Health Education with Flip Sheet Media on Parent’s Knowledge Level abaout Development of Children with Febrile SeizuresAbstractFebrile seizures are seizures that occur in children aged 6 months to 5 years who experience an increase in body temperature that are not caused by the process. Febrile seizures can be controlled by increasing parental knowledge. It is important to do health education for parents with the right methods and media. This study aimed to measure the effect of health education with flip media on parent’s knowledge level about development of children with febrile seizures. This study was a quasi-experimental study with the one group pretest posttest design and using purposive sampling technique. The subjects of the study were 16 parents of children who had experienced febrile seizures. The instrument used a questionnaire and the interventions was health education using flip sheet media. The Marginal Homogeneity Test results showed that there was an effect of health education with flip sheet media on increasing parental knowledge with a p value = 0.005 (α = 0.05). It is recommended to use flip sheet media for health education for parents with febrile seizures.Key words: child development, febrile seizure, flip sheet, healt education, parent’s knowledge

Introduction: A new role of a mother after giving birth is to breastfeed her baby instead of doing other household choirs. This condition will bring stress and tiredness to a mother. Oketani massage not only being useful for increasing breastmilk production but also provide comfort and a feeling of relaxation for the mother. Aim of this study was to describe cortisol levels in breastfeeding mothers who were given oketani massage therapy combine with acupressure at the GB-21 point. Methodology: This research was a quasi experiment with post test design with a control group with a sample of 20 respondents at each group. Statistical analysis using��independent T-test. Results: There was a significant difference in the levels of cortisol between control group and oketani massage combine with acupressure group (p = 0.003). Discussion: Oketani massage works well as a pain reliever, providing comfort, relaxation for the post partum mothers. This condition will reduce the level of cortisol hormone and increase blood flow to�breasts.

Arterial aneurysms are most commonly (60% of cases) located in the infrarenal abdominal aorta. An inflammatory mechanism is involved in only 10% of cases. Infrarenal abdominal aortic aneurysms revealing Takayasu's disease is unusual. Takayasu's disease is a rare vasculitis affecting large arteries in young people. It is 10 times more common in women. We report the case of an acute rupture of an abdominal aortic aneurysm revealing Takayasu arteritis in a 39-year-old man with an uneventful medical history.

Low back pain (LBP) is the most common and most costly musculoskeletal disorder among nursing profession. The ergonomic risk factors are common causes of lumbar injury. This study aims to assess the risk of LBP among nurses in different wards of an Iranian subspecialty hospital by means of MAPO method and to investigate if there is any relationship between calculated index and the self-reported LBP. The study was conducted in 16 sections of an Iranian subspecialty hospital including 174 wards. Exposed nursing staff (N=54) were asked to report LBP experiences in the past year. Our results indicated that approximately 90% of examined wards were in the red band while only 9% were in the yellow and 1% in the green bands. Among all nurses who worked in the high risk wards, 25% reported suffering LBP during the past 12 months. However, 16% of those who were in the medium risk wards also experienced LBP in the past year. Chi-square test showed a significant relationship between LBP incidence and the level of MAPO index (p=0.004). This study suggests that the frequency of LBP among nurses is higher than the general population. The fact that most of the studied wards felt in the red band indicates the elevated risk for low back in the majority of the hospital wards. It is therefore necessary to implement an ergonomic program in order to modify the observed deleterious condition as soon as possible.

Introduction: Microscopic neuroblastic nodules are found in the suprarenal gland of newborns and young infants. The purpose of this study was to determine the morphology and derivation of neuroblastic nodules and giant epithelial cells of human fetal suprarenal gland. Materials and methods: The study consisted of 30 spontaneously aborted human fetal specimens from 11th weeks to 28th weeks of gestational ages. The suprarenal glands were taken from fetal specimens for histological study. The staining was done by hematoxylin and eosin. The following points about the neuroblastic nodule and giant epithelial cells were noted: number, location, size, any specific change like cystic degeneration with increasing age in the cells, distribution pattern of neuroblasts and giant epithelial cells, and their relation to the capsule, cortex, and central vein. Results: The neuroblastic nodules and giant epithelial cells increased in number as the gestation advanced but after 20 weeks of gestation, their number started decreasing. At the gestational age 25–28 weeks, both the giant epithelial cells and neuroblastic cells were absent. Conclusion: Both giant epithelial cells and neuroblastic cells are an integral part of the normal development of the suprarenal gland and they disappear with the advancement of the gestational age. These cells are important because some authors consider them to be the precursor of malignancy in later life.

Resume Objectifs Revoir notre experience dans la prise en charge de la rupture de l’isthme aortique post-traumatique, evaluer les resultats de la chirurgie et ceux de l’exclusion endovasculaire et elaborer une conduite a tenir en fonction de l’existence et de la gravite des lesions associees. Patients De 2000 a 2012, 37 malades ont ete colliges (33 hommes et quatre femmes) d’âge moyen 38 ans souffrant d’une rupture post-traumatique de l’aorte isthmique s’integrant dans le cadre d’un polytraumatisme avec des lesions associees engageant le pronostic vital dans 86,5 % des cas. Vingt-cinq patients ont beneficie d’un traitement chirurgical. Douze patients ont beneficie d’une exclusion endovasculaire. Resultats Six patients sont decedes au cours ou au decours de l’acte chirurgical, soit une mortalite globale de 16 % ; elle est de 24 % dans le groupe des patients operes pour chirurgie aortique et de 0 % dans le groupe des endoprotheses. La morbidite dans le groupe chirurgie a ete dominee par un cas d’accident vasculaire cerebral. Dans le groupe des endoprotheses, les suites operatoires ont ete simples. Les controles scanographiques postoperatoires des patients a j7, a un mois et a 12 mois, ont montre un bon positionnement de l’endoprothese sans endofuite. Conclusion La rupture de l’isthme aortique resulte souvent d’un traumatisme thoracique violent a haute energie et s’associe frequemment a d’autres lesions graves. Les resultats de la reparation chirurgicale immediate restent encore decevants et s’associent a une morbi-mortalite elevee. L’avenement du traitement endovasculaire a bouleverse la prise en charge de la rupture isthmique de l’aorte, particulierement chez les patients a haut risque chirurgical.

Resume Objet Les anevrismes carotidiens sont rares. L’atherosclerose constitue l’etiologie dominante. L’histoire naturelle est dominee par le risque d’evenements neurologiques d’origine thromboembolique. Le traitement repose sur la chirurgie. Le but de ce travail est de preciser les modalites therapeutiques, les indications et les resultats du traitement chirurgical. Patients et methodes Nous rapportons une etude retrospective de dix patients operes pour anevrisme carotidien. Resultats Il s’agit de six hommes et de quatre femmes, d’âge moyen de 43 ans avec des extremes de 17 ans et 70 ans. Tous nos patients se sont presentes avec une masse laterocervicale battante ; deux patients avaient une dysphonie et un patient etait opere en urgence pour rupture anevrismale. L’anevrisme etait d’origine atheromateuse dans quatre cas, inflammatoire dans trois cas, post-traumatique dans deux cas et d’origine inconnue dans un cas. Le traitement chirurgical a consiste en une resection anevrismale dans six cas et une mise a plat dans quatre cas, la restauration arterielle a ete effectuee par anastomose bout a bout dans quatre cas, par interposition d’un greffon veineux dans quatre cas, d’un greffon prothetique dans un cas et par suture de la breche arterielle dans un cas. Nous n’avons deplore aucun deces precoce. La morbidite immediate a comporte un accident vasculaire cerebral constitue ; deux atteintes neurologiques peripheriques regressives et une infection associee a une thrombose asymptomatique d’un greffon prothetique. Les suites tardives etaient simples. Conclusion Les anevrismes carotidiens extracrâniens sont rares, mais potentiellement graves. Le traitement est chirurgical. La restauration carotidienne est l’intervention de choix.

Although the epidemiology of facial injuries has been studied in many populations, there is a paucity of information in the literature in this relation in the Middle East including Iran. The aim of this study was to assess the epidemiology and mode of treatment of facial injuries in western Iran.We examined all patients with a maxillofacial injury who presented to the outpatient department or who were hospitalized in the Besat Hospital of Hamedan City, Iran, between 20 December 2007 and 20 December 2009.Of 2,450 patients (77% male, 23% female) with a facial injury, 90% sustained soft tissue injuries and 37% had bone fractures. Motor vehicle accidents (MVAs) were the most common cause of injuries (35%). The most frequent bone fracture occurred in the nasal bone (63.4%). The incidence of associated injuries was 8.3% (mostly orthopedic). Rigid internal fixation was the main treatment of facial fractures. Malpositioned zygomas and functional and aesthetic problems after reconstruction of nasal-orbital-ethmoid injuries were the most common postoperative complications.Although in many countries the rate of facial injuries due to traffic accidents is decreasing, MVA is still the major cause of facial trauma in Iran. This may be due to the lack of enforcement of traffic laws by police and insufficient compliance of the population in obeying traffic rules. Rigid internal fixation was the most common mode of treatment of facial fractures, and in spite of the severity of facial injuries, the rate of postoperative complications was relatively low.