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Background: The use of tourniquet during complete knee arthroplasty (TKA) improves protection and reduces blood loss intraoperative. Turniquet use, however, may also have a negative impact after TKA on early recovery of muscle strength and lower extremity function. The purpose of this study was to demonstrate the effect of tourniquet use in TKA on surgery length, need for blood transfusion, and amount of postoperative blood drainage by suction drain, incidence of postoperative wound hematoma, postoperative thigh pain, and early mobilization.Methods: Seventy Patients are involved in this study and were divided into two groups; Group A (35) patients were treated with TKA with pneumatic thigh tourniquet. Group B (35) patients were treated with TKA without tourniquet. All patients were suffering from severe knee osteoarthritis and they failed to respond to conservative treatment so they are candidates for primary TKA. The two groups are matched related to age and gender. Selection of patients into two groups done randomly with regard of odd number for group A and even number for group B.Results: The results showed no significant difference regarding age, gender ,postoperative DVT and wound hematoma between group A (when tourniquet was used) and group B (when tourniquet was not used) although we have 2 patients developed DVT and 3 patients had wound hematoma in group A but these are statistically not significant. Regarding post-operative VAS for thigh pain was significantly less in group B and this will result in early mobilization. Also there was significant difference in duration of surgery between two groups with less time in group A due to bloodless field of tourniquet while there was significantly more postoperative drainage amount of blood through the surgical drains in group A and significantly more amount of blood transfusion perioperatively in group B which explain that tourniquet can reduce the total amount of blood loss in TKA.Conclusion: There is significant effect of tourniquet in TKA on thigh pain postoperatively, which will effect postoperative mobilization and rehabilitation. Also the tourniquet can result in significant reduction in time of operation, total blood loss and amount of blood transfusion.Trial registration: NCT, NCT04130009. Registered 17 October 2019 - Retrospectively registered, https://clinicaltrials.gov/NCT04130009

Three species of Malaysian edible seaweed (Eucheuma denticulatum, Sargassum polycystum and Caulerpa lentillifera) were analyzed for their carotenoid composition using a combination of high-performance thin layer chromatography (HPTLC) and ultra-high-performance liquid chromatography-electrospray ionization-tandem mass spectrometry (UHPLC-ESI-MS/MS), while the antioxidant capacities were determined by 2,2-diphenyl-1-picrylhydrazyl (DPPH) and oxygen radical absorbance capacity (ORAC) assays. The HPTLC analysis exhibited a distinct carotenoid pattern among the three seaweed groups. The UHPLC-ESI-MS/MS analysis showed fucoxanthin as the major carotenoid present in S. polycystum while lutein and zeaxanthin in E. denticulatum. For C. lentillifera, β-carotene and canthaxanthin were the major carotenoids. Some of the carotenoids, such as rubixanthin, dinoxanthin, diatoxanthin and antheraxanthin, were also tentatively detected in E. denticulatum and S. polycystum. For antioxidant activity, S. polycystum (20 %) and E. denticulatum (1128 μmol TE/g) showed the highest activity in the DPPH and ORAC assays, respectively. The findings suggest the three edible varieties of seaweeds may provide a good dietary source with a potential to reduce antioxidative stress.

We investigated the added value of diffusion-weighted imaging (DWI)/apparent diffusion coefficient (ADC) in the categorization of small hepatic observation (≤ 20 mm) detected in patients with chronic liver disease in reference to LI-RADS (liver imaging reporting and data system) classification system. We prospectively evaluated 165 patients with chronic liver disease with small hepatic observations (≤ 20 mm) which were previously categorized as LI-RADS grade 3–5 on dynamic contrast-enhanced CT (DCE-CT). All patients were submitted to a functional MRI including DCE and DWI. Using LI-RADS v2017, two radiologists independently evaluated the observations and assigned a LI-RADS category to each observation using DCE-MRI alone and combined DCE-MRI and DWI/ADC. In the combined technique, the radiologists assigned a LI-RADS category based on a modified LI-RADS criteria in which restricted diffusion on DWI was considered a major feature of HCC. We evaluated the inter-reader agreement with Kappa statistics and compared the diagnostic performance of the LI-RADS with two imaging techniques by Fisher’s exact test using histopathology as the reference standard. Combined technique in LI-RADS yielded better sensitivities (reader 1, 97% [65/67]; reader 2, 95.5% [64/67]) for HCC diagnosis than DCE-MRI alone (reader 1, 80.6% [54/67], p = 0.005; reader 2, 83.6% [56/67], p = 0.04). The specificities were insignificantly lower in combined technique (reader 1, 88.4% [107/121]; reader 2, 77.7% [94/121]) than in DCE-MRI alone (reader 1, 90.9% [110/121], p = 0.67; reader 2, 79.3% [96/121], p = 0.88). The inter-reader agreement of the LI-RADS scores between combined technique and DCE-MRI was good (κ = 0.765). The use of DWI/ADC as an additional major criterion, improved the sensitivity of LI-RADS in the diagnosis of HCC while keeping high specificity.

Background: Extracorporeal shock wave therapy (ESWT) is an effective and safe non-invasive treatment option for tendon and other pathologies of the musculoskeletal system.Aim of Study: To provide the physical therapist with an objective guideline about the success rate of shock wave in the treatment of musculoskeletal conditions.Methods: Systematic review and meta-analysis. Sources of data: PubMed, PEDro, Cochrane and science direct were searched from January 2007 till September 2017 for studies of any design investigating the effectiveness of ESWT in GTPS, PT, and AT. Citation tracking was performed using PubMed and Google Scholar. Animal and non-English lan-guage studies were excluded. A quality assessment was per-formed by 2 independent reviewers, and effect size calculations were computed when sufficient data were provided.Results: The meta-analysis of the selected studies revealed significant effects of the shockwave on the ligament, tendon, muscle and joint disorders.Conclusion: Shockwave either focused or radial has a significant effect in treatment of musculoskeletal disorders.

Background: Polycystic ovary syndrome (PCOS) is associated with a high risk of cardiovascular diseases (CVD). Visfatin is an adipocytokine with insulin-like action and it’s closely related to the amount of visceral fats. The objective of our study was to evaluate serum visfatin levels among women with PCOS. Also, to evaluate the association between serum visfatin and cardio-metabolic risk factors as well as clinic-morphological features of PCOS. Methods: Case control study enrolled 120 women diagnosed with PCOS and 80 healthy control women. PCOS cases were stratified according to their fasting plasma glucose (FPG) into three subgroups: those with normal glucose tolerance (NGT), impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM). Serum visfatin levels (ng/ml) were assessed by ELISA. Results: Our results revealed higher values of cardio-metabolic risks; total cholesterol, triglycerides, LDL cholesterol, high-sensitivity C-reactive protein (hs-CRP), fasting serum insulin (FSI), HbA1c, HOMA-IR, and FPG in PCOS compared to healthy women. In addition, compared with healthy women (28.66 ± 10.63), PCOS patients (87.98 ± 17.96) had significantly higher levels of serum visfatin. Among PCOS group, T2DM patients (119.59 ± 14.52) had significantly higher levels of serum visfatin compared to IGT (81.03 ± 15.81) and NGT (85.09 ± 11.01). Receiver operating characteristic analyses revealed that serum visfatin was a useful biomarker discriminating PCOS from control, the AUC was 0.989 with sensitivity = 99.2%, specificity = 99.8%, Additionally, the sensitivities and the specificities of visfatin in differentiating T2DM from NGT were (93.3% and 98.2%). Stepwise multiple linear regression analysis revealed that androstenedione, LH, free androgen index and ovarian volume were the main predictors of visfatin levels among PCOS. Conclusion: Serum visfatin levels could discriminate PCOS from healthy control and T2DM from NGT PCOS women. Moreover, vesfatin was positive correlated to cardio-metabolic risk factors. Interestingly, the sensitivity and specificity power of vesfatin were high. Thus, it could be early predicting of cardio-metabolic risks among PCOS women and might be useful in therapeutic intervention in future. Keywords: Cardiometabolic, PCOS, Visfatin, T2DM

Mungbean is one of the most important pulse crops due to its nutritive value and maintaining soil fertility through biological nitrogen fixation. Genetic variability is one of the pre-requisite for crop improvement. The present investigation was aimed at to enhance the genetic variability for three quantitative traits viz. pod length, number of seeds per pod and 100-seed weight in M 2 and M 3 generations of mungbean following mutagenesis with ethylmethane sulphonate (EMS), hydrazine hydrate (HZ) and sodium azide (SA). Mean pod length did not differ significantly in most of the mutagenic treatments in M 2 . However, significant improvement for the trait was exhibited with lower and moderate concentrations in M 3 generation. The mean number of seeds per pod and 100-seed weight increased with lower and moderate concentrations of the mutagens in M 2 , whereas M 3 generation showed a complete positive trend of shift. Long pod and bold seeded mutants may be exploited to increase the number of seeds per pod and seed size leading to increased yield potential. The genotypic coefficient of variation, heritability and genetic advance increased manifold in the treated population for all these traits suggesting that mutagen induced variability has the substantial scope to improve the mungbean crop. SAARC J. Agri., 15(2): 57-67 (2017)

ProbioticLactobacillus caseiShirota (LcS) is a potential decontaminating agent of aflatoxin B1(AFB1). However, few studies have investigated the influence of diet, especially a high protein (HP) diet, on the binding of AFB1by probiotics. This research was conducted to determine the effect of HP diet on the ability of LcS to bind AFB1and reduce aflatoxin M1(AFM1) in AFB1-induced rats. Sprague Dawley rats were randomly divided into three groups: A (HP only), B (HP + 108 CFU LcS + 25 μg AFB1/kg BW), and C (HP + 25 μg AFB1/kg BW). Levels of AST and ALP were higher in all groups but other liver function’s biomarkers were in the normal range, and the liver’s histology showed no structural changes. The urea level of rats in group B (10.02 ± 0.73 mmol/l) was significantly lower (p<0.05) than that of rats in group A (10.82 ± 0.26 mmol/l). The presence of carcinoma in the small intestine and colon was more obvious in group C than in group B. Moreover, rats in group B had significantly (p<0.05) lower AFM1concentration (0.39 ± 0.01 ng/ml) than rats in group C (5.22 ± 0.28 ng/ml). Through these findings, LcS supplementation with HP diet alleviated the adverse effects of AFB1by preventing AFB1absorption in the small intestine and reducing urinary AFM1.

Background Polycystic ovary syndrome (PCOS) is a set of reproductive and metabolic symptoms associated with an imbalance of reproductive hormones in women. Macrophage migration inhibitory factor (MIF) is an inflammatory adipocytokine associated with metabolic disorders. Probiotics probably has influence on metabolic and inflammatory conditions. We aimed by this study, for the first time, to evaluate the impact of probiotic supplementation on MIF values, clinical and laboratory feature of PCOS. Furthermore, we aimed to explore the power of MIF for diagnosis PCOS. Methods Sixty women diagnosed with PCOS were selected in this single-blinded clinical trial and 40 healthy control women. Participants received probiotic supplements for 12-week. Clinical and laboratory measures were evaluated at baseline and after 12 weeks of intervention. High sensitivity C-reactive protein (hs-CRP) and MIF levels were assessed using an enzyme-linked immunosorbent assay (ELISA). Results Probiotic supplementation improved clinical, hormonal, and inflammatory biomarkers in women with PCOS. Additionally in PCOS group, logistic regression analysis revealed that MIF and HOMA-IR were independent predictors of probiotic response with odds ratios of 1.641 and 0.335, respectively. Regarding inflammatory biomarkers, hs-CRP and MIF, its value increased in PCOS group compared to healthy group. Receiver operating characteristic curve (ROC) analysis revealed that, area under the curve (AUC) for the MIF was 0.981 (95% CI = 0.902–0.898) with sensitivity = 90.2%, specificity = 89.8% and the cutoff values (19.7). Interestingly, the power of MIF was more sensitive and specific than hs-CRP for diagnosis of PCOS. Thus MIF could be a useful diagnostic inflammatory biomarker discriminating PCOS from healthy controls. Moreover in PCOS group stepwise multiple linear regression analysis, detected that HOMA-IR, neutrophil count, hs-CRP and fat mass index (FMI) were main predictors of MIF levels among other clinical and laboratory biomarkers. Conclusion Regarding the effects of probiotic supplementation on inflammatory and metabolic disorders; our novel findings explored a favorable effect of probiotic supplementation on inflammatory biomarkers; clinical, laboratory features of PCOS, and MIF levels. Furthermore, probiotic could be used for treatment of PCOS and its associated morbidity.

Background: Endometrial polyps are a main cause of Abnormal Uterine Bleeding (AUB) in premenopausal & postmenopausal women and suggested by screening transvaginal ultrasound. Objectives: The aim of the current study was to determine the effectiveness and acceptability of outpatient hysteroscopic endometrial polypectomy by vaginoscopic approach, and if the technique confers any advantage in term of patient discomfort and reduction in procedure time over the traditional technique. Patients & Methods: This study is prospective randomized clinical trial, it was carried in Endoscopy Unit in the Department of Obstetrics and Gynecology at Zagazig University Hospitals, in period from May 2018 to April 2019. Results: there was a statistical significant difference between traditional and vaginoscopic groups in procedure time where traditional technique needs more time than vaginoscopic one (7.8 VS 6.1 minutes), and all cases had (100.0%) success rate of polypectomy in both groups without complication. but histopathology results discovered one case (2.5%) of all study groups adenocarcinoma and the patient sent to oncology unit for further evaluation and appropriate management. Conclusions: Office vaginoscopic polypectomy for small polyp is feasible and safe minimally invasive procedure.

BackgroundThis pilot study describes the overall design and results of the Program for the Evaluation and Management of the Cardiac Events registry for the Middle East and North Africa (MENA) Region.MethodsThis prospective, multi-center, multi-country study included patients hospitalized with acute myocardial infarction (AMI) and/or acute heart failure (AHF). We evaluated the clinical characteristics, socioeconomic and educational levels, management, in-hospital outcomes, and 30-day mortality rate of patients that were admitted to one tertiary-care center in each of 14 Arab countries in the MENA region.ResultsBetween 22 April and 28 August 2018, 543 AMI and 381AHF patients were enrolled from 14 Arab countries (mean age, 57±12 years, 82.5% men). Over half of the patients in both study groups had low incomes with limited health care coverage, and limited education. Nearly half of the cohort had a history of diabetes mellitus, hypertension, or hypercholesterolemia. Among patients with ST-elevation myocardial infarctions, 56.4% received primary percutaneous interventions, 24% received thrombolysis, and 19.5% received no acute reperfusion therapy. The main causes of AHF were ischemic heart diseases (55%) and primary valvular heart diseases (15%). The in-hospital and 30-day mortality rates were 2.0% and 3.5%, respectively, for AMI, and 5.4% and 7.0%, respectively, for AHF.ConclusionsThis pilot study revealed a high prevalence of cardiovascular risk factors in patients with AMI and AHF in Arab countries, and low levels of socioeconomic and educational status. Future phases of the study will improve our understanding of the impact that these factors have on the management and outcomes of cardiac events in these patient populations.

Background: labor induction between 41 and 42 weeks of gestation reduce the adverse perinatal risks. Aim of work: to determine the effect of intravenous dexamethazone administration on preparing the cervix and duration of labor induction in term pregnancy. Patients and Methods: this randomized Case control study on 52 women who were primparous, with a gestational age (40- 42)weeks and had Bishop Score 4 or less, who were admitted to obstetrics and gynecology department, zagazig university hospital during period from (April 2018 – April 2019) for the termination of their pregnancy. 6 hours before induction, experimental group (26 participants) was given 8mg intravenous dexamethasone while control group (26 participants) was given 2 ml saline intravenously. Six hours after the injection, the Bishop Score of participant was measured, and labor induction done by using oxytocin. Interval between induction initiation and starting of the active labor phase, duration of first and second stage of labor and the neonatal outcome of two groups were compared. Results: Bishop Score statistically differ between the studied groups after 6 hours of dexamethasone injection (5.88±1.18, vs. 5.19±0.85 respectively). The interval between induction initiation and beginning of active labor phase was shorter in the dexamethasone group compared to control group (90±26.3 minutes vs. 112.88±48.87 minutes). Dexamethasone group has shorter duration of first stage and second stage of labor than control group. Conclusions: The administration of dexamethasone can play a role in cervical ripening and progress of labor.

Background Reperfusion injury might be considered a consequence of insufficient myocardial perfusion (MP) due to microthrombi (MT) embolization into the microcirculation. Streptokinase (SK) a fibrinolytic agent, if injected into the culprit artery immediately after primary percutaneous coronary intervention (PPCI) might tackle and dissolve these MT resulting in better MP and function. Methods Sixty four patients presenting within 24 hours by their first ST elevation myocardial infarction, underwent PPCI, then equally divided into 2 groups; G1 received 250 kU of intracoronary SK (ICSK) vs saline in G2. Successful coronary perfusion was defined as corrected TIMI frame count (cTFC) Results Thirty minutes after ICSK, cTFC (fig) was significantly lower (P≤0.05), while TMBG (fig) was significantly higher (P≤0.02) in G1 vs G2. Peak CK-MB, CK-MB area under the curve were significantly lower (P≤0.015 & P≤0.001 respectively) while STR≥70%was significantly higher in G1 (P≤0.045). Multivariate logistic regression analysis showed that the likelihood of achieving successful MP post-PPCI is associated with ICSK administration [OR=0.123, 95% CI (0.02–0.75), P≤0.024] and total ischemic time (ROC curve). Multivariate linear regression analysis showed that each of, immediate ICSK administration post-PPCI and TMBG were independent predictors for LV GLS improvement after one month. No significant difference in bleeding risk between G1&2 (p=1). Conclusion ICSK given immediately after primary PCI was an independent predictor of successful coronary and myocardial reperfusion. It significantly led to reduction of infarct size and improvement of LV GLS.

Investigation on bioavailability was carried out by determining the absorption and transport of bioaccessible apigenin from Mangifera indica (Water Lily var.) into Caco-2 human intestinal cell using a reliable and sensitive analytical method of LC-MS/MS. Results revealed that the concentration of glucuronidated apigenin lower than apigenin. The apigenin was metabolised inside the cells through glucuronidation process, and cross the monolayer to reach the basolateral sides or effluxed back to the apical side. The permeability coefficient of apigenin from apical to basolateral sides and basolateral to apical sides showed a medium permeability was less than 20 x10-6 cm.sec-1. Since the value of efflux ratio was 1.5, it suggested that the apigenin was absorbed and transported through a simple diffusion mechanism.

History has shown that environmental design can play a vital role in improving public health. Today, architects, urban designers, and planners can collaborate to address one of the most urgent and widespread epidemics of our time which are obesity and its related diseases. Hence, just as design professionals are increasingly embracing green building as an objective for environmental sustainability, they should thoroughly consider the potential effects of their designs on public health and wellbeing. Active Design is one of the approaches that must been taken by the architecture field. It is an idea to design cities and buildings for eco-sustenance that in turn can encourage people to get more exercise. This is not about encouraging us to go to the gym and working out more, but instead, it’s about giving citizens more of a workout through how we interact with our environment daily. There are a few countries that have been publishing their own Active Design Guidelines in promoting the use of this approach on the building design. However, the active design guidelines are not yet publishing in Asia, but the active design approach has been implemented and adapted in the building design whether in a direct or indirect manner. The purpose of this study is to examine, evaluate and review the building layout design in Malaysian Architecture in relation with the active design sustainable approach based on the literature and guidelines which can influence physical activities and health among Malaysian. Three selected building from Malaysia have been selected and analysed through qualitative and quantitative method. The finding of the research would provide deeper understanding of the necessary parameters and factors that are needed to be considered in implementing the active sustainable design approach in Malaysia.

Food authentication is an interesting issue for all parties in the food industry, including the fats and oils industry. Some unethical players try to blend high-quality foods, such as butter, with lower ones like lard, therefore, the analytical methods capable of analyzing the adulteration practices must be developed. This study used proton nuclear magnetic resonance spectroscopy in combination with high-performance liquid chromatography for the authentication of butter from lard adulteration. The identification of triacylglycerol composition of lard as a chemical marker for halal authentication is analyzed using high-performance liquid chromatography and high resolution nuclear magnetic resonance spectroscopy. The suitability of proton nuclear magnetic resonance provides a high-performance approach for determination butter adulterated with lard in their entirety of all proton bearing components. Peaks in the region of 2.60–2.84 ppm show special characteristics only present in lard. Only lard has its own unique characteristics which only polyunsaturated fatty acids would give signals 7 at δ 2.63, that corresponded to the chemical shift of the double-allylic methylene protons. In the same way, the intensity of signal at 2.63 ppm, due to methylenic protons in a position α to two double bonds, that is to say, due to the linoleic group. Furthermore, we also correlate some signals between 1H and 13C-NMR spectra for the confirmation of signals.

A detailed procedure for estimating uncertainty according to the Laboratory of Government Chemists/Valid Analytical Measurement (LGC/VAM) protocol for determination of 18 amino acids in gelatin is proposed. The expanded uncertainty was estimated using mainly the method validation data (precision and trueness). Other sources of uncertainties were contributed by components in standard preparation measurements. The method scope covered a single matrix (gelatin) under a wide range of analyte concentrations. The uncertainty of method precision, μ(P) was 0.0237–0.1128 pmol μl−1 in which hydroxyproline and histidine represented the lowest and highest values of uncertainties, respectively. Proline and phenylalanine represented the lowest and highest uncertainties value for method recovery, μ(R) that was estimated within 0.0064–0.0995 pmol μl−1. The uncertainties from other sources, μ(Std) were 0.0325, 0.0428 and 0.0413 pmol μl−1 that were contributed by hydroxyproline, other amino acids and cystine, respectively. Hydroxyproline and phenylalanine represented the lowest and highest values of expanded uncertainty, U(y) that were determined at 0.0949 and 0.2473 pmol μl−1, respectively. The data were accurately defined and fulfill the technical requirements of ISO 17025:2005.

The purpose of this study was to assess the effect of sex and neck positions on hand grip strength in healthy normal adults. One hundred healthy adults of both sexes participated in this study. They were recruited from the students of the faculty of physical Therapy. Their ages ranged between 17 and 25 years. They were assigned to two equal groups according to their sex. Hand grip strength was measured in several neck positions. Grip strength was measured by using the Jamar handheld dynamometer, and the neck range of motion was measured by using the cervical range of motion. Among females, there was a significant difference between the hand grip strength in neutral position and in other neck positions (P=0.036). Among males, there was a significant difference between the hand grip strength in the neutral position and in other neck positions. Within neck positions, there was a significant difference (P

Homogeneous Charge Compression Ignition (HCCI) engine is a newly introduced technology. However, controlling the HCCI timing of ignition and theheat release rate, at all operating regimes, present the biggest challenge due to the complicated and highly coupled combustion problems. The successful implementation of the common rail injection system in diesel engines has made this possible. The main key for this success is the capability to optimize the most important fuel injection parameters, namely timing, rate, and duration.This work experimentally investigates the performance of an HCCI Diesel engine with a Common Rail Direct Injection (DI) fuel system. The engine used is a turbocharged 2776 cc, 4-stroke, 4-cylinder, water-cooled with overhead valve mechanism. The engine performance is evaluated and presented at different loads and speeds. The Apparent Heat Release Rate during combustion is evaluated from the measured cylinder pressure-crank angle data. The pressure in the fuel line is measured at the entry to different fuel injectors to investigate the effect of pressure wave propagation in the fuel line on the fuel injection system.

The high-pressure Common Rail (HPCR) injection system was originally introduced for diesel engines to both reduce pollutant emissions and enhancement of performance. HPCR separates fuel pressurization and injection processes from each other. The high injection pressure generated by the common rail system provides better atomisation and evaporation of fuel spray, resulting in improved air inlet and fuel jet mixing, which is advantageous for lowering soot emission. In this paper, a mathematical common rail injection system model has been presented. A Simulink/Matlab code was developed to execute this simulation. This work does not only seek to validate the presented numerical model but to have more insight for understanding the overall common rail injection system diesel engine performance under different operating conditions. Some simulation results are illustrated to highlight modelling capability.The engine used is an HCCI turbocharged diesel engine, 2776 cc, 4-stroke, and 4-cylinder, water-cooled with overhead valve mechanism. The common rail pressure, fuel consumption, start and duration of each injection through one engine cycle are measured at various engine speed and loads. The measured common rail fuel pressure and consumption are used to validate the simulation results. The findings of the simulation show good consistency with the experimental results. At last, some simulation results, which highlight the modelling capability, are illustrated at certain values of engine speed and load.

Background. Abnormal uterine bleeding (AUB) may be acute or chronic and is defined as bleeding from the uterine corpus that is abnormal in regularity, volume, frequency, or duration and occurs in the absence of pregnancy. It is a widespread complaint in the primary care units. The prevalence of abnormal bleeding is up to 30% among women of reproductive age. Objective. To assess the role of CT virtual hysteroscopy in the evaluation of the uterine cavity in cases with abnormal uterine bleeding in reproductive age. Methods. Cross sectional study was performed at Obstetrics and Gynecology Department and Radiology Department, Zagazig University hospitals, Egypt, on 124 women with abnormal uterine bleeding in reproductive age, and their uterine cavity was evaluated by both row multidetector computed tomography (MDCT) scanner and Office hysteroscopy. Results. Mean age of studied group was 28.54 ± 5.99 years, and virtual hysteroscopy showed sensitivity 91.1% and specificity 85.3% in detection of abnormalities within uterine cavity. It showed sensitivity 91.1% and specificity 85.3% in cases of endometrial polyps. It yielded 88.5 % sensitivity and 100 % specificity in cases with submucous fibroids, while it yielded only 57.9 % sensitivity and 82.9% specificity in cases of thick endometrium. Conclusion. Virtual CT hysteroscopy is a good negative test in cases of abnormal uterine bleeding but has some limitations that decrease its sensitivity.

We aimed to investigate the utility of right ventricular (RV) dyssynchrony to assess functional capacity utilizing 6-minute walking test distance (6MWTD) and to measure brain natriuretic peptide levels (BNP) in patients with mitral stenosis (MS) and to study its value to predict adverse outcome following percutaneous balloon mitral valvuloplasty (PBMV).A total of 108 patients with moderate to severe MS (26.5 ± 7.5 years) were included in this study. All were candidates for PBMV. RV strain curves were obtained using two-dimensional speckle-tracking echocardiography, and standard deviation (SD) of 4 segments without RV apex (-SD4) was also assessed. 6MWT and BNP were before and after 12 months following PBMV.RV-SD4 was significantly prolonged in patients with MS compared with controls (P 0.001). Patients with 6MWTD ≤300 m had a significantly increased RV-SD4 (P 0.001) and had higher BNP values (P 0.03) compared with those with 6MWTD300 m. RV-SD4 showed a strong correlation with 6MWT and BNP level. RV-SD4 was the strongest independent predictor of adverse outcome following PBMV (P 0.0001). Receiver operating characteristic analysis showed that RV-SD4 ≥24 ms was the cutoff value which predicts the adverse outcome following PBMV. A considerable improvement of mean 6MWT with significant reduction of BNP levels after 12 months of follow-up (P 0.001) in subjects with RV dyssynchrony24 ms.Right ventricular dyssynchrony is a useful predictor of functional status, as assessed with 6MWTD and BNP level in patients with MS. Furthermore, it might be considered as an independent predictor of adverse outcome following PMBV.

Underutilised fruits are not only important sources of food and nutrition, but also secure household income especially for rural and farm communities. However, some of the underutilised fruits have not received much attention as compared to commercial fruits. This could be due to their lack of knowledge of their potential values. Hence, information about their health promoting properties is critical to increase the value of underutilised fruit species to enhance their preservation and sustainable use in strengthening food, nutrition, health and livelihood security. This article aims to provide a comprehensive review on the phytochemical properties and biological activities of underutilised fruit species grown in Malaysia focussing on health promoting aspects. With regard to phytochemistry, only 21 species of underutilised fruits have been identified and quantified. Phytochemical investigations of various parts of the fruits have revealed the presence of over 100 phytochemicals which are phenolics, terpenoids, carotenoids and other miscellaneous compounds. About 51 underutilised fruit species have been explored for interesting biological activities (antioxidant, antimicrobial, anticholinesterase, cytotoxicity, antiatherosclerotic, antihyperlipidemia, antidiabetic, cytoprotective, cardioprotective and antiplatelet activities) supporting their diverse traditional uses. Different parts of the fruits have been analysed mainly in vitro and barely in vivo, with pulp being the most dominant. Of all the underutilised fruits studied, Mangifera species and Canarium odontophyllum have been the major focus for researchers. The gaps obtained from this review create further research opportunities to add to the current knowledge of health promoting properties of underutilised fruits in Malaysia. More studies are needed to confirm the health significance and explain their mechanisms of action in order to fully understand the real potential of this underutilised fruit species.

Background : Klebsiella pneumoniae is among the most common gram-negative bacteria encountered by physicians worldwide. It is a common hospital-acquired pathogen, causing urinary tract infections, nosocomial pneumonia, and intra abdominal infections. K. pneumoniae is also a potential community-acquired pathogen. Objectives : were to determine carbapenem resistance among Klebsiella pneumonia isolates by routine disc diffusion test and E test, determine carbapenemase production by modified Hodge test and to study the presence of bla KPC gene in carbapenem-resistant and carbapenem sensitive Klebsiella pneumoniae isolates. Methodology : Fifty klebsiella pnumoniae isolates were identified and subjected to antimicrobial susceptibility testing by disk diffusion test against three carbapenem antibiotics (Imipenem, Ertapenem, and Meropenem) and were subjected to determination of minimum inhibitory concentration (MIC) to ertapenem using E-test. Modified Hodge test was carried out for strains included in the study. Twenty-six K. pneumoniae isolates were subjected to PCR for detection of bla kpc gene. Thirteen confirmed carbapenem resistant isolates by disc diffusion, E-test and MHT and 13 confirmed carbapenem sensitive isolates by the same tests. Results: 13/50 (26%) isolates were resistant to both meropenem and ertapenem while only 11/50(22%) isolates were resistant to imipenem. Ertapenem sensitivity tests revealed that there was a discrepancy between the results of E test and disc diffusion method in two strains. The two strains were reported resistant by disc diffusion method and intermediate sensitive by E test. All carbapenem resistant strains 13 out of 50 strains showed positive modified Hodge test. The 26 isolates tested for bla kpc gene were negative. In conclusion resistance of K.pneumoniae to carbapenems was detected in 26% of isolates . The disc diffusion susceptibility did not report major errors in comparison to E test for ertapenem. Expression of carbapenemase was detected in all carbapenem resistant isolates by modified Hodge test while bla KPC gene was not detected among either carbapenem resistant or susceptible strains.

The present study investigated the effects of Bifidobacterium longum BB536 on lipid profile, liver and kidney function, and body fat in hypercholesterolaemic rats. 40 Sprague-Dawley rats were randomly divided into five groups. The negative control group received a standard diet. The positive control group received a cholesterol-enriched diet, whereas the intervention groups received a cholesterol-enriched diet supplemented with B. longum BB536 alone or in combination with inulin or Mangifera pajang fibrous polysaccharides. After 8 weeks, plasma lipids, and liver and kidney function were tested. Intake of the cholesterol-enriched diet increased total cholesterol, alanine aminotransferase, gamma-glutamyl transferase, creatinine, urea, liver weight, adipose tissue weight, liver lipid deposition and adipocyte size. B. longum BB536 supplementation significantly reduced total cholesterol, liver lipid deposition and adipocyte size, and positively affected liver and kidney function. These effects were significantly increased in the presence of inulin and M. pajang fibrous polysaccharides.

Fruit seeds are usually thrown out as waste during processing or after human consumption. Over the years, researchers have dedicated their effort to assess the food and nutritional values of many different fruit seeds. In this review, the research findings releated to the food values of ten different fruit seeds namely, guava, pumpkin, papaya, honeydew, mangosteen, rambutan, watermelon, mango, and durian were discussed. For several fruit seeds, the macro nutrient components such as oil, protein, and carbohydrate of are found to vary due to either varietal defferences or geographical variations. Among the seeds discussed, the range of oil content was from 1.8 to 49.0% while the range of protein content was from 6 to 40.0%. While the high oil bearing fruit seeds are potential new sources of oil, those with high protein content can be used for recovery of protein. As some of fruit seeds are edible and found to possess a host of phytonutrients, they can be harnessed for medicinal purposes. This review conclud...

Background: cryotherapy application is commonly used as a physical therapy tools with many advantages, however numerous researchers have stated decrease in subject balance which affects quality of movement following cryotherapy application, thus the purpose of study was to investigate the immediate and late effect of cryotherapy on ankle dominant joint on static balance and test the difference in static balance change between both sexes. Methods: Thirty healthy subjects, Subjects had their static balance tested during two conditions: (1) an experimental condition where the subject received the cryotherapy application by using cooled gel pack to the dominant ankle joint for 15 minutes immediately before static balance testing and (2) a control condition finished at room temperature. Using coin flip for randomization the order of examining condition. Biodex balance system was used to measure static balance. Results: analysis of data using ANOVA and unpaired test, show insignificantly statistically effect in all aspect of static balance within female group and within male group with p-value of overall stability index for female=0.669, for male =0.382, Anterior/posterior stability index for female =0.196, for male=0.552 and medial/lateral stability index for female =0.989, for male=0.46 and insignificant statistically difference between male and female in all aspect of static balance. Conclusion: the result of the study suggest that using cold gel pack for fifteen minutes of cold gel pack on dominant ankle extremity have no effect on static balance on both sexes.

The aims of this descriptive research were identifying optimization level of chemistry teachers and students in the utilization and using computer laboratory commonly used for computer based national test, and learning style of science students in 11th grade at Senior High School while chemistry learning process in 3T regions. The participants consisted of 8 chemistry teachers and 82 natural science students in 3 Bangkalan sub-district of Bangkalan Regency, East Java Province. Data collection was conducted by giving a close-ended questionnaire which consists of 23 statements for chemistry teachers and 18 statements for science students with 4 alternative respons option (very appropriate to very inappropriate). The data was analyzed by percentage formula. The results showed that chemistry teachers have not optimized the using computer laboratories in chemistry learning. The student participants, who have visual and kinesthetic style learning, have never used computer laboratory facilities that available in schools for the benefit of learning chemistry.

Adulteration of butter with cheaper animal fats, such as lard, has become an issue in recent years. A simple and rapid analytical method of attenuated total reflectance in Fourier transform infrared spectroscopy was developed in order to determine the lard content in butter. The multivariate calibration of partial least square model for the prediction of adulterant was developed for quantitative measurement. The model yielded the highest regression with the correlation coefficient (R2) = 0.999, its lowest root mean square error estimation = 0.0947, and its root mean square error prediction = 0.0687, respectively. Cross validation testing evaluates the predictive power of the model. Partial least square model to be effective as their intercept of R2Y and Q2Y were 0.08 and –0.34, respectively.

In-house method validation was conducted to determine amino acid composition in gelatin by a pre-column derivatization procedure with the 6-aminoquinolyl-N-hydroxysuccinimidyl carbamate reagent. The analytical parameters revealed that the validated method was capable of selectively performing a good chromatographic separation for 18 amino acids in less than 40 min; the overall detection and quantitation limit for amino acids fell into ranges of 5.68-12.48 and 36.0-39.0 pmol/μl, respectively; the matrix effect was not observed, and the linearity range was 37.5-1000 pmol/μl. The accuracy (precision and recovery) analyses of the method were conducted under repeatable conditions on different days in random order. Method precision revealed by HorRat values was significantly less than 2, except for histidine with a precision of 2.19, and the method recoveries had a range of 80-115% except for alanine which was recovered at 79.4%. The findings were reproducible and accurately defined, and the method was found to be suited to routine analysis of amino acid composition in gelatin-based ingredients.

The study was aimed to differentiate between porcine and bovine gelatines in adulterated samples by utilising sodium dodecyl sulphate–polyacrylamide gel electrophoresis (SDS–PAGE) combined with principal component analysis (PCA). The distinct polypeptide patterns of 6 porcine type A and 6 bovine type B gelatines at molecular weight ranged from 50 to 220 kDa were studied. Experimental samples of raw gelatine were prepared by adding porcine gelatine in a proportion ranging from 5% to 50% (v/v) to bovine gelatine and vice versa. The method used was able to detect 5% porcine gelatine added to the bovine gelatine. There were no differences in the electrophoretic profiles of the jelly samples when the proteins were extracted with an acetone precipitation method. The simple approach employing SDS–PAGE and PCA reported in this paper may provide a useful tool for food authenticity issues concerning gelatine.

Chronic inflammation and insulin resistance form hallmarks of type 2 diabetes mellitus (T2DM). An increased circulating level of the serine protease granzyme B (GzmB) is observed during prolonged inflammation and is implicated in the pathogenesis of several chronic inflammatory diseases. Moreover, insulin receptor cleavage by unknown proteases, yielding elevated levels of insulin receptor α-subunit (IRα), was observed in T2DM and was proposed as a new mechanism of insulin resistance. Therefore, a possible association between GzmB and IRα is suggested. Accordingly, this study was set to explore whether GzmB and IRα levels are altered in T2DM patients with the impact of obesity. Furthermore, we aimed to identify if GzmB contributes towards inflammation and insulin resistance through its suggested extracellular activities. All subjects were assessed for anthropometric and metabolic parameters related to obesity and T2DM. In addition, fasting plasma insulin, GzmB, interleukin-1β (IL-1β), and IRα levels were estimated by enzyme linked immunosorbent assay. Levels of GzmB and IRα were found to be significantly elevated in T2DM patients compared to nondiabetic subjects. In addition, GzmB levels were positively correlated with measures of obesity and insulin resistance, IL-1β, IRα, and other metabolic parameters. While multiple linear regression analysis revealed that both T2DM and central obesity were predicting factors for GzmB, our findings reveal a possible role of GzmB in T2DM.

Objective: To compare the degree of difficulty and outcome measures of hysteroscopic myomectomy of submucous fibroid according to 2 classification systems. Methods: This prospective study conducted in the Cytogenetic & Endoscopy unit, Zagazig University Hospitals during the period from July 2009 to July 2012, included 100 patients candidates for hysteroscopic resection of submucous fibroids. All fibroids were diagnosed and assessed by saline infusion sonohysterography and diagnostic hysteroscopy. Presurgical classification was performed according to the two classification systems; the European Society of Endoscopic Surgery (ESES)–considering only the penetration of the fibroid into the myometrium – and STEPW considering size, topography, extension, penetration and wall affected. Primary outcome measure was incomplete resection of the fibroid. Secondary outcome measures were operating time (in minutes), the fluid deficit (in milliliters) and any intraoperative complications. Sensitivity, specificity and kappa measure of agreement were calculated for each classification at their best cut off. P value less than 0.05 is considered significant. Results: Myomectomy was considered incomplete in 8 out of 104 fibroids (7.7%) According to ESES, 2 belonged to type 0 and 6 belonged to type 1.Risk ratio and 95% confidence interval (CI) was 0.56 (0.07-3.3) and the difference was not significant (p=0.7); whereas according to the STEPW classification, the incomplete myomectomies were one in group I (1/8, 12.5%) and seven in group II (7/8, 87.5%). The risk ratio (95% CI) was 0.02 (0.0-0.18) and the difference was significant (p= 0.000). Considering the area under the ROC curve, the dichotomized STEPW scores performed better than the dichotomized ESES scores (P

Digital video broadcasting, DVB has become the synonym of digital television as well as data broadcasting. The DVB Project was launched on the 10th of September, 1993. DVB systems distribute data using a variety of approaches. These approaches include: satellite, cable and terrestrial television. These three sub-standards are basically differ in the specifications of the physical representation, modulation, transmission as well as reception of the signal. DVB-T is the consortium standard for broadcast transmission of digital terrestrial television. The key motivation behind this standard was the desire in several European countries to offer high definition television (HDTV) services as efficiently and effectively as possible.DVB-T2 is considered to be the modified version of DVB-T.DVB-T2 leads to performance improvement by introducing state-of-the art communication techniques where it achieves 30% better capacity compared with DVB-T. In some cases, the data rate will be up to 50% higher under comparable conditions. In this paper we demonstrate the architecture of the DVB-T2 system, as well as a MATLAB design and simulation of the DVB-T2 transmitter. The transmitter model is then tested for different data rates. The model provides an overall evaluation of the DVB-T2 transmitter parameters and can be used for educational and testing purposes.

Atrial fibrillation and heart failure often coexist in patients with advanced heart failure symptoms. The result, in addition to a significant impact on quality of life, is an increase in the risk of a adverse clinical outcomes including stroke, hospitalization and overall mortality. Pharmacological therapy for atrial fibrillation in the heart failure population remains limited due to sub-optimal drug efficacy and a likely increased mortality due to pro-arrhythmia. Atrial fibrillation ablation, since it allows for therapy without the need for toxic medication, has the potential to become mainstream treatment in patients with drug refractory, symptomatic atrial fibrillation and heart failure. Randomized studies and observational data suggest that atrial fibrillation ablation provides superior rhythm control to anti-arrhythmic drugs. Atrial fibrilla- tion ablation is relatively safe and may result in improvement of left ventricular function and quality of life. Ongoing studies are attempting to assess a number of outcome measures to help define its role in the heart failure patient population. This review focuses on atrial fibrillation ablation in patients with congestive heart failure, and summarizes the results of available literature.

To detect FMS-like tyrosine kinase-3 internal tandem duplicate (FLT3 ITD) mutation, Myeloproliferative leukemia virus oncogene (cMPL) and Ephrin A 4 receptor (EphA4) expressions in Acute myeloid leukemia (AML) and their correlation to patient's clinicopathological characteristics and survival.RNA was extracted from blood samples of 58 AML patients (39 adults and 19 children) and 20 age and sex matched controls. FLT3 ITD mutation, cMPL and EphA4 expression was studied using RT-PCR and correlated to the clinical and survival data of the patients.FLT3 ITD mutation, cMPL and EphA4 expression was positive in 35.9%, 76.9% and 56.4% of adult AML patients respectively and in 15.8%, 47.4% and 36.8% of pediatric AML patients respectively. 76.9% of adult and 89.5% of pediatric patients expressed CD33. 64.1 % of adults and 42.1% of children expressed CD34. CD34 expression was significantly associated with both FLT3 ITD mutation and cMPL expression. CD34, FLT3 and cMPL negative cases have significantly higher overall survival than positive cases.CD34 expression is significantly associated with both FLT3 ITD mutation and cMPL expression which could be used as a marker for low survival. Normal FLT3 and negative expression of CD34 and cMPL may predict a longer overall survival. Further studies are needed to investigate the mechanism that may correlate CD34 to both markers.

Aim Several techniques for temporary abdominal closurehave been developed. We systematically review theliterature on temporary abdominal closure to ascertainwhether the method can be tailored to the indication.Method Medline,Embase,theCochraneCentralRegisterof Controlled Trials and relevant meeting abstracts untilDecember 2009 were searched using the following head-ings: open abdomen, laparostomy, VAC (vacuum assistedclosure), TNP (topical negative pressure), fascial closure,temporary abdominal closure, fascial dehiscence and deepwound dehiscence. The data were analysed by closuretechniqueandaetiology.Theprimaryend-pointsincludeddelayed fascial closure and in-hospital mortality. The sec-ondary end-points were intra-abdominal complications.Results The search identified 106 papers for inclusion.The techniques described were VAC (38 series), mesh ⁄sheet (30 series), packing (15 series), Wittmann patch(eight series), Bogota´ bag (six series), dynamic retentionsutures (three series), zipper (15 series), skin only andlocking device (one series each). The highest facialclosure rates were seen with the Wittmann patch (78%),dynamic retention sutures (71%) and VAC (61%).Conclusion Temporary abdominal closure has evolvedfrom simple packing to VAC based systems. In theabsence of sepsis Wittmann patch and VAC offered thebest outcome. In its presence VAC had the highestdelayed primary closure and the lowest mortality rates.However, due to data heterogeneity only limited con-clusions can be drawn from this analysis.Keywords Open abdomen, laparostomy, historical evo-lution, systematic review

Aim The study aimed to determine whether the introduction of a screening programme for colorectal cancer influenced resection and recurrence rates and prognosis. Method Details of patients with a biopsy-confirmed diagnosis of colorectal cancer attending from January 2002 to December 2006 were entered into a prospective database. All were followed to death or the end of the study period (December 2008). Patients with a synchronous cancer were excluded from analysis. A comparison was made between screen and non-screen detected cancers for survival, disease-free survival, location of the primary tumour, resection and recurrence rates. Results In all, 841 [median age 72 (30–101) years; 53% men] patients with colorectal cancer were identified. Of these 68 were screen detected of whom 63 underwent surgery. Screen detected cancers were significantly less advanced at presentation (P = 0.001). There was no significant difference in primary tumour location between screen and non-screen detected cancers (P = 0.184). Among curative resections, significantly fewer screened compared with non-screened cancers developed a recurrence [6/59 (10.2%) vs 105/491 (21.4%), P = 0.043]. The mean disease-free survival for screen and non-screen detected cancers was 78.3 and 65.0 months (P = 0.010). Overall mean survival was significantly improved for screened (73.8 months) over non-screened (57.9 months) detected cancers, P = 0.001. Conclusion Screening for colorectal cancer in this population significantly improved overall cancer-related and disease-free survival, possibly as a result of the detection of significantly more early staged cancers.

Aim Colorectal cancer patients identified with indeterminate pulmonary nodules (IPN) in the absence of other metastasis represent a clinical dilemma. This study aimed to identify characteristics that could predict which nodules truly represented a metastasis in an attempt to optimize therapy and to reduce the number of follow-up chest CT scans performed. Method All patients with colon or rectal cancer who presented between 2004 and 2008 were analysed. Patients with IPN on staging CT were identified from a dedicated prospective database and the medical records analysed and follow up recorded. Patients with obvious metastatic disease were excluded from analysis. Association of location, number and size of the nodules and metastatic disease were the primary end-points for analysis. Results Nine hundred and eight patients presenting with cancer of the colon or rectum were identified. Thirty-seven (4%) patients were diagnosed with IPN with no obvious metastatic disease on staging CT. At a median follow up of 23 months there were eight (21%) cases where nodules had progressed. No significant association was detected between nodule size and pulmonary metastasis. Half of the patients with four or more nodules showed progression on serial CT imaging suggestive of pulmonary metastasis (χ2, P ≤ 0.01). Conclusion Colorectal cancer patients with four or more indeterminate pulmonary nodules on preoperative staging CT imaging, even in the absence of metastasis elsewhere, are likely to represent pulmonary metastatic disease. These patients should be followed up with short-term interval CT imaging to enable early detection of progression so that treatment can be tailored appropriately.