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Phoenix dactylifera (date) and Cocos nucifera (coconut) are edible and medicinal crops consumed in Africa to stimulate male sexual performances. Incidence of sexual incompetence, erectile dysfunction, premature ejaculation and reduced libido are on the rise. Consequently, the effect of a pooled extract on mating profiles to determine the sexual performance efficiency in male Wistar rats was investigated. Fifty-two first filial (FI) generation in-bred healthy male Wistar rats were randomly selected and grouped into A to M (n=4) per cage. Group (A) received distilled water and served as the control, while group B, C, D and E received 250, 500, 750 and 1,000mg/kg of the date extract. Graded doses as described earlier were also administered to Group F, G, H and I (coconut milk) and J, K, l and M (mix extract) as oral single daily doses for 60 days. Rats adapted to the sanitized animal room condition for 14 days and adequately provided pelletized rat feed and water ad libitum. The crops were purchased from the open market and processed using maceration apparatus and spray drying process for the date and coconut extract extractions, and were pooled in equal proportion. Mating profiles were assessed by monitoring the activities of each rat in a rectangular Plexiglas surveillance chamber (52 x 45 x 38 cm) on 20th, 40th and 60th days of the treatments by observing in a sound-attenuated room after introducing an equivalent number of female rats (n=52). The mating parameters either decreased or increased in a dose-dependent manner; without traces of weakness or reduced penile reflexes and a higher significance in the combination (P = 0.025) than date (P = 0.045) and coconut (P = 0.05) extracts. We conclude that P. dactylifera and C. nucifera mix has lasting potentials on mating profile in male Wistar rats. [ABSTRACT FROM AUTHOR]

Abstract Background Physicians and medical educators have repeatedly acknowledged the inadequacy of communication skills training in the medical school curriculum and opportunities to improve these skills in practice. This study of a controlled intervention evaluates the effect of teaching practicing physicians the skill of "agenda-setting" on patients' experiences with care. The agenda-setting intervention aimed to engage clinicians in the practice of initiating patient encounters by eliciting the full set of concerns from the patient's perspective and using that information to prioritize and negotiate which clinical issues should most appropriately be dealt with and which (if any) should be deferred to a subsequent visit. Methods Ten physicians from a large physician organization in California with baseline patient survey scores below the statewide 25th percentile participated in the agenda-setting intervention. Eleven physicians matched on baseline scores, geography, specialty, and practice size were selected as controls. Changes in survey summary scores from pre- and post-intervention surveys were compared between the two groups. Multilevel regression models that accounted for the clustering of patients within physicians and controlled for respondent characteristics were used to examine the effect of the intervention on survey scale scores. Results There was statistically significant improvement in intervention physicians' ability to "explain things in a way that was easy to understand" (p = 0.02) and marginally significant improvement in the overall quality of physician-patient interactions (p = 0.08) compared to control group physicians. Changes in patients' experiences with organizational access, care coordination, and office staff interactions did not differ by experimental group. Conclusion A simple and modest behavioral training for practicing physicians has potential to positively affect physician-patient relationship interaction quality. It will be important to evaluate the effect of more extensive trainings, including those that work with physicians on a broader set of communication techniques.

Importance: Endoscopes are paramount to the practice of otolaryngology. To provide physicians in low-middle-income countries with adequate tools to treat otolaryngologic problems, it is necessary to create a low-cost sustainable option., Objective: To describe the design and usability of an open-source, low-cost flexible laryngoscope that addresses the lack of affordable and accessible methods for otolaryngologic visualization in resource-limited settings., Design, Setting, and Participants: This quality improvement study used a mixed-methods approach, including a technical description of device design as well as quantitative and qualitative survey evaluation of device usability. Engineering involved device design, sourcing or manufacturing individual components, fabricating a prototype, and iterative testing. Key assumptions and needs for the device were identified in collaboration with otolaryngologists in Zimbabwe, and designed and simulated by biomedical engineers in a US university laboratory. Board-certified otolaryngologists at a single US university hospital trialed a completed prototype on simulated airways between May 2023 and June 2023., Main Outcomes and Measures: Technical details on the design of the device are provided. Otolaryngologist gave feedback on device characteristics, maneuverability, and visualization using the System Usability Scale, a customized Likert-scale questionnaire (5-point scale), and semistructured interviews., Results: A functional prototype meeting requirements was completed consisting of a distal-chip camera, spring bending tip, handle housing the control mechanism and electronics, and flexible polyether block amide-coated silicone sheath housing the camera and control wires; an external monitor provided real-time visualization and ability to store data. A total of 14 otolaryngologists participated in the device review. The mean (SD) System Usability Scale score was 88.93 (10.08), suggesting excellent usability. The device was rated highly for ease of set up, physical attributes, image quality, and functionality., Conclusions and Relevance: This quality improvement study described the design of a novel open-source low-cost flexible laryngoscope that external review with otolaryngologists suggests was usable and feasible in various resource-limited environments. Future work is needed to translate the model into a clinical setting.

Objective: To assess the readability of patient-facing educational information about the most common otolaryngology diagnoses on popular social media platforms., Study Design: Cross-sectional study., Setting: Social media platforms., Methods: The top 5 otolaryngologic diagnoses were identified from the National Ambulatory Medical Care Survey Database. Facebook, Twitter, TikTok, and Instagram were searched using these terms, and the top 25 patient-facing posts from unique accounts for each search term and poster type (otolaryngologist, other medical professional, layperson) were identified. Captions, text, and audio from images and video, and linked articles were extracted. The readability of each post element was calculated with multiple readability formulae. Readability was summarized and was compared between poster types, platforms, and search terms via Kruskal-Wallis testing., Results: Median readability, by grade level, by grade level, was greater than 10 for captions, 5 for image-associated text, and 9 for linked articles. Captions and images in posts by laypeople were significantly more readable than captions by otolaryngologists or other medical professionals, but there was no difference for linked articles. All post components were more readable in posts about cerumen than those about other search terms., Conclusions: When examining the readability of posts on social media regarding the most common otolaryngology diagnoses, we found that many posts are less readable than recommended for patients, and found that posts by laypeople were significantly more readable than those by medical professionals. Medical professionals should work to make educational social media posts more readable to facilitate patient comprehension., (© 2023 American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

The COVID-19 pandemic disproportionately affected the health and well-being of marginalized communities, and it brought greater awareness to disparities in health care access and utilization. Addressing these disparities is difficult because of their multidimensional nature. Predisposing factors (demographic information, social structure, and beliefs), enabling factors (family and community) and illness levels (perceived and evaluated illness) are thought to jointly contribute to such disparities. Research has demonstrated that disparities in access and utilization of speech-language pathology and laryngology services are the result of racial and ethnic differences, geographic factors, sex, gender, educational background, income level and insurance status. For example, persons from diverse racial and ethnic backgrounds have been found to be less likely to attend or adhere to voice rehabilitation, and they are more likely to delay health care due to language barriers, longer wait times, a lack of transportation and difficulties contacting their physician. The purpose of this paper is to summarize existing research on telehealth, discuss how telehealth offers the potential to eliminate some disparities in the access and utilization of voice care, review its limitations, and encourage continued research in this area. A clinical perspective from a large volume laryngology clinic in a major city in northeastern United States highlights the use of telehealth in the provision of voice care by a laryngologist and speech-language pathologist during and after the COVID19 pandemic., Competing Interests: Declaration of Competing Interest Anaïs Rameau previously served as a medical advisor for Perceptron Health, Inc., and owns equity of the company., (Copyright © 2023 Elsevier Inc. All rights reserved.)

To assess whether 3-dimensional (3D) volumetrics can be used to track and evaluate postoperative course of patients treated with endoscopic suturectomy for nonsyndromic sagittal synostosis, we compared changes in 2-dimensional (2D) measurements along with 3D volumetric correlates throughout the period of helmet therapy. Forty-six patients treated at our institution with endoscopic suturectomy for sagittal synostosis were retrospectively reviewed. Head circumference (HC), cephalic index (CI), and total cranial volumes (TCVs) were measured at 3 timepoints following surgery using optical surface scans obtained for helmet orthotics. All measurements showed significant differences between timepoints on the analysis of variance ( P <0.001). There was a significant correlation between CI and TCV (r=0.35, P =0.004) and between HC and TCV (r=0.81, P <0.001). The normalized rate of change over the course of treatment was significantly higher for TCV (36.7%) than for CI (8.8%) and HC (8.4%, P <0.001), with no difference between HC and CI. The authors conclude that 3D metrics were able to reliably follow the course of postoperative 2D metrics. There was a direct and linear correlation between HC and CI with TCV. Total cranial volumes showed the highest rate of sustained change at every timepoint. Although CI and HC plateau after the first measurement, TCV continues to adapt over the course of treatment. These results demonstrate the feasibility and value of volumetrics from 3D imaging to provide a more comprehensive evaluation of postoperative surgical outcomes than traditional 2D metrics without the ionizing radiation traditionally utilized for CT to obtain 3D metrics., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by Mutaz B. Habal, MD.)

Objectives: Mobile applications (apps) are multiplying in laryngology, with little standardization of content, functionality, or accessibility. The purpose of this study is to evaluate the quality, functionality, health literacy, readability, accessibility, and inclusivity of laryngology mobile applications., Methods: Of the 3230 apps identified from the Apple and Google Play stores, 28 patient-facing apps met inclusion criteria. Apps were evaluated using validated scales assessing quality and functionality: the Mobile App Rating Scale (MARS) and the Institute for Healthcare Informatics App Functionality Scale. The Clear Communication Index (CDC) Institute of Medicine Strategies for Creating Health Literate Mobile Applications, and Patient Education Materials Assessment Tool (PEMAT) were used to evaluate apps health literacy level. Readability was assessed using established readability formulas. Apps were evaluated for language, accessibility features, and representation of a diverse population., Results: Twenty-six apps (92%) had adequate quality (MARS score > 3). The mean PEMAT score was 89% for actionability and 86% for understandability. On average, apps utilized 25/33 health literate strategies. Twenty-two apps (79%) did not pass the CDC index threshold of 90% for health literacy. Twenty-four app descriptions (86%) were above an 8 th grade reading level. Only 4 apps (14%) showed diverse representation, 3 (11%) had non-English language functions, and 2 (7%) offered subtitles. Inter-rater reliability for MARS was adequate (CA-ICC = 0.715)., Conclusion: While most apps scored well in quality and functionality, many laryngology apps did not meet standards for health literacy. Most apps were written at a reading level above the national average, lacked accessibility features, and did not represent diverse populations. Laryngoscope, 133:1540-1549, 2023., (© 2022 The American Laryngological, Rhinological and Otological Society, Inc.)

Craniosynostosis is the premature fusion of the skull. There are two forms of treatment: open surgery and minimally invasive endoscope-assisted suturectomy. Candidates for endoscopic treatment are less than 6 months of age. The techniques are equally effective; however, endoscopic surgery is associated with less blood loss, minimal tissue disruption, shorter operative time, and shorter hospitalization. In this study, the authors aimed to evaluate the impact of race/ethnicity and insurance status on age of presentation/surgery in children with craniosynostosis to highlight potential disparities in healthcare access. Charts were reviewed for children with craniosynostosis at two tertiary care hospitals in New York City from January 1, 2014, to August 31, 2020. Clinical and demographic data were collected, including variables pertaining to family socioeconomic status, home address/zip code, insurance status (no insurance, Medicaid, or private), race/ethnicity, age and date of presentation for initial consultation, type of surgery performed, and details of hospitalization. Children with unknown race/ethnicity and those with syndromic craniosynostosis were excluded. The data were analyzed via t-tests and chi-square tests for statistical significance (p < 0.05). A total of 121 children were identified; 62 surgeries were performed open and 59 endoscopically. The mean age at initial presentation of the cohort was 6.68 months, and on the day of surgery it was 8.45 months. Age at presentation for the open surgery cohort compared with the endoscopic cohort achieved statistical significance at 11.33 months (SD 12.41) for the open cohort and 1.86 months (SD 1.1473) for the endoscopic cohort (p < 0.0001). Age on the day of surgery for the open cohort versus the endoscopic cohort demonstrated statistical significance at 14.19 months (SD 15.05) and 2.58 months (SD 1.030), respectively. A statistically significant difference between the two groups was noted with regard to insurance status (p = 0.0044); the open surgical group comprised more patients without insurance and with Medicaid compared with the endoscopic group. The racial composition of the two groups reached statistical significance when comparing proportions of White, Black, Hispanic, Asian, and other (p = 0.000815), with significantly more Black and Hispanic patients treated in the open surgical group. The results demonstrate a relationship between race and lack of insurance or Medicaid status, and type of surgery received; Black and Hispanic children and children with Medicaid were more likely to present later and undergo open surgery.

Objective: A meta-analysis was performed to understand disparities in the representation of female authorship within the neurosurgical literature and implications for career advancement of women in neurosurgery., Methods: Author names for articles published in 16 of the top neurosurgical journals from 2002 to 2019 were obtained from MEDLINE. The gender of each author was determined using automated prediction methods. Publication trends were compared over time and across subdisciplines. Female authorship was also compared to the proportionate composition of women in the field over time., Results: The metadata obtained from 16 major neurosurgical journals yielded 66,546 research articles. Gender was successfully determined for 96% (127,809/133,578) of first and senior authors, while the remainder (3.9%) were unable to be determined through prediction methods. Across all years, 13.3% (8826) of articles had female first authorship and 9.1% (6073) had female senior authorship. Female first authorship increased significantly over time from 5.8% in 2002 to 17.2% in 2019 (p < 0.001). Female senior authorship also increased significantly over time, from 5.5% in 2002 to 12.0% in 2019 (p < 0.001). The journals with the highest proportions of female first authors and senior authors were the Journal of Neurosurgery: Pediatrics (33.5%) and the Asian Journal of Neurosurgery (23.8%), respectively. Operative Neurosurgery had the lowest fraction of female first (12.4%) and senior (4.7%) authors. There was a significant difference between the year-by-year proportion of female neurosurgical trainees and the year-by-year proportion of female neurosurgical first (p < 0.001) and senior (p < 0.001) authors. Articles were also more likely to have a female first author if the senior author of the article was female (OR 2.69, CI 2.52-2.86; p < 0.001). From 1944 to 2019, the Journal of Neurosurgery showed a steady increase in female first and senior authorship, with a plateau beginning in the 1990s., Conclusions: Large meta-analysis techniques have the potential to effectively leverage large amounts of bibliometric data to quantify the representation of female authorship in the neurosurgical literature. The proportion of female authors in major neurosurgical journals has steadily increased. However, the rate of increase in female senior authorship has lagged behind the rate of increase in first authorship, indicating a disparity in academic advancement in women in neurosurgery.

Objective: Quantify the integrity, measured as completeness and concordance with a thoracic radiologist, of documenting pulmonary nodule characteristics in CT reports and assess impact on making follow-up recommendations., Materials and Methods: This Institutional Review Board-approved, retrospective cohort study was performed at an academic medical center. Natural language processing was performed on radiology reports of CT scans of chest, abdomen, or spine completed in 2016 to assess presence of pulmonary nodules, excluding patients with lung cancer, of which 300 reports were randomly sampled to form the study cohort. Documentation of nodule characteristics were manually extracted from reports by 2 authors with 20% overlap. CT images corresponding to 60 randomly selected reports were further reviewed by a thoracic radiologist to record nodule characteristics. Documentation completeness for all characteristics were reported in percentage and compared using χ2 analysis. Concordance with a thoracic radiologist was reported as percentage agreement; impact on making follow-up recommendations was assessed using kappa., Results: Documentation completeness for pulmonary nodule characteristics differed across variables (range = 2%-90%, P < .001). Concordance with a thoracic radiologist was 75% for documenting nodule laterality and 29% for size. Follow-up recommendations were in agreement in 67% and 49% of reports when there was lack of completeness and concordance in documenting nodule size, respectively., Discussion: Essential pulmonary nodule characteristics were under-reported, potentially impacting recommendations for pulmonary nodule follow-up., Conclusion: Lack of documentation of pulmonary nodule characteristics in radiology reports is common, with potential for compromising patient care and clinical decision support tools., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective: The endoscopic endonasal approach (EEA) has gained increasing popularity for the resection of suprasellar meningiomas (SSMs). Appropriate case selection is critical in optimizing patient outcome. Long-term outcome data are lacking. The authors systematically identified preoperative factors associated with extent of resection (EOR) and determined the relationship between EOR and long-term recurrence after EEA for SSMs., Methods: In this retrospective cohort study, the authors identified preoperative clinical and imaging characteristics associated with EOR and built on the recently published University of California, San Francisco resectability score to propose a score more specific to the EEA. They then examined the relationship between gross-total resection (GTR; 100%), near-total resection (NTR; 95%-99%), and subtotal resection (STR; < 95%) and recurrence or progression with Kaplan-Meier survival analysis., Results: A total of 51 patients were identified. Radiographic GTR was achieved in 40 of 47 (85%) patients in whom it was the surgical goal. Significant independent risk factors for incomplete resection were prior surgery (OR 25.94, 95% CI < 2.00 to 336.49, p = 0.013); tumor lateral to the optic nerve (OR 13.41, 95% CI 1.82-98.99, p = 0.011); and complete internal carotid artery (ICA) encasement (OR 15.12, 95% CI 1.17-194.08, p = 0.037). Tumor size and optic canal invasion were not significant risk factors after adjustment for other variables. A resectability score based on the multivariable model successfully predicted the likelihood of GTR; a score of 0 had a positive predictive value of 97% for GTR, whereas a score of 2 had a negative predictive value of 87.5% for incomplete resection. After a mean follow-up of 40.6 ± 32.4 months (mean ± SD), recurrence was 2.7% after GTR (1 patient with atypical histology), 44.4% after NTR, and 80% after STR (p < 0.0001). Vision was stable or improved in 93.5% and improved in 67.4% of patients with a preoperative deficit. There were 5 (9.8%) postoperative CSF leaks, of which 4 were managed with lumbar drains and 1 required a reoperation., Conclusions: The EEA is a safe and effective approach to SSMs, with favorable visual outcomes in well-selected cases. The combination of postoperative MRI-based EOR with direct endoscopic inspection can be used in lieu of Simpson grade to predict recurrence. GTR dramatically reduces recurrence and can be achieved regardless of tumor size, proximity or encasement of the anterior cerebral artery, or medial optic canal invasion. Risk factors for incomplete resection include prior surgery, tumor lateral to the optic nerve, and complete ICA encasement.

Rationale and Objectives: To quantify the use of Diagnostic Certainty Phrases (DCP) in radiology reports, including DCPs with good agreement (including "diagnostic of," "unlikely" and "represents") in connoting degree of certainty between providers based on previous studies; and to assess whether modality, presence of a trainee, radiologic subspecialty, and individual radiologists are associated with the usage of DCPs with good agreement., Materials and Methods: This retrospective, IRB-approved study was conducted at an academic medical center. Radiology reports that contain DCPs were identified using information retrieval from all reports generated in 2016, excluding mammograms, obstetrical ultrasound, bone densitometry, and interventional studies. DCPs connoting good agreement were further noted. Of the reports that contained DCPs, a two-level hierarchical generalized linear model with attending as the level-two variable was performed comparing the use of DCP with good agreement while considering trainee involvement, modality, and subspecialty., Results: A total of 159,151 reports out of 370,881 were found to have at least one DCP (43%). Reports of CT scans had the most number of DCP (68% of all CT reports). Breast and abdomen subspecialties were associated with use of DCP with good agreement. There was significant variation in use of DCP with good agreement between physicians that could not be explained by modality, trainee presence, and subspecialty., Conclusion: Phrases to convey diagnostic certainty were commonly used in radiology reports. There is wide variation in usage of DCP with good agreement. Future interventions to reduce variation in use of DCPs may reduce ambiguity and improve quality of radiology reports., (Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Background: Evidence-based guidelines and recommendations can be transformed into "If-Then" Clinical Evidence Logic Statements (CELS). Imaging-related CELS were represented in standardized formats in the Harvard Medical School Library of Evidence (HLE)., Objective: We aimed to (1) describe the representation of CELS using established Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT), Clinical Quality Language (CQL), and Fast Healthcare Interoperability Resources (FHIR) standards and (2) assess the limitations of using these standards to represent imaging-related CELS., Methods: This study was exempt from review by the Institutional Review Board as it involved no human subjects. Imaging-related clinical recommendations were extracted from evidence sources and translated into CELS. The clinical terminologies of CELS were represented using SNOMED CT and the condition-action logic was represented in CQL and FHIR. Numbers of fully and partially represented CELS were tallied., Results: A total of 765 CELS were represented in the HLE as of December 2018. We were able to fully represent 137 of 765 (17.9%) CELS using SNOMED CT, CQL, and FHIR. We were able to represent terms using SNOMED CT in the temporal component for action ("Then") statements in CQL and FHIR in 755 of 765 (98.7%) CELS., Conclusions: CELS were represented as shareable clinical decision support (CDS) knowledge artifacts using existing standards-SNOMED CT, FHIR, and CQL-to promote and accelerate adoption of evidence-based practice. Limitations to standardization persist, which could be minimized with an add-on set of standard terms and value sets and by adding time frames to the CQL framework., (©Eseosa Odigie, Ronilda Lacson, Ali Raja, David Osterbur, Ivan Ip, Louise Schneider, Ramin Khorasani. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 13.05.2019.)

Accurate determination of temperature is crucial in the diagnosis of febrile conditions. Although fewer techniques have proven as useful and reliable a predictor of core body temperature as the rectal thermometry, the process of obtaining the rectal temperature could be stressful in dogs. The infrared thermometry is a noncontact device used for measuring body temperature, with advantages which include speed, convenience, and reduced stress to the animals and reduced occupational risks to the animal handler. Therefore, there is the need to assess the consistency and agreement between non-contact infrared thermometry and traditional rectal thermometry in body temperature estimation. This study compared and assessed the sensitivity of non-contact infrared thermometer used on the forehead and nasal regions respectively with that of a rectal thermometer in dogs for body temperature estimation. One hundred and thirty (130) dogs presented for veterinary attention at the Veterinary Teaching Hospital (VTH), University of Ibadan, Nigeria were enrolled in this study during August to September 2014, irrespective of sex, age, breed or health status. Temperatures of dogs presented at the clinic were obtained using both multiple non-contact infrared thermometric measures obtained in the nasal and frontal head regions; and by rectal temperature. A multivariate cross-matrix analysis was used to assess the difference in measurements between the rectal thermometry and non-contact infrared thermometry. Descriptive statistics was used to compare variation and trend regularity of the nasal and fore-head infrared thermometry. A logistic regression of the difference in measurements was computed at 95% confidence interval and P<0.05. The mean difference revealed that the rectal temperature was 5.330C higher than the non-contact infrared forehead-based temperature and 7.570C higher than nasal-based temperature measurements respectively. The Bland-Altman (B-A) plot showed that the 95% limits of agreement between the frontal and nasal obtained infrared laser thermometry methods. Temperature measure obtained using non-contact infrared thermometry (forehead and nasal region of the head) was poor in consistency and agreement compared to rectal thermometry. Usefulness of non-contact forehead infrared thermometry in routine clinical practice as a close estimate of core body temperature depends on accurate calibration and therefore not recommended.

Objective: The post-civil war records of dog bite injuries (DBI) and rabies-like-illness (RLI) among humans in Liberia is a vital epidemiological resource for developing a predictive model to guide the allocation of resources towards human rabies control. Whereas DBI and RLI are high, they are largely under-reported. The objective of this study was to develop a time model of the case-pattern and apply it to derive predictors of time-trend point distribution of DBI-RLI cases., Methods: A retrospective 6 years data of DBI distribution among humans countrywide were converted to quarterly series using a transformation technique of Minimizing Squared First Difference statistic. The generated dataset was used to train a time-trend model of the DBI-RLI syndrome in Liberia. An additive detenninistic time-trend model was selected due to its performance compared to multiplication model of trend and seasonal movement. Parameter predictors were run on least square method to predict DBI cases for a prospective 4 years period, covering 2014-2017., Results: The two-stage predictive model of DBI case-pattern between 2014 and 2017 was characterised by a uniform upward trend within Liberia's coastal and hinterland Counties over the forecast period., Conclusion: This paper describes a translational application of the time-trend distribution pattern of DBI epidemics, 2008-2013 reported in Liberia, on which a predictive model was developed. A computationally feasible two-stage time-trend permutation approach is proposed to estimate the time-trend parameters and conduct predictive inference on DBI-RLI in Liberia.

Background: Deliberate and regular exposure to premium motor spirit fumes is common and could be a risk factor for liver disease in those who are occupationally exposed. A possible association between premium motor spirit fumes and plasma levels of triglyceride, total cholesterol, high density lipoprotein cholesterol and low density lipoprotein cholesterol using a rodent model could provide new insights in the pathology of diseases where cellular dysfunction is an established risk factor., Aim: The aim of this study was to evaluate the possible effect of premium motor spirit fumes on lipids and lipoproteins in workers occupationally exposed to premium motor spirit fumes using rodent model., Materials and Methods: Twenty-five Wister albino rats (of both sexes) were used for this study between the 4(th) of August and 7(th) of September, 2010. The rats were divided into five groups of five rats each. Group 1 rats were not exposed to premium motor spirit fumes (control group), group 2 rats were exposed for 1 hour daily, group 3 for 3 hours daily, group 4 for 5 hours daily and group 5 for 7 hours daily. The experiment lasted for a period of 4 weeks. Blood samples obtained from all the groups after 4 weeks of exposure were used for the estimation of plasma levels of triglyceride, total cholesterol, high density lipoprotein- cholesterol and low density lipoprotein- cholesterol., Result: Results showed significant increase in means of plasma total cholesterol and low density lipoprotein levels (P<0.05). The mean triglyceride and total body weight were significantly lower (P<0.05) in the exposed group when compared with the unexposed. The plasma level of high density lipoprotein, the ratio of low density lipoprotein to high density lipoprotein and the ratio of total cholesterol to high density lipoprotein did not differ significantly in exposed subjects when compared with the control group., Conclusion: These results showed that frequent exposure to petrol fumes may be highly deleterious to the liver cells.

A double-blind, randomised placebo-controlled study was carried out to assess the efficacy of indometacin suppositories as a post-episiotomy analgesic. Thirty patients received 2 X 100 mg indometacin suppositories, and 30 patients received placebo suppositories within 15 min of an episiotomy repair operation. Local infiltration of the episiotomy incision was performed using 20 ml of 0.5% lignocaine in every case. Subjective symptoms of pain were evaluated 15, 30, 60 and 90 min post-episiotomy repair. Average numbers of hours as lying in patients after delivery is 4 h. None of the patients who received indometacin complained of post-episiotomy pain; whereas the patients on placebo manifested varying degrees of pain.