Search

Reflective practice is increasingly being recognized as an important component of doctors’ professional development. Balint group practice is centered on the doctor–patient relationship: what it means, how it may be used to benefit patients, and why it commonly fails owing to a lack of understanding between doctor and patient. The COVID-19 pandemic led to unprecedented disruption to postgraduate medical training programs, including the mandatory Balint groups for psychiatric trainees. This editorial reports on the experience of online Balint groups in the North West of Ireland during the COVID-19 pandemic, and furthermore provides guidance for online Balint group practice into the future.

BACKGROUND AND OBJECTIVE: Fixed orthodontic appliance therapy (FOAT) is universally recognized and most common method for treating malocclusion. Periodontal complications are frequent consequences of orthodontic therapy that need to be evaluated. The study aimed to evaluate clinical periodontal parameters and salivary cytokines levels among patients undergoing FOAT. METHODS: 30 systemically healthy subjects (males and females), age ranged from 17-28 years with health periodontium and malalignment teeth attended Khanzad teaching center for FOAT. Clinical periodontal parameters (plaque index, gingival index, sulcus bleeding index, probing depth, debris index simplified, calculus index simplified & oral hygiene index simplified) and unstimulated saliva were assessed at baseline (0 day) before Fixed orthodontic appliance application and after one and three months of therapy. IL-1beta, IL-6, IL-8 and IL-10 levels were assessed in saliva by enzyme-linked immunosorbent assay (ELISA). RESULTS: The results showed significant increase in the mean values of clinical periodontal parameters and salivary cytokines levels of IL-1beta, IL-6, IL-8 after one and three months of FOAT as compared to base line (P < 0.05), as well as significant decrease in the mean value of IL-10 level after one and three months as compared to baseline (P < 0.05). No significant correlations were detected between periodontal and immunological parameters. CONCLUSION: Fixed orthodontic appliance therapy had a negative influence on periodontal health, since it promotes dental plaque accumulation & gingival inflammation. As well as FOAT led to significant increase of pro inflammatory and significant decrease of anti-inflammatory cytokines

For the simultaneous determination of linagliptin and metformin in pharmaceutical formulations, two spectrophotometric procedures were described that were direct, accurate, and precise. The first was based on the H-point standard addition method (HPSAM) in which a standard solution of linagliptin was added to a mixture of linagliptin and metformin to monitor the absorbance at the wavelength pair of 231.7 nm and 243.4 nm. Linearity, accuracy, and precision were accepted over the concentration range of 0-3.2 μg/mL and 0.8 - 2.8 μg/ mL for linagliptin and metformin, respectively. In the second method, the simultaneous equation method (Vierodt᾿s method) was developed and validated, where two wavelengths 226 and 238 nm of linagliptin and metformin, respectively, were chosen to form the simultaneous equation. The results of applying Vierodt's method showed that linagliptin and metformin could be quantified simultaneously in the concentration range of 0 - 25 μg/mL and 0 -20 μg/mL, respectively. These methods have been successfully applied to the simultaneous determination of linagliptin and metformin in various synthetic mixtures, and pharmaceutical products. Key words: Linagliptin ; Metformin ; H-Point Standard Addition Method ; Vierodt᾿S Method; Simultaneous Determination

The zoonotic potential of Escherichia coli from chicken and beef food products is well documented. The uses of antibiotics on agriculture encourage the development of resistance bacteria capable of causing human disease and passing resistance to human pathogens. This study aimed to detect the antibiotic susceptibility and production of extended-spectrum beta-lactamase (ESBL) of E. coli strains isolated from meat. E. coli was isolated and identified according to standard techniques using traditional and chromogenic media and confirmed by biochemical reaction. Kirby-Bauer disk diffusion method was used to determine antimicrobial susceptibility towards twelve commonly used antibiotics. The resistance of the isolated E. coli towards the third generation of cephalosporins was detected using cefotaxime (30µg), ceftriaxone (30 µg) and ceftazidime (30 µg). ESBL producer E. coli was investigated using combination test. The results showed that 135 (75%) of the 180 meat samples revealed positive isolation of E. coli. 77.33% of the chicken meat samples showed positive isolation of E. coli, while 63.33% (19/30) of minced beef meat samples showed positive growth of E. coli. From these isolates, it was clear that most of them were highly resistant to tetracycline (10 µg), amoxiclav (30 µg) and cefalexin (30 µg). The lowest resistance was observed with ceftriaxone (30 µg) and ceftazidime (30 µg). The resistance of the isolated E. coli towards the third generation of cephalosporins was ranged between 5 to 33%. This study revealed that the isolated E. coli was ESBL producer as 85.71, 83.33, 70.83, 68.18 and 66.66% were detected in chickens leg, skin, wing, abdomen and chest respectively; while minced meat showed isolation of 15.78% of the ESBL producer E. coli. The study concluded that chicken and beef minced meat sold in Khartoum state have high hazardous risk for transmission of ESBLs producing E. coli; thus quality control application is highly needed. Policy actions should be implemented in order to prevent cross transmission of ESBLs producer E. coli to human. Key words: E. coli, ESBL producer E. coli, susceptibility pattern, meat quality.

Résumé Cet article est une tentative de donner une réponse à la question principale de recherche intitulée: quel est l’effet des droits de propriété sur l’adoption des techniques de conservation des eaux et des sols par les producteurs de céréales au Burkina Faso. L’objectif de cet article est d’évaluer l’effet des droits de propriété sur l’adoption des techniques de conservation des eaux et des sols par les producteurs de céréales au Burkina Faso. Un modèle probit multivarié est utilisé sur un échantillon de 4 813 parcelles de l’enquête réalisée par le deuxième Programme National de Gestion des Terroirs (PNGT2) en 2011 sur les ménages au Burkina Faso. Les résultats montrent que les droits de propriété formels influencent positivement la probabilité d’adoption des diguettes en cordons pierreux, des demi-lunes et des haies vives. La principale conclusion de cette recherche est que les droits de propriétés formels influencent positivement la probabilité d’adoption des diguettes en cordons pierreux, des demi-lunes et des haies vives. L’article recommande par conséquent l’utilisation des techniques de conservation des eaux et des sols par les producteurs de céréales disposant de droits de propriété formels sur leurs parcelles. Mots clés: droits de propriété, effet, zaï, diguettes en cordons pierreux, demi-lunes, haies vives Abstract This article is an attempt to give an answer to the main research question entitled: what is the effect of property rights on the adoption of water and soil conservation techniques by cereal producers in Burkina Faso. The objective of this article is to evaluate the effect of property rights on the adoption of water and soil conservation techniques by cereal producers in Burkina Faso. A multivariate probit model is used on a sample of 4,813 plots from the survey carried out by the second National Land Management Program (PNGT2) in 2011 on households in Burkina Faso. The results show that formal property rights positively influence the probability of adoption of stone bunds, half-moons and hedgerows. The main conclusion of this research is that formal property rights positively influence the probability of adoption of stone bunds, half-moons and hedgerows. The article therefore recommends the use of water and soil conservation techniques by cereal producers with formal property rights over their plots. Keywords: property rights, effect, zaï, bunds in stone bunds, half-moons, hedges

Genetically modified cotton (GMC) was compared with two conventional cultivars, using data from trials and commercial farms. Objectives were to highlight disparate agronomic and technological performance parameters and identify perspectives to Burkina Faso comeback to GMC. Results showed that compared materials are similar for most agronomic characteristics, except fiber percent. As this important parameter is concerned, GMC outperformed conventional cultivars in trials (+1.2 to +2.2%) and some commercial fields by +0.3, +0.5, +0.6 and +1% at Banfora, Koudougou, Hounde and Dedougou, respectively. For fiber quality, they did not show significant difference in maturity, micronaire, uniformity index, elongation, short fiber index, reflectance and yellowness. For two important parameters in cotton fiber marketing, Upper Half Mean Length and Strength, GMC was highly handicapped by -1.43 to -2.09 mm and -19.70 to -40.67 kN m Kg-1 compared to conventional cultivars, in commercial production. In trials, differences averaged -1.75 mm and -32.34 kN m Kg-1. Differences between compared materials are genetic, due to failure in recovering important characteristics after the transgenic conversion. Local GMC cultivars could be an asset if more perfectly achieved, on site selected and pre-release evaluated, to take into account local production particularities. Key words: Genetic conversion, Bt cotton, agronomic characteritics, fiber properties, Burkina Faso.

Intensity-modulated radiation therapy (IMRT) was put as the development of three-dimensional conformal radiation therapy (3D-CRT). The purpose of the present study is to compare the dosimetric analysis of two techniques of radiotherapy (IMRT) and 3D-CRT, which include target volume and organ at risk for both plans. The present study enrolled that nine patients with different types of brain cancer which previously irradiated from November 2018 to May 2019 were selected in Zhianawa Cancer Center in Sulaymaniyah; all cases were planned again by both techniques 3D-CRT and IMRT. IMRT planning provides reducing the dose of both right and left optic nerve mean dose for right optic nerve 13.70 Gy and left 14.93 Gy compared with the 3D-CRT plan (right optic nerve 23.54 Gy and left 19.13 Gy). P = 0.2 for the right optic nerve and P = 0.56 for the left optic nerve were statistically significant. IMRT plan reduces dose to the optic chiasm compared to 3D-CRT plan, the mean dose of optic chiasm for IMRT was 33.37 Gy relative to 3D-CRT which was 34.28 Gy and P = 0.92. IMRT plan was better than 3D-CRT for many organs at risk, especially for optic chiasm and both optic nerve deliver less dose than 3D-CRT.

Resistance to single cytokine blockade, namely anti-tumor necrosis factor (TNF) therapy, is a growing concern for patients with inflammatory bowel disease (IBD). The transcription factor T-bet is a critical regulator of intestinal homeostasis, is genetically linked to mucosal inflammation and controls the expression of multiples genes such as the pro-inflammatory cytokines interferon (IFN)-γ and TNF. Inhibiting T-bet may therefore offer a more attractive prospect for treating IBD but remains challenging to target therapeutically. In this study, we evaluate the effect of targeting the transactivation function of T-bet using inhibitors of P-TEFb (CDK9-cyclin T), a transcriptional elongation factor downstream of T-bet.Using an adaptive immune-mediated colitis model, human colonic lymphocytes from patients with IBD and multiple large clinical datasets, we investigate the effect of cyclin-dependent kinase 9 (CDK9) inhibitors on cytokine production and gene expression in colonic CD4Systemic CDK9 inhibition led to histological improvement of immune-mediated colitis and was associated with targeted suppression of colonic CD4Collectively, our findings reveal CDK9 as a potential target for anti-TNF-resistant IBD, which has the potential for rapid translation to the clinic.

Aim Congenital heart diseases (CHDs) are heart abnormalities that present at birth and are one of the most common birth defects in children. Few studies assessed the clinical profile of CHDs in Sudan, and they are almost outdated. The aim of this study was to provide a recent overview of the clinical profile of CHDs in Khartoum, Sudan. Method a descriptive cross-sectional hospital-based study was done in 2016 in 3 main pediatric tertiary care hospitals in Khartoum. Firstly, the authors included all patients presented with suspicion of cardiac diseases. From which only those diagnosed with CHDs were included. The total sample size was 112 patients, from which CHDs comprised 60 patients. Results among the 112 patients, 53.6% had CHDs, 25% had acquired diseases, and 21.4% were normal. Of those with CHD, 60% were having acyanotic CHD, and 21.7% were having cyanotic CHD, the remaining patients had other cardiac defects. VSD was the most predominant individual CHD (33%), followed by ASD (19%), PDA (16.8%) and TOF (16.8%). VSD was the most common acyanotic lesion, while TOF was the most common cyanotic lesion followed by TGA and pulmonary atresia (PA). Conclusions We have an updated overview of the clinical profile of CHDs in Khartoum, Sudan. CHDs were the most common form within all pediatric patients with cardiac disease. From these CHDs, acyanotic lesions were the most common ones. VSD was the most common acyanotic lesion followed by PDA. TOF was the most common cyanotic lesion. These findings are consistent with studies done regionally and internationally.

Mini-channel heatsinks have proven useful in removing high heat fluxes from microelectronic devices. However, further miniaturization of electronic devices requires significant enhancement in the mini-channel heatsinks’ thermohydraulic characteristics, which depend greatly on the coolant and geometrical configuration of the channel. Therefore, the current study explores the potential of mini-channel heatsinks’ using different coolants (water, nanofluid and supercritical carbon dioxide) and various channel configurations. The effect of various channel configurations on the thermohydraulic characteristics of the mini-channel heat sinks is evaluated numerically for different coolants employing three flow rates (17 g/s, 34 g/s and 50 g/s). Hence, the effects of fin height, spacing and thickness, and mass flow rate on the overall heat transfer coefficient (CHT) and pressure drop (ΔP) are reported for the abovementioned coolants. It is found that increasing the mass flow rate increases both the CHT and ΔP. It is also noted that increasing the fin height and spacing decreases both the CHT and ΔP, as opposed to increasing the thickness, which causes both the CHT and ΔP to increase. Among the three coolants used, the sCO2 shows superior performance compared to the water and nanofluid and this based on higher CHT and lower ΔP. Moreover, the performance evaluation criterion (PEC) for the sCO2 is higher than that for the water and nanofluid by 53% at 17 g/s flow rate and 243% at 50 g/s flow rate.

GAVE syndrome (gastric antral vascular ectasia) is a rare cause of gastrointestinal bleeding. It affects mainly the elderly. The syndrome was named “watermelon stomach” because of its typical endoscopic appearance of “watermelon stripes” observed at the gastric antral level. We present the case of an 80-year-old female patient, under iron substitution therapy for an iron deficiency anemia previously diagnosed. The woman was admitted to our hospital for non-specific symptoms, severe asthenia and postural instability. The clinical examination noted pallor of skin and sclera, without hematemesis or melena. Paraclinical tests revealed severe hypochromic microcytic anemia and hyposideremia, with a positive fecal occult blood test. Because the patient was refractory to the iron therapy, presenting with severe anemia, which required blood transfusions, we suspected a diagnosis of acute hemorrhagic gastritis. In order to reveal the source of the hemorrhage, an upper gastrointestinal endoscopy was performed, which described the typical appearance of prominent, tortuous, erythematous streaks traversing the antrum and converging toward the pylorus, creating the “watermelon stripes” pattern, with lesions that bleed easily during the biopsy process. In a different endoscopic session, the argon plasma coagulation treatment was applied, resulting in clinical and biological improvement. Gastric antral vascular ectasia is a rare medical condition, insufficiently recognized and poorly understood, which can be treated efficiently by endoscopic means, if it is early diagnosed. Although this condition tends to be underdiagnosed at the present time, doctors may exceed their limits by acquiring a high grade of clinical suspicion.

A 67 year-old female presented to our centre with a 2 day history of right flank pain, clinically suggestive of ureteric colic. Computed tomography (CT) confirmed a 6mm right ureteric calculus. However, CT also revealed a large 13cm ipsilateral renal mass, concerning for renal cell carcinoma (RCC). At ureteroscopy for management of the obstructing calculus, a small papillary lesion was noted in the bladder, and excised. Histology confirmed pTa low-grade transitional cell carcinoma. Following discussion at the Urology multidisciplinary tumour board, MRI venogram (MRV) was recommended to delineate the extension of tumour into the renal vein, and to characterise a pelvic mass seen on original CT. MRV showed enhancing material extending into the IVC, consistent with tumour thrombus. However, it also identified a concerning 6cm solid ovarian mass. The patient proceeded to open right radical nephrectomy and IVC thrombectomy, hysterectomy, bilateral salpingo-oopherectomy, and omental biopsy, with combined input from Urological, Gynaecological and Vascular surgical teams. Post-operative course was uneventful. Histology showed an 11cm pT3a G2 clear cell RCC, and 7.5cm ovarian fibroma, both fully excised. This case demonstrated the serendipity of a simple ureteric calculus precipitating a cascade of investigations, that ultimately led to complete resection of three primary neoplasms.

BACKGROUND: The safety and efficacy of antenatal glucocorticoids in women in low-resource countries who are at risk for preterm birth are uncertain. METHODS: We conducted a multicountry, randomized trial involving pregnant women between 26 weeks 0 days and 33 weeks 6 days of gestation who were at risk for preterm birth. The participants were assigned to intramuscular dexamethasone or identical placebo. The primary outcomes were neonatal death alone, stillbirth or neonatal death, and possible maternal bacterial infection; neonatal death alone and stillbirth or neonatal death were evaluated with superiority analyses, and possible maternal bacterial infection was evaluated with a noninferiority analysis with the use of a prespecified margin of 1.25 on the relative scale. RESULTS: A total of 2852 women (and their 3070 fetuses) from 29 secondary- and tertiary-level hospitals across Bangladesh, India, Kenya, Nigeria, and Pakistan underwent randomization. The trial was stopped for benefit at the second interim analysis. Neonatal death occurred in 278 of 1417 infants (19.6%) in the dexamethasone group and in 331 of 1406 infants (23.5%) in the placebo group (relative risk, 0.84; 95% confidence interval [CI], 0.72 to 0.97; P=0.03). Stillbirth or neonatal death occurred in 393 of 1532 fetuses and infants (25.7%) and in 444 of 1519 fetuses and infants (29.2%), respectively (relative risk, 0.88; 95% CI, 0.78 to 0.99; P=0.04); the incidence of possible maternal bacterial infection was 4.8% and 6.3%, respectively (relative risk, 0.76; 95% CI, 0.56 to 1.03). There was no significant between-group difference in the incidence of adverse events. CONCLUSIONS: Among women in low-resource countries who were at risk for early preterm birth, the use of dexamethasone resulted in significantly lower risks of neonatal death alone and stillbirth or neonatal death than the use of placebo, without an increase in the incidence of possible maternal bacterial infection. Fil: Oladapo, Olufemi T.. Organizacion Mundial de la Salud; Argentina Fil: Vogel, Joshua P.. Organizacion Mundial de la Salud; Argentina Fil: Piaggio, Gilda. Organizacion Mundial de la Salud; Argentina Fil: Nguyen, My-Huong. Organizacion Mundial de la Salud; Argentina Fil: Althabe, Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Metin Gülmezoglu, A.. Organizacion Mundial de la Salud; Argentina Fil: Bahl, Rajiv. Organizacion Mundial de la Salud; Argentina Fil: Rao, Suman P.N.. Organizacion Mundial de la Salud; Argentina Fil: de Costa, Ayesha. Organizacion Mundial de la Salud; Argentina Fil: Gupta, Shuchita. Organizacion Mundial de la Salud; Argentina Fil: Shahidullah, Mohammod. No especifíca; Fil: Chowdhury, Saleha B.. No especifíca; Fil: Ara, Gulshan. No especifíca; Fil: Akter, Shaheen. No especifíca; Fil: Akhter, Nasreen. No especifíca; Fil: Dey, Probhat R.. No especifíca; Fil: Abdus Sabur, M.. No especifíca; Fil: Azad, Mohammad T.. No especifíca; Fil: Choudhury, Shahana F.. No especifíca; Fil: Matin, M.A.. No especifíca; Fil: Goudar, Shivaprasad S.. No especifíca; Fil: Dhaded, Sangappa M.. No especifíca; Fil: Metgud, Mrityunjay C.. No especifíca; Fil: Pujar, Yeshita V.. No especifíca; Fil: Somannavar, Manjunath S.. No especifíca; Fil: Vernekar, Sunil S.. No especifíca; Fil: Herekar, Veena R.. No especifíca; Fil: Bidri, Shailaja R.. No especifíca; Fil: Mathapati, Sangamesh S.. No especifíca; Fil: Patil, Preeti G.. No especifíca; Fil: Patil, Mallanagouda M.. No especifíca; Fil: Gudadinni, Muttappa R.. No especifíca; Fil: Bijapure, Hidaytullah R.. No especifíca; Fil: Mallapur, Ashalata A.. No especifíca; Fil: Katageri, Geetanjali M.. No especifíca; Fil: Chikkamath, Sumangala B.. No especifíca; Fil: Yelamali, Bhuvaneshwari C.. No especifíca; Fil: Pol, Ramesh R.. No especifíca; Fil: Misra, Sujata S.. No especifíca; Fil: Das, Leena. No especifíca

ObjectivesInforming research participants of the results of studies in which they took part is viewed as an ethical imperative. However, there is little guidance in the literature about how to do this. The Fluoxetine Or Control Under Supervision trial randomised 3127 patients with a recent acute stroke to 6 months of fluoxetine or placebo and was published in the Lancet on 5 December 2018. The trial team decided to inform the participants of the results at exactly the same time as the Lancet publication, and also whether they had been allocated fluoxetine or placebo. In this report, we describe how we informed participants of the results.DesignIn the 6-month and 12-month follow-up questionnaires, we invited participants to provide an email address if they wished to be informed of the results of the trial. We re-opened our trial telephone helpline between 5 December 2018 and 31 March 2019.SettingUK stroke services.Participants3127 participants were randomised. 2847 returned 6-month follow-up forms and 2703 returned 12-month follow-up forms; the remaining participants had died (380), withdrawn consent or did not respond.ResultsOf those returning follow-up questionnaires, a total of 1845 email addresses were provided and a further 50 people requested results to be sent by post. Results were sent to all email and postal addresses provided; 309 emails were returned unrecognised. Seventeen people replied, of whom three called the helpline and the rest responded by email.ConclusionIt is feasible to disseminate results of large trials to research participants, though only around 60% of those randomised wanted to receive the results. The system we developed was efficient and required very little resource, and could be replicated by trialists in the future.Trial registration numberISRCTN83290762; Post-results.

Since President Obama signed the Precision Medicine Initiative in 2015, endeavors to integrate pharmacogenetics in clinical practice and psychiatric care have been evolving rapidly. The nature of general practice and psychiatric medicine, including psychopharmacotherapy and the long-term care necessary for chronic diseases, renders these fields in desperate need of the implementation of pharmacogenetics. This article presents some of the challenges facing pharmacogenetics implementation in family medicine and psychiatric care. Reputable research websites were used to extract papers, data, and lectures concerning this topic. The results reveal that three main challenges are facing this integration: the evaluation of pharmacogenetic testing in general and psychiatric practice, cost-effectiveness, and regulatory burdens. Although considerable advances are being made to address these issues, it is time to gather these efforts under one umbrella to create guidelines based on previous and upcoming research.

Nearly universal among organisms, circadian rhythms coordinate biological activity to earth's orbit around the sun. To identify factors creating this rhythm and to understand the resulting outputs, entrainment of model organisms to defined circadian time-points is required. Here we detail a procedure to entrain many Drosophila to a defined circadian rhythm. Furthermore, we detail post-entrainment steps to prepare samples for immunofluorescence, nucleic acid, or protein extraction-based analysis.

Innate lymphoid cells (ILCs) are emerging as important effectors of innate immunity and play a critical role in maintaining intestinal immune homeostasis. They are tissue-residing immune cells that can be subdivided based on master transcription factor and cytokine expression, bearing striking resemblance to their CD4

Let G be a finite group and let N be a fixed normal subgroup of G. In this paper, a new kind of graph on G, namely the intersection graph is defined and studied. We use to denote this graph, with its vertices are all normal subgroups of G and two distinct vertices are adjacent if their intersection in N. We show some properties of this graph. For instance, the intersection graph is a simple connected with diameter at most two. Furthermore we give the graph structure of for some finite groups such as the symmetric, dihedral, special linear group, quaternion and cyclic groups.

Leydig cell tumour (LCT) of the testis is a rare histological subtype of stromal tumours, accounting for 1 to 3% of testicular neoplasms. The natural history of LCT is poorly understood. The aim of this study was to assess the incidence and natural history of Leydig cell tumours (LCT) of the testes. A search of the National Cancer Registry of Ireland database was performed regarding Leydig cell testicular tumours. Recurrence free survival (RFS) and disease-specific survival (DSS) were analysed. Between 1994 and 2013, 2755 new cases of testicular cancer were diagnosed in Ireland. Of these, 22 (0.79%) were Leydig cell tumours. Nineteen were invasive (stage T1) and three were in situ (stage Tis). One patient developed a local recurrence following an organ preserving procedure and underwent a completion orchidectomy 107 days after initial diagnosis. No further treatment was required. There have been no disease-specific deaths. The 1-, 3- and 5-year overall survival (OS) rates were 95.5, 88.2 and 73.3%, respectively. The 5-year disease-specific survival (DSS) was 100% and the 5-year recurrence free survival (RFS) was 93.3%. From the National Cancer Registry, LCT has been shown to be a rare subtype of testicular tumour. Due to the relatively favourable natural history, it may be possible to tailor less aggressive surveillance regimens in these patients.

Hyposplenism is associated with autoimmune diseases, inflammatory bowel disease, severe celiac disease, autoimmune thyroiditis, untreated HIV infection and chronic graft-versus-host disease. The aim of this study was to review the existing data on hyposplenism associated with celiac disease and Hashimoto's autoimmune thyroiditis. Our research was based on a clinical case concerning a 41-year-old female who presented with asthenia, fatigue, dyspepsia and chronic diarrhea. The medical history revealed autoimmune Hashimoto's thyroiditis, type 2 diabetes, fatty liver disease, chronic gastritis and thrombocytosis. Multiple investigations showed hyposplenism and complex autoimmune dysfunction with positive serum markers for celiac disease and type 1 autoimmune hepatitis along with minor symptomatology. The intestinal symptomatology of celiac disease is often hid by hypothyroidism-associated autoimmune thyroiditis. Asymptomatic or minimally symptomatic celiac disease associated with Hashimoto's autoimmune thyroiditis is diagnosed by biomarkers. Hyposplenism in celiac disease can occur regardless of the disease stage, latent or symptomatic.

This research investigates occupational safety, health systems and administration in construction sites in Khartoum state by identifying and studying the basic elements of this subject, which includes the legal framework, knowledge, training, senior management commitment, resources and equipment related to the occupational safety and health administration. This research discusses the current situation of engineering projects that were selected as case studies in the state of Khartoum. A closed-ended questionnaire was designed and distributed to the working frameworks in these projects. The results of the case studies and questionnaire revealed lack of awareness of the importance of occupational safety and health in the workplace, and the weak commitment of the administration to develop safety programs and follow up their implementation. There is also no separate law on occupational safety and health, which reduces the seriousness of dealing with occupational safety and health in construction sites. The study recommends enacting a law and standard specifications for occupational safety and health at construction sites in Khartoum state., {"references":["Suhaila Mohammed Abbas, Ali Hussain Ali (2007), \"Human resources department, 3rd Edition\", Dar Wael Publishing, Jordan, pp. 348-349.","Nahla Al-Bayari et al. (2009), \"Principles in health and public safety, 3rd Edition,\" Dar Al-Messayra Publishing, Jordan.","Khaled Fathi Madhi, Ahmed Ragheb Al-Khatib (2010), \"General professional safety, First Edition,\" Dar Al-Kanooz Al-Maarifah, Jordan, pp. 98.","Jorma Rantanen et. al. (2004), \"Comprehensive strategy on occupational safety and health: Conclusions adopted by the international customer conference at its 91st session in 2003\", International Labor Office."]}

Cervical (neck) pain is becoming the leading issue worldwide. Accurate segmentation of cervical spine can assist radiologists and doctors in early and batter clinical diagnosis of cervical abnormalities. This paper addresses the challenging issue of cervical image segmentation. Various techniques have been proposed earlier, but still work is needed for accurate identification and segmentation of vertebral bodies. The technique required to segment out vertebra should be robust and invariant to variation in shape, noise, rotation, scale and occlusions. In this paper, we have presented a novel technique for cervical vertebrae segmentation, which is based on deep learning, i.e., U-Net. This technique would have an ability to capture information embedded in x-ray data images for segmentation purpose and have an ability to overcome noise and occlusions in batter and efficient way.