Obturator Nerve Block by Inguinal Approach in the Transurethral Resection of Lateral wall Bladder Tumor

Background: Single spinal anesthetic has been shown to be ineffective in preventing obturator nerve activation and adductor muscle contraction, which can lead to problems such as bladder perforation during transurethral resection of lateral wall bladder tumor (TURBT) under SA. To counteract this, numerous additional approaches are still being investigated, with the inguinal approach lately gaining traction. The aim of the study was to observe the incidence of jerk/ muscle spasm after obturator nerve block by Inguinal Approach in TURBT of lateral wall urinary bladder tumor under SA. Material & Methods: This retrospective observational study was conducted at the Department of Anesthesiology & ICU of National Institute of Kidney Diseases & Urology, Dhaka, Bangladesh. The study duration was 6 months, from January 2022 to July 2022. During this period, a total of 20 cases of transurethral resection of lateral wall bladder tumor (TURBT) had been included as the study population, following inclusion and exclusion criteria. Results: Among the participants, 45% had been from the age group of 60-69 years, 30% had been from the age group of 50-59 years, 15% had been between the ages of 70-79, and 10% had been of 80 years or older. Hypertension was the most common comorbidity, observed in 70% of the participants. 45% had diabetes, 15% had chronic kidney disease, another 15% had chronic obstructive pulmonary disease, 10% had heart disease, and 15% had benign enlargement of prostate. During TURBT, majority of the patients had no jerk, while only 10% had minimal jerk and 1 patient had maximum jerk. During the 24-hour follow-up, 20% of patients regarded their outcome condition as excellent, while 60% had regraded their outcome as good. Only 1 patient regarded their outcome as poor, while follow-up data was unavailable for 15% of patients. Conclusion: The study observed very few incidence of muscle spasm or jerk during TURBT after using the inguinal approach. The study also found positive short-term outcome in most of the patients.

Exploring the norms of eating-out practice among adults in Malaysia

@#Introduction: Eating-out is common in almost all countries, including Malaysia, but this frequent practice may affect human health. In Malaysia, data on eating-out is limited. This study aimed to assess the proportion of eating-out, to assess the association between socio-demographic factors and eating patterns, and to compare energy and nutrient intakes between people eating-out and eating-in. Methods: This cross-sectional study was conducted among 100 adults aged 30 to 70 years old. Three-day food diaries were used to collect data on dietary intake. Eating-out was defined as eating foods prepared outside the home. Respondents who ate outside for at least one meal per day, for two or three days per week were considered as those who frequently practised eating-out. Results: A total of 84% of respondents who ate out had significantly higher sodium intake than those who ate at home (2934 mg/day vs. 2165 mg/day, p=0.025). Foods and drinks that were most commonly consumed outside were nasi lemak, roti canai, rice, ayam masak kicap, vegetable soup, tomyam, rice vermicelli soup (mee-hoon soup), hot teh-o, iced tea, and orange juice. Occupation (p=0.004) and location type (p=0.001) were associated with eatingout. Government and semi-government workers (61%) and urban population (57%) had higher percentage of eating-out compared to eating at home (19% and 12%, respectively). Conclusion: More than two-thirds of our respondents ate out and this habit was related to poor diet quality with excessive intake of sodium. Interventions are needed to improve the diet quality of the overall eating-out behaviour among targeted population.

First case of pulmonary hydatid cyst in a pregnant Syrian refugee woman in Malaysia

@#Pulmonary hydatid cyst (PHC) in pregnancy is a very rare pathology. We report here a case of ruptured PHC during pregnancy in a 26-year old Syrian (refugee) woman who presented with complaints of productive cough with metallic taste and dyspnoea. PHC was suspected due to her clinical and radiological findings. Interestingly, the sputum examination confirmed the diagnosis as numerous protoscoleces were present. Serology for Echinococcus infection revealed positive at high titre. Early diagnosis and prompt treatment by providing care improves the patient outcome. Parasitological examination of the respiratory specimen in suspected ruptured PHC is desirable as a valuable detection tool.

Resource optimization through process re-engineering of inhalational therapy unit at a tertiary care public hospital

Background: Salaries, supplies and machinery account for bulk of public funding necessitating efficient utilisation. Studies suggest that process re-engineering helps improve cost, quality, service, and speed. Disbanded once and re-commissioned, a centralized Inhalational Therapy Unit (ITU) banked and provided portable mechanical ventilators to the inpatient wards. A demand for new ventilators from ITU led to the present study involving its critical review and cost analysis.Methods: An interventional study was conducted at a large tertiary care public hospital in India from April 2015 to June 2015. Critical review of process of providing portable ventilators and cost analysis were conducted. Review of records of and interview with ITU personnel and nursing staff were carried out. Fundamental rethinking and radical redesign of the process was done with attention to human resource, costs, space and actual medical equipment utilization. Two fundamental questions of process re-engineering were deliberated upon: “Why do we do what we do?” “And why do we do it the way we do?” Fundamental rethinking for new process was organized around the outcome.Results: Average utilization coefficient was 6.2% (3.3% to 12.1%). Ventilators utilized per day were 1.43. Expenditure on salaries was INR 315000 per month and INR 10500 per day. Low utilization offered low value for expenses incurred. All activities in ITU focused on “provision of ventilators” (outcome) and the old rule was, “If one needed a ventilator one must contact ITU”. Since nurses were using the “outcome” and performed activities of arranging, they were handed-over the ventilators (based on utilisation patterns). ITU was disbanded, human resource and space were re-allocated to various hospital areas (costs tied were done away with) with no adverse effect on hospital functioning.Conclusions: Process re-engineering led to improved healthcare delivery, curtailed delays in hospital processes, optimised costs involved in human resources and medical equipment.

Identification of dietary patterns associated with characteristics of successful aging

@# Introduction: This study aimed to identify dietary patterns (DPs) and their association with successful aging (SA). Methods: A comparative cross-sectional study was conducted among 579 elderly subjects recruited from four states in Malaysia through a multistage random sampling method. SA was defined as having no chronic illnesses, no functional limitation, normal global function, no depression, a good quality of life and good self-perceived health. Information on dietary intake was obtained using a diet history questionnaire. Cognitive functions were assessed using the Mini Mental State Examination (MMSE), depressive symptoms using Geriatric Depression Score-15 items (GDS-15) and a question regarding their perceived health and quality of life. Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) questionnaires were used to determine functional status. DPs were obtained using the principal component analysis (PCA) approach. An ordinal logistic regression model was used to examine associations between DP scores and SA. Results: Five DPs were identified namely ‘sweet foods-beverages’, ‘meat-vegetablesrice and noodles’, ‘local snacks-fish and seafood-high salt foods’, ‘fruits-legumes’, and ‘tropical fruits-oats’. A higher score for ‘tropical fruits-oats’ DP was associated with SA [Adjusted OR=1.59 (95% CI: 1.08-2.32)]. However, the association diminished when the model was adjusted for education level. Further analysis indicated that this DP increased the chance of SA among those with secondary education and above [Adjusted OR=2.43 (95% CI: 1.09–5.42)]. Conclusion: Tropical fruits-oats’ DP is associated with SA among elderly with secondary education and above. There is a need to investigate DPs among those with lower education.

Cosmetic outcome of hypofractionated whole-breast irradiation with concomitant boost in breast cancer

Background: Breast cancer is the most common cancer in women worldwide, second most common malignancy in Egypt.Methods: 60 early-stage breast cancer patients who underwent breast-conserving surgery were clusterized into 2 groups: Arm A hypofractionation with concomitant boost and Arm B conventional fractionation, each compromising 30 early stage breast cancer patients. Assessment of cosmetic outcome after breast irradiation was recorded in both groups in 4 intervals to correlate cosmesis in relation to different irradiation schedules and boost dosage and timing. The study was conducted from April 2016 till December 2018, 32 months were obtained to assure that all patients completed their irradiation schedule and 12 months follow-up period.Results: Lowest cosmetic outcome was recorded immediately after completion of breast irradiation with excellent/good in 66.7% and 73.3% of patients and fair/poor in 33.3% and 26.7% in Arm A and B, respectively. Improvement in cosmesis after 12 months of breast irradiation reaching excellent/good in 83.4% and fair/poor in 16.7% in both Arm A and B.Conclusion: An abbreviated 4-week hypofractionated schedule with a concomitant boost is as effective as conventional irradiation with comparable cosmesis and may be a reasonable alternative following breast conserving surgery

Antioxidant Activity and Hepatoprotective Potential of Flavonoids from Arbutus pavarii against CCl4 Induced Hepatic Damage

Flavonoids have been shown to have antioxidant factors and effective against hepatotoxicity. This in vivo study aimed to evaluate the efficacy of flavonoids rich extracts in a model of chemical-induced liver cell injury. Materials and Methods: Flavonoids were extracted from leaves and flowers of Arbutus pavarii using Microwave assisted extraction method. Different concentrations of extracted flavonoids (200, 500, 1000, 2000 and 5000mg/kg bw) were evaluated up to two weeks on mice model. The hepatoprotective effects of the extracts were examined using mice pretreated orally with 200 and 400 mg/kg bw of flavonoids extracted from leaves and flowers as well as their combination (200 mg/kg; 1:1) for 28 days. At day 28, the mice were received orally a single dose of 1ml/kg CCl4 in corn oil. Forty-eight hours after Carbon tetrachloride (CCl4) treatment, the animals were sacrificed and their liver and blood samples were collected for determination of biochemical parameters (Alkaline phosphatase (ALT), Aspartate-aminotransferase (AST) and Alanine-aminotransferase (ALP)), histopathological investigation and antioxidant status. Results: Treatment of the mice with a daily dose of flavonoids extracts up to 5 g/kg bw did not cause mortality and did not show hepatotoxicity. Pretreatment with extracts decreased the increased serum levels of ALT, AST, and ALP, decreased lipid peroxidation and maintained the levels of glutathione and antioxidant enzymes status in the CCl4 treated mice, especially in the group treated with combined extracts. The hepato-protcitve effects were confirmed by histopathological examinations. Conclusion: The results shown by the extracted flavonoids need further investigation.

Fruit consumption and associated determinants in a sample of young urban Malaysian adults

@#Introduction: Adequacy of fruit intake contributes to an individual’s health including reducing the risk of non-communicable disease. This study aimed to assess consumption of fruits in various forms and to determine associated factors and barriers. Methods: In this cross-sectional study, a total of 300 adults aged 20-39 years were purposely recruited from several urban locations in the Klang Valley. Consumption of fruits in the past 12 months was assessed using a selfadministered food frequency questionnaire (FFQ), assisted with pictures of serving size of fruits. Anthropometric measurements were taken and body mass index and waist circumference computed. Results: Fruit intake among young adults was lower (1.6±1.0 servings/day) than the Malaysian Dietary Guideline 2010 of ≥ 2 servings/day. Only 32.3% consumed fruits as recommended, with women consuming significantly more fruits than men. Preferred fresh fruits were red apple, banana and papaya. Consumption of fruit juice was associated with increase in waist circumference (R2=0.261, p=0.027) after adjustment for age, sex, ethnicity, education level and marital status. Fruit intake showed no significant association with other anthropometric measurements. Sensory appeal, perceived health benefit, easy to prepare and influence of family were the main determinants of fruit intake, whilst affordability and availability were the major barriers. Conclusion: Fruit consumption among young adults in this study was lower than the recommendation for daily fruit intake. Studies with larger sample size are suggested to verify the finding of significant association between fruit juice consumption and risk of abdominal obesity.

Human parvovirus B19 in children with sickle cell disease; poking the spleen

Parvovirus is a known culprit of transient red cell aplasia [TRCA] in children with sickle cell disease [SCD]. Few reports have previously described the association between the virus and acute splenic sequestration crisis [ASSC] in the same patient. Here, we are shedding light on such a potentially serious combination by reporting two cases of siblings with SCD complicated with concurrent ASSC and TRCA and presenting a review of the relevant literature

Clinacanthus nutans: A review of the medicinal uses, pharmacology and phytochemistry

Clinacanthus nutans Lindau is known as snake grass belonging to the Acanthaceae family. This plant has diverse and potential medicinal uses in traditional herbal medicine for treating skin rashes, insects and snake bites, lesions caused by herpes simplex virus, diabetes, and gout in Malaysia, Indonesia, Thailand and China. Phytochemical investigations documented the varied contents of bioactive compounds from this plant namely flavonoids, glycosides, glycoglycerolipids, cerebrosides and monoacylmonogalatosylglycerol. The pharmacological experiment proved that various types of extracts and pure compounds from this species exhibited a broad range of biological properties such as anti-inflammatory, antiviral, antioxidant, and anti-diabetic activities. The findings of toxicity study showed that extracts from this plant did not show any toxicity thus it can be used as strong therapeutic agents for specific diseased conditions. However, further experiments on chemical components and their mode of action showing biological activities are required to elucidate the complete phytochemical profile and assess to confirm their suitability for future drugs. This review summarizes the medicinal uses, phytochemistry and pharmacology of this plant in order to explore its therapeutic potential and gaps necessitating for prospected research work.

Clinacanthus nutans: A review of the medicinal uses, pharmacology and phytochemistry

Clinacanthus nutans Lindau is known as snake grass belonging to the Acanthaceae family. This plant has diverse and potential medicinal uses in traditional herbal medicine for treating skin rashes, insects and snake bites, lesions caused by herpes simplex virus, diabetes, and gout in Malaysia, Indonesia, Thailand and China. Phytochemical investigations documented the varied contents of bioactive compounds from this plant namely flavonoids, glycosides, glycoglycerolipids, cerebrosides and monoacylmonogalatosylglycerol. The pharmacological experiment proved that various types of extracts and pure compounds from this species exhibited a broad range of biological properties such as anti-inflammatory, antiviral, antioxidant, and anti-diabetic activities. The findings of toxicity study showed that extracts from this plant did not show any toxicity thus it can be used as strong therapeutic agents for specific diseased conditions. However, further experiments on chemical components and their mode of action showing biological activities are required to elucidate the complete phytochemical profile and assess to confirm their suitability for future drugs. This review summarizes the medicinal uses, phytochemistry and pharmacology of this plant in order to explore its therapeutic potential and gaps necessitating for prospected research work.

Early intervention in psychosis [EIP] services, UK: a critical analysis of the evidence

The UK mental health reforms have attracted major government funding. This has been used to commission specialized community teams for people with severe mental illness. The reforms include changes to services for first-episode psychosis, which have gained huge consumer support. The UK service reforms are continuing, with the aim of providing services fit for the 21st century. In this article, we have reviewed the evidence which led to the establishment of early intervention services in the UK by using a selected review methodology. The review includes the historical background to EIP [Early Intervention in psychosis], what is EIP, where it originated from, what was the evidence leading stake holders to push the government to incorporate it in the National Health Policy. What policy reforms took place, and how the government went about implementing these services. We have discussed the current situation of the service. Furthermore we have discussed the gaps in the policy which have been identified. We end the paper with recommendations to policy makers

effect of curing cycle of denture base [PMMA] on microcolonization of candida albicans

The purpose of the study was to assess the growth of Candida Albicans on Polymethylmethacrylate [PMMA] as a denture base, using various curing cycles. Total 200 samples of denture bases were prepared divided into five categories, cut into 2x2 cm, with the thickness of 1.0 mm for the analysis. 160 out of them were further divided into 4 groups for heat cure water bath polymerization. They were assessed on different temperatures i.e. 45[degree sign] c, 100 [degree sign] c 70[degree sign] c, and 70 [degree sign] c for the time span of 45, 60, 420 and 540 min respectively. The specimens of the 5th group were cured chemically. Every specimen of all the five groups was kept in the bottles along with the food stuff for 12, 24, 168, and 336 hrs. The specimens were then mounted on the glass slides to examine under the light microscope for the analysis of Candida Albicans. Results showed that the growth of Candida Albicans observed to be reduced in heat cure polymerization as compared to the ones, cured chemically. Thus concluded that among all the sample types, the group D cured at the temperature of 70 [degree sign] c for 540 min have shown the minimum growth of Candida Albicans

Universal HIV testing for TB patient; is it really applicable universally?

Background: Universal HIV testing for all TB patients regardless of their individual risk factors is being recommended by most of the authorities including WHO in recent guidelines

Objective: To determine the prevalence of HIV infection among Pulmonary TB patients presenting at Department of Pulmonology, Rahim Yar Khan, Pakistan

Patients and Methods: In this cross sectional study, one hundred consecutive newly registered smear positive pulmonary TB patients presented at Department of Pulmonology, Sheikh Zayed Medical College, Rahim Yar Khan from 1[st] April to 31[st] December 2010 were included in this study. Interviews were conducted to record the sociodemographic data and various HIV related risk factors for all patients. Consent was taken from the patients to be included in this study and for HIV testing. Test was done by ICT method at department of pathology of this institute. The data was entered and analyzed in SPSS version 15

Results: Out of 100 TB patients in this study, 56 were male and 44 were female. Majority [51%] of the patients were uneducated. Only 24% were earning more than ten thousands rupees per month. Sixty six percent patients were aged between 15-49 years. All the patients gave their consent for HIV testing. Only 4 of the 100 subjects had travelled abroad, 8 had history of blood transfusion and none of the patients admitted any history of drug abuse. None of the 100 patients in this study was positive for HIV infection

Conclusion: Despite the presence of risk factors in considerable number of participants of this study, HIV infection was not detected in any of the Pulmonary TB patient. This finding put a question mark over universal recommendation of HIV testing in all TB patients worldwide. However, larger study including all TB patients, both Pulmonary as well as Extra Pulmonary is required to confirm this finding

Natural vegetation at middle and high altitudes region in Lawder and Mukairas, Abyan Governorate, Republic of Yemen

This study aims at identifying the nature of natural vegetation at the middle and high altitudes regions in the area under study .The field study has shown the vegetation affluence of this region, of which 116 plant species, belonging to 86 genera and distributed among 45 families, have been collected .It has also illustrated the prevalence of the communities of herbs, shrubs and dwarf hushes. Moreover, the study has demonstrated that there is a plant variation between Lawder and Mukayras due to the increase in their altitudes. It is worth mentioning that some plant species, such as Anisotes trisulcus, have been extinct [disappeared] in the areas with an altitude of 1500 rns. The region under study is characterized by unique different ecological factors and circumstances: weather and geotopography such as cliffs, slopes and the prevailing rock structures, in addition to the weakness of soil profile with scarce and intermittent rainfall. Besides, it has been noticed that there are some succulents that have been prevailed such as Adenium obesum, Euuphorbia spp. and Caralluma spp

[Identification of some microorganisms in Al-Arish sewage water treatment station]

The study aims to classify some microorganisms, which are reproduced in Al-Arish station for sewage water treatment. The result has revealed the presence of Coli form bacteria, Sulfur bacteria. Cyanobactria, Green algae and Protozoa. Those organisms play important role in degradation of organic compounds in wastewater

[ study on the biological phenomenon of greenness, light emission and odours in Aden beaches]

The study aims to disclose the causes of greenness, emission of light and harmful odours in Aden beaches. Water samples were collected during the period of January March 2006, and were examined by light microscope connected to CCD camera. Isolation and identification of microalgae were carried directly by light microscope, while isolation and identification of bacteria were carried by using several bacterial culture. The result has revealed the presence of green gelatinous colonies, the diameter of one colony is about 1 cm. The colonies contain microalgae called Phyaeocystis sp. and two bacteria species that belong to Vibrio genus: V. fischeri and V. harveyi. The source of Bioluminescence and the harmful odours are resulting from bacterial metabolic activity, while the greenness are from the algae

P50 variations in Behcet's patients without neurologic findings

In the present study, subclinical lesion involvement was investigated using the P50 component in Behcet's patients without neurological manifestation. We performed this clinical research in Erciyes University, Faculty of Medicine between December 2000 and November 2001. The studies were carried out on 18 Behcet's patients without neurologic findings and 18 volunteers for control. Standard Ag/AgCl electrodes in plastic cups were used for monopolar EEG derivations. They were attached with electrode paste and tape at the Cz [vertex] according to the 10-20 system. The auditory stimuli were delivered in pairs. The P50 waves, which may be taken from approximately 50 msec from the stimuli, were collected by computer system. Amplitudes and latencies of the P50 components were measured in the same system. This study showed that the suppression of P50 responses performed by the test stimuli, was significantly more decreased in Behcet's patients than the control subjects. The decrease of the suppression of the auditory P50 response to repeated stimuli reflects a deficit in the central nervous system's ability, such as attention, cognition, and sensory input in Behcet's patients and can be used as a neurophysiological marker in subclinical lesions in these patients

[ influence of coating film composition on Hts stability of simvastatin tablets]

The involvement of low- density lipoprotein cholesterol [LDL-C] in atherogenesis has been well-documented in clinical and pathological studies. Epidemiological studies have established that high LDL- C, low high density lipoprotein cholesterol [HDL- C], and high plasma triglycerides [TG] are risk factors for coronary heart disease [CHD]. Cholesterol- enriched TG- rich lipoproteins, including very-low-density lipoproteins [VLDL], intermediate- density lipoproteins [IDL], and remnants, cans also promote atherosclerosis. As such, it is important to study the efficacy and the stability of the drugs uses in the treatment in its pharmaceutical dosage form to achieve the therapeutically goal. In this research we studied the stability of simvastasin in its tablets [5; 20 and 40 mg] by using coating film and we concentrated on the effect of titanium dioxide and iron oxides witch added to the coating film as obscure agents which can aid in the stability of light sensitive active material [simvastatine]. Physical properties of the coated tablets were defined and simvastatine degradation was followed using the method proposed by USP24. The tablets with coated film contains 65 gram of titanium dioxide [for 2000 tablets] and 15 gram of iron oxides [red and yellow] have been showed to be more stable but not sufficiently witch lead us to beginning with 110% o0f label quantity witch gave after 3 years of study sufficient results