Monday, 30 April 2018

Prevalence and Health Impact of Violence Among High School Youth in Vlora City

In recent years, researchers have focused attention on high school youth who are exposed to differents types of violence with serious lifelong consequences. The studies conducted in Albania show that many children suffer needlessly from abuse and neglect. The data related to this phenomenon which have such a high impact on the health and well being, made it necessary for me to evaluate the prevalence and health consequences of the violence on teenagers in the city of Vlora too, in order to develop programs and methods for the prevention and treatment of violence. This descriptive transversal study included 350 teens from 3 high schools in the city of Vlora, one public school and two non public ones randomly selected. A structured and self-administered questionnaire was used for data collection. A p values ≤ 0,05 were accepted as statistically significant. The results showed that the prevalence of the violence on teenagers of Vlora district was 85.7%, with higher result in public schools than non public ones (p=0.0152<0.05). Males result to be more violated than female (p=0.0168). The highest percentage of the violated age was 15-16 years old with 63.3%. The physical violence was found to be present in 46.6% of the cases, psychological violence 20 %, sexual violence 16.7 %, verbale violence in 10%, economical violence 6.7 %. Psychological consequences dominated as health damage from the abuse. 65% of participants were not treated and only 5% had psychological support. The schools and government professionals should work on the awareness of the teens in order to acknowledge the violence, its forms and the wrong concepts of beating or hitting as educative. The health policies for the promotion, prevention and treatment of the violence whenever and where ever it happens.

The World Health Organization defines violence as the use of physical force or real threat power against oneself, against another person, or against a group or community, which either results in or has any chance of resulting in injury, death, psychological harm, development disability, or deprivation. Thus, violent behavior, especially the use of physical violence, is a significant public health problem worldwide because it has serious personal and social consequences. Young victims are more prone to showing symptoms of depression and anxiety, engaging in unhealthy behaviours, such as smoking, alcohol and drug use, or displaying anti-social behaviours and suicidal thoughts. Previous research has shown a high prevalence of violent behavior through physical struggle. Pickett et al. reported that adolescent involvement in fighting in North America and Europe varied among countries, ranging from 37% to 69% for boys and 13% to 32% for girls. 

Youth violence is product of social, cultural, economic and biologic factors. This phenomenon happens in all the European countries. They are one of the causes of health imparity and social inequality, where the groups in disadvantage are in higher risks. Other studies concerning the behaviors of life evaluate as a contributing factor of violence the way parents and children relate, especially when they use violent communication and behavioral forms; when there is little parental control over their children’s school and social life; when adolescents evade from school, relegate their school tasks and have low school performance; when they stay out of the house for long periods and do not notify their parents about their whereabouts in their free time. 

Friday, 27 April 2018

Another Opioid Epidemic Downside: More Heart Infections


Here's yet another outcome of the U.S. opioid emergency: an ascent in genuine heart contaminations in a state hard-hit by the medication plague. Another investigation, done at West Virginia's biggest restorative focus, found that affirmations for endocarditis identified with medicate manhandle dramatically increased in the vicinity of 2008 and 2015. That parallels an expansion in sedate use in the state. Endocarditis is a perilous disease of the heart's inward coating and valves. One way you get it is through utilizing filthy needles to shoot heroin or other infusion drugs. 

In 2015, the specialists found, 66 individuals were admitted to their doctor's facility for endocarditis identified with tranquilize mishandle. That was up from 26 cases in 2008. "Sixty-six cases won't not seem like a major number," said lead analyst Dr. Check Bates. "In any case, these patients are sick, and can invest a long time to a very long time in the healing facility." Bates is executive of cardiovascular research progression at Charleston Area Medical Center in West Virginia - a state intensely influenced by the national opioid scourge. Frequently, the medication mishandle refered to in patients' records was "blended." That is the way the doctor's facility codes opioids - which incorporate solution painkillers like Vicodin (hydrocodone) and OxyContin (oxycodone), and unlawful medications like heroin and illegally made fentanyl, Bates clarified. 

Endocarditis is for the most part treated with intravenous anti-infection agents for two to a month and a half, as per the U.S. National Institutes of Health. Now and again, surgery is additionally expected to repair harmed heart valves, or to help clear the contamination. As indicated by the U.S. Places for Disease Control and Prevention, about 64,000 Americans kicked the bucket of a medication overdose in 2016 - with opioids engaged with 66% of those passings. West Virginia has a portion of the most noteworthy opioid passing rates, and has seen a portion of the biggest increments as of late, the CDC noted. The state has the most noteworthy opioid overdose demise rate among 12-to 25-year-olds - at about 13 passings for each 100,000 individuals, as per Bates and his associates. The scourge is likewise expensive as far as human services, his investigation delineates. The 66 patients treated at the healing facility in 2015 alone aggregated about $4.6 million in doctor's facility charges. 

Be that as it may, the vast majority of the patients were either uninsured or had protection through government programs. So the healing facility was repaid for a small amount of the charges: Over the entire investigation time frame, the analysts say, the clinic charged more than $17 million, with just $3.8 million repaid. Episodically, Bates stated, the patients in this examination took after a run of the mill way. They began with mishandling medicine opioids, and when those medications wound up harder to get they proceeded onward to shoddy, promptly accessible illicit medications like heroin.

Thursday, 26 April 2018

In-Vitro Study on Organic-Inorganic Hybrid Composite of Graphene Oxide-Fe3O4/ Doxorubicin/TiO2 as a Targeted Drug-Delivery System

In our present work, we report a novel targeted drug-delivery system by using a simple and cost-effective procedure. Firstly, magnetic graphene oxide (GO-Fe3 O4 ) was prepared by chemical co-precipitation of Fe3 O4 magnetic nanoparticles on GO platelets and it was used as carrier for loading of doxorubicin (DOX), an anticancer drug. After loading DOX, in order to prevent the premature degradation of drug from GO-Fe3 O4 /DOX composite, it was coated with TiO2 , an inorganic porous coating, by using titanium (IV) butoxide, as precursor. In this way the GO-Fe3 O4 /DOX/TiO2 hybrid composite was synthesized. Then, the drug release of composites were monitored using UV-Vis absorbance technique and the results revealed that incorporation of porous TiO2 coating, enhanced the drug entrapment and decreased the amount of drug release, in which at pH 7.4, 56% and 15% of DOX was released from uncoated and coated composites, respectively. Moreover, after studying the release rate at pH 5.4, corresponds to the endosomal pH of cancer cell, the results showed that drug release is pH-sensitive, because the release rate of DOX in the pH 5.4 noticeably enhanced, compared to pH 7.4. Also, the MTT assays of hybrid composite confirmed its superior responsive to cancer cell lines.

Nowadays cancer is one of the main cause of death in around the world so that, in each year it is responsible for more 13% of death incidence. The World Health Organization in 2015 estimated that 84 million people were died by cancer in the last decade. In addition, GLOBOCAN 2012 reported 14.1 million new cancer per year in the world and estimated that by 2025 this number will raise up to 19.3 million. Currently, four conventional therapeutic strategies for cancer therapy are surgery, radiation, chemotherapy and immunotherapy. Among these, chemotherapy is more common used but it has many disadvantages like high toxicity and side effects of anticancer drugs on healthy cells.

Doxorubicin (DOX) is one of the most commonly used and most effective therapeutic anticancer drugs that has a high potency against of various cancers. In the other hand, DOX like the other anticancer drugs has severe side effects such as gastrointestinal disturbances, nausea, vomiting, hair loss, bonemarrow aplasia and congestive heart failure. As regards to the importance of this matter, there is an urgent need to find the new strategies and materials for targeted drug delivery. In targeted drug delivery systems (TDDSs), suitable carriers can be utilized to protect anticancer drugs from premature degradation in body and also minimize their side effects on normal cells. In this regard, so far a vast range of materials have been used as carrier in TDDSs for cancer therapy, such as polymeric nanoparticlesand vesicles, inorganic materials.

Wednesday, 25 April 2018

Christmas 2016: Needs and the Realities


In this issue, I would like to mention about the main problems, needs and realities for healthcare professionals and especially for surgeons. Surgical residency is a difficult period for physicians and there are lots of problems during this period. Education and practice are the most important parts of surgical residency. When a physician starts the residency period, he/ she wants to be the most capable and active doctor of their branches. Enthusiasm lead physicians for working hard during this period butthey alsoface different type of problems. Several studies were reported in the literature that were indicating the main difficulties of education and social problems. Also lack of standardisation for education is the main problem in most of the European countries and this problem causes lack of confidence at the end of this education period. Surgical residency needs this standardisation so that surgeons would be more confident and capable after they become specialists.

After this education period, unfortunately the problems do not end. Doctors that have become specialists face different type of problem seven they are academic or non-academic. In almost all European countries, lack of academic positions make doctor loose their enthusiasm and interest in academic activities. For non-academics, it is nearly the same. When they start to work in any place of their countries, they face different type of problems. They cannot find enough devices or instruments to show their experience they have gained during their residency period. They do not get enough salaries for satisfaction. In some countries, patients have prejudice for doctors and they do not get satisfied with the health service in hospitals. After a time period, snowflakes are growing bigger and doctors are getting unhappy and reluctant.

In most of the countries, Ministries of Health do not take enough care of doctors and healthcare professionals. Bigger and comprehensive studies must be conducted in order to reveal the problems of these healthcare professionals so they will be happier and more successful doctors even they are residents or specialists.  

Tuesday, 24 April 2018

Fibronectin as an Immunohistochemical Marker for Postmortem Diagnosis of Myocardial Infarction

Acute myocardial infarction is sometimes a diagnostic dilemma in forensic pathology. Our aim is to evaluate the efficacy of fibronectin by immunohistochemical methods for diagnosis of early myocardial infarction in heart autopsies.Three groups of cases selected from autopsied hearts submitted to the pathology department of legal medicine organization of Iran during years 2004-2007 which included 15 cases of definite myocardial infarction (positive control group), 18 cases of noncardiac death (negative control group) and 26 cases suspicious of myocardial infarction based on clinical presentation just before death, presence of marked stenosis in at least one major coronary artery and exclusion of other causes of death (suspicious group). Fibronectin staining was performed on sections prepared from all of the cases. With our proposed cut off value for fibronectin staining the sensitivity and specificity of this marker are 93.3% and 94.4%, respectively. This marker could also support the occurrence of myocardial infarction in 42% of our suspicious cases.We conclude that in spite of usefulness of this marker for detection of myocardial infarction, the results should be interpreted with caution.

Diagnosis of acute myocardial infarction is a challenging issue in forensic pathology. In autopsied hearts macroscopic findings of myocardial infarction accompanied by microscopic confirmation are the gold standards for diagnosis. However, the development of these changes requires time and in real practice we rarely are fortunate enough to see the typical cases. In most instances nothing other than significant narrowing of coronary arteries is found in favor of myocardial infarction. Use of an ancillary method is highly advocated in these situations. Application of triphenyltetrazolium chloride to the fresh myocardium, electron microscopy and some immunohistochemical markers including myoglobin, fatty acid binding protein (FABP), troponin, desmin, fibronectin, fibrinogen, C5b-9 and vascular endothelial growth factor (VEGF) are among many different diagnostic methods which have been used to address this diagnostic dilemma. The electron microscopy is not available in every pathology laboratory and requires comprehensive expertise. The triphenyltetrazolium chloride method requires fresh tissue and a great deal of suspicion at the time of autopsy. The immunohistochemical studies are, however, promising alternatives. The aim of the current study is to evaluate the diagnostic power of one of these immunohistochemical markers, the fibronectin, in suspicious cases of myocardial infarction.

Monday, 23 April 2018

AHA: Infections Could Trigger Stroke in Pregnant Women During Delivery


Pregnant ladies who have a contamination when they enter the doctor's facility for conveyance may be at higher danger of having a stroke amid their stay, as indicated by new research. The investigation, distributed Friday in the diary Stroke, endeavored to decide whether diseases add to stroke hazard amid peripartum, a term meaning in the blink of an eye previously or after labor. The examination, distributed Friday in the diary Stroke, attempted to decide whether contaminations add to stroke hazard amid peripartum, a term meaning without further ado previously or after labor. While maternal strokes are uncommon just around 30 of each 100,000 pregnancies they convey a high rate of casualty. "We needed to understand this since stroke is one of the significant reasons for maternal mortality in this nation," said the investigation's lead creator, Dr. Eliza Miller, a right hand educator of neurology at Columbia University Medical Center. "We needed to check whether contaminations could trigger a stroke in a lady who doesn't have a great deal of hazard factors, in the peripartum period." 

Scientists contemplated information from almost 2.8 million ladies admitted to clinics to conceive an offspring in California, New York and Florida from 2007 to 2011 including 455 patients who endured a stroke amid their remain. Analysts finished up the ladies were 1.74 times more inclined to endure a stroke if, when they were conceded, they had any sort of contamination, including urinary tract, gastrointestinal, respiratory, sexually transmitted, and sepsis, a dangerous disease in the circulation system. Mill operator said the ladies with urinary tract contaminations were 2.56 times as liable to endure a stroke amid their healing center stay, and those with the sepsis were 10.4 times as likely. "What's intriguing about this is the possibility that irritation in the body is some way or another setting off the outcomes," Miller said. "It bodes well that somebody who has sepsis and abnormal amounts of aggravation would have a much higher hazard." 

Dr. Cheryl Bushnell, a neurologist and executive of the Stroke Center at Wake Forest Baptist Medical Center, praised analysts for taking a gander at the association amongst aggravation and stroke among ladies conceiving an offspring. "The connection amongst diseases and stroke has turned out to be increasingly perceived, and this examination brings a more profound jump into irritation as the potential trigger," said Bushnell, who was not engaged with the investigation. "The approach is certainly novel investigating a particular populace." Both Bushnell and Miller called attention to the impediments of the examination, including an absence of a reasonable circumstances and end results relationship. "Observational investigations like these don't really demonstrate anything," Miller said. "However, it's useful for giving us signs to what's happening here and producing thoughts for future research."

Friday, 20 April 2018

Meditation: Different Approaches, Different Benefits


Profound breathing is an extraordinary pressure reliever, and the procedure called care reflection is a useful method to utilize breathing to get more in contact with your internal identity. Individuals who ponder say they feel more positive, and have more vitality and better fixation. There's in excess of one approach to tap contemplation's advantages - through varieties in procedure. An investigation distributed in the diary Mindfulness took a gander at what can be picked up from a couple of well known methodologies. 

Body filter. With body examine contemplation, you center around each body section, each one in turn, from your go to your feet. At the point when combined with centered breathing, contemplate members strongly lessened their number of negative considerations, and musings about the future and the past. Body output can enable you to feel more fixated and concentrated on the "now." Adoring consideration. This sort of contemplation encourages you develop positive affections for a friend or family member and in addition for yourself, your broadened group of friends, and past. This sort of reflection prompted the best lift in members' sentiments of warm, positive musings about others. It can be a decent approach in case you're confronting relational clashes. 

Watching thought. This kind of reflection shows you to perceive and characterize musings - as negative or positive, for example - without getting to be caught up in them. This training helped members turn out to be more mindful of the two musings and judgmental mentalities they held toward others. It additionally can stop rumination - the propensity for drearily going over upsetting circumstances in your psyche. While contemplation when all is said in done can enable you to feel more casual, distinctive writes offer extra advantages. Investigation to discover those that convey you nearer to your own change objectives.

Thursday, 19 April 2018

Infantile Hypophosphatasia in Saudi Child. Case Report

AHypophosphatasia is characterized by low serum alkaline phosphatase (ALP) activity and has a similar radiographic appearance with rickets. There are considerable differences in the severity of the disease. The clinical course of this condition often improves; although early death can occur in the infantile form of the disorder. We experienced one case with severe infantile type of hypophosphatasia.

Hypophosphatasia (HPP) characterized by defective mineralization of bone and dental tissue. The features of this disease include diminished alkaline phosphatase (ALP) activity and increased urinary excretion of Phosphorylethanolamine. This inborn error of metabolism is a rare inherited form of rickets or osteomalacia due to reduced activity of tissue-nonspecific alkaline phosphatase (TNSALP) caused by loss-of-function mutation within the TNSALP gene marked by low serum ALP. HPP is classified into different clinical types with a remarkable range of severity. Perinatal HPP is always fatal from profound skeletal hypomineralization. Infantile HPP presents before six months of age with rickets, failure-to-thrive and hypercalcemia occasionally, craniosynostosis or vitamin B6-responsive seizures as well as respiratory failure associated with progressive chest deformity. Childhood HPP features rickets and loss of deciduous teeth, hypoplasia and myopathy while adult HPP causes osteomalacia.

Autosomal recessive inheritance accounts for severe HPP while autosomal dominant or recessive transmission underlies the mild form. TNSALP replacement therapy is an effective treatment of HPP in infants. The mortality rate of infantile type is 50–100% and patients die due to respiratory infection. We present a case of a 14-month-old girl with the clinical manifestations of rickets, failure to thrive and developmental delay. Hypercalcaemia and low alkaline phosphatase level constitute the main diagnostic laboratory abnormalities if infantile HPP. We aim to share experience.

Wednesday, 18 April 2018

Adolescent Macro-Nutrition and Micro-Nutrition


Adolescence is a crucial position in the life of human beings. Nutritional demand reaches peak in this period. After go through and critically review we found malnutrition rate among adolescent is high. They have both macronutrient and micronutrient deficiency. Behavioral risk factors and peer group pressure have strong influence on food choices. Obvious difference was observed in urban, periurban and rural area. More large scale or depth study can be conducted to get recent picture.

Adolescence is a significant period of life. Actually it is a transitional period from puberty to adulthood. Most of the physical growth occurs in this time period. Healthy and nutritious eating during adolescence is particularly important as body changes during this time affect an individual’s nutritional and dietary needs. Adolescents are becoming more independent and making many food decisions on their own. In urban area they are prone to take fast, junk and energy dense food. Many adolescents experience a growth spurt and an increase in appetite and need healthy foods to meet their growth needs. Adolescents tend to eat more meals away from home than younger children. Peer group pressure is an important determinant of adolescent nutrition. Meal convenience is important to many adolescents and they may be eating too much of the wrong types of food, like soft drinks, fast-food, or processed foods. Also, a common concern of many adolescents is dieting. Girls may feel pressure from peers to be thin and to limit what they eat. This review is an attempt to explore more on adolescent nutrition.

The United Nations’ Sub Committee on Nutrition meeting held in Oslo in 1998 concluded that more data on health and nutrition of school age children are needed to assess their scale of problem. It also believed that the scale of nutritional problems may have been previously under estimated. Traditionally, the main health indicator used by health planners has been mortality rates. Adolescents have the lowest mortality among the different age groups and have therefore received low priority. However, recent studies have shown that the prevalence of malnutrition and anemia is high in these age groups. The recent trend of recognizing adolescent girls as a separate as well as the crucial target group is heartening. Yet, sustained efforts are needed at the national level not only to develop comprehensive and innovative programmes for this segment of our population but also ensure their effective implementation. It is expected that such a holistic approach for the development of adolescent girls will gradually improve their nutritional status as well as enhance their nutrition/health knowledge and social awareness. Equipped with skills for income generation, these girls will be empowered to make decisions regarding themselves and their family, especially the children. 

Tuesday, 17 April 2018

Patients with a Diagnosis of Malignant Cancer First After Tia/Stroke Usually Appear to Have Lower Annual Risk of Stroke/Myocardial Infarction Events Compared to Patients Without Cancer Diagnosis. A 25-Year Follow-Up Hospital-Based Observational Study

Cancer can increase the risk of stroke due to multiple causes especially during the first 3-6 months after diagnosis for lung, pancreatic, colorectal, breast, prostate cancers or with diagnosed cancer in the nervous system or leukaemia. The occurrence of metastasis is associated with an increased risk of haemorrhagic/ischaemic stroke. In patients with cancer in the nervous system, colon, rectum, urinary bladder or leukaemia, an increased risk of ischemic stroke has been found even during long-term observation as for women with breast cancer. Radiotherapy has been reported to be a risk factor for stroke as well as for myocardial infarction (MI), whereas treatment with tamoxifen has been reported to increase the risk of stroke but to decrease the risk of MI. 

Charturwedi et al. declared that the identified ischaemic strokes among cancer patients were low and that the rate of recurrent ischaemic events, which occurred in 6% of cancer patients during a mean observation of 9 months, was not higher than the results from different stroke studies reported. However, in a Chinese stroke study past cancer was shown by Cox regression analysis to be a predictor of recurrent stroke as well as cardiovascular mortality during longterm follow-up. The main purposes of this retrospective study were to determine whether patients admitted due to transient ischaemic attack (TIA) or different subgroups of stroke with a diagnosis of malignant cancer (International Classification of Disease (ICD), ICD-10: C00-C97) either before and/or after admission had different risks of recurrent stroke and MI annually compared to patients without cancer.

This study consists of a cohort of 549 patients who had been hospitalized in the Stroke Unit or on the general ward of the Department of Neurology, University Hospital Link√∂ping in 1986 and retro/prospectively followed up until Feb. 2011. The definitions of risk factors have been reported previously. Cause of death was based on the underlying cause, defined by the World Health Organization (WHO) as the disorder that began the chain of events leading to death. Data about types of cancer were obtained from the Swedish Cancer Registry established in 1958 and with data to 2010, with permission from the National Board of Health and Welfare, Stockholm, Sweden as well from journals and autopsy reports. Patients with basal cell carcinoma were not included in this report because basal cell carcinoma was not included in the Swedish Cancer Registry until 2004. Stage of cancer or cancer treatment was not reported. 

Monday, 16 April 2018

Negative Fateful Life Events Linked to Advanced Brain Aging


Negative decisive life occasions (FLEs) in midlife are related with cutting edge anticipated cerebrum maturing, as indicated by an investigation distributed in the July issue of Neurobiology of Aging. 

Sean N. Hatton, Ph.D., from the University of California in San Diego, and partners inspected whether negative midlife FLEs are related with cutting edge mind maturing subsequent to controlling for physical, mental, and way of life factors in a companion of 359 men (mean age, 62 years) taking an interest in the Vietnam Era twin investigation of maturing. Members were surveyed for negative FLEs, wellbeing and prosperity, general subjective capacity, financial status, sorrow, and ethnicity at two diverse time focuses. Members experienced attractive reverberation imaging, and T1-weighted pictures were prepared. To foresee mind age, neuroanatomical estimations were gone into the Brain-Age Regression Analysis and Computation Utility programming. 

The analysts watched a connection for having more midlife FLEs, particularly identifying with relational connections, with cutting edge anticipated cerebrum maturing. After they controlled for the noteworthy covariates of liquor utilization, cardiovascular hazard, grown-up financial status, and ethnicity, the connection held on. 

"People who had more elevated amounts of significant life occasions hinted at cutting edge anticipated cerebrum maturing," the writers compose. "It stays to be resolved whether the impact of midlife FLEs and different factors on cerebrum age may change with expanding ordered age."

Friday, 13 April 2018

Diabetes Mellitus: Beyond the Triopathy

When diabetes mellitus comes into question, the most common thing that strikes the mind of a physician is triopathy, cardiovascular status and secondary infections due to the immunosupressive state. Attention also needs to be paid to the examination of the oral cavity, auditory, complete ophthalmic, skin, pulmonary, gastrointestinal and muscular system in such patients, so that the work up of a diabetic patient becomes complete in all its aspects. A few noteworthy manifestations are discussed below.

An elevated blood glucose level is associated with dysfunction, damage and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels. The five classic complications associated with diabetes mellitus (DM) include retinopathy, neuropathy, nephropathy, cardiovascular complications (coronary arterial disease, stroke and peripheral vascular disease) and delayed wound healing. Periodontal disease has recently been recognized as the “sixth complication” of DM. Oral involvement is in the form of periodontal disease, dental caries, fissured tongue, irritation fibroma, traumatic ulcers, lichen planus, recurrent aphthous stomatitis, xerostomia and burning mouth syndrome. Taste impairment has also been associated with the development of obesity and it has been reported during the course of diabetes.

Besides the diabetic retinopathy changes known to occur in DM, other significant ocular findings may be in the form of anterior ischemic optic neuropathy, diabetic papillopathy, cranial nerve palsy, ocular ischemic syndrome, retinal vein occlusion, retinal artery occlusion, glaucoma, dry eye and hence a complete ocular workup is mandatory. Diabetic retinopathy changes in pregnancy need a special mention. In patients who had nonproliferative diabetic retinopathy, studies demonstrated that as many as 50% of them may show an increase in their nonproliferative retinopathy during pregnancy. Approximately 5-20 % of these patients develop proliferative changes.

Thursday, 12 April 2018

Optimism/Pessimism and Its Relationship with Locus of Control Among Children and Adolescents

The aim of this study was to examine the gender and developmental period differences in optimism-pessimism and locus of control. Additionally, it aimed to assess the correlation between optimism-pessimism and subscale of locus of control (internal, external, and unknown). The sample consisted (340) participants of school students (165 boys and 125 girls) enrolled randomly, from primary and preparatory schools located in Aleppo city. The participants aged between 10 to 15 years (M= 12.4 male, 12.8 female).The participants completed two measures: 1-Optimism-Pessimism Scale (OPS) 2- Connell’s locus of Control Scale for Children (CLCS-C). Findings of the study revealed that, the external locus of control were higher among girls than among boys, while no significant differences had been found in internal and unknown locus of control. Aon the other hand, finding showed that, there was significant gender differences for optimism. Boys were found to be more optimistic than girls were. Regarding the correlation between optimism-pessimism and subscale of locus of control, there was significant and positive correlation between optimism and Internal control. Additionally between pessimism and external control on one hand, and between pessimism and unknown locus control on the other hand. Furthermore, it has been found a negative and significant correlation between pessimism and internal control and between optimism and unknown locus of control.

The personality of a child depends upon several factors including family composition, home environment, socialization, childhood experiences, education, socio-economic status, parents’ occupations etc. Family influences on personality development are highly significant as parent child relationship, parenting, emotional climate of home; size and type of family determine the process of development during childhood years. (Kokkinos, & Logginidou, 2005). The relation a child has with parents and other family members is one of the most important factors in personality development as family provides physical safety, economic support, social and emotional security (Rigby, 1993, Massachusetts, 2000, Batabyal, A. & Nijkamp, P 2017).

Optimism, pessimism and locus of control have been shown to be pervasive and important attributes of human thought and expression. Optimism has been shown to mitigate the effects of stressors on psychological functioning. Dispositional optimists (who hold generalized positive outcome expectancies) have shown less mood disturbance in response to a number of different stressors, including adaptation to school and college, (Yates, (2000). Optimism has also been associated with better physical and mental health. (Lennings, 2000). Recent years have witnessed substantial progress in understanding the contribution of psychosocial factors to physical and psychological health. One such factor, optimism, or the expectation of positive outcomes, has been tied to better physical health and more successful coping with health challenges (Ismail, A. (2001). However, the routes by which optimism might be associated with better health have not received systematic investigation.  

Wednesday, 11 April 2018

Prevention of Cerebral Palsy Caused By Intrapartum Fetal Brain Damage with Novel Hypoxia Index

 Late deceleration (LD) was known to relate to ominous outcome. However, even 3 connected LDs resulted in vigorous neonate. A possible contradiction were there to be elucidated. An early delivery may not prevent cerebral palsy after the loss of fetal heart rate (FHR) variability, as it is the sign of fetal brain damage. Thus, the vicious signs should be predicted before arriving disaster.

Some recommendations were proposed; early delivery in the loss of FHR acceleration or repeated decelerations, however, there was no description concerning the number of decelerations. Taking these into account, all of late, early, variable decelerations and sudden acute continuous FHR bradycardia were studied using novel hypoxia Index (HI), which was the sum of duration (min) of decelerations divided by the lowest FHR (bpm), and multiplied by 100. Among cases with HI values 25 and 26 developed the loss of FHR variability followed by fetal brain damage and cerebral palsy, while cases with HI 20-24 in abnormal FHR developed neither loss of variability nor cerebral palsy.. The preceded study thus suggested a feasibility of early delivery when HI was increasing in the level below 25.

The HI of 3 LDs was 6 and its neonate was vigorous, while HI was 26 in the loss of variability and infantile brain damage in repeated LDs in 50 min, where the discrepancy of LD was solved by the HI. Also, the HI was 25 in the loss of variability followed by cerebral palsy, while there was neither loss of variability nor cerebral palsy in cases HI being 20-24. 

The threshold of HI was 25 to develop the loss of variability followed by fetal brain damage and cerebral palsy. An early delivery is recommended, when the HI is increasing in the level below 25, thus, the HI is verified to incorporate in the soft wear of computerized FHR monitoring.

Tuesday, 10 April 2018

Percutaneous Closure of Adult Atrial Septal Defects in Adults: Short- and Medium- Term Results

Atrial septal defect (ASD) is the third most common form of congenital heart defects. Controversy still exists regarding its closure in patients > 40 years-old. Few data exist on symptomatic relief and echographic parameters improvement gained after ASD closure in patients over 40 years of age. Aim: Analyze the efficacy and safety of the percutaneous closure technique in a community of adults aged over 40 years-old with (ASD) eligible for percutaneous closure. 

This is a retrospective study that included patients aged over 40 years-old who had percutaneous ASD closure between 2005 and 2013 at the cardiology department of Sahloul university hospital. Follow-up at 24 hours, 7days, 6 months, and yearly included physical examination, electrocardiogram and transthoracic echocardiography; furthermore, telephone interviews were conducted to determine clinical symptomatic status.

There were 27 patients with a mean age of 47 years (from 40 to 65); 7 were aged more than 60 years-old. There were 23 women. 24 patients had clinically significant symptoms due to their ASDs, including dyspnea (22), palpitations (10), fatigue (6), chest pain (10), and dizziness (2). 3 patients reported no symptoms prior to ASD closure. The mean size of ASD as measured by transesophageal echocardiography was 26,43mm ±6, 8 (from 12 mm to 38 mm). The mean pulmonary artery pressure (PAP) was 42, 95 mmHg ± 8, 04. The mean right ventricle diameter was 40, 6 mm ± 3, 3 (35mm, maximum = 45mm). A total of 26 patients had successful defect closure, in one patient, this could not be done due to unusual anatomy of left atrium. The Amplatzer device was used in 25 patients. The mean device size used for all patients was 27, 82 ± 6, 63 mm. There were no major complications. Symptomatic improvement was observed: 20 patients became asymptomatic. At 1year post procedure, the right ventricle diameter showed a statistically significant decrease 34 - + 6 mm (P < 0,001).

This study provided further evidence that transcatheter device closure of ASDs in adults over the age of 40 years is safe, effective, and results in symptomatic relief and regression of pulmonary pression and right ventricle size. Thus, we suggest that percutaneous closure of ASDs in adult patients greater than 40 years of age should be the first option of management.

Monday, 9 April 2018

Myocarditis Rare Side Effect of Immune Checkpoint Inhibitors


Myocarditis in patients treated with safe checkpoint inhibitors (ICIs) might be more typical than already thought, as indicated by an examination distributed online March 19 in the Journal of the American College of Cardiology. Syed S. Mahmood, M.D., M.P.H., from the New York-Presbyterian Hospital in New York City, and partners utilized information from an eight-site registry of 35 patients with ICI-related myocarditis (November 2013 to July 2017). Restorative records were utilized to comprehend the introduction and clinical course of ICI-related myocarditis. 

The specialists found that the pervasiveness of myocarditis was 1.14 percent, with a middle time of beginning of 34 days in the wake of beginning ICIs. Case qualities incorporated a normal age of 65 years, 29 percent female, and 54 percent had no other insusceptible related reactions. Mix ICI (P < 0.001) and diabetes (P = 0.01) were more typical in cases, contrasted with controls. Major unfavorable cardiovascular occasions (MACE) created in 46 percent of patients more than 102 days of middle development. The danger of MACE was lifted four-overlay with troponin T ≥1.5 ng/mL (risk proportion 4.0; P = 0.003). 

"Myocarditis after ICI treatment might be more typical than acknowledged, happens ahead of schedule subsequent to beginning treatment, has a dangerous course, and reacts to higher steroid measurements," the writers compose. A few creators uncovered money related connections to the pharmaceutical business.

Thursday, 5 April 2018

Massive Gastric Submucosal Hematoma: An Unusual Complication After Diagnostic Gastroscopy

A previously healthy 81-year-old man was admitted to our hospital with weakness and fatigue caused by anemia. Laboratory studies were notable for a red-cell count of 1,580,000 per ml, a hemoglobin level of 4.8 g per deciliter, and hematocrit level of 15.1 %. Emergency endoscopic examination revealed an active gastric ulcer.

Two days later, mild epigastric tenderness was present. Computed tomography of the abdomen revealed hepatic portal venous gas and massive gastric submucosal hematoma.

however, there was no evidence of perforation. Four days after conservative treatment, on follow-up computed tomography, neither gastric submucosal hematoma nor hepatic portal venous gas was observed (Panel C). Recovery was uneventful and the patient was well discharged on the 20th hospital day.   

Wednesday, 4 April 2018

Radiation Oncology Missing in Medical School Education


Few scholastic subsidiary radiation oncology (RO) offices report association with formal instructing of medicinal understudies, as indicated by an investigation distributed as of late in the Journal of the American College of Radiology. Malcolm D. Mattes, M.D., from West Virginia University in Morgantown, and associates overviewed chairpersons and residency program executives at RO offices straightforwardly partnered with a medicinal school (49 of 75) keeping in mind the end goal to see all the manners by which radiation oncologists are engaged with therapeutic understudy training, barring elective clerkships. 

The scientists found that 40.8 percent of divisions revealed that no less than one employee takes an interest in a curricular instructive session on an oncology-related subject. Employees from 42.9 percent of divisions are included with sorted out clinical shadowing or preceptorship programs for first-and second-year medicinal understudies. About one out of four divisions detailed no inclusion in the formal educational module at their nearby or partnered medicinal school. 

"Announced novel ways to deal with instructing included advancement of multidisciplinary clerkships or instructive sessions that incorporate RO ideas, visitor addresses on RO amid a required clerkship, composed extracurricular encounters, for example, an oncology course arrangement, investment in extraordinary medicinal understudy improvement projects, and sponsorship or start of a RO premium gathering," the writers compose.

Tuesday, 3 April 2018

A Case of Post-Lyme Disease Syndrome (PLDS) Involving Motor Neuropathy and Myositis

A 53-year-old man presented with bilateral foot drop. His lower-extremity weakness predominantly affected the distal right limb. He presented hypercreatine kinasemia and high antibody titer for Borrelia species (spp). The nerve conduction study and needle electromyography suggested active neurogenic findings, indicating motor neuropathy. The gastrocnemius muscle biopsy showed scattered fiber necrosis and inflammatory cell infiltration, representing myositis. After administration of minocycline, Borrelia spp antibodies became negative. Symptoms gradually improved with repeated intravenous immunoglobulin administration. This is a very rare case of post-Lyme disease syndrome involving motor neuropathy and myositis, which represents an immune-mediated reaction to Borrelia spp infection.

Post-Lyme disease syndrome (PLDS) is characterized by chronic physical weariness, muscle pain, and neurological deficits, such as paresthesia and memory disturbance, after treatment with antibiotics. The diagnosis of chronic Lyme disease can predominantly be classified into four categories. PLDS is defined as a group of subjective symptoms such as paresthesia and memory disturbance that persist despite proper treatment of Borrelia burgdorferi infection. However, the pathogenesis of PLDS remains unknown. Some reports have described cases of PLDS associated with myositis and neuropathy. Thus,, patients with other conditions may be included. However, we provide the first report of chronic motor axonal neuropathy and myositis without acute symptoms of Lyme disease in a patient with PLDS.

A 53-year-old agricultural teacher who traveled frequently both overseas and domestically presented with bilateral foot drop. He had a history of hepatitis B and dengue fever infections. As his job involves teaching agriculture to the local people, he frequently went on walks in the forest, while wearing short pants, that is, with large areas of exposed skin. He visited many countries, including Sri Lanka and Pakistan. He had also visited many regions in Japan, particularly in Nagano and Hokkaido prefectures. Thus, his risk of exposure to tick bites was very high. He reported that he often felt feverish, but the fevers were not severe. He did not have other notable symptoms. 

Monday, 2 April 2018

Percutaneous Closure of Adult Atrial Septal Defects in Adults: Short- and MediumTerm Results

Patients aged 40 years and older with an ASD with a percutaneous closure indication. Indications for closure were: an important left to right shunt (signs of right ventricular overload) regardless of the presence of symptoms, patients with severe pulmonary vascular disease (pulmonary resistances > 5 units Wood), after a vaso-reactivity test or after a targeted treatment. Were not considered for the percutaneous closure, patients with a septal defect diameter exceeding 38 mm (on transesophageal echocardiography (TEE)) or after using a calibration balloon) and those with inadequate morphology (insufficient shorelines, Multiple defects, complex aneurysm, association of other important lesions).

Complete transthoracic echocardiography (TTE), including M mode, 2D, continuous, pulsed colour Doppler were performed prior to surgery and on each follow-up visit. TEE was routinely performed in all patients proposed for percutaneous closure in order to evaluate the ASD morphology and exclude additional lesions, such as pulmonary venous return abnormality. The right ventricle size was studied by measuring its diastolic diameter on the parasternal long axis view (RVTDD), and systolic pulmonary arterial pressure (SPAP) was estimated from the tricuspid regurgitation rate. The ratio of flow rates (Qp/ Qs) was obtained by measuring the time-velocity, as well as the diameters of the pulmonary artery and the left ventricular ejection pathway.

An invasive assessment was performed before surgery when the SPAP estimated in ultrasound was greater than 50% of the systemic pressure or 60 mmHg. In these patients, pulmonary vascular resistance (PVR) had been carefully evaluated. Only patients with PVR ≤ 5 units Wood -either spontaneously or after a vaso-reactivity test with nitrogen monoxide-were considered for the ASD percutaneous closure. In patients with left atrial pressure greater than 15 mmHg during invasive assessment, ASD balloon occlusion was performed and pressure measurement was repeated. In patients with an increased left atrial pressure of more than 10 mm Hg, treatment of heart failure was initiated prior to ASD closure to reduce after surgery left heart failure risk.