Introduction: The duration of orthodontic treatment is one of the issues patients complain about most, especially adult patients which maybe the reason beyond many refusals of undergoing orthodontic treatment [1]. To shorten orthodontic tooth movement times, various attempts have been made local or systemic administration of medicines, [2-5] mechanical or physical stimulation, [6,7] and oral surgery, including gingival fiberotomy, [8] alveolar surgery, [9] and distraction osteogenesis [1]. In 1959, Köle described a surgical procedure involved a radicular corticotomy and supraapical osteotomy. This was accomplished by creating blocks of bone with vertical buccal and lingual corticotomies and a supraapical horizontal osteotomy connecting cut to enable rapid movement of the dentoalveolar process [10,11]. Suya believed that a corticotomy was able to make tooth movement faster because of the simultaneous movement of the tooth and the surrounding bone block [12]. Wilcko et al. in a series of case reports [10,13] mentioned that rapid orthodontics with corticotomies could increase tooth movement by increasing bone turnover, decreasing bone density [14,15] and decreasing hyalinization of the periodontal ligament [1]. Frost found a direct correlation between the severity of bone corticotomy and/or osteotomy and the magnitude of the healing response, leading to accelerated bone turnover at the surgical site. This was called “Regional Acceleratory Phenomenon” (RAP). RAP was explained as a temporary stage of localized soft and hardtissue remodeling that resulted in rebuilding of the injured sites to a normal state through recruitment of osteoclasts and osteoblasts via local intercellular mediator mechanisms involving precursors [16]. Bogoch found a five-fold increase in bone turnover in a long bone adjacent to a corticotomy surgery site. In alveolar bone adjacent to corticotomy, there is a marked increase in regional bone turnover due to activation of new remodeling. Calcium is released from alveolar bone creating a reversible demineralized condition (alveolar osteopenia) resulting in a decrease in bone mass (mineral content or density) but no change in bone volume [17]. According to Hajji, the active orthodontic treatment times in patients with corticotomies were 3 to 4 times shorter compared to those of patients without corticotomies [18]. According to Al Naoum et al. Tooth movement velocities following corticotomies were 2-4 times faster on the experimental side than on the control side particularly during the early stage after corticotomy [19]. Nowzari et al. stated in their case report, using a modified surgical approach and limiting the corticotomy to the buccal and labial aspects, that the PAOO was an effective treatment approach in adults in decreasing treatment duration and in reducing the risk of root resorption. Final lateral cephalometric analysis showed proclination of the upper and the lower anterior teeth [20]. Aljhani and Zawawi [21] applied the combined non-extraction orthodontic treatment with the corticotomy technique in an adult patient, 25 years old, with severely crowded dental arches to accelerate tooth movement and shorten the treatment time. Buccal and lingual corticotomies with alveolar augmentation procedure in the maxilla and the mandible were performed. The total treatment time was 8 months with no adverse effects observed at the end of active treatment. The addition of the decortication procedure to the conventional orthodontic therapy decreased the duration of treatment significantly. Compared with traditional orthodontic treatment, the PAOO procedure that combines the advantages of corticotomy-facilitated orthodontics and periodontal alveolar augmentation offers the advantage of achieving the desired results in a significantly reduced treatment duration.
Total Quality Management (TQM) plays an important role in any company or facility as the implementation of this program will enable companies to continually improve their performance. Thus, organizations will be able to significantly meet the needs of their internal and external clients in terms of quality of services and products and will also be able to develop an efficient and profitable business. Total quality management (TQM) is a major determinant of efficient resource management within any organization. It is only hospitals that have adopted TQM methods that will thrive in this period, where hospitals provide the same type of services. The study evaluated management preparedness to implement TQM at Primary Health Centre’s. Center from the perceptive perception of health staff. Methods: This analysis was a systematic, cross sectional study. Structured questionnaires were used to gather information on the demographic characteristics of the centers' randomly selected workers and their performance in five main areas: organizational, Interpersonal, Economic, Facilities and Economic factors. Focus group dialogue by chosen workers was also used. Results: The study showed that the impact of educational influences on response level had no effect on personnel understanding but affected staff productivity, sufficient monitoring, support system and computerized database service. Number of years of work has an impact on the provision of adequate resources, the efficiency of infrastructure and the computerized database system.TQM has been shown to have improved resource efficiency with the attendant output maximization. It is critical that management show commitment and provide an atmosphere supporting its sustainability. Management should specifically institute periodic performance measurement systems and reinforce the hospital training program. In updating existing TQM guidelines, there is a need to raise awareness of the concept and develop methods and procedures.Quality management has become an important issue in healthcare organizations (hospitals) during the last couple of decades. The increased attention to quality is due to governmental regulations, influence of customers, and hospital management initiatives. Apparently, there are many difficulties in managing healthcare organizations in a competitive marketplace with a little support from official bodies especially in a developing country like India. The purpose of this paper is to provide a framework for implementing the total quality management concept that is compatible with the local culture of India. The SERVQUAL model and its application can help the healthcare facility in achieving satisfaction on both ends - employees’ satisfaction and customer satisfaction. In healthcare organizations, the traditional Indian culture, leadership style, and the mentality of the medical professionals are somehow the barriers to the adoption of the TQM. The suggested integrated framework model of the TQM can be of great help to the healthcare organizations to move out of the barriers and successfully implementing TQM concepts and practices. Quality management has become an important issue in healthcare organizations (hospitals) during the last couple of decades. The increased attention to quality is due to governmental regulations, influence of customers, and hospital management initiatives. So, the role of government as the main provider of healthcare (HC) services has changed. Additionally, the healthcare market is changing from a producer-oriented to a customer-oriented market due to the increasing influence of customers and public pressures. As a consequence, the patient is becoming a customer for the healthcare organizations, or more likely a direct strategic partner who participates in a decision making process. The changes in environment, society, and political policies have significant impacts on management in hospitals as well. There are many difficulties in managing healthcare organizations in a competitive marketplace with a little support from official bodies especially in a developing country like India. The evolution of concepts such as TQM and Six Sigma has only added to the repertoire of the word. TQM ‘Total Quality Management’ is practised widely at different organizations and Hospitals are no exception to this.
The Academicians and HR practitioners have discussed about TQM ‘Total Quality Management’ as a new concept that had its roots in the Japanese management style. Zandin (2001) mentions that TQM helps improve the quality of services and goods through a collaborative approach and standardized performance. Whyte and Witcher (1992) explain TQM as an approach with a holistic perspective on Total, Quality and Management. Total, because TQM takes input from every department and individual; Quality, because TQM helps attain standard on customer service and end-user satisfaction; Management, because TQM brings to fore innovative new forms and practices on Management. The researchers do seem to explain Total Quality Management as a management philosophy to achieve Excellence on Business.
The purpose of this paper is to provide a framework for implementing the total quality management concept that is compatible with the local culture of India. The study verifies that the proposed framework model provides an unbiased, perspective and comprehensive view of hospital reality that can human and other resources, patients, activities to organizational units
Understanding the science of safety and the core principles of high reliability are first steps in creating a true culture of safety wherein human factor can contribute in the improvement in healthcare delivery. In the world of healthcare, very little training in human factors is provided to staff, unlike the other safety-critical industries. Human factors research examines the environmental, organizational and job factor of human interacting with the system as well as physiological and psychological characteristics that influence behavior at work. Principle of safety science is a commitment to zero harm. Understanding and implementing the best practices can build high reliability organizations a roadmap to achieve exemplary clinical outcome. Topics highlighting several key safety principles including Just Culture, Professional bodies in healthcare organization, a range of human factors such as managerial, team and individual characteristics that influence the behavior of healthcare staff in relation to safe patient care and framework to demonstrate the role of human factors in patient safety and are known to reduce patient harm and improve the safety and quality of patient care. Best practices performed consistently over time have demonstrated superlative outcomes. Developing a model which demonstrated consistent application of leader rounding; hourly purposeful rounding and bedside shift report can influence how patient safety can be possibly achieved. A commitment to zero harm and application of best clinical and safety practices are critical steps in developing a culture of safety in healthcare organizations contributed significantly in reduction of patient harm a compelling reason for nurses in all healthcare settings to embrace safety science and the principles of high reliability.
In the world of healthcare, next to no preparation in human elements is given to staff, not at all like the other security basic ventures. In the United States more than 440,000 people kick the bucket every year because of preventable medical clinic mistakes. However human services keeps on falling behind other exceptionally complex associations, for example, the avionics and atomic businesses in generally speaking wellbeing rehearses. Understanding the study of security and the center standards of high dependability are initial phases in making a genuine culture of wellbeing wherein human factor can contribute in the improvement in medicinal services conveyance just as the accomplishment of phenomenal patient consideration conveyance result. Tolerant security is a worldwide test that requires information and aptitudes in numerous regions, including human variables and frameworks building. Some consideration settings or care circumstances are especially inclined to perils, blunders and framework disappointments. For example, in escalated care units (ICUs), patients are powerless, their consideration is mind boggling and includes different trains and shifted wellsprings of data and various exercises are acted in tolerant consideration; these variables add to improving the probability and effect of clinical mistakes. Social insurance associations must make and encourage a situation where security will turn into a top need.
Approach to Human Factors and Ergonomics:
As referred to in WHO report (2009) human factors generally connected near Ergonomics which is the use of logical data concerning people to the structure of articles, frameworks and condition for human use. In a work setting, human components look into inspects the ecological hierarchical and occupation factor of human interfacing with the framework just as physiological and mental qualities that impact conduct at work. Rule of wellbeing science is a pledge to zero damage. Understanding and executing best practices that can assemble high dependability associations and critically supporting those practices, is a guide to accomplishing model clinical results. There are a few key security standards including simply culture, proficient bodies in medicinal services association, a scope of human factors, for example, administrative, group and individual attributes that impact the conduct of social insurance staff comparable to safe patient consideration and structure to show the job of human factors in understanding wellbeing and are known to diminish quiet damage and improve the security and nature of patient consideration.
Implementation Approach
A high reliability framework provides the structure needed for organizations to achieve desired safety and quality goals. Best practices performed consistently over time have demonstrated superlative outcomes. A hospital can develop a model which demonstrates that consistent application of leader rounding; hourly purposeful rounding and bedside shift report can influence how patient safety can be possibly achieved as well as a model to demonstrate the role of human factor in patient safety. Human factors consider three domains of system design: physical, cognitive and organizational. The physical domain focuses on how the human body and physical activity interacts with work design, for example, the layout of computer desks. The cognitive domain focuses on how mental processes interact with other elements of systems. This includes memory, information processing and decision making. The organizational domain focuses on how individuals and teams interact with tools and technologies. According to scientists, human factors approaches can be used to design systems that support health care providers to deliver safe patient care at the same time as reducing work injuries and improving the quality of people’s working life. Taking a human factors approach means that when safety incidents occur, it is important to have a non-punitive culture. Instead of blaming individuals for events, the systems approach focuses on building systems to reduce potential risks and prevent future error, building system defenses to reduce the likelihood of errors resulting in patient harm.
A systems approach is essential and it is human systems which are the critical factor in leading to unsustainability, and potentially can be changed to enable transition towards sustainability. Sociotechnical systems are systems with a human element and there is particular knowledge accumulated about them that is useful in design which produced a model of the organizational, human and technical components of sociotechnical system.
Ruxandra Ioana Aschenbrenner and Angela Sanda Tudo
Introduction: Asthma is a disease which consists from a chronic inflammation of the airways followed by a bronchial hyper-reactivity and a reversible airway obstruction. About 10 percent of the population suffer from this disease, it can develop at any age but the most of the pediatric cases emerge before the age of 10 yrs. Treatments proposed by the Traditional Chinese Medicine can help the patients to have a better management of the disease and overall an increase in the quality of life.A condition where an individual's aviation routes become kindled, thin and swell and produce additional bodily fluid, which makes it hard to relax. Asthma can be minor or it can meddle with every day exerfcises. Now and again, it might prompt a perilous assault. Asthma may cause trouble breathing, chest torment, hack and wheezing. The side effects may here and there erupt. Asthma can ordinarily be made do with salvage inhalers to treat indications (salbutamol) and controller inhalers that forestall manifestations (steroids). Extreme cases may require longer-acting inhalers that keep the aviation routes open (formoterol, salmeterol, tiotropium), just as inhalant steroids.Asthma is an incessant condition that influences the aviation routes. It causes wheezing and can make it difficult to relax. A few triggers incorporate introduction to an allergen or aggravation, infections, work out, passionate pressure, and different variables. Asthma causes within dividers of the aviation routes, or the bronchial cylinders, to get swollen and aggravated. During an asthma assault, the aviation routes will grow, the muscles around them will fix, and it gets hard for air to move all through the lungs. Around 7.9% of individuals in the United States had asthma in 2017. There are numerous sorts of asthma, and a few components can cause asthma or trigger an intense assault.
Asthma is a constant lung issue that can make breathing troublesome. It highlights limited, kindled aviation routes (bronchial cylinders). "Asthma" is an antiquated Greek word signifying "short breath," and as the name suggests, it can leave you heaving for air. One of the indications of an asthma assaults is wheezing with trouble relaxing. Other asthma indications incorporate chest snugness, hacking, and brevity of breath. At the point when the breathing containers of the lungs become incessantly kindled, they can get touchy to breathed in ecological allergens and aggravations that can trigger asthma. These ecological triggers incorporate dust, contamination, and tobacco smoke. Exercise can likewise be an asthma trigger for a few. Others have extreme recalcitrant asthma. In these cases, the asthma doesn't react to treatment — even with high doses of prescription or the right utilization of inhalers. This kind of asthma may influence 3.6% of individuals with the condition, as indicated by one 2015 examination
Eosinophilic asthma is another sort of asthma that, in extreme cases, may not react to the standard drugs. Albeit a few people with eosinophilic asthma make do with standard asthma prescriptions, others may profit by explicit "biologic" treatments. One sort of biologic prescription diminishes the quantities of eosinophils, which are a kind of platelet engaged with an unfavorably susceptible response that can trigger asthma.Asthma is a respiratory issue of the lungs. Asthma influences typical breathing; routine physical exercises become troublesome or unthinkable for an asthma quiet. Asthma can be perilous if legitimate treatment is deferred. Because of elements, for example, expanding contamination, respiratory maladies, for example, asthma are getting alarmingly common. The World Health Organization assesses that India has around 20 million asthma patients. Asthma likewise strikes kids normally matured between 5 to 11. During breath, the air that we take in experiences the nose, throat and into the lungs. Asthma happens when the aviation routes to the lungs grow and fix the encompassing muscles. This makes bodily fluid square the aviation routes which further hinders the gracefully of oxygen to the lungs. The outcome is the asthma assault of hacking, and so forth Purpose: The purpose of this study is to establish an intercultural link between western and Traditional Chinese Medicine for prophylaxis and treatment of pediatric asthma .
Methods: A case report of an 8 years old male patient, who presented asthma with more then one exacerbation per week since 2018. He reacted well to bronchodilator medication but due to recurring manifestation his doctor recommended a TCM consult for secondary prophylaxis. The consult revealed a Wind-Heat syndrome and because the young age of the patient, the parents were open to begin the TCM treatment .
Results: By adding acupuncture sessions, dietary counseling and more water intake to equilibrate his energy levels the patient was able to control his condition.
Conclusion: In TCM the invasion of Wind-Heat blocks the descending of the Lung’s Qi (Qi is the vital energy of the body) and causes wheezing and thoracic oppression. The aim of the TCM doctor is to eliminate the Wind and the Heat, Clarify the Lung’s heat and unblock the descending of the Lung’s Qi in order to stop the wheezing.
Keywords: Asthma, Traditional Chinese Medicine, Diet, Prophylaxis, Intercultural
Background: Role of upfront chemotherapy in locally advanced rectal cancer invading into adjacent structures has not yet been defined. Beside risk of local failure, this entity has high risk for distant metastasis as well.
Patients and methods: Patients with newly diagnosed T4b non-metastatic rectal cancer treated between January 2011 and December 2017 were retrospectively reviewed from a single institution. Primary end point was R0 resection rate.
Results: Thirty eight out of 41 patients were eligible for our study. Median age: 52.5 years (range 29-77). Twenty were males (52.6%). Median distance from anal verge: 6 cm (1.8-15). Median follow up: 28 (20.5-52.2) and 41 months (26.2-63.7) in entire population and R0 resected group, respectively. Oxaliplatin- and irinotecan-based doublet chemotherapy was administered in 35 (92.1%) and 3(7.9%), respectively, (median 7 cycles). All 24 resected patients had R0 resection (63.1%). All resected patients except one case with ulcerative colitis received fluoropyrimidine-based chemoradiation prior to surgery (median radiation dose: 5040 cGY). Standard TME surgery was carried out in 10 patients (26.3%), extended TME surgery was done in 8 patients (21 %), Six patients required pelvic exenteration (15.7%). Complete pathological response was reported in 3 patients (12.5%). Although 17 patients (70.8%) had advanced cN2 disease, 21(87.5%) patients turned to be ypN negative. Three-year progression- free and overall survival in entire population were 52.2% and 78.6%, respectively. For R0 resected group, these figures were 82.2% and 100 %. Distant metastasis rate and and local failure rate in R0 resected group were 4.1 % and 8.3%, respectively.
Conclusions: Induction chemotherapy approach appears promising strategy in this setting. Compared to limited historical control data, we achieved similar R0 resection rate but by far we noted a substantial reduction in distant metastasis rate in resected group. As such this strategy warrants further prospective evaluation in clinical trials.
Statement of the Problem: Inpatient falls are recognized to be amongst the maximum difficult adverse activities suggested in hospitals, frequently prolonging and complicating medical institution stays. In the US, among 700,000 and a million patients fall in hospitals each year, main to an average of 6 extra hospitalization days, wherein the value of treatment for fall accidents amounts to $13000. Observational studies: It shows that 60–70% of all falls inside the health center occur from the mattress or bedside chair. The modern nation of art mentions sitters, mattress rails, and fall danger assessment questionnaires, alongside some of technological answers. In spite of giant research, modern-day solutions are not cost green or scalable, with fall hazard evaluation protocols implemented inconsistently. Philips addresses the state of art obstacles with a generation offering faraway supervision of more than one patient simultaneously. The system receives input simultaneously from a digital camera and/or a biosensor, and assesses the fall threat of sufferers by detecting in actual-time a number of dangers factors recognized to precede and make contributions to a mattress fall incident: affected person restlessness, risky posture and position within the mattress space. Based on the assessed fall threat, the device issues a notification to a remote sitter approximately sufferers at threat, allowing timely preventative interventions. Results of a laboratory take a look at on 112 tests imply that the machine triggers a notification of average 23 seconds in advance of affected person bed go out/fall events. The PPV values of the risk factors detected are 0.975 (restlessness), 0.924 (risky posture), 0.826 (hazardous position). The gadget additionally detects bed falls and exit events (PPV = 1.0) Conclusion & Significance: We have supplied a generation for remote supervision of a couple of patients in parallel, enabling powerful, fee-green, scalable offerings for inpatient fall prediction and prevention.
This work is presented at 3rd International Conference on e-Health and Alternative Healthcare Innovations (E-HEALTH – 2020 Webinar) on October 12-13, 2020
Introduction
An increased awareness is being positioned on inpatient falls. The motives for this are a couple of including related morbidity and mortality, increased price of care, and shortage of compensation from the payors. The World Health Organization defines a fall as “inadvertently coming to relaxation on the ground, floor, or other decrease level, aside from intentional exchange in position.”1 Significantly, even as having been mentioned in among 2% and 12% of admissions, those events are found to purpose damage in as much as 40% of the patients. In addition to the actual personal price, the financial impact associated with these falls are of consequence, associated with an growth in medical institution prices and longer duration of stay. Given the preventable nature of lots of those events, scrutiny by payors has followed. The Centers for Medicare and Medicaid Services have indexed falls as a “never” occasion and therefore do no longer reimburse hospitals for prices associated with the take care of an inpatient fall.
The nature of falls and their occurrence in sufferers with neurologic admissions will inevitably have an effect on the neuro hospitalist, offering a fantastic opportunity for involvement in hazard reduction. Patients with neurological weakness with or without a clouded sensorium are clearly at risk of falls. In addition, assessing sufferers with potentially big head injuries after a fall may additionally properly contain the neuro hospitalist by means of nature in their presence and strong point interest. Beyond the scientific care of the individual affected person, however, falls may be addressed systematically. The result is the capacity to enhance the care of the whole medical institution populace and to broaden or improve the infrastructure necessary to do so for other medical situations or activities.
In this 2-part series, we are able to first check the risk stratification tools which can be available, and then outline the scope of the problem and capacity solutions via a review of the literature. The 2d article will gift a guide to implementing a excellent development undertaking around sanatorium falls. Although particular to falls in the hospitalized affected person, the aim is to provide a stepwise technique which is extensively applicable.
Another key point to keep in mind is that fall prevention alone cannot be the goal of a fall prevention software. A theoretical example can illustrate this point. In theory, we could save you all falls by means of restraining all sufferers, thereby stopping them from leaving the. But restraining sufferers might be unethical and represent negative care. It could battle with the standards of patient autonomy and cause all the complications of mattress rest, consisting of deconditioning, pressure ulcers, aspiration, and deep vein thrombosis, thereby maintaining the affected person in the health facility longer and making it harder for the affected person to recover.
Methods
A literature searches the use of PubMed database changed into accomplished for articles published prior to January 21, 2012 regarding in hospital fall prevention programs. No time restrict was set. Combinations of the words unintended falls (MESH), patient falls, in hospital falls, hospitals, hospitalization (MESH), acute care, prevention, intervention, economics, threat management, and adult had been used. The Cochrane library was searched using the phrase “health facility fall interventions.” References from blanketed articles and reviews had been used to finish the search. The search was used to perceive articles approximately predicting falls and interventions to lessen falls. A evaluation of all abstracts eliminated articles regarding falls in outpatient settings, children, and letters. For studies regarding interventions, research that have been not randomized had been excluded.
Conclusion
We described the effect of falls on hospitalized sufferers in addition to potentially powerful interventions. One can be tempted to transport immediately to intervene as soon as a problem is suspected. In order to effect real change, however, a true great development initiative should be undertaken. This type of paintings is principal to neurohospitalist practice, and part of what may additionally distinguish a neurohospitalist from a neurologist who sees inpatients. Traditional neurology residency applications may touch on these processes, but nice improvement education more normally occurs afterward, if at all.
The aid mission remains to boost the health and prosperity outcomes for patients. Achieving that focus should replicate capabilities to satisfy patient wants despite matters of physicians, caregivers, elaborate diagnostic instrumentality or hospitals. These capabilities square measure notably required for caring for patients in locations remote from larger, a lot of urban populations, representing a lot of progressive instrumentality and specialists for diagnosis and shaping interventions. And best care reaches balanced, integrated outcomes for clinical, money and potency improvement, all with the most effective access and outcomes for patients. Distance capabilities need inter-location communication to connect remote and concrete clinicians, the net being the foremost possible inside the twenty first century. Telemedicine, with data exchange and visual interactions, needs instrumentality in place, and clinical professionals sharpened for causation data, interacting with specialists and diagnostic instrumentality inside a lot of inhabited areas. Capable professionals with spare instrumentality collect initial diagnostic data offer data at the patient location and thus the information-enabled practitioner interactions offer best care: Telemedicine. samples of telemedicine successes shared embrace physiological state, through Labor and Delivery, through postnatal care, all together with mother, foetus and newborn. conjointly Stroke care, group action data from remote pre-event patient records, through Stroke, through care, follow-up and care thenceforth. Another example includes ideal medication choice and dosing. particularly for medical specialty patients, once more reflective full data from patient history gathered at the remote patient and practitioner location. every is proof by clinical, price and potency metrics. each example of telemedicine illustrates the helpful impact accomplished through inter-location data sharing, remote and urban-based clinical professionals optimizing diagnoses, interpretations and best-care determinations. every endeavor should prove best modelling as quantified by outcomes metrics for clinical, money and potency metrics. every should conjointly replicate evidence-based best take care of patients in terms of medical edges and access to stress.
Abstract:
Background:
Obesity is considered as a complex and multifactorial disease mainly attributable to risk factors of genetic, behavioral, socioeconomic, and environmental origins,among them, the association and causative role played by breast feeding , which has been shown to attenuate obesity risk.
Objectives:
We aimed to evaluate state of the link of overweight and obesity with the types of feeding they were utilizing in the first six month of life.
Patients and materials:
The study designed as prospective cohort study, the work has been reported in line with the STROCSS criteria, (24), was conducted over a period of seven years from 1st mays 2012 to 30th April 2019, including 1020 of the total of 1564 overweight and obese patients, All the patients were consulted single bariatric surgeon in two centers Hatwan Private Hospital and Bariatric Unite in Sulaimani teaching hospital-Sulaimani governorate-Kurdistan region-Iraq.
The patients were arranged in 2 groups:
1. Group A: 725 overweight or obese patients, who were exclusively breast-fed
2. Group B: 295 overweight or obese patients, who were exclusively bottle-fed
All the collected data were collected, organized and analyzed with Statistical Package for the Social Sciences (SPSS) version 21. Chi-square test adjusted for clinical characteristics were assessed at the conventional 0.05 level of significance, considering any P value ≤ 0.05 as statistically significant.
Results:
About three quarter of the patients with overweight and obesity were bottle-fed (m=725, 71.08%), females were more prevalent in this group (B), the female to male ratio was 1.33/1. The most common age for bottle feeding were (20-29) and (30-39) years, in another words bottle feeding was present only in those patients aged less than 39 years, while those patients aging more than 40 years (40-59 years of age) were exclusively breast-fed.
Regarding the bottle-fed patients (group B), three hundred thirty six (81.16%) female patients, were recalling the type of feeding, versus 209 (67.20%) of the male breast-fed patients. Regarding parents, mothers (n=119, 16.41%) were outnumbering fathers (n=43, 05.94) in recalling the period of infancy and type of feeding.
Conclusion:
Bottle feeding may have significant link with future risk of overweight and obesity Most of the overweight and patients with obesity who were bottle fed, also were below the age of 40 years. Which coincidental with the entry of bottle, breast-milk substitute to the area, after 1981, and more mothers were started to work outdoors, and Social and Audiovisual Media were encouraging factors for mire bottle feeding.
Abstract
The study of anthropometry defines the sweetness of the torso from a geometrical perspective. Anthropometry therefore aids the cosmetic surgeon in planning the reshaping of the torso and also makes positioning of areolae and therefore the umbilicus easier. When performing surgery on the breast, it's necessary to relate the breast to the torso as an entire, being anthropometry perfect for this process. When the anthropometric proportions are respected, the result is aesthetically optimal, and the perceived beauty of the body is enhanced. The study of anthropometry is widespread within the artistic field, and that i have chosen the work of sculptor, Carlo Rochet, because the basis for my very own use of anthropometry during plastic surgery.
Introduction
The study of anthropometry defines the sweetness of the torso from a geometrical perspective. Anthropometry therefore aids the cosmetic surgeon in planning the reshaping of the torso.
For example, when performing surgery on the breast, it's necessary to relate the breast to the torso as an entire, through the appliance of anthropometry. When the anthropometric proportions are respected, the result is aesthetically optimal and the perceived beauty of the body is enhanced. This anthropometric approach also makes positioning of areolae and the umbilicus very easy.
A rich source of anthropometric studies can be found in the art world. Artists are often involved in the portrayal of beauty and they have developed techniques for determining and describing such. This process goes at least as far back as Leonardo da Vinci.
As the basis for my very own practise, I even have found nineteenth century sculptor, Carlo Rochet’s book, Le Leggi Naturali Delle Proportion (‘The Natural Laws of Proportion’) a superb source, and some of his illustrations, somewhat modified, are herein presented. In this article, i will be able to focus specifically on the appliance of anthropometry when performing cosmetic surgery on the torso.
Methods
In order to apply the anthropometry of the torso, I have gone back to the anthropometric studies of the nineteenth century sculptor Carlo Rochet. The anthropometric underpinnings of beauty are well-known to artists, as they need to breed it in their works. I have been using Rochet’s anthropometric studies because the start line for all my cosmetic surgery procedures.
Carlo Rochet’s scale (Fig. 1) divides the torso, the head, the upper limbs and the lower limbs into four equal sections, each representing the same proportions. When these anthropometric proportions are respected, we have an ‘ideal’ body contour.
Clearly, as plastic surgeons, we cannot choose the size of our patients as a sculptor like Rochet can. However, we should always understand this objective geometrical analysis of beauty to assist us improves, as far as possible, the body’s contours. Turning now to the torso itself, the correct proportions are achieved by dividing the space between the lower jaw and the inner thigh radix into thirds
• First, we measure the position of the lower jaw and the inner thigh radix.
• Finally, we divide the space into three equal sections.
Positioning the areolae
When performing plastic surgery on the breast, it is necessary to consider the torso as a whole, using anthropometry. The proportions are considered correct when the height of the head is equal to the distance between:
•The lower jaw and the nipples (section A)
•And between the nipples and the umbilicus (section B)
By applying this anthropometric technique, the remodelled breasts will have the correct anthropometric proportions, enhancing the beauty of the patient.
Positioning the umbilicus
The umbilicus is positioned using a similar technique to the areolae. The torso is divided into four equal sections by transverse lines:
1.Top of the head to the chin
2.Chin to nipples
3.Nipples to umbilicus
4.Umbilicus to inner thigh radix
With this information, we can now look at how to apply the anthropometric procedures in practise.
Discussion
Artists and sculptors have been applying the principles of anthropometry for centuries, from the time of da Vinci to the modern day. Familiarity with the principles of anthropometry and its relationship with beauty mean we can use anthropometry as an objective tool during our procedures.For my own practise, I have been relying on the work of the sculptor Carlo Rochet, whose book on anthropometry, The Natural Laws of Proportion, was published in Italy in the late 1800s and is now in the public domain. This book provided some of the images used in this article and is the basis of my application of anthropometry to my aesthetic and plastic surgery procedures.
The modified measuring stick, a very simple tool, allows us to measure the patient and calculate the correct positioning of the areolae and umbilicus so as to maintain the correct anthropometric proportions. When remodelling the torso, we should apply anthropometry to ensure correct positioning of the areola and the umbilicus. The breast and umbilicus are part of the torso and have an anthropometric relationship: the rule of thirds. Each time this anthropometric rule is met, we obtain an aesthetically optimal result.
Body proportions can vary greatly, so this anthropometric approach should be seen as a guideline. It is not applicable to all cases, such as unusually long or short torsos. However, in most cases, these rules can help reduce the effects of flawed anthropometric proportions.
Perhaps the most important aspect is that the application of anthropometric principles offers a strongly objective method for determining the correct proportions for our patients. While superficial concepts of beauty may have changed, the underlying anthropometric proportions have been very stable over time. Statues created a thousand years ago show the same anthropometric proportions applied back then just as they do today.
Noura M Alhassani and Moosa Abuzayda
A perfect smile improves the self-confidence, personality; social life and psychology by improving self-image with enhanced self-esteem of the patient. While not every person is born with a perfect and attractive smile, qualities such as straightness, cleanliness or whiteness of teeth may come to mind. Thanks to developments in the field of cosmetic dentistry, people can change the smile they were born with into a smile they love. Several treatment modalities have been proposed to restore the aesthetic appearance of the dentition such as chemical bleaching or full crowns which was considered the most predictable and durable aesthetic correction of anterior teeth. However, this approach is undoubtedly most invasive with substantial removal of large amounts of sound tooth substance and possible adverse effects on pulp and periodontal tissues. Smiles can be improved by veneering teeth using a relatively conservative technique. The appearance of veneers and smile design has not been previously investigated in the UAE. This study aimed to assess the aesthetic preferences of different smile designs rated by a group of prosthodontics residents and specialists.
A questionnaire was devised asking about demographic details such as age and gender of the participant, educational country as well as clinical experience before and after graduation. Images of ten cases that had ceramic veneers fitted on their anterior teeth were included in the questionnaires. There were two images for each case: smiling with lips shown and close-up with retracted lips and cheeks. Each case had 7 questions and the respondents were asked to evaluate and compare the dental aesthetics patterns of porcelain laminate veneer for each case. Each question had a 5 point Likert rating scale from poor to excellent. Images of veneers were taken from patients treated in Ministry of Health Centers in UAE and private dental clinics in Sharjah and Dubai. All patients were over 18 years old and had a minimum of two and up to a maximum of ten porcelain laminate veneers in the maxillary and/or mandibular anterior region placed more than 6 months previously. Patients were not included if any of the following conditions were present, teeth indicated for restoration (for example with a crown) and the presence of advanced dental caries. A questionnaire was distributed among 25 clinicians, they were selected from UAE recognized Specialists in prosthodontics and prosthodontics residents from Hamdan Bin Mohamed College of Dental Medicine. The specialists were recruited from the DHA/ MOH/CPQ database. The participants were therefore not a random sample but a convenience sample and not representative of the residents or specialist prosthodontics’ in Dubai or in the UAE. A Total of 10 Cases Were Evaluated by Each Clinician. The Different Clinical Situations Were as Follows: Figure 1: A, case1, Gummy smile with visible lower teeth; B, case2, Flat incisal plane not following the lower lip line; C, case3, Square teeth with flat incisal plane; D, case4, Half-crwns visible; E, case5, Midline discrepancy, case6, Incisal plane following lower lip line; B, case7, Good incisal curvature following the lower lip line with very white teeth; C, case8, visible papillae following the lower lip curvature and no contact with lower lip; D, case9, Long teeth contacting the lower lip; E, case10, Gingivitis The participants evaluated the appearance of the patient smile, veneer shape, contour and shade, the length/width ratio of the teeth, the relationship of incisal edges to the lower lip, the relationship of the soft tissue around the teeth and the tooth display and lip position when smiling.
A Total of 10 Cases Were Evaluated by Each Clinician. The Different Clinical Situations Were as Follows:
Acute febrile illnesses consistent with malaria are the most common presentation at health clinics in sub-Saharan Africa, accounting for 30–50% of outpatient visits. The symptoms of acute human immunodeficiency virus (HIV) infection can mimic acute malaria. Therefore it is necessary to evaluate patients presenting with malaria symptoms for HIV infection. Similarly, in order to ascertain the burden of HIV-2 in Nigeria, prevalence of HIV-1/HIV-2 co-infection was also evaluated among the cohort of febrile patients attending selected health centers in Lagos. Cross-sectional study of 310 patients referred for malaria blood smears at each of four government health centers namely: Lagos Island general hospital, Shomolu health center, Orile Agege general hospital and Randle general hospital, Surulere were screened for HIV. The cohorts were 108 (34.8%) males and 202 (65.2%) females, patients ranged in age from 1 to 84 years. HIV rapid antigen testing was performed on plasma samples of the febrile patients using a combination of Determine and Unigold kits. Tests were performed serially and confirmed by a third rapid diagnostic kit (SD-Bioline) that differentiates into HIV-1, HIV-2 or HIV-1/HIV-2. Of the 310 patients evaluated, 9 (2.90%) had test results indicating HIV-1 infection, out of which 5(55.5%) were females and 4(44.4%) were males. There was no HIV-2 and neither was there any HIV-1/HIV-2 co-infection detected in this study. These findings provide insights into a major opportunity for expanding recognition of early HIV infection in Nigeria. At multiple sites in Lagos, Nigeria, 1–3% of patients with suspected malaria had HIV infection. anti-env reactivities and a discrimination assay positive only for HIV-2; the two remaining sera (from patients C and F) showed typical dual reactivities for HIV-1 and HIV-2 infections, with positive patterns of HIV-1 and HIV-2 Western blots and a discrimination test positive for both viruses. As a whole, six (4.1%) of 147 HIV-positive sera showed either HIV-2 infection alone (n = 4) or dual reactivity. Of those, four were from Gabonese patients B, C, D, and E, and two were from immigrants from West Africa (patient A from Mali and patient F from Nigeria); two were female patients B and E. Among Gabonese patients, only one (patient E) had traveled to West Africa; the remaining three had never visited any neighboring country. However, one Gabonese man (patient C) lived in Port-Gentil, which has many West African immigrants. For all patients, the most likely risk factor for HIV was a heterosexual relationship with an unknown HIV-infected person. In three asymptomatic patients (A, B, and C) the HIV-2– serostatus was unexpected; in contrast, the three other patients had AIDS-related symptoms. Patients D and E had an HIV-2 Western blot pattern showing a marked decrease in anti-gag and pol reactivities compatible with their advanced stage of HIV-2 disease. The case of a 55-year-old exclusively heterosexual asymptomatic woman (patient B) suggests the possibility of a specific variant of HIV-2 in Central Africa (2). The high frequency in primates in Gabon of natural infection with simian immunodeficiency retroviruses, which show a high degree of genetic relatedness to HIV-2 (3), could support such a hypothesis. Two patients had typical dual reactivities to HIV-1 and HIV-2 antigens. To our knowledge, such dual reactivities have never been reported in Gabon (4). In the patient from Nigeria (patient F), the serologic pattern was typical of that usually observed in West Africa (5). Dual reactivity can result from genuine mixed infections and from serologic cross-reactivity in HIV-1 and HIV-2 infection alone; theoretically, it could also represent infection with a different, cross-reacting recombinant strain (5). HIV-2 infection in Gabon is epidemiologically related to West Africa, because of cultural and, above all, economic ties. However, HIV-2 is not limited to immigrant populations from West Africa or to Gabonese citizens traveling in this area; it has also reached the indigenous Gabonese time. A seroepidemiologic study was performed to determine whether the increase in cases was due to an increase in incidence or to an improvement in diagnosis. All paired samples of sera (acute-phase and convalescent-phase) from patients sent to the arbovirus laboratory for diagnosis of dengue infection from January 1, 1992, to December 31, 1996, were tested for antibodies to C. burnetii by immunofluorescence. All positive samples were also tested for immunoglobulin (IgM) by the same method; the IgG and IgM titers were determined by using a serial twofold dilution. A diagnosis of Q fever was made when there was a seroconversion from negative to positive or a twofold increase in IgG titer associated with the presence of IgM in the second sample. One hundred and fifty-one of 426 paired sera collected between 1992 and 1996 were from patients recently infected with dengue fever. Twenty-five (9.1%) of 275 remaining sera were from Q fever patients. Significant differences were observed in the rates of Q fever in different years (p < 0.01); one (1.9%) of 53 was positive in 1992, five (9.1%) of 55 in 1993, five (8.6%) of 58 in 1994, three (4.8%) of 63 in 1995; a large increase was observed in 1996 (11 [23.9%] of 46). Differences by residence were also assessed. Rates of infection were higher in Cayenne (21 [13.0%] of 161) than in rural areas (4 [3.5%] of 114) (p < 0.01). This study shows that cases of Q fever have occurred in French Guiana in recent years and that a significant increase in the incidence rate occurred in 1996. The reasons for this increase are unclear, and further studies of the epidemiology of Q fever in French Guiana are necessary. The epidemiology of Q fever is unusual in French Guiana because the rates of infection are much higher in Cayenne, the capital city, than in rural areas. No link with classical sources of infection (cattle, sheep, or goat birth products, or work in a slaughterhouse) was found. Indeed, Cayenne, with 80,000 inhabitants, is located near the Atlantic Ocean, and the prevailing winds blow from the sea. Airborne contamination from rural areas is therefore impossible. Furthermore, no large farm is in the immediate vicinity of the city. For identical reasons, contamination from the abattoirs is not likely; they are located on the west side of the city, near the Cayenne River, and the winds blow from the east. In our study, cases were almost equally distributed 
Evaluation of HIV-1/HIV-2 coinfection in febrile patients visiting health centers
Liver cancer is cancer that occurs in the liver. The liver is the largest glandular organ in the body and performs various critical functions to keep the body free of toxins and harmful substances. It’s located in the right upper quadrant of the abdomen, right below the ribs. The liver is responsible for producing bile, which is a substance that helps you digest fats, vitamins, and other nutrients. This vital organ also stores nutrients such as glucose, so that you remain nourished at times when you’re not eating. It also breaks down medications and toxins. When cancer develops in the liver, it destroys liver cells and interferes with the ability of the liver to function normally.
Liver cancer is generally classified as primary or secondary. Primary liver cancer begins in the cells of the liver. Secondary liver cancer develops when cancer cells from another organ spread to the liver. Unlike other cells in the body, cancer cells can break away from the primary site, or where the cancer began. The cells travel to other areas of the body through the bloodstream or the lymphatic system. Cancer cells eventually collect in another body organ and begin to grow there.
Causes of Liver Cancer
Primary liver cancer (hepatocellular carcinoma) tends to occur in livers damaged by birth defects, alcohol abuse, or chronic infection with diseases such as hepatitis B and C, hemochromatosis (a hereditary disease associated with too much iron in the liver), and cirrhosis. More than half of all people diagnosed with primary liver cancer have cirrhosis -- a scarring condition of the liver commonly caused by alcohol abuse. Hepatitis B and C and hemochromatosis can cause permanent damage and liver failure. Liver cancer may also be linked to obesity and fatty liver disease.
The vast majority who get liver malignancy (hepatic malignant growth) get it in the setting of interminable liver malady. Frequency paces of hepatocellular malignancy are ascending in the United States because of expanding pervasiveness of cirrhosis brought about by incessant hepatitis C and nonalcoholic greasy liver ailment. There are numerous treatment choices for liver malignancy. The treatment picked relies on how much the disease has spread and the general soundness of the liver and the general wellbeing of the patient. The sort of doctor that treats liver malignant growth is a master called an oncologist, an inward medication specialist with a board affirmation in oncology .The liver is the biggest organ inside the body and is situated under the correct ribs and underneath the correct lung. The liver has a few capacities. It secretes bile into the digestion tracts to ingest fats, separates and stores supplements, makes thickening variables expected to quit dying, and separates poisonous operators, similar to liquor and medications. When the poisonous operators are separated, they can be disposed of from the body through pee or stool. One of the reasons for cirrhosis, the scarring of the liver, is liquor addiction. An individual can't live without a liver, so liver shut down or liver disappointment is lethal.
Hepatitis is an aggravation of the liver, which can advance to scarring (fibrosis) or liver malignancy. Hepatitis can be brought about by harmful substances, contamination, or immune system illnesses. Normal infections that cause hepatitis are alluded to as types A, B, C, D, and E. It's conceivable to forestall hepatitis with an antibody accessible for types A, B, and E Liver malignant growth causes no side effects of its own. As the tumor develops, it might cause manifestations of agony in the correct side of the mid-region or feeling excessively full subsequent to eating a bit. A few patients may have exacerbating of side effects of incessant liver sickness or cirrhosis, which regularly goes before the improvement of malignancy of the liver. For instance, patients may grumble of
Dr. Haider Ali Muslim AL Rahmahi
Background:
Gynecomastia (GM) is benign enlargement of male beast (glandular enlargement with fat accumulation we classify in 6 grade depend on size and shape of breast .all cases was treated surgically as combine of gland excision and liposuction and added new method HH (Haider and Husam )method which is specific for grade 5 and 6 GM .
Methods: From 2013to 2018, a chart review was performed for 300 patients. Preoperative examination included endocrine and urological examination and exclusion of other pathological conditions. The surgical technique consisted of liposuction through small incision in lateral side of breast ,combine with gland excision by sub areolar incision and sometime HH method depend on grade of gynecomastia.
Results:
Total number of patient 300 cases all of them under want combination of liposuction and gland excision with drain keep for about 8 hours .
Recurrent rate very rare and complication like infection or areolar necrosis also rare and 9 case only suffering from early postoperative bleeding and 22 case develop seroma within 2 weeks.
Conclusions:
This analysis data that include treatment of GM grade 1-6 is performed by liposuction combined with subcutaneous resection of the glandular tissue by sub areolar incision the procedure had low rate of complications and excellent patients satisfaction about the result. Preoperative fellow up is important to rule out and prevent specific complication of procedure and to exclude diseases or malignancy causing the GM as all gland sent to histopathology
Vinegar has been adopted as favoring dating from around 3000 BC in Asian, European and other traditional cuisines of the world .As evidences accumulated, vinegar was proved to exhibit therapeutic properties, including blood pressure reduction , antioxidant activity , antibacterial activity , reduction in the effects of diabetes and prevention of cardiovascular disease . It is also used as a kind of accessory documented in Lei’s treatise on processing of drugs (LeigongpaozhiLun) (618–907 AD). Numerous Chinese medicines such as Frankincense, Rhizoma Corydalis were believed to enhance the promoting blood circulation therapeutic efficiency after preparation by vinegar . Fruitful researches have been carried on the herbal enhancement of therapeutic efficiency after processing ,but there are few relative reports concerning the blood circulation bioactivity of vinegar Vinegar accumulate an overwhelming variety of metabolites that play nondeductible roles in health benefit. During recent years, many studies employed GC–MS technique for quality control and determination of vinegar. Alcohols, organic acids, amino acids, carbohydrates, esters and various micro-constituents were proved to present in vinegar [8]. The previous results showed that the contents of most conventional ingredients (organic acids, free amino acids, carbohydrates) were increased during aging process. Tetramethylpyrazine (TMPZ), a kind of alkaloid metabolites yielding during aging process of vinegar, was used in clinical trials since the 1970s [9]. Reports indicate that TMPZ reduces arterial resistance and increases coronary and cerebral blood flow . A number of alkaloid metabolites are developed as clinical drugs found to have significant biological activities (e.g berberine and paclitaxel) . Hence variation of alkaloid metabolites should not be overlooked for their exhibit notable function properties.
Rice vinegar (RV) and white vinegar (WV) as daily favoring, have also used as accessory in traditional Chinese medicine processing. As we know, the promoting blood circulation efficiency could be enhanced when herbs processed by vinegar. Number of reports focused on health benefits derived by consumption of vinegar. However, few concerned the blood circulation bioactivity.
In this paper, a metabolomics guided strategy was proposed to elaborate on the chemical constituents’ variation of two kinds of vinegar. GC–MS coupled with multivariate statistical analysis were conducted to analyze the chemical components in RV and WV and discriminate these two kinds of vinegar. The anti-platelet activities in vitro were investigated by whole blood aggregometry platelet test. And the anticoagulant activities were monitored by the whole blood viscosity, plasma viscosity, packed cell volume, prothrombin time, and four coagulation tests (PT, TT, APTT, FIB) in vivo .Results were found by keen observation of GC–MS conditions Chromatographic parameters such as column type, carrier gas flow, temperature rate, and ion source temperature were adjusted to be able to obtain the best separation for the compounds. The Rxi-50 capillary column obtained the best separation. The carrier gas at flow rate of 1.0 mL/min and the 250 °C ion source temperature were proved to be the most suitable. Established chromatographic conditions and mass spectra conditions are listed in “Gas chromatography–mass spectrometry analysis’’. Metabolic profiles of RV and WV Five batches of WV and RV with aging time of 1, 4, 5, 7, 14, 20, 30 months were analyzed. Representative GC– MS fingerprints are presented in Fig. 1. A total of 53 compounds were detected, including different kinds of alcohol, organic acids, amino acids, aldehydes, phenols, ketones, heterocyclic, which were same as those reported in literatures [1, 20]. PCA and OPLS-DA were utilized to classify the metabolic phenotypes and identify the differentiating metabolites. A PCA score plot for first and second principal components was utilized to depict the general variation among the samples of two dosage forms (R2 X = 0.78, Q2 = 0.987).
Objective To report the results of a systematic review of national eHealth policies of different countries in relation to patient consent in patient data processing in electronic health records Method eHealth policies of 19 (14.07%) countries are reviewed with regard to patient consent, from a total of 135 countries that are indexed in the World Health Organization Directory of eHealth Policies. 68 (50.37%) policies were excluded based on language and 67 policies in English were selected for further consideration. These 67 (49.62%) policies were further evaluated resulting in exclusion of 43 (31.85%) policies due to policies being outdated and 5 (3.70%) due to broken links. Finally, a total of 19 (14.07%) countries were selected for the review. Results 57.89% out of 19 countries require patients’ informed consent to store patient data, 26.32% allow selective storage of patient data as defined by the patient, 89.47% require patients’ informed consent when sharing or transferring or accessing patient data, 68.42% of the countries allow patients access their own EHR, 73.68% facilitate correction/modification in EHR, and 26.32% facilitate deletion of patient records. 89.47% of countries highlight mechanisms to assure privacy and security of EHR. Conclusion Policymakers’ emphasis on various ethical concerns raised by EHRs has been increased highlighting patient rights related to eHealth as well as the requirement for compliance to different standards and regulations. eHealth policies must address requiring patients’ informed consent in processing of patient data whereas patients have the ability to grant or withhold consent to different processing operations related to their EHR. Furthermore, facilitating patients with access to their own records, facilitating patients with modification, correction and deletion of EHR are widely discussed topics.The questions on consent referred to an individual's electronic health record, which was described in the survey as ‘computer records with complete and detailed health information’. Although the removal of name and address might not ensure anonymity, we used these measures here as being most relevant to conceptions of personal identity, to denote the difference between identifiable and de-identified records. By mentioning that these identifiers would be removed, we also refer to situations were these would not be visible by, for example, researchers performing database queries. Additional questions captured socio-demographic characteristics and other personal information (birth year, sex, ethnicity, highest educational qualification attained, confidence with computers), as well as patterns of personal healthcare use (types of health services accessed in the six months before the survey). Only respondents who provided complete data across all independent and dependent variables of interest were included in the final sample (N = 3157). We examined the frequencies of the missing values and used Pearson's Chi-squared test to establish whether differences existed between the analysis sample and the missing sample in the socio-demographic factors, and the distribution of responses on the three questions of interest. Using logistic regression we determined whether certain factors were associated with an individual's inclusion in the final analysis sample. Descriptive statistics were used to summarise the characteristics of respondents included in the survey sample, and to examine the distribution of responses on the three questions of interest. We examined bivariate associations between the three outcome variables, and between each of the outcome questions and the independent variables, using Pearson's Chi-squared test. Using a multivariate regression model, the associations between each of two outcome questions (consent for de-identified EHRs use and awareness of EHRs) and the socio-demographics and healthcare use were analysed, adjusting the regression analysis for potential clustering at each of the recruitment sites. As a theoretically important consideration, prior awareness of EHRs was also included as an independent variable in the multivariate model for consent preferences. Each regression model was assessed using Hosmer-Lemeshow's goodness of fit test, specifying a grouping of 10. We reported all results at the 95% significance level, and performed the analysis using Stata IC version 11. Full details of the study protocol and the original survey questionnaire have been published elsewhere [49]. In relation to public and patient views on consent options for data sharing, this study illustrates that the majority of respondents (91%) would expect to be explicitly asked for consent before their identifiable EHR is accessed, regardless of the reason for access—including for use by healthcare professionals. When sharing de-identified records (name and address removed), fewer participants (51%) said they would expect explicit consent to be sought before data sharing for care, research and healthcare planning. Socio-demographic factors and personal characteristics were further associated with consent preferences. Respondents who identified themselves as belonging to an ethnic group other than ‘White British’, or who were less confident with computers, and those with lower educational qualifications were more likely to expect to be asked for explicit consent before their de-identified records were accessed. In terms of awareness of EHRs, many participants reported having heard of EHRs before taking part in the survey. However, a sizable minority (41%) reported not being aware of EHRs. Older respondents were more likely to have heard of integrated records. Individuals who identified themselves as belonging to non-White British ethnic groups were less likely to report being aware of EHRs. Those with lower educational qualifications and those reporting less confidence in using computers were also less likely to report having heard of EHRs. Participants who had interacted more with health services seemed to be more exposed to information about EHRs, and the NHS was the second most frequent source of information. Awareness of EHRs was associated with a greater likelihood of reporting acceptance of implicit consent as a model to govern de-identified health information sharing. As participants reported not being aware of EHRs before the survey, some could have been formulating their views at the time of completing the questionnaire. Responses might have also depended.
Informed Consent For Patient Data Processing In Electronic Health Records
Aim: Influence of H. pylori infection on HbA1c levels, how importance to eradicate the Infection and control the glucose levels
Objectives: An early discovery of the changes in blood glucose help to prevent or delay the of development of type 2 diabetes and complications. H. Pylori treatment could have an important role in improving insulin resistance.
Hypothesis
We performed a research literature of the PubMed, Cochrane Library, and Chinese BioMedicine. Web Base and Chinese Science and Technology Journals databases databases for studies of the Influence of H pylori infection on HbA1c levels from the last 10 years. This study focuses on.
Methodology
The data from this study are taken from PubMed, Cochrane Library, and Chinese BioMedicine databases for studies of the Influence of H pylori infection on HbA1c levels from the last 10 years. We selected 5 studies that included 2456 Patients.
Introduction
Helicobacter pylori is a microaerophilic bacterium that is commonly found in patients with gastrointestinal disorders. It is present in approximately one half of the world's population. The most of the people who are infected have no symptoms however Helicobacter pylori is capable of causing some digestive problems such as Abdominal Pain (mild to severe), Belching and Gastric reflux, Mild nausea, Irritable Bowel Syndrome, Bloating and distension, Constant bad breath, Hypochlorhydria. Most commonly associated with Peptic Ulcer Disease (PUD) is responsible for the development of 70% of Gastric and 80 to 95% of Duodenal Ulcers, that can may lead to the development of Cancers (Traci L Testerman 2014). Helicobacter pylori were found high percentage in the polluted well water, contaminated food, faeces, Dental plaque/saliva (Popescu D et al. 2017). Transmission through unclean water person to person, faecal-oral by poor hygiene not properly washing hands after using the toilets, oral-oral by kissing or gastro-oral. This continues to cause inflammation in mononuclear cells that stimulate an initial inflammatory effect, which can lead to duodenal and stomach ulcer. H. Pylori and diabetes mellitus can increase gastrointestinal problems such as dyspepsia, etc. worsening the blood glucose levels and metabolic control by decrease levels of immunity increase risk of H. pylori infections. Diabetes mellitus is a chronic endocrine disorder characterised by high levels of blood glucose (hyperglycaemia) occurring from lacks in insulin secretion, insulin action, or both that globally affected 422million adult people according to World Health Organization (WHO). Diabetes has a global impact that rises from 4.7% to 8.5% since 1980 in Population. Past year’s diabetes has increased in low levels and middle-level income countries.
According to Robert Koch Institute (RKI) in Germany data shows that 6.7 million adults are affected by Diabetes Mellitus in the whole of Germany. The German Federal Ministry of Health (BMG) funds this research to collect data’s to develop of health care policy for the treatment and prevention of diabetes.
Helicobacter pylori and Diabetes :
Diabetes-induced impairment of cellular and humoral immunity may improve a unique sensibility to H. Pylori infection (Borody T et al. 2002). There is no evidence showing that H. Pylori plays a significant role in diabetes, there is more possibility for increased susceptibility to infection in diabetic patients.
diabetes-induced reduction of gastrointestinal motility and acid secretion may promote pathogen colonisation and infection rate in the gut. (Jeon CY et al. 2012).
Changed glucose metabolism may produce chemical changes in the gastric mucosa that promote H. pylori colonisation (de Luis DA et al.1998). All these factors can contribute to H. pylori infection to development of diabetes.
H. Pylori and Insulin secretion :
Decreased insulin secretion is one of the significant causes In Type II Diabetes. Defects in ß cell function characterise progression from normal glucose tolerance to prediabetes and Typ II Diabetes Mellitus (Weyer C et al. 1999). According to the study by Hsieh et al. the Patients with H. pylori infection was more likely to have impaired insulin secretion which may increase the risk for type II Diabetes (Hsieh MC et al. 2013).
Associated factors: H. pylori and Diabetes :
Lifestyle is a significant factor influencing both chronic H. pylori infection and Typ II Diabetes. H. Pylori infection could delay gastric emptying, which can be assumed to cause a mismatch between the onset of insulin action and absorption of carbohydrates in insulin-dependent with diabetes. (Ojetti V et al. 2010)(Burghen GA et al.1992). H. pylori infection has also been associated with platelet activation and aggregation, increases in pro-atherogenic factors such as homocysteine, generation of reactive oxygen species, and increases in lipid peroxides (Stergios A et al. 2012)
Obesity :
Obesity is the primary etiological cause of Type II Diabetes Mellitus with controlled clinical trials determining that a weight loss is sufficient to prevent most obese subjects with impaired glucose tolerance from contracting the disease. (Astrup A et al. 2000)
According to some studies High BMI, Obesity may be associated with an increased incidence of H. pylori colonisation from reduced gastric motility. (Perdichizzi G et al. 1996)
Dyslipidaemia :
In type II Diabetes Obesity, Insulin resistant by defects in Insulin action and hyperglycemia leads to changes in lipoproteins plasma levels. Abnormalities in lipoprotein commonly in type II Diabetes. (Gen Yoshino 1996)
Hypertension :
Hypertension usually has no sign or symptoms. Increase levels of blood pressure are high risk to develop other diseases such as Kidney disease, Diabetic Retinopathy in long-term can cause blindness. Chronic cases with ageing can cause Alzheimer's disease or Dementia. There is a High risk of Stroke and Heart attack.
A strong association between obesity was shown in multiple studies. According to the study by D Segula 2014, One of the largest cohorts studied 82473 revealed a positive association between BMI and hypertension at the age of 18 years and midlife. There was also marked an increase in hypertension risk with weight gain. Framingham study showed that the relative risk in overweight men and women were 1.46 and 1.75, respectively, after adjusting for age. Furthermore, weight reduction of obese females at the age of 18 had led to a reduction in the risk of hypertension. In older populations, hypertension and obesity continue to relate predictably as has been shown in the Honolulu Heart Program and Japanese data survey. (D Segula 2014)
What is Glycated Haemoglobin (Hemoglobin A1C)?
In red blood cells contains a Protein called Haemoglobin (Hb) which carries O2. Glucose in bloodstream connects to the protein Haemoglobin in red blood cells and forms glycated haemoglobin. Haemoglobin in red blood cells bind with the glucose and stays for 3 Months. HbA1c test shows average blood glucose levels in the past 3 Months.
Pathogenetic Mechanisms in H. Pylori and Diabetes
In Cong He, Zhen Yang, and Nong-Hua Lu 2014 studies wrote that '' there is no concrete evidence demonstrating that H. pylori play a role in diabetes, the possibility for a causal relationship is an intriguing issue deserving discussion. There are several lines of evidence to implicate increased susceptibility to infection in diabetic patients. Firstly, a diabetes-induced impairment of cellular and humoral immunity may enhance an individual’s sensitivity to H. pylori infection. (Cong He, Zhen Yang & Nong-Hua Lu 2014 cited in Borody T, Ren Z, Pang G, Clancy R 2002 p. 3032-7) Secondly, diabetes-induced reduction of gastrointestinal motility and acid secretion may promote pathogen colonisation and infection rate in the gut. (Cong He, Zhen Yang & Nong-Hua Lu 2014 cited Christie Y. Jeon et al. 2012 p.520-525) Thirdly, altered glucose metabolism may produce chemical changes in the gastric mucosa that promote H. pylori colonisation (Cong He, Zhen Yang & Nong-Hua Lu 2014 cited de Luis DA et al.1998 p 143-6).
Finally, individuals with diabetes are more frequently exposed to pathogens than their healthy counterparts as they regularly attend hospital settings (Cong He, Zhen Yang & Nong-Hua Lu 2014 cited Gentile S et al.1998 41-8). However, there are also indications that H. pylori infection may contribute to the development of diabetes. Whereas insulin insensitivity is an early phenomenon, pancreatic β-cell function declines gradually over time before the onset of clinical hyperglycemia, the result of many factors that can be influenced by infection, such as insulin resistance (IR), glucotoxicity, lipotoxicity, β-cell dysfunction, chronic inflammation, and genetic and epigenetic factors(Cong He, Zhen Yang & Nong-Hua Lu 2014 cited Donath MY et al. 2011 p 98–107 & Stumvoll M et al. 2005 p 1333–1346).
H. PYLORI ERADICATION AND DIABETES
According to Cong He, Zhen Yang & Nong-Hua Lu 2014 studies ''There are limited and conflicting data regarding the effect of H. pylori eradication on glucose metabolism and insulin sensitivity (Cong He, Zhen Yang & Nong-Hua Lu 2014 cited Park SH et al. 2005 p 508–513, Wada Y et al. 2013 p 41–43, Gen R et al 2010 p190–196). However, it may be beneficial for patients at risk of diabetes to be checked for the presence of H. pylori infection, as a report by Zojaji et al. (Cong He, Zhen Yang & Nong-Hua Lu 2014 cited Zojaji H et al. 2013 p36–40) showed that H. pylori treatment could improve the mean HbA1c and the metabolic abnormalities in patients with T2DM. Additionally, Gen et al. (Cong He, Zhen Yang & Nong-Hua Lu 2014 cited Gen R et al. 2010 p190–196) demonstrated that successful H. pylori eradication significantly decreased fasting insulin and HOMA-IR levels. Other studies focused on the effects of eradication on H. pylori-stimulated inflammatory cytokines. Some reports indicate that CRP levels are decreased after H. pylori eradication, suggesting a beneficial effect on low-grade inflammation (Cong He, Zhen Yang & Nong-Hua Lu 2014 cited Longo-Mbenza B et al. 2007 p229–238 & Gen R et al. 2010 p190–196) However, there are also reports showing no effect of H. pylori eradication on mean HOMA-IR and CRP levels (Cong He, Zhen Yang & Nong-Hua Lu 2014 cited Park SH et al. 2005 p 508–513) or HbA1c levels(Cong He, Zhen Yang & Nong-Hua Lu 2014 cited Wada Y et al. 2013 p 41–43). Recently, Vafaeimanesh et al. (Cong He, Zhen Yang & Nong-Hua Lu 2014 cited Vafaeimanesh J et al. 2013 p 55–58) found that in patients with T2DM, the mean decrease in HbA1c and fasting plasma glucose levels in eradicated cases was similar to non-eradicated subjects three and six months after treatment.
Background: Extensive vascular lesions can endanger the life of a child by their virtue of consumptive coagulopathy or cardiac failure. A conservative surgical approach is difficult and can be life-threatening due to uncontrolled bleeding. We report successful limb salvage in an infant despite an extensive and infected arterio-venous malformation of upper limb, complicated by severe consumptive coagulopathy.
Case Report: A term male, 3.2 kgs, presented with a swelling over left arm detected antenatally. Antenatal scan- soft tissue swelling 10.8x6.8x5.4 cm from left shoulder to elbow with heterogeneous cystic spaces and minimal vascularity; O/E- non compressible, no bruit heard.
As the swelling was increasing in size, prednisolone was started at 1 mg/kg/day and slowly escalated to 3 mg/kg/day. However, he presented at 2 months of age with severe anemia and consumptive coagulopathy refractory to medical treatment. Investigations revealed features of consumptive coagulopathy (hemoglobin: 7.3 g/dL; total leukocyte count: 2160/mm 3; platelet count: 76,000/mm 3; prothrombin time: 35.2 s; international normalized ratio: 3.2; activated partial thromboplastin time: >120 s control-31 s; fibrin degradation product: >800 ng/mL; D-dimer: 4.2 mg/L; fibrinogen: 0.6 g/L). This was accompanied by a sudden increase in size due to infection within the tumor, which got ulcerated and began to discharge a bloody purulent fluid. He was given red blood cell, cryoprecipitate, and fresh frozen plasma transfusions.
Investigations: Doppler – hypoechoic lesion+ heterogeneous echotexture, numerous cystic spaces, weak color Doppler signal- S/O- Hemangioma.MRI- lobulated soft tissue mass 17x16 x9.5 cm with an intensive enhancement, necrotic and hemorrhagic areas, involving flexor and extensor muscles of the arm.Supplied by branches of axillary and brachial arteries.Diagnosed as- Hemangioma , hence was started on propranolol 0.5 mg/kg/ day. At 4 months of age surgery became an imperative lifesaving mode of treatment.
As the swelling was increasing in size, prednisolone was started at 1 mg/kg/day and slowly escalated to 3 mg/kg/day. However, he presented at 2 months of age with severe anemia and consumptive coagulopathy refractory to medical treatment. Investigations revealed features of consumptive coagulopathy (hemoglobin: 7.3 g/dL; total leukocyte count: 2160/mm 3; platelet count: 76,000/mm 3; prothrombin time: 35.2 s; international normalized ratio: 3.2; activated partial thromboplastin time: >120 s control-31 s; fibrin degradation product: >800 ng/mL; D-dimer: 4.2 mg/L; fibrinogen: 0.6 g/L). This was accompanied by a sudden increase in size due to infection within the tumor, which got ulcerated and began to discharge a bloody purulent fluid. He was given red blood cell, cryoprecipitate, and fresh frozen plasma transfusions.
At that point, at four months of age, surgery became imperative as a lifesaving mode of treatment. The embolization was not considered as the lesion was infected, ulcerated, and was bleeding. After detailed discussion with parents, consent was obtained for excision with a probability of disarticulation of the limb.
Operative procedure: Planned for amputation/ disarticulation. Axillary vessels identified and controlledTumor excised into Flexor and extensor muscles preserved as much as possible. Radial nerve through the tumor was divided and re-anastomosed. Disarticulation was hence avoided.Arm and hand movements preserved at 10mth follow-up.
Conclusion: A conservative limb salvage surgery is possible even in case of an extensive vascular anomaly.A good vascular control is a must to prevent life threatening hemorrhage in a conservative surgery.
The project was carried out at 500 bedded Hospital on improvement of the biomedical waste compliance for a period of 3 months. Hospital was with G+6 floors with departments like: Emergency, Laboratory, Radiology, Pharmacy, OPD, ICU, HDU, CCU, NICU, PICU, Oat basement. The audit was carried out on the parameters like; Knowledge on segregation, Handling at point of care, Segregation at point of care/ ward, Transportation & handling and Disposal.
The adherence to the protocol was found to be 66% (baseline) and the nonfresher’s and don’t have any previous knowledge or experience on BMW segregation, Training was provided only during induction, No guideline displayed on instant rsufficient PPE’s at the POC. Mixing of waste of red and yellow bins, Bins were overflowing; Ampoules and needles are not discarded in the puncher proof container instead lying onampoules in the designated container and throws from a distance. Wastes are transported in buckets which in smaller capacity and overflows while transporting. The bins are usually draggedbags are transported unsealed. Puncher proof containers are opened and wastes are shifted to bigger buckets before handed over to agency. Reason being supply of puncher proof containers is limited due to unThe waste segregations area found to be smaller as compare to the amount of waste generated. The frequency of the collection by agency is irregular. The puncher proof containers are lying outside the designated area as no speciffor demarcated. The quality management tools like Dash-board, Histogram, Pareto, Fish Bone, CAPA, Gantt Chart was used in the project. The adherence has increased to 75% over 3 monthsintervals and daily briefing, display of guidelines at waste segregation area, regularization of PPE supply with budget allocation, supply of proper sized waste bins and transport buckets; after reviewing the waste quantity. Waist height platforms were created to keep PPC for easy reachimplement the system of “NOT TO OPEN SEALED PPCs” and demarked area for holding it, regularizing the agency visit from every alternate day to daily.
Study relevance :
The chronic hepatitis, especially with viral etiology are considered to be valuable problem of the public healthcare due to the wide spread, long lasting course and adverse complications. The main aim of this study was determining the multi parameter ultrasound approach at the validation of stage activity of the disease in patients who has a verifies diagnosis of chronic hepatitis.
Materials and methods. There were three groups formed from 172 people for the investigation. The first group consisted of 80 patients with verifies diagnosis of chronic hepatitis, who have no any clinical laboratory data for the signs of liver cirrhosis. The second group consisted of 72 patients with different somatic pathologies without chronic hepatitis. The third group consisted of 20 professional sportsmen. The complex investigation, liver ultrasound and elastography of the patients of all groups was conducted. By the standard methodic the doppler ultrasound conducted to investigate the blood circulation of the portal vein.
Results and discussions.
According to our study, ultrasound signs were present in 35% of patients with chronic hepatitis in a seroscale ultrasound examination. The echo graphical signs, mentioned in the literature as typical for chronic hepatitis, were even observed in young healthy people in 2 cases (11%). In the group of patients without liver disease, the described symptoms occurred in 8 (10.5%) cases. The most common symptom was the liver parenchyma echogenicity. In all patients of the chronic hepatitis group with weak liver fibrosis, the portal vein diameter did not significantly change. The doppler graphical data more clearly showed the difference between the groups.
In all patients with mild hepatic fibrosis, the portal vein diameter increased, but the changes were not significant. As the severity of the liver parenchyma fibrosis increased, a varied change in blood flow velocity in the portal vein was noted. In patients with severe fibrosis, a decrease in the average blood flow velocity in the portal vein was noted. The presence and stage of fibrosis do not significantly affect the frequency of manifestation of each of the studied symptoms, however, the frequency of absence of echographic changes in the liver is significantly lower in healthy people than in hepatitis with severe fibrosis.
Conclusions
The ultrasound liver examination is not considered to be sufficient to diagnose the chronic hepatitis, and assess its stages and activity.
The doppler graphic study is informative for the differential diagnosis of stages of liver fibrosis.
Chirag Saluja Safdarjung and Ajay Kumar
Background: Febrile seizures (FS) are the most common type of childhood seizures, affecting 2–5% of children older than 1 month and most commonly from 6 months–5 years old. It is a major cause of paediatric admissions worldwide. In India, AAP 2010 guidelines are followed for performing Lumbar Puncture (LP) in first episode of febrile seizure despite India having wide difference in the epidemiology of meningitis and immunisation coverage as compared to USA. This study has been done to find out whether AAP guidelines are applicable in India also or there is a need for our own guidelines. Although FS induce by age related hyper-excitability of the brain to fever, determining the cause of the fever is critical in the evaluation of these children. The relationship between seizure and bacterial meningitis has been identified well in previous studies. Seizures may be the sole presentation of bacterial meningitis in febrile infants. Seizures are the first manifestation of meningitis in 16.7% of children and in one-third of these patients, whereas meningeal signs and symptoms may not be evident. Therefore, it is mandatory to exclude underlying meningitis in children presenting with fever and seizure prior to making the diagnosis of FS. The initial concern in these children is always to make a proper decision regarding to do an LP to exclude meningitis. Awareness of the prevalence of meningitis and its related factors in children presenting with FS to help physicians to make proper decisions in these situations is necessary. There are several clinical studies worldwide reporting the prevalence of meningitis among children with FS. Some of these studies suggest that in the absence of typical meningeal signs, then an LP should be considered in children with complex seizures, prior antibiotic therapy, age less than 12 months, or incomplete vaccination history.The present study determines the prevalence of meningitis and its associated risk factors in children with FS.
Aims & objectives: Primary Objective-To find out the prevalence of meningitis in first episode of febrile seizure in children aged 6 to 18 months. Secondary Objective-To find out predictors of meningitis in in children with first episode of febrile seizure.
Materials & Methods: A cross-sectional study over a period of 18 months was carried out in paediatric wards of Safdarjung Hospital. LP was performed and results analysed for meningitis as per guidelines. Exclusion criteria included history of previous non-febrile seizures or a previously diagnosed underlying illness associated with seizures, an immune compromised state, or the presence of a ventriculoperitoneal shunt or known trauma. The data collected were age, gender, type of seizure, history of previous FS, signs of meningeal irritation (neck stiffness, Kernig’s or Brudzinski’s Sign(s)), impaired consciousness lasting longer than one hour after seizure, pretreatment with antibiotics (from any rout for days before occurring seizure), and results of LP, cerebrospinal fluid (CSF) culture, and blood culture. CSF pleocytosis was defined as a white blood cell (WBC) count of 6μL or more in the CSF. The WBC count for traumatized LP was determined by using the following corrections: corrected CSF WBC count= (CSF WBC count – [CSF red blood cell count/500]). Bacterial meningitis (BM) was defined as growth of a pathogen from CSF culture or CSF pleocytosis with growth of a pathogen from the blood culture. CSF pleocytosis with mononuclear cell dominancy and no growth of a pathogen from CSF or blood culture was considered as aseptic meningitis if the patient was not pretreated with antibiotics during the previous week. In cases with CSF pleocytosis and history of pretreatment with antibiotics if a diagnosis of BM was given on the side of caution and the patient was treated as having BM, we identified her or him as a case of BM.
Results: 200 cases were analysed. The prevalence of meningitis in children aged 6 to 18 months presenting with first episode of Febrile Seizure was 16%.Bacterial Meningitis was seen in 3%.The independent predictors of meningitis were high TLC(>16500/mm3),positive CRP and prematurity. High grade fever (>102˚F), high seizure duration (>12 minutes), low MCV (<75fl), malnutrition (lesser weight for age) and longer post ictal state duration(>14 minutes) were seen as predictors of meningitis but after logistic regression they were not found to be independent predictors. Streptococcus pneumoniae was the most common organism isolated in the blood (42.8%) as well as the CSF (50%) of the cases taken. Most common type of cell seen was monocytes which were alone seen in 56.2% of the meningitis cases.
Conclusion: India needs its own guidelines for performing LP in cases of first episode of FS. Meningitis can be predicted in those with high TLC (16500/mm3), CRP positive and who are prematurely born.
Introduction: Obesity is one of the most prevalent chronic diseases in childhood, being an important public health issue. Excess weight has been associated with autonomic dysfunction but the evidence in children is scarce. Therefore, this study aimed to assess the effect of overweight and obesity on the autonomic nervous system activity in children. Because dysfunction of the autonomic nervous system (ANS) may lead to development or stabilization of obesity and is related with cardiovascular mortality, the study of ANS function in obesity is of significant clinical interest. Studies of ANS function in obese children have been limited to investigations of cardiac autonomic function through analysis of heart rate variability. These studies have generally revealed a reduced parasympathetic activity. It remains unclear, whether abnormalities of ANS can be found in the sympathetic nervous system, and outside of the cardiac autonomic nerve function in overweight and obese adolescents and children.
Methods to measure autonomic nervous system function outside the cardiac system include sympathetic skin response (SSR) and quantitative pupillography. SSR is a simple, reproducible method to assess the polysynaptic reflex loop which comprises diverse afferents, a common efferent pathway through the spinal cord, pre- and postganglionic sympathetic fibres, and perspiratory glands as effectors. SSR may be affected by pathology of both the central sudomotor and peripheral nervous systems. In obese adults, SSR is not distorted. However, SSR has, to the best of our knowledge, not been assessed previously in overweight or obese children. Autonomic innervation of the pupil is controlled by both the sympathetic and the parasympathetic nervous systems. Pupillary response may be quantified by means of direct pupillography by measuring the pupil diameter in the dark (PDD) and subsequent exposure to a light stimulus. Pupil size and re-dilation velocities (early and late) are thought to reflect sympathetic pupillary modulation while latency light reflex, amplitude and constriction velocity are controlled by parasympathetic activity. PDD and amplitude, velocity of pupillary constriction and latency of pupillary response and of re-dilation following light stimulation are impaired in diabetic patients and may represent the earliest manifestations of peripheral autonomic neuropathy. In diabetic adolescents the PDD and pupillary dilation are significantly decreased compared to healthy peers and the degree of the impairment correlates with the duration of the disease. It has not previously been studied that how pupillary function is influenced by obesity.
Methods: Data were collected from a cross sectional study including 916 children (7 to 12 years), from 20 primary schools in Porto, Portugal. Anthropometric measurements and bioelectrical impedance analysis were performed to assess body mass index (BMI) and characterize body composition - body fat percentage, body fat mass and total body water. BMI was classified according to age- and sex-specific percentiles defined by the World Health Organization, the US Centers for Disease Control and Prevention and the International Obesity Task Force. Pupillometry was performed to evaluate autonomic activity. Mann-Whitney, the chi-square, and Kruskall-Wallis tests were used as appropriate.
1. Clinical and anthropometric data
A thorough medical history was obtained, and a physical assessment was performed in all participants to exclude any concomitant disease. For anthropometric measurements, all children were assessed barefoot and only wearing light underwear. Body height of those children was measured by the digital stadiometer Dr. Keller III. Body weight was determined by a digital scale. Body mass index (BMI) was calculated by the formula: weight in kilograms divided by the square of height in meters. The BMI-SDS provides a normalized measurement for the degree of overweight or obesity. By applying the LMS method, it is assumed that BMI data of each age group are normally distributed. A cut off ≥1.28 SDS (90th centile) classifies overweight and a cut off ≥1.88 SDS (97th centile) classifies obesity in children. Pubertal stage was assessed according to Tanner stages 20.
In obese children, fasting plasma glucose, fasting insulin, transaminases (ALAT, ASAT, GGT), uric acid, triglycerides, cholesterol, HDL-cholesterol and LDL-cholesterol levels were measured by a certified laboratory. An oral glucose tolerance test (OGTT) was performed to exclude impaired glucose metabolism. Blood samples for the OGTT were collected at 0, 30, 60, 90 and 120 minutes after a glucose load of 1.75 g/kg body weight (maximum of 75g glucose). Impaired glucose tolerance was defined as a glucose level >7.8 mmol/l 120 minutes after the glucose load 18. Insulin sensitivity was determined by applying insulin resistance (HOMA-IR) for the homeostasis model assessment. HOMA-IR was calculated using the equation HOMA-IR = fasting insulin (µU/mL) x fasting glucose (mmol/l)/22.5. (21). Blood pressure was obtained by the arithmetic mean of three single measurements by a certified device in the supine position after a rest period.
2. Autonomic nervous function
For the classification of autonomic nervous function (sympathetic/parasympathetic activity), 3 different methods were applied. Measurements were performed during afternoon between 1 and 3 pm, following a rest period of 15 minutes.
2.1. Heart rate variability (HRV): To screen for cardiac autonomic function, HRV was measured in the resting position and following deep breathing via the computer-based system ProScicard. Measurements were performed over a five minute period, and the time-domain and frequency-domain indices of HRV were analysed: root mean square of successive differences (RMSSD), power spectral analysis in the low frequency spectrum ln(LF); (0.05–0.15 Hz) and in the high frequency spectrum ln(HF); (0.15–0.5 Hz) and the low frequency/high frequency ratio (ln(LF/HF) ratio) were calculated. Measurements under deep breathing were performed over a period of 110 heart beats and a stable respiratory frequency of 6 cycles per minute. The ratio of the longest RR interval during expiration to the shortest interval during inspiration (E/I ratio) was calculated.
2.2. Sympathetic skin response (SSR): For the evaluation of sympathetic skin reaction, all children were investigated in a dark and silent room, in a supine position, with their eyes closed. A short rectangular electric stimulus (10 mA, 0.1 ms duration) over the glabella, sympathetic skin reaction was recorded with surface electrodes (palmar and plantar) with a dedicated device (Keypoint, Natus Europe GmbH, München, Germany). The mean latency of 2 responses, one from each side of the body, was calculated in order to screen for sympathic ANS dysfunction.
2.3. Quantitative pupillography: Using a pupillograph (AMTech Pupilknowlogy GmbH, Weinheim, Germany), pupil diameter in darkness (PDD) was detemined. Pupillary light reflex was measured over a period of 2 seconds (intensity of light stimulus: 104 cd/m2, duration of stimulus 200 ms) and several parameters were obtained: relative light reflex amplitude, latency, constriction velocity, early re-dilation velocity (RDV). The mean value of 2 stable measurements of the left eye were used for further analyses 8.
Results: Final analysis included 858 children, 50.6% boys, with a prevalence of obesity ranging between 7.5% and 16.2% according to the International Obesity Task Force and percentage of body fat criteria, respectively. The average dilation velocity was significantly higher among children with obesity, regardless of BMI criteria.
Conclusions: Our results suggest that obesity in children is associated with a dysautonomia in autonomic nervous system, namely with changes in sympathetic activity. Moreover, this findings provide support for the role of the autonomic nervous system in the interaction between lifestyle, diet and the BMI in children.
This presentation will comprehensively review evaluation and management of laryngeal leukoplakia. Though white vocal fold lesions are common, management remains challenging; doing insufficient may allow precancerous lesions to progress, while doing an excessive amount of may create unnecessary dysphonia through scar. I will present a framework for management of leukoplakia which balances oncologic with functional outcomes with the goal of achieving disease control without creating scar. State-of-the-art advances in care of leukoplakia will be emphasized and surgical techniques discussed will include role of infusion, use of the KTP laser and micro flap resection of diseased epithelium. Advanced use of the KTP laser for office treatment of laryngeal dysplasia, a crucial a part of my very own practice and something which is merely available during a limited number of centres worldwide is going to be discussed also, to incorporate appropriate Anesthesia techniques for office based procedures. Epidemiology of leukoplakia, rates of progression to malignancy and role of office-based biopsy will be reviewed. Though focus are going to be on KTP laser strategies as these represent leading edge approached to management of this disease, i will be able to also discuss cold instrument and CO2 laser techniques so that the audience, regardless of the tools available to them in their own practices, will be able to transition techniques learned in this presentation to care of their own patients. Approaches to anterior commissure involvement, bilateral disease and multiply recurrent dysplasia are going to be discussed through case presentations which should increase audience interest.
Tracheo Bronchopathia Osteo Ch"art-12">The overall incidence of this disease varies as reported within the literature—on average 1:125 to 1:6000 cases during bronchoscopy . The presentation is often asymptomatic or may instead include nonspecific respiratory complaints, with cough and dyspnoea the most common. The etiology of TBOC is unclear, but it's considered secondary to chronic airway inflammation. The diagnosis is formed on bronchoscopic findings and sometimes, CT imaging of the chest, with little role in histopathology to verify findings aside from to exclude other pathologies. Treatment is symptomatic, ranging from cough suppression to excision and dilation depending on severity of the airway compromise.
In this report, we present a case of tracheobronchopathia osteochondroplastica found incidentally during a patient being managed for recurrent vocal fold leukoplakia and dysplasia. We review the clinical manifestations, diagnosis, pathophysiology and treatment for our patient with this rare disease.
A 77 year-old male presented with dysphonia and history of prior outside surgery for leukoplakia, with outside pathologic diagnosis of dysplasia. At time of presentation to our clinic, Tran’s oral stroboscope revealed scar of the right vocal fold consistent with his prior surgery and persistent/recurrent leukoplakia. The patient had no complaints of dyspnea, cough or inspiratory stridor. With persistent disease and desire to re-establish pathologic diagnosis, the patient was taken to the OR for suspension micro laryngoscopy and micro flap excision of diseased vocal cord epithelium. During micro laryngoscopy, views of the anterior subglottic demonstrated little nodular sub mucosal lesion along the anterior tracheal wall just beneath the cricoid cartilage. This anterior tracheal lesion was biopsied during the procedure. While the vocal cord leukoplakia was found on histopathology to be dysplasia without evidence of invasion, the ultimate pathology of the proximal tracheal lesion was chronic inflammation.
Background:
In the late 1800's, Ramon y Cajal, Father of Neuropathology stated that the rationale patients who suffered a medulla spinalis injury (SCI) don't improve is that a scar develops at the location of the SCI which prevents axons from penetrating through the scar barrier. The aim of the study was to find out if a scar following an SCI might be surgically removed, followed by reconstruction of the medulla spinalis which could lead on to functional improvement following the injury.
Method:
Studies were administered within the laboratory to find out a way to ascertain if a bit of a medulla spinalis might be removed followed by subsequent functional improvement. It was found that when a neighbourhood of the medulla spinalis in animals might be surgically excised with reconstruction of the medulla spinalis being successfully performed followed by functional success.
Results:
It was learned in cats when a bit of medulla spinalis was removed, the medulla spinalis might be reconstructed by filling the medulla spinalis defect with collagen followed by the placement of an intact vascularized omentum directly on the underlying collagen connection. Not only was this possible, but a patient underwent excision of 1.6" of her medulla spinalis with subsequent ability to steer which was confirmed by video.
Conclusion:
It appears that chronic medulla spinalis injured patients may have within the future the power to possess the scar which is present during a chronic injury removed with expectations following a medulla spinalis reconstruction that functional return can occur.
Pathophysiology of an SC Injury it's important to know the pathophysiological events that happen following an SCI during which there's deposition of edema and blood that routinely occurs rapidly after injury within the SC. This is the results of leakage of edema and blood through the porous endothelial lining of damaged capillaries located mainly within the central gray matter of the SC. The edema fluid is rich in protein which features a high pressure that draws an increasing amount of edema fluid. As edema and blood accumulates within the injured area, it causes an in depth physical swelling of the medulla spinalis which is contained within its no yielding Dura covering and the surrounding bony spinal column , a condition that causes an increased interstitial pressure at the location of the SCI. As the edema expansion intensifies, the interstitial pressure within the medulla spinalis continues to extend, causing compression of veins within the area. This action leads to an elevated blood pressure which further enhances the capillary extrusion of edema fluid and blood elements from the porous blood vessels at the injury site. Under normal conditions, extracellular edema fluid within the medulla spinalis drains into perivascular spaces with eventual drainage into spinal fluid. This flow pattern is essential for edema fluid elimination since there are no lymphatic’s in the spinal cord. As the volume of edema accumulates in an injured SC, there is eventual blockage of the central canal, subarachnoid and subdural spaces so that the normal edema drainage system within the spinal cord is compromised. Compensatory hydraulics develops within the medulla spinalis following injury within the plan to decrease expanding edema accumulation by displacing edema fluid up and down the medulla spinals. This longitudinal fluid movement, however, cannot catch up on the increasing edema volume that develops within the injury area. As edema accumulation increases, it causes the interstitial pressure at the SC injury site to become excessive, causing capillary compression which eventually can diminish capillary perfusion to the purpose of total vascular occlusion. When this happens, there's irreversible damage to neural tissue unless circulation are often restored within hours of injury. The blood-spinal cord barrier normally prevents leakage of blood into uninjured medulla spinals. Following a medulla spinals injury, however, the blood-spinal cord barrier is broken and blood enters the medulla spinals. It becomes critical at this point to use a way to eliminate, or a minimum of lessen, the deleterious effect of the free blood within the SC since blood is known to be injurious to neural tissue. Blood which leaks from porous SC blood vessels after injury incorporates fibrinogen which may be a normal component of the blood mixture. Fibrinogen is a soluble plasma protein synthesized in the liver that is converted into fibrin in the presence of blood coagulation. The key to eliminating medulla spinals scarring could rest with the absorption of fibrinogen. The evidence for this is that fibrinogen is deposited in the spinal cord following injury, which in turn inhibits neuritis outgrowth by triggering an inhibitory signal transduction pathway to neurons. This inhibition of neuritis outgrowth by the presence of fibrinogen in the SC occurs as early as one day after injury, peaks at seven days, and decreases in the following weeks. These activities indicate the importance of absorbing fibrinogen as early after injury as possible since the neuritis inhibition by fibrinogen may begin the process of spinal cord scarring. Absorbing fibrinogen within the blood of an SC may eventually convince be crucial to limiting scar formation within the injured SC through which axons cannot penetrate. The question is how blood with its fibrinogen component is often absorbed within the SC following injury.
Melasma may be a common hyperpigmentation disorder which mainly affects women with a high prototype and sometimes remains active for several years, being related to a substantial psychological impact. The management of melasma is often challenging, because it is very resistant to treatments and requires long-term therapeutic protocols. Conventional treatment includes de-pigmenting products, like hydroquinone (HQ), retinoid, equinox, atelic acid, arbutin, kojic acid, etc., which exert their action at different stages of melanogenesis. In addition, avoidance of aggravating factors is strongly indicated. Combination therapy is typically prescribed, with a typical association of HQ and retinoic acid. However, HQ?s safety has been questioned in certain cases, and prolonged use may lead to adverse effects such as depigmentation and ochronosis, so it cannot be considered as a golden standard. In the look for safer alternatives, a replacement product supported RetinSphere technology has been designed. It incorporates two topical retinoids: Retinol glycospheres and hydroxypinacoloneretinoate, which directly interacts with the retinoic acid receptor but doesn't induce irritation. Additionally, the product includes other DE pigmenting active ingredients. The objective has been creating a product which may reduce or even substitute the use of HQ in the management of melasma patients. We will show the results of clinical assays on several skin types and thus the efficacy and safety of the new combination of retinoids within the improvement of melasma will be discussed.
Patients/Methods
Prospective, double-blind, vehicle-controlled, and randomized study in 30 patients with melasma. The product was applied on one side of the face and the vehicle on the other, twice daily during 3 months. Standardized photographs were taken using RBX technology on the three visits (basal, at one and a half months and at 3 months). The main variable to work out the efficacy was the development of the hemi facial Melasma Area Severity Index (MASI). Other variables were determined like improvement perceived by the investigator, improvement perceived by the patient, impact on quality of life or side effects. Results The MASI improvement at 3 months of treatment was significant on the treated side vs. the vehicle side, reaching an improvement of 70%, which is like the share of improvement described with hydroquinone. No notable side effects were detected, in spite of an enormous percentage of patients included within the study citing a history that might be compatible with sensitive skin.
Conclusions:
This new combination of retinoids and DE pigmenting agents proved to be effective and safe within the treatment of melasma.
Introduction
Melasma could also be a hyperpigmentation condition distributed generally symmetrically within the facial area, which can have a very negative impact on patients’ quality of life. It mainly affects women with a high prototype. It often persists indefinitely, remaining active for several years. The exact ethology is unknown, but certain trigger factors are suggested like genetics, ultraviolet, light, hormone alterations (pregnancy, oral contraceptives), and increase of the melanocyte-stimulating hormone (MSH).2 Melasma is usually immune to treatments, and therefore, it's a frustrating dermatosis for both patients and dermatologists. The results are variable, often imperceptible. Conventional treatment includes avoiding possible trigger factors, daily application of suitable photo protection also as DE pigmenting products. The efficacy of sun protection is backed by the study of Ennes et al. 7 where 8.3% of the patients showed total disappearance of the melasma and 58% partial improvement when treated exclusively with photo protection cream.
Lakhdar observed an incidence of melasma of two .7% in pregnant women who used photo protection 8 compared to 53% in pregnant women of that exact same population who didn't use it as demonstrated by Khadir.9 DE pigmenting agents exert their action through different mechanisms: elimination of excess melanin, regulation of the activity of melanocytes, control of the dispersion of melanin granules, or inhibition of the transfer of melanin to keratinocytes. Most commonly used DE pigmenting agents include hydroquinone, retinoids, mequinol, azelaic acid, arbutin, kojic acid, oleosin, liquorice extract, ascorbic acid, n-acetyl-glucosamine, niacin amide, etc.10–16 A new product has been designed recently, supported RetinSphere Technology, which encompasses the association of two topical retinoids: retinol glycospheres and hydroxypinacolone retinoate. Retinol encapsulated in glycospheres has been used previously in patients with acne. The retinoic acid ester, hydroxypinacolone retinoate, has similar action to tretinoin, but doesn't cause the irritation observed with this retinoid. Recently, Veraldi demonstrated that use at 0.1% during 2 weeks in patients with acne can improve skin roughness by 50% and scaling by 40%. 14 Unlike retinol and other derivatives that has got to be converted into the biologically active sort of retinoic acid, hydroxypinacolone retinoate binds on to retinoic acid receptors (RAR).17 RetinSphere technology has combined with other DE pigmenting active ingredients like N-acetyl glucosamine (inhibits glycosylation of tyrosinase), kojic acid, Cromabright and Antiques (they uptake the copper and iron ions needed by tyrosinase for its activation), albatin & alistin (they act synergistically inhibiting melanin synthesis), and niacin amide (vitamin B3 that forestalls the transfer of melanosomes to keratinocytes). Furthermore, the formulation contains 10% of hydrating active ingredients and 3% anti-irritant, anti-inflammatory active ingredients. This study aimed to determine the efficacy of the protocol with the study products vs. a vehicle within the treatment of patients with melasma. A secondary objective was to determine the safety of the product vs. the vehicle.
Materials and methods
A prospective, randomized, double-blind, vehicle-controlled study was carried out. 30 patients were selected. Inclusion criteria were as follows:
◠Aged over 18 years.
◠Absence of treatment for melasma in the last 3 months.
◠No desire to get pregnant in the forthcoming months and use of contraceptives.
◠No concomitant diseases.
◠No administration of another topical or systemic product that may interfere or affect the process.
◠No allergy to the product ingredients
Treatment
The treatment protocol included the application of the active cream with sun protection factor SPF 50 (Neoretin discrom control gelcream—IFC Pharmaceuticals) during the day and active serum (Neoretin discrom control serum booster fluid—IFC Pharmaceuticals) at night on one side of the face vs. vehicle gelcream with SPF 50 during the day and vehicle serum during the night on the opposite side of the face; thus, the patient was also the control group. The vehicle had the same photo protector as the study product.
Clinical assessment
The observation period was 3 months, organized into visits at baseline (T0), at one and a half months (T1) and at 3 months (T2). Classical clinical photography was administered and with polarized light via Reveal System with RBX technology (Red/Brown/X identified). To determine the efficacy, the share of improvement within the Melasma Area Severity Index (MASI) after treatment was deemed as principle variable.
Dental appearance is considered as the main feature to determine the attractiveness of face thus it influences the human social interactions .A patient’s smile expresses a feeling of success, affection, sensuality and courtesy that reveals self-confidence. The smile is considered as a sign of communicating that relates to the socialization and attraction. Different factors that affects the smile which includes tooth shape, position, and quality of restoration, color and general arrangement of dentition, Smile has been classified as high, average and low. High smile shows complete display of cervico-incisal length of maxillary incisors along with contiguous band of gingiva whereas low smile has less than 75% of display. In an average smile there is 75 to 100% display of maxillary incisors with the incise curvature of the maxillary anterior teeth paralleling the inner curvature of lower lip.
Certain attractive smile is the most significant social holding motion and key to your expert improvement. With the coming of new materials and procedures in the field of esthetic dentistry, individuals have changed their concept of smile and how it's structured. In the present time we have computerized smile structure as a multipurpose advanced instrument with certain clinically important favorable circumstances.
Nowadays people are concerned more about smile, it is not just a facial expression, but has a lot of benefits. Smile makes people more attractive, an attractive smile plays a major role in voting and judge decisions, job recruitment and other social interactions. Attractive people are considered to be at high social standing, more interesting and more intelligent. Studies show that we are more trustful of others when they smile. In one study done by Schliemann JPW, et al. participants were more trusted by others if they were smiling. This study found that a smile increases the people’s willingness to trust. Attractive smiles not only influence other people’s perceptions but also affect the psychosocial well-being of individual as well as their behavior.
Esthetics are characterized by the smile, however, the smile comprises of dental arch. Dental smile design likings differ from one person to other based on different factors such as: social level, economic level, education level and ethnic origin. There is a lack of similar studies in the UAE.
The purpose of this study is to determine which features of smile are attractive that are rated by the people of dental professionals of UAE. The participants were not randomly selected and were not a representative sample of the UAE population but a convenience sample. The participants were all adults above the age of 17 years. The questionnaire had 7 separate aesthetic features with between 3 to 6 different standardized computer generated images for each feature. The different features include the how much amount of tooth is exposed? lip line height, buckle corridor and midline position.
Results: There were total 380 participants between age of 28.6 years (SD 7.9) of which 228 (60%) were female. Significantly more females compared to males preferred a convex smile irrespective of whether the upper teeth contacted the lower lip. Females tends to prefer low lip line compared to males but this was at the borderline of significance (p=0.067).
Interestingly, more married respondents preferred the low lip line, whereas unmarried respondents were evenly distributed among an average and low lip line (p<0.05). The coincidence of dental and facial midlines would be expected as the preferred choice for both dental professionals and as well as for lay people but significantly more lay people preferred the smile that deviated towards the right. Whereas, dentists preferred midlines to be coincident (p<0.001). Furthermore, residents of Abu Dhabi, Dubai and Sharjah preferred the coincidence of midlines. Whereas, the lay people from Fujairah preferred the right deviation of the dental midline. Over all half of the unmarried respondents had a significantly greater preference for midline coincidence but married respondents were more evenly split regarding this aspect of smile design (p<0.05). There were no preference differences for the smile design features as it is judged by dentists and lay people.
Conclusion and Recommendations
Beauty must be considered and assessed to improve the quality of treatment provided to dental patients. The opinions and perceptions on lay people and dental professionals regarding beauty and attractiveness of smile were similar, except two variables known as smile line and the relation were of inter incise line to the facial mid line.
The majority of lay people and dental professionals preferred that more than half tooth is shown at rest. An Incise curve which is convex to the lower lip, smile width with ten visible teeth, a wide labial corridor and a Colusa plane that is parallel to the commissural line. This can be considered as the preferred esthetic smile among the UAE community.The significant differences between lay people and dental professionals in this study is line height, where the lay people preferred a low smile line and dental professionals preferred an average smile line.Other significant differences between lay people and dental professionals in this study was regarding the inter incise slime related to the facial midline, which shows that dental professionals prefers the inter incise line to coincide with the midline while lay people prefers the inter incise line that deviated to the right of the facial midline.
This sessions goal is to demonstrate successful & reproducible tactics that will increase search traffic, conversions, & improve your rankings in Google.When it comes to search engine optimization (SEO) techniques, change is the only constant. For most medical practices, it is difficult to stand firm on this ever-changing ground, when the rules are changing faster than you have a chance to implement them. In the blink of an eye, SEO tips and tricks that were working just fine become obsolete and start harming your website.
After over a decade of changes and updates in Google’s algorithms, SEO has turned into a complicated strategy that you cannot take lightly anymore. As a chiropractic practice owner, if you want to survive today’s cut-throat competition, you have to learn to stay ahead of time and competitors.
Since 2019 is almost over, it is important to look back at all the SEO strategies that you implemented throughout the year and how powerfully they worked for you. Even if you had a consistent year, put aside all your failures and start preparing for the next year. And remember: The sooner you begin strategizing for the next year, the better results you can expect. However, while planning your SEO strategies, keep in mind the following techniques that will be quite useful in 2020 for increasing traffic and attracting a niche audience to your practice website.Link building is not likely to disappear in 2020, and it will be even more important to create a strategy that establishes quality links. This is one of the most effective ways that Google knows a website can be trusted. Quality should be preferred over quantity when links are created. It is always better to have one link from a popular and trusted website than to have multiple links from irrelevant directories. There is no need to look for new links if they do not add value and help you build authority in your target market. It is critical to start thinking of link building as a long-term process. While the best links may not necessarily come from the most popular websites, it is important to seek coverage from relevant websites. Referral traffic can contribute a lot to your website’s organic search rankings. The biggest challenge will involve dealing with guest blogs and how to include them in your link-building strategy without hurting your practice’s reputation. Google has warned publishers that there will be a closer look at guest blogs in order to control spammy links. This means you will have to develop a diversified link-building strategy that aims for a complete backlink profile rather than individual links. To be on a safer side, it is advised to make the backlink profile cleanup a part of your routine. According to the recent link-building survey by PowerSuite, most SEOs are struggling with the lack of opportunities, but there are some useful tactics worth trying. The advice for 2020 is: Looking at our campaigns & experiments in 2019, we'll review examples of SEO tactics that have increased rankings, how much traffic improvement was seeing over 3, 6, and 12 month timelines. I will present the processes and documentation we used so that attendees can replicate and perform the work independently with their teams as they are able. This session will be targeted to those with mid-tier knowledge of SEO who want to increase results.Voice commands are becoming the norm for searching content from search engines. According to Gartner, more than 30 percent of all web browsing will be voice-activated by 2020. Most users prefer to speak into their smart devices instead of taking the time to type out queries. It is much faster and convenient, and it is catching on fast. In fact, industry experts imply that if voice search sustains its current growth rate, then in the next three years, nearly 50 percent of total searches will be via speech. The top reasons for adopting voice searches are familiarity and convenience. Smartphones and virtual assistants are on the rise, and they are becoming a preferred choice for those who do prefer not to type on small screens.
Optimization for voice search might be challenging as it is different from the traditional way of Googling queries. Instead of incomplete phrases, visitors will now speak proper questions, which search engines will have to understand. You will also need to optimize your website for the new set of “voice keywords.”
Another feature from Google, Quick Answers scans the web for a snippet of content that will answer the user’s query. These snippets are usually in the form of short sentences, bullet points or lists. In order to rank for this snippet box, you need to identify common queries and the intent behind your user’s search. You should then aim to answer these questions within your content. FAQ pages are a great way to tackle this. Optimizing your content in order to rank for the rich snippet feature will be a new achievement for healthcare marketers. However, the aim is to be more concise and mobile-friendly. Providing the user with a quick snippet of content that solves their query reduces the need to scroll through long blogs and articles.
improving SEO Performance in 2020
As it seems, the year 2020 will be an exciting year for SEO. What is important to understand while we proceed toward 2020 is that SEO is already evolving, and ranking on the first page is not the ultimate goal anymore. As the search engines evolve, there will be many more opportunities for increasing your search traffic without focusing much on organic SERPs.
The rise of featured snippets, voice search and mobile optimization can yield better results than an organic ranking. This is why it is useful to keep up with the latest trends and discover how your chiropractic practice can maintain a successful SEO strategy by blending established and the latest trends.
It is difficult to predict how big of an impact each one of these tips could have on your practice, and it might not be possible to implement all of these in your practice website. Assess your business goals and make a list of what you think would be most beneficial for your practice. While traditional SEO techniques are still efficient, many new trends could impact your rankings.
Your chiropractic practice needs to have an SEO strategy in place if you are looking to expand your reach and visibility. SEO is one of the most critical components of any practice’s branding efforts and online presence. The SEO experts at Practice Builders have extensive experience in helping chiropractors attract more traffic and convert more visitors into leads and patients. Check out our and be sure to adjust your SEO strategy for 2020 accordingly
Abstract
The objective of this study was to evaluate upper lip length and thickness changes in the vertical dimensions at maximum smile in patients with class I and class II div 1, 2 of malocclusion According To Angle's Classification.
Participants the present study was conducted on 120 subjects randomly selected from the students and staff of faculty of dentistry in Hama University. It was explained to the subjects that this was a study on lip movements involving a short questionnaire followed by a (5- 10 second) video clip capturing only a small part of the face (chin to nose). Video graphic records of these 120 subjects, who willingly consented to participate in the study, were taken to study the perioral zone at rest and on smiling. The subjects were divided into three groups, namely, group 1 (class I), group 2 (class II div1), group 3 (class II div2), with each group containing 20 males and 20 females. Inclusion criteria:
• Age range between 18 and 28 years.
• No active orthodontic treatment
Selection Criteria for the Class-II Sample
Class II div 1:
• Bilateral Class-II Buccal segments "molar and canine" with convex facial profile. (The skeletal classification was not considerable)
• Proclination of maxillary front teeth with an overjet of > 4 mm.
Class II div 2:
• Bilateral Class-II Buccal segments "molar and canine". (The skeletal classification was not considerable) Exclusion criteria:
• Missing tooth visible on smiling
• Prosthodontics /Restorative work on tooth/ teeth visible on smiling
• Gross facial asymmetry
• Visible periodontal disease, caries, excessive dental attrition
• history of orthodontic treatment
• Lip irregularities, or history of lip surgery. Smile Recording and Measurements The subjects were explained that this was a study on smile involving a 5- to 10-second video clip of a small part of the face. An informed consent was obtained from each subject who agreed to participate in the study voluntarily. A video camera (SONY DSC-H200) was set on the tripod 4 feet from the subject. The subjects were seated on the adjustable stool and instructed to hold the head in natural head position by looking straight into an imaginary mirror. If head position required correction, the researcher helped the subject into natural head orientation. The camera lens was adjusted to be parallel to the apparent occlusal plane and the camera focused only on the mouth (from nose to chin) so that the person could not be identified. Included in the capture area (frame) were 2 rulers with millimeter markings. The rulers were secured in a cross configuration so that if the subject accidentally rotated 1 ruler, the other could be used to analyze the frame. The relaxed lip position was achieved by asking the subject to lick the lips and then swallow. Then, the subjects were instructed to say ‘‘Subject number __’’ and then smile. Recording began 1 second before the subject started speaking and ended after the smile. The video clip was downloaded to a computer (LG RD590) and uploaded to ScenalyzerLive (version 4.0, Andreas Winter, Vienna, Austria), a video-editing software program. Each frame was analyzed, and 2 frames were captured for the study. Each frame was then analyzed, and finally two frames were selected for the study. The first frame represented the subjects’ lips at rest or relaxed lip position, and the second frame represented the subjects’ natural unstrained posed smile. The widest commissureto commissure posed smile frame was selected as one of 10 or more frames showing an identical smile. Thus, the selected smile image represented a sustained and hence repeatable smile position. Each frame was opened in Adobe Photoshop 6.0 (Adobe Systems, San Jose, Calif) and adjusted by using the millimeter ruler in the frame. Calibration of the software was done in accordance with the previous study of Desai et al
Measurements on Rest Frame (Figure 1) 1. Upper lip length- from subnasale to stomion superius 2. Upper lip thickness- vertical distance from the most superior point of cupid’s bow to the most inferior portion of the tubercle of the upper lip
Most people’s off-the-cuff associations with telehealth include technology terms like video, camera, remote communication, or maybe robots. But telehealth isn't about the technology. Telehealth is healthcare – delivering care at a distance. When organizations make telehealth about the technology, for instance by putting IT responsible of telehealth, this high potential solution for several of today’s healthcare problems fails whenever, This presentation explores that telehealth really is about people (patients and providers), about processes, about health outcomes, and, yes, about the technology enabling the care at a distance. it'll include a summary of dozens of the foremost common telehealth applications, the various benefits of telehealth, and pragmatic guidance the way to design executive and operational support telehealth in order that telehealth are able to do its full potential. This work is presented at 3rd International Conference on e-Health and Alternative Healthcare Innovations (E-HEALTH – 2020 Webinar) on October 12-13, 2020 Information Technology It is widely held that information technologies will revolutionize patient care, medical research, medical education, and therefore the administration of health services. My medicine group, for instance , wouldn't function nearly also without the relatively simple technology of email. Statistics Canada reported in March 2001 that 53% of Canadians over 15 years aged (that is, 13 million) used the web over the past year. Commercialism aside, witness the recent explosive growth within the use of the web by many patients and physicians seeking information. the complete text of CMAJ, for instance , was first put online in July 1999, and last year the utilization of the location quite doubled, with users from round the world.1 Access to both good-quality and poor-quality information on the web has already affected the patient–physician relationship. Risto Roine and colleagues systematically review research concerning telemedicine from 1966 to early 2000 and define telemedicine as “the use of data and technology to supply health care services to individuals who are a long way from the health care provider.” Their article analyzes many of the vast array of activities that happen under the telemedicine banner. this is often a well-done and timely analysis, because many Canadian hospitals and health care providers have invested or are currently poised to take a position heavily in computer-based information systems so as to enhance patient care both locally and at a distance. Roine and colleagues found the subsequent sorts of telemedicine to be valuable: “teleradiology, teleneurosurgery, telepsychiatry, transmission of echocardiographic images, and therefore the use of electronic referrals enabling email consultations and video conferencing between primary and secondary health care providers.” generally , cost savings weren't impressive. this is often not surprising, because such technology. specially to develop and support. However, the economic analyses that the authors reviewed did suggest that teleradiology, especially the transmission of CT images, might be cost saving. Physicians in both rural and concrete settings need this service for his or her patients. The evaluation of the impact of telemedicine is difficult. Are the requirements of physicians and patients well met and is that the technology up to the job? Researchers in telemedicine are constantly trying to guage a moving target because technological advances may make routine today what didn't work well yesterday. However, such ongoing evaluations are imperative if we are to understand which technologies are worth investing in. we should always not be too discouraged by a number of the evaluation data presented within the article by Roine and colleagues but, rather, we should always learn from it to switch our efforts to satisfy real needs. Here, I review current trends. Internet resources for patients Patients increasingly obtain health care information from the web . the standard and accuracy of this information and therefore the search engines wont to access it need improvement.10 Health organizations are recognizing the necessity to supply better up-to-date information;11 many organizations publish listings of recommended sites (“sites about sites”). HealthWeb (www.healthweb.org) is such a site maintained by several US health sciences libraries. Some internet site providers even personalize the knowledge for the patient and his or her condition or treatment and permit email access to an assigned health care provider for answers to questions. MediStudy (www.medistudy.com) provides patients and physicians with information about Canadian clinical research trials. Technological advances Laptops and handheld computers are increasingly powerful, portable and wireless, allowing consultant expertise to be brought on to the patient's bedside. the potential of networks and therefore the Internet to transfer large amounts of data reliably and securely is additionally ever-increasing, although the downloading of images, animated material and videos can still be frustratingly slow, even on “high-speed” connections. Soon we'll be ready to receive, by subscription, certain sorts of data, like X-ray film and real-time video, over the regular Internet at higher transfer rates. The infrastructure of the web is additionally improving. a replacement generation of the web , supported fibreoptic cables, called CA*NET3 in Canada and Internet2 within the us is partially in situ and promises extensive “broadband” capability, which can improve the standard and usefulness of video images on the Internet: many applications for medicine are being developed (http://apps.internet2.edu/). The delivery of much of telemedicine in both patient care and academic applications are going to be via this new Internet, taking advantage of the doubtless “unlimited” bandwidth for data transfer. Conclusion We have moved well beyond the pioneering stages of telemedicine. Longer-term planning is required, and our health care budgets must incorporate telemedicine as a part of regular operating expenses. Physicians, other health care specialists and universities must lead the way. The time has come to recruit, very much like we do with researchers, for telemedicine expertise. Programs and centers of excellence associated with medical information technology and medical “e-Learning” should be fostered in Canada. The article by Roine and colleagues2 describes where we've been and can help determine where we'd best go. We must remember that the human element remains most vital which the technology is simply the tool. we'll succeed if we always start with the medical or educational need then determine if indeed technology might help best meet that require. it might be exciting to ascertain this same analysis administered during a decade from now. 
WHY TELEHEALTH IS NOT ABOUT TECHNOLOGY?
Statement of the Problem: Introducing medical picture sharing systems for considerable use is beneficial for medical practice. There are numerous approaches to percentage medical pix, and there are excessive expectancies for cloud computing at present due to its scalability. However, photo sharing via a cloud-based totally environment has raised some protection and privateness concerns. The cause of this observe is to advocate a method that applies blockchain generation to a cloud-primarily based environment to deal with concerns concerning security and privacy without impairing IT aid effectiveness at a practical level. Methodology & Theoretical Orientation: This technique divides medical photos, in particular virtual imaging and communications in medicine (DICOM), in to metadata and pixel information. The former is controlled via blockchain technology in a stable manner, and the latter is managed in a cloud-based environment. In addition, we created a multi-use key from the metadata via hashing. When physicians use medical images, the original DICOM records can be reconstructed with the key. Furthermore, we applied pilot machine to assess performance and scalability and get right of entry to security level. Findings: For processing 1000 clinical pics, our idea takes about four seconds, and it is able to boom approximately linearly with number of processing. Furthermore, our concept has a few protection advantages; improvement integrity, confidentiality, and privateness level. Conclusion & Significance: The call for for scientific photo sharing has drastically increased; therefore new methodologies are required to control clinical photos greater securely and in a scalable manner. We suggest making use of a blockchain to a cloudbased environment to generate a synergistic effect. Although some technical challenges remain, this technique has better security and the potential for practical application. Furthermore, our suggestion could be expanded not best to academic use however also personal quarter for picture-based totally machine development, due to the fact patient registration is a point of departure
Technologies for information security are actively used in organizations where information is intensely used. Information security covers the entire process of protection, processing, and transmission of information within organizations. The information security process starts with a security policy designed to protect the organization’s general assets. Information security policies include rules and practices on obligations of employees, the use of security control instruments and the management of process. In healthcare management, information management systems provide the information needed at each stage of processes related to health care activities. Hospital Information Management Systems (HIMS) are an example for the use of information and communication technology in healthcare. Hospitals are complex structures where multiple functions are carried out together. As well as keeping a complete medical record, basic functions of hospital information management system can be listed as keeping financial records, using resources properly, increasing the service quality, provision of information support for important decisions for clinicians and managers. In this frame, information security and patient privacy are critical points for these functions in healthcare management.
This work is presented at 3rd International Conference on e-Health and Alternative Healthcare Innovations (E-HEALTH – 2020 Webinar) on October 12-13, 2020. The Value and Importance of Health Information Privacy Ethical health research and privacy protections both provide valuable benefits to society. Health research is vital to improving human health and health care. Protecting patients involved in research from harm and preserving their rights is essential to ethical research. The primary justification for protecting personal privacy is to protect the interests of individuals. In contrast, the primary justification for collecting personally identifiable health information for health research is to benefit society. But it is important to stress that privacy also has value at the societal level, because it permits complex activities, including research and public health activities to be carried out in ways that protect individuals’ dignity. At the same time, health research can benefit individuals, for example, when it facilitates access to new therapies, improved diagnostics, and more effective ways to prevent illness and deliver care.
Statement of the Problem: Access to specialty treatment for rural and underserved patients is challenged by maldistribution of specialists WHO primarily apply in urban areas, and barriers like price, distance, and time far from work or college. additionally, several medical aid suppliers (PCPs) report low self-efficacy in identification, treatment and management of advanced and expensive diseases. the aim of this study is to explain the medical specialty ECHO (Extension for Community attention Outcomes) approach in up access to worry by increasing PCPs’ capability although their perceived confidence and self-efficacy. medical specialty ECHO may be a multidisciplinary platform for virtual tele-mentoring of PCPs. Methodology & Theoretical Orientation: Our comprehensive approach to program evaluations includes each qualitative and quantitative chemical analysis. mixture knowledge is collected to assist United States perceive the impact of variety of participants, variety of sessions, variety of continuous medical education (CME) credits awarded, in addition as specific instructive topics. we tend to additionally assess Medicaid claims knowledge in terms of supplier prescription patterns and patients’ use of attention system (outpatient and patient visits, ER visits, etc.). Pre and post self-efficacy surveys are wont to learn additional concerning supplier confidence and learning patterns. Conclusion & Significance: medical specialty ECHO provides virtual support and mentoring in diseases that ar common, chronic and complicated. Weekly sessions embrace CME-approved instructive and up to seven de-identified patient cases. Initial analyses indicate a statistically vital increase in collaborating providers’ diagnostic accuracy when twelve months of participation in ECHO tele mentoring program. additionally, we tend to discover a rise in self-efficacy and apply amendment. whereas ancient telemedicine has been palmy in addressing direct patient care over the past four decades, its main limitation of providing matched direct care remains. Project ECHO provides a structural model for tele-mentoring which will be replicated in any illness state
CD56 is detected in a broad spectrum of lymphoproliferative diseases, Acute Myeloid Leukemia (AML) and other tumors like nasal lymphomas. Despite several reports of the poor prognostic role of CD56 in AML, the study of its relevance in paediatric AML is lacking. The aim of our study was to evaluate the impact of CD56 expression on the clinical outcome in paediatric AML patients. CD56 expression was studied on bone marrow aspirates of 100 consecutive pediatric patients diagnosed on morphology, cytochemistry and flow cytometry as de novo AML (excluding APL). Uniform induction therapy (3+7 course of 60 mg/m2 daunorubicin and 100 mg/m2 cytosine arabinoside) followed by consolidation (high dose cytarabine) was given to all the patients. The patients were followed up for a minimum period of one year and survival data: Event Free Survival (EFS), Disease-Free Survival (DFS), Overall Survival (OS) and Relapse Rate (RR) were calculated. Results showed the age of the study population ranged from 1-18 years. CD56 expression was seen in 39/100 (26 male, 13 female) of the patients. The EFS was 47.3% in the CD56 positive patients cohort (n=39) and 48.84% in the CD56 negative patients (n=61). DFS was 57.3% and 69.7% in CD56 positive and negative group, respectively. RR was 35.9% and 27.9% in CD56 positive and negative group, respectively. No significant difference was found in between the CD56 positive and negative groups with respect to EFS, DFS, RR and OS (p=0.65, 0.23, 0.40 and 0.97, respectively). This study shows that CD56 expression does not have any prognostic impact in pediatric AML patients. This is the first study, to our knowledge, to detect the significance of CD56 expression on prognosis and further studies in larger populations validating these results and also its significance with specific molecular sub-types are required.
In practice there's confusion between integrative medication and integrated medical education, to eliminate this unintentional confusion, we've got to outline every of them clearly.By integrative medication we tend to mean combination between the western medication and also the complementary practice of medicine, that primarily based on five domains: Biologically based approaches, artful therapies, mind-body interventions, practice of medicine and energy medical care, whereas integrated medical education may be a planned knowledge base unit of medical instructional expertise.
The set of medical courses and their contents that students learn underneath steerage of the university to attain the graduate competencies is thought as medical course of study that has many faces as specific, implicit, up to extra-curricular set. The medical course of study structure could take the shape of separate, Linear, pointed or Spiral structure. Harden in 1984 had prompt that integration in concert of the keys for assessing the degree of innovation in medical curricula through the SPICES strategy, which incorporates student cantered learning, downside based-learning, integration and community based mostly with general approach. In 2000, he projected harden ladder that explains the eleven blocks that result in the combination in medical courses starting from isolation up to multi, inter, transdisciplinary approaches.
This entire study illustrates the steps of initiating integrated medical course in detail, with illustration of the benefits and drawbacks of integration in medical education. The study additionally highlights the phases of analysis and the way to enhance the prevailing integrated course via up content, analysis strategies yet because the outcome of medical education.
Actuality: Heart failure has become a topical issue in world health recent years due to the high prevalence, rehospitalization, poor prognosis and mortality rate. As the principal pathophysiological mechanism of the progression of this pathology, the focus is on left-ventricular dysfunction, neurohumoral activity and ventricular remodelling. In recent years, numerous studies on the pathogenesis of the disease has revealed important advances in the treatment of the disease. One of them is the detailed study of the role of BNP in the pathogenesis of the disease and the use of therapies based on this.
Purpose: To study the effects of sacubitril/valsartan combination in patients with long-term chronic heart failure, whose left ventricular ejection fraction is below 40%.
Materials & methods: The results of 30 men and women suffering from long-term chronic heart failure with left ventricular ejection fraction below 40% were studied. Patients were over 25 years of age. Each patient was given a combination of sacubitril / valsartan 200 mg daily (100 mg in the morning and 100 mg in the evening). The patients were re-examined 6 months later with transtoracic echocardiography.
Results of study: An increase in the left ventricular ejection fraction in the majority of patients was observed post-transtoracic echocardiography after 6 months.
Summary: The study found a positive effect of adding the sacubitril / valsartan combination to the treatment of chronic heart failure in the majority of patients with the left ventricular ejection fraction
Abstract
The objective is based on the study that evaluates the upper lip length and thickness changes in the vertical dimensions of maximum smile in patients with class I and class II div 1,2 of malocclusion According To Angle's Classification.
Participants the present study was conducted on 120 subjects randomly which are selected from the students and staff of faculty of dentistry in Hama University. It was explained that this was a study on lip movements involving a short question naire followed by a (5- 10 second) video clip capturing only a small part of the face (chin to nose). Video graphic records on these 120 subjects, who are consented to participate in the study, were taken to the study on perioral zone at rest and on smiling. The subjects were mainly divided into three groups, namely, group 1 (class I), group 2 (class II div1), group 3 (class II div2), containing 20 males and 20 females. Inclusion criteria:
• Age between 18 and 28 years.
• No active orthodontic treatment
Selection Criteria for the Class-II Sample
Class II div 1:
• Bilateral Class-II Buckle segments "Molar and Canine" with convex facial profile. (The skeletal classification was not considerable)
• Proclamation of maxillary front teeth with an overset of > 4 mm.
Class II div 2:
• Bilateral Class-II Buckle segments "molar and canine". (The skeletal classification was not considerable) Exclusion criteria:
• Missing tooth visible on smiling
• Prosthodontics /Restorative work on tooth/ teeth visible on smiling
• Gross facial asymmetry
• Visible periodontal disease, caries, excessive dental attrition
• History of orthodontic treatment
• Lip irregularities, or history of lip surgery. Smile Recording and Measurements The subjects are explained on the study of smile involving between 5- 10-second video clip on the small part of the face. An informed consent was obtained from each subject who are agreed to participate in the study voluntarily. A video camera (SONY DSC-H200) was set on the tripod 4 feet from the subject. The subjects are mainly based on the adjustable stool and instructed to hold the head in a natural head position by looking straight towards an imaginary mirror. If head position is in the required position, then the research will carry out in natural head orientation. The camera lens was adjusted to be parallel across the apparent plane and the camera is focused only on the mouth (from nose to chin), So that the person could not be identified which are included in the capture area (frame) with 2 rulers and millimeter markings. The rulers are screwed in the cross configuration so that if the subject accidentally rotates the 1 ruler, and the other ruler could be used to analyze the frame. The lip position is achieved based on the subject of lick the lips and then swallow. Then, the subjects are instructed to say ‘‘Subject number __’’. Recording began 1 second before the subject started and ended with the smile. The video clip was downloaded to a computer (LG RD590) and then uploaded to Screen analyzer Live (version 4.0, Andreas Winter, Vienna, Austria),which is a video-editing software program. Each frame was analyzed, and 2 frames were captured for the study. Each frame was then finally analyzed and two frames were selected for the study. The first frame represents the subject on lips at relaxed lip position, and the second frame represented the subject on natural unstrained posed smile. The widest range of the subject was posed on smile frame and was selected as one of 10 or more frames the identical smile. Thus, the selected smile image represents a sustainable and repeatable smile position. Each frame was opened in Adobe Photoshop 6.0 (Adobe Systems, San Jose, Calif) and is adjusted by using the millimeter ruler in the frame. Calibration of the software is done based on the previous study of Desai Dental.
Measurements on Rest Frame (Figure 1) 1. Upper lip length- from subscale to station superiors 2. Upper lip thickness-The vertical distance from the most superior point of cupid’s bow to the most inferior portion of the tubercle of the upper lip
Abstract Introduction: This is an overview of the theory that there is a relationship between different blood type (0, A, B, AB) between mother and daughter and the Anorexia of the Female Adolescent, whose causes are however psychological and existential. Based on this theory it is possible to monitor a limited population of girls at risk of this anorexia. It is therefore easy to make early diagnosis and even hypothesize prevention for Anorexia of the Female Adolescent, where late diagnosis is the main cause of therapeutic failure today. Keywords: Anorexia, Blood Type, Adolescent, Lorenzo Bracco, Trauma, Placental Trauma, Blood Mismatch, Predictive Diagnosis, Early Diagnosis, Weight Loss, Anorexia of the Female Adolescent. Research Protocol: It is widely shared that Anorexia of the Female Adolescent (other kinds of anorexia are not subject of this study) is a consequence of psychological and existential causes of the girl (daughter/mother relationship, daughter/father relationship, daughter relationship with herself and with the world around her, affective and emotional communication inside and outside her family, poor dietary habits of the family). But upstream, according to my theory, there is a "conditio sine qua non", a condition necessary but not sufficient for the Anorexia of the Female Adolescent: different blood type (0, A, B, AB) mother/ daughter + blood contact between the two during pregnancy and/or birth. I have collected wide statistics supporting my theory, more than 100 cases of Anorexia of the Female Adolescent collected over the last 25 years: anorexic daughter has always different blood type from the mother. I did not find any exceptions. My theory also facilitates early diagnosis by limiting observation, for Anorexia risk, to only daughters with a different blood type than that of the mother. It even allows for predictive diagnosis well before adolescence if the above-mentioned psychological and existential causes for the daughter are present and there is also difference of mother/daughter blood type and you are certain of a blood contact between the two. For more information, see the book: "Anorexia, the Real Causes: Blood Types and Trauma", winner of the Cesare Pavese Award for nonfiction medical writing. The different blood types are characterized by •Absence of a substance called antigen (blood type 0, where "0" = "zero", it means "antigen absent"), or •Presence of antigen A (blood type A), or •Presence of antigen B (blood type B), or •Presence of both antigens A and B (AB blood type). The blood type difference between mother and daughter is usually not a problem, as the placenta only allows between mother and fetus exchanges of gas, nutrients and substances eliminated from the fetus. The placenta, under normal conditions, does not allow any contact between the mother's and the fetus red blood cells. Neither of them feels the difference of blood types between each other. Contact between the mother's and the fetus's red blood cells can occur only in the case of placenta trauma or severe placental suffering or during any other event that may have led to contact between the blood of both mother and daughter. These events, which cause a reduction in placental impermeability, can be caused by placental suffering due to natural causes or sometimes also following invasive surgical or diagnostic intrauterine interventions. A second way of contact is at birth, if it is particularly traumatic.
Diabesity Europe: A Survey about Different Blood Types 0, A, B, AB between Mother/ Daughter in Relation with Anorexia of the Female Adolescent
People with eating disorders adhere to rigid rules that maintain their disorder. During recovery, these rules fade and new rules are developed. Unfortunately, the rest of the world doesn’t nurture the same recovery focused rules so recovery can be a minefield for many people. Our clients with eating disorders are surrounded by a world that nurtures unrelenting standards and unhealthy relationships to food, weight and shape popular western culture objectifies women and encourages scrutiny, manipulation and transformation of bodies. Social media, television and sexist advertising impact negatively on body satisfaction, self-esteem (Bardone-Cone & Cass, 2007; Tiggemann & Slater, 2013), the perception of heaviness in the body and lowered self-worth (Bardone-Cone & Cass, 2007), and influence eating behavior (Smith, Hames, & Joiner Jr., 2013). Many women internalize the ‘thin ideal’ (Thompson & Stice, 2001), take a hyper-critical observer perspective of their body (Fredrickson & Roberts, 1997) which then influences body-hatred. Gendered cultural context plays a role in the development and maintenance of eating disorders. The aim of this presentation is to highlight the different rules that people in recovery from eating disorders have noticed they need to live by when compared to the rest of the world. Sonja will present some recovery oriented rules that her clients have developed, some that research recommends and others that she has observed in her clinical experience as being essential to recovery and maintaining a recovery focused view. Recommendations for clients with eating disorders, their families and friends as well as clinicians working in this field will be discussed.
Women still be more likely to suffer from eating disorders than men (Hudson, Hiripi, Pope Jr., & Kessler, 2007) and therefore the incidence amongst young women is increasing (Smink, van Hoeken, & Hoek, 2012). The core psychopathology of eating disorders is an over-evaluation of shape, weight and their control (Fairburn, 2008). This effectively means that women with eating disorders evaluate their self-worth largely (if not exclusively) in terms of shape and weight, and their ability to control them. Aspects of Western culture fuel the notion that the self-worth of a woman is tied up in appearance, discipline, purification and fragility.
Factors contributing to disordered eating:
The factors that are related to the development and maintenance of eating disorders are present in girls by early adolescence (Rohde, Stice, & Marti, 2015) and include:
sociocultural pressure to be thin (Rohde, Stice, & Marti, 2015; Stice, 2001; Stice & Shaw, 2002) peer pressure and modeling of disordered eating by significant others (Lieberman, Gauvin, Bukowski, & White, 2001; Pike & Rodin, 1991) thin-ideal internalization (Rohde, Stice, & Marti, 2015; Thompson & Stice, 2001) body dissatisfaction (Cooley & Toray, 2001; Rohde, Stice & Marti, 2015; Stice, 2002; Stice & Shaw, 2002; Striegel-Moore & Bulik, 2007).
Popular western culture objectifies women and encourages scrutiny, manipulation and transformation of bodies. It is more likely, therefore, that women will internalize the ‘thin ideal’ (Thompson & Stice, 2001), a reference point used for evaluation via self-objectification. Self-objectification is where a woman takes an observer perspective of her body, seeing herself as an object, focusing on the imperfections (Fredrickson & Roberts, 1997). Self-objectification is a direct result of a culture of objectification and is thought to be a key mechanism that influences body-hatred and through which the messages from popular culture become harmful. Research affirms that social media, television and sexist advertising encourage objectification and body comparison and thus impact negatively on body satisfaction, self-esteem (Bardone-Cone & Cass, 2007; Tiggemann & Slater, 2013), the perception of heaviness within the body and lowered self-worth (Bardone-Cone & Cass, 2007), and influence eating behavior (Smith, Hames, & Joiner Jr., 2013).
Gendered context plays a task within the development and maintenance of eating disorders. The recovery from eating disorders unavoidably occurs in this same context; a context which is incongruent with recovery-oriented values. It is important that psychologists, where possible, address gendered contexts and stereotypical misperceptions in the following ways: Be informed about cultural objectification and self-objectification contributing to the development and maintenance of body image and eating issues. Ask about the values that stem from a client’s own ethnic background, culture, faith and community, and their understanding of what it is to live well, what it means to be a woman, and how self-worth may be understood and accessed in different ways. Consider the stereotypes of eating disorders that nurture an objectification of a woman’s body and how they impact on the client. An example is making an assumption about a stage of recovery because they ‘don’t look anorexic anymore’. Enquire about the impact of pressures about weight and shape on a client’s day-to-day life. Concerns about shape and weight can underlie presentations of depression, social anxiety and other mental health disorders in women. Encourage clients to prevent following blogs or posts that reinforce harmful cultural messages like the necessity to discipline and alter the body. Encourage clients to focus instead on values-directed activities. Encourage others to avoid commenting on weight or appearance. For example, replacing ‘you look so healthy’ with ‘it's good to ascertain you’. Those with anorexia interpret even ‘you look healthy’ as ‘you look really fat’ and saying, ‘I think you are losing weight’ can be received as a threat and trigger anxiety. Request publishers not use graphics that only serve to sensationalize eating disorders in some way and objectify a woman’s body further. Consider the ‘ever-changing’ body image in body-image research, instead of that specialize in one point in time. This may include considering factors that influence how a woman feels within her body, rather than reinforcing self-objectification by assessing how a woman sees her body. Research more about recovery stories and how people manage to recover; focusing on interpersonal and social influences, rather than reductionist explanations.
Understanding the science of safety and the core principles of high reliability are first steps in creating a true culture of safety wherein human factor can contribute in the improvement in healthcare delivery. In the world of healthcare, very little training in human factors is provided to staff, unlike the other safety-critical industries. Human factors research examines the environmental, organizational and job factor of human interacting with the system as well as physiological and psychological characteristics that influence behavior at work. Principle of safety science is a commitment to zero harm. Understanding and implementing the best practices can build high reliability organizations a roadmap to achieve exemplary clinical outcome. Topics highlighting several key safety principles including Just Culture, Professional bodies in healthcare organization, a range of human factors such as managerial, team and individual characteristics that influence the behavior of healthcare staff in relation to safe patient care and framework to demonstrate the role of human factors in patient safety and are known to reduce patient harm and improve the safety and quality of patient care. Best practices performed consistently over time have demonstrated superlative outcomes. Developing a model which demonstrated consistent application of leader rounding; hourly purposeful rounding and bedside shift report can influence how patient safety can be possibly achieved. A commitment to zero harm and application of best clinical and safety practices are critical steps in developing a culture of safety in healthcare organizations contributed significantly in reduction of patient harm a compelling reason for nurses in all healthcare settings to embrace safety science and the principles of high reliability.
In the world of healthcare, next to no preparation in human elements is given to staff, not at all like the other security basic ventures. In the United States more than 440,000 people kick the bucket every year because of preventable medical clinic mistakes. However human services keeps on falling behind other exceptionally complex associations, for example, the avionics and atomic businesses in generally speaking wellbeing rehearses. Understanding the study of security and the center standards of high dependability are initial phases in making a genuine culture of wellbeing wherein human factor can contribute in the improvement in medicinal services conveyance just as the accomplishment of phenomenal patient consideration conveyance result. Tolerant security is a worldwide test that requires information and aptitudes in numerous regions, including human variables and frameworks building. Some consideration settings or care circumstances are especially inclined to perils, blunders and framework disappointments. For example, in escalated care units (ICUs), patients are powerless, their consideration is mind boggling and includes different trains and shifted wellsprings of data and various exercises are acted in tolerant consideration; these variables add to improving the probability and effect of clinical mistakes. Social insurance associations must make and encourage a situation where security will turn into a top need.
Human Carcinogenesis appears to fit the “Initiation”, “Promotion”, “Progression” concept, that involves multiple steps and mechanisms. The two major, but opposing, hypotheses of the origin of this process, by which one normal cell is “initiated” to start this complex evolutionary process, include the “stem cell” hypothesis and the “de-differentiation” or “Re-programming” hypotheses. With the isolation of human stem cells (embryonic and organ specific adult stem cells), as well as the “induced pluripotent stem cells” (“iPS”), arguments have been made to support both competing hypotheses.
The basic assumption to be made in this presentation is that there appears to be more direct evidence to support the hypothesis. Since every human organ contains organ-specific adult stem cells, a single rare normal adult stem cell can be converted from a cell capable of either symmetrical or asymmetrical cell division to one that can not divide asymmetrically, by an “Error-Prone DNA Repair” Process or by an “Error Prone DNA Replication” process, to become “initiated”. This single “initiated” adult organ-specific stem cell, if exposed to “epigenetic agents”, such as pollutants, drugs, cytokines, hormones, growth factors, at threshold levels, for regular and sustained fashion, in the absence of antioxidants, can be “promoted” to become independent of these promoters and to be transformed to an invasive and metastatic “cancer stem cells”.Evidence will be presented from the isolation and characterization of a human breast adult stem cell, having expressed Oct4A, ABCG-2 genes, but having no expressed Connexin genes or having no function gap junctions. These cells will be shown to give rise to human breast cancer stem cells. Moreover, these normal or “cancer stem cells” will be shown to form 3-D organ-specific “organoids that can be used to screen for both tumor promoters or chemo-preventive agents
Background— Vagal incitement abbreviates the atrial successful recalcitrant period (AERP) and keeps up atrial fibrillation (AF). This examination explored whether the parasympathetic pathways that innervate the atria can be distinguished and removed by utilization of transvenous catheter incitement and radiofrequency current catheter removal (RFCA) methods.
Ages ago, medicine started in a form that is non-invasive where the symptoms were the main indicators of a dis-ease a patient complains about. This over centuries, have elevated to form the way medicine is today; the modern medicine. Truly there existed a time very recently when invasive medicine became the easy and quick resolve of medical issues—subject to approval of both the care provider and the patient. Considering the advantageous state nowadays where science has reached a point –thanks to technology advancers and to invasive-based data specialist—were the comprehensive or so called holistic medicine is by dependence on the scientific history of medicine progress has evolved into a new horizon for the new schools of medicine to come. How does the progress in the advancement of technology and the scientific consecutive revolutions affect the medical orientation by health care providers and the consciousness of the receivers of the same, on the other hand? What does medical education need to go through in order to be an easily accessible resource for individuals? How can medical knowledge be life styled to provide a strong preventive behaviour than a responsive one? What are the reflections of this on Heart Preventive Medication and Healthy Heart Life Style? This paper is designed to attend to those queries and to address the same in the conference applied to.
Conclusions—Transvascular atrial parasympathetic nerve framework adjustment by RFCA annuls vagally intervened AF. This antifibrillatory strategy may give an establishment to researching the handiness of neural removal in interminable creature models of AF and in the end in patients with AF and high vagal tone
Background: Dysmenorrhea is a common gynecological complaint in adolescent and young females. The purpose of this study is to assess the efficacy of Shaofu Zhuyu (SFZY) decoctions as treatments for primary dysmenorrhea.
Methods/design: Fifteen (four English, seven Korean, three Chinese, and one Japanese) databases will be searched from their inception without a language restriction. These include PubMed, AMED, EMBASE, The Cochrane Library, seven Korean Medical Databases (Korean Studies Information, DBPIA, Oriental Medicine Advanced Searching Integrated System, Research Information Service System, KoreaMed, The Town Society of Science Technology, and the Korean National Assembly Library), three Chinese Medical Databases [the Chinese Medical Database (CNKI), Chongqing VIP Chinese Science and Technology Periodical Database (VIP), and WanFang Database], and one Japanese Database (J global). Randomized clinical trials (RCTs) included those that examined an SFZY decoction or a modified SFZY decoction. The control groups include no treatment, placebo, and medication. Trials testing a combination of SFZY decoction and medication compare to the same medication alone will be also included. Data extraction and risk of bias assessments will be performed by two independent reviewers. All statistical analyses will be conducted using Review Manager software (RevMan V.5.3.0). Methodological quality will be assessed with the Cochrane risk of bias tool.
Discussion: This systematic review will provide a detailed summary of the available evidence testing the effects of SFZY decoctions for the treatment of primary dysmenorrhea. The review will benefit patients and practitioners in the fields of traditional and complementary medicine.
Oral health plays a key role in public health. Dental treatments like orthodontic, prosthodontic and surgical treatments are expensive. Some of the frequent dental anomalies need an expensive treatments. One of them is congenitally missing teeth which is generally called as Hypodontia, a highly common dental anamoly. CMT has an occurrence of the dental germ developing after the surrounding tissues have closed the space needed for the tooth development. Other studies demonstrated that delays in tooth development and reductions in tooth size correlate with advanced CMT. Both of these might accord with the terminal reduction theory. It is suggested that anterior agenesis may depend more on genes while posterior missing might be sporadic. It usually occurs in females and in the permanent dentition as well as it tends to occur more in the maxilla or mandible. Patients with missing permanent teeth suffer from an unfavorable appearance as malocclusion periodontal damage, lack of alveolar bone growth, reduced chewing ability, inarticulate pronunciation, changes in skeletal relationships. Different therapeutic approaches for missing mandibular incisors includes resin-bonded fixed dental prosthesis (RBFDP), orthodontic treatment, full- veneer fixed dental prosthesis (FDP), dental implant for a single tooth replacement, extraction of one or more incisors and restoration with an implant supported FDP, extraction of one or more teeth and restoration with an FDP, extraction of one or more teeth and restoration with a removable dental prosthesis (RDP). Implant restorations in the anterior maxillary region is the most difficult challenge in treating CMT. The combination of aesthetic demands, biomechanical/functional issues, and phonetic challenges require implant placement. The incisive foramen is the exit site of the nasopalatine canal where as the terminal branch of the descending palatine artery and nasopalatine nerve pass through the oral cavity. When Implant treatment is not satisfactory, resin-bonded fixed dental prosthesis (RBFDP) is used with the two retainers design for a replacement of missing teeth, which was introduced by Brochette in 1963. In Ceram Alumina which is used in the initial practices of all ceramic RBFPDs. Different ceramic materials including reinforced with leucite, lithium disilicate and zirconium oxide have been used in producing of RBFPDs . Lithium disilicate, acts as a dental restorative material. Currently, it has been updated and improved, and named as the IPS e.max Press system. Primarily, this system includes two phases, phase I which has homogeneously distributing lithium disilicate crystals and lithium orthophosphate in a glass matrix that creates phase II. Existence of these crystals in the structure highly increase the mechanical properties of the material.
A 17-year-old female had congenitally missing mandibular right central incisor. After clinical examination, study casts were performed. After the evaluation, the RBFPD was designed to maintain the patient's aesthetic and dental unity. This design was made with IPS E-max press. Initially, the process began with the Teeth Preparation. The diagnostic cast was waxed to assess the size and morphology of mandibular incisors. The preparation edges were drawn. Later it is reported on teeth limited only at enamel boundaries. The mandibular right lateral incisor and left central incisor teeth were examined and prepared. 1mm supragingival reduction extends to the centre of the interproximal contact, with an incisal finish line 2mm short of the incisal edge and 0,5-mm lingual reduction of the enamel. Lithium disilicate glass-ceramics derived from the SiO2–Li2O system. It was first investigated by Stookey at Corning Glass Works in the year 1950. They contain highly of fine rod-like entangled Li2Si2O5 crystals, and a minor amount of lithium orthophosphate (Li3PO4) crystals which are randomly oriented and uniformly dispersed in the glassy matrix. P2O5 plays a key role and acts as a heterogeneous nucleating agent which promotes volume nucleation of the lithium silicate phases. The mechanism of crystallization involves a volume crystallization where the crystals nucleate and grow throughout the glass. Crystallization of lithium disilicate is heterogeneous and this can be achieved through two different processing 2 to 3 stages. Glass-ceramic is intended to be used as a machinable block for the CAD/CAM milling technique or as a pressable ingot for the lost wax hot pressing technique. The parent glass is formed into glass blocks or ingots by pressure-casting into a steel mold, a glass melt of synthetic raw materials that contains quartz, lithium oxide, phosphor oxide, alumina, potassium oxide, and color-imparting oxides. Before cooling down to room temperature, the poured melt is transferred into a pre-heated furnace at 450–550°C to relax the glass block and avoid stress build-ups in the glass. At this stage, the glass block can be kept in the furnace at the same temperature for about 1 hour and nucleation of the lithium silicate phases begins. Lithium disilicate-based ceramic provides an ideal aesthetics. The RBFPD produced with IPS e.max Press. The retainers of the bridge were then provided with hydrofluoric acid and concentration 9.5% and silane was applied. The teeth, under dam, were etched with 37% orthophosphoric acid and rinsed with distilled water and dried with air and then the bridge was cemented with a dual-cure resin cement. Finishing results in an aesthetic and functional successful outcome. The patient was followed-up clinically for one year. The survival rate of RBFPDs is less than conventional fixed partial dentures. The main reason for failure is possible debonding of the framework from the abutment teeth. Studies revealed that, where cementation was performed under dam or with the simple use of cotton rolls, the estimated survival probability for the debonding or failure. The use of dental dam during cementation reduced the risk of debonding by ten times. Many studies have proven that the success rate of single-retainer all-ceramic RBFDPs made from glass-infiltrated alumina ceramic, observed for 10 years, success rate was found 94.4%. 35 RBFPDs with substructures fabricated from IPS Empress or IPS e. max Press and veneered with IPS e.max Ceram were performed. Research Studies reported 100% survival rate approximately 4-year clinical follow-up of 35 anterior RBFPDs fabricated from IPS e.max Press. Also studies performed a randomize clinical trial on thirty anterior zirconia ceramic RBFPDs were in the follow-up period two debondings happened. 100% survival rate was reported after three years observation. RBFPD indicates a minimally invasive, better aesthetic and durable treatment modality in young patients with single missing teeth when implant therapy is not satisfactory. By selecting the most suitable material, all-ceramic RBFPDs provides aesthetic and minimally invasive restorations and when following a suitable clinical procedure, the survival rate of the RBFDPs is comparable to conventional FDPs
Prescriptions are the primary means for communicating medication instructions between prescribers (healthcare professionals) and pharmacists, therefore; the prescription paper should be complete, legible, precise and unambiguous in its interpretation to minimize drug errors. The global number of prescriptions written increases annually, as well as the number of errors, in which there was a large percentage of outpatient paper prescriptions contain one or more errors, resulting in millions of prescriptions with the potential harm to patients . Errors occur in different stages, so every stage of the medication use process (prescription, dispensation, administration, monitoring of a drug) is vulnerable to errors. Errors are an integral part of human life, therefore the classification of the type of error that occurs, based on an assessment of the actions that led to that error, 5 an unintentional action may lead to an error due to a failure of attention (slip) or memory (lapse) and an intentional action may lead to an error due to a failure or lack of expertise (mistake) or a deliberate rule break (violation) . Prescribing errors are worldwide highly prevalent problem in the health care system 1, it is often associated with a health professional’s inexperience and lack of knowledge regarding the medication in general (dose, frequency, strength, interaction, etc.) and other factors such as tiredness and lapse of memory. In addition to prescription drugs, consumers self-prescribe and take drugs they buy over the counter. Sometimes these drugs can cause an adverse events particularly when taken with other drugs . Dosing errors are the most common type of prescribing error, it is widely recognize in the prescription errors.
It is difficult to statistic the errors accurately, many of previous studies use the incident reporting to identify the rate of errors1, but the accurate methods for identify and assessing the types and the rates of prescribing errors are different, but according to previous studies, retrospective review of prescriptions by pharmacists is noted to be the most effective method.
This research is explorative the study conducted in security force hospital in Riyadh, to assess the quality of the medications prescribing in the security force clinics. Population and Sampling Populations The population of this study is all outpatients prescriptions arrive to central pharmacy of security force hospital in Riyadh city. Sampling Procedure The researcher will use the convenience sample method. Research Instruments.The suitable tool for collecting information of this study is a prospective reviewing which is selected by the researcher. It consists of 2 parts or sections: Section 1: Evaluate the errors of omissions (Quality of prescription form) by researcher. Section 2: Evaluate the errors of commissions (Errors of drugs writing) by specialist pharmacy. Instrument Validity and Reliability To assure the validity, the following procedures were conducted, first review was made of the relevant literature. And the previous instrument were examined to develop drafts, secondly the method was reviewing by professors specialized in same field. Reliability Collection of Prescriptions Achievement of the research involved a collection of 300 prescriptions form during the work hours from central pharmacy, the prescription will include all departments in the hospital. The study was carried out by visiting the hospital and collecting different prescription from 13-9-2015 to 13-12-2015. All information related to patients and hospitals were kept confidential, also all prescriptions were included without exclusion criteria, being these prescriptions obtained from outpatient. Statistical Treatment The prescriptions will be evaluated into two steps and then the data was also analyzed using of SPSS version 20 program descriptive and inferential analysis. Each item was scored one or zero with a total score of 16 for evaluate prescription form and 8 for evaluate the drugs prescription errors. If the omission or commission item was present and clear, it was given a score of zero. If it was absent or not readable, a score of one was given.
Prospective cross-sectional study was performed in the security force clinics in Riyadh, The 300 prescriptions were collected from the central pharmacy with convenience sampling procedure to select the prescriptions and the study used a descriptive and inferential analysis to answer the research questions. Results: A total of 759 drugs were prescribed, in which 4118 errors were discovered in the prescriptions (2408 omissions errors, 1710 commissions errors), the most common omissions errors in the prescription under study was omit patient gender, in which nearly all the prescription didn’t determine the gender of patients, following by omit name of department 298 (99.3%), the most common commission errors was illegible writing 650 (86%) in the prescriptions under study, following by omit strength of drugs 464 (61.4%), omit route of drugs administrations 417 (55.2%), the most common drugs prescribed through the study periods were analgesics 203 (26.9%) and the second highest category of drugs were antibiotics (antibacterial) 136 (18%), the most common drugs subjected to prescribing errors were analgesic 27.10%, antibiotics 15.20% and bronchodilators 10.70%, there is a strong positive correlation between the number of drugs prescribed and the number of commission errors
A total of 759 drugs were prescribed, in which 4118 errors were discovered in the prescriptions (2408 omissions errors, 1710 commissions errors), the most common omissions errors in the prescription under study was omit patient gender, in which nearly all the prescription didn’t determine the gender of patients, following by omit name of department 298 (99.3%), the most common commission errors was illegible writing 650 (86%) in the prescriptions under study, following by omit strength of drugs 464 (61.4%), omit route of drugs administrations 417 (55.2%), the most common drugs prescribed through the study periods were analgesics 203 (26.9%) and the second highest category of drugs were antibiotics (antibacterial) 136 (18%), the most common drugs subjected to prescribing errors were analgesic 27.10%, antibiotics 15.20% and bronchodilators 10.70%, there is a strong positive correlation between the number of drugs prescribed and the number of commission errors. Conclusion: Application of modification prescriptions forms, structured prescribing training program, strict legislation measures relating to drugs prescriptions and development of system by applying CPOE and CDSS are among the necessary intervention (s) that may reduce the prescription errors, increase the patient safety and protect them from medication errors.
A total of 505 patients in general practice were asked to respond to a list of 25 obligatory nourishments for a child while going to have the first teeth, for its effectiveness in dealing with patient’s periodontal health especially include chewing hard food. They were also asked to select the three effective nutrition of periodontal tissue. Indicts of patient perceived importance of the periodontal health were derived and each compared with actual effectiveness as determined from a sample of 250 patient’s opinion.
Although the majority of patient’s 18 of 25 nutrition’s as being very effective, there was no significant association with patient perceived nourishment effectiveness and actual effectiveness. The implications for patient training are discussed.
By comparing the effect of long term workout in the fitness gyms and the habit of consuming hard rational food daily with a weekly schedule, could be very likely and would be support the oral health indeed. What to do to have esthetically and functionally prevention method for further gum and periodontal diseases, which could be less aggressive and conservative, cheap and home treating methods. In case one cares about his body’s physique, also he can care about the Gum structure as well.
To have a review, Bundels attached to teeth and their disattachments provoke further injuries. Let’s take a look at these bundles, if we peal away alveolar septa and papillae & marginal part, we can see the budles (periodontal ligament), [1] which is composed of bundles of connective tissues fiber that anchor the teeth within the jaw. Each bundle is attached to cementum covering the root of the tooth. The other end is embedded in bony tooth sockets (alveolar socket). These bundles of fibers allow the tooth to withstand the forces of biting and chewing.
Endomysium, the connective tissue sheaths that surround each skeletal muscle fiber separating the muscle cells from one another. It also contains capillary nerves and lymphatics.
As an illustration, Organization of skeletal tissues, Intact skeletal muscle. Biceps brachi are attached to bones through tendons connective tissue. The entire muscle is surrounded by connective tissue called epimysium [2]. The muscle is organized into bundles called premysium. Each fasciculus contains many individual fibers surrounded by connective tissue called Endomysium.
In some muscles there might only be relatively few fibers such as in muscle of the eye in which these are only 10 of fibers.
In some of the bigger muscles in the body there may be thousands of fibers, for instance, there can be up to 400000 fibers in the bicep muscle in front of the arm.
Each of these fibers is surrounded by sheaths of fibrous tissue membrane or fascia called Endomysium (endo- means within).
Therefore, by having regular training in fitness centers our extremities muscles can strength and can have an esthetic and supportive function for skeletal system.
As within skeletal growth, the muscles in the body also grow at irregular rates. The enlargement of muscles (hypertrophy) makes them thicker but muscle fibers can also get longer. With certain types of training and genetics, muscle mass can change [3].
According to the aging of muscular system, one reason is reducing the strength and power of the muscles, therefore, by training the endomysiums within the periodontal ligament with special trainings as well as eating hard foods and chewing them we can train them exactly like fitness club.
The experiment above 18-25% of those patients who had answered to the test satisfactory had a healthier gum structure in comparing with the unsatisfactory ones. By making some clinics besides gyms and sport centers which prescribe daily, weekly, monthly schedules to fit the gum muscles with special measurement individually for each patient can make a revolution in gum and oral health history.
Florence Jean B Talirongan*, Hidear Talirongan and Markdy Y Orong
DOI: 10.37421/2157-7420.2020.11.342
Health is a very important prerequisite in people’s well-being and happiness. Several studies were more focused on presenting the occurrence on specific disease like forecasting the number of dengue and malaria cases. This paper utilized the time series data for trend analysis and data forecasting using ARIMA model to visualize the trends of health data on the ten leading causes of deaths, leading cause of morbidity and leading cause of infants’ deaths particularly in the Philippines presented in a tabular data. Figures for each disease trend are presented individually with the use of the GRETL software. Result forecasted that after fourteen years, among the ten leading causes of death, disease of the heart rank first and the last is certain conditions originating in perinatal period; for the leading cause of morbidity, acute respiratory infection is the most vulnerable and tuberculosis (TB) other forms is the least vulnerable; and for the leading cause of infant’s death, first in order is the all causes and the last in rank is diarrhea and gastroenteritis of presumed infectious origin. Future research work will focus on the measles and chickenpox trends and predictions utilizing another algorithms for trend analysis and forecasting.
Jacob A. Rounds*, Judith W. Dexheimer, Heidi CurtisD and Bethani Studebaker
DOI: 10.37421/2157-7420.2020.11.343
Technology is a pervasive tool utilized throughout inpatient and outpatient hospital care. Behavioral medicine has a plethora of technology to integrate and support medical infrastructure and processes.
A systematic literature review was performed to classify the technological hinderances that specifically plague behavioral medicine. Researchers examined articles contained within the databases of CORE, Elsevier, PubMed, ResearchGate, and ScienceOpen and pulled all relevant articles. A total of 85 articles were collected after the removal of duplicates.
Several themes have been identified in the systematic literature review that negatively affects behavioral medicine treatment at the provider, clinical staff, non-clinical staff, patient, and organizational levels. These themes are a lack of behavioral medicine patient resources, a surfeit of stigmas surrounding treatment, higher levels of comorbidities in these patients as compared to non-behavioral medicine specialties, and a reliance on outdated educational protocols for training staff. The themes significantly affect patients within the behavioral medicine specialty more than other subsectors of medicine due to the unique ailments that behavioral medicine encompasses.
The future climate of behavioral medicine treatment could be affected by the aforementioned hinderances. However, evidence in the literature review displays positive findings when employee education and technological integration are combined. Further research should be directed towards the implementation of SBE into clinical and non-clinical behavioral medicine employee training.
Journal of Health & Medical Informatics received 2128 citations as per Google Scholar report
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