bluuebunny/crossref_metadata_2025 huggingface dataset:
Venoarterial Extra Corporeal Membrane Oxygenation and Blood Component Usage in Pediatric Patients Undergoing Cardiac Surgery
Authors: Surti Jigar , Jain Imelda , Mishra Amit , Gajjar Trushar , Solanki Atul , Patel Jigar , Shah Jatin , Shah Sapna
Published: April 2021

Background:

Extra Corporeal Membrane Oxygenation (ECMO) is a well-known tool for providing life-saving support in patients developing post cardiotomy cardiogenic shock in post cardiac surgeries. The current study was designed to evaluate blood transfusion requirements and its relation to mortality in neonate and pediatric cardiac patients requiring venoarterial cardiac ECMO during post-operative period following cardiac surgery.

Materials and Methods:

Overall 24 pediatric patients (including neonates) who underwent VA ECMO in post cardiac surgery at our institute from January 2016 to October 2017 were included in the study. The details of demographics, blood transfusion, ECMO, and morbidity and mortality were collected for all the patients.

Objective of the Study:

The primary objective of our study was to assess the outcome of patients on ECMO in post pediatric cardiac surgery. The secondary objective of the study was to assess the effect of blood transfusion on the outcome of the patients.

Results:

Overall mortality rate was 50% (n = 12). The overall transfusion rate of packed red blood cells was higher in patients who did not survive even after institution of VA ECMO. The transfusion of other blood products like platelets, cryoprecipitate, and fresh frozen plasma were also higher in this group of patients though it was statistically non-significant except for packed red cell transfusion. Though statistically non-significant, the patients who didn't survive even after institution of VA ECMO post-surgery had relatively higher mean age (703.88 ± 998.94 days) as compared to their counterparts (510.63 ± 384.36 days).

Conclusion:

The use of ECMO is associated with considerable morbidity and mortality. Packed red cell transfusion is definitely higher in expired patients, indicative of deteriorated status of the patient. However, considering non-significant association of other blood components, except packed red cell it is recommended that patients' overall clinical condition should be taken into consideration for transfusion of blood products and not only targeting the transfusion triggers.
Hypoxia Due to Unusual Right to Left Shunt after Arterial Switch Surgery
Authors: Genny Suresh Rao Kemundel , Kumar Vignesh , Subramaniam Ganapathy , Balakrishnan KR
Published: April 2021

Hypoxia can occur after repair of transposition of great arteries. The most common cause of right to left shunt after arterial switch surgery is related to increased right ventricular pressures and persistent neonatal pulmonary arterial hypertension. We report a case of TGA repair causing right to left shunt with normal right ventricular pressures. Persistence of Eustachian valve with patent foramen ovale (PFO) is the unusual cause of hypoxia and desaturation. The patient was successfully managed by excision of Eustachian valve and closure of PFO.
Effect of Perioperative Acetaminophen on Body Temperature after Cardiovascular Surgery with Cardiopulmonary Bypass
Authors: Kaneko Shohei , Ichinomiya Taiga , Sato Shuntaro , Sekino Motohiro , Murata Hiroaki , Hara Tetsuya
Published: April 2021

Context:

Postoperative hyperthermia, which may lead to cognitive decline, is a common complication of cardiovascular surgery with cardiopulmonary bypass (CPB).

Aims:

The aim of this study was to examine the effectiveness of perioperative intravenous acetaminophen on body temperature in adult patients after cardiovascular surgery with CPB.

Settings and Design:

This was a single-center retrospective study focusing on adult patients who underwent elective cardiovascular surgery with CPB at a university hospital in Japan.

Subjects and Methods:

Patients were divided into two groups based on whether they received acetaminophen perioperatively. In the acetaminophen group, 15 mg/kg intravenous acetaminophen solution was infused at 30 min after discontinuation of CPB and every 6 h after intensive care unit (ICU) admission.

Statistical Analysis Used:

The primary outcome was the maximum axillary temperature within 12 h after ICU admission. The effects of acetaminophen on postoperative body temperature were estimated by the standardization and inverse probability weighting using propensity scores.

Results:

A total of 201 patients were included in the final analysis (acetaminophen group, n = 101; non-acetaminophen group, n = 100). The maximum axillary temperature within 12 h after ICU admission was 37.20 ± 0.54°C in the acetaminophen group and 37.78 ± 0.59°C in the non-acetaminophen group. Acetaminophen lowered the standardized mean of primary endpoint (−0.54°C, 95% confidence interval, −0.69 to −0.38) compared to non-acetaminophen.

Conclusions:

Perioperative intravenous acetaminophen inhibited body temperature elevation after cardiovascular surgery with CPB, compared with the non-acetaminophen group.
Biventricular Apical Thrombi in a Patient Presenting with New-Onset Dilated Cardiomyopathy
Authors: Suraci Nicholas , Galtes Daniella , Lo Presti Saberio , Santana Orlando
Published: April 2021

The diagnosis of an apical left ventricular thrombus in the setting of a dilated cardiomyopathy is not uncommon. However, biventricular apical thrombi in this setting is unusual. We present a case of a 67-year-old man who was admitted with new onset heart failure with biventricular apical thrombus formation in the absence of a hypercoagulable state.
Clinical Efficacy of Levosimendan vs Milrinone in Preventing Low Cardiac Output Syndrome Following Pediatric Cardiac Surgery
Authors: Jothinath Kaushik , Balakrishnan Soundaravalli , Raju Vijayakumar , Menon Shoba , Osborn Jenit
Published: April 2021

Background:

Prophylactic milrinone is commonly used to prevent Low Cardiac Output Syndrome (LCOS) after pediatric cardiac surgery. This study compares the use of levosimendan with milrinone when used as the primary inotrope following pediatric cardiac surgery.

Subjects and Methods:

Forty infants undergoing corrective surgery for congenital heart disease were recruited during the study and randomized into two groups (group L and group M). During rewarming, a loading dose of levosimendan or milrinone was administered followed by a 24-hour infusion of the chosen inotrope. Echocardiographic variables were measured postoperatively. Statistical analysis was done with SPSS-20 computer package. Association between the variables was found by independent t test. P < 0.05 was considered statistically significant.

Results:

Mean age and weight of the patient in Group L was 8.55 ± 5.83 months and 6.05 ± 2.09 kgs, while that in group M was 6.85 ± 3.57 months and 5.26 ± 2.11 kgs. 4 patients (20%) treated with levosimendan had LCOS in comparison with 6 (30%) patients in those treated with milrinone. Echocardiographic parameters in both groups L and M were comparable (cardiac index 3.47 ± 0.76 vs 3.72 ± 1.05 L/min/m2, EF 66.10 ± 7.82% vs 59.34 ± 10.74%, stroke volume index 25.4 ± 6.3 vs 27.74 ± 10.35 mL/m2). The duration of ventilation, ICU stay and hospital stay were lesser in group L (12.75 ± 9.69, 35.95 ± 12.11, 119.10 ± 46.397 vs 23.60 ± 22.03, 51.20 ± 29.92, 140.20 ± 52.65 hours).

Conclusions:

The incidence of LCOS was lesser in those patients treated with levosimendan, when compared with those treated with milrinone. Cardiac index and stroke volume index were comparable between the two groups. Thus, levosimendan provides a non-inferior alternative to milrinone when used as the primary inotrope following pediatric cardiac surgery.
Intraoperative Comparison of 2D versus 3D Transesophageal Echocardiography for Quantitative Assessment of Mitral Regurgitation
Authors: Lovhale Pravin S. , Gadhinglajkar Shrinivas , Sreedhar Rupa , Sukesan Subin , Pillai Vivek
Published: April 2021

Background:

Effective regurgitant orifice area (EROA) can be represented by 3D echocardiographic vena contracta cross-sectional area (3D-VCA) as a reference method for the quantification of mitral regurgitation (MR) without making any geometrical assumptions. EROA can also be derived from 3D PISA technique with a hemispherical (HS) or hemielliptical (HE) assumption of the proximal flow convergence. However, it is not clear whether HS-PISA and HE-PISA has better agreement with 3D-VCA.

Aims:

This study was conducted to compare the EROA and Rvol obtained from 3D-VCA with those obtained from 2D-VC, 2D-HS-PISA, 3D-HS-PISA, and 3D-HE-PISA.

Setting:

Tertiary care hospital.

Design:

Prospective observational study.

Materials and Methods:

After anesthesia induction, 43 consecutive patients were evaluated with RT-3D-TEE after acquiring images from midesophegeal views and performing the offline analysis of volume dataset. 3D-VCA was measured using multiplanar reconstruction mode and EROA and regurgitant volume were estimated using HS-PISA and HE-PISA methods. The HE-PISA was calculated by using the Knud Thomsen formula.

Statistical Analysis:

Agreement between methods to estimate EROA and regurgitant volumes were tested using Bland–Altman analysis. The interobserver variability and intraobserver variability were assessed using an intraclass correlation coefficient.

Results:

The EROA estimated by 3D-VCA was larger than EROA obtained by 2D-HS-PISA and 3D-HS-PISA, which were significantly greater than 3D-HE-PISA. 3D-HS-PISA-EROA showed the best agreement with 3D-VCA (bias: 0.21; limits of agreement: −0.01 to 0.41; SD: 0.1). Correlation between various methods as compared to 3D-VCA was better in the organic MR group than functional MR group.

Conclusion:

3D-HS-PISA showed the best agreement with 3D-VCA compared to other PISA methods. Better correlation between PISA-EROA and 3D-VCA was observed in patients with organic MR than functional MR.
Evaluation of High-Dose Atorvastatin Pretreatment Influence in Patients Preconditioning of Post Coronary Artery Bypass Graft Surgery
Authors: Bastani Misagh , Khosravi Mohammad Bagher , Shafa Masih , Azemati Simin , Maghsoodi Behzad , Asadpour Elham
Published: April 2021

Context:

Atorvastatin is considered as lipid reductive drugs with anti-inflammatory and pleotherapic effects in coronary artery bypass graph (CABG).

Aim:

This study is conducted to evaluate the effects of atorvastatin in CABG.

Setting and Design:

Patients with a coronary bypass graph procedure in Nemazee hospital in Shiraz were divided into two 50-groups receiving high-dose (80 mg) and low-dose (20 mg) atorvastatin.

Materials and Methods:

Troponin I, creatinine kinase-MB (CK-MB), atrial fibrillation (AF) after CABG, duration of mechanical ventilation, inotrope duration of consumption, blood sugar profile, liver and renal function, death during 30 days of CABG, MACE (major advance cardiac events) during admission in ICU, and 1 month follow up were surveyed.

Statistical Analysis:

Collected data were analyzed by independent and paired t-test and Chi square.

Results:

AST was increased, ALT, ALK-P after CABG were decreased, and urine volume in the second day of admission in ICU was increased in the high-dose group. There was an increase and following decrease in blood sugar of patients in the high-dose after CABG. An inflammatory marker after CABG was raised in both groups, ck-mb had an increase, and then followed by a reduction. Troporin had no significant differences between groups. Patients with high-dose atorvastatin had better glomerular filtration rate and renal performance. Along with decreasing AF in the case group, hemodynamics' disorder reduced and there was less bleeding.

Conclusion:

According to the above, it seems that a short-time prescription of high dose of atorvastatin in CABG can lead to better renal function, decreasing of arrhythmia and AF.
Airway Management by I-Gel for Open Tracheal Resection and Reconstruction Via Combined Cervicotomy and Sternotomy Surgical Approach
Authors: Fiorelli Silvia , Saltelli Giorgia , Teodonio Leonardo , Massullo Domenico
Published: April 2021

Surgical resection and tracheal reconstruction are the most effective treatment options for airway stenosis. Tracheal surgery is challenging and requires a multidisciplinary approach and a highly specialized team of anesthesiologists and thoracic surgeons that are “sharing the airways”. Several airway management tools, different devices, and various approaches can be required to ensure ventilation and gas exchange. We describe the case of a patient affected by tight tracheal stenosis, submitted to tracheal resection and reconstruction via combined cervicotomy and sternotomy surgical approach. Airway management was successfully performed by i-gel® (Intersurgical, UK) supraglottic device.
Aortocoronary Saphenous Vein Graft Aneurysm Misdiagnosed as Aortic Arch Aneurysm
Authors: Papakonstantinou Nikolaos A , Samiotis Ilias , Kratimenos Theodoros , Dedeilias Panagiotis
Published: April 2021

Coronary artery bypass grafting is the mainstay of revascularization worldwide. However, the most widely used saphenous vein grafts are related to a number of late sequelae. Aortocoronary saphenous vein graft aneurysms mainly diagnosed incidentally are one of these complications. Although rare, given the fatal risk of rupture if left untreated, management either with percutaneous intervention or open redo surgery should be considered. However, no guidelines are established in current scarce literature. Hereby, we present the successful percutaneous management of a huge saphenous vein graft aneurysm via coiling, avoiding the risks of repeat sternotomy.
Bilateral Whole Lung Lavage by Lung Isolation in a Child with Pulmonary Alveolar Proteinosis
Authors: Kaushal Brajesh , Chauhan Sandeep , Hasija Suruchi
Published: April 2021

We present two rare cases of children who presented with progressive exertional breathlessness and dry cough. They also had history of bluish discoloration of mucous membranes, hands and feet on exertion. Both were diagnosed to have pulmonary alveolar proteinosis after a high-resolution computed tomography and bronchoalveolar lavage. They were subjected to bilateral whole lung lavage (WLL) as a salvage therapy. Bilateral WLL was performed in a single sitting with the help of a modified endotracheal tube. The anesthetic technique included a modified cuffed endotracheal tube for accomplishing WLL. After the procedure, both children improved clinically and functionally.
Resident involvement in the prostatic urethral lift
Authors: Alam Ridwan , Rabinowitz Matthew J , Kohn Taylor P , Peña Vanessa N , Liu James L , Bhanji Yasin , Herati Amin S
Published: April 2021

Adoption of the prostatic urethral lift (PUL) as a treatment for benign prostatic hyperplasia highlights the importance of training residents with novel technology without compromising patient care. This study examines the effect of resident involvement during PUL on patient and procedural outcomes. Retrospective chart review was conducted on all consecutive PUL cases performed by a single academic urologist between October 2017 and November 2019. Trainees in post-graduate year (PGY) 1–3 are considered junior residents, while those in PGY 4–6 are senior residents. The International Prostate Symptom Score (IPSS) and quality of life (QOL) scores were used to measure outcomes. Simple and mixed-effects linear regression models were used to compare differences. There were 110 patients with a median age of 66.4 years. Residents were involved in 73 cases (66.4%), and senior residents were involved in 31 of those cases. Resident involvement was not associated with adverse perioperative outcomes with respect to the number of implants fired, the percentage of implants successfully placed, or the postoperative catheterization rate. After adjustment for confounding factors, junior residents were associated with significantly longer case length compared to the attending alone (+12.6 min, P = 0.003) but senior residents were not (+2.4 min, P = 0.59). IPSS and QOL scores were not significantly affected by resident involvement (P = 0.12 and P = 0.21, respectively). The presence of surgeons-in-training, particularly those in the early stages, prolongs PUL case length but does not appear to have an adverse impact on patient outcomes.
Clinical outcome of pediatric and young adult subclinical varicoceles
Authors: Cho Patricia S , Yu Richard N , Paltiel Harriet J , Migliozzi Matthew A , Li Xiaoran , Venna Alyssia , Diamond David A
Published: April 2021

Subclinical varicocele represents an abnormality of veins of the pampiniform plexus on scrotal ultrasound (US) without a clinically palpable varicocele. Its significance remains unclear. While guidelines do not recommend surgical intervention, clinical management is variable. As there is limited information on long-term outcome of subclinical varicoceles due to challenges in diagnosis and management, we performed a single-institution, retrospective review of patients from October 1999 to October 2014 with subclinical varicocele and with available US studies reviewed by a single radiologist. Subclinical varicocele was defined as dilation of the pampiniform venous plexus on US involving ≥2 vessels with diameter >2.5 mm, without clinical varicocele on physical examination or prior inguinal surgery. Thirty-six of 98 patients identified were confirmed as having a subclinical varicocele and analyzed. The mean age at initial visit was 15.5 years, with a mean follow-up of 26.5 months. The majority were right-sided (69.4%, n = 25), usually with a contralateral clinical varicocele. Testicular asymmetry (>20% volume difference of the affected side by testicular atrophy index formula) was assessed in 9 patients with unilateral subclinical varicocele without contralateral clinical or subclinical varicocele and observed in 1 patient. Of 17 patients with follow-up, 3 (17.6%) progressed to clinical varicocele without asymmetric testicular volume, as most remained subclinical or resolved without surgery. In our experience, subclinical varicoceles appeared unlikely to progress to clinical varicoceles, to affect testicular volume, or to lead to surgery. Although our study is limited in numbers and follow-up, this information may aid clinical management strategies and guide future prospective studies.
Characterization of Ca2+ -Sensing Receptor-Mediated Ca2+ Influx in Microvascular bEND.3 Endothelial Cells
Authors: Leong Iat-Lon , Tsai Tien-Yao , Shiao Lian-Ru , Zhang Yu-Mei , Wong Kar-Lok , Chan Paul , Leung Yuk-Man
Published: April 2021

Ca2+-sensing receptors (CaSR), activated by elevated concentrations of extracellular Ca2+, have been known to regulate functions of thyroid cells, neurons, and endothelial cells (EC). In this report, we studied CaSR-mediated Ca2+ influx in mouse cerebral microvascular EC (bEND.3 cells). Cytosolic free Ca2+ concentration and Mn2+ influx were measured by fura-2 microfluorometry. High (3 mM) Ca2+ (CaSR agonist), 3 mM spermine (CaSR agonist), and 10 μM cinacalcet (positive allosteric modulator of CaSR) all triggered Ca2+ influx; however, spermine, unlike high Ca2+ and cinacalcet, did not promote Mn2+ influx and its response was poorly sensitive to SKF 96365, a TRP channel blocker. Consistently, 2-aminoethoxydiphenyl borate and ruthenium red (two other general TRP channel blockers) suppressed Ca2+ influx triggered by cinacalcet and high Ca2+ but not by spermine. Ca2+ influx triggered by high Ca2+, spermine, and cinacalcet was similarly suppressed by A784168, a potent and selective TRPV1 antagonist. Our results suggest that CaSR activation triggered Ca2+ influx via TRPV1 channels; intriguingly, pharmacological, and permeability properties of such Ca2+ influx depended on the stimulating ligands.
Effect of metformin therapy on thyroid-stimulating hormone levels in women with polycystic ovarian syndrome
Authors: Dhanpal Vinay , Dharmalingam Mala , Kalra Pramila
Published: April 2021

Introduction:

Metformin has been shown to decrease thyroid-stimulating hormone (TSH) levels without effect on total T4 and total T3 levels, especially in patients with underlying thyroid dysfunction.

The Aim of the Study:

To evaluate the effect of metformin therapy on TSH levels in polycystic ovarian syndrome (PCOS) patients who were euthyroid with or without treatment.

Design of the Study

Nonrandomized prospective intervention trial.

Materials and Methods:

The study included all euthyroid PCOS patients of the reproductive age group diagnosed according to the modified Rotterdam criteria and the patients were divided into two groups. The first group was put on lifestyle modification alone (Group-I), whereas the second group was put on lifestyle modification and metformin therapy (Group-II). In both groups of patients, TSH, total T4, and total T3 levels were done at baseline and after 3 months of follow-up.

Results:

A total of 105 patients with PCOS were nonrandomly assigned to Group I (n = 53) and Group II (n = 52). The baseline parameters (age, body mass index, TSH, and Homeostatic Model Assessment for Insulin Resistance) were similar. Thirty-six patients in Group I and 39 in Group II were followed up for 3 months. The change in TSH levels in both groups was not significant at follow-up (Group I [2.56 ± 0.87 vs. 3.01 ± 1.54; P = 0.102] and Group II [2.90 ± 0.81 vs. 2.76 ± 1.26;P = 0.503]). In a subgroup analysis in patients who had thyroid dysfunction, there was a significant decrease in TSH levels in Group II (3.10 ± 0.54 vs. 2.57 ± 0.50;P = 0.031).

Conclusion:

Metformin significantly decreased TSH levels in women with PCOS with underlying thyroid dysfunction, while it did not show any effect on women without underlying thyroid dysfunction.
Primary hypothyroidism on follow-up in a cohort of Indian patients with subacute thyroiditis
Authors: Kalra Pramila , Prasanna Kumar K. M.
Published: April 2021

Objectives:

Subacute thyroiditis (SAT) is a temporary dysfunction of the thyroid gland and is commonly due to its viral infection. Permanent hypothyroidism after recovery from SAT has been reported in various studies.

Methodology:

This was a prospective study conducted in two tertiary care centers in South India to follow-up these cases for the development of permanent primary hypothyroidism at 1-year follow-up after recovery from SAT.

Results:

The total number of cases followed up was 146, including 103 females (70.5%) and 43 males (29.5%). Females' mean age was 33.03 ± 11.7 years, and males' mean age was 40.17 ± 11.84 years. Seven patients reported the second attack of thyroiditis. The mean thyroid-stimulating hormone (TSH) recorded at baseline was 0.042 ± 0.056 µIU/ml. Permanent hypothyroidism was seen in 19.86% of the cases at a 1-year follow-up and was found to be higher in patients with lower TSH at baseline. The females and males were affected at a younger age as compared to other studies. The incidence of permanent hypothyroidism was found to be higher as compared to some but lesser compared to a few others. The iodine supplementation could also be one of the postulates for this higher incidence of hypothyroidism. The severity of thyrotoxicosis was a significant determinant of the future development of hypothyroidism.

Conclusions:

The patients with SAT need to be followed up for the development of permanent hypothyroidism. The prevalence of hypothyroidism at 1 year was 19.86% after an attack of thyroiditis.
A case of acute liver injury induced by methimazole
Authors: Niveditha Karthika , Menon Arun S , Kumar Harish , Eapen Malini , Gopalakrishna Rajesh
Published: April 2021

Antithyroid drugs, methimazole, and propylthiouracil have been reported to cause hepatotoxicity. We report the case of a patient with methimazole induced liver injury who presented within a few weeks of commencement of the drug. She presented with a cholestatic picture and responded well to discontinuation of the drug and administration of steroids.
Existence and uniqueness of axially symmetric compressible subsonic jet impinging on an infinite wall
Authors: Cheng Jianfeng , Du Lili , Zhang Qin
Published: April 2021

This paper is concerned with the well-posedness theory of the impact of a subsonic axially symmetric jet emerging from a semi-infinitely long nozzle, onto a rigid wall. The fluid motion is described by the steady isentropic Euler system. We showed that there exists a critical value

M_{cr} > 0

, if the given mass flux is less than

M_{cr}

, there exists a unique smooth subsonic axially symmetric jet issuing from the given semi-infinitely long nozzle and hitting a given uneven wall. The surface of the axially symmetric impinging jet is a free boundary, which detaches from the edge of the nozzle smoothly. It is showed that a unique suitable choice of the pressure difference between the chamber and the atmosphere guarantees the continuous fit condition of the free boundary. Moreover, the asymptotic behaviors and the decay properties of the impinging jet and the free surface in downstream were also obtained. The main results in this paper solved the open problem on the well-posedness of the compressible axially symmetric impinging jet, which has proposed by A. Friedman in Chapter 16 in [26]. The key ingredient of our proof is based on the variational method to the quasilinear elliptic equation with the Bernoulli’s type free boundaries.
Variational approximation of interface energies and applications
Authors: Amstutz Samuel , Gourion Daniel , Zabiba Mohammed
Published: April 2021

Minimal partition problems consist in finding a partition of a domain into a given number of components in order to minimize a geometric criterion. In applicative fields such as image processing or continuum mechanics, it is standard to incorporate in this objective an interface energy that accounts for the lengths of the interfaces between components. The present work is focused on the theoretical and numerical treatment of minimal partition problems with such interface energies. The considered approach is based on a

\Gamma

-convergence approximation combined with convex analysis techniques.
The effect of a herbal combination of primrose, gentian root, vervain, elder flowers, and sorrel on olfactory function in patients with a sinonasal olfactory dysfunction
Authors: Reden J. , El-Hifnawi D. , Zahnert T. , Hummel T.
Published: April 2021

Olfactory dysfunction is a common symptom in patients with inflammation of the nasal mucosa. Among numerous drugs, so far only the use of steroids has been shown to have a positive effect on olfactory function. Therefore the aim of the present study was to investigate whether patients with sinonasal disease would benefit in terms of olfactory function from oral treatment with a herbal drug (combination of primrose, gentian root, vervain, elder flowers, and sorrel: Sinupret(r)) which is commonly used in sinusitis. Olfactory function was tested using a standardised olfactory test kit (`sniffin` sticks`). The drug was applied in a double-blind fashion: after an initial therapy of 7 days of oral prednisolone for all participants with a sinonasal olfactory disease, participants were divided into a placebo- and a verum=group; tests were performed before and after treatment over a 2 months period. Statistical analysis did not reveal any major differences in olfactory function in relation to treatment. Considering that its benefit for the inflammatory component of sinusitis has been shown, the herbal drug may exhibit positive effects on olfactory function in a different setting, e.g., when applied without preceding administration of prednisolone, or when used in patients with certain degrees of rhinosinusitis.
Gut Microbiome Changes with Acute Diarrheal Disease in Urban Versus Rural Settings in Northern Ecuador
Authors: Soto-Girón Maria J. , Peña-Gonzalez Angela , Hatt Janet K. , Montero Lorena , Páez Maritza , Ortega Estefania , Smith Shanon , Cevallos William , Trueba Gabriel , Konstantinidis Konstantinos T. , Levy Karen
Published: April 2021

Previous studies have reported lower fecal bacterial diversity in urban populations compared with those living in rural settings. However, most of these studies compare geographically distant populations from different countries and even continents. The extent of differences in the gut microbiome in adjacent rural versus urban populations, and the role of such differences, if any, during enteric infections remain poorly understood. To provide new insights into these issues, we sampled the gut microbiome of young children with and without acute diarrheal disease (ADD) living in rural and urban areas in northern Ecuador. Shotgun metagenomic analyses of non-ADD samples revealed small but significant differences in the abundance of microbial taxa, including a greater abundance of Prevotella and a lower abundance of Bacteroides and Alistipes in rural populations. Greater and more significant shifts in taxon abundance, metabolic pathway abundance, and diversity were observed between ADD and non-ADD status when comparing urban to rural sites (Welch’s t-test, P < 0.05). Collectively our data show substantial functional, diversity, and taxonomic shifts in the gut microbiome of urban populations with ADD, supporting the idea that the microbiome of rural populations may be more resilient to ADD episodes.
Relationship of oxidative stress and antioxidant response with vaso-occlusive crisis in sickle cell anaemia
Authors: Azeh Engwa Godwill , Okolie Amanda , Paul Chinedu Chidili John , Amara Okore Precious , Chigozie Onu Paul , Onyinye Ugwu Maryrose , Ebeshe Oko Daniella , U Ferdinand Paschaline
Published: April 2021

Background: Though sickle cell anaemia (SCA) is known to promote oxidative stress, there is paucity of information on the relationship between oxidative stress and vaso-occlusive crisis (VOC).

Objective: This study was undertaken to evaluate the relationship of oxidative stress and antioxidant response with VOC in SCA.

Methods: A cross-sectional case-control study was carried out at University of Nigeria Teaching Hospital (UNTH), Itu- ku-Ozalla, Enugu Nigeria involving 116 individuals which included 36 SCA subject, 40 sickle cell carriers (AS) and 40 healthy individuals (AA). Baseline information as well as the frequency of VOC was obtained from the participants and anaemia as well as oxidative stress and antioxidant indices were assessed in blood.

Results: Anaemia was prevalent (88.9 %) in SCA individuals compared to AS (52.5%) and AA (47.5 %) individuals. Nitric oxide scavenging (NOS) and superoxide dismutase (SOD) activities as well as glutathione level were significantly (p<0.005) lower while catalase activity was higher in SCA individuals compared to controls (AA and AS). Higher malondialdehyde (MDA) level was associated with very severe VOC while low level of NOS activity was associated with severe VOC in SCA individuals.

Conclusion: Sickle cell anaemia exhibited oxidative stress and alteration in the levels of antioxidant indices which was pos- sibly associated with vaso-occlusive crisis.

Keywords: Sickle cell anaemia; oxidative stress; antioxidant; vaso-occlusive crisis.
Hysterosalpingography: a potential alternative to laparoscopy in the evaluation of tubal obstruction in infertile patients?
Authors: Gündüz Reyhan , Ağaçayak Elif , Okutucu Gülcan , Kömürcü Karuserci Özge , Peker Nurullah , Güli Çetinçakmak Mehmet , Gül Talip
Published: April 2021

Background: Evaluation of the fallopian tubes are important for infertile patients. The two most important diagnostic procedures used to evaluate tubal patency are hysterosalpingography and laparoscopy.

Objectives: To asses the hysterosalpingography and laparoscopy results of patients diagnosed with infertility and investigate the diagnostic value of hysterosalpingography in patients with tubal factor infertility.

Methods: The hysterosalpingography and laparoscopy results of 208 patients who presented to the Obstetrics and Gyne- cology Clinic at Dicle University, Faculty of Medicine between January 2014- January 2018 were retrospectively evaluated. Hysterosalpingography and laparoscopy results were compared with regard to the investigation of the presence of tubal obstruction and of the pelvic structures that could cause tubal obstruction. The specificity, sensitivity, positive, and negative predictive values of hysterosalpingography were computed.

Results: The number of patients evaluated was 208. The ratio of primary infertile patients was 57.2% and 42.8% was secondary infertile. Hysterosalpingography was found to have a specificity of 64.6%, the sensitivity of 81.3%, the positive predictive value of 56.4%, and a negative predictive value of 86% in the determination of tubal obstruction.

Conclusion: Patients with suspected tubal infertility can primarily be examined using hysterosalpingography in considera- tion of the invasive nature and the higher complication rate of laparoscopy.

Keywords: Infertility; hysterosalpingography; laparoscopy; tubal factor.
Patient patronage and perspectives of traditional bone setting at an outpatient orthopaedic clinic in Northern Tanzania
Authors: B Card Elizabeth , E Obayemi Joy , Shirima Octavian , Rajaguru Praveen , Massawe Honest , Premkumar Ajay , P Sheth Neil
Published: April 2021

Background: Much of Sub-Saharan Africa meets the rising rates of musculoskeletal injury with traditional bone setting, especially given limitations in access to allopathic orthopaedic care. Concern for the safety of bone setter practices as well as recognition of their advantages have spurred research to understand the impact of these healers on public health.

Objectives: Our study investigates the role of bone setting in Tanzania through patient utilization and perspectives.

Methods: We surveyed 212 patients at the outpatient orthopaedic clinic at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. Surveys were either self-administered or physician-administered. Summary statistics were calculated using XLSTAT. Open responses were analyzed using a deductive framework method.

Results: Of all surveys, 6.3% (n=13) reported utilizing traditional bone setting for their injury prior to presenting to KCMC. Of the self-administered surveys, 13.6% (n=6) reported utilizing bone setting compared to 4.3% (n=7) of the physician-ad- ministered surveys (p=0.050). Negative perceptions of bone setting were more common than positive perceptions and the main reason patients did not utilize bone setting was concern for competency (35.8%, n=67).

Conclusion: Our study found lower bone setting utilization than expected considering the reliance of Tanzanians on tradi- tional care reported in the literature. This suggests patients utilizing traditional care for musculoskeletal injury are not seeking allopathic care; therefore, collaboration with bone setters could expand allopathic access to these patients. Patients were less likely to report bone setter utilization to a physician revealing the stigma of seeking traditional care, which may present an obstacle for collaboration.

Keywords: Bone setting; traditional medicine; traditional practitioners; orthopaedics; trauma.
Knowledge and practices of seeking informed consent for medical examinations and procedures by health workers in the Democratic Republic of Congo
Authors: Nzaumvila Doudou , Ntotolo Patrick , Govender Indiran , Lukanu Philip , Landu Niati JD , Sanduku Didier , Bongongo Tombo
Published: April 2021

Background: Informed consent (IC) is linked to the ethical principle of respecting patient autonomy, respect for human rights and ethical practice, while in many countries it is a standard procedure. Anecdotally, it should be noted that in the Democratic Republic of Congo (DRC) in many instances ICs are not obtained systematically. To date, no research appears to have been conducted on this matter. This study aimed to assess the knowledge and practice of obtaining IC from patients among health care providers (HCP) in the DRC.

Methods: This was a cross-sectional study, with a convenient sampling of 422 participants. Data from the questions were collected on an imported Microsoft Excel spreadsheet for review at INSTAT.TM The authors set IC's accurate knowledge and practice at 80% or higher. The Fisher Exact test was used to compare categorical association results, and a p-value < 0.05 was considered statistically significant.

Results: Results showed that giving information in detail to patients on their medical condition was associated with formal training on medical ethics and IC (p: 0.0028; OR: 1.894; CI: 1.246 to 2.881), which was also associated with answering the patient’s questions in detail (p: 0.0035; OR: 1.852; CI: 1.236 to 2.774). About 127(30.09 %) of participants scored 80% or higher. Extracurricular training was associated with withholding information from patients, up to 27 times more than other factors (p< 0.0001; OR: 27.042; CI: 13.628 to 53.657). when it comes to get IC, HCP with many years of practice scored better than others, in one of the question the odd ratio was closer to 7 ( p< 0.0001; OR: 6.713; CI: 4.352 to 10.356). Only 47(11.14%) of the participants scored 80% or more of the questions about practice of IC.

Conclusion: For a variety of reasons, knowledge and practice of IC among HCPs was very low. A common programme for the country as part of formal training might lead to an improvement. In addition, patients’ education on IC should be displayed in waiting areas at all medical centres.

Keywords: Informed consent; medical examinations; procedures by health workers in the Democratic Republic of Congo.
Teachers’ and students’ level of utilization of ICT tools for teaching and learning mathematics in Ilorin, Nigeria
Authors: Ameen Khadijat S , Adeniji Saidat M , Abdullahi Kehinde
Published: April 2021

Information and Communication Technology (ICT) is an instrument par excellence that a nation can rely upon to bring about self-reliance in an educational system. Therefore, there is the need to integrate ICT into teaching and learning; hence, the study investigated the assessment of Teachers’ and Students’ level of utilization of ICT tools for teaching and learning mathematics in Ilorin, Nigeria. The study was a descriptive research of the survey type. The population for the study was all senior secondary schools in Ilorin, Kwara State. A total of 170 students and 50 mathematics teachers were randomly selected from senior secondary schools in Ilorin. The instrument used for the study was a researchers-designed questionnaire, which comprised of 24 ICT tools. The instrument was validated and the reliability index of 0.78 was obtained. The data gathered was analyzed statistically using simple percentage and Chi-Square statistics analyses. The findings revealed amongst others that; mathematics teachers and students utilized ICT tools for teaching and learning mathematics respectively. Also, mathematics teachers and students were not skilled in utilizing ICT tools. The findings from the study show that the gender of both teachers and students does not have any influence on the teaching and learning of mathematics with the use of ICT tools. Based on the findings, It was, therefore, recommended among others that seminars and workshops should be organized for both female and male mathematics teachers on the benefits and how to incorporate ICT tools into their teaching activities and students should be encouraged to familiarize themselves with ICT tools so as to increase their level of competencies in the use of ICT tools.
Tutors’ perceptions about science curriculum reforms and challenges for their implementation in Teacher Training Colleges in Rwanda
Authors: Kanamugire Camille , Yadav Lakhan Lal , Mbonyiryivuze Agnes
Published: April 2021

This paper reports science tutors’ perceptions about science curriculum reforms occurred in Rwanda from 1996 to 2013 in Teacher Training Colleges (TTCs). It also highlights their perceptions about challenges and factors for effective implementation of Integrated Science Curriculum (ISC). Data for the study were collected from 26 science tutors teaching ISC in 11 TTCs from 4 provinces using questionnaires and structured interviews. Results showed that a slim majority of science tutors were not resistant to curriculum reform. Even if most of the science tutors were confident while teaching most of the topics in ISC, they have experienced some difficulties in teaching physics and cross-cutting domains related topics as well as practical activities. Other identified challenges include lack of qualified tutors to teach ISC in TTCs, insufficient contact hours allocated to ISC topics, tutors’ heavy workload, lack of sufficient science laboratory equipment and materials. In addition to TTC libraries that are not well equipped, lack of textbooks and teacher’s guides, as well as lack of in-service tutors’ training, were stressed to be some of the challenges. Even if it was found that most competencies, skills, knowledge and attitudes gained by student-teachers after completing ISC were highly rated by science tutors, communication skills and problem-solving skills that are claimed to be important skills needed by graduates of science in the workplaces were poorly rated. The recommended strategies to overcome the identified challenges include active involvement of TTCs’ science tutors in designing and development of ISC. Moreover, all TTCs should be provided with qualified science tutors to teach ISC. Training for in-service science tutors, recruitment of qualified tutors, and provision of adequate facilities, libraries and well-equipped science laboratories for all TTCs are also recommended.
Students’ conceptual understanding of electricity and magnetism and its implications: A review
Authors: Mbonyiryivuze Agnes , Yadav Lakhan Lal , Amadalo Maurice Musasia
Published: April 2021

Physics subject continues to be considered as difficult and unattractive by students. This leads to the development of negative attitudes towards the subject. Electricity and magnetism as one of the most important areas in physics is particularly considered as difficult due to their abstract nature. Different studies on students’ conceptual understanding of electricity and magnetism have been conducted and several instructional strategies for a conceptual change in this subject matter have been provided. However, there are still some persisting misconceptions even after being treated by those suggested instructional strategies. By using diagnostic tests and remedial approaches to sort out learning barriers, there is a possibility that students’ performance might improve, which would likely lead to disappearing these learning barriers and retaining the appropriate concepts over time scales beyond the assessment schedule of individual classes. Therefore, after reporting on the impact of students’ preconceptions on learning, this review paper also highlights some existing studies on students’ misconceptions in electricity and magnetism. The paper also updates physics educators and researchers on some conceptual tests and assessments used to test students’ misconceptions in electricity and magnetism and some suggested strategies for remedying those misconceptions. Some educational implications and practical recommendations for effective teaching and learning in electricity and magnetism are also outlined.
Effect of alley plants species and plantain cultivars on yield of ita 331 upland rice in Umudike southern Nigeria
Authors: Onyenso A.I. , Nwobodo K.A. , Onyenweaku L.N.
Published: April 2021

Alley cropping or hedgerow intercropping is one of the many sub-systems of agroforestry technology. A 5 x 3 factorial experiment in a Randomized Complete Block Design (RCBD) with three replications was used to determine the effect of four alley woody species and three plantain cultivars on the yield of ITA 331 upland rice grain in the 2017 and 2018 farming seasons. The Alley species, plantain  cultivars and Alley species x plantain cultivars treatment interactions showed no significant effects (p>0.05) on ITA 331 upland rice grain yield. Student t-test on the two farming seasons showed significant increase in yield of ITA 331 upland rice grain in 2018 than in 2017. The non-significantly different rice grain yield in the alley species treatment plots could be due to the generally high nutrient release of the decomposed legume-based alley species. Agroforestry combination of alley plants species and plantain cultivars is suitable for ITA 331 upland rice production.

Key words: alley cropping, yield, ITA 331 upland rice grain, alley woody species, plantain cultivars
Anti- nutrient contents of herbs used in the treatment of “ailments of ‘‘utmost native importance” in Cross River State, Nigeria
Authors: Ebu Vincent Tawo , Mgbang John Edward , Bukie James Oshita
Published: April 2021

The use of herbs as medications are enthusiastically recognized and extensively utilized in rural regions and in most developing countries. The lack of knowledge of the anti-nutrient contents of herbs reduces their use by the educated ones. To unveil these in the treatment of “ailments of utmost native importance” in Cross River State, this research carried out anti-nutrient analysis of the species used. Identified plants were separated from weeds and washed with water. The plant parts were processed and their extracts prepared according to the method described by Kumar et al., (2007). Hydrocyanic acid was estimated by the alkaline titration method, oxalate was determined according to procedures stipulated by Day and Underwood (1986) while phytic acid was determined using methods stipulated by Reddy and Love (1999). Results revealed that Phytic acid, oxalate and hydrocyanide all had low levels ranges of 2.47mg/100gDM to 6.17mg/100g DM, 12.82mg/100g DM to 30.41mg/100g DM and 1.62mg/100g to 6.23mg/100g DM respectively. Findings shows that these anti-nutrients are not within harmful ranges, and as such cannot interfere with the availability of potentially useful nutrients embedded in the species. These are below lethal doses to inflict any injury on humans.

Keywords: Herbs, Anti-nutrients, Ailments, Lethal dose, Efficacy.
Livestock trypanosomiasis, owners’ perception and search for human gambiense parasite in cattle and sheep in remote communities of Iseyin, Nigeria
Authors: Enwezor F.N.C. , Emmanuel R.T. , Bizi R.L. , Olanrewaju T.O. , Kugama M.A. , Jarmai K.Y. , Tijjani A.A. , Salawu M.J. , Yarnap J.E. , Abubakar S. , Wayo B. , David K. , Ezebuiro O.G.C. , Olaleye O.O. , Onogwu O.J. , Yusuf R.J. , Asongo I.C. , Ibrahim H. , Abraham O.A. , Saidu M.A. , Abdullahi D. , Umar S. , Sabo H.
Published: April 2021

The study assessed livestock for human and animal infective trypanosomes in seven remote communities of Iseyin, Oyo State, Nigeria. Blood samples collected at random from 330 cattle and 20 sheep were examined using the buffy coat technique and Leishman stained thin film. Packed cell volume and differential leukocyte counts were determined and interviews conducted. Animals examined showed clinical symptoms; emaciation (2%), rough hair coat (0.57%), body weakness (3.14%), ocular discharge (1.43%), dermatophylosis (0.57%) and ticks (0.57%). Leishman stained thin blood films indicated 34 cattle (9.71%) infected with Trypanosoma congolense, 0% infection in sheep and 100% slides positive for Anaplasma and Babesia parasites with no Trypanosoma brucei species. Anaemia was recorded in male cattle between 1year and 10 years old and was statistically significant (p<0.05). Acute inflammatory responses revealed by  neutrophilia, lymphocytopaenia and lymphocytosis; 21.81%, 1.51% and 10% respectively in cattle suggested underlying bacterial orparasitic infections. All (100%) herdsmen confirmed presence of tsetse and other biting flies in bush and canopies around water bodies and stated observable signs and symptoms of trypanosomiasis (samore) which could wipe off the whole herd if untreated. Risk of trypanosome infection remained high as long as the old systems of cattle rearing exist; and urinary schistosomiasis and intestinal ailments due to lack of access to clean and portable water.

Keywords: Livestock;Trypanosoma congolense; Trypanosoma brucei species;Iseyin; Nigeria