Effectiveness of implementation of "mental health nursing students' clinical competency model" on academic performance of nursing students

Background: Clinical nursing competence in mental health is one of the most important topics in theoretical and practical nursing training with many factors affecting it. The purpose of this study is to determine the impact of the implementation of the "mental health nursing students' clinical competence model" on nursing students' academic performance. Methods: This study is a semi experimental following one group of student nurses. "mental health nursing students' clinical competence model" for undergraduate nursing student's education was applied. The study population included 50 nursing students, who were studying from fifth semester to seventh semester and selected through census sampling. During the seventh semester after the completion of theoretical and practical courses in mental health nursing, re-evaluation was conducted and the scores before and after the implementation of the clinical competence model were compared. Results: Rate of clinical competency before the intervention, was estimated at the level of non-mastered; and after intervention was at the level of mastered, demonstrating a significant difference (p<0.001). Areas of clinical competency scores before and after the intervention were compared which showed significant difference in all the areas except the mental competency areas (p<0.05). Conclusions: The implementation of the "mental health nursing students' clinical competence model" and appropriate planning for achievement of mental health nursing specialized competency can ensure the achievement of clinical competency by nursing students.

Biodiversity monitoring, earth observations and the ecology of scale

Human activity and land-use change are dramatically altering the sizes, geographical distributions and functioning of biological populations worldwide, with tremendous consequences for human well-being. Yet our ability to measure, monitor and forecast biodiversity change - crucial to addressing it - remains limited. Biodiversity monitoring systems are being developed to improve this capacity by deriving metrics of change from an array of in situ data (e.g. field plots or species occurrence records) and Earth observations (EO; e.g. satellite or airborne imagery). However, there are few ecologically based frameworks for integrating these data into meaningful metrics of biodiversity change. Here, I describe how concepts of pattern and scale in ecology could be used to design such a framework. I review three core topics: the role of scale in measuring and modelling biodiversity patterns with EO, scale-dependent challenges linking in situ and EO data and opportunities to apply concepts of pattern and scale to EO to improve biodiversity mapping. From this analysis emerges an actionable approach for measuring, monitoring and forecasting biodiversity change, highlighting key opportunities to establish EO as the backbone of global-scale, science-driven conservation.

Variation Trends of Fine Particulate Matter Concentration in Wuhan City from 2013 to 2017

Fine particulate matter (PM_2.5) is directly associated with smog and has become the primary factor that threatens air quality in China. In order to investigate the variation patterns of PM_2.5 concentrations in various regions of Wuhan city across different time spans, we analyzed continuous monitoring data from six monitoring sites in Wuhan city from 2013 to 2017. The results showed that the PM_2.5 concentration from the various monitoring sites in the five-year period showed a decreasing trend. January, October, and December are the three months with relatively high mean monthly PM_2.5 concentrations in the year, while June, July, and August are the three months with relatively low mean monthly PM_2.5 concentrations in the year. The number of days with a daily mean concentration of 35–75 μg/m³ was the highest, while the number of days with a daily mean concentration of more than 250 μg/m³ was the lowest. PM_2.5 accounted for a large proportion of the major pollutants and is the main source of air pollution in Wuhan city, with an average proportion of over 46%.

PATTERNS AND INDICATIONS OF AMPUTATION IN CAPE COAST TEACHING HOSPITAL: A FOUR YEAR RETROSPECTIVE REVIEW

BACKGROUND

Limb amputation is reported to be a major but preventable public health problem that is associated with profound economic, social and psychological effects on the patient and family especially in developing countries where prosthetic services are unavailable, inaccessible or unaffordable.

AIM

The purpose of this study was to determine the patterns of and indications for limb amputations.

METHODOLOGY

A retrospective study, covering a 4-year period, involving 126 patients who underwent amputation at a teaching hospital was carried out. Data on patients including indication for amputation were obtained from theatre record books and folders and analyzed using SPSS and MS Excel. Data was presented in frequencies and percentages. Chi square tests were used to compare categorical variables and differences were considered significant if p<0.05.

RESULTS

The mean age of the 126 patients was 60.92(SD19.03) years with a median of 67years. There were 68 females and 58 males giving a female to male ratio of 1.2:1. Lower limb amputations were performed in 114(90.48%) and upper limb amputations in 12(9.52%) patients. The commonest indication for amputation was diabetic foot gangrene accounting for 54(42.86%) patients, followed by peripheral vascular disease 43(34.13%) and trauma 12(9.52%). Twenty-one of the patients who had amputations for indications other than diabetic foot gangrene also had diabetes mellitus. Below knee amputation was the commonest procedure performed (43.65%). One hundred and twenty (95.2%) were unilateral and 116 (92.1% ) were performed in a single-stage procedure.

CONCLUSION

Most of the amputations in the Cape Coast Teaching Hospital were performed in elderly patients, with a slight preponderance of women over men. Lower limb amputations were far more common than upper limb ones. The commonest indication for amputations was diabetic foot gangrene, with below knee amputation being the commonest type. There is an urgent need for public education on diabetes and its complications and on diabetic foot care. The establishment of a multidisciplinary diabetic foot care clinic is advocated if the incidence of limb amputations is to be reduced in the Cape Coast Teaching Hospital.

Reported Adverse Drug Reactions During the Use of Corticosteroids in a Tertiary Care Hospital

BACKGROUND

Corticosteroids have been used in numerous medical conditions. Studying the pattern and causality of adverse drug reactions (ADRs) helps us gain greater insight into their prevention, detection, assessment, and treatment. This reduces cost of health care and increases compliance. The study aimed to evaluate the ADRs reported in patients receiving corticosteroids for age, type of reaction, duration of steroid therapy, treatment prescribed for the ADR, and causal relationship of the ADR with the prescribed steroid.

METHODS

ADRs observed in the patients admitted to the hospital wards and reported from October 1, 2015, to January 1, 2016, were studied for age, type of reaction, seriousness of the reaction, duration of steroid therapy, and treatment prescribed for the ADR. Causality assessment was done using the WHO-UMC scale.

RESULTS

A total of 59 ADRs were reported. More than three-fourths (76.6%) were adults. The gastrointestinal system was the most common organ system affected (45.8%), followed by the cardiovascular system (18.6%). The other ADRs affected the psychiatric, dermatologic, musculoskeletal, endocrine, metabolic, and nervous systems. In addition, 3.4% of the ADRs were serious causing disability and prolongation of hospitalization respectively. More than half (57.4%) of the patients were on long-term steroids. Most (91.5%) of the ADRs showed a possible causal relationship, whereas 6.8% showed a probable causal relationship with the prescribed steroid. The causal relationship of one ADR with the prescribed steroid seemed unlikely.

CONCLUSION

The decision to initiate corticosteroids requires careful consideration of relative risks and benefits in each patient. Strategies such as low-dose and alternate day therapy may reduce the incidence of adverse effects.

Dynamical Relations in the Self-Pattern

The notion of a self-pattern, as developed in the pattern theory of self (Gallagher, 2013), which holds that the self is best explained in terms of the kind of reality that pertains to a dynamical pattern, acknowledges the importance of neural dynamics, but also expands the account of self to extra-neural (embodied and enactive) dynamics. The pattern theory of self, however, has been criticized for failing to explicate the dynamical relations among elements of the self-pattern (e.g., Kyselo, 2014; Beni, 2016; de Haan et al., 2017); as such, it seems to be nothing more than a mere list of elements. We'll argue that the dynamics of a self-pattern are reflected in three significant and interrelated ways that allow for investigation. First, a self-pattern is reflectively reiterated in its narrative component. Second, studies of psychiatric or neurological disorders can help us understand the precise nature of the dynamical relations in a self-pattern, and how they can fail. Third, referencing predictive processing accounts, neuroscience can also help to explicate the dynamical relations that constitute the self-pattern.

Editorial: Entropy in Landscape Ecology

Entropy and the second law of thermodynamics are the central organizing principles of nature, but the ideas and implications of the second law are poorly developed in landscape ecology. The purpose of this Special Issue “Entropy in Landscape Ecology” in Entropy is to bring together current research on applications of thermodynamics in landscape ecology, to consolidate current knowledge and identify key areas for future research. The special issue contains six articles, which cover a broad range of topics including relationships between entropy and evolution, connections between fractal geometry and entropy, new approaches to calculate configurational entropy of landscapes, example analyses of computing entropy of landscapes, and using entropy in the context of optimal landscape planning. Collectively these papers provide a broad range of contributions to the nascent field of ecological thermodynamics. Formalizing the connections between entropy and ecology are in a very early stage, and that this special issue contains papers that address several centrally important ideas, and provides seminal work that will be a foundation for the future development of ecological and evolutionary thermodynamics.

Pattern of childhood visual impairment and blindness among students in schools for the visually impaired in Lagos State: An update

AIM

The aim of this study was to determine the pattern of childhood visual impairment and blindness (VI and BL) among students attending schools for the visually impaired in Lagos State, with a view to providing information on avoidable causes as well as emerging trends that would be useful to policy-makers for the planning and implementation of strategies for the control of avoidable childhood BL in Lagos State.

SUBJECTS AND METHODS

The study was conducted among students enrolled in two schools for the visually impaired in Lagos State who developed VI/BL before the age of 16 years. Participants and their parents/guardians were interviewed to obtain medical history. Ocular and systemic examinations were also performed. Information was recorded using a modified World Health Organization/Prevention of BL Eye Examination Record for Children with BL and Low Vision and analysed using the Statistical Package for the Social Sciences version 23.0. Z-test determined differences in the proportions of the causes of VI/BL between this study and an earlier study.

RESULTS

A total of 116 students were enrolled in this study of which 65 (56.0%) were males. Avoidable causes accounted for 58.5% of VI/BL. Preventable causes predominated with measles (15; 12.9%) accounting for the largest proportion. Surgical complications (16; 13.8%) were the largest cause of VI/BL. A statistically significant decrease (P = 0.004; 95% confidence interval = 0.09-0.50) in the proportion of avoidable BL between a previous study carried out in Lagos State and this study was found. Hereditary cataract and cortical VI were the findings of this study not recorded in the previous study.

CONCLUSION

Avoidable causes of childhood VI/BL still predominate among students in the schools for the visually impaired in Lagos State; however, there is a statistically significant decrease.

Tobacco use: prevalence, pattern, and predictors, among those aged 15-49 years in Nigeria, a secondary data analysis

INTRODUCTION

Tobacco use is a major global public health challenge. It is a risk factor for most leading causes of death, and its health impacts span from conception to adulthood. This study aims to analyse tobacco use data from the 2013 Nigerian Demographic and Health Survey (NDHS), assessing the prevalence, pattern, and socio-demographic correlates of tobacco use among Nigerians aged 15-49 years.

METHODS

A secondary data analysis involving 2013 NDHS was done. Data on 17 322 respondents were extracted from 36 800 participants. This number represents respondents with complete data on outcome variables of interest. Primary Sampling Unit defined on the basis of Enumeration Areas from the 2006 census was used. Head of selected household, all men and women aged 15-49 were studied. Data was collected using questionnaires. A chi-squared test and a binary logistic regression model were used in the analysis.

RESULTS

Generally, 6.6% of the respondents smoked cigarettes, 1.7% used snuff, 0.4% smoked pipe, and 0.2% chewed tobacco. Based on gender, 6.6% males and 6.3% females smoked cigarettes, 0.3% males and 0.4% females smoked cigarettes as well as used snuff. Predictors of cigarette use included being in age group 25-34 years (AOR 5.8; 95% CI 4.6-7.2), being ≥35 years (AOR 4.1; 95% CI 4.1-6.8), having attained primary education (AOR 1.4; 95% CI 1.2-1.8), living in north region (AOR 1.3; 95% CI 1.1-1.5), as well as being a Moslem (AOR 0.6; 95% CI 0.5-0.7).

CONCLUSIONS

A minor proportion of both genders uses tobacco with the commonest form being cigarettes. The commonest combination was cigarettes and snuff, even on stratification by gender. The identified predictors were age in categories, educational level and religion.

Patterns of tobacco use in patients with upper aero digestive tract cancers: A hospital-based study

Background

Tobacco use is a major risk factor for increasing the burden of upper aero digestive tract (UADT) cancer in the population of Northeast India.

Objective

The objective of this study was to investigate the pattern of tobacco use in different UADT cancer.

Materials and Methods

This was a retrospective study of electronically recorded data of the Hospital Cancer Registry for the period of May 2014 to December 2014. The UADT cancers were evaluated for gender and age-group distribution, their relative proportion, and association with tobacco use and tobacco-associated risk in males to develop UADT cancers. The type of tobacco usage was clustered as chewable, smoking, and both. Relative risk (RR) of UADT with tobacco usage was identified for males.

Results

A total of 1965 (n) UADT cancer patients were identified, male:female was 2.9, tobacco habits was in 1608 (81.8%) patients, both forms of tobacco use in 705 (43.8%), chewable tobacco use in 588 (36.6%) and smoking in 315 (19.6%) patients, tobacco habits in males ranges from 67.3% to 94.3% and in females range from 5.7% to 32.7%, RR of UADT cancer in males for tongue cancer was 1.5 (confidence interval [CI] =1.2-1.9), oropharynx was 1.4 (CI = 1.0-1.8), hypopharynx 1.4 (CI = 1.1-1.7), esophageal cancer was 1.4 (CI = 1.3-1.7), and for laryngeal cancer RR was 1.7 (CI = 1.0-3.0).

Conclusion

Consumption of chewable tobacco is the major form of tobacco use alone or in combination in UADT cancer patients of our population.

Classification of facial vitiligo: A cluster analysis of 473 patients

Vitiligo has a substantial negative impact on quality of life in affected patients, especially those with the involvement of the face. However, the current system can barely distinguish between specific patterns of facial involvement except for the segmental type when focusing only on facial lesions. We classified facial vitiligo into three distinct subtypes using cluster analysis based on facial topography (n = 473): centrofacial vitiligo (72.9%), panfacial vitiligo (18.0%), and hairline vitiligo (9.1%). Centrofacial vitiligo was the most common type and is thought to comprise the typical facial involvement of generalized vitiligo. Panfacial vitiligo was a distinct subtype with onset in old age and less involvement of other body parts. Hairline vitiligo was another distinct subtype with onset in old age and a poor response to conventional phototherapy. A relevant classification system could help us to explore the causes, anticipate the prognosis, and manage the condition in patients with vitiligo.

A pilot study comparing pattern of damage sustained among instruments from different surgical units in a tertiary care centre in Nepal - reappraising the role of instrument reprocessing in retaining their value

Background: The quality of instruments plays a pivotal role in governing safe operating room culture. The reprocessing system followed in the institution determines their durability thereby ensuring patient safety as well as minimizing health spending. Rigorous reprocessing in a centralized instrument reprocessing department by well trained staff following formulated guidelines helps to achieve the target of "safe surgery saves lives" as formulated by the World Health Organization. Methods: We sought to determine the patterns of wear and tear sustained among sets of surgical equipment from two surgical units that had been sent to the repair department within a year of their purchase. Analysis of similar changes in the joints of the instrument, as well as pattern of fractures sustained was performed. Results: All patterns of wear and tear were common in both the general surgical arm and neurosurgical counterpart, with the exception of fractures and mal-alignments. Similar study was performed examining changes in the joints. Stains were the most commonly observed change pattern in both sets of instruments. Fractures were most frequent in the working ends in both sets of instruments. Conclusion: There is an alarming incidence of wear and tear patterns in the instruments used in the surgical units, even within the first year of their use. This supports the strict implementation of reprocessing guidelines by well trained workers and their quality assessments via audit checks. The quality of the purchased instruments also plays a pivotal role.

Influence of patterned titanium coatings on polarization of macrophage and osteogenic differentiation of bone marrow stem cells

Biomaterial surface topography plays a vital role in the osteointegration of implants by regulating the early cell responses and tissue growth-in. However, most of the previous researches focused on the effects of osteogenic cells, only a little is known about the immune cells which dominate osteogenesis after implanting. In this paper, patterned titanium coatings were fabricated and the effects of surface topography on the macrophage behaviors were investigated. On patterned titanium surface, macrophages preferred to polarize to M2, while macrophages on traditional titanium coatings presented higher M1 polarization. Nearly 70% higher expression of anti-inflammatory genes, including interleukin-4, interleukin-10, interleukin-1ra, and arginase, were detected on the patterned titanium coatings. While the pro-inflammatory genes, such as interleukin-1β, interleukin-6, tumor necrosis factor-α, interferon-γ, and inducible nitric oxide synthase were notably depressed. Up-regulation of the osteoinductive cytokines were also detected on the patterned coatings, which indicated advantageous osteogenic microenvironment provided by macrophages. Immunomodulation effect on osteogenesis was also investigated in this study. Stimulated with RAW cells/patterned coatings conditioned medium, bone marrow stem cells presented nearly 1.5 fold higher expression of osteogenic genes and more mineralization nodules than the traditional sprayed Ti coatings. All these results suggested that modulating materials with a patterned surface might be a valuable strategy to endow the implants with favorable osteoimmunomodulatory properties.

Level and pattern of human rabies and dog bites in Techiman Municipality in the Middle Belt of Ghana: a six year retrospective records review

Introduction

Rabies is a viral zoonotic disease that is transmitted primarily by bites from rabid dogs and has the highest case fatality rate of most infectious diseases in humans. We described a 6-year trend of rabies and dog bites in a peri-urban district in Ghana.

Methods

A record review was conducted in the health facilities in Techiman to identify all human rabies and dog bite cases reported from January 2011 to December 2016. Rabies and dog bite data were extracted from health facilities records. Vaccination status of implicated dogs was extracted from the veterinary records at the Techiman Disease Investigation Farm. Data were summarized using proportions and presented using tables, charts and figures.

Results

Thirteen (13) cases of human rabies were recorded from 2011 to 2016. Complete data was available for 10 cases. Median age of rabies victims was 30 (range 3-80 years). A majority were males (8 representing 61.5%). Eight cases came from rural farming communities, 8 had a previous history of dog bite ranging from two weeks to five months before the onset of rabies symptoms and one reported with non-bite rabies. Case fatality was 100%. A total of 680 dog bites were reported by health facilities. About 50.3% (342) of the victims were males, a majority of bites (47.9%) occurred among children aged 1-15 years. Positive rabies cases among offending dogs ranged from 3.3% in 2016 to 17.6% in 2014.

Conclusion

Mass vaccination of dogs and provision of post-exposure vaccination are needed to reduce rabies transmission.

Precise Assembly of Particles for Zigzag or Linear Patterns

Precise control of particles assembly has tremendous potential for fabricating intricate structures and functional materials. However, it is still a challenge to achieve one-dimensional assembly with precisely controlled morphology. An effective strategy is reported to precisely assemble particles into well-defined patterns by liquid confinement through controlling the viscosity of the assembly system. It is found that high viscosity of the system impedes particles rearrangement and facilitates the generation of zigzag or twined zigzag assembly structures, while low viscosity of the system allows particles to rearrange into linear or zipper structures driven by lowering the surface deformation of the liquid. As a result, precise control of different assembly patterns can be achieved through tuning the viscosity of solvent and size confinement ratios. This facile approach shows generality for particles assembly of different sizes and materials.

Anatomically Standardized Maps Reveal Distinct Patterns of Cartilage Thickness With Increasing Severity of Medial Compartment Knee Osteoarthritis

While cartilage thickness alterations are a central element of knee osteoarthritis (OA), differences among disease stages are still incompletely understood. This study aimed to quantify the spatial-variations in cartilage thickness using anatomically standardized thickness maps and test if there are characteristic patterns in patients with different stages of medial compartment knee OA. Magnetic resonance images were acquired for 75 non-OA and 100 OA knees of varying severities (Kellgren and Lawrence (KL) scores 1-4). Three-dimensional cartilage models were reconstructed and a shape matching technique was applied to convert the models into two-dimensional anatomically standardized thickness maps. Difference thickness maps and statistical parametric mapping were used to compare the four OA and the non-OA subgroups. This analysis showed distinct thickness patterns for each clinical stage that formed a coherent succession from the non-OA to the KL 4 subgroups. Interestingly, the only significant difference for early stage (KL 1) was thicker femoral cartilage. With increase in disease severity, typical patterns developed, including thinner cartilage in the anterior area of the medial condyle (significant for KL 3 and 4) and thicker cartilage in the posterior area of the medial and lateral condyles (significant for all OA subgroups). The tibial patterns mainly consisted of thinner cartilage for both medial and lateral compartments (significant for KL 2-4). Comparing anatomically standardized maps allowed identifying patterns of thickening and thinning over the entire cartilage surface, consequently improving the characterization of thickness differences associated with OA. The results also highlighted the value of anatomically standardized maps to analyze spatial variations in cartilage thickness. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2442-2451, 2017.

The patterns of birthmarks suggest a novel population of melanocyte precursors arising around the time of gastrulation

Systematic work in the mouse and chicken has mapped out two neural crest-derived pathways of melanocyte precursor migration. With these in mind, this study reappraises the patterns of congenital pigmentary disorders in humans and identifies three recurrent patterns consistent across genetically different diseases. Only two of these are seen in diseases known to be melanocyte cell-autonomous. The segmental pattern correlates well with the classical dorsolateral population from animal studies, demonstrating respect of the midline, cranio-caudal axial mixing, unilateral migration and involvement of key epidermally derived structures. Importantly however, the melanocyte precursors responsible for the non-segmental pattern, which demonstrates circular, bilateral migration centred on the midline, and not involving key epidermally derived structures, have not been identified previously. We propose that this population originates around the time of gastrulation, most likely within the mesoderm, and ultimately resides within the dermis. Whether it contributes to mature melanocytes in non-disease states is not known; however, parallels with the patterns of acquired vitiligo would suggest that it does. The third pattern, hypo- or hyperpigmented fine and whorled Blaschko's lines, is proposed to be non-cell-autonomous.

Injury patterns among various age and gender groups of trauma patients in southern Iran: A cross-sectional study

Administrative data from trauma referral centers are useful sources while studying epidemiologic aspects of injuries. We aimed to provide a hospital-based view of injuries in Shiraz considering victims' age and gender, using administrative data from trauma research center.A cross-sectional registry-based study of adult trauma patients (age ≥15 years) sustaining injury through traffic accidents, violence, and unintentional incidents was conducted. Information was retrieved from 3 hospital administrative databases. Data on demographics, injury mechanisms, injured body regions, and injury descriptions; outcomes of hospitalization; and development of nosocomial infections were recorded. Injury Severity Score (ISS) was calculated by crosswalking from ICD-10 (International Classification of Diseases) injury diagnosis codes to AIS-98 (Abbreviated Injury Scale) severity codes. Patients were compared based on age groups and gender differences.A total of 47,295 trauma patients with a median age of 30 (interquartile range: 24-44 years) were studied, of whom 73.1% were male and the remaining 26.9% were female (M/F = 2.7:1.0). The most common injury mechanisms in the male group were car and motorcycle accidents whereas females were mostly victims of falls and pedestrian accidents (P < .01). As age increased, a shift from transportation-related to unintentionally caused injuries occurred. Overall, young men had their most severe injuries on head, whereas elderly women suffered more severe extremity injuries. Injury severity was similar between men and women; however, elderly had a significantly higher ISS. Although incidence of nosocomial infections was independent of victims' age and gender, elderly men had a significantly higher mortality rate.Based on administrative data from our trauma center, male gender and age >65 years are associated with increased risk of injury incidence, prolonged hospitalizations, and in-hospital death following trauma. Development of a regional trauma surveillance system may provide further opportunities for studying injuries and evaluating preventive actions.

Pattern of presentation of gastroesophageal reflux disease among patients with dyspepsia in Kano, Nigeria

BACKGROUND

Dyspepsia is a symptom complex rather than a specific disease entity. It can be caused by both organic and functional gastrointestinal (GI) disorders. Gastroesophageal reflux disease (GORD) though a common digestive disorder worldwide is scarcely reported in Nigeria. The aim of this study is to determine the pattern of presentation of GORD among patients with dyspepsia.

METHODS

One hundred and seventy dyspeptic patients were recruited consecutively as they were referred to the Gastroenterology Unit of Aminu Kano Teaching Hospital for upper GI endoscopy. A prepared questionnaire on relevant demographic and clinical history relating to GORD was administered. Upper GI endoscopy was then performed on each patient.

RESULTS

The prevalence of GORD was 24.1%, with a M:F ratio of 1:1.1. Endoscopy-positive variant accounted for 16 cases (9.4%), while endoscopy-negative variant accounted for 25 cases (14.7%), with of the total GORD patients, 26(63.4%) were males while 15(36.6%) were females. Los Angeles Grade A (37.5%) was the predominant endoscopic esophageal mucosal injury found in 6 cases. Barrett's esophagus and esophageal adenocarcinoma accounted 4.9% each and were considered to be rare. Extra-esophageal manifestations were also rare.

CONCLUSIONS

Endoscopy-negative variant still remains the predominant endoscopic finding in GORD patients.

Charcot Collapse: Does Collapse Pattern Dictate Osseous Metabolism?

Charcot fracture pattern (FP) and Charcot dislocation pattern (DP) are 2 distinct collapse patterns identified in Charcot neuroarthropathy of the foot and ankle. These patterns are believed to demonstrate relative differences in central bone mineral density (BMD), which has been theoretically extrapolated to describe local BMD. To assess variation in local bone composition of FP and DP patients, 10 patients, 5 DP and 5 FP were recruited. The patient's age, body mass index (BMI), radiographs, central BMD, local BMD, sRANKL (soluble receptor activator nuclear factor kappa-beta ligand), sRAGE (soluble receptors of advanced glycated end-products), and osteocalcin were measured to determined bone metabolic status and density. Central BMD was determined using DEXA (dual-energy X-ray absorptiometry) scans of the hip. peripheral BMD was determined using scans at the level of the ankle mortise and Chopart's joint, depending on the location of collapse. These scans were then compared with controls. Central and peripheral DEXA scans were significantly reduced in the FP ( P = .002 and P < .0001) when compared with healthy controls. Additionally, FP patients demonstrated statistically significant elevations in sRANKL ( P = .05) and sRAGE ( P = .002) when compared with DP. No significant difference was seen in osteocalcin ( P = 0.22); however, elevated values compared with normal reference ranges suggest increase bone production. These elevations combined with an osteoporotic profile may indicate difficulty of FP patients in repairing micro fracture. Results from this study emphasize the increased risk of nonunion during FP reconstruction, and highlight the variation in bone composition in these 2 Charcot subtypes.

LEVELS OF EVIDENCE

Level III.

Fracture line morphology of complex proximal humeral fractures

BACKGROUND

The aim of this study was to assess proximal humeral fracture patterns using 3-dimensional computed tomography images and relate them to the normal osseous landmarks and soft-tissue attachments.

METHODS

Forty-eight 3-dimensional computed tomography scans of proximal humeral fractures were retrospectively collected, and the fractures were transcribed onto proximal humeral templates. We analyzed the common location and orientation of the fracture lines, with a focus on fractures of the articular surface, tuberosities, metaphysis, and proximal diaphysis. These fractures were compared with the attachments of the rotator cuff and glenohumeral capsule.

RESULTS

Fifty-two percent of the fractures involved the articular surface. No fractures passed through the bicipital groove, and fractures were more commonly found on the posterior lesser tuberosity and on the anterior greater tuberosity, coinciding with the intervals between the rotator cuff tendon insertions. Intracapsular fractures of the calcar were more common (68%) than extracapsular fractures (32%). On the anterolateral aspect of the proximal humerus, fractures radiated from the articular margin, vertically down through the tuberosity zone between the rotator cuff footprints, meeting horizontally oriented fractures in the metaphyseal zone. On the posterior aspect, vertical fractures from the tuberosity zone continued downward to the metaphyseal zone adjacent to the infraspinatus and teres minor footprints.

CONCLUSIONS

Fractures of the proximal humerus follow characteristic patterns. Fractures frequently split the greater tuberosity and are closely related to the intervals of the rotator cuff attachments.

Factors affecting oral health determinants in female university students: a cross-sectional survey in Saudi Arabia

Objective This study aims at investigating factors affecting oral health patterns, attitudes and health risk behaviors among female university students. Methods An online questionnaire was distributed to female university students in Al Madinah in the western region of Saudi Arabia. Students were requested to answer questions on demographic data, oral hygiene practices, dental attendance, smoking history, practice of sports and body weight and height. Results Two hundred and fourteen students participated with age range of 18-31 years (mean = 21.64 ± 1.72 years). Oral hygiene habits were reported by a percentage of 97.2%, 34.6%, 30.8% and 19.2% who used a tooth brush, dental floss, mouthwash, and a miswak (a teeth cleaning twig made from the Salvadora persica tree), respectively. The only factor that was significantly associated with a good oral hygiene level was a university major of non-healthcare specialties (p = 0.009). Conclusion It is concluded that female university students use various oral hygiene methods, however, dental attendance is poor and a number of health risk factors are noticed like smoking, lack of practicing sport and unhealthy body mass index (BMI).

Analysis of β-strand Twist from the 3-dimensional Image of a Protein

Electron cryo-microscopy (Cryo-EM) technique produces density maps that are 3-dimensional (3D) images of molecules. It is challenging to derive atomic structures of proteins from 3D images of medium resolutions. Twist of a β-strand has been studied extensively while little of the known information has been directly obtained from the 3D image of a β-sheet. We describe a method to characterize the twist of β-strands from the 3D image of a protein. An analysis of 11 β-sheet images shows that the Averaged Minimum Twist (AMT) angle is larger for a close set than for a far set of β-traces.

Surface Topography Guides Morphology and Spatial Patterning of Induced Pluripotent Stem Cell Colonies

The relevance of topographic cues for commitment of induced pluripotent stem cells (iPSCs) is largely unknown. In this study, we demonstrate that groove-ridge structures with a periodicity in the submicrometer range induce elongation of iPSC colonies, guide the orientation of apical actin fibers, and direct the polarity of cell division. Elongation of iPSC colonies impacts also on their intrinsic molecular patterning, which seems to be orchestrated from the rim of the colonies. BMP4-induced differentiation is enhanced in elongated colonies, and the submicron grooves impact on the spatial modulation of YAP activity upon induction with this morphogen. Interestingly, TAZ, a YAP paralog, shows distinct cytoskeletal localization in iPSCs. These findings demonstrate that topography can guide orientation and organization of iPSC colonies, which may affect the interaction between mechanosensors and mechanotransducers in iPSCs.

Polymerizable Supramolecular Approach to Highly Conductive PEDOT:PSS Patterns

Owing to its high conductivity, solution processability, mechanical flexibility, and transparency, poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS) has been extensively explored for use in functional devices including solar cells, sensors, light-emitting diodes, and supercapacitors. The ability to fabricate patterned PEDOT:PSS on a solid substrate is of significant importance to develop practical applications of this conducting polymer. Herein, we describe a new approach to obtain PEDOT:PSS patterns that are based on a polymerizable supramolecular concept. Specifically, we found that UV irradiation of a photopolymerizable diacetylene containing PEDOT:PSS film followed by development in deionized water and subsequent treatment with sulfuric acid (glass and silicon wafer) or formic acid (PET) produces micron-sized PEDOT:PSS patterns on solid substrates. The newly designed photolithographic method, which can be employed to generate highly conductive (>1000 S/cm) PEDOT:PSS patterns, has many advantages including the use of aqueous process conditions, a reduced number of process steps, and no requirement for plasma etching procedures.

Spatiotemporal analysis of spontaneous myogenic contractions in the urinary bladder of the rabbit: timing and patterns reflect reported electrophysiology

The dynamics of propagating myogenic contractions in the wall of the resting ex vivo urinary bladder of the rabbit were characterized by spatiotemporal maps and related to cyclic variation in intravesical pressure (P_ves). Patches of propagating contractions (PPCs) enlarged and involuted in near synchrony with peaks in P_ves [mean 3.85  ± 0.3 cycles per minute (cpm)] and were preceded by regions of stretch. The maximum area of the bladder undergoing contraction (55.28 ± 2.65%) and the sizes of individual PPCs (42.61 ± 1.65 mm²) coincided with the peak in P_ves PPCs originated and propagated within temporary patch domains (TPDs) and comprised groups of nearly synchronous cyclic propagating individual contractions (PICs). The TPDs were located principally along the vertical axis of the anterior surface of the bladder. The sites of origin of PICs within PPCs were inconsistent, consecutive contractions often propagating in opposite directions along linear maps of strain rate. Similar patterns of movement occurred in areas of the anterior bladder wall that had been stripped of mucosa. P_ves varied cyclically with area of contraction and with the indices of aggregation of PPCs, indicating that they grew by peripheral enlargement and collision without annihilation. The synchronization of PICs within PPCs was sometimes lost, uncoordinated PICs then occurring irregularly (between 4 and 20 cpm) having little effect on P_ves We postulate that the formation and involution of PPCs within a TPD resulted from cyclic variation in excitation that increased the incidence and distance over which component PICs propagated.

Highly Conductive Transparent and Flexible Electrodes Including Double-Stacked Thin Metal Films for Transparent Flexible Electronics

To keep pace with the era of transparent and deformable electronics, electrode functions should be improved. In this paper, an innovative structure is suggested to overcome the trade-off between optical and electrical properties that commonly arises with transparent electrodes. The structure of double-stacked metal films showed high conductivity (<3 Ω/sq) and high transparency (∼90%) simultaneously. A proper space between two metal films led to high transmittance by an optical phenomenon. The principle of parallel connection allowed the electrode to have high conductivity. In situ fabrication was possible because the only materials composing the electrode were silver and WO₃, which can be deposited by thermal evaporation. The electrode was flexible enough to withstand 10 000 bending cycles with a 1 mm bending radius. Furthermore, a few μm scale patterning of the electrode was easily implemented by using photolithography, which is widely employed industrially for patterning. Flexible organic light-emitting diodes and a transparent flexible thin-film transistor were successfully fabricated with the proposed electrode. Various practical applications of this electrode to new transparent flexible electronics are expected.

Diagnostic approach to autoimmune hepatitis

INTRODUCTION

Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease which, if left without treatment, can evolve into cirrhosis and possibly liver failure. The diagnosis of AIH is hampered by the lack of specific and reliable markers of the disease and a number of clinical, biochemical, immunological, histological and genetic factors should be considered to reach a confident diagnosis Areas covered: Clinical expression of AIH, histological features, serological and genetic profiles, differential diagnosis, overlap with other autoimmune liver diseases, assessed on the basis of personal experience and review of published literature in the last 10 years through a systematic Medline search (keywords: autoimmune hepatitis, diagnosis) Expert commentary: Notwithstanding numerous efforts to identify simple and reliable markers of the disease, the diagnosis of AIH is still based on the combination of histological, immunological and biochemical features and often can represent a real challenge for the hepatologist.

Fluid dynamic instabilities: theory and application to pattern forming in complex media

In this review article, we exemplify the use of stability analysis tools to rationalize pattern formation in complex media. Specifically, we focus on fluid flows, and show how the destabilization of their interface sets the blueprint of the patterns they eventually form. We review the potential use and limitations of the theoretical methods at the end, in terms of their applications to practical settings, e.g. as guidelines to design and fabricate structures while harnessing instabilities.This article is part of the themed issue 'Patterning through instabilities in complex media: theory and applications'.

The molten glass sewing machine

We present a fluid-instability-based approach for digitally fabricating geometrically complex uniformly sized structures in molten glass. Formed by mathematically defined and physically characterized instability patterns, such structures are produced via the additive manufacturing of optically transparent glass, and result from the coiling of an extruded glass thread. We propose a minimal geometrical model-and a methodology-to reliably control the morphology of patterns, so that these building blocks can be assembled into larger structures with tailored functionally and optically tunable properties.This article is part of the themed issue 'Patterning through instabilities in complex media: theory and applications'.

Short communication: Nutrient consumption patterns of Lactobacillus acidophilus KLDS 1.0738 in controlled pH batch fermentations

This work focused on elucidating the nutrient consumption patterns of Lactobacillus acidophilus to guide the design of media for high-cell-density culture. We investigated the nutrient consumption patterns of L. acidophilus KLDS 1.0738 in chemically defined media in controlled pH batch fermentations. The most abundantly consumed amino acids, vitamins, ions, and purines and pyrimidines were Glu and Gly, pyridoxine and nicotinamide, K⁺ and PO₄^3-, and guanine and uracil, respectively. The highest consumption rates for amino acids, vitamins, ions, and purines and pyrimidines were Asp and Arg, folic acid and pyridoxine, Fe²⁺ and Mn²⁺, and uracil and thymine, respectively. Furthermore, most of the amino acids, as well as guanine, thymine, pyridoxine, folic acid, nicotinamide, Mg²⁺, PO₄^3-, and K⁺ had the highest bioavailability from the end of the lag growth phase to the mid-exponential growth phase. The overall consumption of glucose, adenine nucleotides, 2'-deoxyguanosine monohydrate, calcium pantothenate, Fe²⁺ and Mn²⁺ decreased with increasing average growth rate, indicating more effective use of these nutritional components at a higher average growth rate, as biomass yield based on nutritional component consumption increased. Our findings help to formulate complex media for high-cell-density cultivation and provide a theoretical basis for L. acidophilus feeding strategies.

A Method to Categorize 2-Dimensional Patterns Using Statistics of Spatial Organization

We developed a measurement framework of spatial organization to categorize 2-dimensional patterns from 2 multiscalar biological architectures. We propose that underlying shapes of biological entities can be approached using the statistical concept of degrees of freedom, defining it through expansion of area variability in a pattern. To help scope this suggestion, we developed a mathematical argument recognizing the deep foundations of area variability in a polygonal pattern (spatial heterogeneity). This measure uses a parameter called eutacticity. Our measuring platform of spatial heterogeneity can assign particular ranges of distribution of spatial areas for 2 biological architectures: ecological patterns of Namibia fairy circles and epithelial sheets. The spatial organizations of our 2 analyzed biological architectures are demarcated by being in a particular position among spatial order and disorder. We suggest that this theoretical platform can give us some insights about the nature of shapes in biological systems to understand organizational constraints.

Severe Hand Injuries From Fireworks: Injury Patterns, Outcomes, and Fireworks Types

PURPOSE

The purpose of this study was to characterize injury patterns and outcomes of fireworks-related hand injuries and determine if there was an association with certain fireworks types.

METHODS

A retrospective cohort study was conducted on patients treated at a trauma center between 2005 and 2015. A total of 105 patients sustaining operative hand injuries due to fireworks were identified. Medical records were reviewed to identify injury patterns, treatment outcomes, and fireworks types.

RESULTS

Eighty-eight patients (84%) sustained 92 thumb and/or first web space injuries. There were 12 thumb soft tissue-only injuries (13%) and 80 thumb fractures/dislocations (87%). Of these, there were 52 thumb carpometacarpal (CMC) joint dislocations (57%) and 36 thumb fractures outside the thumb CMC joint (39%). Fifteen hands (16%) sustained both thumb CMC joint dislocations and additional thumb fractures. Twenty-three hands (25%) required thumb revision amputation. The number of surgeries for acute reconstruction ranged from 1 to 7, with 17 patients (19%) requiring 3 or more. Sixty-three hands had deep first web space injuries, and 11 (17%) required flaps acutely for first web space reconstruction. Six hands required secondary reconstruction of a first web space contracture. An external fixator was applied to 6 hands to maintain the first web space; none of these required secondary web reconstruction. Excluding isolated pin removals and dressing changes under anesthesia, 19 patients (22%) required later-stage surgeries. Shells/mortars (59%) were the most common fireworks type causing injury.

CONCLUSIONS

Among operative hand injuries, fireworks most commonly fracture the thumb, destabilize the thumb CMC joint, and deeply damage the first web space. The first web space requires particular consideration because deep injury may result in adduction contracture and require secondary reconstruction if not prevented.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Trichoscopic Patterns in Squamous Cell Carcinoma: : A Case Report

Squamous cell carcinoma (SCC) is the second most cutaneous malignancy after basal cell carcinoma (BCC) with increasing incidence. In the view its nodular manifestation; it can appear similar to nodular BCC, atypical fibroxanthoma, sclerosing liposarcoma and desmoplastic melanoma. Prognostic and therapeutic implications are different in all these conditions and thus their distinction becomes important. Trichoscopy is a simple and non-invasive technique to visualize certain morphological features of skin lesions and it improves the diagnostic accuracy for melanocytic and nonmelanocytic pigmented lesions. Here, a case is reported wherein trichoscopic patterns were useful in the diagnosis of SCC on the scalp. To the best of our knowledge, this is the first report on trichoscopic patterns in SCC from India.

Sedentary Behavior Is Only Marginally Associated with Physical Function in Adults Aged 40-75 Years-the Maastricht Study

Background: In an aging population, regular physical activity (PA) and exercise have been recognized as important factors in maintaining physical function and thereby preventing loss of independence and disability. However, (older) adults spent the majority of their day sedentary and therefore insight into the consequences of sedentary behavior on physical function, independent of PA, is warranted. Objective: To examine the associations of objectively measured sedentary time (ST), patterns of sedentary behavior, overall PA, and higher intensity PA (HPA) with objective measures of physical function. Methods: This is a cross-sectional study in 1,932 men and women (aged 40-75 years) participating in The Maastricht Study. The activPAL3 was used to assess daily sedentary behavior: ST (h), sedentary breaks (n), prolonged (≥30 min) sedentary bouts (n), and to assess time spent in (H)PA (h). Measures of physical function included: covered distance during a 6 min walk test [6MWD (meters)], timed chair rise stand test performance [TCST_time (seconds)], grip strength (kg kg^-1), and elbow flexion and knee extension strength (Nm kg^-1). Linear regression analyses were used to examine associations between daily sedentary behavior and PA with physical function. Results: Every additional hour ST was associated with shorter 6MWD [B = -2.69 m (95% CI = -4.69; -0.69)] and lower relative elbow extension strength (B = -0.01 Nm kg^-1 (-0.02; 0.00). More sedentary breaks were associated with faster TCST_time: B = -0.55 s (-0.85; -0.26). Longer average sedentary bout duration was associated with slower TCST_time [B = 0.17 s (0.09; 0.25)] and lower knee extension strength [B = -0.01 Nm kg^-1 (-0.02; 0.00)]. Every hour of PA and HPA were associated with greater 6MWD [B_PA = 15.88 m (9.87; 21.89), B_HPA = 40.72 m (30.18; 51.25)], faster TCST_time [B_PA = -0.55 s (-1.03; -0.07), B_HPA = -2.25 s (-3.09; -1.41)], greater elbow flexion strength [B_PA = 0.03 Nm kg^-1 (0.01; 0.07)], [B_HPA = 0.05 Nm kg^-1 (0.01; 0.08)], and greater knee extension strength [B_PA = 0.04 Nm kg^-1 (0.01; 0.07)], [B_HPA = 0.13 Nm kg^-1 (0.06; 0.20)]. Conclusion: In adults aged 40-75 years, sedentary behavior appeared to be marginally associated with lower physical function, independent of HPA. This suggests that merely reducing sedentary behavior is insufficient to improve/maintain physical function. In contrast, engaging regularly in PA, in particular HPA, is important for physical function.

Maxillofacial fractures in a budding teaching hospital: a study of pattern of presentation and care

INTRODUCTION

Previous reports indicated that there is geographic and sociodemographic variation in the epidemiology of maxillofacial fractures. Audit of maxillofacial injuries managed at any institution is therefore necessary to understand the trends and proffer strategies for prevention. We therefore embarked on this study to determine the pattern of maxillofacial fractures and concomitant injuries in our institution.

METHODS

We carried out a retrospective review of information on demography, aetiology and type of maxillofacial fracture, patients' status, type of crash, level of consciousness and concomitant injuries. The data collected was analysed with SPSS Version 20.

RESULTS

A total of 233 patients aged 2 to 66 years were reviewed. A higher male preponderance (M:F 3.4:1) was observed. Road traffic crashes (RTC) accounted for 78.5% of injuries. Motorcycle related crashes were responsible for 69.4% of RTC and 54.5% of all fractures. Fracture of the mandible (63.2% n=172) was the most predominant skeletal injury and the body (25% n=43) was the most common site of fracture while the zygoma (29%) was predominantly affected in the midface. Ninety three patients (40%) suffered loss of consciousness. The relationship between aetiology of injuries and consciousness level of the patients was statistically significant (p=0.001). Of the 43 patients who had concomitant injuries, craniocerebral affectation (60.5%) was the commonest.

CONCLUSION

RTC remains the major aetiology of maxillofacial fractures. The mandible was mostly affected and nearly half of the patients have associated loss of consciousness. There is need for continual advocacy and enforcement of laws on preventive measures among road users.

The changing trend of cardiovascular disease and its clinical characteristics in Ethiopia: hospital-based observational study

Objective

The aim of this study was to assess the pattern of cardiovascular diseases (CVDs), their clinical characteristics, and associated factors in the outpatient department of the chronic illness clinic of Gondar University Referral Hospital.

Method

A retrospective cross-sectional study was conducted among patients on follow-up at the outpatient chronic illness clinic of the hospital from October 2010 to October 2015. The source population for the study included patients with a diagnosis of CVD whose medical records have the required socio-demographic information during the study period. The data were collected from August 2015 to December 2015. Chi-square and binary logistic regression tests were performed to test the significance of difference among predictive variables and CVDs.

Results

Of 1105 patient medical records, 862 fulfilled the inclusion criteria. The majority of the patients were females (65%) and living in urban areas (62.7%). Hypertension accounted for the majority (62.3%) of CVDs followed by heart failure (HF) (23.9%). Headache was the leading chief complaint among the patients (37.7%) upon diagnosis and was the prominent clinical feature in more than half of the patients during their course of follow-up. Higher proportions of dyslipidemia (85.7%), hypertension (72.8%), and ischemic heart disease (IHD) (73.2%) were associated with urban residency (P<0.01). Patients from rural areas (crude odds ratio [COR] =1.306 [95% confidence interval 1.026–2.166], adjusted odds ratio [AOR] =1.272 [95% confidence interval 1.017–2.030]) and those with comorbidity illnesses (COR= 1.813 [1.279–2.782], AOR =1.551 [95% confidence interval 1.177–2.705]) were more likely to have poor CVD outcome (P<0.05).

Conclusion

Hypertension was found to be the most frequent CVD followed by HF, and hypertensive heart disease was the leading cause of cardiac diseases. Most of the patients had improved assessment in the last follow-up, but patients from rural regions and those with comorbidty had higher likelihood of poor cardiovascular outcome.

A 5-year review of pattern of placenta previa in Ilorin, Nigeria

BACKGROUND

Placenta previa, a major cause of obstetric hemorrhage, is potentially life-threatening to the mother and frequently results in high perinatal morbidity and mortality.

METHODOLOGY

This is a retrospective study of all cases of placenta previa managed at the University of Ilorin Teaching Hospital over a 5-year from January 2011 to December 2015. A pro forma template was used to harvest information from case notes of patients involved in the study.

RESULTS

There were a total of 10,250 deliveries over the 5-year study and 164 cases of placenta previa were managed during this period; giving an incidence of 1.6% of the total deliveries. Of these patients, 65.9% were unbooked while 34.1% were booked. 110 (67%) were above 30 years of age and 51.2% were grand multiparous women. The majority (81.7%) of the patients belonged to the low socioeconomic class. Painless vaginal bleeding (62.2%), intrapartum hemorrhage (22.6%), and abnormal lie presentation (8.5%) were the most common mode of presentation. Vaginal delivery occurred in (29.3%) of patients while 70. 7% were delivered through cesarean section. There was a significant association between patients' age, parity, booking status, and types of placenta previa (P < 0.05). Similarly, there was a significant association between gestational age at delivery, mode of delivery, intraoperative blood loss, and birth weight at delivery and types of placenta previa (P < 0.05). Perinatal mortality was 12.2%, 15.6% of babies had severe birth asphyxia, and there was no maternal mortality.

CONCLUSION

From this study, the risk factors for placenta previa are advanced maternal age above 35 years, grand multiparity, and booking status. Early recognition, appropriate referral of these patients and availability of ultrasound facilities, blood transfusion facilities, improvement in neonatal facilities and trained personnel will go a long way in reducing the perinatal mortality from placenta previa.

Burden of psychiatric morbidity among attendees of a secondary level hospital in Northern India: Implications for integration of mental health care at subdistrict level

BACKGROUND

There is little information available on the type, pattern, trend, and demographic differentials of psychiatric cases attending a subdistrict level facility in India. Our objectives were to describe the sociodemographic profile of the patients availing the psychiatric outpatient department services and document the diagnosis.

MATERIALS AND METHODS

This study is based on a retrospective analysis of routinely recorded administrative data collected during psychiatry consultations that took place between January 2010 and June 2014, at the subdistrict level hospital, Ballabgarh, Faridabad district, Haryana, Northern India. The data were abstracted in Microsoft Excel, scrutinized for duplicates, and cleaned in terms of the International Classification of Diseases 10^th Revision coding. Descriptive analysis was done for dependent variables and continuous variables were compared using independent t-test.

RESULTS

A total of 2806 people (new registrations) were provided psychiatric consultations between January 2010 and June 2014. The mean age of males was 33.7 years (95% confidence interval [CI], 32.9, 34.5) and of females was 35.6 years (95% CI, 34.9, 36.3). Neurotic, stress-related, and somatoform disorders (F40-F48) comprised the major category of diagnoses with 661 cases (24%), followed by unspecified mental disorders (F99) with 528 cases (19%), mood (affective) disorders (F30-F39) with 448 cases (16%), and episodic and paroxysmal disorders (G40-G47) with 334 cases (12%).

CONCLUSIONS

We reported an increase in level and trend in the monthly attendance of patients who required psychiatric at a secondary care hospital in Northern India. We suggest that setting up of mental health units only at district hospital might not be a sufficient health system's approach as has been envisaged under the District Mental Health Program.

Vegetable, fruit, and phytonutrient consumption patterns in Taiwan

Phytonutrients may play important roles in human health and yet only recently a few studies have described phytonutrient consumption patterns, using data obtained from daily consumption methods. We aimed to estimate the phytonutrient content in Taiwanese diets and analyzed main food sources of 10 major phytonutrients. In this study, food items and dietary data gathered with the 24-hour dietary recall from 2908 participants in the 2005–2008 Nutrition and Health Survey in Taiwan were used to create a food phytonutrient database with 933 plant-based foods through integrating database, literature search, and chemical analysis and to appraise phytonutrient consumption status of participants. SUDAAN (Survey Data Analysis) was used for generating weighted phytonutrient intake estimates and for statistical testing. In Taiwanese adults, ~20% met the recommended number of servings for fruits and 30% met that for vegetables from the Taiwan Food-Guide recommendations. However, only 7.4% consumed the recommended numbers for both fruits and vegetables. Those meeting the recommendations tended to be older and with more females compared with those who did not. Phytonutrient intake levels were higher in meeters than nonmeeters. More than 60% of α-carotene, lycopene, hesperetin, epigallocatechin 3-gallate, and isoflavones came from a single phytonutrient-specific food source. In addition, sweet potato leaf, spinach, and water spinach were among the top three sources of multiple phytonutrients. Cross-comparison between this study and two previous studies with similar methodology showed higher mean levels of lycopene and quercetin in the United States, anthocyanidins in Korea, and lutein and zeaxanthin in Taiwan. The Taiwanese phytonutrient pattern is different from that of the Korean and American. It would be interesting to relate phytonutrient patterns to health profiles in the future.

Prevalence and pattern of sexual assault in Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Introduction

Sexual violence is an important public health problem of growing concern all over the world. This study was conducted to determine the prevalence and pattern of sexual assault managed in Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria.

Methods

It was a retrospective study that looked into cases of sexual assault admitted into the hospital between January 2010 and December 2014. Information on patients’ biodata, and relevant details on the cases were extracted from the patients’ case files and analyzed.

Results

Out of the 5317 gynecological admissions during the period under study, 45 (0.84%) were cases of sexual assault. Of these, only 34 case files were available for data extraction. The patients’ ages ranged from 2 to 37 years (mean = 12.6 + 8.3). About two thirds (61.8%) of those affected were young children (aged 12 years and below). In majority of cases (70.6%) the assault was penetrative, and in most of the cases (91.2%) only a single assailant was involved. In close to two thirds of cases, the assailant was either an acquaintance (38.2%) or a family member (20.6%). Although law enforcement agents were informed in majority (58.8%) of cases, arrests were made in less than half (41.2%).

Conclusion

Although the prevalence of sexual assault in this study appears to be low, a major cause for concern is the fact that those affected were predominantly young children. Parents should be more vigilant in monitoring their children’s movement, and stringent laws should be enacted and enforced to curb this heinous act.

Pityriasis lichenoides et varioliformis acuta in skin of color: new observations by dermoscopy

Background

Pityriasis lichenoides is an uncommon skin disease that presents in three different forms: pityriasis lichenoides et varioliformis acuta (PLEVA), pityriasis lichenoides chronica (PLC) and febrile ulceronecrotic-Mucha-Habermann disease. These represent a spectrum of a disease. PLEVA presents as skin eruption of multiple, small, red papules that develop into polymorphic lesions with periods of varying remissions, as well as possible sequels of hyper/hypopigmentation and varicella-like scars. Diagnosis of this condition is mainly clinical, and sometimes clinical differentiation from other conditions may be a difficult task that often requires histological analysis. In this study, PLEVA lesions were examined by dermoscopy, and the significance of specific dermoscopic findings was investigated in order to facilitate their differentiation from other inflammatory conditions.

Objectives

To evaluate dermoscopic patterns in PLEVA and to correlate these patterns with histopathology.

Materials and methods

The study was conducted at S. Nijalingappa Medical College, Bagalkot. It was an observational case series study and patients were selected randomly. Ethical clearance and informed consent were obtained. PLEVA lesions in early and late phases were evaluated. A manual DermLite 3 (3Gen, San Juan Capistrano, CA) dermoscope attached to a Sony (Cyber Shot DSC-W800, Sony Electronics Inc., San Diego, California, USA, digital, 14 mega pixels) camera was employed. Histopathology was done to confirm the diagnosis. Data was collected and analyzed. Results were statistically described in terms of frequencies and types of dermoscopic patterns.

Results

There was a total of 14 patients; 8 males and 6 females. Mean age of patients was 19 years. Mean duration of disease was 7 months. Dermoscopy in early-phase lesions revealed amorphous brownish areas around the hair follicles, dotted vessels, and scaling. Dermoscopy in late-phase lesions showed whitish-structureless areas and central white crust within whitish-structureless rim with scale, focal bluish-grayish areas or centrifugal strands irregularly distributed along the periphery and yellow structures. Red dots and hemorrhage were seen at the center and glomerular vessels at the periphery.

Conclusion

PLEVA demonstrates specific dermoscopic patterns that correlate well with histologic changes. New dermoscopic findings are described. Thus, dermoscopy is a good diagnostic tool in the clinical diagnosis of PLEVA.

Climate and season: the effects on ophthalmic diseases

Seasonal changes and climate have a significant impact on human health. Diseases influenced by temperature and climate conditions are likely to undergo dynamic pattern shifts with consequent impact on human health. A number of infectious and non-infectious ophthalmic diseases are influenced by temperature and seasonality. Awareness of this is important from public and global health perspective in addition to resource allocation strategies. We examine the evidence for a seasonal pattern to ophthalmic diseases and assess the possible impact of climate change.

Space-Time Point Pattern Analysis of Flavescence Dorée Epidemic in a Grapevine Field: Disease Progression and Recovery

Analyses of space-time statistical features of a flavescence dorée (FD) epidemic in Vitis vinifera plants are presented. FD spread was surveyed from 2011 to 2015 in a vineyard of 17,500 m2 surface area in the Piemonte region, Italy; count and position of symptomatic plants were used to test the hypothesis of epidemic Complete Spatial Randomness and isotropicity in the space-time static (year-by-year) point pattern measure. Space-time dynamic (year-to-year) point pattern analyses were applied to newly infected and recovered plants to highlight statistics of FD progression and regression over time. Results highlighted point patterns ranging from disperse (at small scales) to aggregated (at large scales) over the years, suggesting that the FD epidemic is characterized by multiscale properties that may depend on infection incidence, vector population, and flight behavior. Dynamic analyses showed moderate preferential progression and regression along rows. Nearly uniform distributions of direction and negative exponential distributions of distance of newly symptomatic and recovered plants relative to existing symptomatic plants highlighted features of vector mobility similar to Brownian motion. These evidences indicate that space-time epidemics modeling should include environmental setting (e.g., vineyard geometry and topography) to capture anisotropicity as well as statistical features of vector flight behavior, plant recovery and susceptibility, and plant mortality.

A 2016 clinical practice pattern in the management of primary hypothyroidism among doctors from different clinical specialties in New Delhi

BACKGROUND

This study aimed to document practices in managing hypothyroidism among doctors in New Delhi, with special focus on subclinical hypothyroidism, pregnancy, and old age, and to compare it with global practices.

METHODS

During an academic program attended by 394 doctors, all participants were given a questionnaire designed based on thyroid practices survey done by Burch et al. to evaluate the practice patterns. Questions were based on evaluating doctor's preferred choices in diagnosis, therapy, and follow-up of hypothyroidism in different scenarios.

RESULTS

Responses from 308 questionnaires (general physicians [n = 204], obstetricians [n = 51], pediatricians [n = 27], surgeons [n = 12], endocrinologists [n = 10], and others [n = 4]) were analyzed. In the evaluation of 52-year-old female patient with primary hypothyroidism, 52% doctors would prefer thyroid ultrasonography, comparable to global rates. Nearly 96.1% doctors would have initiated levothyroxine, with a large majority of doctors (83.77%) preferred using branded levothyroxine. About 58.74% doctors preferred gradual restoration of euthyroidism. Levothyroxine dose of 25 mcg was the most preferred increment dose (46.07%) during follow-up, with 6 weekly being the most frequent dose adjustment frequency (41.57%). Most preferred target thyroid-stimulating hormone (TSH) in the 52-year-old female patient was 2.5-4.99 mU/L (63.96%), 25-year-old female patient was 1-2.49 mU/L (53.90%), and in 85-year-old female was 2.5-4.99 mU/L (45.45%). Only 68% of doctors in our study preferred keeping TSH <2.5 mU/L during the first trimester of pregnancy, in contrast to global trends of 95% (P < 0.001).

CONCLUSION

There was a disproportionately high use of ultrasonography in hypothyroidism management, near exclusive preference for branded levothyroxine, widespread use of age-specific TSH targets, and low threshold for treating mild thyroid failure, a highly variable approach to both rates and means of restoring euthyroidism for overt primary hypothyroidism. There is a need for spreading awareness regarding TSH targets in pregnancy.

Estimating Between-Person and Within-Person Subscore Reliability with Profile Analysis

Subscores are of increasing interest in educational and psychological testing due to their diagnostic function for evaluating examinees' strengths and weaknesses within particular domains of knowledge. Previous studies about the utility of subscores have mostly focused on the overall reliability of individual subscores and ignored the fact that subscores should be distinct and have added value over the total score. This study introduces a profile reliability approach that partitions the overall subscore reliability into within-person and between-person subscore reliability. The estimation of between-person reliability and within-person reliability coefficients is demonstrated using subscores from number-correct scoring, unidimensional and multidimensional item response theory scoring, and augmented scoring approaches via a simulation study and a real data study. The effects of various testing conditions, such as subtest length, correlations among subscores, and the number of subtests, are examined. Results indicate that there is a substantial trade-off between within-person and between-person reliability of subscores. Profile reliability coefficients can be useful in determining the extent to which subscores provide distinct and reliable information under various testing conditions.

Etiology, clinical characteristics, and management of pleural effusion in Ilorin, Nigeria

Background:

Pleural effusion (PE) is a primary manifestation or secondary complication of many disorders. This study reviews the pattern and management of PE in a Nigerian hospital.

Materials and Methods:

The medical records of 213 patients with clinical diagnosis of PE over a period of 3 years were reviewed.

Results:

PE accounted for 0.5% of the total hospital admissions. The most common cause of PE was tuberculosis (TB) (32.9%), followed by malignancy (29.1%) and pneumonia (15.0%). The male to female ratio was 1.3:1. TB was the leading cause of effusion in males, while it was malignancy in females. Pneumonia accounted for 61.9% of PE in preschool age and 66.7% in school age. Breathlessness (50.0%), cough (39.4%), and chest pain (24.9%) were the common presentations. Most (90.1%) of them were exudative effusion and with half in the right lung. Chest radiography (91.6%), pleural fluid for Ziehl–Neelsen stain (74.7%), cytology (59.2%), and tissue biopsy (57.8%) were the common diagnostic investigations. The majority (92.0%) had closed thoracostomy tube drainage, while 9.9% had chemical pleurodesis. The intra-hospital mortality was 10 (4.7%).

Conclusion:

TB, malignancy, and pneumonia are the leading causes of PE. A multidisciplinary approach is needed for optimal management.

A drop array culture for patterning adherent mouse embryonic stem cell-derived neurospheres

New therapeutic approaches for repairing an injured or degenerating nervous system have accelerated the development of methods to generate populations of neurons derived from various stem cell sources efficiently. Many of these methods require the generation of neurospheres. Here a simple technique is described for creating an array of adherent mouse embryonic stem cell (mESC)-derived neurospheres using a conventional plastic culture dish and a patterning template. mESC-derived neurospheres are confined to circular (4-mm diameter), gel-coated regions within an array. The adherent neurosphere arrays require 3 days to prepare from an mESC source; they can be maintained in 15 μl drops of medium, and exhibit extensive neurite elaboration after 8 days of cultivation. Additionally, the potential of treating the adherent neurospheres in selected drops of an array is demonstrated with a variety of differentiation-inducing reagents and subsequently individually analysing such neurospheres for gene expression, protein levels and morphological development. Copyright © 2016 John Wiley & Sons, Ltd.

Pattern of Local Recurrence and Distant Metastasis in Breast Cancer By Molecular Subtype

BACKGROUND AND PURPOSE

 No longer considered a single disease entity, breast cancer is being classified into several distinct molecular subtypes based on gene expression profiling. These subtypes appear to carry prognostic implications and have the potential to be incorporated into treatment decisions. In this study, we evaluated patterns of local recurrence (LR), distant metastasis (DM), and association of survival with molecular subtype in breast cancer patients in the post-adjuvant radiotherapy setting.

MATERIAL AND METHODS

 The medical records of 1,088 consecutive, non-metastatic breast cancer patients treated at a single institution between 2004 and 2012 were reviewed. Estrogen/progesterone receptors (ER/PR) and human epidermal growth factor receptor-2 (HER2) enrichment were evaluated by immunohistochemistry. Patients were categorized into one of four subtypes: luminal-A (LA; ER/PR+, HER2-, Grade 1-2), luminal-B (LB; ER/PR+, HER2-, Grade > 2), HER2 over-expression (HER2; ER/PR-, HER2+), and triple negative (TN; ER/PR-, HER2-).  Results: The median follow-up time was 6.9 years. During the follow-up, 16% (174/1,088) of patients failed initial treatment and developed either LR (48) or DM (126). The prevalence of LR was the highest in TN (12%) and the lowest in LA (2%). Breast or chest wall relapse was the most frequent site (≈80%) of recurrence in LA, LB, and HER2 subtypes, whereas the regional lymph nodes and chest wall were the common sites of relapse in the TN group (50.0%). DM rates were 6.4% in LA, 12.1% in LB, 19.2% in HER2, and 27.4% in TN subgroups. Five-year survival rates were 84%, 83%, 84%, and 77% in the LA, LB, HER2 and TN subgroups, respectively. There was a statistically significant association between survival and molecular subtypes in an univariate analysis. In the adjusted multivariate analysis, the following variables were independent prognostic factors for survival: T stage, N stage, and molecular subtype.

CONCLUSIONS

 Of the four subtypes, the LA subtype tends to have the best prognosis, fairly high survival, and low recurrent or metastases rates. The TN and HER2 subtypes of breast cancer were associated with significantly poorer overall survival and prone to earlier recurrence and metastases. Our results demonstrate a significant association between molecular subtype and survival. The risk of death and relapse/metastases increases fewfold in TN compared to LA. Future prospective studies are warranted and could ultimately lead to the tailoring of adjuvant radiotherapy treatment fields based on both molecular subtype and the more conventional clinicopathologic characteristics.