Lymphedema after breast cancer

Lymphedema is one of the most significant survivorship issues after the surgical treatment of breast cancer and in this population it has been documented to have significant quality of life consequences. It is the result of obstruction or disruption of the lymphatic system, which can occur as a consequence of tumors, surgery, trauma, and radiation therapy, and this is lead to the accumulation of fluid in the interstitial tissues. We report the case of a patient referred in our department after breast surgery (Patey intervention) for adjuvant chemotherapy. The patient received adjuvant chemotherapy and adjuvant radiotherapy. She developed one year after completion of the treatment a swelling in the right arm, and hand, with a temporary indentation of the skin after finger pression (pitting edema). An ultra sound exam was performed and deep vein thrombosis was excluded. The patient was referred to a physical therapist for management of her lymphedema. Cancer related lymphedema is a common post treatment complication. In breast cancer patients, lymphedema has been described as an often underdiagnosed, and undertreated condition. Also, early detection of lymphedema increases the likelihood of successful treatment. Patients must be informed and conservative surgery like sentinel lymph nodes technique should be performed to reduce the risk.Pan African Medical Journal 2016; 2

Optical Properties of (CuFe(1-x) CrxO4) Nanostructures Prepared by Chemical Deposition Method

Thin films of (CuFe(1-x) CrxO4) with weight ratios (x = 0, 0.2, 0.4, 0.6, 0.8, 1) were prepared using the chemical deposition method on glass bases with dimensions x 1cm (1cm) at (700°C) temperature. Studying the optical properties of the prepared films includes recording the absorbance spectrum and the optical energy gap for the wavelength range (300-900 nm). Moreover, studying the optical constants is represented by the extinction coefficient, the refractive index, and the real and imaginary part of the dielectric constant as a function of wavelength. The optical properties show the appearance of a peak, an absorbance at a wavelength of 370 nm when adding a chromium ion as a substitute for the iron ion. The intensity of this peak increases directly with the increase in the percentage of chromium in the sample. It was also observed that the energy gap decreases significantly to 3eV. There is a slight increase in the value of the optical energy gap to 3.1eV when the percentage increases to x=0.8 due to decrease in size

Removal of Pesticides from Iraqi Soils and Water

Contamination of soil and water with various types of pesticides, resulting from accidental spills at agrochemical manufacturing, formulation, and distribution facilities, farm loading/washdown sites, or abandoned waste sites, is a serious environmental problem in many places in the world. The remediation of two types of pesticides which were (carbofuran and chlorpyrifos) from three types of Iraqi soils (sandy, silty and clayey) was investigated in the present study. The treatment process was performed through washing method using distilled water in batch mode then; a continuous fixed bed unit was used to perform the removal of the same two types of pesticides from wasted washing polluted water using adsorption technique at different operating conditions with low-cost adsorbents which were watermelon peel (WP) and used tea leaves (UTL). The results show that the maximum removal efficiencies of pesticide from polluted soils were 81.268, 99.531 and 89.151 for clayey, sandy and silty soils respectively for carbofuran and 77.420, 94.790 and 85.481 for clayey, sandy and silty soils respectively for chlorpyrifos. Adsorption isotherm and kinetic models have been used to fit the experimental data. Finally, in this study a novel way was suggested and experimented as a safe, economic, beneficial and eco-friendly non-conventional method to get rid of the WP and UTL loaded with carbofuran and chlorpyrifos pesticides wasted. This method was trying to convert these toxic residues to applicable useful material like rodenticide. The results show that good ability for these residue to be an active rodenticide through the LD50 calculated

Contributions of city councils to the decentralization of social services

Refah devleti uygulamalarının tartışılıp neo-liberal politikaların uygulanmaya konulduğu 1980’li yıllardaki ekonomik ve mali krizler, ülkelerin sosyal politika belirleyicilerinde çeşitli aktörlerin yer almasına imkân tanımıştır. Özellikle ülkelerdeki sosyal refah politikalarının belirlenmesinde merkezi idareye destek olma amacı taşıyan yönetişim ilkesi katılımcı bir yönetim mekanizmasına zemin hazırlamıştır. Böylece sosyal politikaların bel kemiğini oluşturan sosyal hizmetlerde yerel yönetimlerden sivil toplum kuruluşlarına kadar katılımcı bir idare şekli yerelde ortaya çıkarılmıştır. Özellikle kent konseyleri eliyle yerel alandaki sosyal yönlü hizmetlerin türünü belirleyen yerel halk, kararlara da katılarak hizmetlerin niteliğinin gelişmesine ve verimliliğinin artmasına katkı yapmıştır. Türkiye de kamu yönetimi alanında başlattığı reformlar aracılığıyla yaşanan bu tür gelişmeleri yerelde uygulama koymuştur. Bu bağlamda 2004 yılından itibaren yerel yönetim alanında başlatılan yasal düzenlemelerin içerisine kent konseyleri de eklenerek sosyal hizmetlerin yerelleşme süreci hızlandırılmak istenmiştir. Çalışmada kent konseylerinin sosyal hizmetlerin yerel idareler eliyle yaygınlaştırılması arayışı sürecine olası katkılarının ortaya konması amaçlanmıştı

Engellilere Yönelik Yerel Sosyal Hizmetlerde Belediyelerin Yeri: Malatya Büyükşehir Belediyesi

20. yüzyılın ikinci yarısından itibaren engellilere yönelik tıbbi bakım hizmetleri yanındaçeşitli destek ve koruma hizmetleri de sunulmaya başlanmıştır. Ancak toplum hayatında engelli bireylerin kendi varlıklarını gösterebilme konusunda uzunca bir dönem geri planda kalmıştır. Bu durum engellilere yönelik politika ve hizmetlerde merkezi idare dışındaki diğer kurumların görev ve sorumlulukları çok fazla yüklenememesinden kaynaklı olduğu söylenebilir. Fakat bu olumsuz olgu yerel sosyal politikalar konusunda belediyelere görev ve sorumluluklar verilmesiyle birlikte değişim göstermeye başlamıştır. Özellikle 2000’li yıllardan itibaren yerel yönetim alanında yapılan reformlarla engellilere yönelik yerel nitelikli hizmetlerde belediyelere bazı yetki ve görevler verilmiştir. Böylece engellilere sunulan yerel hizmet ve politika konusunda merkezi yönetimin yanında belediyeler de temel aktör olarak yerini almaya başlamıştır. Reform döneminde 5216 sayılı Büyükşehir Belediye Yasası, 5393 sayılı Belediye Yasası ile 2012 yılında çıkarılan 6360 sayılı yasa engelli alanında belediyelere yönelik emredici hükümler ile görevler yükleyerek çeşitli haklar ile hizmetleri ortaya koymuştur. Bu bağlamda belediyeler kendi imkânları dâhilinde hizmetlerin niteliğinden mekânların kullanıma kadar farklı hizmetleri engellilerin kullanımına sunmaya ve toplum hayatına uyum konusunda destek olmaya çalışmıştır. Dolayısıyla çalışmada engelli bireylere yönelik belediyelere verilen görev ve sorumluluklar ile hizmet ve uygulamalar Malatya Büyükşehir Belediyesi örneği üzerinden ele alınmıştır. Böylece yerel alanda belediyelerin engellilere yönelik sunduğu iyi hizmet uygulamalarını ortaya koymak, olası eksiklikleri tespit etmek ve ileride yapılacak hizmetlere yol göstermek amaçlanmıştır

La libéralisation du commerce extérieur égyptien et l'accord du GATT

(La présente étude reflète les vues des auteurs, et non celles de la Banque centrale). Après sept ans de négociations sur la libéralisation du commerce mondial, les États membres de l'Accord général sur les tarifs douaniers et le commerce (GATT) sont parvenus, le 15 décembre 1993, à un accord sur toutes les questions soumises aux négociations. Ces questions concernent la libéralisation du commerce de l'habillement et des textiles, précédemment régi par l'Accord multifibres (AMF) et, pour la p..

La problématique du coût des nouvelles thérapeutiques en oncologie: qu’en-est-il du Maroc?

Le cancer est un problème majeur de santé public en Afrique. Les progrès réalisé dans le traitement des cancers ces dix dernières années est indéniable. L'émergence des thérapies ciblés en oncologie a permit de modifier l'histoire naturelle de certains cancers réputés de mauvais pronostic. En dépit de leurs efficacité, ces thérapeutiques pose un problème majeur de coût qui les rend inaccessible à la majorité des patients dans les pays en voie développement. Au Maroc, le cancer est reconnu comme a une affection de longue durée et les patients bénéficient de ce fait d'une couverture médicale totale. L'implication de la société civile a permis aussi d'améliorer la prise en charge ainsi qu'un accès plus élargi aux médicaments innovants pour les patients les plus démunis.Pan African Medical Journal 2016; 2

Developing prevention model of acute lung injury: Validity of lung injury prediction score and risk panel

AbstractBackgroundAcute lung injury (ALI) is an example of a critical care syndrome with few therapeutic modalities once the syndrome is fully established, and little has been done on the prevention of ALI.Aim of the workThe aim of this work was to early identify the onset of acute lung injury (ALI) on admission and to prospectively evaluate the lung injury prediction score (LIPS).Patients and methodsThe study was carried out on 100 patients who aged >18years, patients who had one or more of the acute lung injury (ALI) predisposing conditions on admission or within 6h after were subjected to lung injury prediction score (LIPS).ResultsAcute lung injury developed in 15 patients, 11 patients (73.3%) had LIPS >3, while 4 patients (26.7%) had LIPS ⩽3 and only 4.70% of those who didn’t develop ALI had LIPS >3, with a statistically significant relationship between patients above and below LIPS value of 3 (P=0.000), LIPS cutoff value of ⩾3.5 on admission had a 73% sensitivity and 95% specificity with an area under the receiver operating curve of 0.883 (95% CI 0.782 to 0.984). Sepsis and pneumonia were the most frequent risk factors (60%).ConclusionsLung injury predictive score (LIPS) could early predict patients at risk to develop ALI on admission, Hyperbilirubinemia, high blood urea level and abnormal chest X-ray on admission were not included in the original LIPS but had significant association with development of ALI

Métastase vésicale d’un adénocarcinome gastrique en bague à chaton

Bien que le cancer primitif de la vessie représente le deuxième cancer urologique après le cancer de la  prostate, les métastases vésicales sont rares et le primitif gastrique reste exceptionnel. On rapporte le cas d’un patient âgé de 46 ans, avec des épigatsralgies chroniques, qui présentait une hématurie totale avec des signes irritatifs urinaires. La cystoscopie a montré une vessie inflammatoire sans lésion tumorale décelable. La biopsie vésicale avec une étude anatomopathologique a été en faveur d’un adénocarcinome peu différencié à cellules indépendantes. Le scanner thoraco-abdomino-pelvien a montré un épaississement vésical et gastrique. La fibroscopie oeso-gastroduodénale a montré une tumeur bourgeonnante ulcérée fundique qui a été biopsiée. L’étude anatomo-pathologique a montré un adénocarcinome gastrique à cellules indépendantes mucipares. Le patient a eu 6 cures de chimiothérapie palliative de première ligne type EOX à base  d’Epirubicine, Oxaliplatine, et Capécitabine, avec une légère régression tumorale puis une chimiothérapie de maintenance à base de Capécitabine.Key words: Métastase vésicale, adénocarcinome gastrique, cellules en bague à chato

Dynamic robust bootstrap method based on LTS estimators

The applications of bootstrap methods in regression analysis have drawn much attention to the statistics practitioners because of some practical reasons. In order to make reliable inferences about the parameters of a model, require that the parameter estimates are normally distributed. Nevertheless, in real situations, many estimates are not normal and the use of bootstrap method is more appropriate as it does not rely on the normality assumption. It is now evident that the presence of outliers have an unduly effect on the bootstrap estimates. There is a possibility that the bootstrap samples may contain more outliers than the original sample. In this paper, we propose a robust bootstrap algorithm based on Least Trimmed of Squares (LTS) estimator which will be unaffected in the presence of outliers. We call this method Dynamic Robust Bootstrap-LTS based (DRBLTS) because here we have employed the LTS estimator in the modified bootstrap algorithm. The performance of the DRBLTS is evaluated by real data sets and simulation study. The numerical examples indicate that the DRBLTS is more efficient than the other methods