Problems and Functional Disabilities Among Patients with Cervical Disc and Relationship with Low Back Pain

Background: cervical disc disorder is associated with many  problems and functional disabilities which affect quality of life for patients. Neck pain is as common as low back pain which are considered from associated problems with cervical disc. Aim: This study was conducted to assess problems and functional disabilities among patients with cervical disc and relationship with low back pain. Design and Setting: A descriptive exploratory correlational study design was used and data were collected from Physical Medicine and Rehabilitation Department and it's affiliated out patient clinic of Tanta Main University Hospital. Sample: Purposive sampling of (90) patients from previous mentioned setting during follow-up period. Tools: Three tools were used for data collection: Tool (I); Sociodemographic and Medical data of the patients, Tool (II); Neck Disability Index scale to examine the degree of disability resulted from cervical disc and its effect on daily activities. Tool (III); Roland-Morris Low Back Pain and Disability Questionnaire to assess pain-related disability resulting from low back pain.  Results: As a result of this study, the majority (66.7%) of the patients had complete level of neck disability and (82.2%) of them had high level of disability due to low back pain. Moreover the majority of the patients (67.6%) had high level of disability due to low back pain associated with complete neck disability due to cervical disc. Significant positive correlation was noted between total score of neck disability index and total score of roland-morrislow back pain and disability.Conclusion and Recommendation: These results indicate that majority of the patients had complete level of neck disability and high level of disability due to low back pain. Significant positive correlation was noted between total score of neck disability index and total score of roland-morrislow back pain and disability. Further research must be done in many settings to evaluate whether disability prevention or interventions can improve functional disabilities. Keywords: Cervical disc, functional disability, Low Back Pain. DOI: 10.7176/JHMN/61-05 Publication date: April 30th 201

DEVELOPMENT AND CLINICAL EVALUATION OF TOPICAL HYDROQUINONE NIOSOMAL GEL FORMULATION FOR THE TREATMENT OF MELASMA

Objective: The goal of the present study was to develop niosomal gel as a nanocarrier for improved depigmentation effect of hydroquinone (HQ). As well as to evaluate the prepared niosomes for entrapment efficiency, transmission electron microscopy (TEM), zeta potential, and in vitro release study. As an ultimate point of the objectives was to evaluate the best-prepared niosomal gel formula clinically in well-diagnosed patients of melasma and the results were compared with a commercial product. Methods: The effect of incorporation of co-surfactant such as Tween 20, Tween 40, and Tween 60 with Span 80, was studied to determine the highest entrapment efficiency and the desired release rate. Niosomes showed the highest entrapment efficiency was incorporated in different gelling agents like Carbopol 934 and Carboxymethylcellulose sodium (CMC Na) with different concentrations. Accelerated stability testing of HQ from niosomal gel formulations; the expiry date t90 was estimated. The best-prepared niosomal gel formula was studied clinically in patients of melasma and the results were compared with the commercial product (Clearique 2%)®Delta Pharma Company.  Results: There was a significant increase in the clinical efficacy of the niosomal therapy and a highly significant decrease regarding to modified melasma area and severity index (MASI), duration to achieve improvement, side effects, and the recurrence of melasma in patients treated with niosomal gel compared to the commercial product. Conclusion: The incorporation of hydroquinone in niosomal gel improves its therapeutic effect regarding clinical effect, duration of treatment, side effects, recurrence and patient compliance

Evaluation of regulatory T cells in obese asthmatic children

Background: Asthma is an airway inflammatory disorder with functional and structural changes. Regulatory T (T reg) cells are important in controlling immune responses. The study was aimed to investigate the frequency of Treg cells in obese asthmatic children, in comparison to non-obese asthmatics and healthy matched controls .Methods: In addition to anthropometric and body mass index (BMI) assessment, peripheral blood samples from healthy control subjects (n = 30) and asthmatic obese (n=30) and asthmatic non-obese children (n=30) were examined for serum IgE, eosinophils counts, and flowcytometric measurement of CD4+CD25+CD127 low/neg- T cells. Pulmonary function testing was performed for asthmatic children . Results: Obese asthmatics showed significantly higher levels of serum IgE and CD4+CD25+CD127 low/neg- T cells as compared to healthy controls (p<0.001, 0.001, respectively) while comparable numbers of T reg cells were found among obese and non-obese asthmatic children. Asthmatics receiving inhaled corticosteroids (ICS) showed higher percentages of CD4+CD25+CD127 low/neg- T cells than the non-receivers (median 11.8% vs 8.8%, p <0.001). No significant correlations were found between Treg and age, eosinophil percentage, total serum IgE, pulmonary functions, or BMI and its Z score . Conclusion: Our study demonstrates an increased frequency of Treg cells in asthmatic children compared to controls with possible association with the use of ICS but not with obesity. Small sample size and lack of obese non-asthmatic group are the main points of limitation in our study

Non-Invasive Data Acquisition and IoT Solution for Human Vital Signs Monitoring: Applications, Limitations and Future Prospects

The rapid development of technology has brought about a revolution in healthcare stimulating a wide range of smart and autonomous applications in homes, clinics, surgeries and hospitals. Smart healthcare opens the opportunity for a qualitative advance in the relations between healthcare providers and end-users for the provision of healthcare such as enabling doctors to diagnose remotely while optimizing the accuracy of the diagnosis and maximizing the benefits of treatment by enabling close patient monitoring. This paper presents a comprehensive review of non-invasive vital data acquisition and the Internet of Things in healthcare informatics and thus reports the challenges in healthcare informatics and suggests future work that would lead to solutions to address the open challenges in IoT and non-invasive vital data acquisition. In particular, the conducted review has revealed that there has been a daunting challenge in the development of multi-frequency vital IoT systems, and addressing this issue will help enable the vital IoT node to be reachable by the broker in multiple area ranges. Furthermore, the utilization of multi-camera systems has proven its high potential to increase the accuracy of vital data acquisition, but the implementation of such systems has not been fully developed with unfilled gaps to be bridged. Moreover, the application of deep learning to the real-time analysis of vital data on the node/edge side will enable optimal, instant offline decision making. Finally, the synergistic integration of reliable power management and energy harvesting systems into non-invasive data acquisition has been omitted so far, and the successful implementation of such systems will lead to a smart, robust, sustainable and self-powered healthcare system

Proposed Framework for Smart Healthcare Services

Smart healthcare is of great interest to researchers and governments due to the increasing development of new smart cities. However, there is no current standard practice to format the cloud computing infrastructure and to assist the healthcare system architect in designing a comprehensive solution for the basic services that are required by the healthcare users while taking into consideration a balanced approach towards their specific functional and non-functional needs such as openness, scalability, concurrency, interoperability and security factors. The integration of smart healthcare services with cloud computing needs a concrete framework. The main objective of this paper is to analyze the different frameworks that discuss smart healthcare services and reach to a conclusion of the common factors to arrive at a unified and smart framework

Mismatch Repair Proteins and Microsatellite Instability in Colorectal Carcinoma (MLH1, MSH2, MSH6 and PMS2): Histopathological and Immunohistochemical Study

BACKGROUND: Colorectal cancer (CRC) is one of the most common cancers worldwide. Microsatellite instability (MSI) is detected in about 15% of all colorectal cancers. CRC with MSI has particular characteristics such as improved survival rates and better prognosis. They also have a distinct sensitivity to the action of chemotherapy.AIM: The aim of the study was to detect microsatellite instability in a cohort of colorectal cancer Egyptian patients using the immunohistochemical expression of mismatch repair proteins (MLH1, MSH2, MSH6 and PMS2).MATERIAL AND METHODS: Cases were divided into Microsatellite stable (MSS), Microsatellite unstable low (MSI-L) and Microsatellite unstable high (MSI-H). This Microsatellite stability status was correlated with different clinicopathological parameters.RESULTS: There was a statistically significant correlation between the age of cases, tumor site & grade and the microsatellite stability status. There was no statistically significant correlation between the gender of patients, tumor subtype, stage, mucoid change, necrosis, tumor borders, lymphocytic response, lymphovascular emboli and the microsatellite stability status.CONCLUSION: Testing for MSI should be done for all colorectal cancer patients, especially those younger than 50 years old, right sided and high-grade CRCs

The Association Between Hypertension and Insomnia Among Saudi Population: A Cross-Sectional Study

Objective To assess the relationship between hypertension and insomnia among the Saudi population. Methods The study will employ a cross-sectional design to investigate the association between hypertension and insomnia among the Saudi population. This design allows for the collection of data at a single point in time, offering insights into the relationship between the variables. Results The study included 581 participants. The most frequent age among them was 18-28 (n= 266, 45.8 Per Cent), followed by 29-39 (n= 129, 22.2 Per Cent). The most frequent gender among study participants was female (n= 320, 55.1 Per Cent), followed by male (n= 261, 44.9 Per Cent). Study participants' most frequent body mass index was normal 18.5-24.9 kg/m2 (n= 231, 39.8 Per Cent) followed by overweight 25-29.9 kg/m2 (n= 200, 34.4 Per Cent). Marital status among study participants, with most of them being single (n=283, 48.7 Per Cent) followed by married (n= 238, 41 Per Cent). The number of hours of sleep during the day among study participants with most of them had 6-8 hours. Participants were asked if they had difficulty sleeping. There most of the participants were nothing (n= 201, 34.6 Per Cent). On the other hand, 154 participants had middle (26.5 Per Cent). They asked if they had difficulty staying asleep. There most of the participants were nothing (n= 227, 39.1 Per Cent). On the other hand, 152 participants had middle (26.2 Per Cent). Participants were asked if they had trouble waking up early. There most of the participants were nothing (n= 189, 32.5 Per Cent). Followed by middle (n=148, 25.5 Per Cent). Conclusion The results of the study showed that most of the study participants were of normal weight according to their body mass index. Most of them are single. Most participants sleep approximately 6-8 hours a day. The largest percentage of participants work in the government or private sector. Most of them had good social contact

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed