A Prospective study Comparing Preservation of Ilioinguinal Nerve Verses Ilioinguinal Neurectomy in Lichtenstein Hernia Repair

BACKGROUND AND OBJECTIVES: Surgical repair of inguinal hernias are among the most common general surgical procedures performed today. Chronic inguinal neuralgia is one of the most significant complications following inguinal hernia repair, with a reported incidence ranging from to 29% to 76%. Ilioinguinal nerve entrapment seems to be important cause of inguinodynia. We conducted this study to investigate the short to mid-term neurosensory effect of preservation of ilioinguinal nerve verses ilioinguinal neurectomy in Lichtenstein’s repair of inguinal hernias. METRHODS: 60 patients between the age of 18 and 80 years with inguinal hernias undergoing Lichtenstein’s hernia repair from July 2017 to June 2018, were randomized to receive either ilioinguinal nerve preservation or ilioinguinal neurectomy during the afore mentioned surgery. All the surgeries were performed by surgeons specialized in hernia repair under spinal anesthesia. The primary outcome was the incidence of chronicgroin pain at the end of 1 month, 3 months and 6 months following the procedure. Secondary outcomes included incidence of postoperative sensory loss or sensory change at the groin region and quality of life measurement assessed by modified SF-36 questionnaire at the end of 8months. RESULTS: The incidence of chronic groin pain at 6 months was significantly lower in the neurectomy group than in the nerve preservation group (33.3% vs. 12.0%; P-0.001). No significant intergroup differences were found regarding the incidence of groin numbness, postoperative sensory change at the groin region, and health related quality of life, all of which was measured at 6 months following the procedure. CONCLUSION: Ilioinguinal Neurectomy significantly decreases the incidence of chronic groin pain after Lichtenstein’s hernia repair without significant added morbidity. It can therefore be considered for patients undergoing Lichtenstein mesh repair

Evaluation of Resazurin Microtiter Plate Assay and HPLCPhotodiode Array Analysis of the Roots of Asparagus adscendens

Asparagus adscendens Roxb. (Asparagaceae), is native to the Himalayas. The present study, for the first time, was undertaken to explore the antimicrobial potential, to determine the minimum inhibitory concentration (MIC) values of the methanol extract of the roots of Asparagus adscendens and its solid phase extraction (SPE) fractions by using resazurin microtiter assay (REMA) against gram positive and negative bacterial registered strains and to carry out HPLC-Photodiode array analysis of the SPE fractions. The methanol extract and all SPE exhibited considerable level of antibacterial potential against gram-positive bacteria (MIC: 2.5-0.009 mg/mL) than against gram-negative bacteria (MIC: 1.25-2.5 mg/mL). The use of microtiter plates has the advantage of lower cost, fast and quantitative results. Like other Asparagus species, the presence of phenolic compounds in all SPE fractions was evident in the HPLC-PDA data

Access to health care for persons with disabilities in rural South Africa

BACKGROUND: Global research suggests that persons with disabilities face barriers when accessing health care services. Yet, information regarding the nature of these barriers, especially in low-income and middle-income countries is sparse. Rural contexts in these countries may present greater barriers than urban contexts, but little is known about access issues in such contexts. There is a paucity of research in South Africa looking at "triple vulnerability" - poverty, disability and rurality. This study explored issues of access to health care for persons with disabilities in an impoverished rural area in South Africa. METHODS: The study includes a quantitative survey with interviews with 773 participants in 527 households. Comparisons in terms of access to health care between persons with disabilities and persons with no disabilities were explored. The approach to data analysis included quantitative data analysis using descriptive and inferential statistics. Frequency and cross tabulation, comparing and contrasting the frequency of different phenomena between persons with disabilities and persons with no disabilities, were used. Chi-square tests and Analysis of Variance tests were then incorporated into the analysis. RESULTS: Persons with disabilities have a higher rate of unmet health needs as compared to non-disabled. In rural Madwaleni in South Africa, persons with disabilities faced significantly more barriers to accessing health care compared to persons without disabilities. Barriers increased with disability severity and was reduced with increasing level of education, living in a household without disabled members and with age. CONCLUSIONS: This study has shown that access to health care in a rural area in South Africa for persons with disabilities is more of an issue than for persons without disabilities in that they face more barriers. Implications are that we need to look beyond the medical issues of disability and address social and inclusion issues as well

運動情報の可聴化に関する研究

電気通信大学201

Juvenile myoclonic epilepsy refractory to treatment in a tertiary referral center

INTRODUCTION: Juvenile myoclonic epilepsy (JME) is an epileptic syndrome often regarded as one in which seizures are relatively easy to control. Individuals with JME, however, often require lifelong therapy to remain seizure-free, and a few have refractory epilepsy. We ascertained a population with JME and characterized a subgroup with refractory epilepsy. MATERIAL AND METHODS: We audited and reviewed clinical records of individuals diagnosed with JME identified via a sample of 6600 individuals in a clinical database from a specialized epilepsy clinic at a tertiary referral center. RESULTS: We identified 240 people with a diagnosis of JME (146 females), with a mean age at seizure onset of 14.2years (SD: 4.5), and a mean age at diagnosis of 15.6years (SD: 4.9). Clinical phenotypes seen were classic JME phenotype (88%), childhood absence epilepsy evolving into JME (6%), JME with adolescent absences (4%), and JME with astatic seizures (2%). More than a quarter (28%) had a family history of epilepsy. The most commonly used antiepileptic drug (AED) was sodium valproate in 78% of individuals, followed by levetiracetam (64%) and lamotrigine (55%). In the previous year, 47.5% were seizure-free. Using the International League against Epilepsy (ILAE) definitions and considering National Institute for Health and Care Excellence (NICE)-recommended AEDs for this syndrome, 121 individuals (50.4%) were identified as having refractory epilepsy. DISCUSSION: Juvenile myoclonic epilepsy is often regarded as a benign epileptic syndrome, but in this setting, half of the individuals with JME have refractory epilepsy with only about a quarter of those seizure-free in the previous year. Despite some advances in the understanding of this syndrome, there is still much to do before we can offer all the best outcomes

Social Network and Tax Evasion: Theoretical Model and Empirical Evidence in Bangladesh

This paper examines ethical and behavioral aspects of taxpayers, the financial condition of citizens, tax fairness, taxpayer services, complexities in the tax regime, tax rates, penalties and enforcement, and tax amnesties and the black economy. Primary data were collected by conducting a survey utilizing structured printed questionnaires. Secondary data were collected from project reports, government publications and documents, books, journals, reports, newspapers and electronic media. Empirical findings suggest that all these issues are associated with tax evasion in Bangladesh. We also find that eligibility in a social network increases the likelihood that others will take-up. This suggests that taxpayers affect each other’s decisions about tax avoidance, highlighting the importance of accounting for social interactions in understanding enforcement and tax avoidance behavior, and providing a concrete example of optimization frictions in the context of behavioral responses to taxation. The involvement and nexus of the three actors in tax policy formulation, implementation and compliance processes were examined. The empirical findings indicate the presence of this nexus which facilitates tax evasion. The high magnitude of tax evasion in Bangladesh is significantly acknowledged by respondents in the study. The empirical findings suggest that the absence of a participatory policy making process, lack of research into, and reform of, the tax system, short-term oriented and politically motivated tax policies, loopholes, anomalies and complexities of tax laws and policies are responsible for creating scope for tax evasion

Socio-economic Factors of Tax Compliance: An Empirical Study of Individual Taxpayers in the Dhaka Zones, Bangladesh

Tax compliance can be affected by many factors such as magnitude of compliance cost, the extent of penalty, perceived fairness of the tax system, awareness level of taxpayers and perceptions of government spending. The purpose of the study is identifying factors that affect compliance of individual income taxpayers in Bangladesh. The target population of the study is individual income taxpayers of the fifteen zones of Dhaka. The sample size is determined to 385 self-assessment assesse and 376 general procedure return submitted income taxpayers to which the questionnaire was distributed during the period of 1st December 2019 to 15th February, 2020. The results of the ordered logistic regression model reveal that the fairness, tax penalty and relationship with regard to taxpayer’s perception of government spending have positive and significant relationships with compliance. It also examines the effects of compliance decisions of referrals on others compliance decisions. The findings show a negative but insignificant relationship between them which implies that individual income taxpayer’s make their compliance decisions independent of others' decisions. Finally, the study having evaluated the effect of cost of complying with the tax law on tax compliance and concluded that there is a negative relationship between them implying that higher cost of compliance will lead to lower levels of compliance. Therefore, this paper suggests that maintaining tax fairness, optimum levels of penalty, spending the tax revenue on public development projects, keeping tax rates to the minimum as much as possible and keeping compliance costs to the minimum can enhance the compliance of taxpayers

Liquid chromatography mass spectrometry analysis and cytotoxicity of Asparagus adscendens roots against human cancer cell lines

Background: Asparagus adscendens Roxb. (Asparagaceae), is native to the Himalayas. This plant has been used in the prevention and effective treatment of various forms of cancers. Objective: This paper reports, for the first time, on the cytotoxicity of the methanol (MeOH) extract of the roots of A. adscendens and its solid‑phase extraction (SPE) fractions against four human carcinoma cell lines and LC‑ESI‑QTOF‑MS analysis of the SPE fractions. Materials and Methods: Finely powdered roots of A. adscendens were macerated in methanol and extracted through SPE using gradient solvent system (water: methanol) proceeded for analysis on LC‑ESI‑QTOF‑MS and cytotoxicity against four human carcinoma cell lines: breast (MCF7), liver (HEPG2), lung (A549), and urinary bladder (EJ138), using the 3‑(4,5‑dimethylthiazol‑2‑yl)‑2,5‑diphenyltetrazoliumbromide assay. Results: The MeOH extract and four SPE fractions exhibited cytotoxicity against all cell lines with the IC50 values ranging from 6 to 79 μg/mL. As observedin other Asparagus species, the presence of saponins and sapogenins in the SPE fractions was evident in the liquid chromatography‑mass spectrometry data. Conclusion: It is reasonable to assume that the cytotoxicity of the MeOH extract of the roots of A. adscendens and its SPE fractions, at least partly, due to the presence of saponins and their aglycones. This suggests that A. adscendens could be exploited as a potential source of cytotoxic compounds with putative anticancer potential