Bicycle ergometer versus treadmill on balance and gait parameters in children with hemophilia

Background and purpose: Children with hemophilia often bleed inside the joints andmuscles, which may impair postural adjustments. These postural adjustments are necessary to control gait and postural balance during daily activities. The inability to quickly recover postural balance could elevate the risk of bleeding. So, the purpose of this study was to compare between the effects of bicycle ergometer and treadmill on balance and gait parameters in children with hemophilia.Materials and methods: Thirty hemophilic boys with the ages ranging from 10 to 14 years had participated in this study. They were assigned randomly into two equal study groups. Group A received a designed physical therapy program and aerobic exercise training by bicycle ergometer. While group B received the same physical therapy program in addition to aerobic exercise training by the treadmill. Both groups received treatment sessions three times per week for three successive months. Stability indices and kinematic gait parameters were evaluated before and after three successive months of treatment.Results: There were non significant differences between the pre-treatment mean values of all measuring variables for the two groups. Significant improvement was observed in the two groups when comparing their pre and post treatment mean values. Also, significant differences were recorded when comparing the post treatment results of the two groups in favor of the study group B.Conclusion: Aerobic exercise, in the form of treadmill training for children with hemophilia, is an excellent supplement to regularly scheduled physical therapy intervention. It improves the degree of stability and gait parameters for those patients

Modelling the circumstellar medium in RS Ophiuchi and its link to Type Ia supernovae

Recent interpretations of narrow, variable absorption lines detected in some Type Ia supernovae suggest that their progenitors are surrounded by dense, circumstellar material. Similar variations detected in the symbiotic recurrent nova system RS Oph, which undergoes thermonuclear outbursts every ~20 years, making it an ideal candidate to investigate the origin of these lines. To this end, we present simulations of multiple mass transfer-nova cycles in RS Oph. We find that the quiescent mass transfer produces a dense, equatorial outflow, i.e., concentrated towards the binary orbital plane, and an accretion disc forms around the white dwarf. The interaction of a spherical nova outburst with these aspherical circumstellar structures produces a bipolar outflow, similar to that seen in HST imaging of the 2006 outburst. In order to produce an ionization structure that is consistent with observations, a mass-loss rate of $5 \times 10^{-7}\,\mathrm{M}_{\odot}\,\mathrm{yr}^{-1}$ from the red giant is required. The simulations also produce a polar accretion flow, which may explain the broad wings of the quiescent H {\alpha} line and hard X-rays. By comparing simulated absorption line profiles to observations of the 2006 outburst, we are able to determine which components arise in the wind and which are due to the novae. We explore the possible behaviour of absorption line profiles as they may appear should a supernova occur in a system like RS Oph. Our models show similarities to supernovae like SN 2006X, but require a high mass-loss rate, $\dot{M} \sim 10^{-6}$ to $10^{-5}\,\mathrm{M_\odot}\,\mathrm{yr}^{-1}$, to explain the variability in SN 2006X

Pattern of irritable bowel syndrome and its impact on quality of life in primary health care center attendees, Suez governorate, Egypt

Introduction: Irritable bowel syndrome (IBS) is one of the most common disorders diagnosed by gastroenterologists and a common cause of general practice visits. Although this disease is not life threatening, patients with IBS seem to be seriously affected in their everyday life. The study was designed to explore the pattern of IBS in clinical practice and the impact on the quality of life. Methods: This is a case control descriptive study. 117 individuals were included in this study. Rome II criteria were used for the diagnosis of IBS. Impact of IBS on patient's quality of life was determined by irritable bowel syndrome quality of life (IBS-QOL) questionnaire. Results: Prevalence of IBS among the study sample was 34.2%. 10% were IBS-Diarrhea, 37.5% were IBS-Constipation and 52.5% were alternators. There is statistical insignificant relationship between IBS (+) and age while it was a significant relation regarding gender (more common among women 80%). There is statistical significance relationship between IBS (+) on one hand and marital status and occupational status on the other hand. Patients with IBS had statistically significant lower scores for all IBS- QOL domains compared with the control group. Conclusion: IBS is a prevalent disorder that affects females more than males and it has significant impacts on work, lifestyle and social well-being.Key words: Irritable bowel syndrome, quality of life, Roma I

HER2 Over Expression in Malignant Palpable Breast Lumps of Pre and Postmenopausal Women Attending RICK.

Back ground: Human Epidermal growth factor Receptor 2 (HER-2/neu) over expression in breast cancer is associated with poor outcome and decrease disease free survival (DFS). The aim of this study was to evaluate the over expression of HER2/neu among premenopausal and postmenopausalfemales presented with malignant palpable breast lumps to Radio Isotope Center Khartoum (RICK).Methods: The study was a case-control conducted among patients attending Radiation Isotopes Centre Khartoum (RICK). A total of 328 women were randomly selected. Data were collected by a pre coded, pre tested questionnaire. Tissue biopsies of breast lumps had been analyzed using immunohistochemical techniques for HERR-2/neu over expression and its relation to other prognostic factors was evaluated.Results: HER-2/neu + vein first pregnancy at . 23 years, were 32 (41%) in the cases, 6 (35%) in the controls of premenopausal women, and 21(44%) in the cases, 5 (38%) in the controls of postmenopausal women. HER-2/neu + veexpression in relation to age at menarche . 12 years was39 (51%) in the cases, 7(39%) in the controls of premenopausal women, and 36 (56%) in the cases, 7 (45%) in the controls of postmenopausal women. HER-2/neu+ vein relation to Body Mass Index > 29 kg/m2 showed 7 (37%) in the cases, 2 (33%) in the controls of premenopausal women(x2=0.024), and 8(38%) in the cases, 2(40%) in the controls of postmenopausal women (x2=0.006). HER-2/neu+ veexpression in relation to history of abortion or miscarriage (ever) was found to be 21 (39%) in the cases, 4 (33%) in the controls of premenopausal women, and 18 (44%) in the cases, 3 (33%) in the controls among postmenopausal women. HER-2/neu+ veexpression in relation to the history of breast cancer in a first degree relatives was 3 (25%) in the cases, 1(50%) in thecontrols of premenopausal women, and 4 (22%) in the cases, 2 (28%) in the controls of postmenopausal women. HER-2/neu+ veexpression in relation to the use of oral contraceptives was 3 (37%) in the cases, 1(50%) in the controls among premenopausal women, and 3 (27%) in thecases, 1 (50%) in the controls of postmenopausal women.Conclusion: The study confirmed an etiological association between HER2/neu+ve and HER2/neu . ve and age at first pregnancy . 23 years, age of menarche at . 12 years, abortion or miscarriage in premenopausal and postmenopausal Sudanese women, while an etiological association was confirmed between HER2/neu+ve and HER2/neu .ve, and BMI in premenopausal women, and the family history of cancer in pos menopausal women.Keywords: Human Epidermal, Growth factor, Recepto

Organ procurement organizations Internet enrollment for organ donation: Abandoning informed consent

BACKGROUND: Requirements for organ donation after cardiac or imminent death have been introduced to address the transplantable organs shortage in the United States. Organ procurement organizations (OPOs) increasingly use the Internet for organ donation consent. METHODS: An analysis of OPO Web sites available to the public for enrollment and consent for organ donation. The Web sites and consent forms were examined for the minimal information recommended by the United States Department of Health and Human Services for informed consent. Content scores were calculated as percentages of data elements in four information categories: donor knowledge, donor consent reinforcement, donation promotion, and informed consent. RESULTS: There were 60 Web sites for organ donation enrollment serving the 52 states. The median percent (10 percentile-90 percentile) content scores of the Web sites for donor knowledge, donor consent reinforcement, and donation promotion were 33% (20–47), 79% (57–86), and 75% (50–100), respectively. The informed consent score was 0% (0–33). The content scores for donor knowledge and informed consent were significantly lower than donor consent reinforcement and donation promotion for all Web sites (P < .05). The content scores for the four categories were similar among the 11 regions of the United Network for Organ Sharing. CONCLUSION: The Web sites and consent forms for public enrollment in organ donation do not fulfill the necessary requirements for informed consent. The Web sites predominantly provide positive reinforcement and promotional information rather than the transparent disclosure of organ donation process. Independent regulatory oversight is essential to ensure that Internet enrollment for organ donation complies with legal and ethical standards for informed consent

The Effect of Contrast Agents on Dose Calculations of Volumetric Modulated Arc Radiotherapy Plans for Critical Structures

Radiotherapy dose calculation requires accurate Computed Tomography (CT) imaging while tissue delineation may necessitate the use of contrast agents (CA). Acquiring these two sets is a common practice in radiotherapy. This study aims to evaluate the effect of CA on the dose calculations. Two hundred and twenty-six volumetric modulated arc therapy (VMAT) patients that had planning CT with contrast (CCT) and non-contrast CT (NCCT) of different cancer sites (e.g., brain, head, and neck (H&N), chest, abdomen, and pelvis) were evaluated. Treatment plans were recalculated using CCT, then compared to NCCT. The variation in Hounsfield units (HU) and dose distributions for critical structures and target volumes were analyzed using mean HU, mean and maximum relative dose values, D2%, D98%, and 3D gamma analysis. HU variations were statistically significant for most structures. However, this was not clinically significant as the difference in mean HU values was within 30 HU for soft tissue and 50 HU for lungs. Variation in target volumes’ D2% and D98% were insignificant for all sites except brain and nasopharynx. Dose maximum differences were within 2% for the majority of critical structures and target volumes. 3D gamma analysis results revealed that majority of plans satisfied the 2% and 2 mm criteria. CCT may be acquired for VMAT radiotherapy planning purposes instead of NCCT, since there is no clinically significant difference in dose calculations based on either image set

Fecal occult blood and fecal calprotectin as point-of-care markers of intestinal morbidity in Ugandan children with Schistosoma mansoni infection.

BACKGROUND: Calprotectin is a calcium-binding cytoplasmic protein found in neutrophils and increasingly used as a marker of bowel inflammation. Fecal occult blood (FOB) is also a dependable indicator of bowel morbidity. The objective of our study was to determine the applicability of these tests as surrogate markers of Schistosoma mansoni intestinal morbidity before and after treatment with praziquantel (PZQ). METHODS: 216 children (ages 3-9 years old) from Buliisa District in Lake Albert, Uganda were examined and treated with PZQ at baseline in October 2012 with 211 of them re-examined 24 days later for S. mansoni and other soil transmitted helminths (STH). POC calprotectin and FOB assays were performed at both time points on a subset of children. Associations between the test results and infection were analysed by logistic regression. RESULTS: Fecal calprotectin concentrations of 150-300 µg/g were associated with S. mansoni egg patent infection both at baseline and follow up (OR: 12.5 P = 0.05; OR: 6.8 P = 0.02). FOB had a very strong association with baseline anemia (OR: 9.2 P = 0.03) and medium and high egg intensity schistosomiasis at follow up (OR: 6.6 P = 0.03; OR: 51.3 P = 0.003). Both tests were strongly associated with heavy intensity S. mansoni infections. There was a significant decrease in FOB and calprotectin test positivity after PZQ treatment in those children who had egg patent schistosomiasis at baseline. CONCLUSIONS: Both FOB and calprotectin rapid assays were found to correlate positively and strongly with egg patent S. mansoni infection with a positive ameloriation response after PZQ treatment indicative of short term reversion of morbidity. Both tests were appropriate for use in the field with excellent operational performance and reliability. Due to its lower-cost which makes its scale-up of use affordable, FOB could be immediately adopted as a monitoring tool for PC campaigns for efficacy evaluation before and after treatment

Trends of Coagulation Parameters in Human Immunodeficiency Virus Patients

Background and Objectives: HIV disease is recognized to cause inconsistencies in coagulation via various pathways during infection. Some studies have indicated that HIV-infected patients are prone to developing thrombocytopenia, thrombosis, or autoantibodies that may cause difficulties in diagnosis. This study is intended to measure the trend of coagulation parameters in Sudanese patients with HIV. Materials and Methods: A cross-sectional study was carried out in patients with HIV admitted to the Sudan National AIDS Program (SNAP) from January 2018 to December 2019. Prothrombin time (PT), partial thromboplastin time (PTT), thrombin time (TT), D-dimer (DD), hemoglobin (HB), total lymphocyte count (TLC), platelet count (PLT), and a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13 (ADAMTS13), were evaluated among HIV Sudanese patients. Results: Out of the 44 HIV patients included, 6 (13.6%) were found to have thrombotic thrombocytopenic purpura-like events and 12 (27.2%) had antiphospholipid antibodies, of whom 8 (66.6%) showed anticardiolipin antibody (1gG (75%) and IgM (25%)) and 4 showed lupus anticoagulants. The HB, TLC, and PLT values were found to be significantly lower in HIV patients than in control (p = 0.000, 0.000, and 0.050, respectively). The PT and ADAMTS13 values showed no significant difference between HIV patients and control (p = 0.613 and 0.266, respectively). The PTT, TT, and DD values were found to be augmented in HIV patients versus the control (p = 0.000). Conclusions: Thrombotic thrombocytopenic purpura-like events among HIV Sudanese patients were explored. In addition, antiphospholipid antibodies were strikingly seen in these patients. Additional research is anticipated to confirm these diagnoses