Sulfur Hexafluoride 20% versus Lactated Ringer’s Solution for Prevention of Early Postoperative Vitreous Hemorrhage after Diabetic Vitrectomy

Purpose: To compare the hemostatic effect of sulfur hexafluoride 20% (SF6 20%) with lactated Ringer′s solution for prevention of early postoperative vitreous hemorrhage following diabetic vitrectomy. Methods: In a prospective randomized clinical trial, 50 eyes undergoing diabetic vitrectomy were divided into two groups. At the conclusion of surgery, in one group the vitreous cavity was filled with SF6 20% while in the other group lactated Ringer′s solution was retained in the vitreous cavity. The two groups were compared for the rate of early postoperative vitreous hemorrhage. Results: The incidence of vitreous hemorrhage was lower in the SF6 group than the Ringer′s group 4 days (20% vs 68%, P=0.001), 7 days (24% vs 60%, P=0.01) and 4 weeks (16% vs 40%, P=0.059) after vitrectomy. Conclusion: In comparison with lactated Ringer′s solution, SF6 20% had a significant hemostatic effect especially in the early postoperative period after diabetic vitrectomy and reduced the incidence of vitreous hemorrhage

The Efficacy of Phonological Processing Treatments on Stuttering Severity in Persian Pre-school Children

AbstractObjectives: Correct phonological encoding is crucial to fluent speech production. Phonological working memory and phonological awareness are important phonological processes that affect phonological encoding. Studies have shown weakness in phonological encoding in people who stutter. The purpose of this study was to investigate the effect of phonological processing on stuttering severity of Persian pre-school children.Method: Six children who stutter participated in a 13-session treatment protocol. The treatment protocol of the phonological processing included nonword repetition in the phonological working memory and phonological awareness therapy. Stuttering severity measurement was performed pre- and post-treatment.Results: Stuttering severity score was compared in pre- and post-treatment, and in the follow-up phase; that showed stuttering severity was reduced in children who stutter. Moreover, severity rating, reported by parents during treatment, showed a reduction in stuttering severity. Conclusion: The poor performance of phonological awareness and phonological working memory in phonological processing affect stuttering severity. The outcomes of this study showed that treatment of sub-systems of phonological processing can play a role in reducing stuttering severity.

Time-dependent physicochemical characteristics of Malaysian residual soil stabilized with magnesium chloride solution

The effects of non-traditional additives on the geotechnical properties of tropical soils have been the subject of investigation in recent years. This study investigates the strength development and micro-structural characteristics of tropical residual soil stabilized with magnesium chloride (MgCl2) solution. Unconfined compression strength (UCS) and standard direct shear tests were used to assess the strength and shear properties of the stabilized soil. In addition, the micro-structural characteristics of untreated and stabilized soil were discussed using various spectroscopic and microscopic techniques such as X-ray diffractometry (XRD), energy-dispersive X-ray spectrometry (EDAX), field emission scanning electron microscopy (FESEM), Fourier transform infrared spectroscopy (FTIR) and Brunauer, Emmett and Teller (BET) surface area analysis. From the engineering point of view, the results indicated that the strength of MgCl2-stabilized soil improved noticeably. The degree of improvement was approximately two times stronger than natural soil after a 7-day curing period. The results also concluded the use of 5 % of MgCl2 by dry weight of soil as the optimum amount for stabilization of the selected soil. In addition, the micro-structural study revealed that the stabilization process modified the porous network of the soil. The pores of the soils had been filled by the newly formed crystalline compounds known as magnesium aluminate hydrate (M-A-H).Ministry of Education Malaysia under the Fundamental Research Grant (FRGS) (R.J130000.7822.4F658); Universiti Teknologi Malaysia (UTM); Construction Research Centre UT

Effectiveness of Semmes-Weinstein monofilament examination for diabetic peripheral neuropathy screening in Ahvaz, Iran

Foot care prevention programs can reduce the occurrence of foot ulcerations and amputations. This investigation evaluated Effectiveness of Semmes-Weinstein monofilament examination for diabetic peripheral neuropathy screening in Ahvaz, Iran. In this quasi-experimental design 150 patients with diabetes mellitus were recruited by purposive sampling. All patients were tested for sensory neuropathy using Semmes-Weinstein Monofilament Examination. In the next phase nerve conduction velocity was examined. The sensitivity of Semmes-Weinstein Monofilament 10 g was 38.5-61.5 at sites 1-8, whereas the specificity was 77.5-95.5. Monofilament was found to be simple, cheap and useful method and suitable for detection of sensory neuropathy in clinical examinations. Hence, we recommend screening of patients for neuropathy as soon as they are diagnosed with diabetes

Health effects of exposure to electromagnetic fields generated by computers in a government office in Ahvaz city-2016

زمینه و اهداف: مواجهه با میدان‌های الکترومغناطیس به واسطه استفاده از تجهیزات الکترونیکی روی می‌دهد. هدف مطالعه حاضر بررسی مواجهه با میدان‌های الکترومغناطیس و تاثیر آن بر سلامت عمومی کاربران رایانه است. مواد و روش‌ها: مطالعه حاضر از نوع مقطعی و با مشارکت 73 کارمند مرد انجام گرفت. میدانهای الکترومغناطیس توسط دستگاه کالیبره شده گوس متر مدل HI-3603 ساخت امریکا اندازه گیری گردید و برای سنجش سلامت از پرسشنامه سلامت عمومی استفاده گردید. جهت تحلیل نتایج از آزمونهای تی تست و کای دو استفاده شد. در طی انجام این مطالعه کلیه موازین اخلاقی رعایت و مجوزهای مربوطه دریافت گردید. یافته‌ها: شدت میدان الکتریکی در نمایشگرهای رومیزی و رایانه همراه به ترتیب 1/2-0/26و 0/87-0.28ولت بر متر بود که این مقدار در نمایشگرهای رومیزی در فاصله cm 30 برابر 1/2 ولت بر متر بود که از حد استاندارد بالاتر می‌باشد. نتایج پرسشنامه سلامت عمومی نیز نشان داد که 39 % از افراد گروه کاربران رایانه فاقد سلامت عمومی می‌باشند. هم چنین بین سلامت عمومی دو گروه اختلاف معناداری دیده شد (p<0.001) نتیجه‌گیری: در استانداردهای مواجهه با میدان‌های الکترومغناطیس، عامل زمان لحاظ نمی‌شود و تنها یک مقدار سقف بیان می‌گردد. مطابق با نتایج مشخص گردید که در بیشتر نقاط این مقادیر کمتر از استاندارد می‌باشند. اما با نظر داشتن این نکته که زمان استفاده از این تجهیزات طولانی می‌باشد و محدود به زمان کار نمی‌باشد، اثرات این مواجهه با مقادیر کمتر از حد مجاز در سلامت کاربران رایانه را می‌توان به صورت تجمعی در نظر داشت.Background and Aims: Exposure to electromagnetic fields occurs as a result of electronic equipment exploitation. The aim of this study was to evaluate the exposure to electromagnetic fields and its impact on the public health of computer users.Materials and methods: The present cross-sectional study involved 73 male employees. A calibrated gauss meter (model HI-3603, USA) was employed to measure the intensity of electromagnetic fields. A general health questionnaire was also used to assess the health status of the operators. T tests and chisquare test were used for data analysis. Ethical issues were all considered in all stages of the study, and required permission were received.Results: The electric field intensity range of desktop and laptop displays were measured 0.26 - 1.2 and 0.28 - 0.87 v/m, respectively. The corresponding intensity at a distance of 30 cm from desktop displays was 1.2 v/m; which was more than the standard level. Indeed, general health questionnaire results revealed that 39% of computer users suffer from the lack of public health. The public health status between two groups was significantly different (p<0.001).Conclusion: Exposure duration factor is not considered in exposure level standards for electromagnetic fields, and a ceiling amount is only reported. According to the results of this study, electromagnetic field intensity values were below standard limits at most of the measured points; however, given the long duration time of equipment usage, the health consequences of this exposure could be accounted as cumulative exposure

Correlation between Acoustic Parameters and Disease Severity and Duration in Patients with Multiple Sclerosis

Background: Since in multiple sclerosis (MS), changes in speech and voice quality often precede other signs and symptoms; early diagnosis of these changes is necessary. In this study, an acoustic examination of phonation subsystem was performed. Due to the progressive nature of multiple sclerosis, the aim of this study was to examine the correlation between acoustic parameters of voice quality and disease severity and duration. Methods: This descriptive-analytic study was performed on 43 patients with multiple sclerosis. The disease severity was detected by a neurologist based on the Expanded Disability Status Scale (EDSS) for each patient. Acoustic analysis was performed during the production of sustained vowel /a/ and accordingly, the maximum phonation time (MPT), perturbation of the frequency (jitter), perturbation of amplitude (shimmer), the maximum and minimum frequency, and the highest and lowest intensity were evaluated. All the acoustic analyses were performed using PRAAT software. Data were statistically analyzed using Spearman's correlation coefficient by SPSS version 21. Results: The lowest intensity showed a significant correlation with disease severity (P=0.00). Also, the highest and lowest intensity showed a significant correlation with disease duration (P=0.022 and P=0.002). Conclusion: One of the earlier symptoms of central nervous system impairment resulting from multiple sclerosis is changes in phonation subsystem and voice quality. These changes may appear at any clinical stages; however, the symptoms might get worse over time, with the progression of the disease. Therefore, immediate acoustic assessments and interventions can prevent more degradation of voice quality

Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.

Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury. METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 to measure the global, regional, and national burden of TBI and SCI by age and sex. We measured the incidence and prevalence of all causes of injury requiring medical care in inpatient and outpatient records, literature studies, and survey data. By use of clinical record data, we estimated the proportion of each cause of injury that required medical care that would result in TBI or SCI being considered as the nature of injury. We used literature studies to establish standardised mortality ratios and applied differential equations to convert incidence to prevalence of long-term disability. Finally, we applied GBD disability weights to calculate YLDs. We used a Bayesian meta-regression tool for epidemiological modelling, used cause-specific mortality rates for non-fatal estimation, and adjusted our results for disability experienced with comorbid conditions. We also analysed results on the basis of the Socio-demographic Index, a compound measure of income per capita, education, and fertility. FINDINGS: In 2016, there were 27·08 million (95% uncertainty interval [UI] 24·30-30·30 million) new cases of TBI and 0·93 million (0·78-1·16 million) new cases of SCI, with age-standardised incidence rates of 369 (331-412) per 100 000 population for TBI and 13 (11-16) per 100 000 for SCI. In 2016, the number of prevalent cases of TBI was 55·50 million (53·40-57·62 million) and of SCI was 27·04 million (24·98-30·15 million). From 1990 to 2016, the age-standardised prevalence of TBI increased by 8·4% (95% UI 7·7 to 9·2), whereas that of SCI did not change significantly (-0·2% [-2·1 to 2·7]). Age-standardised incidence rates increased by 3·6% (1·8 to 5·5) for TBI, but did not change significantly for SCI (-3·6% [-7·4 to 4·0]). TBI caused 8·1 million (95% UI 6·0-10·4 million) YLDs and SCI caused 9·5 million (6·7-12·4 million) YLDs in 2016, corresponding to age-standardised rates of 111 (82-141) per 100 000 for TBI and 130 (90-170) per 100 000 for SCI. Falls and road injuries were the leading causes of new cases of TBI and SCI in most regions. INTERPRETATION: TBI and SCI constitute a considerable portion of the global injury burden and are caused primarily by falls and road injuries. The increase in incidence of TBI over time might continue in view of increases in population density, population ageing, and increasing use of motor vehicles, motorcycles, and bicycles. The number of individuals living with SCI is expected to increase in view of population growth, which is concerning because of the specialised care that people with SCI can require. Our study was limited by data sparsity in some regions, and it will be important to invest greater resources in collection of data for TBI and SCI to improve the accuracy of future assessments

Global, regional, and national burden of neurological disorders, 1990–2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background: Neurological disorders are increasingly recognised as major causes of death and disability worldwide. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 is to provide the most comprehensive and up-to-date estimates of the global, regional, and national burden from neurological disorders. Methods: We estimated prevalence, incidence, deaths, and disability-adjusted life-years (DALYs; the sum of years of life lost [YLLs] and years lived with disability [YLDs]) by age and sex for 15 neurological disorder categories (tetanus, meningitis, encephalitis, stroke, brain and other CNS cancers, traumatic brain injury, spinal cord injury, Alzheimer's disease and other dementias, Parkinson's disease, multiple sclerosis, motor neuron diseases, idiopathic epilepsy, migraine, tension-type headache, and a residual category for other less common neurological disorders) in 195 countries from 1990 to 2016. DisMod-MR 2.1, a Bayesian meta-regression tool, was the main method of estimation of prevalence and incidence, and the Cause of Death Ensemble model (CODEm) was used for mortality estimation. We quantified the contribution of 84 risks and combinations of risk to the disease estimates for the 15 neurological disorder categories using the GBD comparative risk assessment approach. Findings: Globally, in 2016, neurological disorders were the leading cause of DALYs (276 million [95% UI 247–308]) and second leading cause of deaths (9·0 million [8·8–9·4]). The absolute number of deaths and DALYs from all neurological disorders combined increased (deaths by 39% [34–44] and DALYs by 15% [9–21]) whereas their age-standardised rates decreased (deaths by 28% [26–30] and DALYs by 27% [24–31]) between 1990 and 2016. The only neurological disorders that had a decrease in rates and absolute numbers of deaths and DALYs were tetanus, meningitis, and encephalitis. The four largest contributors of neurological DALYs were stroke (42·2% [38·6–46·1]), migraine (16·3% [11·7–20·8]), Alzheimer's and other dementias (10·4% [9·0–12·1]), and meningitis (7·9% [6·6–10·4]). For the combined neurological disorders, age-standardised DALY rates were significantly higher in males than in females (male-to-female ratio 1·12 [1·05–1·20]), but migraine, multiple sclerosis, and tension-type headache were more common and caused more burden in females, with male-to-female ratios of less than 0·7. The 84 risks quantified in GBD explain less than 10% of neurological disorder DALY burdens, except stroke, for which 88·8% (86·5–90·9) of DALYs are attributable to risk factors, and to a lesser extent Alzheimer's disease and other dementias (22·3% [11·8–35·1] of DALYs are risk attributable) and idiopathic epilepsy (14·1% [10·8–17·5] of DALYs are risk attributable). Interpretation: Globally, the burden of neurological disorders, as measured by the absolute number of DALYs, continues to increase. As populations are growing and ageing, and the prevalence of major disabling neurological disorders steeply increases with age, governments will face increasing demand for treatment, rehabilitation, and support services for neurological disorders. The scarcity of established modifiable risks for most of the neurological burden demonstrates that new knowledge is required to develop effective prevention and treatment strategies. Funding: Bill & Melinda Gates Foundation

Global injury morbidity and mortality from 1990 to 2017 : results from the Global Burden of Disease Study 2017

Correction:Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.Peer reviewe

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97\ub71 (95% UI 95\ub78-98\ub71) in Iceland, followed by 96\ub76 (94\ub79-97\ub79) in Norway and 96\ub71 (94\ub75-97\ub73) in the Netherlands, to values as low as 18\ub76 (13\ub71-24\ub74) in the Central African Republic, 19\ub70 (14\ub73-23\ub77) in Somalia, and 23\ub74 (20\ub72-26\ub78) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91\ub75 (89\ub71-93\ub76) in Beijing to 48\ub70 (43\ub74-53\ub72) in Tibet (a 43\ub75-point difference), while India saw a 30\ub78-point disparity, from 64\ub78 (59\ub76-68\ub78) in Goa to 34\ub70 (30\ub73-38\ub71) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4\ub78-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20\ub79-point to 17\ub70-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17\ub72-point to 20\ub74-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations