Iris Publishers- Effect of Body Wash with Tea Tree Oil on the Prevention of Methicillin–Resistant Staphylococcus aureus in Critically Ill Patients at a university hospital in Egypt

Authored by Nahla Shaaban Khalil

Colonization with Methicillin-Resistant Staphylococcus aureus (MRSA) is independently is associated with mortality in critically ill adults. Tea tree has broad bactericidal activity. Clinical evidence supports its efficacy in eradicating MRSA, but there are no published data on its role in preventing MRSA colonization.
To determine whether the daily use of 5% tea tree oil compared with standard care (soap and water) had a lower incidence of Methicillin-Resistant Staphylococcus aureus colonization.
A quasi-experimental design was utilized and conducted at the neurological, intensive care units at Mansoura University Hospital including 120 adult critically ill patients participated in the study.
There were highly statistically significant differences between the study and control groups on the seventh day. So, all the study group subjects’ swabs from nose and groin were free from MRSA, while all the control group subjects’ swabs showed positive for MRSA infection. Tea tree oil is effective in preventing MRSA infection. Therefore, the establishment of using tea tree oil in the prevention of MRSA infection and further researches are highly recommended on a larger probability sample in the different geographical hospitals in Egypt to ensure generalization of findings.
MRSA is a major nosocomial pathogen that causes severe morbidity and mortality rate in many hospitalized patients especially critically ill patients and considered one of the main causes of the death worldwide [1]. It is the leading cause of life threating problems such as bloodstream infection, pneumonia, surgical site infection, arthritis, osteomyelitis, and endocarditis if not treated quickly; MRSA can cause sepsis and death [2,3]. Moreover, MRSA infection leads to increased hospitalization length and health care costs [4]. Its prevalence in Egypt is high compared to other African countries. Its prevalence of HA-MRSA increased from 48.5% in 2005 to 69.1% in 2013 and CA-MRSA 23.3% to 60% [5]. Furthermore, about two billion people worldwide carry Staphylococcus aureus, between 2 million and 53 million people in the United States (USA) carry MRSA [6]. Mortality rate due to MRSA is 50 % and higher for patients infected with MRSA in intensive care unit [7]. According to centers for disease control and Prevention (CDC) approximately 2.3 million individuals in the USA diagnosed with MRSA, approximately 86% of persons diagnosed with MRSA associated nosocomial or health care infection and 14% were community infection, 94,000 cases are MRSA infection and 11,000 dies from MRSA infection in the USA each year [8]. Approximately 25-35 % of the populations carry Staphylococcus aureus bacteria on the skin or nose is generally harmless, the bacteria enter the body through a cut of the skin or another open wound [9]. MRSA infection symptoms generally begin as swollen, painful red bumps that may resemble pimples or spider bites. In addition, it has a wide range of symptoms depending on the infected part of the body. The affected area may be redness, warm to touch, abscess and fever [10]. Critically ill patients usually are exposed to a number of intrinsic and extrinsic factors in ICU increased risk of MRSA. Typically, the patients have multiple invasive procedures or devices as intravenous tubing, hemodialysis catheters, urinary catheters, mechanical ventilation and tracheotomy that may contribute to limitation of patients positioning and mobility, even so, increasing the risk of MRSA occurrence [11]. Moreover, length of ICU stay, antibiotic use, diminished immune response, old age, superficial wound, MRSA colonization adds to comorbidity as diabetes and chronic disease side by side with the patient underlying disease contribute to MRSA development [12]. Additionally, it has been noted that health care workers have an increased risk of colonization and contribute to the transmission of MRSA infections in hospitals [13]. Today, MRSA is not a response to antibiotics therapy; it becomes resistant to beta-lactam antibiotics and causes serious complications [14]. In recent years, natural products such as herbal medicine and essential oil spread increasingly owning to plant naturally derived oil like tea tree oil (TTO). it’s a safe and effective herbal source of therapeutic help in the health care system all over the world [15]. TTO has antimicrobial, antifungal and antiviral, and anti-inflammatory properties due to the presence of a compound that is known terpinene-4 [16,17]. In addition, TTO is safe and well tolerated by patients, and considered as an alternative therapy to prevent and treat MRSA infection [18].


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Iris Publishers- Evaluation of Adherence to the Guidelines of Clinical Practice of Vascular Lines by the Nursing Staff of the UMAE H.E. N.- 14 C.M.N. “A.R.C.” Veracruz Norte

Authored by Jose Maria Dominguez Ruiz

Clinical practice guidelines are proposed to improve the quality of care. Its purpose is to establish a national reference to guide the making of clinical decisions based on recommendations based on the best available scientific evidence. The perspective of nursing in the 21st century is that all nurses look for evidence and apply it in their daily practice, in order to reflect on the assumptions considered as true and that guide the practice of day-to-day life, and which the impact and results of these interventions are routinely evaluated on patients.
To analyze the attachment to the prevention, diagnosis and treatment of infections related to vascular lines according to the recommendations of the clinical practice guide in the nursing staff of the intensive care unit in the High Specialty Medical Unit Number 14.
Observational, prospective and cross-sectional study, through review of 112 clinical files of patients with central venous catheters of the intensive care unit in the highly specialized medical unit number 14 Veracruz, Veracruz, Mexico, from August 2017 to November 2018. Incomplete files were excluded. To evaluate the adherence according to the recommendations of the clinical practice guideline, the single card of prevention, diagnosis and treatment of vascular-related infections was used, an adequate adherence was considered greater than 80%.
It was discovered that 73% did not adhere to the recommendations of the clinical practice guide, while 18% had medium attachment and only 9% had attachment. Of this percentage, 7% corresponds to the night shift, with the evening shift being the one that does not show adherence to the recommendations. 9% attachment for seniority: less than 5 years (2.25%), 6-15 years (2.25%), 16-25 years (2.25%), more than 26 years (2.25%).
There is a need to continue with the continuous training and it is suggested to carry out an educational intervention to later evaluate in order to improve the results. It follows that no personal impulse has been shown in the research development on the subject.
The epidemiological profile that currently characterizes the national health system is dominated by diseases that are difficult to manage, as well as injuries generated by determinants of a complex nature related to both the living conditions of society and the abilities of people to make decisions. in favor of your own health and that of yours. As part of the use of high technology, the use of intravascular catheters is a fundamental tool in the monitoring and treatment of patients admitted to health institutions, regardless of the complexity of their condition; they are of vital importance especially in those that are in critical condition [1].The use of venous catheters is relatively recent, they appear in the literature in the year 1900 and in 1929, Werner Fossmann underwent central venous catheterization with cadavers, until 1957 Ross introduces the basic principles of intravenous therapy. However, in 1970, Swan The epidemiological profile that currently characterizes the national health system is dominated by diseases that are difficult to manage, as well as injuries generated by determinants of a complex nature related to both the living conditions of society and the abilities of people to make decisions. in favor of your own health and that of yours. As part of the use of high technology, the use of intravascular catheters is a fundamental tool in the monitoring and treatment of patients admitted to health institutions, regardless of the complexity of their condition; they are of vital importance especially in those that are in critical condition [1].The use of venous catheters is relatively recent, they appear in the literature in the year 1900 and in 1929, Werner Fossmann underwent central venous catheterization with cadavers, until 1957 Ross introduces the basic principles of intravenous therapy.


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Iris Publishers-Sewage Water Effects on Okra (Abelmoschus esculentus (L) Moench) Growth Affected by Organic Matter, and Avm of Pseudomonas fluorescens

Authored by Abdul Khalil Gardezi

Okra (Abelmoschus esculentus) is a tropical crop, member of the Malvaceae family. Its fruits are grown and widely used in many countries of Asia and Africa. India is the main producer. It is cultivated in Mexico in small plots with scarce know-how. A sustainable and low-cost technology is needed to increase the profits of the farmers. Pseudomonas fluorescens have been used to increase germination and for biological control of pathogenic fungus. The study was done under greenhouse conditions. Two soils were used. One came from a parcel irrigated with sewage water and the other one was irrigated with clean water from a well. Half of the treatments were inoculated with Pseudomonas fluorescens. Four doses of vermicompost were applied as a source of organic matter. There were significant differences (p≤0.05) in most variables recorded due to the treatments. The soil irrigated with contaminated water only affected root length and fruit number. The plants inoculated with Pseudomonas fluorescens had better shoot and root growth, and fruit number, but it had no effect on fruit weight (p≤0.05). Vermicompost, as source of organic matter, also had a positive effect on Okra growth. Fruit number, and their dry weight augmented with the application of the lowest quantity of organic matter used (25t ha^-1). Irrigation with sewage water, inoculation with Pseudomonas fluorescens, and lower quantities of vermicompost can be used to increase the yields of Okra. The use of Pseudomonas fluorescens can help to overcome the negative effects of contaminated waters, and other environmental and biological stresses. Recommendations are made to validate this result under field conditions.

Okra (Abelmoschus esculentus (L) Moench), member of the Malvaceae family, is grown in the tropics, and widely used, as vegetable, for its fruits in many countries of Asia and Africa. Nigeria has the largest harvested area (1.46 million ha in 2016), but India is the main producer (5.5 million tons in 2016; FAO, 2018).
• It is cultivated in Mexico, also as vegetable, for export in small plots with scarce know-how. It is an important source of income for the farmers.
A sustainable and low-cost technology is needed to increase the profits of the farmers. Flourescent pseudomonads are the most common group of soil microbes found in combination with organic matter and associated with the suppression of root diseases [1-3]. They have also this beneficial effect in okra [4,5].
Pseudomonas fluorescens is a symbiotic species in plants that allows them to obtain the nutritional elements essential for their growth. This species is known for its ability to reduce the incidence of diseases in the roots of plants, as well as the inhibition of a large number of phytopathogens [6,7].
The use of organic matter is also a sustainable alternative to provide nutrients [8,9]. Water is a scarce resource. Contaminated water can be used to irrigate crops. The need to know what kind of crops for human consumption can be grown in contaminated soils, and the application of inoculation compensation for the natural lack of nutrients has led to a series of studies with this purpose.
The present work assessed the growth and yield of plants of okra (Abelmoschus esculentus (L) Moench), inoculated with Pseudomonas fluorescens, fertilized with organic matter, and cultivated in soils irrigated with clean and contaminated waters.

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Iris Publishers-Forest Fires The Disaster in California and Spain

Authored by Manuel Mateos de Vicente

Before dealing with such a problem the background of the author will be mentioned. My preparation includes a variety of subjects related to forest in subjects as follow:
• Soil Physics and Soil Chemistry
• Biophysical Chemistry
• Soil and Water Conservation
• Molecular structure of the different clays
To develop a land taking into account the different soil horizons, plantations and fertilizes.
Visiting forests in Spain and other countries, even Tasmania where I saw the best trees integration with as great variety.
What happens when a land is planted with pine trees? There are families whose way of living is destroyed. They cannot have beehives and have to sell the goats herd. Solution: To burn the pine forest.
Wolves are proliferating and killing cows and calves by dozens. Solution: To burn patches where the wolves live.
What to do when a tree is rotten at the base? If we cut it, we face an important fine. We individuals are stupid, and we have to call the government to send a forester to certify the need to cut such a dangerous tree, which may take two months if it happens in a village 30 or more miles away from the capital city.
The Government of Spain has planted forest with trees not autochthonous from Spain, such as eucalyptus, a tree that kills any other plantation with its leaves composed of chemicals that kill other species. The authorities lack needed information to explain that eucalyptus do not impoverish the soil on a permanent basis. Fire-break lanes are generally too narrow and sometimes separated many miles. Some of them are not taken care of.
The forests should be taken care such as trimming branches and removing from the soil surface the shrubs which have fallen or ground and could easily burn.
Way of trimming oaks in the part of Spain where I was born which was developed for the need to use the fruit to feed pigs. It is now criticized, and opposed, by technical persons formed in the universities.
Some trees planted in the street where I live are imported from lands of desert-like climate. A daily irrigation made the trunk to rotten and some of them have caused deaths when they fell. So far 12 trees have fallen in the last year, only 5 years after planted.

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Iris Publishers- Open access Journal of Dentistry & Oral Health | The Use of Raman Fluorescence Technology to Evaluate the Effectiveness of Remineralization of Solid Tooth Tissue

Authored by Alexandrov MT

Tooth enamel is the most mineralized tissue of the body. Composition - 96 wt. % inorganic matter and 4 wt. % of organic matter and water. Inorganic the substance mainly consists of calcium phosphate associated with hydroxyapatite, the chemical formula of which is [Ca10 (PO4) 6 (OH) 2]. The presence of hydroxyapatite is confirmed by the presence of its spectral bands in the hard tissues of the tooth [1]. It is believed that Raman spectroscopy allows you to objectively evaluate spectral bands associated with specific chemical structures of tooth hard tissues [2,3]. So currently this technology can be considered preferable in the study of remineralization of teeth [4-10]. The purpose of our study is to determine the effectiveness of the Raman-fluorescent method of diagnosing the remineralization of hard tooth tissues using demineralizing pastes, gel, suspension and rinse aid.
In this pre-clinical in vitro study on 25 model test objects of teeth (incisors of the lower jaws), removed for clinical reasons, Raman fluorescence spectroscopy was performed (after their hygienic cleaning professional toothpaste) using the Inspector M laser hardware-software complex with a probe radiation waves with the length of 532 nm. 5 of the model test objects of teeth are placed in a 10% suspension of Nano-HAP (Ca, Mg, Zn) for 1 min for 21 days (the period recommended for demineralizing therapy); 5 test objects were cleaned with paste containing Nano-HAP (Ca, Mg, Zn) daily for 21 days in the morning and in the evening; A gel containing nanogap in a complex with soluble calcium in one drug was inflicted (once a day) on 5 test objects for 21 days; 5 test objects were processed with rinse for 21 day daily; control group - 5 test objects that were in deionized water for 21 days. Measurements of the Raman-fluorescent characteristics of tooth hard tissues were carried out after 21 days. Repeated measurements in all groups were performed after 14 days to determine the duration of the preservation of the mineralization effect of tooth enamel. AIC “Inspector M” is designed to measure Raman spectra or photoluminescence spectra of liquids, solids, powders and gels. The device consists of a laser radiation source, a system for collecting, filtering and analyzing the scattered radiation, equipped with a lownoise multi-channel detector - analyzer (CCD line) to measure the amplitude and spectral characteristics of the scattered radiation [11-13].
The spectral range of the complex covers the molecular region of the fluctuations in organic and inorganic substances which allows to measure within several seconds the Raman or fluorescence spectrum of the object under study, determine the spectral position and relative intensities of Raman and fluorescent spectral lines. The software of this device facilitates the qualitative and quantitative analysis of the spectra obtained and the identification of the substance, comparing the resulting spectrum with the reference [3]. With the use of AIC “InSpectr M” the test objects were subjected to non-destructive effects of low-intensity laser radiation in the visible range (532nm). The results of the study were processed online, using during the work the presented hardware-software complex. The measurements were carried out contact-stable and perpendicular to the surface of the tooth enamel.


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Iris Publishers- Open access Journal of Dentistry & Oral Health | Research of The Effect of Saliva and Hygiene Products for Oral Cavity with the Use of The Indicators of Mineralization of Hard Tooth Tissues of Various Functional Groups

Authored by Alexandrov MT

Aim: In vitro using Raman-fluorescence spectroscopy study the effect of saliva and hygiene products for oral cavity on the mineralization indicators of various anatomical and topographic zones of the teeth for their various functional groups, justify its clinical expediency and effectivity.
Methods: In preclinical In vitro study on 90 model tooth test objects (incisors, premolars and molars) removed according to clinical indications, Raman-Fluorescence study of the degree of mineralization (Raman characteristics spectrum) was conducted and violation of the hygienic condition of the teeth (the presence of plaque and its fluorescence intensity) in various functional groups of teeth was also investigated. For the registration of the studied parameters APK “InSpectr M” with a wavelength probe radiation of 532 nm was used. Advantages of Raman Fluorescent spectroscopy for determining the degree of mineralization and hygienic condition tooth digital tissues are objectivity (digital technology), expressivity, non-invasive, simple and non-destructive degree control of mineralization / demineralization of the selected tooth tissues and its hygienic state, possibility of documenting and storing information (creating a database).
Result: During the study a qualitative and quantitative analysis of the effects of saliva and hygiene products for the oral cavity on mineralization and hygienic condition of various functional groups of teeth was performed. Currently, dental caries is one of the most common dental diseases among children and adults of the Russian Federation. One of local factors of caries occurrence are unsatisfactory hygienic oral care and changes in the quantitative and qualitative composition of the oral fluid [1]. In the system of caries prevention, the leading aspect is oral hygiene. The theoretical justification for the use of oral hygiene with the aim of remineralization in the prevention of caries and mineralization of hard tooth tissues are scientific studies confirming that the most important feature of enamel is permeability, which is ensured by the presence of micro-spaces in it, filled with water, which are able to permeate substances both inorganic and organic nature - depending on their polarity and size. Penetration and the movement of ions in the aqueous phase of the enamel is promoted by osmotic pressure, which is the main mechanism of the process of remineralization and demineralization of solid tooth tissues. In this physiological process, the decisive role is played by the oral fluid (saliva), which is the main source of income of substances in tooth structure [2-4]. However, the unexplored question of how to expressly, simultaneously and without changing the studied structures of the tooth hold the diagnostic measurements of its mineralization and the presence of plaque, and how oral hygiene products (toothpastes and powders of different mechanism of action) and methods of their use affect the mineralization of hard tooth tissues and their hygienic status.

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Iris Publishers- Open Access Journal of Addiction and Psychology | The Efficacy of Choice Theory to Identify At-Risk Gambling Behavior in College Students

Authored by Tracy Poe

Researchers agree that the age of onset of gambling is a predictor of future gambling problems [1-3]. Because other theories have failed to identify the internal drivers of problem gambling behavior among college students, Choice Theory was used to determine if the need for control or the need for achievement can predict at-risk problem gambling among the target population. The assessment tools/questionnaires used: (a) Demographic Information; (b) The South Oaks Gambling Screen (SOGS); (c) Desirability of Control Scale; and (d) The Gambling Motivation Scale. The SOGS was utilized to determine a classification for being at-risk of developing gambling disorder. Results from an independent samples t-test indicated that there was not a significant relationship between the classification status of being at-risk of developing gambling disorder and need for control among college students. However, results from an independent samples t-test indicated that there was a significant relationship between the classification status of being atrisk of developing gambling disorder and need for achievement among college students. Of the college students who participated in this study, 21.22% met the criteria for being considered at risk of developing gambling disorder, which is comparable to a previous study reporting 17% of college students meet the criteria for gambling disorder [4]. This rate of prevalence of students at-risk in the sample reaffirms the need for ongoing support and intervention for gambling disorder prevention and interventions with young adults in the college setting. Gambling is defined as “risking something of value with the anticipation of gaining something of more value” American Psychiatric Association [5] and is a behavioral condition which does not involve ingesting substances. According to Glasser W [6], behavior is intentional, purposeful, and based on choices. Thus, gambling is purposeful behavior. While there are physiological tests for ingesting substances, researchers and clinicians must rely on the individual’s self-report or observations of gambling behavior. Different populations are impacted differently by gambling; specific to the proposed study are college students who are atrisk of developing a gambling disorder. According to the (NCRG) [7], 75% of college students reported past year gambling and 18% reported gambling on a weekly basis. As a result, 17% of college students meet the criteria for gambling disorders compared to only 5.5% of the adult population in the United States [4]. Consequently, college gambling has become an important public health concern [7]. Indeed, recent research has indicated that young adults experience more gambling-related problems than any other group Derevensky J et al. [8], highlighting the need for interventions for this vulnerable population.

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Iris Publishers- Open Access Journal of Addiction and Psychology | When the Brain Coordinates Life-Risk Behavior: A Rewarding Anorexia

Authored by Valérie Compan

Understanding how brain supports adapted (and adaptive) decisions when individuals deal with challenge of the environment (stressor) is critical as adapted decision-making (goal-directed behavior) is supposed to protect from disturbances including unexpected death. How does the brain can then trigger chronic consumption of drugs or persistent food restriction (anorexia) until the point of death? In the neurosciences field, most of studies report correlations between behavioral disturbances in the face of environmental challenges and deregulations of neural circuits. Even if causal relationship is less described, exploring these correlations in simpler animal models makes possible the study of molecular and behavioral phenotypes in isolation and has revealed the conservation of specific molecular mechanisms in humans. For instance, involvement of serotonergic system in eating behavior remains crucial as current investigations, consistent with several decades (79 years from 1940 to 2019) of studies, reveals the conservation of specific molecular underpinnings of eating behaviors in animals and humans with eating disorders, suggesting the robustness of identified effects. In this context, studies describe commonalities between restrictive food intake and addiction, as in the nucleus accumbens - a critical structure of the brain’s reward system - activation of addictive signaling under the control of serotonin (5-HT, 5-hydroxytryptamine) 4 receptors (5-Ht₄Rs) mediates reduction in motivation for food in food-deprived mice, and ties anorexia and motor hyperactivity; Two hallmarks of anorexia nervosa. Accordingly, the brain prevents the transition from transient to persistent hypophagia (anorexia) with a network governing goal-directed behavior against depressive-like behavior, under the control of 5-Ht₄Rs localized in the medial prefrontal cortex. Food restriction at the onset following stress appears as an adapted behavior for managing stressors (as mediated by specific molecular changes related to depression resistance), but in the face of chronic stress, loss-of-control of the mPFC could imbalance the activity of the NAc and triggers persistent anorexia.

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Iris Publishers- Opena access Journal of Cardiovascular Research | The Reuse of (Single-Use) Cardiac Disposable of Coronary Angiography and Angioplasty: Safety and Economic Issues in Gaza Strip

Authored by Mohammed Habib

Background: Most countries outside the United States routinely reuse disposable medical equipment. We investigated the reuse of puncture needle, wires, sheath, manifold, inflation device, diagnostic and angioplasty catheters restored by a process strictly controlled for bioburden and sterility, in patients undergoing diagnostic coronary angiography and PCI.
Methods: We enrolled total 135 samples from different disposable (18 catheters, 6 manifold, 6 pressure line ,6 coronary wire, 6 femoral sheath, 2 inflation devices, 1 puncture needle) from 3 hospital in Gaza strip (45 sample from each hospital), were shipped to a central facility and were decontaminated, cleaned and tested for sterilization. The disposables were sterilized by exposure to Formaldehyde (90 samples,) or Cidex (45 samples) using a carefully validated protocol. Safety point: After sterilization disposables well rinsing with normal saline then taking swaps from outer side and inner side and were collected into a suitable container and transferred directly from collecting site to the laboratory to make culture. Cost-effective point: An average of five uses for diagnostic and three uses for angioplasty disposables.
Results: The disposable materials were collected from Aid Hospital and the European Gaza Hospital and sterilized by exposure to formaldehyde were negative results. while samples was collected from Al Shifa hospitals and sterilized by Cidex were 3 staphylococcus positive results. The procedure success rates similar to those of new products. Cost analysis suggests that An average of five uses for diagnostic disposables and three uses for angioplasty disposables may save approximately $5000 and $11500 respectively, per 100 procedures.
Conclusion: Reuse of medical devices labelled “single use only” is common in Palestinian hospitals. Restoration of disposable of coronary angiography and angioplasty using a controlled process appears to be safe, cost saving in sterilization by Formaldehyde (but not Cidex) with success rates similar to those of new products and no detectable sacrifice in performance.

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Iris Publishers- Open access Journal of Cardiovascular Research | Marantic or Non-Bacterial Thrombotic Endocarditis

Authored by Viren Ahluwalia

Marantic endocarditis (MAE), “verrucous” or “Libman Sachs Endocarditis” are all different synonyms of the nowadays agreed term non-bacterial thrombotic endocarditis (NBTE), which is defined as fibrinous sterile valvular vegetations in the absence of infective endocarditis. MAE is associated with an autoimmunemediated inflammatory and thrombotic pathogenesis, but not with an infective pathogen. It is seen in conditions such as antiphospholipid syndrome and systemic lupus erythematosus (SLE), but also in terminal malignancies. The incidence of MAE is largely unknown. Small scale post mortem examinations reported NBTE to range between 0.9 to 1.6 % [1]. This report aims to review current literature around MAE including presentation, diagnosis and management. MAE is most commonly associated with malignancy with numerous MAE case reports in the literature ranging from pancreatic cancer to adenocarcinoma of the lungs. Overall, adenocarcinomas have been shown to be mostly associated with MAE and of those mucin-secreting and pancreatic adenocarcinoma have the highest association [2,3]. It also has a well-documented association with systemic lupus erythematosus (SLE) and is associated with greater overall mortality in such patients [4]. Other associations include autoimmune disorders, hyper coagulate states, septicemia, severe burns, or chronic disease like tuberculosis, uremia or AIDS. The trigger for MAE and how it relates to commonly associated conditions is not well understood. The potential underlying pathophysiology might include endothelial injury in the setting of hypercoagulability [5]. This endothelial damage would then lead to primary and secondary clotting cascade activation involving platelets, clotting factors and inflammatory mediators leading thrombi formation and ‘vegetation’ on affected valves. It has a greater propensity to affect left sided valves.

MAE most commonly presents initially as a consequence of its distal embolic sequalae; Common complications include cerebrovascular events, such as strokes or transient ischemic attacks [6]. Emboli can ultimately affect any arterial system including critical limb ischaemia, splenic and renal infarcts and acute mesenteric ischaemia [3]. Localisation of causation can be linked to symptoms related to underlying aetiology. In patients with malignancy there maybe systemic constitutional symptoms including weight loss, night sweats and loss of appetite. Patients with SLE may describe a history of rashes, arthralgia and renal impairment, whilst those with antiphospholipid syndrome may describe recurrent deep vein thromboses or miscarriages.
Valvular vegetations in MAE are usually small, broad based and irregular shaped. Left sided (mitral more than aortic) and bilateral vegetations are more likely to represent MAE, than infective endocarditis (see picture). MAE are rarely associated with destructive changes to the heart valve. There is no definitive investigation in diagnosing MAE, with the key principle differential diagnosis being infective endocarditis. All patients should have a full work up including routine bloods to assess for organ dysfunction and serial blood cultures. Specific antibody (antiphospholipid antibodies) and auto-immune screen should be performed to rule autoimmune conditions such as SLE. As with conventional infective endocarditis imaging is crucial in proving MAE, with transesophageal echocardiography having much greater sensitivity over transthoracic [7] in demonstrating vegetations.

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Iris Publishers- Open access Journal of Cardiovascular Research | Antisynthetase Syndrome with Anti-Pl12 Antibodies and Cardiac Involvement

Authored by Ibtissam Romani

 

Background: The antisynthetase syndrome (ASS) is a rare chronic autoimmune disorder associated with a various manifestation including myositis, interstitial lung disease, fever, Raynaud’s phenomenon, “mechanic’s hands, polyarthritis and antibody specificity. Cardiac involvement is relatively rare but possible. We report a case of ASS anti PL12 positive with cardiac manifestations.
Case report: A 36 year old woman was admitted to the Department of Cardiology in our hospital for presyncope episodes, and exertional dyspnea. Physical examination revealed signs of congestive heart failure. Her heart rate was 40 bpm with a second-degree AV block Mobitz I on the electrocardiography. Transthoracic echocardiography showed cardiomyopathy with severe biventricular dysfunction and pulmonary hypertension. Further investigations were done to identify the cause of this cardiomyopathy especially as the patient presented arthralgias for last 2 years and history suggestive of Raynaud’s phenomenon and weakness of limbs. They revealed ASS syndrome with anti PL12 antibodies, diffuse interstitial lung involvement and cardiac involvement. The patient was treated with diuretic and corticosteroid therapy (methylprednisolone 1g pulse). On 4th day of admission, patient developed a complete AV block. Permanent dual chamber pacemaker implantation was performed. The patient was initiated on Cyclophosphamide and oral prednisolone which resulted in improved muscle strength and exercise tolerance.
Conclusion: Antisynthetase syndrome is a rare inflammatory myopathy. The cardiac involvement is even rarer and it is associated with worse outcome. The cardiovascular manifestations are various. This is the first report of ASS associated with complete heart block, cardiomyopathy and pulmonary hypertension in the same patient. Given the possible severe consequences, the cardiac involvement should be considered in patients with antisynthetase syndrome and clinicians should be familiar with this entity.

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Iris Publishers- Open access journal of Cardiovascular Research | Does Normal Breathing Rate Effects Interest of People in Cricket?

Authored by Arslan Hassan

The intention of our current study was to relate the normal breathing rate of people with the interest of people in cricket [1]. The breathing rate or respiration rate is the rate at which a normal person breaths per minute. Normally the breathing rate is measured by respirometer when the person is in rest state [2]. The respiration rate may be increase due to illness or diseases [3]. A normal person breath in minute about 12-18 times. A normal rate can change with the increasing age or level of activity. Cricket is a professional game in the world and many people take interest in cricket and become fans of their favourite teams or become fans of just single player. There are many categories of fans that watch and play cricket as it gives them relaxation from their boring routine and keeps them mentally and physically fit.

The breathing rate or respiration rate is the rate at which a normal person breaths per minute. Normally the breathing rate is measured by respirometer when the person is in rest state. The respiration rate may be increase due to illness or diseases. A normal person breath in minute about 12-18 times. Normal breathing rate change with the age differences such from the birth of baby to 7 weeks the breathing rate is 30-40 age up to 6 months breathing rate is 25 to 40 and at age of 6 breathing rate is 20-25 and adults have normal breathing rate is 12 to 18. Sometimes babies have the breathing rate more than 50 which means they are suffering from the serious diseases. The normal breathing rate is the indicator for respiratory diseases. There are many reasons that are responsible for fluctuation in the normal breathing rate of a person such as anxiety in which person breaths faster than the normal, in fever with the increase in the temperature of body the respiration rate also increases, respiratory illnesses such as asthma or pneumonia produces difficulties for breathing which can increase the breathing rate hearts diseases and dehydration both can increase the respiration rate of a person [4,5]. A normal rate can change with the increasing age or level of activity but when there is range of breathing is too much or too much low it means that this is a medical problem and call for doctor.
Cricket is a professional game in the world and many people take interest in cricket and become fans of their favorite teams or become fans of just single player [6]. There are many categories of fans that watch and play cricket as it gives them relaxation from their boring routine and keeps them mentally and physically fit. Some are fanatic types of fans of cricket which go in ground with full preparation as they are going on the fashion show and they can live or can die with the score at the end. Some fans are the talker which talks all the match and won’t stop and they have no sports etiquette at all but gives us good company. Cricket have some loudmouth fans for which we cannot say anything whether they are lover or hater of cricket. Some are the fantasy team watcher which only talk about their favorites not for any other they do not focus on a single game. Some fans are the blind followers which are just spectator and mix up with those which cheers against their teams they just want to be always in action of cheering [7]. Some are the loyal season ticket holders which are the heart and souls of fans and they can’t think of any other teams except their own team. They are sports lover.

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Iris Publishers- Open access Journal of Orthopedics Research | Mini Access Spine for Fixation of Thoracolumbar Spine Fractures

Authored by Bahaa Ali kornah

Introduction: The aim of treatment of spinal fractures is to resorted stability. Spine fractures are serious injuries can lead to neurological complications. The surgical technique can be either through posterior midline incision or paraspinal posterior open approaches or Percutaneous. The goal of this study is to evaluate the effectiveness of Mini access approach for treatment of dorsolumbar fractures by mini open surgical using ordinary pedicle screw fixation. This study involves Patients of acute traumatic single level dorso-lumbar spine fractures requiring surgical intervention. Thirty two (22 male, 10 female), age range 17-52 years (mean 31.1 ± 7.9 yrs) with dorso-lumbar fractures (D12:8, L1:17, L2:4, L3:3) with TLICS score>6 were studied (Feb 2009-Feb 18). Total of 128 screws were used of which 3 screws were mal positioned (2.3%). Open conversion was done in two cases (6.25%) due to difficulty in screw positioning.
Result: No patient had post-operative neurological deterioration. Operative time (minutes) 65.0±23.2. The average blood loss is 94ml Fluoroscopy time 5.2±2(seconds). Postoperative hospital stay (days) 3.1±1.8 days. The follow-up period an average of 10 months. The Accuracy rate of screws placement Type I: position acceptable in 108 screws. In 16 screws were classified as Type II: placement unacceptable. In 3 screws were classified as Type III: screws that are causing neurovascular injury) all cases causing radicular pain).
Conclusion: We conclude that Mini access Spine surgery for pedicle screws fixation is a safe, reliable, cost effective technique with favorable results in acute polytrauma cases requiring standalone ligamentotaxis. It is cost effective, minimal soft tissue dissection with short hospital stay. The authors believe that the data support its use and that this technique may be applicable for cases not needs spinal decompression, Mini access spinal technologies enable surgeons to achieve the same surgical objectives as with a traditional, open procedure.

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Iris Publishers- Open access Journal of Journal of Orthopedics Research | Non-United Fracture Scaphoid Surgery, Simple Step by Step Precise Technique

Authored by Safa Eldin Abaza

For many years, we have been using a simplified reconstruction technique for scaphoid non-unions that involves the use of precise iliac bone graft first described by modified Matti-Russe technique, based on consideration of the three elements of bone healing, deep knowledge of the applied anatomy, vascularity and biomechanics of the carpal bone. We have retrospectively reviewed the results of 69 consecutive patients with nonunion of different sites of the scaphoid treated by one senior author between 2005 and 2018. The objectives of our technique are to apply simple step by step technique that can be utilize by an average orthopedic and hand surgeon starting from simple careful volar soft tissue dissection not to add insult to vasculature, simple reduction, excision of the fibrous none union part of the fracture, preparation and micro fractures of the fracture bed, precise bone graft harvesting, simple fixation and closure. This technique is simple, fast and precise, only used for an established scaphoid nonunion without significant arthritis, chronic non-union with bone cyst formation and may be used in recurrent non-union after failed surgery associated with DISI carpal deformity but no significant radiocarpal or mid carpal arthritis.

McLaughlin 1954 “An unsolved problem”
Barton 1996“Awkward but important little bone”
Little has changed since 1950 still” Awkward but important little bone”
Green Etal “If all bones heal by the same process, why are scaphoid difficult to heal”
1. Failure of timely diagnosis
2. Systemic and local factors
3. Inappropriate treatment.
Bone healing is a complex process requiring mainly on
1. Viable bone cells
2. Continuous bone to bone contact with minimal shears at fracture site
3. Blood supply
Unfortunately the Scaphoid nonunion are lacking all the three elements for union
1. Bindra using microcomputer tomography found “bone trabeculae are more tightly packed and thick at the proximal pole and distal pole In contrast to the waist with the trabeculae are thinnest and sparsely with High numbers of fracture waist and the necessity for a supplement of viable bone cells with highest quality of bone graft.
2. Vascular anatomy: Gleeman in 1980 majority via radial artery 70-80% interosseous vascularity and entire proximal pole from dorsal vessels enter distally and dorsally travel proximally along the dorsal ridge, 20-30% volar radial artery arise from either the artery directly or the superficial palmar branch to enter through the tubercle region, so we do not dissect or violate the dorsal aspect of fracture site and preservation of the superficial palmar branch of the radial artery.
3. In a Comparison of Two Percutaneous Volar Approaches for Screw Fixation of Scaphoid Waist Fractures, Radiographic and Biomechanical Study of an Osteotomy-Simulated Model [1] Figure 1 to 3.
Conclusions: The data suggest that, in a cadaveric osteotomysimulated scaphoid waist fracture model, the transtrapezial approach reliably achieves central positioning of a screw in the proximal and distal poles. This position offers a biomechanical advantage compared with central placement in only the proximal pole, so we use simple K wires fixation and stopped using the screws fixation principle as it is bulky and needs violation of the scaphotrapezial joint with subsequent osteoarthritis Figure 1 to 3.

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Iris Publishers- Open access Journal of Agriculture and Soil Science | Foragers and Food Production in Africa: A Cross- Cultural and Analytical Perspective

Authored by Robert K Hitchcock

Virtually all hunters and gatherers in Africa today not only depend on foraging for their livelihoods but they also engage in food production and trade of domestic crops, livestock, and other resources. Many of them also take part in various kinds of work for other people in exchange for cash, food, and other goods. Drawing on case studies from western, central, eastern, and southern Africa, this paper assesses the causes and consequences of the shifts from hunting and gathering to agriculture, pastoralism, and small-scale business activities. Today, there are few ‘isolated hunter-gatherers’ who depend completely on foraging and are not enmeshed in the global, national, and local socioeconomic systems. Climate change, globalization, and the expansion of markets are leading to significant changes in local subsistence and livelihood strategies. These and other factors are also contributing to an expansion of innovative efforts to cope with the many serious challenges facing Africa’s indigenous peoples. Foragers and Food Production in Africa: A Cross-Cultural and Analytical Perspective. Paper for the 48th annual Society for Cross- Cultural Research (SCCR) meetings, Jacksonville, Florida, February 13-16, 2019. In Africa today, there are approximately 533,850 huntergatherers in 24 different countries on the continent (which contains a total of 54 nation-states) (Table 1). Some of the people who have been defined as hunter-gatherers or foragers include the Batwa (Pygmies) of Central Africa, occupying a dozen countries in the Congo Basin and its surrounding areas. In southern Africa, the San (Bushmen), reside in 7 countries, a large proportion of them in the Kalahari Desert, but some of them are also found in Afromontane areas such as the Maluti-Drakensberg Mountains of Lesotho and South Africa. There are also sizable numbers of former foragers who reside today in Central and East Africa, from the Haddad of Chad [1] to the Hadza of Tanzania [2] and from the Ogiek of Kenya to the Eyle of Somalia [3,4]. Virtually all of the huntergatherers and former foragers in Africa obtain a portion of their livelihoods from agriculture or from trade of wild meat and other forest products for domestic crops. A substantial number of former foragers raise their own crops, as seen, for example, among virtually all San, eastern African hunter-gatherers such as the Chabu and the Boni, and most if not all Batw

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Iris Publishers- Open access Journal of Agriculture and Soil Science | Chronic Exposure and the Risk of Building Antibiotic Resistance in Rural Communities of the Developing World

Authored by Mark Coyne 

Antibiotic resistance is a global issue, not least the question if resistance is intrinsic, acquired, or adaptive. The current scenario demands investigations to detect resistance in environments from the urban/rural nexus. The complexity of antibiotic resistance in the environment is linked with the characteristics of recipient compartments in various environmental systems. Much research focuses on resistance in point sources (hotspots) of exposure, but after release the risk of antibiotics affecting humans is quite complex. Dispersion, dilution, and concentration reduction are part of the natural cycle required to examine the fate of antibiotics in the environment. Antibiotic residues at any stage threaten public health no matter if they cause acute exposure or because of much lower concentrations persisting in sediments, soils, irrigation waters, groundwater, aerosols, and produce where they may reflect chronic exposure. In either case, human exposure is undeniable with differential impact. In view of local constraints and unintended feedback we propose a research agenda to enhance understanding the future of exposure intensity and the fate and synergistic effect of antibiotics released into the environment in developing resistance. We advocate the need to investigate sub-lethal antibiotic concentrations and human populations aimed at limiting the acute and chronic public exposure to antibiotic residues and resistant microbes from soil and water among occupational groups and rural population inhabiting resource-limited settings.  The benefits of antibiotic use cannot be overemphasized; they certainly outweigh the harm associated with their side effects. However, when antibiotics are abused or overused, that harm increases manifold with no benefit. Global antibiotic production for human use is a $40 billion-ayear industry. Approximately 250 to 300 tons year of antibiotics are used in human medicine and a much greater amount of antibiotics are produced for livestock and aquaculture. To fulfill ever increasing human demands, huge amounts of antibiotics are produced worldwide, with projections for additionally expanded production in the future [1]. It is estimated that global antibiotic use will rise to 105,596 tons year–1 in 2030, with China the largest consumer followed by the US, Brazil, Mexico, and India [2]. This increase reflects their broadened use for treating genuine contamination identified with human well-being and welfare, and for advancing and developing disease aversion in domesticated animals. In particular, low- and middle-income countries showed increased antibiotic use between 2000 and 2015 (+39%) which suggests an alarming projection for a 200% rise globally by 2030.

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Iris Publishers- Open access journal of Biostatistics & Biometric Applications | Canonical Analysis for the Birth Reduction Complications after Introduction of Free Maternity Health Care Services in Kenya

Authored by Amos Kipkorir Langat

There is a growing movement, globally and particularly in the Africa region, to reduce financial barriers to health care. Approximately 585,000 women of Reproductive age die each year from pregnancy related causes worldwide according to the World Health Organization (WHO). The purpose of the study was to examine how free maternity healthcare programme influences maternal mortality rate in Kenya. The study was guided by the following research objectives: to determine how free antenatal care influences maternal mortality rate in Bomet County; to establish how free delivery care influences the lives of others in Bomet County; to assess how free Emergency medical services influences maternal mortality rate in Bomet County and to identify how free postnatal care influences maternal mortality rate in Bomet County. The target population of this study entailed 224 mothers who attend various health maternity clinic, 20 nurses, 10 paramedics and 5 doctors. A descriptive survey research design was adopted for the study. The study focused on collecting primary and secondary data using a structured questionnaire and focus group discussions. Validity of the research instruments was determined by content and construct validity while reliability of the research instruments was determined by internal consistency method. Data collected was analyzed using both qualitative and quantitative approaches. Parametric and Nonparametric data was analyzed; such as measures of central tendency, variability and dispersion and correlation. Data were analyzed by use of and the results were presented in the table form and context. The key findings of the study revealed that free maternity care has a direct relationship to maternal mortality rate; the rate of deaths due to pregnancy related causes have reduced significantly in Kenya since the introduction of this program. The study recommended that the government should develop both long term and short term strategies in implementing free maternal healthcare services in public hospitals including creating awareness, training staff and adding more services to the program. The Free Maternal Health Care Initiative provides subsidized health insurance to pregnant women, giving them access to an existing range of insurance benefits that includes comprehensive maternity care with some notable exceptions such as ambulance service and post-partum family planning counselling. It is supported from the general pool of resources of the National Health Insurance Fund, which includes contributions from international partners via the health sector budget support.

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Iris Publishers- Open access journal of Biostatistics & Biometric Applications | Effective Lifestyles for a Healthy Life above Forty Years

Authored by Matthew Chukwuma Michael

This paper seek to identify the effective lifestyles that enhance a healthy life above forty years of age. It highlighted and explained some age-related health issue and lucidly showed how they vary with age. It viewed lifestyle from the perspective of a cultural way of doing things and the individualistic perspective as those individual habits that may be relatively distinct from the general way. It discussed some effects of lifestyle and age on health. It concluded that effective lifestyles for healthy life above forty years are those lifestyles that should be adopted in order to achieve a complete wellbeing of the individual in that age group. It finally highlighted them to include, but not limited to, proper choice of what to eat and what to avoid; proper choice of life partners; regular, enjoyable and satisfactory sexual life; planning of economic and financial life; avoiding illicit drugs and drug/substance abuse and adopting good stress management strategies.

Life is a process of observing, experiencing and performing the characteristics of life which include; feeding/nutrition, growth, excretion, irritability, movement, respiration, reproduction and ultimately, death. It is easier to explain the act of living than to explain life itself. We experience the characteristics of life on daily basis except one (Death) which we experience once in a life time. Funny as it may, but obvious, people are scared of death and often times, do not want/pray to experience it. However, death is part of the events that define life; hence, all living organisms die in order to complete their life journey. Health is a state of general mental, physical, psychological, social and economic wellbeing of an individual. Therefore, health of an individual is measured by the quality of life he/she lives and how useful the individual is to the society.
Age, as they say, is just a number but a saying goes that a fool at forty is a fool forever. More so, for every functional process, there is a period for optimum performance, wear and tear, repair and, finally, breakdown. Living organisms are not exceptions; from birth, many events occur in the transition to death and, those events, most times, depend on age. Most times, the longevity and functionality of a system/process depends to a large extent on the way it is operated/handled or managed. What increases longevity is ensuring that what promotes good standard and specifications of a system are upheld. To the human organism, the way we observe, experience and perform the characteristics of life are called lifestyles. Where the lifestyles are found to meet up with good standards and specifications, they are said to be effective. Thus, it is not out of place to examine the effective lifestyles that will enhance healthy life at forty years and beyond.

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Iris Publishers- Open access Journal of Cancer Research & Clinical Imaging | Commentary of Sarcopenia and Postoperative Complications in Gastrointestinal Cancer

Authored by Mikhail V Osipov

 

The undoubted achievement of the authors of the article is the detailed literature review and scrupulous data collecting, which allowed researchers to identify multiply factors and analyze an impact of those on the outcome. The most appropriate design for this type of study is a multivariate analysis. Current study presents results of a several univariate comparisons using one-by-one comparison of separate risk factors affecting the outcome using the SPSS package. At the same time, age and gender of the patient - a major factors which could impact on the outcome - were not taken into account in the analysis. The results presented in the study lean on p-values given for factors that has categories, i.e. categorical variables - a stage or degree of severity (for example, BMI has 3 levels: Underweight, Eutrophy, Overweight, which obviously can have an opposite impact on the outcome). A question arises, which of those categories was used for the comparison giving single p-value and how this significance corresponds beside the levels of single risk factor. Also, the key question is how much the severity of Sarcopenia, which has 3 stages, affects the outcome. Authors should remember that this approach (direct comparison when combining all categories into one) the Simpson paradox could cause.
The use of the t-test is admissible for the discrete sample and normal distribution, and there’s need to check the distribution for normality before the analysis, otherwise in the present study, with a sample size of 46 cases and a discrete distribution pattern, t-test may cause deviation. It is appropriate to use Fisher test or mid-p test for discrete distribution in the present analysis. The use of nonlinear logistic regression requires, above all, a description of the model, which the authors did not specify. Although the presence of Sarcopenia empirically to a certain extent can influence the occurrence of postoperative complications due to difficulties in adapting process of human organism, the result obtained in this study requires further improvement. In this regard, the authors are recommended to correct the results of the study in accordance with the specified shortcomings.

 

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