Iris Publishers-Open access Journal of Pediatrics & Neonatal Care | Isolated Benign Infantile Neutropenia

 

authored by Othman Rizk A Mishref*

Abstract

Keywords:Neutropenia; Bone marrow failure; Severe combined immunodeficiency

History

A previously healthy, 10-month-old male infant presented with cold symptoms and fever (temperature up to 38.5 °c) for the last 3 days, that was responding to paracetamol for few hours then recurs. It was associated with slightly decreased oral intake. He is not irritable. He is breast feeding with little smashed food. There were no significant symptoms or signs other than fever. He had been doing well until his current illness.

• The bowel pattern and urination had been normal.

• No relevant past or family history or chronic illness or hematologic disorders.

• No previous hospital admission

• No history of contact with any specific infection

• perinatal history: full term, normal vaginal delivery, smooth perinatal history.

• Nutritional history: exclusive breast feeding till age of 6 months and then started weaning with smashed food, but mainly dependent on breast feeding.

• Vaccination history: vaccinated up to date.

• Normal developmental history

• Medication history: Nil.

Examination

Vital signs are normal. Height and weight are at the 50th percentile for age. Physical examination was normal. No; oral thrush, lymphadenopathy, hepatosplenomegaly, or skin lesions are noted.

Routine investigations were done; complete blood count (CBC), C-Reactive Protein (CRP), Liver Function Tests (LFT), Renal Function Tests (RFT), all came normal except CBC showed marked neutropenia, absolute neutrophil count of 40/μL.

Clinical Course and Discussion

The patient was admitted for neutropenia workup. He was commenced on IV antibiotics (ceftazidime). He had undergone many laboratory tests without any clue to the diagnosis. These tests included a CBC, urine analysis, chest X-ray, blood culture, urine culture, stool culture, Widal test, Paul-Bunnell test, tests for brucellosis, leptospirosis, and dengue fever.

He had persistently low absolute neutrophil count (ANC) during hospital stay (Table 1):

Table 1:Laboratory results.

It is most unlikely that this infant has an acute bacterial infection, as fever has improved since admission and stayed afebrile till discharge from hospital, together with no focal site of infection or any complications, looks well, not toxic look, active and playing and feeding well. A chronic infection such as tuberculosis (TB) may present with continuous high fever, loss of weight, toxic look, night sweating as seen in disseminated/miliary TB. However, the patient received BCG vaccine and there is a BCG scar in the left shoulder. Other chronic infections without localizing symptoms include CMV, toxoplasmosis, malaria, EB virus, brucellosis are unlikely. Similarly, infiltrative disorders (malignancy/histiocytosis/sarcoidosis) are also a possibility

Of note, a CBC at birth demonstrated normal absolute neutrophil counts. There is no history of increased bacterial or fungal infections. He is the only child for the family and there is no family history of recurrent bacterial infection, neutropenia, immunodeficiency disease, autoimmune disease, or malignancy. There is no history of infant deaths in the family and CBC was done for both mother and father and was found to be normal. There has been no history of recent medication use. His growth and development had been normal until the onset of this illness.

The patient was discharged after 12 days. During his hospital stay he does well. During subsequent febrile illnesses, he does well clinically. Three months later, after he initially presented with neutropenia, his ANC improves to 1700 /μL. All investigations came normal except persistent neutropenia, positive Antineutrophil antibody, and diagnosis of chronic benign neutropenia of infancy and childhood is done.

Final Diagnosis

Chronic benign neutropenia of infancy and childhood.

Background

Neutropenia is defined as a decrease in the absolute neutrophil count (ANC) <1,500/ μL. ANC= (%bands + %mature neutrophils) X total WBC count. Neutropenia may be due to decreased neutrophil production, storage, or release; redistribution from circulating to marginated pools; or increased destruction. Neutropenia can be classified to; mild (ANC 1,000-1,500/μL), moderate (ANC 500- 1,000/μL), or severe (ANC <500/μL). ANC <200 is also termed agranulocytosis [1].

Acute neutropenia evolves over a few days because of rapid neutrophil consumption and compromised neutrophil production. Chronic neutropenia lasts longer than 3 months and arises from reduced production, increased destruction, or excessive splenic sequestration of neutrophils. The etiology of neutropenia can be classified as either an acquired, extrinsic disorders (Table 2&3) or more rarely an inherited, intrinsic defect (Table 4). Cyclic neutropenia is a rare (1-2/million) Autosomal Dominant (AD) disorder characterized by primary cyclic (every 21 days) variations in bone marrow reserve; regularly recurring fever every 21 days with oropharyngeal and skin infections. In general, common disorders are usually benign clinically and occur in children with no significant medical history of bacterial or fungal infections. Rare congenital disorders result in extremely high risks of infection and require specific laboratory tests to be diagnosed [2].

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Iris Publishers-Open access Journal of Modern Concepts in Material Science | Improving the Lifetime of Mechanical System Such as Hinge Kit System Subjected to Repeated Impact Stress

 

authored by  Seongwoo Woo*

Abstract

To enhance the lifetime of mechanical system, parametric Accelerated Life Testing (ALT) as new systematic reliability method suggests evaluating the design of mechanical systems subjected to repeated stresses, based on failure mechanism and design. This newly developed parametric ALT helps an engineer uncover the missing design parameters (or design flaws) of the mechanical system having an effect on reliability during the product developing process. As a result, companies can circumvent product recalls due to the design flaws from the marketplace. As an experiment instance, the redesign of hinge kit system (HKS) in a domestic refrigerator was investigated.

Keywords: Reliability design; HKS; Fracture; Parametric ALT; Design flaws

Introduction

The mechanical products such as automobile, airplane, and refrigerator manage power to achieve a job that requires forces and movement, which produce mechanical advantages by adapting product mechanisms. For example, using the vapor-compression refrigeration system, a refrigerator supplies chilled air from the evaporator to the refrigerator and freezer section. Customers want a refrigerator that have high performance and reliability for multi-functions. Accordingly, a HKS structured as a spring-damper therefore was designed as a consumer want to gently open and close a refrigerator door with minimal effort. If there is design fault in the system when the loads are exerted, HKS may unexpectedly fail in its anticipated lifetime. After recognizing the product failure by parametric ALT, an engineer might most favorably design. This study proposes a parametric ALT as systematic reliability method that can be applicable to mechanical systems. It composes: (1) a parametric ALT plan, (2) a load analysis, (3) a customized ALTs with the design alterations, and (4) an assessment of whether the product design(s) achieves the objective BX lifetime. As an experiment instance, we will discuss as following: the redesign of HKS in a refrigerator.

Parametric ALT in Mechanical System

If there is a wrong design in the product where the (dynamic) loading are exerted, it might suddenly be unsuccessful during its lifetime. After recognizing the market failure by parametric ALTs, an engineer will design the parts such as material pattern to overcome its own loads.

To get the required mission cycle of an ALT, sample size formulation with the AF might be defined as [1]:

Case Study: Reliability Design of a HKS Subjected to Repeated Stresses

As a customer utilizes the refrigerator, one would close its door comfortably. For this purpose, the HKS is newly designed (Figure 1).

From the marketplace, HKS components in a domestic refrigerator were failing due to design problems. Formed on the customer working states, HKS were subjected to dissimilar loading during the operations of the refrigerator door (Figure 2).

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Iris Publishers-Open access Journal of Dentistry & Oral Health | Novel Upgrading of Conventional Glass Ionomer Cement Using Nanohydroxyapatite, Silica and Zirconia

 

authored by Wan Zaripah Wan Bakar*

Abstract

Conventional glass ionomer cement is one of the commonly used dental restorative material due to its properties especially bond to tooth structure and anticariogenic. However, their uses are limited due to some weaknesses such as low in mechanical strength. Many modifications have been done to improve it but not fully successful. Recently a group of researchers has proved that addition of hydroxyapatite, silica and zirconia able to enhanced the mechano-physico and aesthetic properties.

Discussion

Glass ionomer cement (GIC) or term by the International Organization for Standardization, (ISO), is “glass polyalkenoate cement” [1]. was one of the mostly used material in dentistry since its invention in 1972 by Wilson and Kent. Conventional GIC was an acid-base cements produced from the reaction of weak polymeric acids with powdered glasses [2], composed of water soluble, polyacrylic acid and a fluoroaluminosilicate glass [3,4]. Later, the resin modified GIC (RMGIC) was produced by an incorporation of hydrophilic resin monomer into GIC and set by light curing [5]. Conventional GIC was well liked due to its easy to use [6], moisture less sensitive and the main attractions of GIC are the adhesive properties to enamel and dentin where it bond chemically to hard dental tissues by the formation of ionic bonds between carboxylate gropes and calcium [7], It is anti-cariogenic due to the ability to release fluoride and also act as fluoride reservoir if recharge [8], one of the magnificent inhibitor for caries process [9], inadequacy of exothermic polymerization and close thermal expansion to tooth [10,11]. It was highly used for treatment of deciduous teeth, as a liner or base, temporary restoration for permanent teeth and very suitable for atraumatic restorative treatment (ART) [12].

However, there are few weaknesses regarding to this material where its lack in strength and low resistance to abrasion and wears [13]. It has low hardness which cannot withstand occlusal stress for a long period of time [10]. Even it is tooth-coloured material but has poor aesthetic due to too opaque, not easily polished and has very poor resistance to acidic exposure in a situation of mouth with highly acidic environment [14]. Higher compressive strength of RM-GIC is may be due to the presence of resinous polymer that are absent in conventional GIC [15]. Compare to other material such as amalgam that highly controversial with its hazardous effect and metallic colour which is not aestrhetic especially for anterior restoration, GIC has better features. Also comparing to composite resins which become more popular. there are concerns that resin composites may be toxic based on the fact that they may release components which is harmful to pulp tissue if carelessly applied [16], GIC is more safe.

Due to its important usage many studies for improvement has been done by researchers since many years ago. The filler has been modified by incorporating elements such as silver-cermet, stainless steel powder [17], titanium dioxide, silver tin alloy, carbon and alumina-silicate fibres [3,7,10,18]. Hydroxyapatite, silica and recently zirconia have been used to modify the nano powder of the conventional GIC. HA participates in the setting reaction of GIC which increased the flexural strength [19]. The resemblance between chemical formula of HA (Ca10(PO4)6(OH)2) and natural bone and teeth due to the continuous formation of aluminum salt bridges, improved the final strength of the cements [3,20,21,22]. In other circumstances, the incorporation of HA alone into GIC did not improve the mechanical properties of GIC as HA did not involve in the cross-linking matrix and also disrupts the stetting reaction of GIC [23].

On the other hand, limited literatures can be found on the incorporation of silica into GIC. Rahman, et al. [2014] described on one pot synthesis of nanosilica-hydroxyapatite (nanoSiO2-HA) via sol-gel method has successfully produced elongated nanoHA with size of~103nm and spherical nanoSiO2 with size of~30nm. This incorporation of nanoSiO2-HA resulted in the hardness enhancement of~73 % when compared to conventional GIC [22]. Studies have found that the incorporation of a HA-SiO2 phase in a conventional GIC enhanced its mechanical properties with favorable cytotoxic response [24,25]. A comprehensive review of the available literature has revealed that not all modifications in glass powder have resulted in the desirable strengthening of GICs.

Lately, zirconia has been used to modify the powder of GIC. Zirconia was popularized into dentistry in the early 1990s, as an endodontic posts and hard framework cores for crowns and fixed partial dentures [26]. Earlier, Gu and colleague reported on the improvements on mechanical strength with the addition of hydroxyapatite/zirconia (HA/ZrO2) into the GIC. but the presence of voids on the fractured surface and cracks at the interface showed the failure of HA/ZrO2 in improving the brittle manner of GIC [23]. Study using HA/yittra-stabilized ZrO2 nanocomposite has successfully improved the characteristic of GIC owing to the high strength, fracture toughness and biocompatibility of ZrO2 [11]. Recently, a new prototype named GiZiDent which is a GICnanozirconia- silica-HA hubrid has been produced by Wan Bakar, et al. 2017 [27]. They have found a specific tec technique of synhesizing and specific ratio of addition the new nano powder to the conventional GIC to produce new hybrid material with many mprovedvements following ISO standard [28].

This new noivel material has improved tmechano-physicochemico and biological properties of the conventional GIC [28,29]. The incorporation of nanoceramics (HA, SiO2, ZrO2) has resulted in improved mechanical properties of GICs due to their ability to release F-, high surface area, and better particle size distribution [3,24,30]. GIC nano ZrOO2-SiO2-HA demonstrated, a statistically significant difference in cell viability at both 100 and 200mg/ml concentrations for the 24h and 72h. incubation periods [31]. Study result showed an overall higher F- ion elusion from the GIC-nano- ZrO2-SiO2-HA when compared to conventional GIC throughout the duration of the study (p≤0.05) [32]. Nanozirconia which is translucent may also improve the aesthetic property of GIC as shown in a study by Rahman, et al. [30].

Conclusion

The new novel nano GIC-ZrOO2-SiO2-HA can be a promising dental restorative material in future for a wider scope of used including high stress bearing area.

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Iris Publishers-Open access Journal of Otolaryngology and Rhinology | Maxillary Alveolar Carcinoma: Risk of Recurrence and its Relation with Prognostic Indicators

 

authored by  Zubair Durrani*

Abstract

Background: Maxillary Alveolar carcinoma is a relatively uncommon entity with occurrence reported between 3.5 to 10% of all oral cancers. Recurrence when occurs locally are particularly difficult to treat due to the close proximity of this region to the infratemporal fossa and the base of skull. There is also a debate when to perform elective neck dissection in these patients.

Objectives: The aim of this study was to identify cases with recurrence and correlate its association with various prognostic factors and disease free survival in these patients.

Methodology: Overall, 15 cases were identified with maxillary alveolar carcinomas that were treated between 2011 to 2015. Eight of these cases were Squamous cell carcinomas, 5 Adeno carcinomas and 2 Adenocystic carcinomas. T stages, N stage, grade of tumor, surgical margin involvement by the tumor, presence of perineural and lymphovascular invasion were identified as prognostic indicators. The chi-square and Pearson correlation tests were applied to analyze the association between recurrence and these prognostic factors.

Results: Recurrence developed in 3 SCC (37.5%) and 1 ADC (20%) patient during the three years period following the treatment. Among the SCC patients, 2 recurrences were local and 1 regional. Recurrence was found to have a strong positive correlation with T stage (r=0.330, p=0.271), surgical margin involvement (r=0.575, p=0.566) and three years disease free survival (r=0.959, p=0.000). A weak positive correlation was also established with tumor grade (r=0.155, p=0.0613) and perineural invasion (r=0.149, p =0.725).

Keywords: Oral squamous cell carcinoma; Maxillary alveolus; Hard palate; Prognostic factors; Survival rates; Recurrence

Introduction

Background

Oral carcinoma is one of the ten most frequently occurring cancers around the world and when grouped together with pharyngeal cancer, it is the sixth most common cancer in the world [1]. In the Asian and South east population the prevalence of oral cancer is on the rise. The unique cultural practices in the Asian population such as snuff dipping, smoking, use of alcohol and areca nut are the main predisposing factors for the development of this cancer. The incidence of OSCC restricted to the hard palate and maxillary ridge is very low, with an estimated 3.5 to 10 % of all OSCC [2,3]. Because of the anatomical proximity of the upper alveolar mucosa with the maxillary gingivo‐buccal sulcus, cancer of the maxillary alveolus may spread to the nearby spaces thus making it difficult to locate the actual initiation point of the disease [4].

Various prognostic factors have been suggested that could affect patients overall survival and disease specific survival in oral cancer. Of the known prognostic factors, the TNM stage, histological grade, and tumor thickness are widely recognized [5]. Other prognostic factors like lympho-vascular invasion (LVI) and peri-neural invasion (PNI), extracapsular spread and involvement of surgical margin by tumor cell are also known to play a role in recurrence and overall poor prognosis [6-9].

Objectives

The aim of this study was to identify cases of recurrence and correlate its association with various prognostic factors and disease-free survival in these patients.

Methodology

A retrospective cohort study was planned to identify patients who had undergone surgical resection for maxillary alveolar carcinoma over a period of 4 years from 2011 to 2015. Data was collected through clinical and pathological records of the patient. A total of 26 Maxillectomies were performed during this period. Out of these, 15 cases were maxillary alveolar carcinomas while the rest were either non-malignant lesions or the sarcomas of maxillary alveolus. The 15 carcinomas were then classified according to their type. Gender, age distribution, T stage, N stage, histological grade, perineural and lymphovascular invasion and involvement of surgical margin by the tumor was determined. The cases which had received Adjuvant Radiotherapy and those who had developed recurrence were identified. Disease free survival was measured at three years following completion of treatment.

4 cases with recurrence were then categorized separately. Various prognostic indicators that might have played a role in recurrence were correlated with risk of recurrence and their significance determined using chi-square and Pearson correlation. These prognostic indicators were tumor grade, T stage, N stage, Perineural invasion (PNI), lymphovascular invasion (LVI) and involvement of surgical margin by tumor. Recurrence was then evaluated for its impact upon disease free survival.

Results

The distribution of the 15 carcinomas according to its type was as following: 8 squamous cell carcinomas (SCC), 5 Adenocarcinomas (ADC) and 2 Adeno-cystic carcinomas (ACC). Gender wise, SCC had affected 8 females, ADC 5 males and ACC 1 male and 1 female. SCC had occurred between the ages of 35 to 76, ADC between 35 to 58 while the 2 ACC cases were found in 43 and 53 years old. Mean age for SCC was 51.1 years, median 50 years and modal 45 years with standard deviation of 12.35 years. 7 cases of SCC were well to moderately differentiated while 1 was poorly differentiated. 4 ADC cases were well differentiated and 1 was poorly differentiated while there was 1 each in well and poorly differentiated category for ACC. Only 1 SCC presented at T1 stage, 5 SCC and 2 ADC presented at T2 stage, 1 SCC, 3 ADC and 1 ACC presented at T3 stage while 1 SCC and 1 ACC presented at T4 stage. On histopathological evaluation perineural invasion and lympho-vascular invasion was found in 2 case of SCC only. 5 SCC and 2 ADC had microscopically margin involved on surgical resection specimen. Adjuvant Radiotherapy was given to 5 SCC cases, 1 ADC and 2 ACC cases (Table 1).

5 SSC (62.5%), 4 ADC (80%) and 2 ACC (100%) patients were disease free at 3 years following treatment. 3 SCC (37.5%) and 1 ADC (20%) patient had developed recurrence. Of the three recurrences in SCC cases, 2 were local and 1 regional. The impact of various prognostic factors on 4 cases of recurrence was then evaluated. Recurrence was found to have strong positive correlation with T stage (r=0.330, p=0.271) and surgical margin involvement (r=0.575, p=0.566) while a weak positive correlation was identified with tumor grade (r=0.155, p=0.0613) and perineural invasion (r=0.149, p=0.725). Since none of the recurrence cases had either clinical or radiological nodal involvement or lymphovascular invasion found in them, it was designated as not having any relationship with recurrence. Recurrence was also found to have a strong positive relation with three years disease free survival (r=0.959, p =0.000) (Table2).

Discussion

The biology of oral cancer varies with site of its presentation. The tongue carcinoma, for example, is a much aggressive entity as compared to lip carcinoma. Similarly maxillary alveolar carcinoma differs from Mandibular alveolar carcinoma in terms of biological behavior. The rarity of maxillary alveolar carcinoma, its location in oral cavity and the limited information about its biology has led to debate about its optimum management.

Lin, et al. [10] in a case series of 725 cases of maxillary alveolar and hard palate carcinoma, found cervical metastasis in 4.1% in T1, 14.9% in T2, 10.3% in T3 and 24.7% in T4 cases. They also found significant effect of T stage and Nodal stage on mean overall survival [10]. Dalal, et al. [11] found 23% cervical metastasis in 25 of the 30 cases of T4 squamous cell carcinoma at initial presentation. Hence recommending Elective neck dissection for all T4 maxillary alveolar carcinomas [11]. Joosten et al reported that in a group of 77 patients out of 95, 14.3% (11/77) had occult metastasis. In T2-T4 patients, this number increased to 19.0% while in T4 alone it was 24.1%. 45.5% of the occult metastasis developed in the contralateral neck. Their salvage rate for recurrence cases was 40%. Based upon these findings, they recommended elective neck dissection for all T2-T4 cases [12]. Similar recommendation was also made by Morris et al, based upon their analysis of 139 patients of maxillary alveolar and hard palate carcinoma. Regional failure in their study was 28.4%, ranging from 18.7% (pT1) to 37.3% (pT4) [13].

The other peculiarity of maxillary alveolar carcinoma is its anatomical location. Anterior alveolus is superiorly related to nasal cavity, middle alveolus is closely associated with maxillary sinus and then to orbital cavity and the posterior alveolus carcinomas tend to infiltrate to the infratemporal fossa. McMahon, et al. [14] in a review of 50 patients reported recurrences in 16, out of which 11 were local. Of these 11, 8 were in superior and posterior direction that included orbit, infratemporal fossa, pterygopalatine fossa, the traversing canals of sphenoidal bone, the gasser an ganglion and the dura of the middle cranial fossa. Hence they concluded that the advance cancer of mid face often equated with disease of the skull base [14]. Wang, et al. [15] in a 10-year review of survival outcome for hard palate and maxillary alveolar carcinoma found involvement of soft palate or infratemporal fossa as poor outcome indicators. Ulcerative tumor features, tumor volume larger than 10 ml and local disease that could not be salvaged had poor survival outcome [15]. Li, et al. [16] in-case series of 155 cases stated that the 5-year disease specific survival rates N+ and N- patients was 21.54 % and 47.36% respectively. They also reported that cervical metastasis was found in as high as 49.03% of all cases with 40% presenting at initial consultation and 9.03 % presenting after therapy [16]. Likhterov, et al. [17] in a study of 75 cases reported 19 out of total of 22 recurrences occurred locally. Additionally they identified recurrence was associated with T4 disease, positive margins and surveillance imaging. Furthermore in cases where reconstructive flap was used to repair the defect, it needed flap mobilization to obtain biopsy. In 13 of the 19 cases salvage surgery was attempted and was successful in 6 (42%) cases [17].

Conclusion

Based upon the literature search, it seems the consensus is developing that Elective neck dissection is indicated for lesions between T2-T4 (SCC). The most important prognostic factors are T stage, N stage and surgical margin involvement. Tumor grade and perineural invasion may be weaker indicators but play a role in recurrence and disease free survival. Recurrence can occur in the form of nodal metastasis but local is more common. Surgical salvage probably offers the best chance to the patient for clearance but the overall survival for these patients remains poor.

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Iris Publishers-Open access Journal of Cardiology Research & Reports | Lipoprotein X in Cholestasis and Questionable Atherogenic Risk

 

authored by Tania Leme da Rocha Martínez*

Abstract

Lipoprotein X is still an enigma for its lack of evidence as a risk association with atherosclerosis. Primary biliary cirrhosis is a chronic, autoimmune cholestatic liver disease characterized by the presence of T cells that destroy the biliary epithelium. In patients with primary biliary cirrhosis, total cholesterol levels may reach values between 500 and 1000 mg/dL, with cutaneous xanthomas similar to those observed in genetic hypercholesterolemias. The rise in cholesterol is largely due to increased serum levels of lipoprotein-X. It has a small amount of albumin, apoprotein AI, apoprotein Cs and apoprotein E and has no apoprotein B. The formation of lipoprotein-X results from regurgitation of bile lipids in plasma, as well as the accumulation of plasma phospholipids and free cholesterol, resulting from the lower activity of lecithin: acyltransferase cholesterol. Multicenter randomized trials are needed to assess the impact of lipid-lowering patients on lipid reduction and cardiovascular risk, as well as the effect on hepatic cholestasis. Treatment with statins is not indicated for lowering cholesterol in patients with primary biliary cirrhosis and dyslipidemia, as there is no evidence that these patients have high cardiovascular risk.

Keywords: Atherosclerosis; Cholesterol; Lecithin cholesterol acyl transferase; Lipoprotein X; Primary Biliary cirrhosis

Abbreviations: LCAT: Lecithin Cholesterol Acyl Transferase; LDL: Low Density Lipoprotein; LDL-c: Low Density Lipoprotein Cholesterol; LP-X: Lipoprotein X; PBC: Primary Biliary Cirrhosis

Introduction

Cholestatic Liver Diseases among the cholestatic diseases of the liver, Primary Biliary Cirrhosis (PBC), although rare, is very representative of a secondary cause of dyslipidemia. PBC is a chronic, autoimmune cholestatic liver disease characterized by the presence of T cells that destroy the biliary epithelium [1]. The average annual incidence ranges from 1.6 to 14.6 cases per 100,000 people, respectively [2]. PBC affects more women than men, in the ratio of 8:1 [3]. The mean age of diagnosis is around 66 years [4]. The disease can be divided into four phases[4]: an asymptomatic phase lasting up to 20 years; symptomatic from 5 to 10 years, in which the patient is anicteric or only slightly jaundiced; short preterminal characterized by severe jaundice; and finally terminal liver failure [4]. Hypercholesterolemia in PBC: in patients with PBC, total cholesterol levels can reach values between 500 and 1000 mg/dL, with cutaneous xanthomas similar to those observed in genetic hypercholesterolemias. In these patients, the increase in serum cholesterol levels is largely due to the increased level of lipoprotein-X (LP-X), which is a lipoprotein with a lower density than LDL, has no apoprotein B in its structure and is enriched with free cholesterol and phospholipids [5]. The formation of LP-X results from regurgitation of bile lipids in plasma, as well as the accumulation of plasma phospholipids and free cholesterol, resulting from lower lecithin activity: acyltransferase cholesterol (LCAT) [5,6]. LP-X has been shown to have antiatherogenic properties, such as inhibition of oxidation of LDL-c particles [7]. In this context, patients with PBC who have high cholesterol due to the increase in LP-X may have attenuated cardiovascular risk.

Few studies have evaluated cardiovascular events in patients with dyslipidemia secondary to PBC, since the disease has a rare prevalence. Only one observational study demonstrated cardiovascular mortality of 12% in this population [8]. These results pointed to a possible role of statins in reducing cardiovascular risk in these patients. Case reports suggest that statins, in addition to reducing LDL-c and triglyceride levels, reduce intrahepatic cholestasis markers, with improved liver function [9-11]. Multicenter randomized trials are needed to assess the impact of lipid-lowering patients on lipid reduction and cardiovascular risk, as well as the effect on hepatic cholestasis. Treatment with statins is not indicated for lowering cholesterol in patients with PBC and dyslipidemia, as there is no evidence that these patients have high cardiovascular risk.

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Iris Publishers-Open access Journal of Archives in Biomedical Engineering & Biotechnology | The Physics of Phenomenological Structuralism

 

authored by Paul C Mocombe*

Abstract

This work highlights the physics and metaphysics of the universe (multiverse) according to Paul C. Mocombe’s theory of phenomenological structuralism. The author posits that phenomenological structuralism offers an emergent metaphysical materialist account regarding the formation and perpetuation of the multiverse, consciousness, and society.

Keywords: Structurationism; Praxis, Panpsychism; Social Class Language Game; Phenomenological Structuralism; ORCH-OR Theory; Univon Multiverse Hypothesis; Free-will; Determinism; Haitian Epistemology

Introduction

This work highlights the physics and metaphysics of the universe (multiverse) according to Paul C. Mocombe’s theory of phenomenological structuralism. The author posits that phenomenological structuralism offers an emergent metaphysical materialist account regarding the formation and perpetuation of the multiverse, consciousness, and society. Paul C. Mocombe’s structurationist theory of phenomenological structuralism, building on and synthesizing a form of M-theory with, mathematical elements of univon multiverse hypothesis, the quantum computation of ORCHOR theory, structurationism, and the multiverse ideas of Haitian ontology/epistemology and quantum mechanics abductively posits that consciousness is a fifth force of nature, a quantum material substance/energy, psychion, the phenomenal property, qualia or informational content, of which is recycled/entangled/ superimposed throughout the multiverse and becomes embodied via the microtubules of brains and multiple worlds to constitute mind. Mind, in turn, is manifested in simultaneous, entangled, superimposed, and interconnecting material resource frameworks, multiple worlds, as praxis or practical consciousness of organic life, which in-turn becomes the phenomenal properties, qualia, of material (subatomic particle energy, psychion) consciousness that is recycled/entangled/superimposed throughout the multiverses. In this sense, the physics of phenomenological structuralism posits an emergent materialist multiverse that is superimposed and entangled like consciousness.

Background of the Problem

Two views regarding the origins and nature of consciousness and the universe dominate contemporary physics. On the one hand, are theorists who view consciousness as fundamental to the universe and a by-product of a supernatural or cosmic creator who fine-tuned the universe for life and intelligent beings [1]. On the other hand, are materialists/physicalists who view our universe as a random product of chance among a plethora of multiverses some of which have life while others do not. Consciousness, in the latter, is simply a product of the mechanical and chemical processes of the brain imposing meaning onto a meaningless and absurd universe and the world.

Both positions are problematic when it comes to understanding the constitution of consciousness and the universe/multiverse. The former presupposes that consciousness in the form of a creator created the multiverse, and beings with consciousness are a perception in the mind of said creator (s). The latter assumes that consciousness is simply a chemical illusion of the mechanical brain interacting with matter. Although this latter position gives a mechanical understanding regarding the constitution of the universe/multiverse, it fails to explain the “hard problem” of consciousness (David Chalmers’s term), i.e., the subjective experiences of consciousness. For me, building on Paul C. Mocombe’s [2] metaphysical materialist theory of phenomenological structuralism, consciousness is emergent and comes to constitute a fifth force of the multiverse, with phenomenal properties, qualia, following matter random constitution, evolution, and disaggregation from the original four forces of nature, i.e., the weak and strong nuclear forces, gravity, and electromagnetism. In other words, consciousness is an emergent fifth force of nature, a quantum material substance/energy, psychion, the phenomenal properties, qualia, of which are recycled/entangled/superimposed throughout the multiverse and becomes embodied via the microtubules of brains and multiple worlds to constitute mind. Mind, in turn, is manifested in simultaneous, entangled, superimposed, and interconnecting material resource frameworks, multiple worlds, as praxis or practical consciousness of organic life, which in-turn becomes the emergent phenomenal properties, qualia, of material (subatomic particle energy, psychion) consciousness that is recycled/entangled/superimposed throughout the multiverses following matter disaggregation. Consciousness from this understanding is emergent and material following the constitution of space/time, which is fundamental.

In the human sphere, consciousness refers to subjective awareness of phenomenal experiences (ideology, language, self, feelings, choice, control of voluntary behavior, thoughts, etc.) of internal and external worlds emerging in space/time. The academic literature “describes three possibilities regarding the origin and place of this (human) consciousness in the universe: (A) as an emergent property of complex brain neuronal computation, (B) as spiritual quality of the universe, distinct from purely physical actions, and (C) as composed of discrete ‘proto-conscious’ events acting in accordance with physical laws not yet fully understood” [3]. The latter position, (C), represents the ORCH-OR (“orchestrated objective reduction”) theory of Stuart Hameroff and Roger Penrose (2014), which includes aspects of (A) and (B), and posits that “consciousness consists of discrete moments, each an ‘orchestrated’ quantum-computational process terminated by… an action [,objective reduction or OR,] rooted in quantum aspects of the fine structure of space-time geometry, this being coupled to brain neuronal processes via microtubules” (pg. 70). In this view, the understanding is that a proto-conscious experience existed in the universe, panpsychism, and as a result of emergent structures of the brain it (proto-conscious experience, psychion) became embodied and evolved as a result of quantum neuronal computations of “brains.” “Brains”, in the human form, as a part of the universe/multiverse, are used to both experience being-in-theworld and to capture the nature of reality as such in the form and emergence of the practice and language of science.

Paul C. Mocombe’s [4] structurationist sociology, phenomenological structuralism, which attempts to resolve the structure/agency problematic of the social sciences, builds on the ORCH-OR theory and panpsychism of Hameroff and Penrose, while holding on to the multiverse hypothesis of quantum mechanics (M-theory and the mathematics of univon multiverse hypothesis) and Haitian ontology/epistemology, which the authors reject because it is not “a more down-to-earth viewpoint,” to capture the nature and constitution of the universe/multiverse as such. (Hameroff and Penrose, [2]. For Mocombe [4], quantum superposition, entanglement, wave-function realism, and evidence in Haitian Vodou of spirit possession, which represent ancestors from a parallel world, Vilokan, of the earth’s of which we ought to pattern our behaviors and structures, are grounding proofs for the acceptance of the multiple worlds hypothesis of quantum mechanics. Within the latter hypothesis, the understanding is that “each possibility in a superposition evolves to form its own universe, resulting in an infinite multitude of coexisting ‘parallel’ worlds. The stream of consciousness of the observer is supposed somehow to ‘split’, so that there is one in each of the worlds—at least in those worlds for which the observer remains alive and conscious. Each instance of the observer’s consciousness experiences a separate independent world and is not directly aware of any of the other worlds” (Hameroff and Penrose, 2014, pg. 50). It is within this multiple world hypothesis, physics, that Mocombe constitutes his understanding of the emergence of the material multiverse and the notion of consciousness in each of the universes according to his theory of phenomenological structuralism. For Mocombe, consciousness is an emergent fifth force of nature, a quantum material substance/energy, psychion, the phenomenal properties, qualia, of which are recycled/entangled/superimposed throughout the multiverse and becomes embodied via the microtubules of brains. It (consciousness) is manifested in simultaneous, entangled, superimposed, and interconnecting material resource frameworks as mind or embodied praxis or practical consciousness, which in-turn becomes the phenomenal properties, qualia, of material (subatomic particle energy, psychion) consciousness that is recycled/entangled/superimposed throughout the multiverses following matter disaggregation [5-10].

In other words, I adopt from the “membrane theory” model of Lisa Randall and Raman Sundrum (1999) the assertion, in keeping with the logic of Haitian Vodou, that there might be an additional dimension on the cosmological scale, the scale described by general relativity, which gives rise to four dimensional multiverses within it. Our universe is embedded in a vastly bigger five-dimensional space (the four-dimensional space of relativity, plus a fifth dimension for the subatomic forces including consciousness), a kind of super-universe. Within this super-space, our universe is just one of a whole array of co-existing universes (Haitian Vodou only accounts for our universe and its parallel), each a separate fourdimensional bubble within a wider arena of five-dimensional space where consciousness (a subatomic force) is recycled/entangled/ superimposed between the species of the five-dimensional superspace, i.e., superverses, and their four-dimensional multiverses Figure 3.

The origins of consciousness and the multiverse within this phenomenal structural paradigm is emergent, and not the product of a supreme creator or god. For this position, I build on the mathematics of Richard Gauthier (2020) in his “univon multiverse hypothesis.” Unlike Gauthier, who holds on to God or a supreme creator to account for the origins and nature of consciousness within the multiverse, I do not. According to Gauthier’s (2020) model, identical univon quantum particles, produced from a univon quantum field, created not only our universe but also many other identically fine-tuned universes in a multiverse. The univon, also called a cosmic quantum, is composed of a helically circulating superluminal primordial information quantum (sprinq). [(The univon is the quantum particle of a conscious cosmic quantum field having both physical and mental potentialities. Quantum fields may be composed of cosmic ectoplasm or mind-stuff, which according to yoga philosophy is a subtle vibrational substance formed from consciousness by a cosmic creative power, that takes the form of objects within a cosmic mind)]. The physical [(and mind-stuff)] constants carried in the information content of each univon’s sprinq are exactly the same in all univons and in all sprinqs, though sprinqs express different fundamental particle attributes in different environments. The univon is radioactive. The decay of a univon into less energetic products is the starting point (t=0) of its created universe. The univon’s sprinq rapidly multiplies itself into different quantum fields and particles, leading very quickly to the early universe’s exponentially-rapid inflationary period and then to the Big Bang, which produces abundant relic dark matter particles of the universe as well as the less abundant ordinary matter. Univons made many other [(entangling)] equally fine-tuned universes with identical fundamental forces and constants…. (pgs. 1-3).

In my metaphysical materialistic model, which differs in language and the need for a “cosmic mind,” the “univon” is the cosmological scale described by Einstein constituted by the forces, constants, particles, etc., sprinqs in Gauthier’s hypothesis and phenomenal properties or qualia in my model, of the multiverses, with gravity and the psychionic force of consciousness emergent forces following matter aggregation, evolution, and disaggregation, which give rise to inflation, big bangs, and additional (entangled) universes with similar informational (physical and mental) content. Hence, the mathematics for both models are the same as seen in Figures 1 and 2, which is adopted from Gauthier (2020). I tie this physical model to Mocombe’s structuration theory, phenomenological structuralism, to explain the emergence and constitution of the multiverses, consciousness, minds, and society in them (Figure 1,2).

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