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author:("bari, S.")
1.  Effect of Taxane-Based Neoadjuvant Chemotherapy on Fibroglandular Tissue Volume and Percent Breast Density in the Contralateral Normal Breast: Evaluated at 3T MR 
NMR in biomedicine  2013;26(12):10.1002/nbm.3006.
The aim of this study was to evaluate the change of breast density in the normal breast of patients receiving neoadjuvant chemotherapy (NAC). Forty-four breast cancer patients were studied. MRI acquisition was performed before treatment (baseline), and 4 and 12 weeks after treatment. A computer algorithm-based program was used to segment breast tissue and calculate breast volume (BV), fibroglandular tissue volume (FV) and percent density (PD) (the ratio of FV over BV x100%). The reduction of FV and PD after treatment was compared to baseline using paired t-tests with a Bonferroni-Holm correction. The association of density reduction with age was analyzed. FV and PD after NAC showed significant decreases compared to the baseline. FV was 110.0ml (67.2, 189.8) (geometric mean (interquartile range)) at baseline, 104.3ml (66.6, 164.4) after 4 weeks (p< 0.0001), and 94.7ml (60.2, 144.4) after 12 weeks (comparison to baseline, p<0.0001; comparison to 4 weeks, p=0.016). PD was 11.2% (6.4, 22.4) at baseline, 10.6% (6.6, 20.3) after 4 weeks (p< 0.0001), and 9.7% (6.2, 17.9) after 12 weeks (comparison to baseline, p=0.0001; comparison to 4 weeks, p =0.018). Younger patients tended to show a higher density reduction, but overall correlation with age was only moderate (r=0.28 for FV, p=0.07 and r=0.52 for PD, p=0.0003). Our study showed that breast density measured from MR images acquired at 3T MR can be accurately quantified using a robust computer-aided algorithm based on nonparametric nonuniformity normalization (N3) and an adaptive fuzzy C-means algorithm. Similar to doxorubicin and cyclophosphamide regimens, the taxane-based NAC regimen also caused density atrophy in the normal breast and showed reduction in FV and PD. The effect of breast density reduction was age-related and duration-related.
doi:10.1002/nbm.3006
PMCID: PMC3838444  PMID: 23940080
breast density; normal breast; neoadjuvant chemotherapy; taxane; MRI; fibroglandular tissue volume; percent density; 3T MR
2.  A call for action to improve access to care and treatment for patients with rare diseases in the Asia-Pacific region 
This article is a call for action to the relevant stakeholders to improve access to care and treatment for patients with rare diseases in the Asia-Pacific region by looking into three main areas: (a) developing legislative definitions to confer enforceable protection, (b) creating or strengthening policies by objectively measuring the impact brought about by rare diseases and establishing platforms to reach out to the rare disease community, and (c) fostering collaboration across sectors and countries. It is hoped that these suggested actions can catalyze discussions and progress in the region.
doi:10.1186/s13023-014-0137-1
PMCID: PMC4172816  PMID: 25223275
Challenges; Policy; Access to care; Asia-Pacific region
3.  The prevalence of metabolic disorders in various phenotypes of polycystic ovary syndrome: a community based study in Southwest of Iran 
Background
Polycystic ovary syndrome (PCOS) is a common endocrinopathy, associated with metabolic abnormalities. Metabolic features of various phenotypes of this syndrome are still debatable. The aim of present study hence was to evaluate the metabolic and hormonal features of PCOS phenotypes in comparison to a group of healthy control.
Methods
A total of 646 reproductive-aged women were randomly selected using the stratified, multistage probability cluster sampling method. The subjects were divided into five phenotypes: A (oligo/anovulation + hyperandrogenism + polycystic ovaries), B (oligo/anovulation + hyperandrogenism), C (hyperandrogenism + polycystic ovaries) and D (oligo/anovulation + polycystic ovaries). Hormonal and metabolic profiles and the prevalence of metabolic syndrome among these groups were compared using ANCOVA adjusted for age and body mass index.
Results
Among women with PCOS (n = 85), those of groups A and C had higher serum levels of insulin and homeostatic model assessment for insulin%20resistance (HOMA-IR), compared to PCOS women of group D. Serum concentrations of cholesterol, low density lipoprotein, triglycerides and glucose in group A were higher than in other phenotypes, whereas the metabolic syndrome was more prevalent among group B.
Conclusions
Women who had all three components of the syndrome showed the highest level of metabolic disturbances indicating that metabolic screening of the severest phenotype of PCOS may be necessary.
Electronic supplementary material
The online version of this article (doi:10.1186/1477-7827-12-89) contains supplementary material, which is available to authorized users.
doi:10.1186/1477-7827-12-89
PMCID: PMC4180586  PMID: 25224635
PCOS; Metabolic disorders; Metabolic syndrome; Phenotype
4.  Association between smoking and cognitive impairment in multiple sclerosis 
Purpose
Although smoking is known to cause various symptoms in multiple sclerosis (MS) patients, there have been no reports regarding the relationship between smoking and cognitive impairment in MS. Studying the effects of cigarette smoking in MS patients is imperative as there is a high prevalence of cognitive impairment in MS patients. In this study we examined the potentially deleterious effects of heavy smoking on mentation of patients with MS.
Patients and methods
MS patients receiving care at the Neurology Clinic at Bezmialem Vakıf University, between the ages of 18–65 years who have at least graduated elementary school were included in the study. The Brief Repeatable Battery of Neuropsychological Tests (BRB-N) is a commonly used method to assess cognitive function in MS patients and was utilized in our study. Patients that smoked for at least 10 pack-years were considered heavy smokers.
Results
All the patients were stratified into two groups: heavy smokers (n=20) and nonsmokers (n=24). For heavy smokers, their cognitive functioning was more impaired than that of nonsmokers (P=0.04, χ2=4.227). For patients with cognitive impairment, 78.9% of the Paced Auditory Serial Addition Test and 63.2% of the Symbol Digit Modalities Test scores were found to be lower.
Conclusion
Previous reports have suggested that smoking increases the frequency of relapse among individuals with relapsing-remitting MS and accelerates disease progression in patients with progressive MS. According to the results of our study, heavy smokers had increased cognitive impairment when compared to nonsmokers. Extensive studies are necessary to further elucidate the relationship between smoking and cognitive impairment in MS patients.
doi:10.2147/NDT.S68389
PMCID: PMC4166212  PMID: 25246792
cigarette; BRB-N; nicotine; cognition; tobacco; mentation; memory
5.  Evaluation of bacterial contamination rate of the anterior chamber during phacoemulsification surgery using an automated microbial detection system 
AIM
To assess the incidence of anterior chamber bacterial contamination during phacoemulsification surgery using an automated microbial detection system (BacT/Alert).
METHODS
Sixty-nine eyes of 60 patients who had uneventful phacoemulsification surgery, enrolled in this prospective study. No prophylactic topical or systemic antibiotics were used before surgery. After antisepsis with povidone-iodine, two intraoperative anterior chamber aqueous samples were obtained, the first whilst entering anterior chamber, and the second at the end of surgery. BacT/Alert culture system was used to detect bacterial contamination in the aqueous samples.
RESULTS
Neither aqueous samples obtained at the beginning nor conclusion of the surgery was positive for microorganisms on BacT/Alert culture system. The rate of bacterial contamination during surgery was 0%. None of the eyes developed acute-onset endophthalmitis after surgery.
CONCLUSION
In this study, no bacterial contamination of anterior chamber was observed during cataract surgery. This result shows that meticulous surgical preparation and technique can prevent anterior chamber contamination during phacoemulsification cataract surgery.
doi:10.3980/j.issn.2222-3959.2014.04.19
PMCID: PMC4137208  PMID: 25161944
phacoemulsification; bacterial contamination; endophthalmitis
6.  Multiple Sclerosis Presents with Psychotic Symptoms and Coexists with Hypertrophic Cardiomyopathy 
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system. Psychiatric symptoms are not infrequent during MS, yet onset of MS with psychosis is rarely encountered. A 27-year-old Caucasian male was admitted due to numbness in his right arm and difficulty in walking. His clinical and laboratorial exams lead to the MS diagnosis. Nine months earlier, he also developed psychotic disorder, not otherwise specified (PD-NOS). His sudden onset of PD-NOS, his rapid and complete response to antipsychotics, and a relatively short interval between psychiatric and neurological signs indicate a high likelihood that PD-NOS was a manifestation of underlying MS. He also suffers from hypertrophic obstructive cardiomyopathy (HOCM). The patient's neurological complaints were recovered with methylprednisolone (1 g/day, i.v.) given for five days. Glatiramer acetate (1 × 1 tb.s.c.) was prescribed for consolidation and, after nine months of his admission, the patient fully recovered from neurological and psychiatric complaints. Interestingly, very recent studies indicate specific alpha-actinin antibodies in MS and alpha-actinin mutations cause HOCM. Thus, concurrence of MS with HOCM can be even a new syndrome, if further genetic studies prove.
doi:10.1155/2014/383108
PMCID: PMC4147190  PMID: 25197588
7.  Importance of Metastatic Lymph Node Ratio in Non-Metastatic, Lymph Node-Invaded Colon Cancer: A Clinical Trial 
Background
The aim of this study was to evaluate the prognostic importance of the metastatic lymph node ratio for stage III colon cancer patients and to find a cut-off value at which the overall survival and disease-free survival change.
Material/Methods
Patients with pathological stage III colon cancer were retrospectively evaluated for: age; preoperative values of Crp, Cea, Ca 19-9, and Afp; pathologic situation of vascular, perineural, lymphatic, and serosal involvement; and metastatic lymph node ratio values were calculated.
Results
The study included 58 stage III colon cancer patients: 20 (34.5%) females and 38 (65.5%) males were involved in the study. Multivariate analysis was applied to the following variables to evaluate significance for overall survival and disease-free survival: age, Crp, Cea, perineural invasion, and metastatic lymph node ratio. The metastatic lymph node ratio (<0.25 or ≥0.25) is the only independent variable significant for overall and disease-free survival.
Conclusions
Metastatic lymph node ratio is an ideal prognostic marker for stage III colon cancer patients, and 0.25 is the cut-off value for prognosis.
doi:10.12659/MSM.890804
PMCID: PMC4136934  PMID: 25087904
Colonic Neoplasms; Lymph Nodes; Prognosis
8.  An Approach for Economic Analysis of Intermodal Transportation 
The Scientific World Journal  2014;2014:630320.
A different intermodal transportation model based on cost analysis considering technical, economical, and operational parameters is presented. The model consists of such intermodal modes as sea-road, sea-railway, road-railway, and multimode of sea-road-railway. A case study of cargo transportation has been carried out by using the suggested model. Then, the single road transportation mode has been compared to intermodal modes in terms of transportation costs. This comparison takes into account the external costs of intermodal transportation. The research reveals that, in the short distance transportation, single transportation modes always tend to be advantageous. As the transportation distance gets longer, intermodal transportation advantages begin to be effective on the costs. In addition, the proposed method in this study leads to determining the fleet size and capacity for transportation and the appropriate transportation mode.
doi:10.1155/2014/630320
PMCID: PMC4134783  PMID: 25152919
9.  Giant Bilateral Adrenal Myelolipoma with Congenital Adrenal Hyperplasia 
Case Reports in Surgery  2014;2014:728198.
Myelolipomas are rare and benign neoplasms, predominant of the adrenal glands, consisting of adipose and mature hematopoietic tissue, commonly discovered incidentally with increased use of radiologic imaging. Few cases of giant bilateral adrenal masses are reported, especially in the setting of congenital adrenal hyperplasia (CAH). We report the case of a 39-year-old male with a history of CAH secondary to 21-α hydroxylase deficiency on steroids since childhood, self-discontinued during adolescence, presenting with abdominal distension, fatigue, decreased libido, and easy bruising. Imaging revealed giant bilateral adrenal masses. He subsequently underwent bilateral adrenalectomy found to be myelolipomas measuring 30 × 25 × 20 cm on the left and weighing 4.1 kg and 25 × 20 × 13 cm on the right and weighing 2.7 kg. Adrenal myelolipomas are found to coexist with many other conditions such as Cushing's syndrome, Addison's disease, and CAH. We discuss the association with high adrenocorticotropic hormone (ACTH) states and review the studies involving ACTH as proponent leading to myelolipomas. Massive growth of these tumors, as in our case, can produce compression and hemorrhagic symptoms. We believe it is possible that self-discontinuation of steroids, in the setting of CAH, may have resulted in the growth of his adrenal masses.
doi:10.1155/2014/728198
PMCID: PMC4124659  PMID: 25140269
10.  Evidence for Association of the E23K Variant of KCNJ11 Gene with Type 2 Diabetes in Tunisian Population: Population-Based Study and Meta-Analysis 
BioMed Research International  2014;2014:265274.
Aims. Genetic association studies have reported the E23K variant of KCNJ11 gene to be associated with Type 2 diabetes. In Arab populations, only four studies have investigated the role of this variant. We aimed to replicate and validate the association between the E23K variant and Type 2 diabetes in Tunisian and Arab populations. Methods. We have performed a case-control association study including 250 Tunisian patients with Type 2 diabetes and 267 controls. Allelic association has also been evaluated by 2 meta-analyses including all population-based studies among Tunisians and Arabs (2 and 5 populations, resp.). Results. A significant association between the E23K variant and Type 2 diabetes was found (OR = 1.6, 95% CI = 1.14–2.27, and P = 0.007). Furthermore, our meta-analysis has confirmed the significant role of the E23K variant in susceptibility of Type 2 diabetes in Tunisian and Arab populations (OR = 1.29, 95% CI = 1.15–1.46, and P < 10−3 and OR = 1.33, 95% CI = 1.13–1.56, and P = 0.001, resp.). Conclusion. Both case-control and meta-analyses results revealed the significant association between the E23K variant of KCNJ11 and Type 2 diabetes among Tunisians and Arabs.
doi:10.1155/2014/265274
PMCID: PMC4140131  PMID: 25165692
11.  Performance Optimization of an Air-Standard Irreversible Dual-Atkinson Cycle Engine Based on the Ecological Coefficient of Performance Criterion 
The Scientific World Journal  2014;2014:815787.
This paper presents an ecological performance analysis and optimization for an air-standard irreversible Dual-Atkinson cycle (DAC) based on the ecological coefficient of performance (ECOP) criterion which includes internal irreversibilities, heat leak, and finite-rate of heat transfer. A comprehensive numerical analysis has been realized so as to investigate the global and optimal performances of the cycle. The results obtained based on the ECOP criterion are compared with a different ecological function which is named as the ecologic objective-function and with the maximum power output conditions. The results have been attained introducing the compression ratio, cut-off ratio, pressure ratio, Atkinson cycle ratio, source temperature ratio, and internal irreversibility parameter. The change of cycle performance with respect to these parameters is investigated and graphically presented.
doi:10.1155/2014/815787
PMCID: PMC4138611  PMID: 25170525
12.  Synchronous multifocal osteogenic sarcoma on multimodality imaging including bone scintigraphy 
Multifocal osteosarcoma is diagnosed when there are two or more lesions in the skeleton without presence of pulmonary metastases. It is further classified as synchronous type when the patient is demonstrated to have more than one lesion simultaneously at presentation and is known as Synchronous Multifocal Osteogenicsarcoma (MOGS). We report a case of synchronous MOGS showing its multimodality imaging findings including nuclear scan findings with pathological correlation.
doi:10.4103/0972-3919.136591
PMCID: PMC4157199  PMID: 25210291
Metachronous; multifocal/multicentric; osteosarcoma; synchronous; MOGS
13.  Nuclear morphometric and morphological analysis of exfoliated buccal and tongue dorsum cells in type-1 diabetic patients 
Background:
Diabetes mellitus type 1 that results from immunologically mediated damage to the β-cells in the pancreas. Diabetes mellitus is characterized by recurrent or persistent hyperglycemia. Hyperglycemia can be associated with salivary gland dysfunction and alterations in the oral epithelial cells.
Aim:
The aim of this study was to evaluate the qualitative and quantitative changes in buccal and tongue dorsum epithelial cells using an exfoliative cytology method in type 1 diabetic patients.
Materials and Methods:
We performed light microscopic analysis of the buccal and tongue dorsum smears in thirty type 1 diabetic patients and thirty healthy individuals. The oral smears were stained using Papanicolaou method for cytological examination and nuclear morphometric analysis. In each case, the mean nuclear area, perimeter, length, breadth, and roundness factor were evaluated in each smear using the image analysis software (Q Win, Leica™).
Results:
The nuclear area, length, breadth, and perimeters were significantly higher in the diabetic group from tongue dorsum smear than that of the control group (P < 0.05). In the cytological examination, karyorrhexis-karyolysis-karyopyknosis, binucleation, nuclear membrane irregularity, cytoplasmic polymorphism, perinuclear halo were observed in oral smears with type 1 diabetic patients. Binucleation (P = 0.002) and nuclear membrane irregularity (P = 0.024) were significantly more common in buccal smears of diabetic group. Furthermore, the sensitivity of buccal mucosa was significantly higher in the diabetic group (P = 0.006).
Conclusion:
The light microscopic and nuclear morphometric study indicates that type 1 diabetes can produce morphological and nuclear morphometric changes in the oral mucosa that are noticeable with exfoliative cytology.
doi:10.4103/0970-9371.145642
PMCID: PMC4274524  PMID: 25538382
Nuclear morphometry; type 1 diabetes; diabetes mellitus; exfoliative cytology; Papanicolaou stain
14.  Retroperitoneal Extragastrointestinal Stromal Tumor: Radiologic Pathologic Correlation 
Neoplasms with histology and immunohistochemistry similar to gastrointestinal stromal tumors may occur primarily outside the gastrointestinal tract, usually in the omentum and mesentery. These are referred to as extragastrointestinal stromal tumors (EGISTs). Retroperitoneum is a very rare site for such neoplasms. We report a patient with EGIST in the retroperitoneum, elaborating the cross-sectional imaging and histopathologic findings.
doi:10.4103/2156-7514.135484
PMCID: PMC4142468  PMID: 25161803
CD117; extragastrointestinal stromal tumor; gastrointestinal stromal tumor; retroperitoneum
15.  Severe tricuspid regurgitation mimicking constrictive pericarditis 
Patient: Female, 62
Final Diagnosis: Tricuspid regurgitation
Symptoms: Dyspnea exertional • fatigue • leg edema
Medication: —
Clinical Procedure: —
Specialty: Cardiology
Objective:
Challenging differential diagnosis
Background:
Tricuspid regurgitation (TR) can mimic some hemodynamic findings of constrictive pericarditis (CP), due to the restraining effect of the enlarged right heart on intact pericardium and on the left ventricle. In this article, we report a case of severe tricuspid regurgitation in which hemodynamic findings were consistent with CP.
Case Report:
A 62-year-old Caucasian woman presented with right heart failure symptoms. Echocardiography showed enlarged right heart chambers and severe tricuspid regurgitation. Right heart catheterization surprisingly demonstrated a constrictive physiology. Diastolic pressures of both ventricles were elevated and equalized, with a prominent deep and plateau pattern. The patient was re-evaluated with a further focus on constrictive pericarditis. However, echocardiography, thorax CT, and cardiac MRI did not demonstrate any pathological finding related to pericardium. The remaining explanation was that the severe TR itself and secondary right heart enlargement caused the restraining effect on the intact pericardium and on the left ventricle. The pericardium was normal and tricuspid annulus was severely dilated on surgical inspection. The tricuspid valve was replaced with a bioprosthetic valve. The patient did well just after the surgery, with a rapid decrease in cardiac pressures; however, she died due to respiratory failure on the 15th postoperative day.
Conclusions:
This was a case with right heart failure symptoms in which invasive hemodynamic findings were consistent with constrictive pericarditis and the noninvasive imaging modalities were not. This case illustrates that severe TR can mimic some hemodynamic findings of constrictive pericarditis, due to restraining effect of the enlarged right heart on intact pericardium and on the left ventricle. Lack of significant respiratory changes in hemodynamic parameters that can safely be demonstrated by echocardiography and cardiac MRI suggest a normal pericardium.
doi:10.12659/AJCR.890092
PMCID: PMC4079647  PMID: 24995118
Pericarditis, Constrictive; Cardiac Catheterization; Tricuspid Valve Insufficiency
16.  Ulcérations buccales et péri-anales: un mode de révélation inhabituel d'une granulomatose avec polyangéite - à propos d'un cas 
La granulomatose avec polyangéite, est une vascularite systémique rare qui touche avec prédilection les voies aériennes supérieures, les poumons et les reins. L'atteinte cutanéo-muqueuse ainsi que l'atteinte digestive ne sont pas inhabituelles mais elles sont rarement inaugurales de la maladie. Nous rapportons l'observation d'une femme âgée de 57 ans, ayant une granulomatose avec polyangéite multi-systémique avec comme premières manifestations une atteinte cutanéo-muqueuse à type de nécrose de la langue et d'ulcérations péri-anales ainsi que des rectorragies. La présence de signes radiologiques orientant vers une hémmorragie intra-alvéolaire, l'atteinte rénale, l'atteinte neurologique périphérique ainsi que la positivité des C-ANCA de type anti-PR3 ont permis de rattacher les manifestations dermatologiques à cette vascularite. Des manifestations cutanéo-muqueuses atypiques, au cours d'une granulomateuse avec polyangéite, doivent être connues par le clinicien pour un diagnostic et une prise en charge adéquate.
doi:10.11604/pamj.2014.18.121.3984
PMCID: PMC4232196  PMID: 25404981
Granulomatose avec polyangéite; nécrose linguale; ulcère péri-anal; rectorragie; Granulomatosis with polyangiitis; lingual necrosis; perianal ulcer; rectorrhagia
17.  Preparation and pharmaceutical evaluation of glibenclamide slow release mucoadhesive buccal film 
Buccal mucoadhesive systems among novel drug delivery systems have attracted great attention in recent years due to their ability to adhere and remain on the oral mucosa and to release their drug content gradually. Buccal mucoadhesive films can improve the drug therapeutic effect by enhancement of drug absorption through oral mucosa increasing the drug bioavailability via reducing the hepatic first pass effect. The aim of the current study was to formulate the drug as buccal bioadhesive film, which releases the drug at sufficient concentration with a sustain manner reducing the frequency of the dosage form administration. One of the advantagees of this formulation is better patient compliances due to the ease of administration with no water to swallow the product. The mucoadhesive films of glibenclamide were prepared using hydroxypropyl methylcellulose (HPMC) K4M, K15M and Eudragit RL100 polymers and propylene glycol as plasticizer and co-solvent. Films were prepared using solvent casting method, and were evaluated with regard to drug content, thickness, weight variations, swelling index, tensile strength, ex vivo adhesion force and percentage of in vitro drug release. Films with high concentrations of HPMC K4M and K15M did not have favorable appearance and uniformity. The formulations prepared from Eudragit were transparent, uniform, flexible, and without bubble. The highest and the lowest percentages of swelling were observed for the films containing HPMC K15M and Eudragit RL100, respectively. Films made of HPMC K15M had adhesion force higher than those containing Eudragit RL100. Formulations with Eudragit RL100 showed the highest mean dissolution time (MDT). Drug release kinetics of all formulations followed Higuchi's model and the mechanism of diffusion was considered non-Fickian type. It was concluded that formulations containing Eudragit RL100 were more favorable than others with regard to uniformity, flexibility, rate and percentage of drug release.
PMCID: PMC4311287  PMID: 25657792
Glibenclamide; Mucoadhesive; Buccal film; Eudragit polymer
19.  The Prevalence of Musculoskeletal Disorder and Association with Productivity Loss: A Preliminary Study among Labour Intensive Manual Harvesting Activities in Oil Palm Plantation 
Industrial Health  2013;52(1):78-85.
Production agriculture such as harvesting in oil palm plantation has been frequently associated with MSD and significant loss of productivities. This study tends to evaluate from the viewpoint of health, the association between self-reported prevalence of musculoskeletal disorders and productivities; the impact of musculoskeletal disorders on productivity. A cross-sectional study was conducted among 143 harvesters in oil palm plantation. A general questionnaire was used to collect socio-demographic background data while Nordic Musculoskeletal Questionnaire was used to determine the prevalence of MSD. Expressed in 4 different indicators; daily harvesting quantity, efficiency score, sick leave and presenteeism, the productivity data were analysed for association. There is significant association between reported acute prevalence of MSD (within 7 d) and productivity loss in terms of presenteeism (χ2=5.088; p<0.05) as well as quantity of daily harvest (χ2=7.406; p<0.01). Logistic regression adjusted for age, BMI and smoking indicate that harvesters with MSD (past seven days) were more likely to be engaged in presenteeism (OR=2.87 95% CI=1.34, 6.14) and had lower daily productivity (OR=2.09 95% CI=1.02, 4.29) compared to harvesters without MSD (past 7 d). This study reveals that oil palm harvesters suffering acute MSD (for the past week) were likely to be still present to work and produce half lesser than their healthy counterparts. Thus, further study with comprehensive surveillance strategy is essential in order to determine the urgency or need of appropriate intervention.
doi:10.2486/indhealth.2013-0017
PMCID: PMC4202763  PMID: 24292878
Ergonomics; Musculoskeletal disorders; Oil palm; Harvesters; Productivity
20.  Changes in cerebral metabolism in patients with a minimally conscious state responding to zolpidem 
Background: Zolpidem, a short-acting non-benzodiazepine GABA agonist hypnotic, has been shown to induce paradoxical responses in some patients with disorders of consciousness (DOC), leading to recovery of arousal and cognitive abilities. We here assessed zolpidem-induced changes in regional brain metabolism in three patients with known zolpidem response in chronic post-anoxic minimally conscious state (MCS).
Methods: [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) and standardized clinical assessments using the Coma Recovery Scale-Revised were performed after administration of 10 mg zolpidem or placebo in a randomized double blind 2-day protocol. PET data preprocessing and comparison with a healthy age-matched control group were performed using statistical parametric mapping (SPM8).
Results: Behaviorally, all patients recovered functional communication after administration of zolpidem (i.e., emergence from the MCS). FDG-PET showed increased metabolism in dorsolateral prefrontal and mesiofrontal cortices after zolpidem but not after placebo administration.
Conclusion: Our data show a metabolic activation of prefrontal areas, corroborating the proposed mesocircuit hypothesis to explain the paradoxical effect of zolpidem observed in some patients with DOC. It also suggests the key role of the prefrontal cortices in the recovery of functional communication and object use in hypoxic patients with chronic MCS.
doi:10.3389/fnhum.2014.00917
PMCID: PMC4251320  PMID: 25520636
minimally conscious state; zolpidem; brain metabolism; positron emission tomography; prefrontal cortex; mesocircuit hypothesis
21.  Analysis of Deoxynivalenol and Deoxynivalenol-3-glucoside in Hard Red Spring Wheat Inoculated with Fusarium Graminearum 
Toxins  2013;5(12):2522-2532.
Deoxynivalenol (DON) is a mycotoxin affecting wheat quality. The formation of the “masked” mycotoxin deoxinyvalenol-3-glucoside (D3G) results from a defense mechanism the plant uses for detoxification. Both mycotoxins are important from a food safety point of view. The aim of this work was to analyze DON and D3G content in inoculated near-isogenic wheat lines grown at two locations in Minnesota, USA during three different years. Regression analysis showed positive correlation between DON content measured with LC and GC among wheat lines, locality and year. The relationship between DON and D3G showed a linear increase until a certain point, after which the DON content and the D3G increased. Wheat lines having higher susceptibility to Fusarium showed the opposite trend. ANOVA demonstrated that the line and location have a greater effect on variation of DON and D3G than do their interaction among years. The most important factor affecting DON and D3G was the growing location. In conclusion, the year, environmental conditions and location have an effect on the D3G/DON ratio in response to Fusarium infection.
doi:10.3390/toxins5122522
PMCID: PMC3873699  PMID: 24351715
fusarium; wheat; deoxinyvalenol; deoxynivalenol-3-glucoside
22.  Occurrence of Deoxynivalenol and Deoxynivalenol-3-glucoside in Hard Red Spring Wheat Grown in the USA 
Toxins  2013;5(12):2656-2670.
Deoxynivalenol (DON) is a mycotoxin found in wheat that is infected with Fusarium fungus. DON may also be converted to a type of “masked mycotoxin”, named deoxynivalenol-3-glucoside (D3G), as a result of detoxification of the plant. In this study, DON and D3G were measured using gas chromatographic (GC) and liquid chromatography-mass spectrometry (LC-MS) in wheat samples collected during 2011 and 2012 in the USA. Results indicate that the growing region had a significant effect on the DON and D3G (p < 0.0001). There was a positive correlation between both methods (GC and LC-MS) used for determination of DON content. DON showed a significant and positive correlation with D3G during 2011. Overall, DON production had an effect on D3G content and kernel damage, and was dependent on environmental conditions during Fusarium infection.
doi:10.3390/toxins5122656
PMCID: PMC3873704  PMID: 24351720
deoxynivalenol; deoxynivalenol-3-glucoside; wheat; USA
23.  Formulation of nicotine mucoadhesive tablet for smoking cessation and evaluation of its pharmaceuticals properties 
Background:
Nicotine replacement therapy (NRT) with gradual decreasing of nicotine is one of the smoking cessation methods. Muccoadhesive formulations are among the novel drug delivery systems that are available in the form of tablets and films, and can be used for NRT. Muccoadhesive nicotine tablets when placed in the upper gum will attach to the buccal mucosa and release nicotine content in a controlled manner. This will meet the immediate and long-term need of the individual to the nicotine, such that the person can decrease his/her dependency on smoking.[1]
Materials and Methods:
In this study, the tablets were prepared using different conventional bioadhesive polymers such as Hydroxypropyl Methycellulose (HPMC) 50cps, sodium carboxy methyl cellulose (NaCMC), and carbapol 934 (CP934) in singular or mixture form. Magnesium hydroxide were used as the pH increasing agent; magnesium stearate as the lubricant; and lactose as the excipiente. Nicotine hydrogen bitartrate, more stable than the liquid, was used in different formulations. Pharmaceutics characteristics such as adhesion degree and drug release rate were evaluated.
Results:
Increasing of HPMC 50cps in the formulations decrease speed release of nicotine. The carbapol in formulations beget slow releasing of nicotine. With increasing the percent of lactose, the rate of release in formulations was increased. Formulations, which have HPMC 50cps has best adhesiveness and the formulations contains carbapol had not suitable adhesiveness. Formulations contains NaCMC were very fast release and had not suitable adhesiveness.
Conclusion:
The formulation contains mixture of HPMC50cps and CP934 was the best because of suitable adhesiveness and minimum swing in release.
doi:10.4103/2277-9175.122515
PMCID: PMC3908699  PMID: 24524034
Mucoadhesive tablet; nicotine; smoking cessation
24.  Malignant Mesenchymal Renal Tumor: A Rare Case of Primary Renal Fibrosarcoma 
Malignant mesenchymal neoplasms of kidney constitute a rare group of tumors. Primary fibrosarcoma of kidney is an extremely rare subtype of primary malignant mesenchymal renal neoplasms. An elderly female presented with a gradually increasing abdominal lump and mild abdominal discomfort. On cross-sectional imaging, the lesion showed features suggestive of an atypical renal mass not conforming to either ball or bean type growth pattern. The mass was surgically removed and on histopathological and immunohistological investigations diagnosed to be primary renal fibrosarcoma.
doi:10.4103/2156-7514.122322
PMCID: PMC3883277  PMID: 24404411
Atypical renal mass; malignant mesenchymal renal tumor; primary renal fibrosarcoma
25.  Ampleur et impact des évènements indésirables graves liés aux soins: étude d'incidence dans un hôpital du Centre-Est tunisien 
Introduction
La prévention des événements indésirables représente une priorité de santé du fait de leur fréquence et de leur gravité potentielle. Ce travail a été mené afin d'avoir un diagnostic de la situation épidémiologique relative aux événements indésirables survenant dans notre hôpital.
Méthodes
Une étude prospective a été menée auprès de tous les patients qui ont été hospitalisés au CHU Farhat Hached - Sousse (Tunisie) sur une période d'un mois dans quatorze services de l'hôpital. La détection d'évènement indésirable grave (EIG) était basée sur les critères adoptés dans différentes études. Les tests T et Chi 2 ont été utilisés pour identifier les facteurs contribuant à l'apparition d'évènements indésirables.
Résultats
Au total, 162 EIG ont été identifiés pendant la période. 45% de ces évènements étaient des infections nosocomiales. Ces EIG ont eu comme conséquences un décès chez 9,2% des patients, la mise en jeu du pronostic vital de 26% des patients et la prolongation de la durée de séjour chez 61,7% d'entre eux. L'admission dans des circonstances particulières et l'exposition à des soins invasifs étaient identifiés comme des facteurs de risque potentiels EIG.
Conclusion
Le renforcement de la stratégie de gestion des risques sanitaires en ciblant préférentiellement le risque infectieux constitue une étape fondamentale dans l'amélioration de la sécurité des patients au sein de notre établissement de santé.
doi:10.11604/pamj.2013.16.68.1161
PMCID: PMC3976656  PMID: 24711868
Evènements indésirables graves; infections associées aux soins; soins invasifs; gestion des risques; sécurité des patients; Serious Adverse Events; healthcare associated infections; invasive care; Risk Management; Patients safety

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