Introduction: Cerebrovascular accident (CVA), also known as stroke, is characterized by the interruption of blood flow in a particular area of the brain, being of the ischemic or hemorrhagic type. Its involvement can lead to emotional dysfunctions, among which depression, mania, bipolar disorder and post-stroke anxiety disorder. Objective: To propose psychoeducational intervention in a group of caregivers of the patients who were affected with stroke, aiming at a better understanding of the emotional aspects. Methodology: A welcome space will be provided for the companions to share their experiences through a conversation, followed by the delivery of psychoeducational material on the stroke. Results: It is known that there is usually a deficiency related to the qualification of the caregivers regarding the continuity of the physical and emotional assistance of the patient, which can lead to doubts, unrealistic expectations and inadequate management of the patient. Therefore, psychoeducation is a tool that can be used in the hospital context, since it is understood that the hospital psychologist has been increasingly active in the definition of behaviors and treatments within a multidisciplinary team. Conclusion: The need for a psychoeducational intervention in caregivers of patients diagnosed by CVA is necessary because of its abrupt character and reverberation on the caregiver, who needs guidelines to face the possible post-stroke psychological complications in the patient.
Epiphrenic oesophageal diverticulum is rare world-wide and account for less than 10% of all oesophageal diverticula. We present Mrs O.E. a 64-year old Nigerian of the Yoruba tribe who presented with early satiety and upper abdominal discomfort of five months duration. The early satiety was of insidious onset and had been progressive. This initially made her to reduce the size of her meal intake but eventually progressively led her to taking just a meal per day. This is in contrast with her premorbid intake of three meals per day. She has associated history of regurgitation worse in the recumbent position which she described as containing undigested food. She has no abdominal swelling, odynophagia or dysphagia. No history of haematemesis or melaena. She has weight loss and easy fatigability. The upper abdominal (epigastric) discomfort is characterized as a feeling of peppery, burning sensation which radiates to the back and had no association with meals or with time of the day. It has no relation to posture and said to be worse with consumption of peppery or spicy food substance. Minimally relieved with the use of antacids. No other significant contributory history. Review of systems was also not contributory. Clinical examination was not remarkable. A provisional diagnosis of a suspected Gastric Tumour was made likely a Gastric Lymphoma or Adenocarcinoma to rule out Gastrointestinal Stromal Tumour(GIST). Barium swallow revealed a Distal (Epiphrenic) oesophageal diverticulum. Findings at upper GI Endoscopy include: (1) Distal (Epiphrenic) oesophageal diverticulum (2) Reflux oesophagitis (3) Gastric Atrophy; probably age-related to rule out chronic Helicobacter pylori-infection. Histology revealed Reflux oesophagitis, Mildly active chronic corporeal gastritis with mild atrophy and Chronic non-specific antral gastritis. She was managed conservatively with long term proton pump inhibitor therapy, modification of dietary habits and liberal oral fluid intake with significant clinical improvement and resolution…
We present Mr M.A. a 27 year old Nigerian of the Yoruba tribe who has been having recurrent dyspeptic symptoms for 5 years but not previously endoscopically evaluated for peptic ulcer disease who now presented with six days history of abdominal pain which was initially epigastric but later became generalized associated with four episodes of vomiting and a day history of abdominal distension and fever. He was acutely ill-looking and dehydrated. The Abdomen was moderately distended, does not move with respiration, generalized tenderness with guarding and rebound tenderness, intra-abdominal organs were difficult to palpate due to the guarding. Bowel sound was absent. Examination of the other systems was not remarkable. A provisional diagnosis of Generalized peritonitis likely secondary to perforated peptic ulcer was made. He had an emergency exploratory laparotomy under general anaesthesia. He was commenced on intravenous fluids and parenteral proton pump inhibitor(PPI) and antibiotics. Intra-op findings include 2 liters of bilious peritoneal fluid, Multiple fibrous adhesions, a 2.5cm x 2cm gastric perforation at the anterior wall of the antrum and a grossly normal bowel. The surgical operation performed was a Graham Omental patch closure of the gastric defect with Bilateral Truncal Vagotomy and Peritoneal lavage. Post-operative state was satisfactory and he was later discharged. He presented at the gastroenterology out-patient clinic eight months later with complaints of early satiety, feeling of indigestion and episodes of vomiting. Vomitus is usually offensive / foul smelling and contains undigested or partially digested stale food substances. Abdominal examination revealed a positive succussion splash. Other clinical examination findings were not remarkable. A Provisional Diagnosis of suspected Gastric outlet obstruction probably secondary to a chronic duodenal ulcer was made. Endoscopy findings revealed copious fluid and food debris in the stomach cavity which had an offensive smell with remnants of partially digested stale food substances…
The review article explains that the homeopathy remedies are treatment of different women’s troubles is a common condition that includes various hormonal changes at puberty, menarche, and pregnancy until menopause. Researches have supported that women with great physical and mental stress have disturbed menses. Female life is divided into 3 phases. Firstly, birth to puberty, secondly, puberty to adult, thirdly, menopause or climacteric. Hence girls should be given proper diet, routine health checkups. Women suffering with acne, dysmenorrhoea, PCOD, regular U.T.I need proper treatments
Recommender Systems are intelligent applications designed to assist the user in a decision-making process whereby user wants to choose one item amongst the potentially overwhelming set of alternative products or services. This research is aimed at developing an intelligent recommender system that provides high quality recommendations in the financial domain. Hashed and anonymized datasets (which are account statements) were acquired from online sources and bank customers. The acquired data was pre-processed using the Microsoft Excel 2016 and WEKA 3.8.3 data mining software. The K-nearest neighbor (KNN) algorithm was used to classify the dataset and train the model. The trained model was used to develop a recommender system using the Java 2 platform Enterprise Edition (J2EE). For effective management of the data and consideration of rapid increase in data growth, a graph-oriented database approach was proposed and utilized. The database management system used was the Neo4j. From the evaluation of the algorithms implemented in the recommender system taxonomy, the KNN algorithm recorded the best performance building the model in 0.3seconds with an accuracy of 89.8%. The fuzzy decision tree algorithm performed second best building the model within 0.48 seconds with an accuracy of 62.8%. The decision table algorithm performed poorly building the model in 3.9 seconds with an accuracy of 53%. However, the baseline accuracy of the dataset used was evaluated to be 62.75% of accuracy in 0.4 seconds. It is therefore recommended, as proposed in this study that the graph technology be used in developing recommender systems especially for institutions with massively growing data like the financial institutions. In addition, bank products should be classified and targeted towards customers in order to bolster their level of involvements and improve financial inclusion. With a targeted product, customers will be more willing to opt-in if products are suitable and within financial reach….
Introduction: Malignant melanoma is a lethal skin cancer which is on the rise despite increasing education on sun awareness. It is most common in young Caucasian individuals however any age or ethnicity can be affected. Discussion: There are four main types of malignant melanoma which include superficial spreading MM (most common), Nodular (most lethal), Acral lentignous melanoma and Lentigo maligna melanoma. Once it has metastasized the prognosis is poor but new treatments are giving us much better outcomes. Aim: The main aim of this study is to identify which MMs are most likely to metastasize based on the location with the two main groups being above neck and below neck. Methods and results: forty-five patients were included in the study, 37 were below neck and 8 were above neck. Out of the 37 below neck MM patients, none had distant metastases , but 25% of the above neck MM patients had distant metastases. Conclusion: This small study has demonstrated that above neck malignant melanoma is more likely to metastasize than below neck malignant melanoma despite advanced Tumor scores in the below neck subgroup.
Abstract: psoriasis is a chronic multifactorial disease that has negative impact on the patient’s quality of life. Selecting appropriate treatment for each patient must be both effective and relatively safe. Methotrexate and Etanercept are systemic therapies used for moderate – severe chronic plaque psoriasis. Objective: The aim of study is to assess the efficacy of methotrexate and etanercept in the treatment of chronic plaque psoriasis. Patients and Methods: This therapeutic, interventional comparative single centre study was carried out at the Centre of Dermatology and Venereology, Baghdad Teaching Hospital, from January 2015 –July 2017. A total of 62 patients were enrolled; divided into two groups. Group I: Thirty-three patients (23 males and 10 females), their ages ranged between 15 and 65 years mean ±SD 33.13±13.07, received etanercept 50mg twice weekly for 3 months then once weekly thereafter. Group II: Twenty-nine patients (19 males and 10 females), their ages ranged between 15 and 62 years mean±SD 38.16±15.2, received methotrexate 15 mg per week for six months then tapered. Both groups were followed up monthly for 6 months and their PASI score, DLQI, side effect and pictures were recorded. Results: Seven patients defaulted from the study for unknown reason,30 patients completed in etanercept group, while 25 patients completed in methotrexate group. After 12 weeks the PASI score decrease from baseline 19.13±10.67 to 6.38±4.96 and then to 3.34±5.38 after 24 weeks treatment with Etanercept compared to reduction in PASI score from baseline 18.97±10.54 to 5.72± 4.8 to 2.95±-6.01 after 12 weeks and 24 weeks respectively. There is significant statistical effect in the two groups. Conclusions: We conclude that both are effective monotherapy for patients with moderate to severe plaque psoriasis with tolerable side effect
Management of Oro-Cutaneous Manifestations in Behçet disease and Recurrent Oral Aphthosis, review article
Recurrent oral aphthosis is a major health problem affecting 20% of population. Its pathogenesis is not well elucidated, however, it’s considered as part of major criteria of Behçet disease. Many therapies advised to manage these ulcerations in both diseases and most of them are symptomatic, however, in the last decades; some of them have shown therapeutic as well as prophylactic roles. Herein, we review the different aspects of these therapies with emphasis on Iraqi experience.
The Effectiveness of Cream of Centella asiatica Ethanol Extract in Chitosan Nanoparticles Compared with Centella asiatica Ethanol Extract Cream, Silver Sulfadiazine Cream, and Control on Superficial Dermal Burn Healing in Rats
Introduction: Centella asiatica extract is known to promote wound healing. Nowadays nanotechnology, especially nanoparticle is used to increase the bioavailability of active ingredients into the skin, one of which is chitosan nanoparticle. However, the effectiveness of Centella asiatica ethanol extract in chitosan nanoparticle (CAEECN) towards superficial dermal burn healing is not fully understood. Aim: To determine the effectiveness of CAEECN cream compared to Centella asiatica ethanol extract (CAEE) cream, silver sulfadiazine (SSD) cream and control in superficial dermis burn healing in Sprague-Dawley rats. Materials and Methods: A total of 20 male Sprague-Dawley rats were divided into 4 groups. After anesthetizing, 4 superficial dermis burns were made on the back of each rat and was given 4 treatments (CAEECN, CAEE, SSD, and control) afterward. Each group was sacrificed separately (respectively on day 3rd, 7th, 14th, and 21st post-burn induction). Several evaluations were macroscopic (wound size), and microscopic parameters (reepithelialization ratio and distance, wound contraction index, wound size, and angiogenesis). Results: There was no significant difference in wound size between treatments on day 0, 3, 7, 14, and 21. But three active agents (CAEECN, CAEE, and SSD) treated group showed early decrease of wound size compare to control group on day-3. Microscopically, there were no significant differences in reepithelialization ratio and distance, wound contraction index, wound size, angiogenesis. Nevertheless, CAEECN treated group showed the smallest wound size on day-3 and highest angiogenesis on day 21. Conclusion: Effectiveness of CAEECN in burn wound healing in rats showed no significant difference compared to CAEE, SSD, and control. But in three active agents (CAEECN, CAEE, and SSD) treated group, showed an early decrease of wound size compared to control group on day-3. Microscopically, CAEECN treated group showed the smallest wound size on day-3 and highest angiogenesis on day 21.
EXPERIENCE REPORT: PUBLIC ATTENDANCE WITH ANAMNESIS, BIOIMPED ASSESSMENT AND BASIC SKIN CLEANING PROTOCOL SERVICES
Introduction: Concern about beauty is noticeably growing in our society. Thus, aesthetics are used to meet the search needs not only for physical well-being, but also for biopsychosocial. Skin care is essential for maintaining its vitality. Therefore, daily treatment is indispensable to establish skin balance, controlling hydration, oiliness and protection against ultraviolet rays. The importance of teaching people how to take care of their skin is essential to the quality of life, however there are still myths and conflicts to be fought about preventive care. Thereby, it helps to strengthen the construction of positive self-image, as well as collaboration to improve the quality of life, encompassing mental, physical and psychological health of the individual. Objectives: To provide participants with basic knowledge of daily facial skin care, guiding the correct order of the products to be used, prevention methods against photoaging, epidermal intoxication, oiliness and dehydration. Provide practical and explanatory demonstration on the subject, and demonstrate physiological patterns of hydration and oiliness of the patient’s skin through bioimpedance. Methodology: At first, an anamnesis form was made to evaluate the community skin routine. Factors such as age, ethnicity, history and habits were considered relevant in the condition of a skin. Then instructions were given and questions about the correct skin cleansing protocol were solved. Participants also underwent an assessment of the proportion of the amount of oil and water on their faces, made from a digital bioelectrical impedance device. Finally, the skin was cleaned following the steps of: cleaning, exfoliation, toning, moisturizing and use of sunscreen. Results: A total of 42 people were attended with the anamnesis and simple skin cleansing service, 34 female and 8 male, aged between 9 and 55 years. The data obtained with the questionnaire sheet showed that there are varied patterns of self-care regarding the skin, highlighting…