Objectives: Nutrition support is critically important in management malnourished hospitalized patients who are intolerated to Enteral Feeding (EF) regard Less the offending inciting factor. In this case situation, total or Partial Parenteral Nutrition (TPN) may save malnourished patient’s life. Regarding TPN, the route may be either Peripheral (PPN) or Central (CPN). Intravenous Lipid Emulsions (ILEs) is a major component of TPN due to its unique dual nutritional advantages in providing high dense calories and essential fat acids of Ꞷ-3 and Ꞷ-6. The aim of this study is to compare the clinical impacts of using ILE co-infusion with Amino Acid (AA) in daily pattern, either centrally or peripherally, (Group I) with intermittent ILE co-infusion with AA centrally (Group II). Methods: We performed a retrospective analysis of patients who were in tolerated to EF and were candidate to either peripheral or central TPN. Patients were excluded if they discharged or died before completing at least 1 week of TPN. All patient’s continuous variables were expressed as mean± SD by using the Independent Samples T-Test while categorical variables were expressed as numbers with percentages by using Chi Square Test. Results: The mean overall age was 58.37±9.95 years and 224 (68.7%) patients were male. The changes in albumin level (∆ALB) was significantly higher in Group I than Group II (1.49±0.89 g/dL vs 0.71±0.78 g/dL, respectively). The hospital Length of Stay (LOS) and overall 28-day hospital mortality were significantly lower in Group I compared with Group II (14.05±1.71 days and 19.51% vs 16.01±2.57 days and 32.09%, respectively). Conclusion: In summary, IFE is an integral part of TPN and has a significant positive clinical impact especially, if it is administered in daily manner regardLess the route.

Background: Febrile seizures (FS) are the most frequent convulsive neurological complication in young children aged between 6 months and 5 years. Patients presented to the ER with FS should be stabilized and may need hospitalization. Objective: The study aims to determine the presentation, investigation, management done, and recurrence rate of febrile seizures in a sample of patients from three Lebanese hospitals. Methods: This is a retrospective, multi-center, study conducted in three hospitals in Lebanon, using a data collection form with 60 pediatric patients recruited retrospectively between January 1st 2018 and June 1st 2019. The researchers collected demographics (gender, age) and FS (Febrile Seizure) data (Number of FS, Symptoms, and clinical findings) from medical files. Later on, parents were contacted to check about the recurrence of FS. Results: The prevalence of FS in the hospitals is 1.5% (60 FS / 4100 Pediatric cases). Among the 60 patients, 48.3% were boys and 51.7% were aged between 1 and 5 years. The top 3 FS features were fever (83.3%), otalgia (30%), and diarrhea (28.3%). Upon physical exam, 41.7% had erythematous TM, 23.3% had dehydration and 20% had rash. After investigations, 63.3% were discharged and 36.7% were admitted. After 1-year of the initial FS, 26.7% showed FS Recurrence. The multivariate analysis shows that factors predicting the FS recurrence at 1-year are: the number of the FS episodes at presentation (p = 0.001) and the duration of the seizure (p = 0.003). Conclusion: To the best of our knowledge, our study is the first to examine FS patients in different Lebanese hospitals. This is a critical opportunity for the exploration of this patient population and the examination of existing management and treatment strategies. This would allow the formulation of adequate treatment modalities and preventative strategies through the elaboration of country-specific risk factors and the identification of high-risk populations.

A single blind comparative clinical study was done in order to evaluate the effectiveness of an external application of ointment which was prepared from seed powder of Pongamia pinnata. Two different concentrations, 5 and 10%, of the drug were prepared. Patients were selected from the outdoor patient division, Rural Siddha Ayurvedic Hospital, Kobalapuram. Thirty patients with bilateral involvement of the lesions were selected for the survey and categorized each to the Test1, Test 2, Standard and Control groups respectively, such that 15 lesions were included in each group. Ointment prepared from the seed power of P. pinnata was given to apply twice a day on the selected lesion in the test groups. Observation was done after two weeks and follow up week. At the end of the treatment, p-value for skin pigmentation reduction T1 and T2 were 0.003 and 0.000 respectively indicating that significant improvement was achieved compared to the control group (p-value of 0.104). The p-values for the area size difference of the two groups were 0.001 and 0.001 respectively. It shows the effectiveness of the area reduction of both groups were significant and same. But the p-value for the control group was 0.153 and it implies an increase of the lesion area. So the improvement of the pigmentation reduction of the lesion and reduction of area size can be seen with the external application of the ointment prepared from the seed powder of P. pinnata.

Aim: To investigates the histomorphological studies of the cerebellar cortex and the behaviour of mice after palm wine administration. Materials and Methods: 40 adult mice (25-30g) were grouped into (A, B, C and D) comprised of 10 mice each. They were kept in plastic cages and fed with feed and water ad libitum. Group A (control group) received distilled water, group B, C and D received 14.3mL/kg daily palm wine,14.3mL/kg palm wine every other day and 14.3mL/kg 50% diluted palm wine every other day respectively, orally for four weeks. They were weighted using weighing balance, the neurobehavioral evaluation was performed using the open field maze and the health status was appraised by the rectal temperature. After the last dose of administration, the animals were anaesthetized; the cerebellum was excised, weighed and fixed in 10% formal saline for H&E, Cresyl fast violet and bieschowsky silver stain techniques. Data were analyzed using one-way ANOVA at p<0.05 followed by a posthoc test, results were expressed as mean±S.E.M. Results: Decrease in the rectal temperature of the entire treated group when compared to the control group, relative weight of the cerebellum was higher in the treated group compared to control, neurobehavioral observations (motor parameters) showed difference between treated mice compared to control. Histological observations showed vacuolation and slight degeneration of Purkinje neuron cell bodies except in group D animals. Conclusion: The study showed that palm wine intake on regular basis may affect the histoarchitecture of the cerebellum, neurobehavioural activities such as locomotion and balancing.

Regional Anesthesia (RA) is preferred over General Anesthesia (GA) for patients with COVID 19 to reduce the risk of transmission. Minimizing the many aerosol-generating procedures performed during general anesthesia, anesthesiologists can reduce exposure to patients’ respiratory secretions and the risk of perioperative viral transmission to healthcare workers and other patients. To avoid any airway manipulation, regional anesthesia should be considered whenever surgery is planned for a suspect or confirmed COVID-19 patient or any patient who poses an infection risk. Regional anesthesia has benefits of preservation of respiratory function, avoidance of aerosolization and hence viral transmission.

Background: Acute appendicitis (AA) is the inflammation of the vermicular appendage. It is one of the most common causes of abdominal pain and surgical abdominal emergencies in children. Nowadays and according to literature, the method of treatment remains a dialectical subject. The long delay before admission to hospital is associated with increased rates of perforation. In this study, we evaluate how physicians in Lebanon act in front of acute appendicitis. Materials and Methods: Retrospective, observational, multicenter study on all pediatric patients who underwent appendectomy in three Lebanese hospitals: Nabih Berri Governmental University Hospital, Bahman Hospital and Rafic Hariri University Hospital during year 2017. Results: The study included 102 patients, mean age 10.7 years. Up to 48 Hours of delay, no correlation was found between delay in surgery and the risk of developing a complicated form of the disease such as perforation and peritonitis and postoperative complications up to 30 days after discharge for group 1 (surgery <24 hours) and group 2 (surgery between 24 to 48 hours). In group 1 the complication rate was 13.7% identical to that of group 2 which was 13.68 %. Patients with AA showed a male/female ratio of 0.7 (p <0 .0001). Treatment with antibiotherapy before surgery achieved better outcomes. The treatment option was independent from the clinical presentation. The polled difference in Length of Stay (LOS) showed a trend for shorter LOS in the Immediate Surgery (IS) group. Conclusion: While the complication rate was the same in children who underwent Immediate appendectomy (within the first 24 hours) and patients who were observed and treated with intravenous antibiotics and good hydration followed by delayed appendectomy throughout 24 to 48 hours, Immediate surgery was associated with a shorter hospitalization.

In order to explore the impact of different contents of Moringa oleifera (Moringaceae) leaf powder on blood biochemical parameters, daily administration of dietary formulations was carried out in rats of the species Rattus norvegicus for three months. In the first month of the dietary trials, a significant difference was observed between the different dietary formulations for total protein, albumin, blood glucose, total cholesterol, HDL cholesterol, total/HDL cholesterol, urea, chlorine, sodium and sodium/potassium. After two months of food consumption, albumin, globulin, albumin/globulin, triglycerides, AST, creatinine, calcium, sodium and sodium/potassium showed a significant difference between the foods tested. Three months of dietary trials reported only significant differences between foods for globulin, albumin/globulin, blood glucose, creatinine, urea and calcium. In the same vein, the study showed that the time of administration and the levels of Moringa oleifera leaf powder changed the levels of biochemical parameters in rats. Thus, the 50% content decreased the biochemical parameters the most compared to the controls. Conversely, the 100% content increased these biochemical parameters more. Consumption of Moringa oleifera leaf powder was more conducive to an increase in the level of biochemical parameters than to a decrease.

Introduction: NAFLD is defined as fatty liver i.e. an accumulation of lipids inside the hepatocytes exceeding 5% of the weight of the liver, without hepatitis B or hepatitis C infection and in the absence of ‘excessive’ alcohol intake. The prevalence in the Asian society is 16-25%. This may be under-estimated as patients are usually asymptomatic. The interest in this disease is currently heightened as more evidence is showing that a significant proportion of patient with NAFLD can progress to liver cirrhosis, liver failure and hepatoma. Objectives: 1. To determine the prevalence of NAFLD in the adult patients undergoing ultrasound examination for other causes in our outpatient setting. 2. To determine the prevalence of risk factors. Methods: Prospective study from 1 March–31 December 2019. Ultrasound abdomen for patients attending surgical outpatient clinic were screened for the word ‘fatty liver’. Patients fulfilling study criteria were included. Once consented, full history and body measurements were taken, followed by fasting blood test (FSL, FBS, LFT). Data analysis was done using IBM® SPSS® Statistics Version 24. Results: During the study period, 359 patients underwent ultrasound abdomen, 132 had fatty liver and 79 were included in the study. Mean age was 49.01±11.67 years, BMI 26.67±3.61 kg/m2, ALT 40.82±83.40 μ/L, FBS 5.79±1.51 mmol/L, total cholesterol 5.24±0.85 mmol/l and TG 1.47±0.80 mmol/L. Patients with risk factors are male (46.8%), type 2 DM (24.1%), obesity (67.1%), hypertension (49.4%) and hypercholesterolaemia (51.9%). Discussions: The prevalence of NAFLD in our centre is 22%, which is compatible with other western and Asian studies. The prevalence of male risk factor is similar to other Malaysian studies (45-50%). The prevalence of other risk factors is also high. Conclusions: In conclusion, the prevalence of NAFLD is high among our population and the associated factors are mostly obesity and hypercholesterolaemia. These patients are asymptomatic and they are at risk of getting chronic liver disease in the long term.

Modern herbal medicine has played a significant role in treating oxidative stress and related complications. Kolaviron was evaluated for possible anticataractogenic potential. Following incubation of porcine lenses for 24 h at 37 0C. Porcine lenses 160 randomly distributed into control containing no selenite 40 lenses. Toxic control containing selenite, kolaviron and selenite group and finally Gallic acid and selenite group were obtained from a local slaughterhouse and homogenized in 50 mM Tris-HCl, pH 8.0, containing 0.1 M NaCl, 5 mM EDTA, 0.01% β-mercaptoethanol and 0.02% sodium azide. The mean activities of catalase, superoxide dismutase and Glutathione-S-transferase and the mean level of reduced glutathione were all significantly (p<0.05) higher in Group III lenses than the mean values in Group II lenses. The mean concentration of malondialdehyde in Group III lenses was significantly (p<0.05) lower than that in Group II lenses. Porcine lenses simultaneously exposed to selenite and kolaviron showed increased mean activities of enzymatic antioxidants, mean levels of reduced glutathione and decreased malondialdehyde levels. Further studies are required to confirm whether the kolaviron can be developed for pharmacological management of cataract.

Dietary salt plays a very crucial role in maintaining human health. Faulty salt intake practices are deeply associated with many healths related problems. Despite significant progress has been made by the government through the supply of iodized salt at every level, some households in this hilly region of Himachal Pradesh still use Rock Salt/Sendha Namak in place of iodized salt. The present editorial explains the reasons and perception of the people for using Rock Salt.

Search for naturally occurring compounds with Anti-candida activity has become quite intense due to the side effects of synthetic fungicides and the development of pathogens against such fungicides. Therefore, in recent years, considerable attention has been directed towards the identification of anti-fungal activity. Hence searching of varieties of plants for their antifungal activity against Candida albicans was considered worthwhile. The main goal of this research was to assess the anti-candida activity of the plant Rhinacanthusnasutus (L) Kurz against the Candida albicans. For this study fresh and dry plant materials (leaves, root and stem) were used at different concentration (100%, 50% & 25%) and different time period (12h, 24h & 48h) using hot and cold extracts to test effectiveness. Canidaalbicans sample were collected from university of Colombo and Sabouroud Dextrose Agar media were used determine the anti-candida activity and the antifungal activities were assessed by the presence or absence of inhibition zones in disc diffusion method.Among the different plant extracts, the results showed fresh leaves are more effective than root and stem; the zone of inhibition against the Candida albicans for leaves, root and stem are 14.14±0.12mm, 12.65±0.28mm and 11.81±0.69mm respectively. Fresh leaves extract (14.14±0.20mm) were more efficient than dry extract (13.36±1.80mm) and cold extract (14.14±0.20mm) were more effective than hot extract (13.36±1.80mm) and effective duration for the inhibition is 48h with 10mg/10ml of extract. Rhinacanthusnasutus (L) Kurzhas better effective anti-candida activity than the positive control Fluconazole (10mg/10mL) (14.14±0.20>11.33±0.47). The findings suggest the usefulness of leaves, stem and root aqueous extracts of Rhinacanthusnasutus(L) Kurz against pathogenic fungal (Candida albicans) strains.

Background: As COVID-19 has become the recent major concern all over the world; as this virus was able to paralyze most of the human beings’ activities, an urgent solution to eradicate and control the spread of this disease is needed. It is known that both Ferritin: Albumin and Monocyte: Lymphocyte ratios are increased in COVID-19 infection. In our study, we primarily investigated the dynamic effects of Hydroxychloroquine+Azithromycin+High dose Vit C or immuno-enhancing nutrients (IENs) on this innovated combined ratio across six studied groups. Methods: This was a single-center randomized, controlled, open label study was conducted on 48 eligible patients in the COVID-19 isolation department at Queen Alia Military Hospital, Royal Medical Services, Amman/Jordan over 7 weeks. Age≥16 years and positive RT-PCR are considered the major inclusion criteria. An ANOVA+Tukey Kramer post-hoc multiple comparison and Chi square analyses were primarily used in this study. Result: Our total study population was 48, 79.2% were males and 20.8% were females. The age of the total sample was 31.35+14.67 years. The hospital length of stay, variation in body temperature, up-trending in R:rR was significantly lowest in groups that include IENs followed by high dose Vitamin C than groups without them. There is insignificant role of antibiotic in mild cases of COVID-19 infected patients with pulmonary infiltration. Conclusion: The existing approved COVID-19 drugs of Hydroxychloroquine with or without Azithromycin are likely ineffective without our immune system support and the IENs likely improve the clinical outcomes at least dynamically in the worst scenario.

Clinical supervisors of radiography students have a responsibility to organise and manage clinical training resources. However, there is a lack of literature to support radiographers in this role. Most of the literature on the managerial function of a clinical supervisor is from the nursing and medical professions. This article borrows the nursing and medical professions literature and applies it to radiography. The managerial tasks of a clinical supervisor reviewed and discussed are the orientation process of students, clinical teaching and learning resources, requirements for appointment as a clinical supervisor, developing and maintaining competency as a clinical supervisor and quality assurance programmes in clinical supervision. This information will guide radiographers in the facilitation of practice-based learning for radiography students during their clinical practice.

Clinical supervisors are faced with daily challenges of managing and supporting radiography students from all levels of training and with varying degree of autonomy. However, there is a lack of literature and guidelines to support radiographers who provide practice-based learning to radiography students with learning difficulties and disabilities during clinical practice. The purpose of this article is to bring about awareness and provide information and guidance to clinical supervisors of radiography students on how to support learners with learning difficulties and disabilities. This information will also be useful to other healthcare professionals, such as nurses, pharmacists, physiotherapists, and medical doctors who facilitate practice-based learning for healthcare students in the clinical environments.

Background: Glomerular filtration rate is an important clinical indicator of kidney function, Sickle cell disease (SCD) is regarded as a chronic vasculopathy marked by endothelial injury and lipoprotein metabolism may be affected. Objective: To correlate the activities of lecithin:cholesterol acyl-transferase (LCAT) and lipoprotein lipase (LPL)  in adult SCD patients with  estimated glomerular filtration rate (eGFR). Methods: One hundred and eighty confirmed SCD patients were consecutively recruited for the study. They consisted of 120 males aged: 26.4±2.4 years and 60 females aged 25.4±1.6 years. They were grouped into 3 categories based on their eGFR viz: eGFR >90mL/min/1.73m2; eGFR 60 to 89mL/min/1.73m2 and eGFR <60mL/min/1.73m2. Serum triglyceride and total cholesterol were determined using reagent kits by Randox laboratories, UK, while HDL- cholesterol was determined in the supernatant after precipitation with magnesium chloride/ phosphotungstic acid solution. LCAT was measured using the Anasolv LCAT assay kit supplied by DAICCHI chemicals, Japan and LPL was assayed by colorimetric method as previously described. Results: Serum LPL and LCAT were significantly lower (p<0.001) with decreasing eGFR. The eGFR correlated negatively with urea (r = -0.174, p<0.02), creatinine (r = -0.195, p<0.01) and triglyceride (r = -0.145, p<0.05) while HDL-c (r = 0.149, p<0.05), LPL (r = 0.148, p<0.05) and LCAT (r = 0.209, p<0.005) correlated positively with eGFR. Conclusions: The activities of LCAT and LPL were lower with decreasing levels of glomerular filtration rate. The importance of adequate lipid and lipoproteins metabolism cannot be overemphasized in the management of SCD patients.

Introduction: The calcaneus is the most frequently injured tarsal bone. Many calcaneal fractures are work-related as they result from a fall from height, especially in males’ age 35–45 years. These fractures frequently result in long-term disability with potentially severe economic impact on the patient. Operative treatment of displaced calcaneal fractures has been a controversial due to tissue condition and wound infection. In this study, our objective is to investigate the outcome of percutaneous fixation of displaced calcaneal fractures with cannulated cancellous screws. Materials and Methods: A retrospective review of 15 patients with calcaneal fractures who had percutaneous reduction and screw fixation for displaced fracture of calcaneus was done. The patients were assessed with plain radiography. In developing countries like India, cost of medical treatment is often a concern, so computed tomography scan was not done as most of the patients were poor and did not afford the treatment. The fractures were classified according to Essex‑Lopresti classification system. Functional assessment involved the use of calcaneal fracture scoring system. Results: The age of the patients ranged from 25 to 45 years (mean: 35 years). Time to union averaged 14.5 weeks (range 12–17). The treatment outcome as measured by calcaneal fracture scoring system ranged from 66 to 90 (mean 78). Conclusion: Percutaneous fixation of fracture calcaneum, offers the prospect of fewer complications and better outcome.