Background: Fatigue is a common presenting complaint of patients in the primary care offices. Low levels of vitamin D have been associated with fatigue in cancer patients. Normalization of vitamin D level improves their fatigue. Whether low vitamin D plays a role in fatigue in medically stable patients is not known. Aims: This prospective non-randomized therapeutic study observed the prevalence of low vitamin D in fatigue and the effect of normalization of vitamin D on fatigue. Material and Methods: One hundred and seventy four adult patients, who presented in our primary care office with fatigue and stable chronic medical conditions,completed fatigue assessment questionnaires. Patients with low vitamin D levels received ergocalciferol therapy for 5 weeks. Scores of pre- and post-treatment fatigue assessment questionnaires were compared. Results: Prevalence of low vitamin D was 77.2% in patients who presented with fatigue. After normalization of vitamin D levels fatigue symptom scores improved significantly (P < 0.001) in all five subscale categories of fatigue assessment questionnaires. Conclusion: The prevalence of low vitamin D is high in patients who present with fatigue and stable chronic medical conditions, if any. Normalization of vitamin D levels with ergocalciferol therapy significantly improves the severity of their fatigue symptoms.

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Psychiatric disorders are associated with long-term disability and huge social and economic costs. The possible influence of heavy metals exposure on public health remains a matter of concern. A recurring research question that persisted among researchers in neuropsychiatry has been "are psychiatric patients more likely to have a high body burden of lead or other heavy metals?" This is an update account on the role of lead and cadmium in psychiatry. This review, which has employed search words like "lead and cadmium in psychiatry" , "lead and cadmium in schizophrenia", "lead and cadmium in psychosis" in citation indices such as PubMed, Google Scholar, Scirus, and Scopus. A total of 415 articles were found; 60 fulfiled the inclusion criteria. Evidence-based information suggests that lead and cadmium may be involved in psychiatry. Should environmental lead and cadmium be implicated in the etiogenesis of psychiatry given the characteristic high environmental pollution in Sub Sahara Africa, it is worthwhile for toxicologists and scientists in Sub-Sahara Africa to investigate if lead and cadmium can become additional biomarkers in the diagnosis of psychiatric disorders.

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Background: For the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections and decolonization of MRSA carriers, the use of mupirocin a topical antibiotic is increasing day by day. Aim: The present study was carried out to determine the prevalence rate of high-level and low-level mupirocin resistant MRSA isolates among patients admitted to a tertiary care hospital. Materials and Methods: This is a prospective study carried out on MRSA isolated from the various clinical specimens from outpatient and inpatient departments during period of one year. A total of 82 MRSA isolates were recovered from 6468 different clinical specimens. Mupirocin resistant MRSA was detected by two different methods: Epsilometer test (E-test) and agar dilution method. D-shaped zone test (D-zone test) was also performed for determination of inducible clindamycin resistance in MRSA isolates. Results: Out of 82 non-duplicate MRSA isolates mupirocin resistance were found in 15 (18.3%) isolates by both E-test and agar dilution method. Of these 15 mupirocin resistant, 8 (53.3%) isolates were high-level resistant (MuH) and 7 (46.7%) isolates were low-level resistant (MuL). Four isolates were D-zone test positive showing simultaneous inducible clindamycin resistance among mupirocin resistant MRSA isolates. Conclusion: Higher prevalence of both high-level and low-level of mupirocin resistant MRSA was observed in patient from the population. It is advisable to perform routine test to detect MRSA colonization among health care workers and nasal decolonization to prevent spread of MRSA infections among hospitalized patients.

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Ablative intracranial surgery for Parkinson's disease has advanced to embedding electrodes into precise areas of the basal ganglia. Electrode implantation surgery, referred to as deep brain stimulation (DBS), is preferred in view of its reversibility, adjustability, and capability to be safely performed bilaterally. DBS is been increasingly used for other movement disorders, intractable tremors epilepsy, and sometimes chronic pain. Anesthesiologists need to amalgamate the knowledge of neuroanatomical structures and surgical techniques involved in placement of microelectrodes in defined cerebral target areas. Perioperative verbal communication with the patient during the procedure is quintessential and may attenuate the need for pharmacological agents. This review will endeavor to assimilate the present knowledge regarding the patient selection, available/practiced anesthesia regimens, and perioperative complications after our thorough search for literature published between 1991 and 2013.

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Antibiotics are systemically and locally used extensively in endodontics. However, local antibiotic application mode is considered more effective than systemic administration. The local mode enables the dentist to target bacteria in every nook and corner of root canal system, which is otherwise beyond reach if targeted by instrumentation or conventional root canal treatment protocols. Therefore, they are an important adjunct to conventional treatment of root canal. The present study reviews the various antibiotic containing dental agents used in endodontics. A web-based research on MedLine was performed with terms Review Articles published in the last 10 year's dental journals in English for literature researching, extracting, and synthesizing data. Relevant articles were shortlisted. Important cross-reference articles were also reviewed.

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Background: In Iranian traditional medicine, Ferula assa-foetida oleo gum resin (asafoetida) have been used as anti-convulsant agents. Aims: This study was designed to evaluate the anti-convulsant effect of asafoetida on chemical and amygdala -kindled rats. Materials and Methods: In chemical model, rats received orally asafoetida at dose of 50 and 100 mg/kg 90 minutes prior to Pentylenetetrazol injection in dose of 35 mg/kg intraperitoneally (i.p.) and control group received normal saline. Convulsive behavior was recorded for 30 minutes. For amygdala kindle model, bipolar stimulating and monopolar recording electrodes were implanted stereotaxically. After kindling, the effect of asafoetida (50 and 100mg/kg) on after discharge duration, duration of stage 5 seizure and latency to the onset of bilateral forelimb clonuses was measured. Results: Pretreatment animals with asafoetida significantly reduced the mean seizure stage during the 20 kindling injection of Pentylenetetrazol. Seizure parameters in amigdala kindle model improved in treatment animals at both dose 50 and 100 mg/kg. The number of stimulations in stage 3, 4, and 5 in asafoetida-treated rats at both doses significantly increased. Conclusions: These results showed that asafoetida could prevent seizure in both chemical and electrical kindling model and this effect may partially be related to the terpenoids compounds.

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Background: Obese subjects are at risk of multiple comorbidities including stroke and coronary heart disease (CHD), which is partly due to disturbances in the hemostatic system. Aims: The aims of the present study were to determine the effects of a weight-loss program on fibrinogen and fibrinolytic markers. Materials and Methods: Twenty-eight obese subjects were involved in a weight-loss program consisted of exercise and nutritional education for 12-weeks duration. Physical parameters were documented and blood specimen was tested at pre and post-intervention for fibrinogen, tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), and thrombin activatable fibrinolysis inhibitor (TAFI). Paired t-test was used for statistical analysis. Results: There was a significant decline in the levels of t-PA, PAI-I, TAFI and fibrinogen following the weight-loss program (P < 0.01 for each). A significant positive correlation between tPA levels and body weight, body mass index (BMI), waist circumference, and fat-free mass were found. There was also a significant correlation betwen BMI and other blood parameters. Conclusion: Reduced fibrinogen, fibrinolytic, and physical parameters were demonstrated in obese subjects following the weight reduction program. These findings suggest the possible beneficial effects of this program on the hemostatic burden particularly on the fibrinolytic biomarkers.

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Background: Epilepsy is a major public health problem and specially in developing countries where its incidence is found to be higher. In countries like Ethiopia, epilepsy is thought as a supernatural happening and patients usually suffer from social discrimination and prejudice. Aims: The objective of this study was to assess the knowledge, attitude, and practice of people with epilepsy regarding their illness and its treatment at Jimma University Specialized Hospital (JUSH). Materials and Methods: A cross-sectional hospital-based study was conducted among patients with epilepsy on follow-up at epilepsy clinic. The study was done between June and July 2013 and data was analyzed by using SPSS version 16.0. Results: A total of 180 epileptic patients, on follow-up clinic, were interviewed out. A total of 25.5% and 60% of the respondents have knowledge about the cause and treatment of epilepsy, respectively. And, 70% of the respondents have positive attitude towards their treatment. About 53.3% of the respondents suggested correct positioning of the patients during seizure to prevent aspiration. Conclusion: The study has showed that the majority of the respondents have medium knowledge and better attitude towards epilepsy and its treatments. They also have medium knowledge about the first aid measures to be taken for seizing patients.

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Background: Cystic neoplasms of the pancreas are rare and constitute approximately 0.5% of all pancreatic neoplasms. Aims: The study was to describe clinicopathological features of pancreatic cystic tumors. Patients and Methods: In our retrospective study, we reviewed 10 cases of pancreatic cystic neoplasms that were diagnosed at the pathology department of Mongi Slim hospital over a 14-year period (2000-2013). We adopted the latest World Health Organization (WHO) classification (2010) in grouping all tumors. Results: There were one male and nine female patients (sex ratio M/F = 1:9) aged between 21 and 68 years (mean = 37.5 years). The most common clinical presentation was epigastric and abdominal pain (n = 6) followed by vomiting (n = 3). Abdominal computed tomography (CT) scan disclosed a cystic lesion of the pancreas ranging in size between 2 and 10 cm (mean = 6.75 cm). All patients underwent surgical treatment. Histopathological examination of the surgical specimen established the diagnosis of solid pseudopapillary neoplasm (n = 2), serous cystic neoplasm (n = 2), mucinous cystadenoma (n = 4), mucinous cystadenocarcinoma (n = 1), and intraductal papillary mucinous neoplasm with invasive carcinoma (n = 1). Conclusion: Better understanding of pancreatic cystic neoplasms is essential for clinicians to make accurate diagnosis and to provide the best management for patients.

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Context: Non-Hodgkin's lymphomas (NHL) primarily involving the orbit, is relatively uncommon. Rarely two pathologically different NHL cell types have been found to be coexistent. Case Report: We report a case of orbital lymphoma in a 62-year-old male with rare histopathological findings secondary to transformation of once cell type into another. Tissue diagnosis and molecular studies led to revelation of diffuse large B cell lymphoma evolving from MALT lymphoma. Conclusion: Proliferation of two morphologically and phenotypically different B cells resulting in malignancy has not been found in the orbit so far. They are usually aggressive tumors and require chemo-immunotherapy.

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Context: Endocapsular hematoma has previously been described as a cataract surgery complication more commonly observed in eyes receiving a combined cataract and glaucoma surgery. However, it can also be a rare form of ocular bleed following thrombolysis with streptokinase. Case Report: A 65-year-old diabetic male presented to us with complain of sudden painless diminution of vision in his left eye, which he developed while he was being thrombolysed with streptokinase administered intravenously for an episode of acute myocardial infarct. On examination, left eye was pseudophakic with collection of blood in the capsular bag (Endocapsular hematoma). Conclusion: Endocapsular hematoma can be a rare form of ocular bleeding complicated by thrombolysis. Reporting this case becomes more relevant in the present era with increasing number of patients suffering from ischemic heart disease and likely to undergo thrombolysis.

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Background : Preventing child abuse is an area of evaluation that should be deeply considered. The enhancing skill of maternal child care is also useful in this field. Aim: The aim of this study was to assess the impact of a training strategy to improve parenting in the families identified as at risk of child maltreatment. Materials and Methods : This randomized and controlled trial was conducted in 60 mothers allocated in the experimental and controlled group by a simple random allocation in Amirkola Children's Hospital in North Iran from January 2009 to December 2009. Mean score of maternal child abuse before and after intervention has been assessed by Conflict Tactics Scale for Parent and Child. Data analysis was based on the independent t-test, the paired t-test and one way analysis of variance. Results : The mean and standard deviation of maternal child abuse score in the experimental group before and after intervention were 30.21 ± 1.21 and 23.31 ± 1.52, respectively, (P < 0.001, t = 6.63), but no difference was found in the control group. Conclusions : The training program on maternal skills to prevent child abuse was a powerful resource. Therefore, healthcare providers in the field of pediatric about parenting skills should be taught with a specific consideration.

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Background: The click and tone-evoked auditory brainstem responses are widely used in clinical practice due to their consistency and predictability. More recently, the speech-evoked responses have been used to evaluate subcortical processing of complex signals, not revealed by responses to clicks and tones. Aims: Disyllable stimuli corresponding to familiar words can induce a pattern of voltage fluctuations in the brain stem resulting in a familiar waveform, and they can yield better information about brain stem nuclei along the ascending central auditory pathway. Materials and Methods: We describe a new method with the use of the disyllable word "baba" corresponding to English "daddy" that is commonly used in many other ethnic languages spanning from West Africa to the Eastern Mediterranean all the way to the East Asia. Results: This method was applied in 20 young adults institutionally diagnosed as dyslexic (10 subjects) or light dyslexic (10 subjects) who were matched with 20 sex, age, education, hearing sensitivity, and IQ-matched normal subjects. The absolute peak latencies of the negative wave C and the interpeak latencies of A-C elicited by verbal stimuli "baba" were found to be significantly increased in the dyslexic group in comparison with the control group. Conclusions: The method is easy and helpful to diagnose abnormalities affecting the auditory pathway, to identify subjects with early perception and cortical representation abnormalities, and to apply the suitable therapeutic and rehabilitation management.

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