The Frequency of Different Risk Factors for Lower Back Pain in a Tertiary Care Hospital

Background and purpose Lower back pain is an extremely common health problem and causes more global disability than any other condition. Moreover, it causes an enormous economic burden in both developed and developing countries. The aim of this study is to determine the frequency of different risk factors for lower back pain in a tertiary care centre in Islamabad. Methods A cross-sectional study was conducted at Shifa International Hospital’s neurosurgery and neurology outpatient department from September 2016 to February 2017. A total of 375 patients with lower back pain were interviewed regarding risk factors. Results Among the 375 patients, the majority were men (51.7%, n = 194). The mean patient age was 42.05 ± 15.35 years (mean ± standard deviation); most of the patients belonged to the 21- to 40-year-old age group (48%, n = 180). The majority (78.4%) had chronic back pain. Lower back pain was found to be predominant in housewives (30.1%, n = 113), followed by those with office jobs (18.1%, n = 68), private jobs (i.e., truck drivers, shopkeepers) (14.7%, n = 55), and healthcare workers (12.3%, n = 46). In terms of work schedule, 51.2% of patients reported working around 41–50 hours per week. The major risk factors identified were lack of exercise (76.3%, n = 286), use of soft foam mattress (52.0%, n = 195), prolonged sitting (50.4%, n = 189), lifting heavy weight (48.5%, n = 182), bending or twisting (41.6%, n = 156), sleep disorder (41.6%, n = 156), anxiety (39.5%, n = 148), hypertension (32.3%, n = 121), and depression (28.8%, n = 108). Conclusions Our study concludes that lower back pain is a multifactorial phenomenon. Age, gender, profession, working hours, comorbid conditions, trauma, lifestyle, and stresses in life all play a role in its causation. Increasing physical activity and modifying lifestyle are suggested to prevent this major health issue.

Chronic Kidney Disease and Calciphylaxis: A Literature Review

Calcific uremic arteriolopathy (CUA), also known as calciphylaxis, is a rare complication of chronic kidney disease (CKD). Its incidence is increasing due to a better understanding and diagnosis by physicians. Calciphylaxis is a fatal complication of many metabolic disorders. If not managed properly, it can lead to death within a year. This review is an effort to highlight the importance of research on prompt diagnosis and treatment guidelines for calciphylaxis, as it poses a challenge due to its diverse clinical presentation and high mortality rate.

Pregnancy with Takayasu’s Arteritis: A Case Report and Literature Review

Takayasu's arteritis (TA) is a rare and chronic inflammatory disease of the large vessels. It affects women of reproductive age and leads to an increased risk of cardiovascular complications, such as hypertension and congestive heart failure. We are presenting a case of a pregnant woman with TA, who was seen and managed at a tertiary care institute and ultimately enjoyed a favorable outcome. Thus, multidisciplinary care for patients with TA has proven to be crucial in optimized and favorable maternal and fetal/neonatal outcomes.

The Synergistic Effect of Immune Checkpoint Blockade and Radiotherapy in Recurrent/Metastatic Sinonasal Cancer

Treatment options for recurrent/metastatic sinonasal cancer (RMSNC) patients are limited. We present two cases with RMSNC treated with a combination of immune checkpoint blockade and hypo-fractionated stereotactic radiotherapy (HSRT).  Case 1 presented with RMSNC three months after the primary treatment. The patient progressed under first-line chemotherapy and pembrolizumab was offered. The disease progressed after the sixth cycle. We performed reirradiation with HSRT to the primary site. Case 2 presented with local recurrence eight years after the primary treatment for maxillary sinus cancer. He refused surgery and chemotherapy and was offered nivolumab treatment. After two doses, we performed reirradiation with HSRT. Case 1 showed regression at both the local and the metastatic sites after radiotherapy. The second patient’s symptoms resolved completely three months after radiotherapy. The HSRT and immune checkpoint blockade combination is a promising treatment option for patients with RMSNC.

Indications, Clinical Outcomes, and Survival Rate of Pediatric Penetrating Keratoplasty in Suburban Malaysia: A 10-year Experience

Purpose To describe the demographics, indications, clinical outcomes and survival rate of penetrating keratoplasty in Malaysian children living in a suburban area, and discuss the literature on paediatric penetrating keratoplasty. Methodology A retrospective review of medical records was performed on children younger than 17 years of age who had undergone penetrating keratoplasty in Hospital Universiti Sains Malaysia from January 2008 to December 2017. We recorded demographic data, presenting visual acuity, indications, final visual acuity, and graft survival at 12 months into the postoperative period. Results Sixteen eyes of 14 children had penetrating keratoplasty. Mean age was 7.8 ± 5.9 years. Both genders were equally affected. The main indications were infective keratitis (56.25%), congenital corneal opacity (18.75%) and trauma (12.50%). There were 62.50% of patients who had a preoperative visual acuity worse than 6/60. Fifty percent had other combined procedures during the surgery, including lens aspiration, peripheral iridectomy, pupilloplasty and glaucoma tube implant. Best corrected visual acuity of 6/12 or better was achieved in 18.75% of patients. A hazy graft was noted in 68.75% of patients, and was attributed to graft rejection, glaucoma and graft failure. There was a statistically significant association between the presence of vascularized cornea, intraocular inflammation and combined surgery with survival rate of the graft at one-year postoperative period (p < 0.05). Conclusions Infective keratitis is the main indication for penetrating keratoplasty in our pediatric patients. Good visual outcome was documented in a small percentage of the patients. Amblyopia and hazy graft were the main barriers to success in this group of patients. Vascularized cornea, inflammation and combined surgery had significantly affected the survival rate of the grafts in our series.

Effect of Health Education on Dengue Fever: A Comparison of Knowledge, Attitude, and Practices in Public and Private High School Children of Jeddah

Objective More than half of the world’s population live in areas with a potential risk of acquiring dengue fever (DF). Health education interventions are effective, barring a language communication gap. The objective of this study was to estimate the effect of health education in the knowledge, attitude, and practices (KAP) towards DF control and prevention in public and private schools. Materials and methods We assessed the DF control and prevention strategy KAP of students of eight public and private schools in Jeddah, Saudi Arabia before the dengue health education intervention sessions (pre-I) and three months following the education intervention sessions (post-I) using the same closed-ended validated questionnaire. Schools and students were selected by a multistage stratified random sample method. Statistical analysis was done using the paired and independent T-test in IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, NY). Results We found a significant mean difference in the overall knowledge (pre-I, 7.86 ± 2.61; post-I, 10.94 ± 2.35), attitude (pre-I, 5.16 ± 1.50; post-I 6.23 ± 1.30), and practice (pre-I, 2.96 ± 1.33; post-I, 3.94 ± 1.12) scores. Private schools scored better post-intervention scores in knowledge and practice compared to public schools in local and English language medium. Conclusions Health education programs are essential for DF prevention and management. Institutes whose populations consists of students with various language backgrounds should not be ignored. Bilingual educational sessions are important in such private institutes. Our results indicate additional emphasis is required on putting interventional knowledge into practice.

Glioblastoma Multiforme in a Patient with Multiple Myeloma: A Case Report and Literature Review

Lenalidomide is an immunomodulatory drug approved by the US Food and Drug Administration in 2006 for the treatment of multiple myeloma. In 2012, the Food and Drug Administration issued a statement warning physicians of the increased risk with lenalidomide treatment of the following secondary primary malignancies: Acute myelogenous leukemia, myelodysplastic syndromes, and Hodgkin lymphoma. The statement did not mention glioblastoma multiforme, a Grade 4 astrocytoma, or other high-grade astrocytomas that have been reported on rare occasions in the setting of multiple myeloma.

EFFECT OF SUBLIMINAL MESSAGES IN EDUCATION OF AFFECTIVE AREA (ENVIRONMENT-ORIENTED) and A RESEARCH FOR ITS EFFECTIVE IMPLEMENTATION

Bu araştırmada, öncelikli olarak subliminal mesajların öneminden bahsedilmiş, ardından ortaöğretim öğrencilerinin çevreye yönelik derslerinde, kullanılmasının faydalı olacağı düşünülen subliminal mesajların veriliş şekilleri incelenmiştir. Çevreye yönelik eğitimde subliminal mesajların faydalı uygulanabilirliği ve etkisinin belirlenmesi için “betimsel araştırma” tercih edilen araştırmanın çalışma grubunu ise Sinop ili içerisinde yer alan Atatürk Ortaokulu’nda eğitim gören 7 ve 8. sınıf öğrencileri oluşturmuştur. Bu çalışmada geçerliliği ve güvenilirliği ölçülmüş 4 önerme, 80 kişilik katılımcı gruba, çeşitli tekniklerle hazırlanan (illüstrasyon, simge, tipografi, renk) subliminal mesajlar yardımı ile sunulmuş ve “Evet”, “Hayır” şeklinde cevaplamaları istenmiştir. Araştırma sonunda görülmektedir ki subliminal mesajlar, katılımcıların cevaplarına müdahalede bulunmuş, illüstrasyon ile %25, simge ile %37,5, tipografi ile 22,5 ve renk ile verilen mesajlar sayesinde %37,5 oranında değişmeler olduğu gözlemlenmiştir. Simge ve Renk ile verilen mesajlar ise katılımcılar üzerinde eşit oranda ve diğerlerine göre daha yüksek düzeyde etkili olmuştur. Sıradan yöntemlerle hazırlanmış bir çevre eğitimi kitabı ya da düz anlatım tarzında işlenmiş bir çevre eğitimi dersi yerine, bilinçaltına müdahalede bulunan subliminal mesajlar içeren eğitim kitapları, öğrencide kalıcı davranış değişikliği oluşturacak ve verilen bilgileri unutmamasını sağlayacaktır. Sevil BÜYÜKALAN FİLİZ* , İbrahim Gökhan CEYLAN** Hatice BAHATTİN CEYLAN

THE SLUM THEMES IN POST 1950’S TURKISH CONTEMPORARY PAINTING

ANATOLIA TRADITIONAL ARCHITECTURE IN REFLECTING VIEW TO ENGRAVINGS AT TRAVEL BOOKS WRITTEN BY WESTERN PEOPLE