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Background :laparoscopic groin hernia repair has gained wide popularity in surgical practice in the last two decades. Trans abdominal pre peritoneal (TAPP) and totally extra peritoneal (TEP) repair are standing head to head as the most common laparoscopic techniques for groin hernia. Methods: This prospective randomized study was conducted between December 2013 and December 2015. Sixty male patients suffering from non complicated inguinal hernia were included. Patients were randomized into group A (TAPP) and group B (TEP). Intra operative variables and postoperative pain and complications were recorded in a pre structured form Results: In TEP group patient had lees post operative pain, were able to resume their normal daily activities and spent less operative time than TAPP group. No significant difference in terms of Intra operative and post operative complications between both groups. Conclusion: . TEP has a significant advantages over TAPP in reduction of operative time and postoperative pain, which resulted in earlier recovery and return to normal activity. Although both techniques seem to effective, TEP has a step over TAPP.

The main objective of the present study was to determine some of the physical, chemical and sensory characteristics of essential oil extracted from orange peel using microwave pretreatment-improved...

RATIONALE: The risk of tuberculosis (TB) disease in tuberculin skin test positive (TST+) persons ranges from 5–15%. National averages of risk mask local variation.OBJECTIVE: Quantify local TB disea...

By the fifteenth century, many legal jurisdictions throughout the Mamluk realm were pluralistic: all of the four Sunni maḏhab‑s were represented by their own courts within a single political jurisdiction. Naturally, this pluralism had the potential of descending into judicial chaos, if judges hailing from different maḏhab‑s were to refuse or negate the judgments of parallel maḏhab‑jurisdictions. It is towards addressing this and other concerns regarding the judiciary that the Ḥanafī jurist al‑Qāsim Ibn Quṭlūbuġā (d. 879/1474) authored a handbook for judges, Mūǧabāt al‑aḥkām wa‑wāqiʿāt al‑ayyām. After providing an overview of the structure and objective of the work, this article addresses its first and central theme — namely, the doctrine of “legal consequence” (al‑mūǧab) — and analyzes how the set of procedural rules associated with this doctrine were part of a solution to the conflict of laws latent in a multi‑maḏhab judiciary. I argue that this doctrine, one of a number of such jurisprudential doctrines and procedures shared by the maḏhab‑s, is evidence of the development of a wider maḏhab-law legal system underpinning the four Sunni maḏhab‑s in the Mamluk era.

Background Platelet transfusions are commonly used to treat critically ill patients with thrombocytopenia. Whether platelet transfusions are associated with a reduction in the risk of major bleeding is unknown. Patients/Methods Observational cohort study nested in a previous multicenter, randomized thromboprophylaxis trial in the intensive care unit (ICU). The objective was to evaluate the association between platelet transfusions and adjudicated major bleeding events. Platelet transfusion episodes were reviewed for timing of administration, product type, and dose. Major bleeding with and without platelet transfusions was adjusted for severity of thrombocytopenia, use of anti‐platelet agents, surgery and other covariates. Secondary outcomes were thrombosis, death in ICU and platelet count increment. Results Among 2,256 patients, 71 (3.1%) received 190 platelet transfusions. Of those, 121 (63.7%) were administered to 54 non‐bleeding, thrombocytopenic patients. Adjusted rates of major bleeding were not statistically different with or without the administration of platelet transfusions (hazard ratio for transfused patients 0.85; 95% confidence interval, 0.42‐1.72). We did not find a significant association between platelet transfusion use and thrombosis or death in ICU in adjusted analyses. Thrombocytopenia, anemia, major or minor bleeding and use of anticoagulants were associated with platelet transfusion administration. The median post‐transfusion platelet count increment was 20×109/L at 3.5 hours post‐transfusion. Conclusions Rates of major bleeding were not different for patients who did and did not receive platelet transfusions. Inferences were limited by the small number of transfused patients. Clinical trials are needed to better investigate the potential hemostatic benefit and potential harms of platelet transfusions for this high‐risk population.

In Rule-Formulation and Binding Precedent in the Madhhab-Law Tradition, Talal Al-Azem argues for the existence of a ‘madhhab-law tradition’ of jurisprudence, and examines how legal rules were forged by generations of scholarly commentary.

In Rule-Formulation and Binding Precedent in the Madhhab-Law Tradition, Talal Al-Azem argues for the existence of a ‘madhhab-law tradition’ of jurisprudence, and examines how legal rules were forged by generations of scholarly commentary.

This thesis examines the role that scholarly digests and commentaries played in the formation of legal rules in the Muslim legal institution known as the madhhab. I posit that a shared approach to legal rule-determination, and the respect of juristic precedent that it entails, underlies the jurisprudential processes of all of the four post-classical Sunni madhhabs (the Ḥanafī, Mālikī, Shāfi'ī, and Ḥanbalī), and unites them in a wider ‘madhhab-law tradition’. Taking the Ḥanafī madhhab as a case study, the thesis analyses a commentary written by the late Mamluk jurist Ibn Quṭlūbughā (d. 879/1474) upon the digest of the celebrated Abbasid-era Abū al-Ḥusayn al-Qudūrī (d. 428/1037). In discussing the madhhab's heritage of precedent, Ibn Quṭlūbughā's commentary weaves an intricate tapestry of quotations and references from previous jurists and works, providing us with insight into how author-scholars reacted to, and interacted with, other jurists over space and time. Chapter 1 provides a short introduction to the lives of Qudūrī and Ibn Quṭlūbughā, and the contexts within which they produced their works. Chapter 2 employs both quantitative and qualitative analysis of the commentary, in order to deduce historical and geographical patterns out of which a periodisation of rule-determination in the Ḥanafī madhhab is proposed. In Chapter 3, Ibn Quṭlūbughā's jurisprudential theory of rule-determination is studied, examining both the justifications and the processes employed by jurists in arriving at a legal rule in the Ḥanafī madhhab. Chapter 4 then turns to the craft of commentary itself, analysing over eighty case examples for the logical relationships, rhetorical devices, and legal arguments that inform the actual practice of rule-determination through commentary. A final chapter then summarises the conclusions, and situates them within a broader discussion as to the nature of the madhhab-law tradition.

This article seeks to elucidate effects of early-life influences on later-life tuberculosis outcomes using a dynamic computer simulation model. To illustrate the value of such a model, three research questions are considered: 1) If we implemented an intervention capable of reducing infection rates to varying degrees, what would the impact be on tuberculosis prevalence by age? 2) If there were a temporary increase in the rate of infection, what would the impact be on tuberculosis outcomes for the population? 3) If a fixed number of recently infected individuals were targeted for prophylactic treatment, who should be chosen to maximize impact?

Platelets release several growth factors which stimulate tissue regeneration. Several techniques for platelet concentrates such as platelet rich plasma (PRP), plasma rich in growth factors (PRGF), platelet rich fibrin (PRF) and concentrated growth factors (CGF) have been introduced in dental surgeries for the prevention of hemorrhage and acceleration of tissue regeneration. However, a fabricating growth factors-enriched bone graft matrix which is called “sticky bone” has been demonstrated to provide stabilization in bony defects. In this article, we presented the method of preparing and utilizing CGF and sticky bone and evaluate the effect of CGF mixed with bone graft and CGF barrier membrane in periodontal surgeries.Methodology: We used websites such as PubMed, Scopus, and ISI Web of knowledge to get related articles about this subject. The research process involved specific key words " concentrated growth factor”- “Platelet rich fibrin”- growth factors-enriched bone graft” - “sticky bone” to find more articles which published from 2007 to March 2018.Results: We reviewed 48 articles, 43 articles were excluded. Only five articles have been conducted. Original human studies and case report were included.Conclusion: We concluded that the use of sticky bone and CGF is effective in bone grafting and implant.

ObjectiveIn a prospective cohort study we examined the relationship between Raynaud’s phenomenon (RP) onset and other connective tissue disease (CTD) characteristics in rheumatoid arthritis (RA) to determine if RP is predictive of RA severity and associated with other CTD signs, and if late onset RP in RA has an effect on prognosis compared to other patients with RA.MethodsUsing a standardized assessment, data were collected on 328 subjects with RA [mean age 60.3 ± 0.7; 77% women; 76% erosions, 75% positive rheumatoid factor (RF)] seen at one London, Ontario, rheumatology clinic. The data included RA disease duration; presence and duration of RP; presence of nodules, joint damage, telangiectasia, and sclerodactyly; and RF status (+/−), RF value, antinuclear antibodies, and E-nuclear antibodies.ResultsThe mean RA disease duration was 12 ± 0.6 years. Seventy-one (22%) had RP and the mean RP duration was 9.2 ± 1.5 years. Patients presented with RP a mean of 3.8 ± 1.4 years after the diagnosis of RA. RP status was positively associated with the presence of sclerodactyly (p < 0.001), but not nodules or erosions. Higher RF values were associated with longer RA disease duration (p < 0.002) and longer RP duration (p < 0.01).ConclusionIdiopathic RP may have a different clinical effect on RA than secondary RP; the latter is correlated with more severe RA. Sclerodactyly is associated with erosive arthritis and RP in RA. Higher RF values were indicative of increased RA and RP duration.

Nasogastric tube has a key role in the management of substantial number of hospitalized patients particularly the critically ill. In spite of the apparent simple insertion technique, nasogastric tube placement has its serious perhaps fatal complications which need to be carefully assessed. Pulmonary misplacement and associated complications are commonplace during nasogastric tube procedure. We present a case of tension pneumothorax and massive surgical emphysema in critically ill ventilated patient due to inadvertent nasogastric tube insertion and also discussed the risk factors, complication list, and arrays of techniques for safer tube placement.

Pulmonary embolism (PE) is a common cause of morbidity and mortality in hospitalized patients. Malignancy, prolonged recumbence, and chemotherapy are renowned risk factors for development of clinically significant PE. Cancer exerts a multitude of pathophysiological processes, for example, hypercoagulability and abnormal vessels with sluggish circulation that can lead to PE. One of the peculiar characteristics of tumor cells is their ability to reach the circulation and behave as blood clot—not a metastasis-occluding the pulmonary circulation. We present a case of fatal pulmonary embolism diagnosed histologically to be due to tumor cell embolism.

In a worldwide collaborative effort, 19, 630 Y- chromosomes were sampled from 129 different populations in 51 countries. These chromosomes were typed for 23 short-tandem repeat (STR) loci (DYS19, DYS389I, DYS389II, DYS390, DYS391, DYS392, DYS393, DYS385ab, DYS437, DYS438, DYS439, DYS448, DYS456, DYS458, DYS635, GATAH4, DYS481, DYS533, DYS549, DYS570, DYS576, and DYS643) and using the PowerPlex Y23 System (PPY23, Promega Corporation, Madison, WI). Locus-specific allelic spectra of these markers were determined and a consistently high level of allelic diversity was observed. A considerable number of null, duplicate and off- ladder alleles were revealed. Standard single- locus and haplotype-based parameters were calculated and compared between subsets of Y-STR markers established for forensic casework. The PPY23 marker set provides substantially stronger discriminatory power than other available kits but at the same time reveals the same general patterns of population structure as other marker sets. A strong correlation was observed between the number of Y-STRs included in a marker set and some of the forensic parameters under study. Interestingly a weak but consistent trend toward smaller genetic distances resulting from larger numbers of markers became apparent.

Pesticide applicators in the Plant Protection Department of the Agriculture Affairs and Fish Resources Authority are monitored regularly by the Occupational Health Section of the Ministry of Health. The aim is to protect them from the adverse effects of pesticides and to prevent acute poisoning by removing from exposure those who have low cholinesterase (ChE) activity levels or low white blood cell counts. Thirty-eight workers routinely examined in July 1988 were reexamined at the onset of the locust invasion in Kuwait in November 1988; also examined were 36 farmers recruited for the first time to fight locusts and a matched control group of 38 firefighters. After 2 to 3 months, when the locust invasion decreased markedly and pesticide spraying nearly stopped, the exposed workers were reexamined. The pesticides used to control locusts were five organophosphates and one organochlorine (lindane). Sixty percent of normal for red blood cell (RBC) ChE activity and 50% of normal for plasma ChE activity were used as threshold levels for removing workers from continued exposure to ChE-inhibiting pesticides. The different reactions of study groups during the locust control period are described, including results from tests of pulmonary function, RBC and plasma ChE activity, and nerve conduction velocity.

Saudi Arabia has borders covering over 4,300 km that are shared with seven countries. Such large borders pose many challenges for security and patrol. Thermal imagers are considered the most reliable means of threat detection, however, they are quite costly, which can prevent using them over large areas. This work discusses a multi-sensor acoustic and optical implementation for threat detection as an effort to reduce system cost. The acoustic sensor provides position and direction recognition by using a four microphone setup. The data analysis of field tests will be discussed in this work.

Hypoparathyroidism is characterized by hypocalcemia, hyperphosphatemia and low or inappropriately normal levels of parathyroid hormone (PTH). Pseudohypoparathyroidism is characterized by similar findings however PTH is elevated due to PTH resistance. PTH is a key calcium regulating hormone essential for calcium homeostasis, vitamin D-dependant calcium absorption, renal calcium reabsorption and renal phosphate clearance. The most common cause of hypoparathyroidism is iatrogenic in the setting of anterior neck surgery. Hypoparathyroidism may be due to congenital or acquired disorders. Causes include autoimmune diseases, genetic abnormalities, destruction or infiltrative disorders of the parathyroids. Impaired secretion of PTH may be seen with hypomagnesemia or hypermagnesemia Work-up includes a comprehensive history, physical examination, and a relevant biochemical investigation. Treatment of symptomatic or profound asymptomatic hypocalcemia (Corrected Calcium (Ca) 1.9 mmol/L) is aimed at rapid intravenous administration of calcium and oral supplementation of vitamin D metabolites. Oral calcium and vitamin D analogs are critical in the treatment of hypocalcemia. In the long-term management of hypoparathyroidism thiazide diuretics are of value as they enhance renal calcium reabsorption and increase serum calcium and are of particular benefit in those with activating mutations of the calcium-sensing receptor. Parathyroid hormone replacement is of great value in improving serum calcium and lowering serum phosphate as well as the doses of calcium and calcitriol supplementation required. It has been shown to lower urinary calcium losses. Careful monitoring of vitamin D, phosphorous, and calcium is necessary during acute and long-term therapy. Although hypocalcemic patients commonly present with symptoms of neuromuscular irritability with perioral numbers paresthesias, tingling, seizures and, bronchospasm; hypocalcemia may be identified on the biochemical profile of an asymptomatic patient.

This thesis examines the role that scholarly digests and commentaries played in the formation of legal rules in the Muslim legal institution known as the madhhab. I posit that a shared approach to legal rule-determination, and the respect of juristic precedent that it entails, underlies the jurisprudential processes of all of the four post-classical Sunni madhhabs (the Ḥanafī, Mālikī, Shāfi'ī, and Ḥanbalī), and unites them in a wider ‘madhhab-law tradition’. Taking the Ḥanafī madhhab as a case study, the thesis analyses a commentary written by the late Mamluk jurist Ibn Quṭlūbughā (d. 879/1474) upon the digest of the celebrated Abbasid-era Abū al-Ḥusayn al-Qudūrī (d. 428/1037). In discussing the madhhab's heritage of precedent, Ibn Quṭlūbughā's commentary weaves an intricate tapestry of quotations and references from previous jurists and works, providing us with insight into how author-scholars reacted to, and interacted with, other jurists over space and time. Chapter 1 provides a short introduction to the lives of Qudūrī and Ibn Quṭlūbughā, and the contexts within which they produced their works. Chapter 2 employs both quantitative and qualitative analysis of the commentary, in order to deduce historical and geographical patterns out of which a periodisation of rule-determination in the Ḥanafī madhhab is proposed. In Chapter 3, Ibn Quṭlūbughā's jurisprudential theory of rule-determination is studied, examining both the justifications and the processes employed by jurists in arriving at a legal rule in the Ḥanafī madhhab. Chapter 4 then turns to the craft of commentary itself, analysing over eighty case examples for the logical relationships, rhetorical devices, and legal arguments that inform the actual practice of rule-determination through commentary. A final chapter then summarises the conclusions, and situates them within a broader discussion as to the nature of the madhhab-law tradition.

Setting: The Canadian province of Manitoba. Objective: To confirm the putative hypervirulence observed in Mycobacterium tuberculosis Type1 strain and further characterize the progression and manifestation of pulmonary tuberculosis caused by this strain in comparison to other common clinical isolates from Manitoba. Design : C3H and BALB/c mice were exposed to aerosols either of Type1, Type2, Type5, Type72 or H37Rv strain to study their respective survival profiles. Additionally, bacillary loads and lung histology were examined at 15 days post-exposure. Results: In both mouse models, Type-1 infected mice succumbed to disease significantly earlier than other strains ( p ⩽0.0002). Differences between average log 10 CFU values between clinical isolates were less than 1log10 difference. In C3H mice, the amount of granulomatous inflammation was highest in Type1 infected mice but not significantly different than all clinical strains. In contrast, BALB/c mice infected with Type1 induced the lowest amount of granulomatous inflammation compared to other clinical isolates. Conclusion: Our results indicate that although mice infected with the Type1 strain died significantly earlier than mice infected with other clinical strains in both C3H and BALB/c mice, the hypervirulence of the Type1 strain is not attributed to the growth rate of the organism, as differences in growth between clinical M. tuberculosis isolates were insignificant.

Background To describe the demographic and geographic distribution of tuberculosis (TB) in Manitoba, thus determining risk factors associated with clustering and higher incidence rates in distinct subpopulations. Methods Data from the Manitoba TB Registry was compiled to generate a database on 855 patients with tuberculosis and their contacts from 1992–1999. Recovered isolates of M. tuberculosis were typed by IS6110 restriction fragment length polymorphisms. Bivariate and multivariate logistic regression models were used to identify risk factors involved in clustering. Results A trend to clustering was observed among the Canadian-born treaty Aboriginal subgroup in contrast to the foreign-born. The dominant type, designated fingerprint type 1, accounts for 25.8% of total cases and 75.3% of treaty Aboriginal cases. Among type 1 patients residing in urban areas, 98.9% lived in Winnipeg. In rural areas, 92.8% lived on Aboriginal reserves. Statistical models revealed that significant risk factors for acquiring clustered tuberculosis are gender, age, ethnic origin and residence. Those at increased risk are: males (p < 0.05); those under age 65 (p < 0.01 for each age subgroup); treaty Aboriginals (p < 0.001), and those living on reserve land (p < 0.001). Conclusion Molecular typing of isolates in conjunction with contact tracing data supports the notion of the largest ongoing transmission of a single strain of TB within the treaty-status population of Canada recorded to date. This data demonstrates the necessity of continued surveillance of countries with low prevalence of the disease in order to determine and target high-risk populations for concentrated prevention and control measures.