A foreign body (FB) in the upper aerodigestive tract is a common clinical problem that presents as as acute emergency. Sharp FB, such as fish bone or chicken bone, commonly lodges in the tonsil, base of tongue, vallecula or pyriform fossa. Dislodgement of a FB into the laryngopharynx is very rare and specifically onto the vocal cord is extremely uncommon. This case report illustrates a rare case of a sharp FB that was dislodged into the airway and stuck on to the right vocal cord, which was removed under local anaesthesia.

In this study, functional magnetic resonance imaging (fMRI) is used to investigate func-tional specialisation in human auditory cortices during listening. A silent fMRI paradigm was used to reduce the scanner sound artefacts on functional images. The subject was instructed to pay attention to the white noise stimulus binaurally given at an inten-sity level of 70 dB higher than the hearing level for normal people. Functional speciali-sation was studied using the Matlab-based Statistical Parametric Mapping (SPM5) software by means of fixed effects (FFX), random effects (RFX) and conjunction analyses. Individual analyses on all subjects indicated asymmetrical bilateral activation of the left and right hemispheres in Brodmann areas (BA) 22, 41 and 42, involving the primary and secondary auditory cortices. The percentage of signal change is larger in the BA22, 41 and 42 on the right as compared to the ones on the left (p>0.05). The average number of activated voxels in all the respective Brodmann areas are higher in the right hemisphere than in the left (p>0.05). FFX results showed that the point of maximum intensity was in the right BA41 whereby 599±1 activated voxels were ob-served in the right temporal lobe as compared to 485±1 in the left temporal lobe. The RFX results were consistent with that of FFX. The analysis of conjunction which fol-lowed, showed that the right BA41 and left BA22 as the common activated areas in all subjects. The results confirmed the specialisation of the right auditory cortices in pro-cessing non verbal stimuli.

Carcinoma, Ductal ; pathology ; surgery ; Female ; Head and Neck Neoplasms ; pathology ; surgery ; Humans ; Middle Aged ; Neck Dissection ; Salivary Ducts ; pathology ; surgery

Driving activity has become more important as this medium being practical, it is also cheaper and faster in connecting human from one to another place. However, in some occurrence, it can cause accidents as they become fatigued while driving. Driver fatigue is one of the top contributors to the road accidents and can be dangerous as other road safety issues such as drink driving. Worst is, there are no laws regulating driver fatigue. Therefore, the main purpose of this study is to develop the regression model of apsychophysical factor for drivers’ fatigue which can predict the relationship between the process input parameters and output responses. The study was participated by ten subjects. The heart rate was taken and recorded using heart rate monitor. Design Expert 8.0.6 software was used for the regression analysis. The modeling validation runs werewithin the 90% prediction intervals of the developed model and the residual errors were less than 10%. The R 2 value is 0.9400 whichmeans that the linear regression line passed exactly through all points. The significant parameters that influenced the heart rate were also identified.The parameters are time exposure, type of road, and gender.
Psychophysical ; fatigue ; regression modeling ; heart rate

The occurrence of severe lead (Pb) poisoning has risen in certain countries. There is increasing evidence that chronic lead exposure disturbs the prooxidant: antioxidant balance in the brain tissue and alters brain histology. The present study observed the antioxidant effect of tocotrienol-rich fraction (TRF) on brain tissues of the experimental rats following lead poisoning. Eighteen (n=18) male Sprague-Dawley rats, 6-weeks old, were randomly divided into control (CTRL) group and experimental groups; fed with 0.2% w/v lead acetate, as PB2 group; and fed with 0.2% w/v lead acetate and daily TRF supplementation (200 mg/kg body weight) as PB2T group. The experiment was conducted for 30 days. At the end of the study, the brain tissues were harvested and histopathological changes of the hippocampal region were observed. Biochemical findings such as brain lead, TRF and malondialdehyde (MDA) levels, and erythrocyte superoxide dismutase (SOD) activity were determined. It was observed that atypical apoptotic-like and disorganized neurons were present in the hippocampal region of the untreated PB2 group compared to PB2T group. Biochemical parameters showed a significant decrease (p < 0.05) in brain lead level in PB2T compared to PB. Even though no significant difference (p > 0.05) was obtained for MDA level, there was a significant increase (p < 0.05) in the erythrocyte SOD activity in PB2T compared to PB2 and CTRL. Supplementation with TRF improved histopathological changes in the brain tissues caused by lead exposure in drinking water by reducing lead accumulation in the brain of experimental rats.
Lead Poisoning

Background and Objective: Epilepsy and depression are interlinked and lead to an increased risk of suicidal ideation and suicide. Although depression is a significant risk factor for suicidal ideation in epilepsy patients, epilepsy itself is independently associated with suicidal ideation. There are various other factors related to epilepsy that further increase this risk. Methods: We conducted a study of suicidal-ideation amongst epilepsy patients in our centre. Demographic data and clinical history were obtained while suicidal ideation was determined using the Columbia Suicide Severity Rating Scale (C-SSRS). Beck’s Depression Inventory–II (BDI-II) was used to identify presence of depression. Results: We recruited 80 patients with epilepsy and an equal number of controls. Epilepsy patients were more likely to be depressed with a mean BDI-II score of 9.09 ±6.48 compared to controls who has a mean score of 5.56 ±4.56. The proportion of epilepsy patients with suicidal ideation was 33.75% vs. 5.00% in the control group (p<0.001). Epilepsy patients were 9.68 times more likely to have suicidal ideation compared to controls: OR 9.68 (95% CI 3.19, 29.28). Amongst epilepsy patients, those with suicidal ideation were more likely to be on 3 or more anti-epileptic drugs (10.00% vs. 6.25%, p=0.016), with a higher seizure frequency (11.25% vs. 2.50%, p=0.004) and higher incidence of previous head surgery (10.00% vs. 5.00%, p=0.022). Conclusion: Suicidal ideation was significantly prevalent amongst epilepsy patients especially in patients with frequent seizures, use of > 3 anti-epileptic drugs or prior head surgery. Our findings suggest that assessment of suicidal ideation is pertinent in high-risk epilepsy patients and should be routinely carried out in the clinical setting.

Abstract Utilization is an important indicator for health service planning and can be determined through the count of actual usage of health services. There are also several determinants to health care utilization. This systematic review aims to explore the technical components from spatial analysis in primary health care utilization, the determinants frequently discussed, and the gap in the spatial analysis from these studies. Two databases were searched according to search strategy. A total of 15 articles were eligible. Each study was different in terms of analysis unit, spatial analysis, and utilization outcome. Spatial accessibility, sociodemographic, and geographical aspect were the frequent determinants discussed among the study of spatial utilization in this review. Several studies found the association between the determinants with utilization. However, spatial analysis in primary health care utilization studies still subjected to several limitation in term of their unit of analysis and source of data.

The aim of this work was to study radiation and the effects of temperature on conductivity properties of polyvinyl alcohol (PVA)-based potassium hydroxide (KOH) and propylene carbonate (PC), where the ionic conduction preferentially occurs in the amorphous phase by free radicals ions through gamma-irradiation. Alkaline composite polymer electrolyte (ACPE) consisting of PVA, KOH and PC of different concentration ratios were prepared by solvent-casting technique. The ACPE were irradiated with different doses from 5 kGy up to 200 kGy. The conductivity properties of the electrolyte films were measured at different frequencies in the range 20 Hz to 1 MHz using LCR meter. The results showed that the conductivity properties were dependent on the radiation dose, temperature and the concentration of the polymer blends.
Radiation ; asparaginase/prednisone/vincristine ; Personal Computers ; Temperature ; Concentration

PURPOSE: The quality assurance (QA) chart rounds are multidisciplinary meetings to review radiation therapy (RT) treatment plans. This study focus on describing the changes in RT management based on QA round reviews in a single institution. MATERIALS AND METHODS: After 9 full years of implementation, a retrospective review of all patients whose charts passed through departmental QA chart rounds from 2007 to 2015. The reviewed cases were presented for RT plan review; subcategorized based on decision in QA rounds into: approved, minor modifications or major modifications. Major modification defined as any substantial change which required patient re-simulation orre-planning prior to commencement of RT. Minor modification included treatment plan changes which didn’t necessarily require RT re-planning. RESULTS: Overall 7,149 RT treatment plans for different anatomical sites were reviewed at QA rounds. From these treatment plans, 6,654 (93%) were approved, 144 (2%) required minor modifications, while 351 (5%) required major modifications. Major modification included changes in: selected RT dose (96/351, 27%), target volume definition (127/351, 36%), organs-at-risk contouring (10/351, 3%), dose volume objectives/constraints criteria (90/351, 26%), and intent of treatment (28/351, 8%). The RT plans which required major modification according to the tumor subtype were as follows: head and neck (104/904, 12%), thoracic (12/199, 6%), gastrointestinal (33/687,5%), skin (5/106, 5%), genitourinary (16/359, 4%), breast (104/2387, 4%), central nervous system (36/846, 4%), sarcoma (11/277, 4%), pediatric (7/251, 3%), lymphoma (10/423, 2%), gynecological tumors (2/359, 1%), and others (11/351, 3%). CONCLUSION: Multi-disciplinary standardized QA chart rounds provide a comprehensive and an influential method on RT plans and/ or treatment decisions.
Breast ; Central Nervous System ; Head ; Humans ; Jordan ; Lymphoma ; Methods ; Neck ; Peer Review ; Radiotherapy ; Retrospective Studies ; Sarcoma ; Skin

Incidence of inadvertent arterial puncture secondary to central venous catheter insertion is not common with an arterial puncture rate of <1%. This is due to the advancements and wide availability of ultrasound to guide its insertion. Formation of arteriovenous fistula after arterial puncture is an unexpected complication. Till date, only five cases (including this case) of acquired arteriovenous fistula formation has been described due to inadvertent common carotid puncture. The present case is a 26-year-old man sustained traumatic brain injuries, chest injuries and multiple bony fractures. During resuscitative phase, attempts at left central venous catheter via left internal jugular vein under ultrasound guidance resulted in inadvertent puncture into the left common carotid artery. Surgical neck exploration revealed that the catheter had punctured through the left internal jugular vein into the common carotid artery with formation of arteriovenous fistula. The catheter was removed successfully and common carotid artery was repaired. Postoperatively, the patient recovered and clinic visits revealed no neurological deficits. From our literature review, the safest method for removal is via endovascular and open surgical removal. The pull/push technique (direct removal with compression) is not recommended due to the high risk for stroke, bleeding and hematoma formation.