Medicine Essay Example | Topics and Well Written Essays - 2000 words

Medicine - Essay Example The practice of medicine has been shaped through the years by advancement and refinement of existing techniques of that era. As per N.D Jewson the concept of sick man was found to disappear from medical cosmology in two related sense of period ,1770 to 1870. Medical cosmology is basically meta physical and attempts to circumscribe and define the universal nature of medical disease ( Althruser and Bailbar, 1970 ). Three distinct period in history of medicine are associated with three different places and three different thoughts of diagnosis. From middle age- 18th century BED SIDE Medicine ( BM ) was widely prevalent, then by 1794 to 1848 came the era of HOSPTIAL MEDICINE ( HM ). And from the time forward it was Laboratory Medicine ( LM ) that ruled the medical world. The Laboratories contribution to the medicine has been recently recognized by the historians as something more than addition of knowledge, but as an seat of medicine which helps clinicians to account what they observe in patient. The first medical diagnosis made by human race was based on observations made with eyes and ears by ancient physicians. The Greek attribute all diverse reactions and diseases to bodily fluid called humor. Ancient Egypt's and Mesopotamian clinicians made diagnosis and treatment based primarily on observation of clinical symptoms as palpitations, acultation, etc. Other less scientific diagnosis that was widely prevalent in that time was spiritual sacrifice of animal and examination of those animals organs, being correlating to the patient's stage. Aptly described as the father of medicine ,Hippocrates in 300 BC attributed all diseases to body fluids. Later Gallen ( AD 131 to 101 ) who is called as the founder of experimental physiology combines Hippocrates and Pythogras theorem, holding four elements earth, fire, water and air contributing to four elements blood, bile, phlegm and black bile. In the middle age, in Europe early Christians considered diseases sin or punishment and diagnosis were based on symptoms, pulse, excreta ( especially urine). The concept of uroscopy was introduced and testing of urine for all diseases was made mandatory. The 17th century saw the descriptive work of medicine, as the medical journals started evolving and there was more ground work done for diagnosis and therapy of diseases. Many inventions as blood circulation, microscope, uroscopy, gravimeter analysis, experiments on blood transfusion, and attempt to use pulse rate and temperature as health indicator were followed. 18th century was considered to be the golden age of medicine as text book of medicines and laboratory medicines evolved. Blood pressure measurement and heart beat measurement and coagulation concepts were established in this century. The 19th century saw the growth of sophistication in technology in labs, transformation of society, introduction of the concept of bacteriolo gy, stethoscope, opthalmoscope, layrngoscope, x-ray, microscope, etc.( Starr, 1982). The three concepts in medicine At the beginning of medical cosmology, Bedside Medicine was widely predominant, mainly in the last 3rd of 18th century. The ideology was centered around University of Edinburg and in certain parts of England (Jewson, 1974). The BM treats patients as the patrons and physicians as

FAMILY VIOLENCE AND ABUSE Essay Example | Topics and Well Written Essays - 1250 words

FAMILY VIOLENCE AND ABUSE - Essay Example He also threatened to injure maim her. The historical and the current standing posed beyond doubt that Marcia’s life was in great jeopardy and she needed redemption. The case also fulfills the requirement that the aggressor is not the defendant. The deceased aggressed the defendant’s myriad times thus attributing to the retaliation by his wife, Marcia. The obligation of applying just sufficient force in the defense as required by the law was not achievable because the husband threats were recurrent and he would justice only she shut her up for good. Marcia Norman option to end the life of her husband was pegged on her mission to save her life-perfect self-defense, and therefore was legally right. The eminent past and continuous history of mal-abuse by her husband would not allow limited room for her right of freedom from harm (Leverick, 2009). The courts would factually consider immense psychological distress and trauma that Marcia had undergone. According to a witness from the case, after she was asked whether she thought it was correct for Marcia to shoot her husband, she admits that from the examination and the assessment of her records and psychological files, it was exclusively fine for her to do so. She adds that Norman Marcia assumed herself doomed from the torture she endured from her husband. She had a perception of persecution ahead due to the immense social degradation and demeaning that her husband accorded her, and recognized that her death was probably not avoidable in future. The witness also notes the fact that Ms Marcia had attempted suicide before and there was a conviction that she would not succeed in her struggle against her unwavering husband. The witness notes that she believed that the defendant had grown insecure to an extent that he could not have any sense of attachment to her family. She could not run away from the deceased due to his immense power and

Assignment 4 Essay Example | Topics and Well Written Essays - 500 words - 3

Assignment 4 - Essay Example The alternative remedies or solutions must be solicited from the present employees of the company; and each suggestion/opinion must be fully considered in terms of its advantages and disadvantages for the financial upkeep of Sunbelt Video. If an alternate plan, aside from cutting hours and laying-off has been considered – then a significant period of time must be given to make the aforementioned alternate plan work. It is vital in any company operation for employees to actively partake in decision-makings with regards to the longevity of the company. After all, it is their bread and butter on the line. Relatively speaking, persons in authority must discern that leadership is mainly creating a goal and paving the way for others to follow. However, this means that those following the pre-set objective do not have any idea on how to accomplish the goal. Thus, it would be quite difficult for others to carry on where somebody has left off should any difficulties arise during the course of achieving the objective (Team Technology, n.d.). On the other hand, management that lacks leadership usually just handle things according to set principles and traditions, making sure that everything should conform within a pre-set guideline (Team Technology, n.d.) hence innovations are often dismissed and are rarely considered. professional manner where she must have a one-on-one conversation with him. During the course of the exchange, Bob must be made to understand the financial plight of the company and must be told that if he has any kind of grievances to air regarding management’s decision or otherwise, then he must approach the proper authority and discuss them accordingly. In true to life situations or circumstances, it is essential to consider all the factors so that the risk which will be undertaken or any unforeseeable risk as a result or consequence of a decision or action is minimized. In addition, real situations must be analyzed

FAMILY VIOLENCE AND ABUSE Essay Example | Topics and Well Written Essays - 1250 words

FAMILY VIOLENCE AND ABUSE - Essay Example He also threatened to injure maim her. The historical and the current standing posed beyond doubt that Marcia’s life was in great jeopardy and she needed redemption. The case also fulfills the requirement that the aggressor is not the defendant. The deceased aggressed the defendant’s myriad times thus attributing to the retaliation by his wife, Marcia. The obligation of applying just sufficient force in the defense as required by the law was not achievable because the husband threats were recurrent and he would justice only she shut her up for good. Marcia Norman option to end the life of her husband was pegged on her mission to save her life-perfect self-defense, and therefore was legally right. The eminent past and continuous history of mal-abuse by her husband would not allow limited room for her right of freedom from harm (Leverick, 2009). The courts would factually consider immense psychological distress and trauma that Marcia had undergone. According to a witness from the case, after she was asked whether she thought it was correct for Marcia to shoot her husband, she admits that from the examination and the assessment of her records and psychological files, it was exclusively fine for her to do so. She adds that Norman Marcia assumed herself doomed from the torture she endured from her husband. She had a perception of persecution ahead due to the immense social degradation and demeaning that her husband accorded her, and recognized that her death was probably not avoidable in future. The witness also notes the fact that Ms Marcia had attempted suicide before and there was a conviction that she would not succeed in her struggle against her unwavering husband. The witness notes that she believed that the defendant had grown insecure to an extent that he could not have any sense of attachment to her family. She could not run away from the deceased due to his immense power and

Ethnic and Religious Conflict in Nigeria Essay Example for Free

Ethnic and Religious Conflict in Nigeria Essay Basically, Nigeria is a plural society and heterogeneous in virtually all the facet of life. The custom and tradition of Nigerians is so diverse to the extent that Nigeria as a country is now confronted with the problem of religion and ethnicity towards their political stability. The origin and history of ethnic conflict (societal wars and violence) can be traced from eternal (internal) state rivalry to external (physical). And its root cause is not very far from power competition and decision making over economic resources and other important human factor, like position. The implementation process has always involved more than one or two persons. In general concept, the author of this work traces conflict back to the first and early Patriarchal of human history and ever since then, there has been an increase (in various dimensions) of Conflict in the face of human world. Some are personal (internal) conflict, family, community, and group, intellectual, state, national and international in nature, to mention but few. In conforming to this idea, Badawi (2006) in his statement titled â€Å"World Apart† stated thus, â€Å"indeed the greatest discord today is among the descendants of Abraham. These are the people of the book, the followers of Judaism, Christianity and Islam, who had in fact shared a common beginning in the religion of Abraham†. In shedding more light in the above statement, Badawi statement goes far beyond religion, rather, he was tracing one of the earliest source of conflict which Badawi mentioned the off-springs of the said Abraham. Even before Abraham, there had been conflict, so it is as old as human history down to the Abrahamic period, to ancient kingdoms, Dukes, and Kings. In about 88 B. C. , King Mithriadates VI of Pontus invaded Roman territory in Asian Minor. He advised Asian debtors to kill their Roman creditors. Happy to reduce their credit card bills, the Asians massacred 80,000 Romans. Ethno-political conflicts have greatly shaped our present world and of course have its structural phenomenon, (William Easterly, 2001). For instances, the conflict we now call Israeli and Palestinian war, has been an ever-lengthening sort. The Assyrian, Babylonian war, by King Nebuchadnezzar of the hanging Garden in history, the Persia war, Alexander the Great (the Macedonian mad man in history), the German war of Adolf’s. Hitler, the Roman wars, narrowing all these down, we came to the horn of African continent which seem to be an epidemic field of conflicts of diverse kinds till date. The giant-lion of African continent, just like the origin of conflict is said to have stated very old in human history, even so in the case of Nigeria, which can be traced to the colonial period of history. Conflict takes different sizes and shapes with diverse reasons and purposes. Majority of the conflicts takes time before their escalation and at such, could have been transformed right at their respective early stages. The history of ethnicity and ethnic conflicts in Nigeria is also traced back to the colonial transgressions that forced the ethnic groups of the northern and southern provinces to become an entity called Nigeria in 1914. In the case of Nigeria situation, disturbing history of colonialism, this generated hatred and conflict among different ethnic groups. The task of addressing this seed of conflict planted by the British has been a complex one. After weakening the former diverse kingdoms, Emperors, etc now called Nigeria and reordering the groups’ politics, the colonial powers failed in nation building and providing for the peoples basic needs. Hence, unemployment, poverty increase, and due to these, conflict over scarce resources ensue. The Southern and Northern protectorates were also being amalgamated into a nation. Thereafter, the merging of different colonies into one country called Nigeria was forcefully done without the peoples consent. This was a major seed of conflict that is still troubling Nigeria today. This article is focused on the historical incidents of ethnic conflicts in within Nigeria societies, the cause of the conflicts and perhaps, the government actions towards ethnic conflict in the country. In conclusion, this paper will explore into decision-making (by the elites and those in authority) process has contributed immensely in generating the syndromes of conflict in the said state. The Nigerian political situation has witnessed more breaking of heads, than counting them. In fact, even when it has been convenient for heads to be counted, the outcome has always been the breaking of heads instead. Conflict in Nigeria is so intense because of lack of democratic behaviour. The head of the individual in the democratic context signifies citizenship. So when heads are broken in the Nigerian political community, the issue in respect of broken heads is citizenship. If conflict in Nigeria means the absence of democratic behaviour, it follows, therefore, that conflict in Nigeria is interwoven with the absence of democratic governance. Gurr (2000): has also shown that the incidence of conflicts at the global level declined in recent years with the deepening of democratisation. Nation-states where conflicts persist are those where what obtains is the democratisation of disempowerment (Ake 1996). Beyond the veneer of elections, the state remains ambushed, privatised, repressive and unpopular. The people who were tantalised by the prospect of a democratic revolution that would terminate decades of alienation and pauperisation have been short changed and given a ‘choice less democracy’ (Mkandawire 1999). The ‘credibility gap’ which fostered the De-linkage of the people from the state, and ignited social forces to struggle for democracy, is not being bridged (Rothchild 1995: 58). African peoples out of clear rational calculations sans atavistic attachments have turned their backs on the state ‘and given their loyalty to sub-national social formations such as the community, the sub nationality or ethnic groups’ (Ake 2000: 114). It is against this backdrop that the proliferation and exacerbation of violent ethno-religious conflicts in Nigeria in the post-transition period can be appreciated. This article adopts an analytical framework that holds that The interface between ethnicity and democratisation is found in absence of effective citizenship and good governance in post-transition societies. In the circumstance that democracy does not go beyond the conduct of multiparty elections to include improvement in the quality of life of the people, there is frustration, and people who already feel alienated from the state are vulnerable and likely to be mobilised around counter-elites who exploit extant popular alienation from the state by whipping up sectarian sentiments. This has been the case in Nigeria and several multi-ethnic states of Africa (Osaghae 1994). Although the foregoing theoretical discussion has focused on ethnicity, the term ethno-religious is adopted because some of the recent violent conflicts to be examined were triggered by religious issues. The relevance of religion is also underlined by the fact that in Nigeria ethnic boundaries tend to coincide with religion, with the exception of the Yoruba ethnic group (Ibrahim 1999). The Nigeria state was amalgamated in the year 1914 by lord lugard. The various geographical areas or territory which was amalgamated to form Nigeria by the colonialist comprises of various cleavages, clans, towns even there were kingdoms and chiefdoms with diverse culture, language, religion, norms values, customs and political structures etc. The focus of the research monogram is to examine the role of religion and ethnicity in Nigeria nascent democracy. In Nigeria especially, religion plays a very vital and influential role in the society that has manifested itself as a potent force in the political development of the Nigerian state from pre-independence to post-independence. Hardly can the Nigerian state be talked about without reference to religion (Kukah, 1994; Falola, 1990; Kenny, 2006; International IDEA, 2000; Suberu, 2009). However, religion in Nigeria, at different levels, is mostly mentioned in negative terms. Or rather, historical events linked to religion tilts more towards its negative than its positive contribution to the Nigerian state. The Jihad, the civil war propaganda, the Sharia law controversy, the tensions provoked by the Nigerian accession to the Organization of Islamic Countries (OIC) and the incessant religious crises that have engulfed the Northern part mainly indicate that religion cannot be ignored or wished away in the Nigerian political development. Several religious crises have occurred in Nigeria. They have been documented as academic dissertations for some of them. This piece of work does not intend to start the discourse on religious violence anew but only recognizes the fact that as a recurrent phenomenon it is worth being explored further. Thus â€Å"Boko Haram† menace which gained global recognition and even press support ranging from July 2009 till date is a the central focus of this study together with other riots which has engulfed the Nigeria state from 1999 till date which most Nigeria educated elite believed that religion and ethnicity were the basic causes. The educated elite have conducted series of research on what the causes of this violent riots maybe. Most have concluded that it can be traced and linked to the failure of governance in Nigeria. 1. 2 STATEMENT OF PROBLEMS The mistake of 1914 has polarised the Nigeria society together with its citizens in which loyalty to the State is a mirage instead people pay loyalty to their various families and ethnic groups the effect of this can be traced to 1967 civil-war which disintegrate the country or in the political system which almost lead to secession of the country with the easterner believed to be the aggrieved ethnic in the war. Similarly Nigeria has a long history of religious crisis which has affected the political instability of Nigeria. The maintasine riot of 1980 can be said to be the first major religious riot in Nigerian history, claiming about 800 lives. The Boko Haram insurgence in the northern part of the country which has been directed mainly against the Christians, they have suffered a lot both physically, psychologically, economically, spiritually and even politically in the far North which has led political writers and pundits to affirm that Boko Haram conflict has its roots in Religion. The thrust of this work will be to examine the underlying reasons behind political instability in Nigeria using religion and ethnicity as a paradigm. 1. 3 SCOPE OF THE STUDY. The study will cover the impacts of religion and ethnicity towards the stabilization or in- stabilization of the Nigeria political system it will cover how religion and ethnicity have impacted on the political stability of Nigeria. Furthermore the study will emphasize more on the role the government is playing in stabilizing the un-stabilized country. 1. 4OBJECTIVE OF THE STUDY The following can be regarded as the aims and objective of the study 1. To know the meaning of religion, ethnicity, political stability, and political instability 2. To know how religion and ethnicity have negatively impacted on Nigerian political development 3. To develop possible solutions and panaceas to the problems of religions and ethnicity to Nigerian political in-stability 1. 5 RESEARCH QUESTIONS 1 What meaning does religion, ethnicity and political instability carries 2 How has religion and ethnicity impacted on the political stability of Nigeria 3 what are the possible solutions to the problem of religion and ethnicity in Nigeria political system 1. 6 JUSTIFICATION OF STUDY Many a developing countries of the world are currently experiencing the problems which ethnicity and religion have caused. The ethnic problem which led to the apartheid era in South Africa is also the same ethnicity and religion problem which has almost disintegrated the Nigerian State. Recalling back to what happen during the civil war in the late sixties and early seventies which led to the introduction of the national youth service corp. by the then military president General Yakubu Gowon which aim at integrating back the almost disintegrated country. Books, Journals, Magazines, Pamphlets, and lot of researches have been written and carried out respectively on the issue of ethnicity and religion, and its impact on the Nigeria political stability. This research work will serve as an additional material to the issue on ethnicity and religion to political instability in Nigeria, this work will focus more on ethnicity and religion and its impact on Nigerian politics 1. 7RESEARCH METHODOLOGY The research methodology will be based on secondary data collections ranging from books, Journals Newspapers, News Magazines, Pamphlets and even the Internet. In conducting any research basically there are two methodologies employed by researchers which are the primary and the secondary methods. This research work will be basically conducted using the secondary methodology as earlier mentioned. 1. 8DEFINITION OF TERMS Ethnicity: According to the oxford advance learners dictionary ethnicity can simply mean â€Å"the fact of belonging to a particular race† from the dictionary meaning we can deduced the fact that Humans believed in race and they have passion for race which leads to humans ethnocentrism i. e. highly ethnocentric in nature. Ethnicity has a strategic interaction of persons and other actors, who have different beliefs, attitude’s, values and goals as they decide particular conflict the distribution of resource’s and general issues of political rules within a context of norms, expectations and institutions. Any of the rule, expectation and institutions may be reversed, maintained or inverted by the individual who win the right to control them, in the course of those political negotiations that are sometimes called cooperation, and sometimes called war, and are usually somewhere between the two. In another sense, ethnic identity are political resources just like money or vote. Instrumentalist like Micheal Banton and Micheal Hecthtar, argue that ethnic identity are not inherent in group or socio-formation of people. They see ethnic identity as socio-capital brought to bear on the political negotiation table by different groups and at different times. Hutchinson and Smith also argue that ethnic identity are an important resource that political Elite employ in securing the support of the masses as a strategy for gaining a desired good. These goods and or goals are â€Å"measured in terms of wealth, power, and status and†¦ joining or national communities helps to secure these ends either by influencing the state, or in certain situations, through secession. Religion: religion on its own part can be regarded as the belief in the existence of God or gods and the activity that are connected in the worship of them. Religion can also be stress further by meaning one of the system of faith that are based on the belief in the existence of a particular God or gods. For example the Jewish religion, Christianity Islam and other world religion. Furthermore in the classical and ancient ages religion has achieved a lot in their politics for example the doctrine of Islam was used in many Arab nations has their constitution even up till the present age. The Ancient Romans, also, during the time of Constantine accepted Christianity as a religion and a mode of life which also affected their political terrain. Religion in the 21 century is now used narrowly towards Christianity and Islam even though other religion still exist but the former two religion have elevated to prominence that other religion are now beneath them. For instance about Political stability: can depict the mean of a system of politics in which the government of that State is experiencing a stable government and peaceful existence in the State or in otherworld’s a legitimately accepted government by the people. Democratically governed States are believed to be stable. In the global sense every political entity must be ruled democratically without internal oppression or external aggression. Any country of the world that is free from the aforementioned point are regarded as stable political system in other words internal oppression has cause a lot of havoc to many democracies of the world which has infringed on their stability as noted by Ojo 2002. Descent Rule: These covers a larger set of cases that we commonly understand to be ethnic than the rules that ethnic groups must have a myth of common ancestry or common origin. But it excludes several cases in which individuals routinely consider themselves, and are considered as members, of a group that we classify as ethnic even when their parents were not coded as members of this group. Take for example the category â€Å"Yoruba† when it was invented in Nigeria in the nineteenth century. At this time period, the parents of those who were classified as Yoruba were not themselves classified as Yoruba for the reason that this category did not exist during their lifetimes. According to Descent Rule, then, the category Yoruba in the nineteenth century would not be coded as ethnic. But the category Yoruba is universally coded as an ethnic category by all comparative political scientists, without making a distinction between time periods. As another example, consider the category â€Å"Backward Caste† in India, which included as members individuals who possessed a given set of last names and/or ancestral occupations. The category was introduced by the Indian Central Government in 1990. Within a few years, 52% of the Indian population classified itself and was classified as backward. Yet the parents of those who termed themselves â€Å"Backward Caste† were not coded by themselves or by others as â€Å"Backward Caste† because, as in the case of the first generation of Yoruba’s, this category did not exist during their lifetimes Democracy: According to Abraham Lincoln he defines democracy as the government of the people by the people and for the people. In this wise democracy connotes a system of government in which all the people in a country will have the outright say on the government of their country although in a representative manner meaning that they will elect representatives that will represent their interest in the government. Advanced countries if the world where democracy is practiced completely they have national identity as opposed to the developing world where they have ethnic identity. Advanced democracies always believe in secularism in which every religion is accepted and embraced not a system in which part will have cognisance to a religion and the other will believe in other religion causing serious tension in such states like Nigeria. Federalism : Elasar (cited in Akande, 1996:1)† the formation of European union (EU) which simply begun as a trading partnership for coal and steel is now moving towards a more integrated political union founded upon federal principle of governance†. The African union (AU) which is the federation of African counties where a central government intended to be created with sharing or division of power among the federating unit, even the world highest organization body united Nation have in some little degree, evolved the principle of federalism. Federalism is a system of government which embraces unity in diversity. Federalism as a system of government is one in which there will be central and regional governments each one autonomous of each other.

Role of Multi-Detector CT in Paranasal Sinuses

Role of Multi-Detector CT in Paranasal Sinuses SUMMARY OF THESIS Name of speciality : Radio-diagnosis Name of System : Head and Neck Title of Thesis and : Role of Multi-Detector Computed Tomography in Paranasal Sinuses  Pathology, 2015. Lakshmi Kumar Chalamarla Name of Supervisor : Dr. Kavita Kapoor, Consultant Imaging, Batra Hospital and  Medical Research Centre, New Delhi. Hospital/Institute : Batra Hospital and Medical Research  Centre, New Delhi-110062. AIMS AND OBJECTIVES To characterize pathologies of paranasal sinuses on MDCT and to delineate their anatomical location, extension and bony involvement. To correlate the multi detector computed tomography findings with clinical/surgical/histopathological/ microbiological findings. MATERIAL AND METHODS STUDY AREA: The study was conducted at the Department of Radio-diagnosis and Imaging in collaboration with the Department of ENT, Department of Pathology, and Department of Microbiology, Batra Hospital and Medical Research Centre. Other departments are collaborated for acquiring cases, and follow up of patients to correlate clinically or histopathologically or microbiologically. STUDY POPULATION: 100 patients were included in our study mostly urban population. Patients belonged to both OPD and IPD cases. The study comprised of 65 males and 35 females. The number of male patients were higher than the female patients. There were 15 patients in 0 20 years age group, 36 patients in 21 40 years age group, 37 in 41 60 years age group and 12 were greater than 60 years. The age group of patients ranged from minimum of 9 months to maximum of 81 years. The highest number of patients were in 41 60 years age group. SAMPLE SIZE: 100 patients referred for evaluation of sinus complaints were enrolled in the study after fulfilling the inclusion and exclusion criteria and taking written/verbal informed consent from July 2013 to April 2015. INCLUSION CRITERIA: Patients with complaints like headache/nasal obstruction/discharge/hyposmia /swelling over cheek and with clinically suspected paranasal sinuses lesions referred for MDCT PNS evaluation. EXCLUSION CRITERIA: Acute sinonasal inflammatory disease. Previous evidence of sinonasal surgery. All cases of trauma. SAMPLE SIZE CALCULATION: (Ref.: Methods in biostatistics, Dr. B. K. Mahajan, 7th edition, pg. 85) For calculation of sample size Mahajans allowable error formula was applied. N = 4pq/e2 Where p = % of population = Target population/Total populationÃâ€"100 q = 1-p e = 20% of p As per CT room register over last 3 years Minimum no. of MDCT PNS cases at our hospital/month = 20 Maximum no. of MDCT PNS cases coming under exclusion criteria/month = 5 So, Minimum no. of MDCT PNS cases at our hospital/year = 240 Maximum no. of cases coming under exclusion criteria/year = 60 So, p = 180/240Ãâ€"100 = 75 q = 25 e = 20% of p = 15 N = 4Ãâ€"75Ãâ€"25/152 = 33. The minimum sample size thus calculated should be 33. STUDY DESIGN: Observational study. CT PNS of the patients was evaluated for the cause of sinus complaints. Causes deduced from CT PNS were correlated with clinical/histopathological/surgical/ microbiological findings. ETHICAL ISSUES: The study was conducted after necessary approval from the Institutional review board and ethics committee. MDCT is a non-invasive modality. All safety and screening measures were undertaken as per the American College of Radiology practice guidelines for performing Computed Tomography. INSTRUMENTATION: Light VCT 64 slice MDCT of GE radical system with advanced workstation 4.3 GE. Protocol followed for MDCT PNS: 1. Scout : Lateral kV : 120 mA : 10 Scout Plane : 900 2. Axial Images kV : 120 mA : 120 Start/End : 0 to 74.3 Total Exposure Time : 5.4 sec Gantry tilt : 0 Interval : 0.625 mm Slice thickness : 0.625 mm Helical Scan Rotation Time : 0.6 sec Rotation Length : Full Pitch and Speed : 0.531:1 10.62 mm/rotation Detector Coverage : 20 mm PROFORMA Unique ID No: HISTORY: Presenting Complaints: Nasal discharge: Headache: Nasal obstruction: Epistaxis: Swelling over cheek: Hyposmia/Anosmia: Others: H/O Smoking: Occupational exposure: History of Allergy: Any other Systemic Illness: Family History: EXAMINATION: General Examination: Local Examination: Inspection: Probe test: Others: Important Surgical Findings: Investigational Results: MDCT PNS : Histopathology: Microbiological and other important lab tests: Department of Radio-diagnosis and Imaging Batra Hospital and Medical research Centre M.B.Road, New Delhi-110062. INFORMED CONSENT FORM I s/d/w of r/o do hereby declare that I give informed consent to participate in the thesis study titled, ROLE OF MULTI-DETECTOR COMPUTED TOMOGRAPHY IN PARANASAL SINUSES PATHOLOGY. Dr. Lakshmi Kumar Chalamarla has informed me to my full satisfaction, in the language understand, about the purpose, nature of study and various investigations to be carried out for the study. I have been informed about the duration of the study and the possible benefits and risks. I give full, free and voluntary consent for being enrolled in the above study and reserve the right to withdraw from the study whenever I wish to without any prejudice of my right to undergo further treatment at this hospital and its associated hospitals. I have been given a copy of this form along with the patient information sheet. For illiterates patient information sheet will be shared with the family members. The family members are expected to read out and then get the informed consent. We will try to take written consent, if not we will take verbal consent in front of relatives. (Signature/Thumb (Signature/Thumb Impression of patient) Impression of relative) Name: Name: Date: Relation: Verbal Consent: Date: PATIENT INFORMATION SHEET Title: ROLE OF MULTI-DETECTOR COMPUTED TOMOGRAPHY IN PARANASAL SINUSES PATHOLOGY. Introduction: This statement describes the purpose, procedures, benefits, risks and discomforts of the study and your right to withdraw from the study at any point of time. Purpose: This study involves MDCT scan evaluation of patients with paranasal sinus complaints. Study Procedure: Your relevant clinical history will be recorded, clinical examination will be conducted and findings noted. MDCT PNS will be performed and the radiological findings will be recorded. These findings are correlated with clinical/surgical/histopathological/microbiological findings. Benefits: No monetary benefits will be given to you. However, any new information that can come to light regarding any new findings in the study will help in further management of the disease and help all other ailing patients suffering from this problem. Confidentiality: Records of your study participation will be kept confidential, under safe custody. Any publication of data will not identify you by name. By signing the consent form you authorise the sharing of your study related medical records to the regulatory authorities and the Institutional Ethical Committee. Information regarding withdrawal: You have the right to withdraw yourself from the study at any time during the course of the study without any prejudice to you or your familys right to undergo future treatment at BATRA HOSPITAL. Contact for additional information: Any time during or after the study, you can obtain further information about the study from Dr. Lakshmi Kumar Chalamarla, Department of Radio-diagnosis, BHMRC, New Delhi. DATA ANALYSIS Sensitivity, specificity, positive predictive value and negative predictive values were calculated, followed by use of Fischer Exact test. Diagnostic accuracy of MDCT for different pathologies were calculated The research hypothesis and statistical methods were formed in consultation with the Biostatistician. SALIENT FINDINGS Key imaging features considered were significant anatomical variations, site of involvement, bony and soft tissue changes, invasion of surrounding structures, pathognomic features and correlation with clinical complaints/surgical/pathological/microbiological findings. The patients were divided into five categories: bacterial sinusitis, fungal sinusitis, benign tumors, malignant tumors, and others. 84 patients presented with sub acute or chronic bacterial sinusitis, 4 patients were of fungal sinusitis, 4 patients presented with benign tumors, 3 patients with malignant tumors and 5 patients with other conditions. Among 84 patients with bacterial sinusitis, 26 patients presented with sporadic pattern, 23 patients with infundibular pattern, 23 patients with ostiomeatal unit pattern, 8 patients with polyposis pattern, and 4 patients with sphenoid recess pattern. The various causative factors which came across in infundibular pattern were Haller cells in 6 cases, giant bulla ethmoidalis in 6 cases, uncinate process pneumatisation in 1 case, and mucoperiosteal thickening in 10 cases. The various causative factors for ostiomeatal pattern which were found during our study were: inferior turbinate hypertrophy in 6 cases, giant bulla ethmoidalis in 6 cases, deviated nasal septum with or without septal spur in 4 cases, concha bullosa in 3 cases, concha lamella in 2 cases, agger nasi cell in 1 case, and paradoxical middle turbinate in 1 case. The various findings which were encountered in bacterial sinusitis in our study were: mucoperiosteal thickening in 84 cases, ostiomeatal unit block in 31 patients, bone thickening in 20 patients, bone thinning in 8 cases, and bone sclerosis in 6 patients. Various anatomical variations were encountered during our study. One or the other anatomic variation was found in 99 cases ( 99% ). Of the structures around ostiomeatal unit, giant bulla ethmoidalis was found in 35 cases, middle turbinate pneumatisation in 33 cases, paradoxical curvature of middle turbinate in 19 cases. Haller cell was found in 15 cases. Type 1 frontal sinus drainage pathway in 78 cases, type 2 frontal sinus drainage pathway in 21 cases. Deviated nasal septum with or without septal spur in 55 cases, inferior turbinate hypertrophy in 30 cases, accessory maxillary ostia in 26 cases, and agger nasi cell in 93 cases. Type 1 optic nerve course was found in 53 cases, type 2 in 14 cases, type 3 in 9 cases, and type 4 optic nerve course along with Onodi cells in 23 cases. Type 1 anterior clinoid process pneumatisation was found in 10 cases, type 2 pneumatisation in 1 case. Sphenoid septum lateral attachment in 7 cases, and sphenoid sinus septum pneumatisation in 14 cases. Among 4 patients with fungal sinusitis, the various findings were: bilateral / multisinus involvement was found in 4 cases, expansion of any involved sinus was found in 4 cases, intrasinus hyperdensity was found in 4 cases. Bony thinning was found in 4 cases, bony erosions and nasal cavity involvement was found in 3 cases. The various findings in 4 cases of benign tumors seen ( 1 inverted papilloma, 1 juvenile angiofibroma and 2 ivory osteomas ) were: bony thinning in 2 cases, bony remodelling in 2 cases, multisinus involvement in 2 cases, intracranial extension in 1 case, and intra orbital extension in 1 case. Bony destruction, bone thickening/sclerosis, and calcification were not seen in any of the cases. Among 3 cases of malignant tumors, various findings were: : Bony destruction in 3 cases, bony thinning in 3 cases, bony remodelling in 0 cases, multisinus involvement in 2 cases, intracranial extension in 2 cases, and intra orbital extension in 3 cases. Bone thickening/sclerosis, and calcification were not seen in any of the cases. In our study we found sensitivity and specificity for bacterial sinusitis as 100% and 94.11% respectively. The fungal sinusitis had sensitivity an specificity of 75% and 100% respectively. Benign, malignant tumors and others had sensitivity and specificity of 100%. The diagnostic accuracy for bacterial sinusitis and fungal sinusitis was 99%, and the diagnostic accuracy of benign, malignant tumors and others was 100%. The p value was obtained after applying Fischer Exact test. The p value obtained was statistically significant for all the disease conditions. Based on the statistical values it can be inferred that multi detector computed tomography is useful to characterize paranasal sinuses lesions with respect to anatomical delineation, extension and bony involvement. There are certain limitations in our study. Our findings cannot be generalised to the whole population because of the limited sample size. However, our findings add value to the research done. The role of contrast cannot be adequately studied. The role of MRI in various paranasal sinus pathologies was not evaluated. CONCLUSIONS Paranasal sinus diseases are very commonly encountered problems in clinical practice. Clinical assessment alone is not sufficient to reach a diagnosis, as the presentation of most of the conditions is nonspecific. Imaging forms the mainstay not only in making correct diagnosis, but also to know the extent of lesion, pre-operative assessment of the sinonasal anatomy and commonly encountered anatomic variations. X ray has low sensitivity, specificity, positive and negative predictive values. CT is highly sensitive and specific in determining the presence of paranasal sinus pathology and clearly demonstrates the complex anatomy. The introduction of multi detector CT has transformed the axial imaging modality into a volumetric one and allows the pathology to be displayed in any desired plane. The capability of thin-section acquisition improves visualisation of tiny pathological details, and the isotropic nature of high spatial resolution data sets enables display in multiple planes, obvi ating image acquisition in prone or hyper extended patient position. RECOMMENDATIONS MDCT has proved to be highly sensitive in classifying the lesions into clinically relevant categories, making diagnosis and more so in knowing the extent of involvement with a high diagnostic accuracy. MDCT is an indispensible tool before Functional Endoscopic Sinus Surgery (FESS) to accurately delineate the fine bony details that contribute to disease and also can predispose to complications which can be fatal. MDCT is very useful in predicting the diagnosis of fungal sinusitis by the presence of intrasinus hyperdensity, granulomatous diseases by the presence of nasal septal perforation and intracranial or intraorbital invasion, malignancy by bone destruction and invasion. MDCT can tailor the surgery according to the extent of disease. It helps in determining the prognosis of the malignant tumors depending on the site and extent of the disease. It can also obviate the need for surgery in certain conditions like polyposis. MRI can be problem solving tool in differentiating inflammatory sinonasal diseases from tumors, and also for the presence of intracranial or intraorbital extension. However, MRI alone cannot be performed in the evaluation of paranasal sinus diseases because of the problem of signal voids. It has to be supplemented by CT. MDCT is the preferred modality of all imaging studies available because of its ease, availability, accuracy, precision and low cost.

Breathe Right Strips Essay -- Chronic Nasal Congestion Health CNS Essa

Breath Right Strips Introduction According to the text, Breathe Right Strips were invented by Bruce Johnson, a chronic nasal congestion sufferer. Mr. Johnson Brought his creation to CNS Inc. CNS took the product and primarily marketed it to sports teams, nasal sufferers and night-time snorers. The product really became prominent when Jerry Rice of the San Francisco 49ers wore the product in the Super Bowl. According to cns.com, Breathe Right Strips is also available in vapor strips, clear and tan strips, and nasal strips for kids. Some of the other products include nasal spray, throat spray, fiberchoice and a portable vaporizer. Armed with these few, but strong products in 1995 CNS, decided to go global. Summary of the Facts The facts are that that there are advantages and disadvantages of CNS going global with the product. The advantages are that CNS can attempt to increase its market share and not have to rely on only domestic dollars, partnerships can begin to develop between local suppliers, and they can avoid costs of domestic licensing. The disadvantages are that there are local customs that need to be considered, the lack of name recognition of the brand, there may be stronger global competition, the international company may be used to different marketing, and there may be different trade regulations. The decision for CNS to go global takes careful analysis and an international strategy. Analysis The strategy that CNS decided to use is the three-stage approach. Stage 1 is Explore/test concept. Stage two is the Establish the product, and stage three is Manage the product. Using the SWOT analysis, I will analyze their marketing approach as it pertains to entering international territory. The strengths are that breathe right has already shown that it could successfully market the product in North America and make it a success. They have proven that they can package the product to tailor it to the international market, which would allow then to penetrate the market and refine messages for the local market as spelled out in stage 2 of their strategy. They have the ability to identify potential partners in the local global markets. When they first entered the global market, they partner with 3M, who had a handle on the marketing practices of the global market. According to The Business Journal, they regained control of their ... ...ons to attract people that are unaware of the product. They can also opt to do what they have always done, because the product is successful. To take the do-nothing approach is dreadful, because the competition is out there lurking, just waiting for CNS to rest on their laurels. Conclusion The CNS Company is already a successful company due to the achievements of its breathing right strips. In my analysis we learned that they already do a lot of things right. What they need to be aware of is the different economical situations in the global marketplace, there are different ways that the product is approved abroad, and there is competition lurking. CNS needs to continue to leverage their strengths, but capitalize on their opportunities and benchmark the competition. Works Cited Kerin, Hartley, Berkowitz, and Rudelius. Marketing McGraw Hill 8th Edition â€Å"CNS Inc. to regain control of Breathe Right international sales from 3M† The Business Journal Minneapolis-St.Paul: 11 Oct. 1999 â€Å"Innovative Solutions to Everyday Problems† 2004 http://www.cns.com/products/products.html â€Å"1-2-3 Breathe† 2004 http://www.ginmiller.com/gmf04/gmfstore/healthbeauty/123breeathe.htm Breathe Right Strips Essay -- Chronic Nasal Congestion Health CNS Essa Breath Right Strips Introduction According to the text, Breathe Right Strips were invented by Bruce Johnson, a chronic nasal congestion sufferer. Mr. Johnson Brought his creation to CNS Inc. CNS took the product and primarily marketed it to sports teams, nasal sufferers and night-time snorers. The product really became prominent when Jerry Rice of the San Francisco 49ers wore the product in the Super Bowl. According to cns.com, Breathe Right Strips is also available in vapor strips, clear and tan strips, and nasal strips for kids. Some of the other products include nasal spray, throat spray, fiberchoice and a portable vaporizer. Armed with these few, but strong products in 1995 CNS, decided to go global. Summary of the Facts The facts are that that there are advantages and disadvantages of CNS going global with the product. The advantages are that CNS can attempt to increase its market share and not have to rely on only domestic dollars, partnerships can begin to develop between local suppliers, and they can avoid costs of domestic licensing. The disadvantages are that there are local customs that need to be considered, the lack of name recognition of the brand, there may be stronger global competition, the international company may be used to different marketing, and there may be different trade regulations. The decision for CNS to go global takes careful analysis and an international strategy. Analysis The strategy that CNS decided to use is the three-stage approach. Stage 1 is Explore/test concept. Stage two is the Establish the product, and stage three is Manage the product. Using the SWOT analysis, I will analyze their marketing approach as it pertains to entering international territory. The strengths are that breathe right has already shown that it could successfully market the product in North America and make it a success. They have proven that they can package the product to tailor it to the international market, which would allow then to penetrate the market and refine messages for the local market as spelled out in stage 2 of their strategy. They have the ability to identify potential partners in the local global markets. When they first entered the global market, they partner with 3M, who had a handle on the marketing practices of the global market. According to The Business Journal, they regained control of their ... ...ons to attract people that are unaware of the product. They can also opt to do what they have always done, because the product is successful. To take the do-nothing approach is dreadful, because the competition is out there lurking, just waiting for CNS to rest on their laurels. Conclusion The CNS Company is already a successful company due to the achievements of its breathing right strips. In my analysis we learned that they already do a lot of things right. What they need to be aware of is the different economical situations in the global marketplace, there are different ways that the product is approved abroad, and there is competition lurking. CNS needs to continue to leverage their strengths, but capitalize on their opportunities and benchmark the competition. Works Cited Kerin, Hartley, Berkowitz, and Rudelius. Marketing McGraw Hill 8th Edition â€Å"CNS Inc. to regain control of Breathe Right international sales from 3M† The Business Journal Minneapolis-St.Paul: 11 Oct. 1999 â€Å"Innovative Solutions to Everyday Problems† 2004 http://www.cns.com/products/products.html â€Å"1-2-3 Breathe† 2004 http://www.ginmiller.com/gmf04/gmfstore/healthbeauty/123breeathe.htm