Burden of Illness of Type 2 Diabetes Mellitus in the Kingdom of Saudi Arabia: A Five-Year Longitudinal Study.

INTRODUCTION: Type 2 diabetes mellitus (T2DM) is associated with huge clinical and economic burden in the Kingdom of Saudi Arabia (KSA) which can be curtailed by efficacious treatment. In order to achieve this, current treatment pathways for T2DM and associated costs need to be assessed. METHODS: A longitudinal cohort review was conducted to collect country-specific and patient-specific clinical data, over a minimum observation period of 5 years in the KSA. Patient demographics, clinical characteristics and treatment patterns were recorded. The IQVIA Core Diabetes Model (CDM) version 9.5 Plus was used to assess the burden of illness, which included long-term projections of clinical (life expectancy [LE], quality-adjusted life-years [QALYs], event rates of diabetes-related complications) and direct medical cost (per-patient annual or lifelong [50 years]) outcomes of the most commonly used first-line (1st-line) regimens for T2DM from a payer perspective in the KSA. RESULTS: Data were collected from a subpopulation of 638 patients from 15 participating centres. There was an equal gender representation with a majority of the patients belonging to Arabian/Saudi ethnicity (71.0%). Biguanides (81.5%), sulfonylureas (51.6%), dipeptidyl peptidase 4 (DPP4) inhibitors (26.2%) and fast-acting insulins (17.2%) were the most prescribed 1st-line agents. The most frequently used 1st-line regimens resulted in an estimated LE of 25-28 years, QALYs of 18-21 years and lifelong total cost of illness of 201,377-437,371 Saudi Arabian riyal (53,700-116,632 US dollars). CONCLUSION: Our study addresses gaps in the current research by providing a complete landscape of baseline demographic, clinical characteristics and treatment patterns from a heterogeneous group of patients with T2DM in the KSA. Additionally, the burden of illness analysis using CDM showed substantially higher cost of T2DM care from a payer perspective in the KSA.

Evaluating the health risks of heavy metal pollution in dust storms in the city of Erbil in the Kurdistan region of Iraq.

This study examined the heavy metal content in dust storm samples from Erbil, Iraq, along with four other locations. Using ICP-MS, Cd, Ni, Cr, Hg, Pb, Zn, Mn, Cu, Co, Fe and As were determined. The health risks due to exposure to these metals through ingestion, inhalation and dermal contact were assessed for both adults and children. Non-carcinogenic risks were evaluated using the hazard quotient (HQ) and hazard index (HI). Children faced a cumulative risk with HQ > 0.2 for As and Cr and HI > 1. The carcinogenic risk was measured using the carcinogenic risk factor (CRF), which fell below 10-6, indicating low cancer risk. However, children had a higher cancer risk (10-4 to 10-6) for As. The pollution indices revealed varying pollution levels from unpolluted to moderately polluted in the studied areas. Overall, this study highlights potential health risks associated with heavy metal exposure during dust storms, particularly for children, and emphasises the importance of addressing these concerns to safeguard public health.

Mechanisms of anti-ulcer actions of Prangos pabularia (L.) in ethanol-induced gastric ulcer in rats.

Peptic ulcer disease is the greatest digestive disorder that has increased incidence and recurrence rates across all nations. Prangos pabularia (L.) has been well documented as a folkloric medicinal herb utilized for multiple disease conditions including gastric ulcers. Hence, the target study was investigation the gastro-protection effects of root extracts of Prangos pabularia (REPP) on ethanol-mediated stomach injury in rats. Sprague Dawley rats were clustered in 5 cages: A and B, normal and ulcer control rats pre-ingested with 1 % carboxymethyl cellulose (CMC)); C, reference rats had 20 mg/kg omeprazole; D and E, rats pre-supplemented with 250 and 500 mg/kg of REPP, respectively. After one hour, group A was given orally 1 % CMC, and groups B-E were given 100 % ethanol. The ulcer area, gastric acidity, and gastric wall mucus of all stomachs were determined. The gastric tissue homogenates were examined for antioxidant and MDA contents. Moreover, the gastric tissues were analyzed by histopathological and immunohistochemically assays. Acute toxicity results showed lack of any toxic effects or histological changes in rats exposed to 2 and 5 g/kg of REPP ingestion. The ulcer controls had extensive gastric mucosal damage with lower gastric juice and a reduced gastric pH. REPP treatment caused a significant reduction of the ethanol-induced gastric lacerations represented by an upsurge in gastric mucus and gastric wall glycoproteins (increased PAS), a decrease in the gastric acidity, leukocyte infiltration, positively modulated Bax and HSP 70 proteins, consequently lowered ulcer areas. REPP supplementation positively modulated oxidative stress (increased SOD, CAT, PGE2, and reduced MDA) and inflammatory cytokines (decreased serum TNF-α, IL-6, and increased IL-10) levels. The outcomes could be scientific evidence to back-up the folkloric use of A. Judaica as a medicinal remedy for oxidative stress-related disorders (gastric ulcer).

Evaluation of relative active tectonics by using geomorphic indices of the Bamo anticline, Zagros Fold-Thrust Belt, Kurdistan Region of Iraq.

The Mountain Front Flexure forms a prominent morphotectonic structures along the Zagros Fold-Thrust Belt (ZFTB). It consists of several segments that defines tectonic salients and recessions within the belt. These segments are separated by strike-slip faults, including Khanaqin fault, which forms the boundary between the Kirkuk embayment and Lurestan Arc. The Bamo anticline is a complex N-S trending structure located above the Khanaqin fault zone, and it is thought to manifest active deformation in the Zagros Fold-Thrust Belt and along the fault. This study examines the state of active tectonics along the Bamo anticline through quantitative analyses of the evolved landscape using geomorphic indices. For that reason, six indices have been chosen for the analysis, such as stream length-gradient index (SL), drainage basin asymmetry (AF), hypsometric integral and hypsometric curve (HI & HC), ratio of valley-floor width to valley height (VF), basin shape (BS), and mountain front sinuosity (Smf). Each index's results were categorized into three classes, and the results from the first five indices, excluding Smf, were integrated to get the index of relative active tectonics (IRAT). This index was then compared with the results of Smf to assess the relative active tectonics (RAT) along the anticline. The results of the IRAT, classified into four classes from very high to low tectonic activity, reveal that no area is classified as class 1 (very high activity). However, 38% and 56% of the region are categorized as classes 2 (high activity) and 3 (moderate activity), respectively. Furthermore, the remaining 6% of the research area exhibits class 4 (low activity). The Smf values for the Northern, Middle, and Southern segments of the anticline are 1.12, 1.18, and 1.27, respectively. Consequently, based on the Smf data, all mountain fronts are classified as class 2 (moderate tectonic activity.

Desire to stay shorter time at the shopping mall: insight from protection motivation (PMT), behavioral inhibition system (BIS), reactance, and expectancy theories.

After withdrawing the movement control order (MCO), new variant (Omicron) of COVID-19 returns as an outbreak again. Therefore, consumers are very much informed by various media to be more cautious in visiting shopping malls and spend less time in there. The purpose of this study was to identify the predictors influencing the desire to stay shorter at the shopping mall. This study was conducted in Malaysia, with the application of three psychological theories and one behavioural theory. This is quantitative research based on an online cross-sectional survey design. Data were collected from 296 respondents, by applying the online snowball sampling method through numerous media platforms i.e., Viber, WhatsApp, Messenger, and other apps in three severely affected cities in Malaysia i.e., Selangor state, Putrajaya, and Kuala Lumpur. SmartPLS was used to analyse the data. Using structural equation modelling, this study result shows risk, protection motivation, and fear have a significant effect on the desire to stay a shorter time at the shopping mall. Social norm moderates the association between fear and the desire to spend a shorter time at the shopping mall. These findings, highlight the need for a more empirical study to design more robust strategies, and a safer and risk-free shopping mall environment.

Advances on concrete strength properties after adding polypropylene fibers from health personal protective equipment (PPE) of COVID-19: Implication on waste management and sustainable environment.

Using Health personal protective equipment (PPE) such as face masks, safety foot shoes and protective suits has expanded dramatically due to COVID-19 pandemic leading to a widespread distribution of the PPE, particularly the face masks, in the environments including streets, dump sites, seashores and other risky locations. The environmental degradation of polypropylene, the essential plastic component in single-use face masks (SUM), takes between 20 and 30 years and thus it is essential to develop experimental approaches to recycle the polypropylene or to reuse it in different ways. This paper explores the integration of SUM into concrete structures to improve its mechanical properties. We first to cut the inner nose wire and ear loops, then distribute the PPE material among five different mixed styles. The PPE were applied by volume at 0%, 1%, 1.5%, 2.0%, and 2.5%, with tests focusing on UCS, STS, FS, and PV to determine the concrete's overall consistency and assess the improvement in its mechanical properties. The results showed that adding PPE improves the strength properties and general performance of the concrete specimens. The pattern of rising intensity started to fade after 2%. The findings demonstrated that adding PPE fibers enhanced the UCS by 9.4% at the optimum 2% PPE. The PPE fibers, on the other side, are crucial in calculating the STS and FS of the reinforcement concrete.

The Impact of Data Management on the Achievable Dose and Efficiency of Computed Tomography During the COVID-19 Era: A Facility-Based Ambispective Study.

Purpose: This study primarily aimed to evaluate the effectiveness of computational data management and analytical software for establishing departmental diagnostic reference levels (DRLs) for computed tomography (CT) scanning in clinical settings, and monitor achievable doses (ADs) for CT imaging, particularly during the coronavirus disease 2019 (COVID-19) era. Secondarily, it aimed to correlate these standards with national and international benchmarks. Patients and Methods: This ambidirectional cohort study enrolled 4668 patients (6419 CT-based examinations) who visited King Fahd Hospital of the University from May 25, 2021, to November 4, 2021. Participants' demographic data were acquired from their electronic medical charts, in addition to all corresponding CT-dose determinant parameters. The study was divided into two phases (pre- and post-data management) based on the implementation of digital data management software. Results: In both phases of the study, the size-specific dose estimate (SSDE) was the most significant confounder of dose determination compared to the dose-length product (DLP) and computed tomography dose index (CTDI) (P = 0.003). The head was the most frequently imaged body region (pre-implementation, 1051 examinations [35.1%]; post-implementation, 1071 examinations [31.3%]; P = 0.001), followed by the abdominal region (pre-implementation, 616 examinations [20.6%]; post-implementation, 256 examinations [7.48%]; P = 0.001). Based on the SSDE, DLP, and volume CTDI, the average per-section radiation exposure among organ-based scanning type was highest for the lumbar spine during the pre- and post-implementation periods. Conclusion: Data management software enabled the establishment of DRLs and reduction of ADs in CT examinations, which consequently improved key performance indicators, despite the ergonomic complexities of COVID-19. Institutions are encouraged to apply DRLs and ADs via automatic systems that monitor patient dose indices to evaluate aggregate results.

Assessment of supplied water quality during mass gatherings in arid environments.

Mass gathering events commonly encounter environmental challenges that necessitate assurance of water quality and food security. The current outbreak of the coronavirus disease 2019 (COVID-19) call for maintaining safe drinking water supply and providing assessment tools of drinking water quality to avoid contamination in water sources or distribution networks. Arid environmental conditions also add more stress on supplied water to mass gathering events. Herein, we assess the quality of the water supply (desalinated 95% and groundwater 5%) in Makkah city, Saudi Arabia during a mass gathering event in 2019 (9.6 million people) for religious purposes. Fifty five samples were randomly collected from nine different districts of Makkah city, analyzed for TDS, turbidity, pH, EC, free Cl2, Al, Cd, Pb, Cr, F, major ions, coliform and E.coli bacteria and were finally used to estimate the water quality index (WQI). Major ions, trace elements and heavy metals analyses show values below permissible limits in most of the samples, while a few samples show slightly higher values. No bacterial count found in any sample. WQI values of all fifty-five samples were below 50 and were identified as "excellent water". The WQI variations could be attributed to the distribution network conditions rather than a direct impact of adding groundwater with uncontrolled chemical composition. The use of WQI to report the quality of water during mass gathering events to governmental authorities has been proved to be beneficial and should be applied for further mass gathering events worldwide.

Evaluation of Pediatric Imaging Modalities Practices of Radiologists and Technologists: A Survey-Based Study.

Introduction: Radiation protection for pediatric patients is the main concern in pediatric computed tomography (CT) due to their sensitive organs, such as the brain and the thyroid glands. Accordingly, an optimization of pediatric CT practices is vital to minimize the radiation dose for this population. Aim: To assess the pediatric CT practices of radiologists and technologists in a CT unit. Materials and Methods: The study was conducted among 26 hospitals, located in various regions in Saudi Arabia. A total of 200 hard copies of the questionnaire were distributed manually and were collected for analysis. In total, 117 completed surveys were gathered from technologies, while 49 were gathered from radiologists. Results: In the case of infants with hydrocephalus, 65% of the radiologists ordered an ultrasound (US), 24% ordered a head CT scan, and 10% ordered a magnetic resonance imaging (MRI) and general X-ray for diagnosis. For pediatric patients complaining of persistent headache, 59% and 27% of the radiologists recommended CT and MRI, respectively, for diagnosis. Conclusion: Most of the radiologists utilize CT head scan to diagnose persistent headache (by 59%) and ventriculoperitoneal shunt (VPS) malfunction (by 41%) in pediatric patients compared with the other modalities. The use of CT can increase the risk of later malignancy among pediatric patients due to radiation exposure. Alternative imaging modalities such as US and MRI (non-ionized radiation) should be considered to reduce the ionizing radiation hazards and optimize the current practices of radiologists. Most of the technologists follow radiation protection protocols in this study as 63% of the technologists used lead apron for pediatric patient's protection. Radiation awareness training for the technologists could improve the knowledge about the benefits of using lead apron and reduce the radiation risks in pediatric patients.

Geo-environmental approach to assess heavy metals around auto-body refinishing shops using bio-monitors.

The vehicular industry is looking for continuous challenges to develop the sustainability of its manufacturing, maintenance processes, and vehicle emissions due to marketability, environmental, economic, and policy concerns. The present study focuses on the impact of these processes on the environment. In Pakistan, most of the auto-body refinishing processes are carried out in an open atmosphere. The shades of Azadirachta indica (Neem Tree) are generally used for the outdoor practice of scrapping, grinding, and painting in auto-body refinishing shops of Pakistan. Azadirachta indica leaves were selected as bio-indicator. For the present work, 26 affected sites and 10 control sites were selected from Karachi city, which is the financial hub and biggest city of Pakistan. Concentrations of different metals (Fe, Co, Cd, Cr, Cu, Mn, Mo, Ni, Pb, and Zn) were determined by atomic absorption spectrophotometer. A geographic information system (GIS) is used to present the variation in concentrations within Karachi city. The only positive correlation was observed in Pb and Mn (0.750). Principal component analysis (PCA) is applied to identify the anthropogenic effect between auto-body refinishing areas and control areas. Almost all analyzed metals show higher concentration at affected sites but Pb (87.14 mg/kg), Mn (46.47 mg/kg) and Fe (146.95 mg/kg) were leading the values, as compared to their concentration at control sites, Pb (48.83 mg/kg), Mn (15.23 mg/kg) and Fe (43.07 mg/kg). All analyzed metals are frequently present in different color pigments, whereas Pb, Mn, and Fe may also come from other sources, like the anti-knocking agent, vehicular exhaust, and scraping of car surface.

Effect of COVID-19 on control of T1DM patients in Aseer region of Saudi Arabia.

BACKGROUND: The novel corona virus disease, also known as COVID-19, has emerged as a major health concern globally. Its association with comorbid condition has increased its mortality. Diabetes mellitus (DM) is associated with increased risk of infection in comparison to general population. This risk is higher in type 1 DM that type 2 DM. METHODS: A cross sectional study was done in T1DM patients in whom a structured questionnaire was administered after lockdown. Data regarding social demographical variables, Information regarding sugar levels, psychological effects, changes in weight, exercise habits and other variables were included in the validated, electronic questionnaire. Ethic approval was obtained from the Diabetic center Abha, study duration was from January-2020 to October-2020. RESULTS: Out of 143 total patients (46.9%) were males while 53.1% were females. Mean ± S.D of age was obtained 29.6 ± 1.8. [Figure 1] depicted that 23% of the respondents were effected psychologically. [Figure 2] depicted that 80.4% used insulin as a treatment. [Figure 3] depicted that 8% of the respondents make an emergency visit to the health care centers for high rise in diabetes during lockdown. CONCLUSION: COVID-19 and the lockdown affected the management of T1DM. It resulted in changes in lifestyle, compliance to medication, and psychological impact on the participant.

Use of Geophysical and Remote Sensing Data for Assessment of Aquifer Depletion and Related Land Deformation.

An integrated approach [field, Interferometric Synthetic Aperture Radar (InSAR), hydrogeology, geodesy, and spatial analysis] was adopted to identify the nature, intensity, and spatial distribution of deformational features (sinkholes, fissures, differential settling) reported over fossil aquifers in arid lands, their controlling factors, and possible remedies. The Lower Mega Aquifer System (area 2 × 106 km2) in central and northern Arabia was used as a test site. Findings suggest that excessive groundwater extraction from the fossil aquifer is the main cause of deformation: (1) deformational features correlated spatially and/or temporally with increased agricultural development and groundwater extraction, and with a decline in water levels and groundwater storage (- 3.7 ± 0.6 km3/year); (2) earthquake events (years 1985-2016; magnitude 1-5) are largely (65% of reported earthquakes) shallow (1-5 km) and increased from 1 event/year in the early 1980s (extraction 1 km3/year), up to 13 events/year in the 1990s (average annual extraction > 6.4 km3). Results indicate that faults played a role in localizing deformation given that deformational sites and InSAR-based high subsidence rates (- 4 to - 15 mm/year) were largely found within, but not outside of, NW-SE-trending grabens bound by the Kahf fault system. Findings from the analysis of Gravity Recovery and Climate Experiment solutions indicate that sustainable extraction could be attained if groundwater extraction was reduced by 3.5-4 km3/year. This study provides replicable and cost-effective methodologies for optimum utilization of fossil aquifers and for minimizing deformation associated with their use.

Dental implants and grafting success remain high despite large variations in maxillary sinus mucosal thickening.

BACKGROUND: Although mucosal thickening is the most common radiographic finding observed regarding sinus pathology, the knowledge regarding its clinical significance on the outcomes of dental implants and grafting in the maxillary sinuses is still limited. We hypothesized that mucosal thickening would not alter the predictability for sinus floor augmentation and dental implant placement. The purpose of this retrospective study was to evaluate the outcomes of dental implant placement in sinus-augmented areas with preexisting sinus mucosal thickening. METHODS: This study involved the review of cone-beam computed tomographic (CBCT) scans taken on patients that underwent both maxillary sinus elevation with grafting and implant placement at the University of Michigan School of Dentistry from 2004 to 2014. Cases with documented radiographic and clinical follow-up were included. The data analyses revealed the following. RESULTS: A total of 29 CBCT scans met the inclusion criteria for evaluation, and 93.1% of them had maxillary sinus mucosal/tissue thickening. Specifically, 6.9% of cases exhibited no thickening, 6.9% had minimal thickening (1-2 mm), 20.7% of cases had moderate thickening (2-5 mm), and 65.5% had severe thickening (>5 mm). We propose these categorical measurements of tissue thickening as a new "mucosal thickening index." The tissue thickening did not vary based on gender, age, or smoking status, nor did it relate to the underlying alveolar ridge height. However, patients with a history of periodontal diseases demonstrated a significant association with mucosal thickening (p = 0.0043). These data indicate that there is high implant and grafting success rate (100%) in the maxillary sinus despite large and varied physiologic sinus mucosal/tissue thickening. CONCLUSIONS: Based on study findings, this research will help guide dental practitioners regarding cases that exhibit mucosal thickening. These data support the concept that physiologic mucosal thickening in varied ranges is not associated with implant or grafting failure in the maxillary sinus.

Incidental Findings From Cone-Beam Computed Tomography During Implant Therapy.

INTRODUCTION: This report reviews relevant literature on foreign bodies identified with cone-beam computed tomography (CBCT) and documents a rare case of a foreign body that was serendipitously identified during routine implant treatment planning. CASE PRESENTATION: The literature shows a frequent occurrence of incidental findings with CBCT. This case documents incidental findings in the maxillary sinus and external auditory canal that were identified during routine CBCT used for implant treatment planning. The finding in the maxillary sinus was diagnosed as a mucous retention pseudocyst that did not require treatment. The finding in the external auditory canal was diagnosed as a foreign body (remnant of a cotton swab). Removal of the foreign body was prompted because of its presumed association with chronic headaches that were unresolved. Removal of the foreign body alleviated the chronic headaches, and implant placement proceeded uneventfully. CONCLUSIONS: This review and case underscore the importance of a thorough review of the entire tomographic image volume. Using advanced technology for treatment creates new responsibilities and places more liability on providers not to overlook findings that may be significant to the patient's health.

Effectiveness of Laser Application for Periodontal Surgical Therapy: Systematic Review and Meta-Analysis.

BACKGROUND: Evidence has shown some improved clinical outcomes and morbidity reduction with the use of lasers for non-surgical periodontal therapy due to ablation, vaporization, hemostasis, and field sterilization. The purpose of this systematic review is to evaluate and compare studies involving lasers as monotherapy or adjunctive to surgical periodontal treatment. METHODS: Electronic and manual searches were conducted by two independent reviewers in several databases for articles written in English up to December 2014. Articles were included in this review if they reported outcomes of surgical periodontal therapy with and without the use of lasers. The primary outcome was probing depth (PD), and secondary outcomes were measured changes in clinical factors such as clinical attachment level (CAL) and gingival recession (GR). For the comparative studies included, the pooled weighted mean difference (WMD) and 95% confidence interval (CI) of each variable were calculated using random-effects meta-analysis. RESULTS: Eight and nine articles were included in the quantitative and qualitative analyses, respectively. Although low-to-moderate risk of bias was detected, high heterogeneity among studies was found. In flap surgery with or without laser treatment, there was no statistically significant difference in primary outcome. Similarly, in guided tissue regeneration (GTR)/enamel matrix derivative (EMD) with and without laser treatment, the WMD of PD was negligible; however, the GTR/EMD group showed better outcomes (P = 0.005) than the laser group. Regarding the secondary outcomes, in the flap surgery group, the WMD of CAL gain was 1.34 mm, and the WMD of GR was -0.24 mm; no significant difference was detected between groups. In GTR/EMD with and without laser treatment, the WMD of CAL gain was 0.10 mm and the WMD of recession was -0.18 mm; again, no significant difference was detected between groups. CONCLUSIONS: The available evidence is insufficient to support the effectiveness of dental lasers as an adjunct to resective or regenerative surgical periodontal therapy. However, precautions must be exercised when interpreting the results of this study because of the small sample size and high heterogeneity among studies.

Effect of oxidative stress on the expression of thin filament-associated proteins in gastric smooth muscle cells.

Thin filament-associated proteins such as calponin, caldesmon, and smoothelin are believed to regulate acto-myosin interaction and thus, muscle contraction. Oxidative stress has been found to affect the normal contractile behavior of smooth muscle and is involved in the pathogenesis of a number of human diseases such as diabetes mellitus, hypertension, and atherosclerosis. However, very little is known about the effect of oxidative stress on the expression of smooth muscle contractile proteins. The aim of the current study is to investigate the effect of oxidative stress on the expression of thin filament-associated proteins in rat gastric smooth muscle. Single smooth muscle cells of the stomach obtained from Sprague-Dawley rats were used. Muscle cells were treated with hydrogen peroxide (H2O2) (500 µM) for 30 min or the peroxynitrite donor 3-morpholinosydnonimine (SIN-1) (1 mM) for 90 min to induce oxidative stress. Calponin, caldesmon, and smoothelin expressions were measured via specifically designed enzyme-linked immunosorbent assay. We found that exposure to exogenous H2O2 or incubation of dispersed gastric muscle cells with SIN-1 significantly increased the expression of calponin, caldesmon, and smoothelin proteins. In conclusion: oxidative stress increases the expression of thin filament-associated proteins in gastric smooth muscle, suggesting an important role in gastrointestinal motility disorders associated with oxidative stress.

Structural study of polymorphs and solvates of finasteride.

NMR and XRD data are reported for several new forms of finasteride, including the results of complete structure determinations for three solvates. Form III of finasteride, hitherto only mentioned in the patent literature, and a new anhydrous form designated Form X, have been found in mixtures of polymorphs and their (13)C NMR chemical shifts obtained. The results demonstrate that the crystallographic asymmetric units contain three molecules and one molecule, respectively. Attempts to reproduce "Form H1", as described in a patent, resulted in a new IPA solvate hydrate. The previously-reported acetic acid, dioxane, and ethyl acetate solvates have been further characterised, and new THF and diethyl ether solvates prepared and characterised. The crystal structures of the dioxane, IPA, and THF solvates have been determined by single-crystal X-ray diffraction. All the solvates (except the acetic acid case) are found to be hemihydrates, to have a finasteride: solvent molar ratio of 2:1 and to have a common structure. The solvate molecules are highly disordered and sited in channels in the structure. The powder XRD patterns are characteristic of the common structure. These solvates may be distinguished by the characteristic CPMAS (13)C signals from the solvent molecules, but the resonances of the host finasteride structures differ only marginally, and powder XRD patterns are almost indistinguishable. Magic-angle spinning (MAS) proton spectra give sharp lines for the solvent peaks, confirming their high degree of mobility. This is further shown in one case by direct polarisation (13)C spectra. Mobility of the tert-butyl group is also implied. Thermal characteristics have been studied and TGA used (in conjunction with solution-state proton NMR) to estimate molar ratios.

Clinical measurement of proprioceptive function after anterior cruciate ligament reconstruction.

OBJECTIVE: Proprioception is very important for the integrity and stability of the knee joint. Patients with anterior cruciate ligament (ACL) tear have a decline in proprioceptive functions of the injured knee. However, improvement of proprioceptive functions of the knee after ACL reconstruction is a subject of considerable debate. This study was conducted to evaluate the results of a simple clinical proprioception test developed by the author in patients with ACL reconstructed knees. METHODS: This study was conducted in King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia, from January 1996 to June 2002. The proprioceptive function of the knee joint was studied in a group of ACL reconstructed patients (n=22) and compared them with a group of ACL deficient patients (n=32) and a group of healthy controls (n=30). Proprioception was evaluated based on the performance in a simple clinical test. RESULTS: There was a significant difference in proprioceptive functions between the ACL deficient knees and the ACL reconstructed group (p<0.05), but there was no significant difference between the ACL reconstructed and the normal control group (p>0.05). CONCLUSION: These findings indicate that proprioceptive deficits in ACL deficient knees, as measured clinically using the described test, might improve after ACL reconstruction.

Assessment of nosocomial urinary tract infections in orthopaedic patients: a prospective and comparative study using two different catheters.

Catheter-related nosocomial urinary tract infection in postoperative orthopedic and trauma patients was studied prospectively using nitrofuroxone-impregnated urinary catheters (study group) and regular silicone-coated Foley catheters. Fifty adults in each group were randomly assigned. In Group A, antibiotic-impregnated catheters were used, and in the other, non-antibiotic-impregnated urinary catheters were used (Group B). The variables studied were age, sex, type of surgery, duration of surgery, number of catheter days, days of intravenous line, and hospital days. In patients, urinary tract infection (UTI) was diagnosed by culture and the organism was isolated. The average age in the study group was 43.90 years (range, 14-95 years) compared with the control group (mean age, 42.22 years; range, 14-102 years). Catheter days in the nitrofuroxone-impregnated catheters was 7.9 days (range, 2-37 days) versus 7.2 days (range, 2-30 days). The intravenous line in the group was 9.16 days (range, 2-35 days) versus 8.8 days (2-22 days). There were six infections (P = 0.028) in the control group compared with the study group. The length of operation was similar in each group. Our study indicates that nitrofuroxone-impregnated catheters have the potential to reduce nosocomial catheter-related UTIs in postoperative orthopedic and trauma patients.

Honey potentiates the gastric protection effects of sucralfate against ammonia-induced gastric lesions in rats.

BACKGROUND: Natural honey is widely used all over the world as a complementary and alternative medicine in various disorders including gastrointestinal lesions. AIM: To evaluate the effects of combination of low dosage of honey (0.312 g/kg) and sucralfate (0.125 or 0.250 g /kg) on gastric protection and to determine any potentiating interactions between them against ammonia-induced gastric lesions in rats. MATERIAL AND METHODS: Twenty-four hours fasted rats were given I ml of ammonium hydroxide 1 % intragastrically and they were killed one hour later under deep ether anesthesia. The gastric lesion index was calculated according to the method of Takaishi et al 1998. Non protein sulthydryls level was determined spectrophotometrically as described by Sedlak and Lindsay 1968. RESULTS: Administration of ammonium hydroxide produced red and black linear lesions and significant depletion of gastric nonprotein sulthydryls level. Oral administration of honey (0.312g/kg) or sucralfate (0.125 and 0.250 g/kg) 30 min before ammonium hydroxide reduced the severity of gastric mucosal lesions by 1 I or 18 and 42 % respectively, and has shown the changes in nonprotein sulfhydryls level induced by ammonium hydroxide. Furthermore, pretreatment with a combination of a low dose of honey (0.312 g /kg) and sucralfate (0.125 g or 0.250 g/kg) afforded significantly greater protection (58 and 77 %) than that obtained with either of them administered alone. CONCLUSION: The present results suggest potentiation of gastric protection effect of sucralfate by honey and this may have a clinical value in the treatment of peptic ulcer diseases in Helicobacter pylori positive patients.