Left ventricle pedunculated thrombi risks and outcomes: a case report and literature review / Riscos e desfechos de trombos pedunculados no ventrículo esquerdo: relato de caso e revisão da literatura

Abstract A 42-year-old male with ischemic cardiomyopathy presented with acute bilateral femoral artery embolization. After management with embolectomy and fasciotomy in both femoral arteries, transthoracic echocardiography revealed two pedunculated highly mobile left ventricle (LV) thrombi. Given the procedural risk, anticoagulation therapy was recommended over surgery. However, the bleeding risk impeded the continuation of anticoagulation, which increased the thrombus size. Multiorgan failure and disseminated intravascular coagulopathy followed and the patient died. We also systematically reviewed the PubMed and Scopus databases for pedunculated LV thrombi cases and retrieved 74 and 63 reports respectively. Of these, 37 relevant reports (45 cases) plus 11 reports from the manual search were included for data extraction, a total of 56 cases besides our case. Based on the etiologies and risks, LV thrombi are predictable and preventable, especially after ischemic events. A clear diagnostic algorithm and vigilant follow-up are needed as well as multidisciplinary management once a diagnosis is confirmed.

Resumo Relatamos o caso de um homem de 42 anos com cardiomiopatia isquêmica que apresentou embolização aguda bilateral das artérias femorais. Embolectomia das artérias femorais e fasciotomia foram realizadas bilateralmente e, posteriormente, o ecocardiograma transtorácico revelou a presença de dois trombos pedunculados altamente móveis no ventrículo esquerdo (VE). Diante do risco associado à abordagem cirúrgica, recomendou-se terapia anticoagulante. No entanto, o risco de sangramento impediu a continuação da anticoagulação, o que levou ao aumento dos trombos. Posteriormente, o paciente evoluiu com falência de múltiplos órgãos e coagulação intravascular disseminada, vindo a óbito. Além do relato de caso, realizamos buscas sistemáticas nas bases de dados PubMed e Scopus por casos de trombos pedunculados no VE. Foram recuperados 74 e 63 relatos, respectivamente, dos quais 37 relatos relevantes (45 casos) e 11 da busca manual foram selecionados para extração de dados, totalizando 56 casos além do nosso. Com base nas etiologias e nos riscos, os trombos no VE são previsíveis e evitáveis, especialmente após eventos isquêmicos. Isso requer um algoritmo diagnóstico claro e acompanhamento vigilante, bem como manejo multidisciplinar após confirmação do diagnóstico.

A Single Centre Open Label Non-Randomized Phase-IV Post Marketing Surveillance Study to Evaluate the Efficacy and Safety of Roop Mantra Ayurvedic Medicinal Cream

Objectives: The objective of the study was to evaluate the efficacy and safety of a polyherbal Roop Mantra Ayurvedic Medicinal Cream in subjects with acne, facial scars, pimples, blemishes, dull and dry skin. Methods: This was a 60-day, single-centre, open-labelled, non-randomized phase-IV surveillance study with 120 subjects. Subjects were selected based on the study's inclusion criteria. The study included three scheduled clinical visits on days 0 (screening and baseline visit), 30 (follow-up visit), and 60 (final visit). Following an evaluation of baseline data, all subjects were given Roop Mantra Ayurvedic Medicinal Cream for 60 days. The primary outcome of the study was to assess the efficacy of Roop Mantra Ayurvedic Medicinal Cream based on changes in parameters such as skin texture, skin health, global acne assessment parameters and an investigator assessment scale. The secondary outcome of the study was the determination of local intolerance and adverse effects to Roop Mantra Ayurvedic Medicinal Cream . Results: The study findings revealed that the use of Roop Mantra Ayurvedic Medicinal Cream for 60 days improved skin texture and appearance while significantly reducing acne, pimples, blemishes, and skin dryness. Roop Mantra Ayurvedic Medicinal Cream was likewise dermatologically well tolerated and did not cause any adverse effects during the study period. Conclusion: Roop Mantra Ayurvedic Medicinal Cream showed highly satisfactory results in terms of skin texture, skin appearance and general acne parameters without having any adverse effects on the skin. Given the positive outcomes, Roop Mantra Ayurvedic Medicinal Cream is clinically effective and safe alternative for treating various skin problems.

Relationship of Dental Caries and Body Mass Index amongst School Children in Hail, Saudi Arabia: A Cross-Sectional Study

ABSTRACT Objective: To determine caries prevalence and its association with body mass index in school children between 9-12 years of age in Hail, Saudi Arabia. Material and Methods: This descriptive cross-sectional study included 524 school children 9-12 years of age. These children were selected from 9 Public schools in Hail Province. Dental caries was recorded as per criteria established by the World Health Organization using assessment form for children 2013. Children were weighed using an electronic scale nearest to 0.1 kg with children attired in light clothing and wearing no shoes. The height was measured using a stadiometer to the nearest full centimeter with the children in a standing position. Body Mass Index (BMI) was determined using the formula BMI = kg/m2. Results: Caries prevalence in the population was 86%. The comparisons of mean DMFT between the groups demonstrate higher scores in the overweight group (mean=2.43) compared to normal weight (mean=1.85) and underweight children (mean=1.56) which is statistically significant (p=0.000). Bonferroni Post hoc test to compare the underweight and overweight group (p=0.000) and overweight and normal weight (p=0.000) were highly significant. Conclusion: A positive correlation of caries severity, namely DMFT, with BMI is established.

Survival Outcomes and Patterns of Failure in Maxillary Alveolus Squamous Cell Carcinoma

Abstract Introduction Squamous cell carcinoma (SCC) of the maxillary alveolus is a relatively rare disease. There is lack of data on this subsite as compared with other sites. The factors that affect survival in cases of maxillary alveolar SCC are tumor stage, local and cervical metastases, histological grading, and the margin status. Objectives To evaluate the overall survival (OS), the disease free survival (DFS), and the complex interaction and effects of margin status, histological differentiation, habits (such as smoking and the use of smokeless tobacco products), and cervical and distant metastases based on clinicopathological data. Methods We examined the electronic database at our hospital from 2003 to 2017. We included all cases with a histopathological diagnosis of SCC of the maxillary alveolus. Tumors originating primarily from the maxillary alveolus were included, while those originating from adjacent subsites, like the hard palate, the buccal mucosa or the maxillary sinus were excluded. We also excluded all the patients who were not operated on with a curative intent. Results More than half of the patients had stage-IV tumors at the time of presentation, while only one fourth of them had nodal metastasis. The rate of recurrence increased in cases of primary tumors in advanced stages and the degree of histological differentiation. The 2-year and 5-year OS rates were of 54.5% (18 patients) and 30.3% (10 patients) respectively. Conclusion Primary tumors in advanced stages, histological grade, and presence of nodal metastasis are poor prognostic markers in terms of long-term survival.

Assessment of Variation in Clinical Presentation of Visceral Leishmaniasis Among Patients Attending the Tropical Diseases Teaching Hospital in Sudan

Background: Visceral leishmaniasis (also known as Kala-azar) is a systemic parasitic infection with many clinical presentations. The present study assesses the variation in presentations among patients who attended the Tropical Diseases Teaching Hospital (TDTH) in Khartoum, Sudan. Methods: This analytical cross-sectional, hospital-based study was conducted at the TDTH between November 2019 and September 2020. Medical records of patients who presented at the TDTH were reviewed using a structured data extraction checklist. The Chi-square test was used to determine the associations between sociodemographic and clinical presentations of patients. P-value < 0.05 was considered as statistically significant. Results: Out of 195 patients, 79.5% were male and 48.2% were <31 years old. Fever was the main clinical presentation (90.2%) while 53.3% presented with weight loss and 72.3% and 39% presented, respectively, with splenomegaly and hepatomegaly. HIV was detected in 4.6% of the patients. RK39 was the main diagnostic test. We found a significant association between the abdominal distention and the age of the patients (P < 0.05) ­ age groups 11­20 and 41­50 years were more likely to present with abdominal distention than other age groups. Conclusion: There is no exact clinical presentation or routine laboratory findings that are pathognomonic for visceral leishmaniasis; therefore, it should be considered in the differential diagnosis of any patient with fever, weight loss, and abdominal distention, and among patients with HIV.

Chemical profile, anti 5-lipoxygenase and cyclooxegenase inhibitory effects of ginger (Zingiber officinale) rhizome, callus and callus treated with elicitors / Perfil químico, anti-5-lipoxigenase e efeitos inibitórios da ciclooxegenase do rizoma de gengibre (Zingiber officinale), do calo e calos tratados com elicitores

The present study investigated the chemical profiles and evaluated the inhibitory effect against 5-Lipoxygenase (5-Lox) activity for extracts of ginger rhizome, callus, and callus treated with the elicitors; yeast extract (100, 300 and 500 mg/L), glycine (100, 200 and 300 mg/L) and salicylic acid (100 and 200 mg/L). Oils and chloroform: methanol (CM) extracts were prepared by maceration in petroleum ether and CM (1:1, v/v), respectively. Chemical profiles were determined by gas chromatography/mass spectrometry (GC/MS) analysis. Oil of the callus recorded higher 5-Lox inhibitory effect (IC50 58.33±4.66 µg/mL) than the oil of rhizome (IC50168.34±15.64 µg/mL) and comparable to that of the positive control; Nordihydroguaiaretic acid (IC50 61.25±1.02 µg/mL). The chemical profile of the callus oil contained large amounts of fatty acids, mainly the unsaturated fatty acid oleic acid (31.11%) and saturated fatty acid palmitic acid (28.56%). Elicitors modified the chemical profile of the callus and ameliorated the anti-5-Lox activity of CM extract of the callus. CM extracts of callus treated with 100 and 300 mg/L yeast extract and 50 mg/L salicylic acid significantly suppressed (P ≤ 0.05) the 5-Lox activity by 33.16%, 25.46% and 16%, respectively as compared to the CM extract of untreated callus. In conclusion, ginger callus could be considered as a valuable dietary supplement in the treatment of various inflammatory disorders.

O presente estudo teve como objetivo investigar os perfis químicos e avaliar o efeito inibitório da atividade da 5-Lipoxigenase (5-Lox) em extratos de rizoma, calo e calo de gengibre tratados com os eliciadores; extrato de levedura (100, 300 e 500 mg / L), glicina (100, 200 e 300 mg / L) e ácido salicílico (100 e 200 mg / L). Extratos de óleos e clorofórmio: metanol (CM) foram preparados por maceração em éter e CM (1: 1, v / v), respectivamente. Os perfis químicos foram determinados por análise de cromatografia gasosa / espectrometria de massa (GC / MS). O óleo do calo registrou maior efeito inibitório de 5-Lox (IC50 58,33 ± 4,66 µg / mL) do que o óleo de rizoma (IC50168,34 ± 15,64 µg / mL) e comparável ao do controle positivo; Ácido nordi-hidroguaiarético (IC50 61,25 ± 1,02 µg / mL). O perfil químico do óleo de calo continha grandes quantidades de ácidos graxos, principalmente o ácido graxo insaturado ácido oleico (31,11%) e ácido graxo saturado palmítico (28,56%). Os elicitores modificaram o perfil químico do calo e melhoraram a atividade anti-5-Lox do extrato de CM do calo. Extratos de CM de calos tratados com 100 e 300 mg / L de extrato de levedura e 50 mg / L de ácido salicílico suprimiram significativamente (P ≤ 0,05) a atividade de 5-Lox em 33,16%, 25,46% e 16%, respectivamente, em comparação com o extrato de CM de calo não tratado. Em conclusão, o calo de gengibre pode ser considerado um suplemento dietético valioso no tratamento de vários distúrbios inflamatórios.

Improving micropropagation of some grape cultivars via boron, calcium and phosphate

BACKGROUND: An efficient regeneration protocol is a priority for the successful application of plant biotechnology. Grape nodal explants were used to develop a micropropagation protocol for Thompson Seedless and Taify cvs. Explants were cultured on MS medium supplemented with Kinetin or benzylaminopurine (BA) and indolebutyric acid (IBA). RESULTS: For both cultivars, axillary buds were grown, only, on a medium enriched with kinetin, moreover, shoot tip necrosis and callus formation were observed on Thompson Seedless cv. cultures grown on a medium with BA. Supplementing the growth medium with 100 mM (boron) B and 2.5 mM (calcium) Ca successfully help overcome these phenomena. The highest regenerated shoot numbers (14 and 6.2 explant 1 ) for Taify and Thompson Seedless cvs., respectively, were on media supplemented with 13.2 mM BA + 4.9 mM IBA and BA 13.2 mM + 5.8 mM IBA, respectively. Moreover, these media supported the developing shoots to have the heaviest dry weights (1.46 and 0.72 mg explant 1 ) for Taify and Thompson Seedless cvs., respectively. Thompson Seedless cv. regenerated shoot numbers and their dry weights were significantly increased by increasing the MS medium PO4 concentration. However, these two parameters were significantly decreased for Taify cv. Developing shoots were elongated and rooted on MS medium enriched with 4.9 mM, IBA 100 mM B and 2.5 mM Ca. Plantlets were acclimatized and successfully transferred to the greenhouse conditions. CONCLUSIONS: A novel promising protocol for Thomson Seedless and Taify cvs. micropropagation using single nodes has been developed.

Prognostic Value of Urine Albumen/Creatinin Ratio in Sepsis in Critical Care Patients

Several scoring systems were developed for prognosis and outcome prediction in sepsis.This study aims to evaluate the urinary albumin/creatinine ratio(ACR)as a prognosticp redictorinsepsis.The study included 50 adult septic patient sinapros pectiveobser vational study. Study excluded patients with preexisting chronic kidney disease or diabetes mellitus. After clinical evaluation, urine spot samples were collected on admission and 24h later for ACR1 and ACR2.Admission APACHEIVscoreandthehighestrecordedSOFAscoreoftheirdailyestimationwereconsidered.Thisstudyalsoevaluatedtheneedformechanicalventilation,inotropicorvasoactivesupport,renalreplacementtherapy(RRT),andin-hospitalmortality.InapopulationwithMean±SD51.4±16.3(19-82)yearoldwith34(68%)males,wefoundthattheACR2iscorrelatedwithbothAPACHEIVandSOFAscores(P<0.001).ACR2washigherinpatientswhoneededmechanicalventilationandinotropicorvasoactivesupport[121(21-235)and166.5(89-235)mg/grespectively]comparedto[49(22-120)and56.5(21-211)mg/g],P<0.001inboth.ΔACR,ACR2,increasing AC Rand APACHEIVwerepredictorsofmortality.TheAUCformortalitypredictionwaslargestforΔACR(1),increasingACR(0.985),ACR2(0.963)thenAPACHEIV(0.90).∆ACRandACR2of91.5mg/gand-22was88.2%&100%sensitiveand90.9%&100%specificrespectivelytopredictmortality.WeconcludedthattheurinaryACRmightbeusedasasimpletestforprognosisandmortalitypredictioninsepsis

Functional Gait Parameters As Objective Assessment Tools In Patients With Chronic Low Back Pain: A Case Study

We report a 38 yrs old patient with a previously diagnosed Chronic Low Back Pain who became severely functionally impaired as evidenced by the Oswestry Disability Questionnaire (56%). The aim of this study was to introduce changes in functional gait parameters as an assessment tool before and after a single session of Kinesiotape application in a patient with chronic LBP. We introduced, for the first time, gait parameters including the 10-meter walk test and the 6-minute walk test as the functional gait parameters of interest. There was (1) a 25% & 36% increase in normal walking speed and fast walking speed, respectively as evidenced by the 10MWT with 72% decrease in pain and (2) a 86% increase in walking tolerance as evidenced by the 6MWT with 88% decrease in pain. Our data demonstrated for the first time the possible effective use of gait assessment as objective motor performance measures to assess the therapy-induced improvement following therapeutic intervention in patient with chronic low back pain. We hope that these data will act as a starting point for further research to test the potential gait assessment measures to provide a more in-depth objective assessment in response to rehabilitation therapies in chronic low back pain patients.

A Survey to Assess Osteoporosis Knowledge of the General population of Riyadh, Saudi Arabia

Background: Osteoporosis refers to a disorder of the skeletal tissues that affect the density and quality of thebone. In most communities, the disorder is known to affect up to half of the population of women aged above 50years, while affecting up to 205 of men of the similar age. Various research studies have however revealed thatthe majority of people are usually not aware of this condition. Normally, fractures resulting from osteoporosiscan lead to disability, premature mortality or poor quality of life.This study therefore aims to assess the knowledgeand awareness among adult residents of Riyadh in the Kingdom of Saudi Arabia regarding osteoporosis and itsrisk factors. Methods: This study was a cross-sectional, data was collected among adult residents in Riyadh inSaudi Arabia. It used stratified random sampling method for the selection of the study population. For the datacollection, the study used a pre-coded self-administered questionnaire. It used SPSS software version 20 in datamanagement and analysis. Results: 385 completed the survey through the questionnaires, 41.8% were females,and 58.2% were males. From the chi-square analysis, we failed to reject the null hypothesis that there is noassociation between gender and awareness of risk factors associated with osteoporosis. Conclusion: Althoughvarious research studies have asserted that awareness of risk factors associated with osteoporosis is mostworrisome compared to other elements such as attitude and preventive measures, this study deduces thatawareness does not depend on gender or age. Instead, it agrees with assertions from other studies, which indicatethat awareness is positively correlated with levels of education.

Preferred characterization of orbital infection (cellulitis) with exposure dose and relative medication

Background: A retrospective study presenting the endemic orbital infection (cellulitis) that breakout during dusty storm season; aiming to ascertain and showing the precedence of MRI for diagnosis of orbital infection rather than CT and revealing the diagnostic abilities of cross-sectional matrices spectrum.Methods: Based on retrospective collection of diagnostics (CT and MRI) information for randomly selected patients with cellulitis and the targeting the relevant data (image interpretation, exposure dose (DLP and CTDIvol), age, BMI and matrix cross-section spectrum findings).Results: The exposure dose of orbital CT exam was 59.4 (mGy) as CT dose index (CTDIvol) and 917.3 (mGy/cm) as dose length product (DLP) that increase by increment of age and BMI. The obese patients only exposed to dose exceeding the National Diagnostic Reference by 2.8%. MRI confirmed the inflammation around the optic nerve and extension to posterio-inferior portion of the globe and affecting the optic nerve with left sided proptosis (0.5cm) better than CT. The cross-sectional matrix successfully revealed that: the Lt optic nerve’s gray value (density) increases by a factor of 17.7 (a u) and enlarged by 5 pixels greater than the Rt optic nerve. Thickening, rough surface increased gray value by 30.5 (a u), muco-thickening and choncheal enlargement at the medial boarder of Lt orbit as 10.0 pixel and Lt eye ball enlarged by a factor of 10.9 pixels.Conclusions: MRI wisely diagnose orbital infection with more details and overcoming patient radiation exposure and usage of image spectrum gives detailed characterization of lesion morphology.

The effect of high fat dietary modification and nutritional status on the outcome of critically ill ventilated children: single-center study / 소아과

BACKGROUND: Ventilator dependency constitutes a major problem in the intensive care setting. Malnutrition is considered a major determinant of extubation failure, however, attention has been attracted to modulating carbon dioxide production through decreasing carbohydrate loading and increasing the percent of fat in enteral feeds. The detected interrelation between substrate oxidation and ventilation outcome became the base of several research to determine the appropriate composition of the nonprotein calories of diet in ventilated patients. PURPOSE: We aimed to assess the effect of high-fat dietary modification and nutritional status on ventilatory and final outcomes of pediatric intensive care. METHODS: Fifty-one ventilated children (1 month to 12 years of age) with pulmonary disease who could be enterally fed, in the Cairo University Pediatric intensive care unit, were divided into 2 groups: group A included 25 patients who received isocaloric high-fat, low-carbohydrate diet; group B included 26 patients who received standard isocaloric diet. Comprehensive nutritional assessment was done for all patients. RESULTS: Group A had a significant reduction in carbon dioxide tension, but no similar reduction in the duration or level of ventilatory support. Assisted minute ventilation was predicted by weight-for-age and caloric intake rather than the type of diet. Poor nutritional status was associated with higher mortality and lower extubation rates. Mild hypertriglyceridemia and some gastrointestinal intolerance were significant in group A, with no impact on the adequacy of energy or protein delivery. CONCLUSION: The high-fat enteral feeding protocol may contribute to reducing carbon dioxide tension, with mild hypertriglyceridemia and negligible gastrointestinal intolerance as potential adverse effects. Optimization of nutritional status rather than dietary modification may improve ventilatory and survival outcomes in critically ill-ventilated children.

Clomiphene citrate and metformin" stair step" protocol vs. traditional protocol in patients with polycystic ovary syndrome "PCOS"

Background: Clomiphene citrate is the most popular drug for ovulation induction mainly in cases of PCOS, used alone or with combination of other drugs e.g. metformin

Aim: To evaluate the efficacy of stair step protocol versus traditional protocol using clomiphene citrate alone or combined with metformin and to assess the uterine and systemic side effects of cumulative doses in single cycle

Patient and Methods: Sixty [60] patients in two groups diagnosed as PCOS, based on the revised Rotterdam criteria [2003], *Group 1: In the stair-step protocol [n = 30], Clomiphene Citrate was administered at 50 mg daily for 5 days following the onset of a spontaneous or progestin- induced menses. The follicular response monitored by TVS starting on day 8. When the mean diameter of the follicle size is below 11mm on cycle day 14, the dosage increases to 100 mg/day for 5 days. Then on cycle day 19 re-evaluation by TVS was restarted. Metformin with initial dose 500mg/day [and gradually increased to 1,500 mg /day during 6 weeks].**Group 2: In the traditional protocol [n = 30], Clomiphene citrate was administered 100 mg daily for 5 days after the onset of spontaneous or progestin-induced menstruation. The following variables were measured: ovulation rate [The number of follicles that mature and ovulate during given menstrual cycle], Side effects on uterine artery and systemic side effects e.g. Hot flushes

Results: The findings of this study indicated no significant difference between the 2 groups in using clomiphene citrate by stair step protocol or traditional protocol [P>0.05]

Conclusion: Clomiphene citrate in the stair step protocol combined with metformin has a higher efficacy compared to CC in the traditional protocol in patients with PCOS in terms of ovulation and clinical pregnancy rates without any detrimental side effects on endometrial thickness or Doppler of uterine arteries, stair step protocol suitable for use in clinical practice

study of sexual dysfunction in a sample of medicated and non medicated egyptian female patients with schizophrenia

Background: the relationship between sexuality and schizophrenia is complex. It may be related to both the psychopathology and the pharmacotherapy, as the sexual functions may be affected by symptoms itself, living with a severe chronic mental health illness, and the adverse effects of antipsychotics or other medications. Systematic studies have revealed that sexual dysfunction is highly prevalent in both untreated and treated schizophrenia patients, affecting 30–80% of women and 45–80% of men. The prevalence of sexual dysfunction may be higher in patients with schizophrenia than in patients treated for other mental disorders

Aim of the Work: to compare a group of females with Schizophrenia to healthy female control group regarding frequency and type of sexual dysfunction

Patients and Methods: this study was sought to extend our knowledge about the association of schizophrenia and its treatment with sexuality problems. It was done at Institute of Psychiatry, Faculty of Medicine, Ain Shams University to determine the rate of occurrence of sexual dysfunctions in married females with schizophrenia in comparison to control group. It included 90 females diagnosed as schizophrenia [divided into 3 groups of 30s 1-untreated patients 2-patients treated with typical anti psychotics 3- patients treated with Atypical antipsychotics] and 30 females as a control group

Results: the study revealed high prevalence of sexual dysfunction among all patients group yet it was highest among the drug naive group as 100% of them had sexual dysfunction

Conclusion: the relation between schizophrenia and female sexuality is complex it could be the result of side effect of antipsychotic medications yet the high prevalence of sexual dysfunction among drug naïve patients, suggest that sexual dysfunction is an integral part of the disease

Antidiabetic and antioxidant activity of ethyl acetate extract fraction of Moringa oleifera leaves in streptozotocin-induced diabetes rats via inhibition of inflammatory mediators

Objective: To evaluate the antioxidant and antidiabetic mechanism(s) of ethyl acetate extract fraction of Moringa oleifera (M. oleifera) leaves on streptozotocin-induced diabetes in male Sprague-Dawley rats. Methods: A total of 24 adult male rats were segregated randomly into four groups (6 rats each group). Streptozotocin-induced diabetes rats were given (oral gavage) ethyl acetate extract fraction of M. oleifera (200 mg/kg b.w.) for 30 d. The rats of control and experimental groups were sacrificed after 24 hours of final dose of treatment, to extract blood and pancreatic tissue for biochemical and histopathological analysis. Results: The ethyl acetate extract fraction of M. oleifera significantly reversed (P<0.05) the manifestation of streptozotocin on the levels of serum glucose & insulin, lipid profile, hepatic damage markers (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and lactate dehydrogenase), malondialdehyde formation, antioxidants (glutathione, Vitamin C & Vitamin E), antioxidant enzymes (superoxide dismutase, glutathione S-transferase, glutathione peroxidase and catalase) and pro-inflammatory cytokines (IL-1 β , TNF- α & IL-6). Histopathological analysis of pancreatic tissues was in concurrence with the biochemical results. Conclusions: These findings support that M. oleifera leaves have potent therapeutic effect on diabetes mellitus via increasing antioxidant levels and inhibition of pro-inflammatory mediators.

critical review on risks versus benefits of bariatric surgery

Background: bariatric surgery refers to a series of weight loss procedures that an obese individual can have in order to reduce their food intake, therefore causing them to lose weight. Obese patients lose more weight with bariatric surgery than with medical weight-loss treatment. The laparoscopic Roux-en-Y gastric bypass procedure results in more short-term weight loss than laparoscopic adjustable gastric banding, but the latter has fewer postoperative complications and a lower mortality rate; long-term comparative data are currently lacking. The decision regarding which procedure to perform should be based on individual patient and surgeon factors

Aim and Intervention of the study: to review the history of bariatric surgery in order to compare the different bariatric operations, to list the current indications for these procedures, to evaluate the outcomes, and to consider the risks

Position: a critical review of controlled randomized studies has provided evidence that bariatric surgery produces durable weight loss exceeding 100 lb [46 kg], full and long-term remission of type 2 diabetes in over 80% with salutary effects on the other comorbidities as well with significant reductions in all-cause mortality

Conclusion: bariatric surgery is the therapy of choice for patients with severe obesity

Effect of implementation of electronic file system and the completeness of clinical evaluation in chronic non-communicable diseases clinic

Objective: To evaluate the effect of implementation of the Electronic File System [EFS] on the completeness of clinical evaluation in the Chronic Non-Communicable Diseases [NCD] Clinic

Design: A Cross-Sectional, Comparative Study

Setting: Health Center, Bahrain

Method: All patients attending NCD clinic before implementation of Electronic File System [EFS] from 15 February to 31 March 2015 were reviewed and considered the first group [156]. All patients attending NCD clinic after the implementation of EFS from 15 May to 30 June 2015 were reviewed and considered the second group [168]. The clinical item evaluations to be completed by the physician were 9 items and by the nurse 30 items for each patient. The total number of clinical evaluation items before EFS multiplied by the number of cases [39 x 156] was 6,084. The total number of clinical evaluation items after EFS multiplied by the number of cases [39 x 168] was 6,552

Results: Three hundred twenty-four patients were included in the study. The patients were divided into two groups, 156 [48.1%] before EFS and 168 [51.9%] after EFS. The completeness of clinical items evaluation improved after the implementation of the EFS from 3,684 [60.5%] to 4,224 [64.5%]. The completeness by the nurse improved significantly after the implementation, from 2,988 [49.1%] to 3,653 [55.8%] and deteriorated by the physician from 696 [11.4%] to 571 [8.7%]

Conclusion: The average completeness of clinical evaluation remains low after the implementation of the EFS. There are several possible causes and further studies are needed to identify the main underlying causes for such low figures in order to plan and implement improvement

Seroprevalence of three influenza A viruses (H1N1, H3N2, and H3N8) in pet dogs presented to a veterinary hospital in Ohio

The prevalence of canine H3N8 influenza and human H1N1 and H3N2 influenza in dogs in Ohio was estimated by conducting serologic tests on 1,082 canine serum samples. In addition, risk factors, such as health status and age were examined. The prevalences of human H1N1, H3N2, and canine H3N8 influenzas were 4.0%, 2.4%, and 2.3%, respectively. Two samples were seropositive for two subtypes (H1N1 and H3N2; H1N1 and canine influenza virus [CIV] H3N8). Compared to healthy dogs, dogs with respiratory signs were 5.795 times more likely to be seropositive against H1N1 virus (p = 0.042). The prevalence of human flu infection increased with dog age and varied by serum collection month. The commercial enzyme-linked immunosorbent assay used in this study did not detect nucleoprotein-specific antibodies from many hemagglutination inhibition positive sera, which indicates a need for the development and validation of rapid tests for influenza screening in canine populations. In summary, we observed low exposure of dogs to CIV and human influenza viruses in Ohio but identified potential risk factors for consideration in future investigations. Our findings support the need for establishment of reliable diagnostic standards for serologic detection of influenza infection in canine species.

assessment of postoperative levels of pain with reference to validated protocols at a hospital in Karachi Pakistan

Objective: The aim of study is to assess the postoperative levels of pain in accordance with established protocols

Method: The type of study is a hospital wide survey conducted from February 2014 to April 2014, at department of surgery and associated wards, at a tertiary care hospital in Karachi Pakistan. World Health Organization pain scoring system was used as a base to develop a questionnaire to assess the level of pain. The results were correlation with various other variables involved

Results: The study was conducted on 200 patients out of whom 38% [n=76] were males having mean age of 44.16 +/- 20 and 62% [n=124] were females having mean age of 36 +/- 14.5 years. Generally patients experiences mild pain [40%], moderate [39%] severe [16%] and no pain [5%] when recorded after 24 hours postoperatively. While after 48 hours the scores recorded for the same patients were as, mild [56%], moderate to severe [34%] and in the no pain group [10%] of patients were recorded

Conclusion: It is noted that absolute pain free surgeries are not possible at the moment, but with the use of latest advancements in the field of health sciences, post-operative pain can be minimized and should be the one of the prime goals for a good surgical outcome

Post-pandemic seroprevalence of human influenza viruses in domestic cats

The continuous exposure of cats to diverse influenza viruses raises the concern of a potential role of cats in the epidemiology of these viruses. Our previous seroprevalence study of domestic cat sera collected during the 2009 H1N1 pandemic wave (September 2009–September 2010) revealed a high prevalence of pandemic H1N1, as well as seasonal H1N1 and H3N2 human flu virus infection (22.5%, 33.0%, and 43.5%, respectively). In this study, we extended the serosurvey of influenza viruses in cat sera collected post-pandemic (June 2011–August 2012). A total of 432 cat sera were tested using the hemagglutination inhibition assay. The results showed an increase in pandemic H1N1 prevalence (33.6%) and a significant reduction in both seasonal H1N1 and H3N2 prevalence (10.9% and 17.6%, respectively) compared to our previous survey conducted during the pandemic wave. The pandemic H1N1 prevalence in cats showed an irregular seasonality pattern in the post-pandemic phase. Pandemic H1N1 reactivity was more frequent among female cats than male cats. In contrast to our earlier finding, no significant association between clinical respiratory disease and influenza virus infection was observed. Our study highlights a high susceptibility among cats to human influenza virus infection that is correlated with influenza prevalence in the human population.