Study of depression among patients with type 2 diabetes mellitus at a tertiary care hospital

Background: Diabetes and depression are two major issues related to community health. Diabetes patients frequently co-occur with depression. Diabetes patients frequently co-occur with depression, which calls for serious attention because delayed diagnosis and treatment can worsen the patients' complications. Assessing the prevalence of depression in diabetic patients and identifying the various factors associated with it were the objectives of this research study. Methods: In this study 70 adult patients suffering from type 2 DM participated in this 6-month prospective study. Sociodemographic data and clinical features of the participants were collected. The presence and severity of depressive symptoms in patients have been assessed by a PHQ9 questionnaire. Ethical approval was taken before the commencement of the study. SPSS (Version 20) was used for data analysis. Results: The majority of the patients were from 41-50 years of age group (32.9%) with a female predominance (58.6%), with no symptoms of depression before type 2 DM (92.9%). Most of them had primary education (32.9%) and majority were homemakers (44.3%) residing in urban are (65.7%) living joint family setup (68.6%). Most of them had 11 to 20 years of type 2 DM duration (745.8%) with a high family history of type 2 DM (75.7%). Majority of them were on Oral therapy (47.1%) with ophthalmic complications (32.9%). The majority of them had mild depression (5-9) i.e. 67.1%. Conclusions: Due to patient-specific diabetes management and inappropriate diabetes treatment, the majority of cases were found to have depressive disorders. This article focused on a few common factors and their relationships that lead to depression in people with diabetes.

The impact of COVID-19 vaccination on the risk of hospitalization in Fayoum healthcare workers

Background: Healthcare workers (HCWs) face several challenges including treating COVID-19 patients. The immunization of the population through vaccination is recognized as a public health priority. The aim of the study is to assess the impact of vaccination on the risk of hospitalization and mortality in HCWs due to COVID-19 infection. Methods: This study was conducted in Egypt in El Fayoum governorate on the HCWs from April 2021 to the end of the year 2021. A cohort retrospective approach was carried out using (the national electronic disease surveillance system) NEDSS and COVID-19 vaccine registration system. Hospitalization is determined by assessment of the cases according to the protocol of COVID-19 management of MOHP November 2020. Results: There was no association between hospitalization and both sex and residence (p=0.1, and 0.06 respectively). There was no statistical significant association between hospitalization and vaccination (time, status, or type). The p=0.2, 0.6, and 0.07 respectively. Age and the presence of comorbidities were statistically significant predictors with p=0.004 and 0.04, respectively, as increasing age and the presence of comorbidities will increase the likelihood of hospitalization by 1.04 and 1.9 folds, respectively. Conclusions: This study shows no significant association between vaccination and hospitalization of HCWs.

Study the effectiveness and safety of vitamin D as an additional treatment for type 2 diabetic patients using oral anti-diabetics at a tertiary care hospital

Background: The prevalence of type 2 DM is alarmingly rising on a global scale. Improved treatments for type 2 DM are still needed, in order to slow the disease抯 development. A role in the pathophysiology of type 2 DM has been suggested by the correlation between vitamin D insufficiency and several non-skeletal illnesses, including DM. The goal of the study was to determine if vitamin D supplementation may help type 2 DM patients whose glycemic status was uncontrolled even after using oral antidiabetics. Methods: 60 individuals with type 2 DM and vitamin D insufficiency participated in this 12-week open-label, before-and-after study. For 12 weeks, in addition to oral anti-diabetic medications, these patients also received 60,000 IU of vitamin D3 orally every week. HbA1c, FBS, and 25(OH)D levels parameters were included. Results: The majority of the patients were from 41-50 years of age group (48.3%) with a male predominance (60%). Most of them were having >1 year of type 2 DM duration (78.3%) with a high family history of type 2 DM (70%). After 12 weeks, there was a substantial (p<0.001*) drop in FBG levels and a significant (p<0.001*) decrease in HbA1c. 25(OH)D levels showed a high rise (p<0.001*). None of the patients had any side effects. Conclusions: Vitamin D treatment improves glycemic status, which slows the development of type 2 DM and its associated effects. As such, vitamin D supplementation is a safe and promising adjuvant treatment for individuals with type 2 diabetes who are low in vitamin D.

Clinical outcomes of the liver-first approach in the management of synchronous colorectal liver metastases: a retrospective study

Introduction: Almost 25% of colorectal cancer (CRC) patients have synchronous colorectal liver metastasis (SCLM) coinciding with the disease diagnosis. Liver-first approach for the treatment of SCLM involves neoadjuvant chemotherapy, subsequent liver resection, and then primary tumor resection. This strategy is adopted as the prognosis of the disease depends mainly on the metastases, not the primary tumor. This study aims to evaluate the feasibility of the liver-first approach and clinical prognosis in managing SCLM. Materials and Methods: This retrospective study included 25 patients with SCLM from July 2015 to July 2020. All patients were subjected to a liver-first approach with an "intention-to-treat" approach. Follow-up was planned for at least 3 years. Data were collected from the hospital records and included survival rates and univariate analyses of the prognostic factors, such as gender, age, and number of chemotherapy cycles to evaluate their effect on the survival probability. Results: Nineteen patients completed the treatment paradigm. Long-term outcomes reported a median overall survival (OS) of 32 months. One-year and 3-year survival probabilities were 89.5% and 42.1%, respectively. The median disease-free survival was 13 months. The number of metastatic lesions, unilobar versus bilobar disease, and the frequency of administered chemotherapy cycles significantly affected survival (p < 0.05). Seven patients (36.84%) remained disease free (no recurrence) while 2 patients (10.53%) survived with recurrence. The overall mortality included 10 deaths (52.63%) due to recurrence. Conclusion: Synchronous colorectal liver metastasis treated with the liver-first approach achieved a notable overall advantage. However, the recurrence rate remained relatively high. (AU)

Molecular characterization of Aeromonas hydrophila isolates from diseased fishes in district Kasur, Punjab, Pakistan / Caracterização molecular de isolados de Aeromonas hydrophila de peixes doentes no distrito de Kasur, Punjab, Paquistão

Abstract Pakistan is an agricultural country and fisheries play a very important role in the economic development of the country. Different diseases are prevalent in Pakistani fish but information related to the causative agents is not well-known. Keeping in view the significance of bacterial pathogens as the causative agents of multiple fish diseases, the present study was conducted for identification, characterization and analysis of virulence genes of Aeromonas spp. isolated from diseased fishes. A total of fifty fish samples having multiple clinical indications were collected from different fish farms of district Kasur, Punjab Pakistan. For isolation of Aeromonas spp. samples were enriched and inoculated on Aeromonas isolation medium. Isolates were identified and characterized by different biochemical tests, Analytical Profile Index (API) 20E kit and Polymerase Chain Reaction (PCR) assays. All isolates were screened for three putative virulence genes including aerolysin (aer), haemolysin (hyl) and heat labile cytotonic enterotoxin (alt). Seven isolates of Aeromonas (A.) hydrophila were retrieved and identified based on API 20E. These isolates were further confirmed as A. hydrophila on the basis of PCR assays. Three isolates were detected positive for the presence of virulence genes (alt and hyl). Whereas aerolysin (aer) gene was not present in any of A. hydrophila isolates. The present study confirmed A. hydrophila as the causative agent of epizootic ulcerative syndrome and motile Aeromonas septicemia in fish farms of district Kasur, Punjab Pakistan. Moreover, detection of two virulence genes (alt and hyl) in A. hydrophila isolates is a threat for fish consumers of study area.

Resumo O Paquistão é um país agrícola, onde a pesca desempenha um papel muito importante para o desenvolvimento econômico. Diferentes doenças são prevalentes em peixes do Paquistão, mas as informações relacionadas aos agentes causadores não são bem conhecidas. Tendo em vista a importância dos patógenos bacterianos como agentes causadores de múltiplas doenças em peixes, o presente estudo foi conduzido para identificação, caracterização e análise de genes de virulência de isolados de Aeromonas spp. de peixes doentes. Foram coletadas 50 amostras de peixes com múltiplas indicações clínicas em diferentes fazendas do distrito de Kasur, Punjab, Paquistão. Para isolar Aeromonas spp., as amostras foram enriquecidas e inoculadas em meio de isolamento. Os isolados foram identificados e caracterizados por diferentes testes bioquímicos, kit Analytical Profile Index (API) 20E, e ensaios de reação em cadeia da polimerase (PCR). Todos os isolados foram selecionados para três genes de virulência putativos, incluindo aerolisina (aer), hemolisina (hyl) e enterotoxina citotônica termolábil (alt). Sete isolados de Aeromonas hydrophila foram recuperados e identificados com base no API 20E. Esses isolados foram posteriormente confirmados como A. hydrophila de acordo com ensaios de PCR. Três isolados indicaram a presença de genes de virulência (alt e hyl), enquanto o gene aerolisina (aer) não esteve presente em nenhum dos isolados de A. hydrophila. O presente estudo confirmou A. hydrophila como o agente causador da síndrome ulcerativa epizoótica e septicemia móvel por Aeromonas em fazendas de peixes, no distrito de Kasur, Punjab, Paquistão. Além disso, a detecção de dois genes de virulência (alt e hyl) em isolados de A. hydrophila é uma ameaça para os consumidores de peixes da área de estudo.

Molecular characterization of Aeromonas hydrophila isolates from diseased fishes in district Kasur, Punjab, Pakistan

Abstract Pakistan is an agricultural country and fisheries play a very important role in the economic development of the country. Different diseases are prevalent in Pakistani fish but information related to the causative agents is not well-known. Keeping in view the significance of bacterial pathogens as the causative agents of multiple fish diseases, the present study was conducted for identification, characterization and analysis of virulence genes of Aeromonas spp. isolated from diseased fishes. A total of fifty fish samples having multiple clinical indications were collected from different fish farms of district Kasur, Punjab Pakistan. For isolation of Aeromonas spp. samples were enriched and inoculated on Aeromonas isolation medium. Isolates were identified and characterized by different biochemical tests, Analytical Profile Index (API) 20E kit and Polymerase Chain Reaction (PCR) assays. All isolates were screened for three putative virulence genes including aerolysin (aer), haemolysin (hyl) and heat labile cytotonic enterotoxin (alt). Seven isolates of Aeromonas (A.) hydrophila were retrieved and identified based on API 20E. These isolates were further confirmed as A. hydrophila on the basis of PCR assays. Three isolates were detected positive for the presence of virulence genes (alt and hyl). Whereas aerolysin (aer) gene was not present in any of A. hydrophila isolates. The present study confirmed A. hydrophila as the causative agent of epizootic ulcerative syndrome and motile Aeromonas septicemia in fish farms of district Kasur, Punjab Pakistan. Moreover, detection of two virulence genes (alt and hyl) in A. hydrophila isolates is a threat for fish consumers of study area.

Resumo O Paquistão é um país agrícola, onde a pesca desempenha um papel muito importante para o desenvolvimento econômico. Diferentes doenças são prevalentes em peixes do Paquistão, mas as informações relacionadas aos agentes causadores não são bem conhecidas. Tendo em vista a importância dos patógenos bacterianos como agentes causadores de múltiplas doenças em peixes, o presente estudo foi conduzido para identificação, caracterização e análise de genes de virulência de isolados de Aeromonas spp. de peixes doentes. Foram coletadas 50 amostras de peixes com múltiplas indicações clínicas em diferentes fazendas do distrito de Kasur, Punjab, Paquistão. Para isolar Aeromonas spp., as amostras foram enriquecidas e inoculadas em meio de isolamento. Os isolados foram identificados e caracterizados por diferentes testes bioquímicos, kit Analytical Profile Index (API) 20E, e ensaios de reação em cadeia da polimerase (PCR). Todos os isolados foram selecionados para três genes de virulência putativos, incluindo aerolisina (aer), hemolisina (hyl) e enterotoxina citotônica termolábil (alt). Sete isolados de Aeromonas hydrophila foram recuperados e identificados com base no API 20E. Esses isolados foram posteriormente confirmados como A. hydrophila de acordo com ensaios de PCR. Três isolados indicaram a presença de genes de virulência (alt e hyl), enquanto o gene aerolisina (aer) não esteve presente em nenhum dos isolados de A. hydrophila. O presente estudo confirmou A. hydrophila como o agente causador da síndrome ulcerativa epizoótica e septicemia móvel por Aeromonas em fazendas de peixes, no distrito de Kasur, Punjab, Paquistão. Além disso, a detecção de dois genes de virulência (alt e hyl) em isolados de A. hydrophila é uma ameaça para os consumidores de peixes da área de estudo.

Histomorphological, Histochemical and Ultrastructural Studies on the Healthy Liver of Yemen Veiled Chameleon (Chamaeleo calyptratus) in Southern Saudi Arabia / Estudios Histomorfológicos, Histoquímicos y Ultraestructurales en el Hígado Sano del Camaleón Velado de Yemen (Chamaeleo calyptratus) en el Sur de Arabia Saudita

SUMMARY: The livers of reptiles are being studied as a model for the link between the environment and hepatic tissue. There have been few investigations on the histology of reptile livers, and very few or no studies have examined the histology of liver of veiled chameleon (Chamaeleo calyptratus). This paper describes the histomorphological, histochemical and ultrastructural characterization of the liver of veiled chameleons in southern Saudi Arabia. Seven Chamaeleo calyptratus were captured in the summer season in Abha City, Aseer region, southern Saudi Arabia. Chamaeleon liver samples were processed for histomorphology, histochemistry and ultrastructure analyses. Morphologically liver of Chamaeleo calyptratus was observed as a large dark brown organ with lighter speckles, which represent melanin deposits. It located at the ventral part of abdominal cavity forward of the stomach. Its dimensions approximately were 3.7 x 2 cm. The liver was a bilobed organ divided into two lobes, right and left lobes. The right one was bigger than the others. The gallbladder was well developed and had an elongated shape, situated between the two lobes and contained the bile for the digestion. Microscopically, the liver was found to be covered by a thick layer of connective tissue, which formed the hepatic capsule. Hepatic parenchyma probably appeared in cross sections as hepatic glandular-like alveoli "acini" or follicular structures with various diameters, each acinus contains approximately four to six hepatocytes, surrounded by sinusoidal capillaries filled with abundant melanomacrophages, which are absent in birds and mammals. Melanomacrophages are common in the hepatic parenchyma's perisinusoidal areas, particularly near portal spaces. Hepatocytes are polyhedral or pyramidal with and mostly contained large, rounded nuclei mostly peripherally located, with prominent dark oval nucleoli. Some of nuclei are eccentric or central position. The cytoplasm appeared spongy or vacuolated and more eosinophilic when stained by hematoxylin-eosin and strongly reactive to PAS staining technique, indicating abundant glycogen content. The reticular fibers that surround hepatocytes, blood arteries, and sinusoids supported the hepatic parenchyma. The blood sinusoids are seen interspersed among hepatocytes of varying sizes. The sinusoidal lumen was bordered by flattened endothelial cells and includes elliptical nucleated erythrocytes and liver macrophages as phagocytes, which are also known as Kupffer cells. Branches of the portal vein, hepatic artery, small bile duct, and lymph vessels were detected in the hepatic portal area "tract" or triad which made up of connective. Hematopoietic tissue was observed in subcapsular region and portal triads. Ultrastructurally, the hepatocyte appeared polyhedric containing a single large rounded basal or eccentric vesicular nucleus with prominent nucleolus. Extensive network of rough endoplasmic reticulum (RER) often arranged in an array parallel to the nuclear membrane with many mitochondria, and Golgi apparatus were described. The cytoplasm contained glycogen granules, vesicles or vacuoles scattered throughout the cytoplasm especially at the apical region were reported. The bile canaliculi and the hepatic "Kupffer" cells were also discussed. This is the first study on the histological characterization of the healthy liver of Yemen veiled chameleon in southern Saudi Arabia. The findings reported here should be used as a reference to compare with the pathological abnormalities of the liver in this animal.

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Interleukin-37 has A Promising Cardioprotective Effect on Isoproterenol-Induced Myocardial Infarction / La Interleucina-37 tiene un Efecto Cardioprotector Prometedor sobre el Infarto de Miocardio Inducido por Isoproterenol

SUMMARY: The main cause of mortality and disability globally is myocardial infarction (MI). Isoproterenol (ISO), a β-adrenoceptor agonist, has been used to induce rat myocardial necrosis. Whereas interleukin-37 (IL-37) has anti-inflammatory and cytoprotective properties. The study aimed to investigate the potential protective effects of IL-37 administration on cardiac architecture, oxidative stress, and inflammatory markers during ISO-induced MI in rats. Three groups of adult male rats were used in this study, the normal control group (n=8), ISO-induced MI group (n=8) that received isoproterenol hydrochloride (ISO) (100 mg/kg/day, SC, for the first 2 consecutive days), and IL-37-treated group (ISO+IL-37) (n=8) that received recombinant human IL-37 (40 µg/kg /day, intraperitoneally, for 2 weeks during and after ISO injections. Heart rate (HR.) and ECG changes were monitored. Some oxidative stress markers such as superoxide dismutase (SOD), nitric oxide (NOx), malondialdehyde (MDA), and glutathione (GSH) tissue levels in the tissue homogenate were assayed. Interleukin- 6 (IL-6), tumor necrosis factor- α (TNF-α), caspase-8, P53, and C- reactive protein (CRP) were among the inflammatory markers examined. In addition, serum levels of creatinine kinase (CK-MB) and lactate dehydrogenase (LDH) were analyzed to evaluate the myocardial injury. For histological analysis, tissues were sectioned, fixed in paraffin, and stained with hematoxylin and eosin (H&E), Masson Trichrome and, immunohistochemical against NF-kB, TNF-α, and Caspase-9. IL-37 improved ECG changes, cardiac enzyme markers, and some inflammatory markers of oxidative stress in ISO-induced MI. It also improved the histopathological and immunohistochemical changes in MI. In conclusion: IL-37 might be a promising therapeutic modality in myocardial infarction.

La principal causa de mortalidad y discapacidad a nivel mundial es el infarto de miocardio (IM). El isoproterenol (ISO), un agonista de los receptores adrenérgicos β, se ha utilizado para inducir necrosis miocárdica en ratas. Mientras que la interleucina-37 (IL-37) tiene propiedades antiinflamatorias y citoprotectoras. El estudio tuvo como objetivo investigar los posibles efectos protectores de la administración de IL-37 en la arquitectura cardíaca, el estrés oxidativo y los marcadores inflamatorios durante el infarto de miocardio inducido por ISO en ratas. En este estudio se utilizaron tres grupos de ratas macho adultas, el grupo control normal (n=8), el grupo con IM inducido por ISO (n=8) que recibió clorhidrato de isoproterenol (ISO) (100 mg/kg/día, SC, durante los primeros 2 días consecutivos) y el grupo tratado con IL-37 (ISO+IL- 37) (n=8) que recibió IL-37 humana recombinante (40 µg/kg/día, por vía intraperitoneal, durante 2 semanas durante y después de las inyecciones de ISO. Se monitorearon la frecuencia cardíaca (FC) y los cambios en el ECG. Se analizaron algunos marcadores de estrés oxidativo como la superóxido dismutasa (SOD), el óxido nítrico (NOx), el malondialdehído (MDA) y los niveles tisulares de glutatión (GSH) en el homogeneizado de tejido. La interleucina-6 (IL-6), el factor de necrosis tumoral-α (TNF-α), la caspasa-8, la P53 y la proteína C reactiva (CRP) se encontraban entre los marcadores inflamatorios examinados. Se analizaron los niveles de creatinoquinasa (CK-MB) y lactato deshidrogenasa (LDH) para evaluar la lesión miocárdica; para el análisis histológico se seccionaron los tejidos, se fijaron en parafina y se tiñeron con hematoxilina y eosina (H&E), Tricromo de Masson e inmunohistoquímica contra NF-kB, TNF-α y Caspasa-9. IL-37 mejoró los cambios de ECG, los marcadores de enzimas cardíacas y algunos marcadores inflamatorios de estrés oxidativo en el IM inducido por ISO. Además mejoró los cambios histopatológicos e inmunohistoquímicos en MI. En conclusión: la IL-37 podría ser una modalidad terapéutica prometedora en el infarto de miocardio.

Elements affecting emergency department rate of return within72 hours:a retrospective cross-sectional study

Background:Many patients view emergency departments (EDs) as their top choice for medical problems because they act as an easily accessible entry point into the healthcare system. The frequency of ED visits, the causes, and the burden must be considered to evaluate the quality and outcome of care.The researcher aimed to investigate the elements that affect the rate of return to the emergency department within 72 hours. In addition, to determine the underlying factors associated with unplanned ED return visits. Methods:It was aretrospective cross-sectional study.Results:The result of this study shows that 1535 unplanned ED return visits out of 53387. The rate was 2.9%. A total of 339 (22%) patients of unplanned ED returned visits were admitted to the hospital which is representing 8% of the total hospital admission from ED.Conclusions:The study found that certain types of presenting complaints, such as fever, cough, and throat pain related to respiratory tract infection, were associated with a higher rate of unplanned return at a rate of 33% (513).The results of this studysuggest that interventions aimed at improving access to follow-up care, and patient education with effective communication. In addition, continuously monitoring the rate of unplanned ED return and linking that rate to the ED physician's individual performance review might effectively reduce the rate and improve the quality and outcome of care

Cytokine polymorphisms and genotypic susceptibility of HCV infection in ribavirin response to peg interferon

@#Immune responses are largely regulated by cytokines. Genetic polymorphisms of the regulatory coding regions are recognized to impact the expression of cytokines. The abnormal cytokine levels in hepatitis C virus (HCV) infection seems to be involved in disease progression, viral survival, and therapeutic response. The current study assesses the polymorphisms associated with IL-6, IL-10, IL28B, IFN-γ, TGF-β, and TNF-α on the genotypic susceptibility to HCV infection and Ribavirin response to Peg interferon. Droplet digital polymerase chain reaction (PCR) was used to assess the gene polymorphisms associated with IL-6 A/G (rs2069837), IL-10-1082 G/A (rs1800896)], IL28B C/T (rs12979860), IFN-γ +874 A/T (rs2430561), TGF-β 1-509 C/T (rs1800469) and TNF-α-308 G/A promoter (rs1800629) from stored samples of 200 healthy individuals and 300 HCV infected patients. There was a significant association of AG and AA genotypes of IL28B, IFN-γ, TGF-β1, and TNF-α over HCV susceptibility and treatment outcome. However, no association between IL-6 and IL-10 gene polymorphism to HCV susceptibility response to the treatment. The observations indicate IL28B CT, TGF-β1 CT, TT and TNF- AG with AA genotypes influence the cytokine expression, which is related to susceptibility and resistance to HCV infection and combined antiviral therapy.

Peripheral Blood Smear Atypical Lymphocytes Association With Covid-19 Mortality

@#Introduction: COVID-19 disease is currently pandemic, and its prevalence in Saudi Arabia is concerning. The SARSCoV-2 virus primarily affects the lungs, but it also affects the haematopoietic system. The atypical lymphocytes on peripheral blood film that have a distinct morphological appearance were of particular interest in this study. Our goal was to see a link between atypical lymphocytes and COVID-19 patient mortality. Methods: This four-month single-centered prospective descriptive study was conducted in Makkah, Saudi Arabia. COVID-19 patients of both genders were randomly selected based on inclusion criteria. The data from the patient’s electronic medical record was extracted. All patients’ peripheral blood film parameters were recorded on days 3, 7, and 14 after admission. The statistical data was analysed using SPSS version 23. The Fisher’s exact test was used to determine the relationship with mortality. A p value of 0.05 was considered significant. Results: The total number of cases enrolled in the study was 226. The patients’ average age was 58 years (SD 0.5289). On the third day of admission, 88.2 % of patients with COVID-19 had atypical lymphocytes, with a mean of 2.35 ± 0.927. A significant correlation (p < 0.001) exists between atypical lymphocytes decreasing percentage number on the 3rd, 7th, and 14th days of admission and death. Conclusion: The decrease in the number of atypical lymphocytes on peripheral blood film has a significant association with the patients’ mortality. This fact can be used to develop a tailored management strategy based on the observation of peripheral blood film.

Subarachnoid lavage following inadvertent intrathecal injection of tranexamic acid

Tranexamic acid (TXA) is a commonly used antifibrinolytic drug during surgical procedures to reduce blood loss. An Inadvertent intrathecal injection of TXAmay lead to serious side effects including seizures and ventricular fibrillation with reported fatalities. We report a case of an inadvertentintrathecal injection of TXAwhich occurred as a result of similarities in appearance between TXAand heavy bupivacaine ampoules. The patient had subarachnoid lavage after experiencing back pain, systemic hypertension followed by generalized tonic clonic seizures

Retardo na transferência do pronto-socorro para a unidade de terapia intensiva: impacto nos desfechos do paciente. Um estudo retrospectivo / Delayed intensive care unit admission from the emergency department: impact on patient outcomes. A retrospective study

RESUMO Objetivo: Estudar o impacto do retardo na admissão à unidade de terapia intensiva em mais do que 4 horas nos desfechos de pacientes críticos. Métodos: Este foi um estudo observacional retrospectivo, no qual pacientes adultos admitidos diretamente do pronto-socorro para a unidade de terapia intensiva foram divididos em dois grupos: Tempo Adequado, se admitidos dentro de 4 horas, e Admissão Retardada, nos casos em que a admissão demorou mais do que 4 horas para ocorrer. Compararam-se, entre os grupos, o tempo de permanência na unidade de terapia intensiva e a taxa de mortalidade na unidade de terapia intensiva e no hospital. Foi realizado pareamento por escore de propensão para correção de desequilíbrios. Utilizou-se uma análise de regressão logística para explorar retardo da admissão como fator independente de risco para mortalidade na unidade de terapia intensiva. Resultados: Durante o período do estudo, 1.887 pacientes foram admitidos diretamente do pronto-socorro para a unidade de terapia intensiva, sendo que 42% dessas admissões foram retardadas. Os pacientes com retardo tiveram permanências na unidade de terapia intensiva significantemente mais longas e maior mortalidade na unidade de terapia intensiva e no hospital. Esses resultados persistiram após pareamento dos grupos por escore de propensão. O retardo da admissão foi fator independente de risco para mortalidade na unidade de terapia intensiva (RC = 2,6; IC95% 1,9 - 3,5; p < 0,001). A associação de retardo e mortalidade na unidade de terapia intensiva surgiu após período de retardo de 2 horas e foi mais alta após período de retardo de 4 horas. Conclusão: O retardo da admissão do pronto-socorro para a unidade de terapia intensiva é fator de risco independente para mortalidade na unidade de terapia intensiva, sendo a associação mais forte após retardo de 4 horas.

Abstract Objective: To study the impact of delayed admission by more than 4 hours on the outcomes of critically ill patients. Methods: This was a retrospective observational study in which adult patients admitted directly from the emergency department to the intensive care unit were divided into two groups: Timely Admission if they were admitted within 4 hours and Delayed Admission if admission was delayed for more than 4 hours. Intensive care unit length of stay and hospital/intensive care unit mortality were compared between the groups. Propensity score matching was performed to correct for imbalances. Logistic regression analysis was used to explore delayed admission as an independent risk factor for intensive care unit mortality. Results: During the study period, 1,887 patients were admitted directly from the emergency department to the intensive care unit, with 42% being delayed admissions. Delayed patients had significantly longer intensive care unit lengths of stay and higher intensive care unit and hospital mortality. These results were persistent after propensity score matching of the groups. Delayed admission was an independent risk factor for intensive care unit mortality (OR = 2.6; 95%CI 1.9 - 3.5; p < 0.001). The association of delay and intensive care unit mortality emerged after a delay of 2 hours and was highest after a delay of 4 hours. Conclusion: Delayed admission to the intensive care unit from the emergency department is an independent risk factor for intensive care unit mortality, with the strongest association being after a delay of 4 hours.

Impact of Multiphase Computed Tomography Angiography for Endovascular Treatment Decision-Making on Outcomes in Patients with Acute Ischemic Stroke / 대한뇌졸중학회지

Background@#and Purpose Various imaging paradigms are used for endovascular treatment (EVT) decision-making and outcome estimation in acute ischemic stroke (AIS). We aim to compare how these imaging paradigms perform for EVT patient selection and outcome estimation. @*Methods@#Prospective multi-center cohort study of patients with AIS symptoms with multi-phase computed tomography angiography (mCTA) and computed tomography perfusion (CTP) baseline imaging. mCTA-based EVT-eligibility was defined as presence of large vessel occlusion (LVO) and moderate-to-good collaterals on mCTA. CTP-based eligibility was defined as presence of LVO, ischemic core (defined on relative cerebral blood flow, absolute cerebral blood flow, and cerebral blood volume maps) 1.8, absolute mismatch >15 mL. EVT-eligibility and adjusted rates of good outcome (modified Rankin Scale 0–2) based on these imaging paradigms were compared. @*Results@#Of 289/464 patients with LVO, 263 (91%) were EVT-eligible by mCTA-criteria versus 63 (22%), 19 (7%) and 103 (36%) by rCBF, aCBF, and CBV-CTP-criteria. CTP and mCTA-criteria were discordant in 40% to 53%. Estimated outcomes were best in patients who met both mCTA and CTP eligibility-criteria and were treated with EVT (62% to 87% good outcome). Patients eligible for EVT by mCTA-criteria and not by CTP-criteria receiving EVT achieved good outcome rates of 53% to 57%. Few patients met CTP-criteria and not mCTA-criteria for EVT. @*Conclusions@#Simpler imaging selection criteria that rely on little else than detection of the occluded blood vessel may be more sensitive and less specific, thus resulting in more patients being offered EVT and arguably benefiting from it.

Impact of Multiphase Computed Tomography Angiography for Endovascular Treatment Decision-Making on Outcomes in Patients with Acute Ischemic Stroke / 대한뇌졸중학회지

Background@#and Purpose Various imaging paradigms are used for endovascular treatment (EVT) decision-making and outcome estimation in acute ischemic stroke (AIS). We aim to compare how these imaging paradigms perform for EVT patient selection and outcome estimation. @*Methods@#Prospective multi-center cohort study of patients with AIS symptoms with multi-phase computed tomography angiography (mCTA) and computed tomography perfusion (CTP) baseline imaging. mCTA-based EVT-eligibility was defined as presence of large vessel occlusion (LVO) and moderate-to-good collaterals on mCTA. CTP-based eligibility was defined as presence of LVO, ischemic core (defined on relative cerebral blood flow, absolute cerebral blood flow, and cerebral blood volume maps) 1.8, absolute mismatch >15 mL. EVT-eligibility and adjusted rates of good outcome (modified Rankin Scale 0–2) based on these imaging paradigms were compared. @*Results@#Of 289/464 patients with LVO, 263 (91%) were EVT-eligible by mCTA-criteria versus 63 (22%), 19 (7%) and 103 (36%) by rCBF, aCBF, and CBV-CTP-criteria. CTP and mCTA-criteria were discordant in 40% to 53%. Estimated outcomes were best in patients who met both mCTA and CTP eligibility-criteria and were treated with EVT (62% to 87% good outcome). Patients eligible for EVT by mCTA-criteria and not by CTP-criteria receiving EVT achieved good outcome rates of 53% to 57%. Few patients met CTP-criteria and not mCTA-criteria for EVT. @*Conclusions@#Simpler imaging selection criteria that rely on little else than detection of the occluded blood vessel may be more sensitive and less specific, thus resulting in more patients being offered EVT and arguably benefiting from it.

Alcohol Consumption Practices Among Nepali Migrant Workers in Shah Alam, Selangor

Introduction@#Malaysia has been considered an industrialized country and there is a demand for manpower in low-skilled jobs which usually filled by migrant workers. Therefore, this study focused to identify the level of alcohol consumption and its associated factors among Nepali migrant workers in Shah Alam, Selangor.@*Methods@#A cross-sectional study using a convenient sampling method was conducted among 233 Nepali migrant workers in Shah Alam, Selangor using a selfadministered questionnaire. A validated questionnaire (The Alcohol Use Disorder Identification Test) by WHO was used in the study. @*Results@#The results showed that 60.09% of Nepali workers consumed alcohol with most of them are in low (31.43%) and medium (29.28%) risk level for alcohol consumption. The empirical findings revealed a significant association between income, education level, and peer pressure with alcohol consumption (p value <0.001 respectively). However, the study found no association between age, marital status, years of working, and body mass index with alcohol consumption (p value= 0.44, 0.19, 0.42, 0.40 respectively).@*Conclusion@#In conclusion, most Nepali migrant workers consumed alcohol but in low and medium risk severity. The results highlighted socio-demographic factors such as income and education as well as peer pressure among the important factors affecting alcohol consumption. Thus, it is important to address this issue by creating awareness by conducting health talk and campaign. This can give a clear idea to migrant workers on the health effect of alcohol consumption. More education and promotion are needed to address the health effect of excessive alcohol consumption and work productivity among migrant workers in their own language.

Cephalometric comparison of dentofacial parameters between Yemeni and Caucasian adults / Comparação cefalométrica de parâmetros dentofaciais entre adultos iemenitas e caucasianos

Objective: The purposes of our research were to establish cephalometric standards for Yemeni adults and to compare them with those of the Caucasians. Material and Methods: 100 Yemeni students (fifty males, mean age of 23.6 ± 2.1 years, and fifty female, mean age of 21.5 ± 3.1 years) with normal occlusions and well-balanced faces were involved in the study. Inclusion criteria were a class I occlusion with minor or no crowding, the whole teeth is present except third molars and no previous orthodontic, orthopedic or maxillofacial surgery treatment. Five angular and eighteen linear measurements were used for the skeletal, dental and soft tissue analysis. All participant's Lateral cephalometric radiographs were evaluated. The average values and standard deviations for all the angles and linear measurements were determined. The differences for each measurement between the Yemeni and Caucasian participants were calculated using unpaired t­tests. Results: Yemeni subjects had a more retrognathic mandibular positions (P< 0.05), protrusive mandibular incisors (P< 0.01), more protruded lip positions (P < 0.01), deeper mentolabial sulci (P< 0.01) and a steeper mandibular planes (P< 0.001) compared to the Caucasians. Yemeni females had a larger lower face height than Caucasian females (P< 0.001). Conclusions The study provides specific standards for Yemeni adults and shows that the Yemenis had different skeletal and dentoalveolar cephalometric standards in comparison with Caucasians (AU)

Objetivo: O objetivo de nossa pesquisa foi estabelecer padrões cefalométricos para adultos iemenitas e compará-los com os caucasianos. Material e Métodos: Cem estudantes iemenitas (cinquenta homens, idade média de 23,6 ± 2,1 anos, e cinquenta mulheres, idade média de 21,5 ± 3,1 anos) com oclusões normais e faces bem equilibradas foram envolvidos no estudo. Os critérios de inclusão foram: oclusão de classe I com pouco ou nenhum apinhamento, todos os dentes presentes, exceto terceiros molares e sem histórico de tratamento ortodôntico, ortopédico ou cirurgia maxilo-facial prévio. Cinco medidas angulares e dezoito lineares foram utilizadas para a análise esquelética, dentária e de tecidos moles. Todas as radiografias cefalométricas laterais dos participantes foram avaliadas. Foram determinados os valores médios e desvios padrão para todos os ângulos e medidas lineares. As diferenças para cada medição entre os participantes iemenitas e caucasianos foram calculadas usando testes t não pareados. Resultados: Os indivíduos iemenitas tinham posições mandibulares mais retrognáticas (P <0,05), incisivos inferiores protrusivos (P <0,01), posições dos lábios mais protuberantes (P <0,01), sulcos mentolabiais mais profundos (P <0,01) e planos mandibulares mais inclinados (P <0,001) em comparação com os caucasianos. As mulheres iemenitas tinham uma altura facial inferior maior do que as mulheres brancas (P <0,001). Conclusão:O estudo fornece padrões específicos para adultos iemenitas e mostra que os iemenitas apresentaram padrões cefalométricos esqueléticos e dentoalveolares diferentes em comparação com os caucasianos. (AU)

Knowledge about composite restorations repair vs replacement- a survey among a subpopulation of saudi dental students / Conhecimento sobre reparo e substituição de restaurações de resina - uma pesquisa entre uma subpopulação de estudantes sauditas de odontologia

Objective: The purpose of this study was to evaluate the knowledge among dental students at King Khalid University, Jazan University, and Najran University in the kingdom of Saudi Arabia about when to repair or replace defective direct composite restoration. Materials and Methods: A questionnaire-based survey was formulated, pursuing the information about management (repair/replacement) of defective composite restorations and distributed among 200 dental students of three universities in the southern region of the kingdom of Saudi Arabia. The data were collected with the help of an online questionnaire. Data entry and the analysis were done using the statistical software package SPSS version 20.0. It was presented using descriptive statistics in the form of frequencies and percentages for qualitative variables, and range means and standard deviations for age, quantitative variable. Analytic statistics were done using Chi-Square tests (χ2) to test the significant difference between categorical variables. The level of significance, the p-value was 0.01(p<0.01). Results: The decision to choose between composite repair or replacement was influenced by whether this topic was taught to them at various undergraduate levels during Bachelor of Dental Surgery. The reason associated with the decision to repair defective composite restorations, 76% reported as cost-effective followed by Increased longevity (71%), the permanent filling (70%), patient's preference for repair (65%), and least time consuming (50%). 67% participants preferred significantly (p<0.001) repair due to secondary caries in the previously restored tooth with composite, followed by the small surface defect in a composite restoration (65%), risk of pulpal damage significantly (p<0.001) in a defective composite restoration (62.5%) and more invasive and destructive treatment option (35%). More than half of respondents 123 (61.5%) reported that they were not taught about composite repair during the Bachelor of Dental Surgery. Conclusion: It is suggested with the help of our study that didactic and clinical training components regarding composite repair should be seriously included in the teaching curriculum of dental institutions as it is in the best interest of the patient. Dental students should be provided with clinical training on this topic so that they can follow proper decision-making protocols available during repair or replacement of defective resin composite restorations. Other researches in the future can be carried out for refining the guidelines and techniques utilized for composite repair. (AU)

Objetivo: O objetivo deste estudo foi avaliar o conhecimento entre estudantes de odontologia da King Khalid University, Jazan University e Najran University, no reino da Arábia Saudita, sobre quando reparar ou substituir restaurações de resina composta direta defeituosas. Material e Métodos: Foi formulada uma pesquisa baseada em questionário, buscando informações sobre o manejo (reparo / substituição) de restaurações de resina composta e distribuída entre 200 estudantes de odontologia de três universidades da região sul do reino da Arábia Saudita. Os dados foram coletados com o auxílio de um questionário online. A entrada e análise dos dados foram feitas com o software estatístico SPSS versão 20.0. Foi apresentado por meio de estatística descritiva na forma de frequências e percentuais para as variáveis qualitativas, e amplitude de médias e desvios-padrão para a idade, variável quantitativa. A estatística analítica foi feita usando testes de qui-quadrado (χ2) para testar a diferença significativa entre as variáveis categóricas. Ao nível de significância, o valor de p foi de 0,01 (p <0,01). Resultados: A decisão de escolher entre o reparo ou substituição do compósito foi influenciada pelo fato de este tópico ter sido ensinado a eles em vários níveis de graduação durante o Bacharelado em Odontologia. O motivo associado à decisão de reparar restaurações de resina composta defeituosas, 76% relataram como custo-benefício seguido por maior longevidade (71%), restauração definitva (70%), preferência do paciente para reparo (65%) e menos demorado ( 50%). Sessenta e sete por cento dos participantes preferiram o reparo significativamente (p <0,001) devido a cárie secundária no dente previamente restaurado com resina composta, seguido pelo pequeno defeito de superfície em uma restauração composta (65%), risco de dano pulpar significativamente (p <0,001) em um restauração de resina composta com defeito (62,5%) e opção de tratamento mais invasiva e destrutiva (35%). Mais da metade dos entrevistados, 123 (61,5%) relataram que não foram ensinados sobre reparo de resina composta durante o Bacharelado em Odonotlogia. Conclusão: É sugerido com a ajuda de nosso estudo que os componentes do treinamento didático e clínico sobre reparo de resina composta devem ser seriamente incluídos no currículo de ensino de instituições odontológicas, pois é do interesse do paciente. Os estudantes de odontologia devem receber treinamento clínico sobre este tópico para que possam seguir os protocolos de tomada de decisão adequados disponíveis durante o reparo ou substituição de restaurações de resina composta com defeito. Outras pesquisas no futuro podem ser realizadas para refinar as diretrizes e técnicas utilizadas para reparo de resina (AU)

Baseline growth of the Trinidad freshwater crab Poppiana dentata (Randall, 1840) under laboratory conditions / Crescimento do caranguejo de água doce de Trinidad, Poppiana dentata (Randall, 1840), em condições laboratoriais

Poppiana dentata (Randall, 1840) is widely distributed throughout riverine habitats in Trinidad. However, there is a scarcity of information on the biology of this species. This study provides the first baseline examination that describes growth aspects for P. dentata. Juvenile crabs were obtained from berried females collected in northwest Trinidad. Carapace width (CW), length (CL), moult incident, intermoult period and qualitative aspects were recorded for crabs (N = 23) over 9 months. CW, CL and intermoult period were used to derive percentage size increment, specific growth rate (SGR) and size at structural maturity for both sexes. Growth curves and logistic equations were also generated for each sex. Hatched crabs (< 5 mm CW) underwent rapid hardening after their first moult, indicating a fast turnover of moult cycles. SGR and CW percent increment were also the highest for this initial moult (P < 0.05). CW, CL, intermoult period, size increment and SGR did not differ between sexes (P > 0.05), with logistic equations expressed as CW = 32.81 (1+exp (1.481 ̵ 0.031t))-1 for males and CW = 34.07 (1+exp (1.516 ̵ 0.027t))-1 for females. Yet, breakpoint analyses indicated dissimilar sizes for structural maturity (male: 28.40 mm CW; female: 16.84 mm CW). These patterns reflect a shorter life span for this species in comparison to what has been reported for other trichodactylid relatives. This can have implications for P. dentata populations residing in anthropogenically disturbed habitats; thus, highlighting the need for conservation strategies to ensure preservation of native wild stock.

O Poppiana dentata (Randall, 1840) está amplamente distribuído nos habitats fluviais de Trinidad. Existem, porém, poucas informações sobre a biologia dessa espécie. Este estudo fornece a primeira análise de referência que descreve aspectos do crescimento do P. dentata. Caranguejos jovens foram obtidos a partir de fêmeas em desova na região noroeste de Trinidad. A largura da carapaça (LC), o comprimento da carapaça (CC), a incidência de muda, o período de intermuda e aspectos qualitativos foram registrados para caranguejos (N = 23) ao longo de mais de nove meses. A LC, o CC e o período de intermuda foram utilizados para obter o aumento porcentual, a taxa específica de crescimento (TEC), e o tamanho na maturidade estrutural para os dois sexos. Curvas de crescimento e equações logísticas foram também geradas para cada sexo. Os caranguejos que nasceram (com largura de carapaça < 5 mm) apresentaram um endurecimento rápido depois de sua primeira muda, o que indica uma rápida rotação dos ciclos de muda. A TEC e o aumento da porcentual da LC foram também os mais altos para esta muda inicial (P < 0,05). Não houve variação da LC, CC, do período de intermuda, aumento do tamanho e da TEC entre os sexos (P > 0,05), e as equações logísticas foram expressas como: LC = 32,81 (1+exp (1,481 ̵ 0,031t))-1 para machos, e LC = 34,07 (1+exp (1,516 ̵ 0,027t))-1 para fêmeas. Porém, as análises de quebra indicaram tamanhos diferentes para maturidade estrutural (LC para macho: 28,40; para fêmea: 16,84 mm). Esses padrões refletem um período de vida mais curto para esta espécie em comparação com o que tem sido registrado para outras famílias de Trichodactylidae. Isso pode ter implicações para as populações de P. dentata que residem em habitats modificados antropogenicamente; destaca-se, assim, a necessidade de estratégias de conservação para assegurar a preservação das populações selvagens nativas.

Baseline growth of the Trinidad freshwater crab Poppiana dentata () under laboratory conditions

Abstract Poppiana dentata (Randall, 1840) is widely distributed throughout riverine habitats in Trinidad. However, there is a scarcity of information on the biology of this species. This study provides the first baseline examination that describes growth aspects for P. dentata. Juvenile crabs were obtained from berried females collected in northwest Trinidad. Carapace width (CW), length (CL), moult incident, intermoult period and qualitative aspects were recorded for crabs (N = 23) over 9 months. CW, CL and intermoult period were used to derive percentage size increment, specific growth rate (SGR) and size at structural maturity for both sexes. Growth curves and logistic equations were also generated for each sex. Hatched crabs ( 5 mm CW) underwent rapid hardening after their first moult, indicating a fast turnover of moult cycles. SGR and CW percent increment were also the highest for this initial moult (P 0.05). CW, CL, intermoult period, size increment and SGR did not differ between sexes (P > 0.05), with logistic equations expressed as CW = 32.81 (1+exp (1.481 0.031t))-1 for males and CW = 34.07 (1+exp (1.516 0.027t))-1 for females. Yet, breakpoint analyses indicated dissimilar sizes for structural maturity (male: 28.40 mm CW; female: 16.84 mm CW). These patterns reflect a shorter life span for this species in comparison to what has been reported for other trichodactylid relatives. This can have implications for P. dentata populations residing in anthropogenically disturbed habitats; thus, highlighting the need for conservation strategies to ensure preservation of native wild stock.

Resumo O Poppiana dentata (Randall, 1840) está amplamente distribuído nos habitats fluviais de Trinidad. Existem, porém, poucas informações sobre a biologia dessa espécie. Este estudo fornece a primeira análise de referência que descreve aspectos do crescimento do P. dentata. Caranguejos jovens foram obtidos a partir de fêmeas em desova na região noroeste de Trinidad. A largura da carapaça (LC), o comprimento da carapaça (CC), a incidência de muda, o período de intermuda e aspectos qualitativos foram registrados para caranguejos (N = 23) ao longo de mais de nove meses. A LC, o CC e o período de intermuda foram utilizados para obter o aumento porcentual, a taxa específica de crescimento (TEC), e o tamanho na maturidade estrutural para os dois sexos. Curvas de crescimento e equações logísticas foram também geradas para cada sexo. Os caranguejos que nasceram (com largura de carapaça 5 mm) apresentaram um endurecimento rápido depois de sua primeira muda, o que indica uma rápida rotação dos ciclos de muda. A TEC e o aumento da porcentual da LC foram também os mais altos para esta muda inicial (P 0,05). Não houve variação da LC, CC, do período de intermuda, aumento do tamanho e da TEC entre os sexos (P > 0,05), e as equações logísticas foram expressas como: LC = 32,81 (1+exp (1,481 0,031t))-1 para machos, e LC = 34,07 (1+exp (1,516 0,027t))-1 para fêmeas. Porém, as análises de quebra indicaram tamanhos diferentes para maturidade estrutural (LC para macho: 28,40; para fêmea: 16,84 mm). Esses padrões refletem um período de vida mais curto para esta espécie em comparação com o que tem sido registrado para outras famílias de Trichodactylidae. Isso pode ter implicações para as populações de P. dentata que residem em habitats modificados antropogenicamente; destaca-se, assim, a necessidade de estratégias de conservação para assegurar a preservação das populações selvagens nativas.