Management of 'floating arm': a case report of adolescent ipsilateral proximal humerus fracture with open distal complex intraarticular fracture.

Simultaneous ipsilateral fractures of the proximal and distal humerus, known as 'floating arm', are rarely seen in adolescents and are considered challenging to manage. Most of the published cases have involved proximal humerus and distal supracondylar fractures. This paper presents a special case of floating arm injury in a 14-year-old boy following a motor vehicle accident that was managed in a well-established trauma center. The injury consisted of displaced proximal humerus and open distal T-condylar intraarticular fractures. The patient was discharged in good condition and regained functionality with no reported complications.

Dysphagia Unmasked: A Case Report of Esophageal Leiomyomatosis.

Esophageal leiomyomatosis, an uncommon benign condition marked by the proliferation of smooth muscle cells within the esophageal wall, frequently presents diagnostic challenges due to its rarity and diverse clinical manifestations. In this case report, we document the clinical journey of a 28-year-old female who presented with a two-year history of progressive dysphagia. Upon physical examination and endoscopy, a submucosal mass in the lower esophagus was identified, prompting further imaging and subsequent biopsy, which confirmed the diagnosis of leiomyomatosis. A multidisciplinary team recommended surgical intervention, leading to a minimally invasive laparoscopic resection of the esophageal leiomyomas. Postoperatively, the patient experienced a substantial improvement in her dysphagia and was discharged in stable condition. This case not only underscores the importance of a multidisciplinary approach in achieving an accurate diagnosis but also highlights the successful application of minimally invasive surgical techniques for alleviating symptoms in esophageal leiomyomatosis patients. The rarity and varied clinical presentation of this condition emphasize the need for individualized and tailored management strategies.

How COVID-19 Pandemic Restrictions Affected Kuwaiti College Students' Anthropometry, Lifestyle Behaviors, and Dietary Habits.

The COVID-19 pandemic and the measures implemented to control it have led to widespread lifestyle changes globally. While previous studies have explored these effects across different age groups, this research focuses uniquely on college students in Kuwait. A cross-sectional study (N = 1259) was conducted among college students using a validated online questionnaire covering various aspects, including demographics, academic performance, self-reported body weight and height, sleep duration, dietary habits, and physical activity. There were equal proportions of individuals reporting decreased, increased, or no change in body weight, BMI, and dietary habits due to COVID-19, with no significant gender differences observed. A higher decrease (44.3%) than increase (29.2%) occurred due to COVID-19 in the proportion of college students engaging in physical activity. Significant differences were found in the students' responses to most of the eating behavior questions, concerning the changes attributable to the COVID-19 pandemic restrictions. Multivariable analysis showed significant interaction effects for gender by losing above 9 kg during the last 6 months in age (p = 0.037), total physical activity in METs-min/week (p = 0.048), and cake/donuts intake (p = 0.006). Logistic regression analysis, adjusted for age, revealed that a decrease in BMI was associated with an increase in daily vegetable intake (aOR = 1.531, p = 0.031), whereas increases in BMI were associated with an increased intake of sugar-sweetened drinks equal to or above 4 days/week (aOR = 1.551, p = 0.032) and increased chocolates/candy intake equal to or above 4 days/week (aOR = 1.792, p = 0.037). It was concluded that, in response to a major epidemic, such as COVID-19, college students, as a population, are susceptible to significant changes in lifestyle and eating behaviors that can impact their health and well-being. Future risks for college students' health can be reduced through appropriate lifestyle interventions.

Interplay of orientational order and roughness in simulated thin film growth of anisotropically interacting particles.

Roughness and orientational order in thin films of anisotropic particles are investigated using kinetic Monte Carlo simulations on a cubic lattice. Anisotropic next-neighbor interactions between the lattice particles were chosen to mimic the effects of shape anisotropy in the interactions of disk- or rodlike molecules with van der Waals attractions. Increasing anisotropy leads first to a preferred orientation in the film (which is close to the corresponding equilibrium transition) while the qualitative mode of roughness evolution (known from isotropic systems) does not change. At strong anisotropies, an effective step-edge (Ehrlich-Schwoebel) barrier appears and a nonequilibrium roughening effect is found, accompanied by reordering in the film which can be interpreted as the nucleation and growth of domains of lying-down disks or rods. The information on order and roughness is combined into a diagram of dynamic growth modes.

A Glucagonoma Presenting as Cerebral Vein Thrombosis and Diabetes.

Glucagonomas are rare pancreatic neuroendocrine tumors (pNETs), malignant in 80% of cases, thus highlighting the importance of early diagnosis and treatment. Primary manifestations are diabetes, dermatosis, depression, weight loss, and deep vein thrombosis. Unlike other pNETs, glucagonomas are associated with a higher incidence of thromboembolic events, often resulting in death. We present the case of a glucagonoma patient whose primary manifestation was cerebral sinus venous thrombosis (CS-VT). Early diagnosis enabled curative resection. The purpose of this paper is to review the underlying mechanisms associated with increased coagulopathy in glucagonomas.

Evaluating Depression Among Acne Vulgaris Patients Treated With Isotretinoin.

Background Isotretinoin is the most effective treatment for moderate to severe acne. However, isotretinoin has many side effects related to its use. Since 1983, when Hetzen reported the first occurrence of new depressive symptoms in patients treated with isotretinoin, a lot of controversies emerged regarding the causal relationship between isotretinoin and depression. Objective To evaluate depression among acne patients treated with isotretinoin versus doxycycline at King Fahad Hospital of the University between December 2019-March 2020. Methods Using the Global Acne Grading System, patients aged 18 - 30 years old with moderate to severe acne vulgaris who have not received isotretinoin previously and has no personal or family history of any psychiatric illnesses, were evaluated for depression using the patient health questionnaire-9 before starting treatment and 8 weeks after. Twenty-nine patients had met the inclusion criteria and were included in the study. Results Of the 29 patients included, 18 patients completed the study (nine males, nine females). Twelve patients received isotretinoin 0.5mg/kg (study group) and six patients received doxycycline 100mg (control group). The mean depression score for the isotretinoin group has decreased from (4 ± 2.48) to (3.08 ± 2.84) but the result was statistically insignificant with a p-value of 0.19, CI (-5.28, 2.36). For the doxycycline group, the mean depression score has decreased from (5.5 ± 2.5) to (2.83 ± 0.75) with a p-value of 0.043, CI (0.12, 5.21). There was no statistically significant difference in the mean depression score between the two groups after 8 weeks of starting treatment [p-valve 0.837, CI (-2.28, 2.78)]. Conclusion This study showed that, after 8 weeks of starting treatment, isotretinoin at 0.5 mg/kg has no risk of developing depression. The results of this study did not reveal a direct relationship between the use of isotretinoin and the development of depression. Furthermore, optimum control and treatment of acne vulgaris have shown to improve depression scores.

Proapelin is processed extracellularly in a cell line-dependent manner with clear modulation by proprotein convertases.

Apelin is a peptide hormone that binds to a class A GPCR (the apelin receptor/APJ) to regulate various bodily systems. Upon signal peptide removal, the resulting 55-residue isoform, proapelin/apelin-55, can be further processed to 36-, 17-, or 13-residue isoforms with length-dependent pharmacological properties. Processing was initially proposed to occur intracellularly. However, detection of apelin-55 in extracellular fluids indicates that extracellular processing may also occur. To test for this, apelin-55 was applied exogenously to HEK293A cells overexpressing proprotein convertase subtilisin kexin 3 (PCSK3), the only apelin processing enzyme identified thus far, and to differentiated 3T3-L1 adipocytes, which endogenously express apelin, PCSK3 and other proprotein convertases. Analysis of culture media constituents from each cell type by high performance liquid chromatography-mass spectrometry and western blot demonstrated a time-dependent decrease in apelin-55 levels. This decrease was partially, but not fully, attenuated by PCSK inhibitor treatment in both cell lines. Comparison of the resulting apelin-55-derived peptide profile between the two cell lines demonstrated distinct processing patterns, with apelin-36 production apparent in 3T3-L1 adipocytes vs. detection of the prodomain of a shorter isoform (likely the apelin-13 prodomain, observed after additional proteolytic processing) in PCSK3-transfected HEK293A cells. Extracellular processing of apelin, with distinct cell type dependence, provides an alternative mechanism to regulate isoform-mediated physiological effects of apelin.

Human neural stem cell transplantation into the corpus callosum of Alzheimer's mice.

The hippocampus has been the target of stem cell transplantations in preclinical studies focused on Alzheimer's disease, with results showing improvements in histological and behavioral outcomes. The corpus callosum is another structure that is affected early in Alzheimer's disease. Therefore, we hypothesize that this structure is a novel target for human neural stem cell transplantation in transgenic Alzheimer's disease mouse models. This study demonstrates the feasibility of targeting the corpus callosum and identifies an effective immunosuppression regimen for transplanted neural stem cell survival. These results support further preclinical development of the corpus callosum as a therapeutic target in Alzheimer's disease.

The role of ghrelin in the regulation of glucose homeostasis.

Ghrelin is a 28-amino acid (aa) stomach-derived peptide discovered in 1999 as the endogenous ligand for growth hormone secretagogue-receptor (GHS-R). Ghrelin-producing cells constitute a distinct group of endocrine cells dispersed throughout the gastric mucosa and to a lesser extent in the small intestine and the endocrine pancreas. Ghrelin plasma levels rise during fasting and chronic caloric restriction to stimulate food intake and fat storage and to prevent life-threatening falls in blood glucose. Plasma ghrelin levels decrease after a meal is consumed and in conditions of energy surplus (such as obesity). Ghrelin has emerged as a key player in the regulation of appetite and energy homeostasis. Ghrelin achieves these functions through binding the ghrelin receptor GHS-R in appetite-regulating neurons and in peripheral metabolic organs including the endocrine pancreas. Ghrelin levels are negatively correlated with body mass index (BMI) and insulin resistance. In addition, ghrelin secretion is impaired in obesity and insulin resistance. Several studies highlight an important role for ghrelin in glucose homeostasis. Genetic, immunological, and pharmacological blockade of ghrelin signaling resulted in improved glucose tolerance and insulin sensitivity. Furthermore, exogenous ghrelin administration was shown to decrease glucose-induced insulin release and increase glucose level in both humans and rodents. GHS-R was shown to be expressed in pancreatic ß-cells and ghrelin suppressed insulin release via a Ca2+-mediated pathway. In this review, we provide a detailed summary of recent advances in the field that focuses on the role of insulin and insulin resistance in the regulation of ghrelin secretion and on the role of ghrelin in glucose-stimulated insulin secretion (GSIS).

Diabetic foot complications and their risk factors from a large retrospective cohort study.

BACKGROUND: Foot complications are considered to be a serious consequence of diabetes mellitus, posing a major medical and economical threat. Identifying the extent of this problem and its risk factors will enable health providers to set up better prevention programs. Saudi National Diabetes Registry (SNDR), being a large database source, would be the best tool to evaluate this problem. METHODS: This is a cross-sectional study of a cohort of 62,681 patients aged ≥ 25 years from SNDR database, selected for studying foot complications associated with diabetes and related risk factors. RESULTS: The overall prevalence of diabetic foot complications was 3.3% with 95% confidence interval (95% CI) of (3.16%-3.44%), whilst the prevalences of foot ulcer, gangrene, and amputations were 2.05% (1.94%-2.16%), 0.19% (0.16%-0.22%), and 1.06% (0.98%-1.14%), respectively. The prevalence of foot complications increased with age and diabetes duration predominantly amongst the male patients. Diabetic foot is more commonly seen among type 2 patients, although it is more prevalent among type 1 diabetic patients. The Univariate analysis showed Charcot joints, peripheral vascular disease (PVD), neuropathy, diabetes duration ≥ 10 years, insulin use, retinopathy, nephropathy, age ≥ 45 years, cerebral vascular disease (CVD), poor glycemic control, coronary artery disease (CAD), male gender, smoking, and hypertension to be significant risk factors with odds ratio and 95% CI at 42.53 (18.16-99.62), 14.47 (8.99-23.31), 12.06 (10.54-13.80), 7.22 (6.10-8.55), 4.69 (4.28-5.14), 4.45 (4.05-4.89), 2.88 (2.43-3.40), 2.81 (2.31-3.43), 2.24 (1.98-2.45), 2.02 (1.84-2.22), 1.54 (1.29-1.83), and 1.51 (1.38-1.65), respectively. CONCLUSIONS: Risk factors for diabetic foot complications are highly prevalent; they have put these complications at a higher rate and warrant primary and secondary prevention programs to minimize morbidity and mortality in addition to economic impact of the complications. Other measurements, such as decompression of lower extremity nerves, should be considered among diabetic patients.

Histological Bulbar Manifestations in the ALS Rat.

BACKGROUND: Almost all patients with amyotrophic lateral sclerosis (ALS) develop bulbar symptoms; therefore, it is important to have valid animal models that accurately reflect these features. While the SOD1-G93A rat is extensively used as an ALS model, bulbar symptoms in this model are not well characterized. OBJECTIVE: In the present study, we aimed to better characterize bulbar dysfunction in terms of histology to determine whether the SOD1-G93A rat is a useful model for bulbar-onset ALS. METHODS: Sixty-day-old SOD1-G93A rats on a Sprague-Dawley background and age-matched wild-type controls were assessed weekly for global motor function, facial nerve function, and vagal nerve function. The study endpoint was determined when an SOD1-G93A rat could not right itself within 30 s of being placed on its side. At that point, neuronal counts were assessed in different brainstem cranial nerve nuclei. In addition, the masseter muscle, posterior belly of the digastric muscle, and tongue muscle were evaluated for intact neuromuscular junctions. RESULTS: Our data demonstrate decreases in the number of motor neurons in the trigeminal, facial, and hypoglossal nuclei, as well as compromised neuromuscular junction integrity in the muscles they innervate. CONCLUSION: These findings suggest that, from a histological standpoint, the SOD1-G93A rat is a valid model of ALS bulbar symptoms.

Determination of total iron in food samples after flow injection preconcentration on polyurethane foam functionalized with N,N-bis(salicylidene)-1,3-propanediamine.

A highly selective flow injection sorption system was developed for the fast determination of total iron in food samples. Iron (III) was reduced to iron (II) by ascorbic acid and preconcentrated on a mini-column packed with polyurethane foam (PUF) functionalized with N,N-bis(salicylidene)-1,3-propanediamine (SPDA). The retained Fe (II) was eluted with hydrochloric acid and subsequently reacted to 2,4,6-tri(2'-pyridyl)-1,3,5-triazine (TPTZ) then measured at 593 nm. The procedure has resulted preconcentration factor 36, sample frequency 20 h(-1) and detection limit 18 µg L(-1). The precision (RSD) was found to be 5.7% and 3.1% at concentration levels 0.1 and 5.0 µg mL(-1) iron (II), respectively. Finally, the method was successfully applied to determination of total iron in reference material and food samples.

Meteorological factors, aeroallergens and asthma-related visits in Kuwait: a 12-month retrospective study.

BACKGROUND: The increasing prevalence of asthma in many countries has been related to weather factors and aeroallergen concentrations, but this has not been studied in Kuwait. We evaluated the effect of meteorological factors and the occurrence of aerobiologicals on the number of asthma cases in Kuwait. METHODS: The number of daily asthma visits to the allergy center and emergency department at Al-Sabha Hospital for 1 year were examined on a monthly basis for correlation with major metereological factors (temperature, relative humidity, rain, wind speed and direction). Spore and pollen counts were collected hourly. RESULTS: A total of 4353 patients received asthma treatment during the year. The highest pollen count was in the month of September with a maximum relative humidity of 47% and no precipitation, but with a high mean temperature of 39.7 degrees C. Pollen counts were higher in the late summer (September) and occurred with a high patient visit to the allergy center. Fungal spore counts were significantly higher in early winter (December). The high fungal spore count seemed related to with high relative humidity and high precipitation with a low mean average temperature of 19.7 degrees C. The increase number of patients with bronchial asthma visiting an emergency clinic during December was significantly associated with high aerial counts for fungal spores (P<.03), and the months of September and October were more significant for pollen. CONCLUSION: This study indicates that meteorological factors, aeroallergen concentrations and asthma-related visits are interrelated. The results may prove useful in the generation of hypotheses and development of designs for more comprehensive, individual-based epidemiological studies.

Pilot study: tendency of increasing iodine content in human milk and cow's milk.

The iodine supply in Germany has improved throughout the last decade, albeit with enormous differences between individuals and regions. In the Thuringian city of Jena, analyses of the iodine content of human milk have been undertaken regularly since 1982. Significantly increasing iodine concentrations in human and cow's milk have been found. Therefore, the current situation and the effectiveness of measures to prevent iodine deficiency demands re-evaluation. The iodine content of human milk from 32 lactating mothers was analysed on the 5th day (mean) postpartum and mothers' dietary iodine intake during the last two months of pregnancy was assessed by means of a food frequency questionnaire. To corroborate the assumption that the increasing iodine levels of cow's milk are one of the main reasons for the improved iodine supply, the iodine concentration of 34 cow's milk bulk-samples was also determined. Both human and cow's milk samples were analysed by the ICP-MS method. Twenty women took iodine supplements (mean daily intake = 175 microg). The average daily iodine intake of the 20 supplemented and 12 non-supplemented women was 258 microg and 116 microg, respectively. Daily iodine intake from food and beverages was significantly lower in supplemented women (83 microg/day). The average iodine content of human milk was 169 +/- 88 microg/l with a range of 33 - 348 microg/l. This content is two times higher than levels from 1994 in the same area. There was no difference in the human milk iodine content between mothers taking supplements and those who did not. Cow's milk samples showed a mean iodine concentration of 178 +/- 131 microg/l (range 48 - 661 microg/l).

Guided tissue regeneration in intrabony defects using an experimental bioresorbable polydioxanon (PDS) membrane. A 24-month split-mouth study.

AIM: The comparison of the clinical, radiographic, and microbiological healing results in deep intrabony defects following GTR therapy with two different bioresorbable membranes in a prospective split-mouth design. MATERIAL AND METHODS: 31 pairs of contralateral intrabony defects were randomly treated with either an experimental Polydioxanon (PDS) membrane or a Polylactic acid (PLA) matrix barrier. After 6, 12 and 24 months, healing results were assessed using clinical examinations (REC, PPD, CAL, vertical relative attachment gain V-rAG), quantitative digital subtraction radiography (amount and area of bone density changes), and microbiological analysis. RESULTS: Postoperative membrane exposures occurred in 14 PDS and 2 PLA treated sites. 6, 12 and 24 months p.o., both membranes provided a significant gain in CAL [median values: 6 months (PDS vs. PLA: 3.0 vs. 3.0 mm); 12 and 24 months (PDS vs. PLA: 4.0 vs. 4.0 mm)], which corresponded to a V-rAG of 57.1% (PDS) vs. 62.5% (PLA) after 24 months. PDS and PLA treated sites revealed significant bone density gain 6, 12 and 24 months after surgery. 38.8% (PDS) vs. 41.8% (PLA) of the initial defect areas showed bone density gain. While the gain in bone density was significantly greater in PDS than in PLA sites, neither CAL gain nor the area of bone density changes revealed significant differences. Microbiological culture revealed similar bacterial loads in PDS and PLA sites during the first 12 months. CONCLUSION: This 24-month study indicates that the PDS and PLA membranes can provide similar favorable regeneration results in deep intrabony periodontal defects, although considerably more postoperative membrane exposures have to be expected in PDS treated sites.

GTR therapy of intrabony defects using 2 different bioresorbable membranes: 12-month results.

This prospective split-mouth study was designed to compare the clinical and radiographic healing results in intrabony periodontal defects 12 months after GTR therapy with 2 different bioresorbable barriers. The study comprised 25 healthy patients with one pair of contralaterally located intrabony defects with a probing pocket depth of > or = 6 mm and radiographic evidence of angular bone loss of > or = 4 mm. The 2 defects of each patient were randomized for treatment either with polylactic acid (PLA) membranes or with polyglactin-910 (PG-910) membranes. The patients received systemic doxycycline (100 mg/d) for 11 days postoperatively. One blinded examiner recorded the following clinical parameters using a pressure calibrated probe at baseline and after 12 months: papillary bleeding index (PBI), gingival recession (REC), probing pocket depth (PPD), and probing attachment level (PAL). The vertical relative attachment gain (V-rAG) was calculated as a % of the PAL gain related to the maximum possible attachment gain (expressed by the intraoperatively measured depth of the osseous defect). Geometrically standardized intraoral radiographs were quantitatively evaluated for bone changes (density, area) in the defect region using digital subtraction radiography (DSR). Clinical and radiographic data were statistically analyzed using the Wilcoxon-signed-rank test (alpha=0.05). Postoperative membrane exposures occurred in 9 PLA and 13 PG-910 treated sites. After 12 months of healing, both barrier types provided significant PPD reductions and PAL gain [median (25/75 percentile)]: deltaPPD [PLA: 3.0 (2.0/4.0) mm; PG-910: 3.0 (2.0/4.5) mm]; deltaPAL [PLA: 3.0 (2.5/4.0) mm; PG-910: 2.0 (1.0/4.0) mm]. V-rAG amounted to 60% in PLA sites and 54% in PG-910 sites. DSR revealed significant bone density gain after 12 months. 58.3% of the initial defect area in PLA sites and 54.0% of the initial defect area in PG-910 sites showed bone density gain. Neither clinical nor radiographic data revealed any significant difference between the 2 barrier types after 12 months. In conclusion, this 12-month study demonstrated that PLA and PG-910 membranes provided similar favorable regeneration results in deep intrabony periodontal defects.

Postoperative exposure of bioresorbable GTR membranes: effect on healing results.

The goal of this investigation was to evaluate the effect of postoperative exposure of two different bioresorbable membranes on the guided tissue regeneration (GTR) healing results compared to nonexposed sites. In each of 25 patients one pair of contralateral intrabony lesions was treated either with polylactic acid (PLA) or polyglactin 910 (PG-910) membranes. Postoperative exposure occurred in 9 PLA and 13 PG-910 sites. Standardized clinical [papillary bleeding index (PBI), gingival recession (REC), probing pocket depth (PPD), probing attachment level (PAL)] and radiographic examinations (digital subtraction radiography) were performed immediately before (baseline) and 6 and 12 months postoperatively (p.o.). Subgingival bacterial samples from surgical sites were evaluated by culture at baseline, 6 weeks, and 6 and 12 months p.o. Six months after surgery the changes (delta) of REC were significantly (P < or = 0.05) greater in exposed than in nonexposed sites, independently of the membrane material (median): exposed sites, delta REC = -1 mm; nonexposed sites, delta REC = 0.0 mm. However, 12 months p.o. no significant differences were found due to a decrease in the initial recessions in exposed sites. Although a higher percentage of exposed than nonexposed sites harbored periodontal pathogens 6 weeks p.o. at the gingiva-faced membrane surface, membrane exposure did not have a significant negative effect on delta PPD, delta PAL, or radiographic bone density changes 6 and 12 months p.o. Both membranes showed significant gains in PAL and bone density in both exposed and nonexposed sites. In conclusion, this study demonstrates that with consistent infection control the postoperative exposure of PLA and PG-910 membranes has no significant negative effect on the regeneration outcome, although higher initial gingival recessions must be expected than in the nonexposed sites. However, in exposed sites plaque and infection control were clearly impeded by the rough, exposed membrane surfaces and by the initially negative gingival morphology.