Association of soluble triggering receptor expressed on myeloid cells-1 with rheumatoid arthritis in Iraqi patients: A case-control study.

Rheumatoid arthritis (RA) is a common chronic immune-mediated inflammatory arthritis, impacting 0.5-1% of the global population, and leading to progressive deterioration of the musculoskeletal and joint systems. This study aims to analyze the serum levels of soluble triggering receptors expressed on myeloid cells-1 (sTREM-1) in Iraqi patients with RA and healthy individuals. It also intends to assess the diagnostic significance of these receptors, investigate their association with disease activity and examine their correlation with the sociodemographic and clinical characteristics of the patients. From December 2020 to June 2021, 117 RA patients with a mean age of 50 years participated in the study. The patients were categorized into inactive and active disease groups based on their DAS28 score and CDAI, as determined by a Rheumatologist. The serum levels of a specific triggering receptor expressed on myeloid cells-1 (TREM-1) (Pg/mL) were measured. The results showed that the active RA patients had significantly higher levels of the receptor (270.17±187) compared to both the inactive RA patients (112.81±37.48) and the healthy controls (43.89±29.53) (P < 0.001). The sTREM-1 demonstrated a high discriminatory ability (AUC ≥ 0.936) between RA and control groups. Moreover, a direct association was observed between the DAS-28ESR and sTREM-1 levels.

Logistic models to minimize the material handling cost within a cross-dock.

Retail supply chains are intended to empower effectiveness, speed, and cost-savings, guaranteeing that items get to the end client brilliantly, giving rise to the new logistic strategy of cross-docking. Cross-docking popularity depends heavily on properly executing operational-level policies like assigning doors to trucks or handling resources to doors. This paper proposes a linear programming model based on door-to-storage assignment. The model aims to optimize the material handling cost within a cross-dock when goods are unloaded and transferred from the dock area to the storage area. A fraction of the products unloaded at the incoming gates is assigned to different storage zones depending on their demand frequency and the loading sequence. Numerical example considering a varying number of inbound cars, doors, products, and storage areas is analyzed, and the result proves that the cost can be minimized or savings can be intensified based on the feasibility of the research problem. The result explains that a variation in the number of inbound trucks, product quantity, and per-pallet handling prices influences the net material handling cost. However, it remains unaffected by the alteration in the number of material handling resources. The result also verifies that applying direct transfer of product through cross-docking is economical as fewer products in storage reduce the handling cost.

Green Synthesis, Characterization, and Antileishmanial Activity of the Silver Nanoparticles Alone and Along with Meglumine Antimoniate against Leishmania major Infection.

Background: The most commonly available drugs for leishmaniasis are pentavalent antimony compounds; whereas the recent studies showed various complications and limitations of these drugs. We aimed to green synthesized silver nanoparticles (AgNPs) and study the promising antileishmanial and synergic effects of green synthesized silver nanoparticles alone and combined with glucantime. Methods: The precipitation technique was used to drop silver ions via an extract of Astragalus spinosus to AgNPs at Department of Biological Sciences, Faculty of Science and Humanities, Shaqra University, Saudi Arabia in 2022. Then, its anti-amastigotes, caspase-3-like activity, triggering the nitric oxide (NO) as well as its cytotoxicity effects on macrophage cells as well as effects on leishmaniasis in BALB/c mice infected by L. major were measured. Results: The size of the AgNPs were ranging from 30-40 nm. The IC50 value for AgNPs, AgNPs+ meglumine antimoniate (MA), and MA was 59.3, 18.6, and 51.2 µg/mL, respectively. The determined FIC value for AgNPs and MA was found to be 0.31 and 0.36, respectively; demonstrating the synergistic potency of AgNPs when combined with MA. The diameter of CL lesions treated with various doses of AgNPs and AgNPs+MA notably (p<0.001) decreased. AgNPs, particularly at the concentrations of ½ IC50 and IC50, considerably triggered the caspase-3 activation. The calculated CC50 of AgNPs and MA was 612.5 and 789.8 µg/mL, respectively. Green synthesized AgNPs, especially in combination with MA had synergic antileishmanial effects and displayed a promising drug candidate for treating L. major CL. Conclusion: We found satisfactory findings in the parasite reduction in both in vitro and animal models. Still, more studies are expected to explain the precise action mechanisms of AgNPs and their efficacy in humans.

Management of a patient with Sheehan's syndrome and diabetes insipidus complicated by recurrent hyponatremia.

SUMMARY: A 38-year-old female was initially seen in the intensive care unit after severe postpartum hemorrhage. She was initially diagnosed to have Sheehan's syndrome and after discharge, she was diagnosed to have a vesicovaginal fistula which initially caused a delay in diagnosing diabetes insipidus in the patient because she was having urinary incontinence. The patient had the vesicovaginal fistula repaired and was on replacement with levothyroxine, prednisone, and desmopressin. Years after her diagnosis, the patient experienced recurrent episodes of hyponatremia in the setting of desmopressin therapy. This case highlights the challenges of diagnosing diabetes insipidus in a patient with Sheehan's syndrome and a vesicovaginal fistula, as well as the long-term management of central diabetes insipidus in a resource-limited setting. LEARNING POINTS: Sheehan's syndrome is rarely associated with diabetes insipidus, and in our patient, it was initially missed due to a vesicovaginal fistula which caused urinary incontinence. Water intoxication is more common in young children and older adults but can occur years after initiating treatment with desmopressin in adults and should be kept in mind when treating patients with hyponatremia who have hypopituitarism associated with diabetes insipidus. Water intoxication is much more common in patients with diabetes insipidus being treated with intranasal desmopressin than in those using the oral preparations.

Evaluation of different surgical approaches to remove dental implants from the maxillary sinus.

Dental implant surgery on atrophied maxilla has many risks; in some patients, simultaneous sinus lifting with implant placement must be performed to increase the chances of successful implantation; this procedure can cause implant migration. Eleven patients were diagnosed with implant migration into the maxillary sinus in four anatomical areas: the sinus floor above the alveolar bone, near the junction of the sinus and nasal floor, near the floor of the orbit, and the most posterior aspect of the sinus. Surgical removal was performed through four different direct non-endoscopic transoral approaches depending on the location of the displaced implant. Surgical challenges, surgery duration and postoperative complications were reported. The least challenging surgical intervention was noted when removing the displaced implants from the floor of the sinus through the crestal approach. More challenges were experienced during the surgical removal of anteriorly displaced implants near the roof of the orbital floor due to surgical access and the proximity of vital anatomical structures. Bleeding from the pterygoid venous plexus was profound with the posterior lateral approach. The choice of an appropriate surgical approach to retrieve displaced dental implants from the maxillary sinus depends on the location of the implant and the surrounding vital anatomical structures.

Family History, Consanguinity and Other Risk Factors Affecting the Prevalence of Prediabetes and Undiagnosed Diabetes Mellitus in Overweight and Obese Yemeni Adults.

OBJECTIVE: Overweight and obese adults are at high risk for developing prediabetes and diabetes. The aim of this study was to measure the prevalence of prediabetes (pre-DM) and diabetes (DM) among Yemeni adults who were overweight or obese and had first-degree relatives with DM, consanguinity and other risk factors. PATIENTS AND METHODS: This cross-sectional study included 612 adults, all with a BMI≥25 kg/m2. BMI, blood pressure (BP) and waist circumference (WC) were measured in the clinic. Fasting blood glucose (FBG) was collected for all subjects. The patients either had first-degree relatives with diabetes or not, and the subjects answered a questionnaire regarding the consanguinity of their parents, exercise, khat chewing, smoking, and eating vegetables and fruits daily. RESULTS: Of the 612 study participants (32% males and 68% females) aged 20-70 years old, 429 (70.1%) had a family history (FM) of DM ± consanguinity of parents, and 183 (29.9%) had no FM of diabetes. Multivariate analysis showed significant risk in those with class III obesity for pre-DM (AOR 3.10 95% CI 1.56-6.18 p value 0.001) and DM (AOR 3.35 95% CI 1.47-7.65 p value 0.004) and those who had siblings with DM had a risk for pre-DM (AOR 1.72 95% CI 1.09-2.71 p value 0.02) and DM (AOR 2.24 95% CI 1.25-4.0 p value 0.007). Khat chewing increased the risk for pre-DM (AOR 1.61 95% CI 1.04-2.48 p value 0.032) and for DM (AOR 2.09 95% CI 1.14-3.82 p value 0.017). Having consanguineous parents plus siblings with DM were associated with a higher risk of DM (p value 0.031). CONCLUSION: There is a high prevalence of pre-DM and undiagnosed DM among overweight and obese Yemeni individuals. Class III obesity, having siblings with DM, chewing khat, and having consanguineous parents plus siblings with DM all increased the risk. This group should be screened at an early age for early detection of pre-DM and DM.