LEVELS OF OSTEOPROTEGERIN AND IRISIN IN POSTMENOPAUSAL OSTEOPOROSIS WOMEN.

BACKGROUND: Osteoporosis (OP) is a highly prevalent disorder affecting 50 million individuals around the world. It is also a typical skeletal disorder described by low bone mass, which leads to reduced bone strength and an enhanced risk of fractures. Osteoprotegerin As a member of the TNF receptor superfamily, osteoprotegerin is well recognized for its protective effect against excessive bone resorption. Irisin is Irisin is a muscle-secreted hormone that is generated by the cleavage of membrane protein FNDC-5 (fibronectin type III domain-containing protein 5) (FNDC5). Irisin is widely distributed in the human body and is involved in the browning of white adipose tissue, improving insulin resistance, improving cognitive function, and regulating bone metabolism. METHODS: This study was a prospective cross-sectional study involving 90 postmenopausal osteoporosis (PMOP) Iraqi women in Kirkuk City over one year time; from April 2023 to the end of July 2024. Sixty women with osteoporosis are diagnosed by DEXA. And 30 women as a control group. The blood samples were collected from each woman included in this study for the estimation of osteoprotegerin and irisin. Were measured using the ELISA kit. RESULT: This was conducted on sixty postmenopausal osteoporosis women. The age range was (50-65) years and the mean body mass index was (30.05) and thirty women as a control group. The age range was (50-65) years, and the mean body mass index was (27.55). The study found that the mean serum level of osteoprotegerin, increased in postmenopausal osteoporosis women compared to control (P-Value = 0.0007, while the mean serum level of irisin was lower in postmenopausal osteoporosis women compared to control this result was highly significant at a P value of 0.0004. CONCLUSION: This study reveals that there was a positive correlation between serum osteoprotegerin, level with irisin (R=0.175).

EVALUATION OF SERUM VASPIN LEVEL IN IRAQI WOMEN WITH GESTATIONAL DIABETES MELLITUS.

BACKGROUND: Gestational diabetes mellitus (GDM) traditionally refers to abnormal glucose tolerance with onset or first recognition during pregnancy. The objectives: The study is designed to measure vaspin in the serum of women with GDM and estimate its association with insulin resistance, HbA1c, HDL, LDL, triglyceride and total cholesterol. METHODS: This study was a case-control study conducted on 90 pregnant women (26 weeks and more), 60 of them patients with GDM, and 30 normal pregnant women as the control group, The blood sample was taken from participating women, and an interview was carried out with them using questionnaire form. vaspin and insulin were measured by ELISA technique, HbA1c was measured by ichroma™, lipid profile, and fasting blood glucose was measured by colourimetric method. RESULT: Vaspin was increased significantly in the patient group in comparison to control (268.98±154.02) ng/ml. Insulin level increased significantly in the patient group (27.88±19.69) ng/ml, HbA1c and blood glucose also increased significantly in the patient group in comparison to the control respectively (5.08±0.613) (126.47±29.05) mg/dl. However, there was no significant difference in insulin resistance, HDL, LDL, TG, and TC. CONCLUSION: The study shows that vaspin was increased in GDM but there is no negative correlation with HbA1c, insulin resistance, and lipid profile.

Tumor-secreted extracellular vesicles counteract therapy response by triggering inflammatory mesenchymal stem cell development.

PURPOSE: Therapy resistance is a major clinical hurdle in bone cancer treatment and seems to be largely driven by poorly understood microenvironmental factors. Recent evidence suggests a critical role for a unique subpopulation of mesenchymal stem cells with inflammatory features (iMSCs), though their origin and function remained unexplored. We demonstrate that cancer-secreted extracellular vesicles (EVs) trigger the development of iMSCs, which hinder therapy response in vivo, and set out to identify strategies to counteract their function. EXPERIMENTAL DESIGN: The role of iMSCs in therapy resistance was evaluated in an orthotopic xenograft mouse model of osteosarcoma. EV-induced alterations of the MSC transcriptome were analyzed and compared with scRNA-seq data of osteosarcoma and multiple myeloma patient biopsies. Functional assays identified EV components driving iMSC development. We assessed the efficacy of clinical drugs in blocking iMSC-induced resistance in vivo. RESULTS: We found that iMSCs are induced by interaction with cancer EVs and completely abrogate the antimetastatic effect of TGFb signaling inhibition. Importantly, EV-induced iMSCs faithfully recapitulate the inflammatory single-cell RNA signature of stromal cells enriched in multiple myeloma and osteosarcoma patient biopsies. Mechanistically, cancer EVs act through two distinct mechanisms. EV-associated TGFb induces IL6 production, while the EV-RNA cargo enhances TLR3-mediated chemokine production. We reveal that simultaneous blockade of downstream EV-activated pathways with ladarixin and tocilizumab disrupts metastasis formation and overcomes iMSC-induced resistance. CONCLUSIONS: Our observations establish iMSCs as major contributors to drug resistance, reveal EVs as physiological triggers of iMSC development and highlight a promising combination strategy to improve therapy response in bone cancer patients.

ASSOCIATION OF PLASMA NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN WITH METABOLIC SYNDROME.

This prospective hospital-based study conducted in Tikrit City aimed to investigate the role of Neutrophil gelatinase-associated lipocalin (NGAL ) and level of hemoglobin A1c and lipid profile concentrations in Metabolic syndrome (MetS) with hypertension and Diabetes mellitus (DM). Objective - estimate of serum Neutrophil gelatinase-associated lipocalin levels in Metabolic syndrome patients and the Control Group. The study included 60 patients with metabolic syndrome along with 30 healthy individuals as controls who were 18-50 years old; the samples were collected at a specific time (10 P.M. to 1 A.M.) from October 2023 to the end of November 2023 from Tikrit Teaching Hospital in Tikrit City and analyzed for various parameters. Patients with Metabolic Syndrome had their waist measured men as >102 cm (>40 in) and Women >88 cm (>35 in) and BMI >30 kg/m2 and/or waist ship ratio >0.9 in men and >0.85 in women. The mean serum level NGAL in patients with metabolic syndrome compared with the control group (523.12±271.8 versus 353.66± 151.0 pg/ml). The result was a significant difference (p<0.001). The study found that metabolic syndrome patients who had HbA1c% results were significantly different (p<0.001) compared with the control group. Also, the serum level lipid profile concentrations in patients with metabolic syndrome compared with the control group which was significantly different (p<0.001). The results of this research clearly indicate that a high level of NGAL associated with metabolic syndrome is a significant risk factor for the incidence and mortality of cardiovascular disease. Reducing the prevalence of cardiovascular disease in the general population should involve identifying, treating, and preventing the underlying risk factors of metabolic syndrome. Male obesity, diabetes, dyslipidemia, and hypertension are well-known main cardiovascular risk factors.

THE RELATION OF THYROID DISTURBANCE AND ISCHEMIC HEART DISEASE IN IRAQI PATIENTS.

This study conducted in Baghdad focused on patients with coronary heart disease admitted to three hospitals. The study included 60 Iraqi patients with coronary heart disease and a control group of 30 healthy individuals. Blood samples were collected from both groups after fasting. The study analyzed the demographic characteristics of the patients and control group, including age groups, sex distribution, and BMI. The majority of patients had hypertension, while 58.33% had diabetes. The study found that IHD patients had significantly higher T3 and T4 levels compared to the control group. However, there was no significant difference in TSH levels. The study also examined thyroid function parameters among different age groups and found no significant differences in individuals with hypothyroidism. The highest prevalence of hyperthyroidism was among individuals with hypertension, while the highest spread of hypothyroidism was among individuals with diabetes. The study observed significant differences in mean HbA1c levels among the three groups, with the highest levels in patients with hypothyroidism. In conclusion, this study suggests potential alterations in thyroid function associated with ischemic heart disease and emphasizes the need for further research on the clinical implications and underlying mechanisms involved.

EVALUATION OF VITAMIN K2 IN PATIENTS WITH TYPE 2 DIABETES MELLITUS.

There is a rising interest in studying the possible therapeutic value of fat-soluble micronutrients like vitamin K2 for preventing or controlling type 2 diabetes mellitus. The present study was designed to evaluate levels of vitamin K2 in patients with type 2 diabetes mellitus. The study enrolled 60 patients with type 2 diabetes mellitus and 30 individuals as a control group. Blood samples were collected from each participant for estimation of vitamin K2 by (ELISA), HbA1c by (Cobas), lipid profile by (colourimetric methods) and calculated BMI. The mean±Standard Deviation (SD) of vitamin K2 levels for the type 2 diabetes group were (185.13±30.08) pg/ml, with a highly significant decrease (p<0.001) when compared with the control group (303.91±58.60) pg/ml. The HbA1c, cholesterol, TG, and LDL-C level for the type 2 diabetes group highly significant increase (p<0.001) when compared with the control while HDL-C decreased when compared with the control group. The current study concluded that: Vitamin K2 levels showed a highly significant decrease in patients with uncontrolled type 2 diabetes mellitus when compared with those in the control group. Vitamin K2 levels play an important role in improving glycated haemoglobin and lipid profiles in patients with type 2 diabetes mellitus.

EVALUATION OF FETUIN-A LEVEL IN POLYCYSTIC OVARY SYNDROME AND ITS ASSOCIATION WITH ASPROSIN AND SOME BIOCHEMICAL PARAMETERS.

An ovarian cyst is a common hormonal disorder that affects the ovaries in females of reproductive age. Environmental and genetic factors may contribute to the beginning of the disease, although the lack of a clear aetiology. Menstrual irregularities, increased hair growth, and acne are some of the most important signs. In order to control symptoms and prevent the development of chronic medical disorders, early identification is essential. The goal of this study was to assess fetuin-A levels and relationships in polycystic ovary syndrome (PCOS) patients. The connection between fetuin-A and asprosin and several biochemical parameters, including fasting blood sugar, insulin, cholesterol, and triglycerides in women patients with polycystic ovarian syndrome. Ninety females were included in the trial; 60 individuals (females) were selected who were diagnosed with PCOS by a gynaecological specialist and ranged in age from 15 to 45. The result was a change in the ovulation-inducing hormones LH and FSH as well as an increase in the proteins fetuin-A and Asprosin. On the other hand, 30 individuals (all female) were used as a control group. Their ages were recorded as well as the fact that they did not have PCOS. For all groups, laboratory tests were done to determine the levels of fetuin-A, Asprosin, fasting blood sugar, Insulin, total cholesterol, and triglyceride. For parents and a control group, investigators performed an asprosin analysis, The findings of the comparison were statistically not significant (P value=0.115). performed a Fetuin-A analysis as well, the results were statistically highly significant with a P value of 0.0002 when compared to the outcomes of the two sick groups and the healthy controls.

TESTOSTERONE AND SERUM ZINC LEVELS IN MEN WITH BENIGN PROSTATIC HYPERPLASIA.

Benign prostatic hyperplasia (BPH) is a common benign tumour of the prostate that becomes more common as men age. The purpose of this study is to investigate the relationships between serum zinc and testosterone in BPH patients in Iraq. This case-control study entailed gathering 90 subjects which were separated into two groups, group A consisted of 60 patients with benign prostatic hyperplasia, while group B consisted of 30 healthy males. Diagnosis revealed patient's prostate volumes (PV) were equal to or more than 25 millilitres. Both groups had their serum zinc and serum testosterone levels. The study showed that the mean prostate size was elevated significantly in the BPH group (54.0±8.4cc) as compared with the control group (19.66±2.88cc) (P:0.01). There is a significant reduction in the serum testosterone concentration of benign prostatic hyperplasia patients, (4.05±3.1 ng/ml), as compared with control subjects, (11.37±2.87; p≤0.01). There is a significant reduction in the serum zinc concentration of benign prostatic hyperplasia patients, (70.4±9.63 ng/ml), as compared with control subjects, (99.3±10.5; p≤0.01). The higher percentage of benign prostatic hyperplasia is in patients above 66 years, and the lowest is in the age group 45-55 years. Serum testosterone and zinc are significantly lower in benign prostatic hyperplasia patients than in age-matched healthy controls. All benign prostatic hyperplasia patients have larger prostates than normal healthy control participants of the same BMI. All BMI groups of benign prostatic hyperplasia patients had lower serum testosterone and zinc than normal healthy control persons of the same BMI.

THE ROLE OF MELATONIN AND VITAMIN D IN IRAQI PREMENOPAUSAL WOMEN OSTEOARTHRITIS PATIENTS.

Osteoarthritis (OA) is the most common form of arthritis, affecting 1 in 3 people over age 40 and women more so than men. The prevalence of OA is rising due to the increasing prevalence of OA risk factors, including obesity, physical inactivity, and joint injury. The aim of the study is to determine the correlation of Melatonin, Vitamin D (VitD) with osteoarthritis (OA) in women premenopausal OA women in age between 40-50 years old. The study included 60 patients with OA and 30 patients without OA from the general Balad Hospital in Salah Al-Den governorates. All subjects were premenopausal women between 40-50 years old. OA was diagnosed according to the clinical examination, X-ray diagnosis by Bone mineral density testing using STRATOS device, and biochemical tests using ELISA and COBOS 6000. This study proved that Melatonin is correlated with osteoarthritis in premenopausal women, there is a significant decrease (P≤0.01) in Melatonin (1.308+0.20 pg/dl), Vitamin D (22.82+1.53) mg/ml. Melatonin was positively correlated with vitamin D with no correlation with other biomarkers. Osteoarthritis in premenopausal women is strongly affected by Melatonin levels and Vitamin D, and it's recommended to use Melatonin and other chemical parameters as markers and potential therapeutic drugs.

EVALUATION OF VITAMIN D SERUM LEVELS AND THYROID FUNCTION TEST IN HYPOTHYROIDISM IRAQI PATIENTS.

The role of Vitamin D is primarily to maintain calcium and phosphate levels in the bloodstream. Significantly, steroid hormone receptors are the binding sites for both vitamin D and thyroid hormone. However, the vitamin D and thyroid function relationship is still not fully understood. The study aims to measure vitamin D serum levels and to investigate its relation with hypothyroidism in Iraq patients.This case-control study was carried out during the period from the first of March to the end of May 2023 in Baghdad City, Iraq. The study included 90 subjects that were divided into 2 groups. The first group consists of 60 people infected with hypothyroidism. The second group (control group) consists of 30 healthy people. Blood samples were assessed for serum vitamin D, TSH, T3 and T4 using a chemiluminescence microparticle immunoassay analyzer while serum anti-TPO used an enzyme-linked immunosorbent assay technique.The study showed that the level of T3, T4 and vitamin D in hypothyroidism patients significantly decreased compared to the control group (p<0.001). While TSH and anti-TPO levels in hypothyroidism patients significantly increase in comparison to the control group (p<0.001). The study found a significant negative correlation between (vitamin D and T3) with (p<0.01), while the study showed a significant positive correlation between (TSH and vitamin D) with (p<0.01). Finally, the study demonstrated a non-significant weak negative correlation (p>0.05) between (vitamin D and T4), but a non-significant weak positive correlation (p>0.05) between (vitamin D and anti-TPO).Patients with hypothyroidism had noticeably low levels of vitamin D, indicating that this vitamin D may be involved in the aetiology of hypothyroidism.

The State of the Do-Not-Resuscitate Order in a Pediatric Intensive Care Unit in the Middle East: A Retrospective Study.

Objectives: The Do-Not-Resuscitate (DNR) order is part of most hospitals' policies on the process of making and communicating decisions about a patient's resuscitation status. Yet it has not become a part of our society's ritual of dying in the Middle East especially among children. Given the diversity of pediatric patients, the DNR order continues to represent a challenge to all parties involved in the care of children including the medical team and the family. Methods: This was a retrospective review of the medical charts of patients who had died in the pediatric intensive care unit (PICU) of a tertiary academic institution in Beirut, Lebanon within the period of January 2012 and December 2017. Results: Eighty-two charts were extracted, 79 were included in the analysis. Three were excluded as one patient had died in the Emergency Department (ED) and 2 charts were incomplete. Most patients were male, Lebanese, and from Muslim families. These patients clinically presented with primary cardiac and oncological diseases or were admitted from the ED with respiratory distress or from the operating room for post-operative management. The primary cause of death was multiorgan failure and cardiac arrest. Only 34% of families had agreed to a DNR order prior to death and 10% suggested "soft" resuscitation. Most discussions were held in the presence of the parents, the PICU team and the patient's primary physician. Conclusions: The DNR order presents one of the most difficult challenges for all care providers involved, especially within a culturally conservative setting such as Lebanon. As the numbers suggest, it is difficult for parents to reach the decision to completely withhold resuscitative measures for pediatric patients, instead opting for "soft" resuscitations like administering epinephrine without chest compressions.

Disease-free Survival of Patients with Differentiated Thyroid Cancer: A Study from a Tertiary Center in Oman.

OBJECTIVES: As with global trends, the prevalence of differentiated thyroid cancer (DTC) has increased in recent years in Oman. However, to the best of our knowledge, no local studies have yet been published evaluating the prognosis of DTC cases in Oman. This study aimed to assess disease-free survival (DFS) and prognostic factors related to DTC among Omani patients attending a tertiary care center. METHODS: This retrospective, observational cohort study was conducted between January 2006 and May 2016 at the National Diabetes and Endocrine Center in Oman. Data related to DFS and prognostic factors were obtained from the electronic medical records of all ≥ 18-year-old patients diagnosed with DTC during the study period. RESULTS: A total of 346 DTC cases were identified. Overall, 82.7% of patients were disease-free at their last follow-up appointment. Univariate analysis indicated that various tumor characteristics including histological subtype (i.e., papillary carcinoma, Hurthle cell cancer, and minimally invasive follicular thyroid carcinoma), lymph node status, number of lymph node metastases, distant metastasis status, and TNM status (primary tumor (T), regional lymph node (N), distant metastasis (M) stage) were strong prognostic factors for DFS (p < 0.050). According to multivariate regression analysis, lymph node status, extrathyroidal extension, and angiovascular invasion were independent predictors of DFS (p < 0.050). CONCLUSIONS: The overall prognosis of DTC among Omani patients was excellent. Treatment and follow-up strategies for patients with DTC should be tailored based on the individual's risk factor profile.

Interactions between nanoparticles in nanosuspension.

Nanoparticles are particles with a characteristic dimension below 100 nm. The properties of nanoparticles differ substantially from those of "big" colloidal particles (size bigger than 1 µm) because radius of surface forces, which is around 100 nm, is greater than or comparable with the nanoparticles size. The latter means that each nanoparticle could be completely covered by the surface forces of the neighbouring particles at small enough separation. It also means that the well-known Derjaguin approximation cannot be applied directly and some modifications are required. Pairwise interaction between nanoparticles can be used only at an extremely low volume fraction of nanoparticles (below some critical volume fraction, which is ~0.02%), and above this concentration a new theory based on many-particle interactions should be applied, which is yet to be developed. Some recent progress in the area of interaction between nanoparticles is reviewed and the properties of nanosuspensions based on interaction between nanoparticles are described. The authors have not attempted to cover all available literature in the area but instead have tried to underline the fundamental problems in the area which need to be addressed.

[Cancer-testis genes in colon cancer]. / Rakovo-testikuliarnye geny pri rake tolstoi kishki.

The expression of cancer-testis (CT) genes varies with tumor type. There are tumors with high, low, and intermediate gene expressions. Tumor cells of different origin are characterized by ST gene co-expression. The expression of ST genes increases in later stages of tumor development in the presence of metastases. In colon cancer, the tumor samples showed most frequently MAGE-A and SSX mRNA. The peripheral blood samples displayed most commonly XAGE, MAGE-C, and SSX mRNA. In patients with colon cancer, the expression of TSP50, MAGE-A(1-6), and SSX1,2,4 genes was associated with a poor prognosis, that of MAGE-C1 and XAGE1 was related to a favorable prognosis.

A Rare Case of Adrenal Pheochromocytoma with Unusual Clinical and Biochemical Presentation: A Case Report and Literature Review.

A 50-year-old Omani woman presented to the Outpatient Clinic, Royal Hospital, Oman with right upper abdominal pain and backache that had lasted 10 days. She had no palpitation, sweating, or hypertension (blood pressure 122/78mmHg). The patient's history revealed that she had a similar incidence of abdominal pain two months prior, which was a "dull ache" in nature and somewhat associated with headache. The pain was relieved using a mild analgesic drug. Abdominal ultrasonography showed a right adrenal mass, and both computed tomography and magnetic resonance imaging of the adrenal glands confirmed a right adrenal mass consistent with adrenal pheochromocytoma. However, clinical biochemistry tests revealed normal levels of plasma catecholamines (dopamine, norepinephrine, and epinephrine) and metanephrine, which are unusual findings in adrenal pheochromocytoma. Meanwhile, the patient had markedly raised plasma normetanephrine (10-fold) which, together with the normal metanephrine, constitutes a metabolic profile that is compatible with extra-adrenal pheochromocytoma. The patient also had markedly raised chromogranin A (16-fold), consistent with the presence of a neuroendocrine tumor. Laparoscopic right adrenalectomy was done and the adrenal tumor was excised and retrieved in total. Histopathology and immunohistochemistry confirmed the diagnosis of adrenal pheochromocytoma; the tumor cells being positive for chromogranin, synaptophysin, and S-100 protein. Following surgery, the patient did well and showed full recovery at follow-up after three months. Molecular genetic testing showed no pathogenic mutation in pheochromocytoma genes: MAX, SDHA, SDHAF2, SDHB, SDHC, SDHD, VHL, and PRKAR1A. A review of the literature was conducted to identify the pathophysiology and any previous reports of such case. To our knowledge, this is the first report in Oman of the extremely rare entity of pheochromocytoma with an unusual clinical and biochemical scenario.

The prevalence of thyroid cancer in patients with hyperthyroidism.

OBJECTIVES: To determine the prevalence of thyroid cancer in patients with hyperthyroidism. METHODS: This is a retrospective observational study using the data of 71 Omani patients with a diagnosis of hyperthyroidism due to Grave's disease, toxic multinodular goiter, and solitary toxic adenoma. These patients underwent thyroidectomy at the Royal Hospital (RH), Muscat, Oman, and were followed up at the National Diabetes and Endocrine Center (NDEC) between 2007 and 2013. The details were collected from the medical records of both the RH and the NDEC. Patients who underwent thyroidectomy for other reasons like non-toxic goiter and hypothyroidism with cancer were excluded from the study. RESULTS: Thyroid cancer was identified in 32.8% (n=23) of patients with hyperthyroidism. Half of these patients 52.1% (n=12) had papillary micro-cancer (intra-thyroidal), and 3 patients with Grave's disease (13%) had lymph nodes metastasis (loco-regional infiltration. The cancer preponderance was higher in young (n=21, 91.3%) and female patients (n=18, 73.9%). Most patients with thyroid cancer had abnormal ultrasound neck findings and thyroid scintigraphy (99 mTc uptake). CONCLUSION: Many patients with hyperthyroidism in Muscat, Oman, especially those with Grave's disease, show malignancy, and hence a proper initial evaluation of these patients is required as part of long-term management.

Congenital Adrenal Hyperplasia due to 17-alpha-hydoxylase/17,20-lyase Deficiency Presenting with Hypertension and Pseudohermaphroditism: First Case Report from Oman.

This is the first report of congenital adrenal hyperplasia (CAH) due to combined 17α-hydroxylase/17,20 lyase deficiency in an Omani patient who was initially treated for many years as a case of hypertension. CAH is an uncommon disorder that results from a defect in steroid hormones biosynthesis in the adrenal cortex. The clinical presentation depends on the site of enzymatic mutations and the types of accumulated steroid precursors. A 22-year-old woman who was diagnosed to have hypertension since the age of 10 years who was treated with anti-hypertensive therapy was referred to the National Diabetes and Endocrine Centre, Royal Hospital, Oman. The patient also had primary amenorrhea and features of sexual infantilism. Full laboratory and radio-imaging investigations were done. Adrenal steroids, pituitary function and karyotyping study were performed and the diagnosis was confirmed by molecular mutation study. Laboratory investigations revealed adrenal steroids and pituitary hormones profile in addition to 46XY karyotype that are consistent with the diagnosis of CAH due to 17α-hydroxylase deficiency. Extensive laboratory workup revealed low levels of serum cortisol (and its precursors 17α-hydroxyprogesterone and 11-deoxycortisol), adrenal androgens (dehydroepiandrosterone sulfate and androstenedione), and estrogen (estradiol); and high levels of mineralocorticoids precursors (11-deoxycorticosterone and corticosterone) with high levels of ACTH, FSH and LH. Mutation analysis revealed CYP17A1-homozygous mutation (c.287G>A p.Arg96Gln) resulting in the complete absence of 17α-hydroxylase/17,20-lyase activity. The patient was treated with dexamethasone and ethinyl estradiol with cessation of anti-hypertensive therapy. A review of the literature was conducted to identify previous studies related to this subtype of CAH. This is the first biochemically and genetically proven case of CAH due to 17α-hydroxylase/17,20-lyase deficiency in Oman and in the Arab World described in the literature.

Instrumental vaginal delivery--back to basics.

Assisted vaginal delivery using forceps or a vacuum extractor is an essential part of obstetric practice. Operative vaginal delivery rates in the UK have remained stable between 10% and 15%, yielding safe and satisfactory outcomes for the majority of mothers and their babies. However, there has been an increase in medico-legal cases due to an increasing awareness of the potential morbidity for both the mother and the baby. There are many factors that can play a part in both the maternal and fetal complications resulting from instrumental deliveries. The aim of this educational review is to address these factors and identify measures to reduce them by adherence to the basics and relevant evidence.

Tubular nanofiltration of highly concentrated C.I. Acid Black 210 dye.

Tubular nanofiltration membrane performance to treat water for reuse was carried out by choosing C.I. Acid Black 210 dye as a model dye. It has been shown that increasing pH causes reduction in irreversible fouling factor (IFF) and the dye removal is also affected by solution pH. The total organic carbon removal for pH 4, pH 7, pH 8 and pH 10 is 97.9, 92.3, 94.5 and 94.6%, respectively. The conductivity removal for pH 4, pH 7, pH 8 and pH 10 is 85.1, 88.3, 87.8 and 90.7% respectively. The increase in the initial dye concentration causes rapid increase in fouling until 100 mg/l. Then the fouling increases gradually as it reaches a maximum IFF around 13%. This study also shows that the colour of permeate changes from colourless to light greenish/yellowish (initial concentration of 2,000 and 4,000 mg/l) as the initial dye concentration increases. The conductivity removal was also reduced as the initial dye concentration increased due to screening of the Donnan effect with the presence of salt.

Evaluation of several commercial synthetic polymers as flocculant aids for removal of highly concentrated C.I. Acid Black 210 dye.

The removal of C.I. Acid Black 210 dye from highly concentrated solutions was studied using a coagulation/flocculation process. Aluminium sulphate was used as a primary coagulant and five commercial polymers were used as flocculant aids. The five commercial polymers were ACCEPTA 2058 (poly-diallyl-dimethyl ammonium chloride), ACCEPTA 2047 (high molecular mass (MM) anionic polyacrylamide), ACCEPTA 2111 (high MM cationic polyacrylamide), ACCEPTA 2105 (Low-medium MM cationic polyacrylamide) and ACCEPTA 2037 (Composite of high MM cationic polyacrylamide-inorganic salt(s)). The five polymers behaved differently and they showed maximum colour removal increment in the order: ACCEPTA 2058 > ACCEPTA 2037 > ACCEPTA 2111 approximately = ACCEPTA 2047 > ACCEPTA 2105. Results also showed that the aluminium sulphate is important as primary coagulant and settling time has significant effect on the dye removal.