Sonographic Assessment of the Salivary Glands among Sudanese Snuff-dippers.

Background: The parotid, submandibular, and sublingual glands, as well as the smaller subsidiary glands, are all the examples of the salivary glands. The likelihood of the salivary glands being impacted by snuff components increases due to this close proximity of the salivary glands to the mouth when snuff is used. The aim of this study was to evaluate the salivary glands of the Sudanese snuff-dippers. Methods: Sixty-five adult snuff-dippers (research group) and 36 adult nonusers (control group) were enrolled in the study. Sonography of the submandibular and parotid glands was performed; size, blood flow, echogenicity, echotexture, and any other pathological changes were evaluated. The study was conducted in the ultrasound unit at our institution from June 2021 to June 2022. Results: The result of the study showed that the average size of the left submandibular gland and left and right parotid glands of snuff-dippers was significantly greater than the average size of nonusers. Blood supply and tissue characteristics were normal. Conclusion: The study concluded that the snuff use could affect the parotid and submandibular glands; ultrasonography is a modality of choice in the examination of the salivary glands of snuff users and other tobacco users.

Ultrasound Imaging in Subjects with Sickle Cell Disease: The Saudi Arabia Experiences.

Background: Abdominal organ sonography is a crucial part of the workup for treating sickle cell disease (SCD) patients. Objective: The main objective of this study was to evaluate the abdominal organs in SCD patients using ultrasonography. Methodology: A non-interventional descriptive cross-sectional study was carried out in Asir region Saudi Arabia from April 2019 to July 2020. The study was conducted in 78 patients with sickle cell disease (SCD). Data were gathered using a data collection sheet included demographic information, clinical information including medication types, and complications linked to SCD. Furthermore, the study evaluated abdominal ultrasound findings pertaining to the liver, gall bladder, spleen, and kidneys. The data were analyzed using Statistical Package for Social Sciences (SPSS). Results: More than half of the study participants 43 (55.1%) were females. About 53.8% of the study participants received blood transfusions, and (11.5%) receive extra-vaccine. Concerning ultrasound findings, hepatomegaly was found in seventeen (21.8%), focal liver lesions in four (5.1%), gallstones in five (6.4%), splenomegaly in fifteen (19.3%), and the presence of splenic focal lesions was found in seven (9.0%). The most frequent complication associated with SCD was osteomyelitis sepsis in six cases (7.7%). The study revealed a significant correlation between the type of crisis and type of medication used and the size of the spleen (P-value <0.01), and no notable correlation was found between the types of crises and the size of the liver (P-value >0.05). Conclusion: Abdominal sonography in SCD patients revealed a wide range of alterations in the liver, gallbladder, and spleen. The most frequently observed complications in SCD were hepatomegaly, splenomegaly, localized lesions in both organs, and the presence of gallstones.

ISOLATION AND CHARACTERIZATION OF BACTERIOPHAGE WITH LYTIC ACTIVITY AGAINST CARBAPENEM RESISTANCE STRAIN OF KLEBSIELLA PNEUMONIA.

OBJECTIVE: Aim: Klebsiella pneumonia has emerged as an increasingly important cause of community-acquired nosocomial infections and many of these strains are highly virulent and exhibit a strong propensity to spread. Infections cause by K. pneumonia produces carbapen¬emase (KPC) enzyme and can be difficult to treat since only a few antibiotics are effective against them. Bacteriophage targeting this strain can be an alternative treatment. Characterisation of bacteriophage is utmost important in assisting the application of bacteriophage in phage therapy. PATIENTS AND METHODS: Materials and methods: In the present study, the lytic bacteriophage, k3w7, isolated by the host Klebsiella pneumoniae kP2 was characterised using transmission electron microscope (TEM), plaque assay, and restriction digestive enzyme to investigate mor¬phology, host spectrum, bacteriophage life cycle and stability accordingly. RESULTS: Results and conclusions: As shown by TEM, k3w7 was observed to have the characteristic of icosahedral heads 100 nm and contractile sheaths 120 nm suggesting it belongs to the family of myoviridae.The Investigation has done on the phage growth cycle showed a short latent period of 20 min and a burst size of approximately 220 plaque forming units per infected cell. Stability test showed the phage was stable over a wide range of pH and temperatures. According to restriction analysis, k3w7 had 50 -kb double-stranded DNA genome as well as the heterogeneous nature of genetic material. These findings suggest that K3W7 has a potential use in therapy against infections caused by K. pneumonia produces carbapenemase.

Association of Smoking with the Blood Concentration of 25-Hydroxy Vitamin D and Testosterone at High and Low Altitudes.

PURPOSE: This research examined the association of cigarette smoking and altitude with the blood levels of 25-hydroxy vitamin D, testosterone and carotid artery thickness. PATIENTS AND METHODS: This comparative cross-sectional study involved 37 non-smokers and 24 smokers from a high-altitude area (≥2245 m above sea level) and 40 smokers and 40 non-smokers from a low-altitude area (39-283 m above sea level). The blood testosterone level was determined spectrophotometrically, and the 25-hydroxy vitamin D concentration was measured by ELISA. The IMT of the right and left carotid arteries was determined using ultrasound imaging. RESULTS: Smoking notably elevated the thickness of the intima media of the right and left carotid arteries at both high and low altitudes (p ≤ 0.001). Smoking at high altitude was associated with a significant increase in the concentration of 25-hydroxy vitamin D and testosterone, while at low altitude it was associated with a significant decrease in both parameters (p ≤ 0.046). CONCLUSION: These contrasting results suggest that future studies should focus on finding out if other biochemical parameters show any significant differences in smokers or/and non-smokers when they are tested at elevated height and sea-level. This indicates that dose modifications of medicines (related to alterations in vitamin D and testosterone levels) should be kept in mind while treating smokers and non-smokers at elevated height above sea level.

The Role of Lung Ultrasound Before and During the COVID-19 Pandemic: A Review Article.

Lung Ultrasound (LUS) has evolved considerably over the last few years. The aim of the current review is to conduct a systematic review reported from a number of studies to show the usefulness of (LUS) and point of care ultrasound for diagnosing COVID-19. A systematic search of electronic data was conducted, including the national library of medicine, and the national institute of medicine, PubMed Central (PMC), to identify the articles published on (LUS) to monitor COVID-19. This review highlights the ultrasound findings reported in articles before the occurrence of the pandemic (11), clinical articles before COVID-19 (14), review studies during the pandemic (27), clinical cases during the pandemic (5) and other varying aims articles. The reviewed studies revealed that ultrasound findings can be used to help in the detection and staging of the disease. The common patterns observed included irregular and thickened A-lines, multiple B-lines ranging from focal to diffuse interstitial consolidation, and pleural effusion. Sub-plural consolidation is found to be associated with the progression of the disease and its complications. Pneumothorax was not recorded for COVID-19 patients. Further improvement in the diagnostic performance of (LUS) for COVID-19 patients can be achieved by using elastography, contrast-enhanced ultrasound, and power Doppler imaging.

Correlation between Computed Tomography Clinical Diagnosis and Findings in Pediatric Computed Tomography.

<b>Background and Objective:</b> Pediatric Computed Tomography (CT) is a fast, accurate imaging examination using ionizing radiation to create detailed images of pathological conditions. The radiation benefit should be outweighing the risk through the procure justification and dose optimization. The study aimed to investigate the correlation between the physician's initial diagnosis and the CT findings to build procedure justification for a pediatric patient's head scan. <b>Materials and Methods:</b> The study included 81 children examined clinically and by CT scan to diagnose cranial and cerebral pathology. Eighty-one pediatric patients were investigated by CT scan and clinical diagnosis. <b>Results:</b> The patient age ranged between 1-15 years old, (44%) were male and (56%) females. The patients referred to the CT scan from emergency department n = 10 (7%), outpatient clinics n = 66, (84%) and inpatients clinics n = 5, (9%). The study showed that 46% of patients were normal with no CT findings. Almost half of the cases were negative and did not confirm the clinical diagnosis. <b>Conclusion:</b> The study concluded that most head CT scans in children were not justified. An effort towards improving the refereeing physician's awareness about radiation dose and request justification should be conducted.

Occupational and patients effective radiation doses in dental imaging.

Ionizing radiation exposure from medical applications is increasing annually worldwide. It was estimated that 325 million dental procedures were performed in the United States. Radiation exposure from dental radiography consists of intraoral, panoramic, and 3D imaging cone-beam computed tomography (CBCT) imaging. Recent studies reported an association between dental imaging procedures and increased cancer probability of brain and thyroid. Previous studies showed that some dental imaging practices exposed patients and staff to unnecessary radiation doses due to incorrect image acquisition and insufficient radiation protection measures. This study aims to (i) measure the occupational and patients doses during dental procedures and (ii) assess the current imaging techniques and radiation protection practices. Two hundred fourteen patients were evaluated for periapical, bitewing, cephalometric, occlusal, and panoramic procedures. Organ equivalent doses were quantified for the breast, eye lens, and thyroid gland during CBCT procedure. Occupational and ambient dose assessment were assessed using calibrated thermoluminescent dosimeters (TLD-100(LiF: Mg. Ti). Ambient doses were measure at different locations at the department using TLDs. Patients' radiation doses were quantified using kerma area product (PKA (mGy.cm) and the entrance surface air kerma (ESAK (mGy). Fixed tube voltage (65 kVp) and tube current-time product (7 mAs) were used. The overall mean, sd, and range of patients dose values during intraoral (mGy), panoramic and CBCT examinations were 4.6 ± 0.7 (1.4-7.1), 135 ± 45 (75.2-168.5), and 215 ± 165 (186-2115), respectively. The mean and range of the annual occupational doses (mSv) were 1.4 (0.6-3.7), which below the annual dose limits for radiation workers (20 mSv/y). The study showed that inadequate radiation protection for patients existed in terms of the use of the thyroid shield, the technologist's presence inside the room during radiation exposure. Patients' radiation doses were comparable with the international diagnostic reference level (DRL). Staff education and training in radiation protection aspects are highly recommended.

Clinical and Biochemical Predictors of Nonalcoholic Fatty Liver Disease among Type 2 Diabetes Mellitus Patients at Primary Health Care Level in South Western Saudi Arabia.

OBJECTIVES: To predict the role of different clinical and biochemical parameters in identifying nonalcoholic fatty liver disease (NAFLD) among patients with type 2 diabetes mellitus (T2DM) in Abha city, southwestern Saudi Arabia. METHODS: A stratified random sample was selected. A detailed clinical and biochemical examinations were performed. Using portable abdominal ultrasound examination, NAFLD was identified. The study used receiver operating characteristic (ROC) analysis. RESULTS: The study covered 237 T2DM patients. NAFLD was detected among 174 patients. Area under the curve (AUC) calculations showed that the ability of age, duration of DM in years, and body mass index to predict NAFLD was poor (AUC < 0.6). Similarly, biochemical factors like HbA1c%, AST, cholesterol, triglycerides, HDL, LDL, and VLDL were poor in discriminating between those with and without NAFLD among T2DM. On the other hand, the ability of ALT to predict NAFLD among T2DM was good (AUC = 0.701, 95% CI: 0.637-0.761). The analysis identified the optimal cutoff point of ALT to be ≤22.1 nmol/L. The corresponding sensitivity was 60.7% (95% CI: 53.0-68.0) and specificity was 62.5% (95% CI: 49.5-74.3). CONCLUSIONS: Early identification of NAFLD among T2DM is important. A threshold cutoff value of 22.1 nmol/L of ALT has been identified to predict NAFLD. They should be referred for ultrasound examination for NAFLD.

Lipid profile, random blood glucose and carotid arteries thickness in human male subjects with different ages and body mass indexes.

OBJECTIVE: This article investigated the effect of age and body mass index of male humans on the carotid arteries intima media thickness (IMT) and the blood concentration of glucose, triglycerides, total cholesterol and HDL cholesterol. METHODS: Thirty seven normal male human subjects participated in this study. The participants were classified to three groups depending on their age; 20-29 (11), 30-39 (14) and 40-49 (12). Also, the study subjects were divided to three groups according to their body mass index; normal (13), overweight (13) and obese (11). The Anova test was used for the statistical analysis of the obtained results. RESULTS: The body mass index significantly affected the blood glucose concentration while its effect on all the other parameters was insignificant. The age significantly affected all the studied parameters except the blood glucose, triglycerides and HDL cholesterol. The total cholesterol/HDL ratio was significantly affected by the age and insignificantly by the body mass index. CONCLUSIONS: The age was more effective on the studied parameters than the body mass index. Worsening of the lipid profile was seen in the overweight participants rather than the obese ones.

Non-Alcoholic Fatty Liver Disease among Type-2 Diabetes Mellitus Patients in Abha City, South Western Saudi Arabia.

The objective of this study was to determine the prevalence and the factors associated with non-alcoholic fatty liver disease (NAFLD) among type-2 diabetes mellitus (T2DM) patients in Abha City, Southwestern Saudi Arabia. Using a cross-sectional study design, a representative sample of 245 T2DM patients were recruited from all primary healthcare centers in Abha city. A detailed medical history as well as laboratory investigations were done. NAFLD was diagnosed using abdominal ultrasound examination. The overall prevalence of NAFLD was 72.8% (95% CI: 66.6%⁻78.1%). In a multivariable regression analysis, the risk of NAFLD was significantly higher among overweight T2DM patients (aOR = 6.112, 95% CI: 1.529⁻4.432), Obese (aOR = 10.455, 95% CI: 2.645⁻41.326), with high ALT of more than 12 IU/L (aOR = 2.335, 95% CI: 1.096⁻5.062), moderate diet-compliant patients (aOR = 2.413, 95% CI: 1.003⁻5.805) and poor diet-compliant patients (aOR = 6.562, 95% CI: 2.056⁻20.967). On the other hand, high HDL (high density cholesterol) (in mg/dL) was a protective factor for NAFLD (aOR = 0.044, 95% CI: 0.005⁻0.365). It was concluded that NAFLD is a common association of T2DM. Increasing BMI (Body mass index), lower HDL level, and poor dietary control are significant factors associated with NAFLD among T2DM patients. Health education to improve dietary control and avoid excessive weight gain, testing for NAFLD among diabetic patients, especially those with abnormal BMI and HDL, are recommended for early detection and to ensure optimal levels of HDL.

Stents farmacológicos de segunda geração para tratamento de lesões proximais isoladas da artéria descendente anterior. dados do registro Safira / Second-generation drug-eluting stent treatment for isolated proximal left anterior descending artery stenoses. the Safira registry data

Introdução: A estenose grave do terço proximal da artéria descendente anterior (ADA) é classificada como lesão de alto risco, visto que pode comprometer grande parte do miocárdio ventricular esquerdo. Os stents farmacológicos (SF) de segunda geração têm demonstrado maior eficácia e segurança quando comparados aos não farmacológicos ou aos de primeira geração. São escassos os relatos na literatura do emprego desses dispositivos para o tratamento de lesões isoladas do terço proximal da ADA. Métodos: Estudo observacional e prospectivo, que incluiu pacientes uniarteriais, portadores de lesão de novo no terço proximal da ADA, tratados eletivamente com SF de segunda geração. Avaliamos os desfechos clínicos hospitalares e tardios. Resultados: Foram incluídos 70 pacientes, sendo a maioria do sexo masculino (70%), com média de idades de 65,4 ± 11,2 anos e com alta prevalência de diabetes (37%). O quadro clínico mais frequente foi angina estável (57,1%) e metade das lesões era do tipo B2 ou C. Foram tratadas 70 lesões com 71 stents, com sucesso angiográfico de 100%. O desfecho primário composto por óbito cardíaco, infarto não fatal ou revascularização do vaso alvo no seguimento clínico de 2,5 anos ocorreu em 3% dos pacientes. A mortalidade cardíaca foi de 1,5%, e a revascularização da lesão alvo foi necessária em apenas 1,5% dos pacientes. Conclusões: Em pacientes uniarteriais com lesões de novo da ADA proximal, o tratamento eletivo com SF de segunda geração parece ser uma opção segura, com baixas taxas de eventos cardíacos adversos ou necessidade de nova revascularização

Background: Severe stenosis of the proximal left anterior descending artery (LAD) is classified as a high-risk lesion, as it may affect a large part of the left ventricular myocardium. Second-generation drug-eluting stents (DES) have been shown to be more effective and safer when compared to bare-metal or first-generation ones. There are few reports in the literature on the use of these devices for the treatment of isolated lesions in the proximal LAD. Methods: Observational and prospective study, which included single-vessel patients with de novo lesions in the proximal LAD, electively treated with second-generation DES. In-hospital and late clinical outcomes were evaluated. Results: Seventy patients were included, most of them males (70%), with a mean age of 65.4 ± 11.2 years and a high prevalence of diabetes (37%). The most common clinical presentation was stable angina (57.1%) and half of the lesions were type B2 or C. A total of 70 lesions were treated with 71 stents, with 100% angiographic success. The primary endpoint, consisting of cardiac death, nonfatal infarction, or target-vessel revascularization during the 2.5-year clinical follow-up, occurred in 3% of the patients. Cardiac death was 1.5%, and target-lesion revascularization was required in only 1.5% of the patients. Conclusions: Elective treatment with second-generation DES seems to be a safe option in single-vessel patients with de novo lesions in the proximal LAD, with low rates of adverse cardiac events or need for additional revascularization procedure

Iodine-deficiency disorders in the Aseer region, south-western Saudi Arabia: 20 years after the national survey and universal salt iodization.

OBJECTIVE: To study (i) the current prevalence of iodine-deficiency disorders among schoolchildren in south-western Saudi Arabia after universal salt iodization and (ii) the iodine content of table salts and water. DESIGN: Cross-sectional study on a stratified proportional allocation sample of children. Thyroid gland enlargement was assessed clinically and by ultrasound scanning. Urine, table salt and water samples were taken to measure iodine content. Settings The Aseer region, south-western Saudi Arabia. SUBJECTS: Schoolchildren aged 8-10 years. RESULTS: The study included 3046 schoolchildren. The total goitre rate amounted to 24·0 %. Prevalence of enlarged thyroid by ultrasound was 22·7 %. The median urinary iodine concentration of the study sample amounted to 17·0 µg/l. The iodine content of table salt ranged from 0 to 112 mg/kg; 22·5 % of the table salt samples were below the recommended iodine content (15 mg/kg) set by WHO. The total goitre rate increased significantly from 19·8 % among children using table salt with iodine content ≥15 mg/kg to reach 48·5 % among children using table salt with 0 mg iodine/kg. Analysis of water samples taken from schools showed that the majority of water samples (78·8 %) had an iodine content of 0 µg/l. CONCLUSIONS: The study documented that 18 years after the national study, and after more than a decade of universal salt iodization in Saudi Arabia, the problem of iodine-deficiency disorders is still endemic in the Aseer region. Efforts should focus on fostering advocacy and communication and ensuring the availability of adequately iodized salt.