Approach to the Management of Hypertriglyceridemia Complicated With Acute Pancreatitis in Pregnancy: A Case Report.

This is a case of a 32-year-old woman, Gravida 3 para 2, previous two cesarean sections, who presented to our emergency department at 24+3 weeks of gestation complaining of severe epigastric pain radiating to the back. She was diagnosed with severe hypertriglyceridemia complicated with acute pancreatitis and was managed by a multi-disciplinary team, which included obstetrics, gastroenterology, endocrinology, hematology, nutrition, and ICU team. Initially, conservative treatment was employed for her management. She was placed on nil per oral status and initiated on a normal saline infusion at a rate of 150 ml/hour, along with insulin infusion at 0.1 unit/kg/hour and dextrose (D5) at 80 ml/hour. Additionally, she received omeprazole, meropenem, clexane (40 mg once daily subcutaneous injection), iron, vitamin supplements, and analgesics as required. Subsequently, due to the failure of the initial conservative medical management, the patient was admitted to the ICU. Plasmapheresis was performed after the insertion of a vascath, using 3000 ml of albumin 5% as replacement fluid and oral calcium. Following this, she was prescribed Omacor (Omega 3) at a dosage of 2 grams orally twice daily, along with a low carbohydrate and fat diet, to manage her triglyceride levels. After the removal of the central line, her triglycerides increased to 14.3 mmol/L, leading to the initiation of fenofibrate at a daily dose of one tablet. With persistent elevation to 16.4 mmol/L, Lipitor at 40 mg once daily was introduced. Following this intervention, her triglyceride levels stabilized, and her overall condition improved. She was discharged at 25+1 weeks with a prescribed regimen, and scheduled follow-ups were arranged in the endocrine and obstetrics clinics. At 36 weeks of gestation, she presented to the emergency room with abdominal, back, and leg pain. Fetal distress, indicated by fetal tachycardia (170-180 bpm) on cardiotocography, prompted an urgent category 1 cesarean section, which proceeded without complications.

Epidemiology and management of Fusarium wilt of Eucalyptus camaldulensis through systemic acquired resistance.

Eucalyptus camaldulensis is a multifunctional tree and is globally used for the reclamation of problematic lands. Eucalyptus camaldulensis is prone to attack by a number of pathogens, but the most important threat is the Fusarium wilt (Fusarium oxysporum). Keeping in view the importance of E. camaldulensis and to manage this disease, five plant activators, i.e., salicylic acid (C7H6O3), benzoic acid (C7H6O2), citric acid (C6H8O7), dipotassium phosphate (K2HPO4), monopotassium phosphate (KH2PO4) and nutritional mixture namely Compound (NPK) and nutriotop (Fe, Zn, Cu, B, Mn) were evaluated in the Fusarium infested field under RCBD in the Research Area, Department of Forestry and Range Management, University of Agriculture, Faisalabad (UAF). Among plant activators, salicylic acid and a combination of compound + nutriotop exhibited the lowest disease incidence and enhanced fresh and dry weight of leaves compared to other treatments and control. Results of the environmental study indicated maximum disease incidence between 35-40 °C (max. T), 6-25 °C (mini. T), 70-80% relative humidity and 1.5-2.5 km/h wind speed while pan evaporation expressed weak correlation with disease development. It was concluded that Fusarium wilt of Eucalyptus camaldulensis could be managed through activation of the basal defense system of the host plant with provision of salicylic acid and balanced nutrition by considering environmental factors. Recent exploration is expected to be helpful for future research efforts on epidemiology and ecologically sound intervention of Fusarium wilt of Eucalyptus camaldulensis.

Preparation and in vivo evaluation of nano sized cubosomal dispersion loaded with Ruta graveolens extracts as a novel approach to reduce asthma-mediated lung inflammation.

Asthma is a chronic disease affecting people of all ages. Asthma medications are associated with adverse effects restricting their long-term usage, demanding newer alternative therapies. This study aimed to investigate the anti-asthmatic properties of Ruta graveolens extract and its prepared nano-cubosomal dispersion (Ruta-ND). Firstly, the R. graveolens methanolic extract exhibited higher anti-inflammatory activity on Lipopolysaccharide (LPS)-activated BEAS-2B cells. To ensure best bioavailability and hence best cellular uptake, R. graveolens extract was loaded in nano-cubosomal dispersion (ND). Then, the anti-asthmatic effects of Ruta extract and ND were simultaneously evaluated in rats' model with ovalbumin-induced allergic asthma. R. graveolens extract and Ruta-ND subsided asthma score and improved lung function by restoring FEV1/FVC ratio to the expected values in control rats. Also, it showed strong antioxidant and anti-inflammatory activities manifested by lowering levels of malondialdehyde (MDA), IL-4, IL-7, TGF-ß, and Ig-E, and increasing levels of superoxide dismutase (SOD) and INF-γ in bronchoalveolar lavage fluid. Our research findings also indicate autophagy induction and apoptosis inhibition by Ruta extract and Ruta-ND. Finally, the HPLC MS/MS phytochemical profiling of R. graveolens extract evident production of various alkaloids, flavonoids, coumarins, and other phenolics with reported pharmacological properties corresponding to/emphasize our study findings. In conclusion, R. graveolens exhibited promise in managing Ova-induced allergic asthma and could be developed as an alternative anti-allergic asthma drug.

In Vitro Evaluation of Candida albicans Adhesion and Related Surface Properties of CAD/CAM Denture Base Resins.

OBJECTIVE: The aim of this study was to evaluate the surface roughness, contact angle, and adhesion of Candida albicans to computer-aided designing/computer-aided manufacturing (CAD/CAM) and heat-polymerized (HP) denture base materials. MATERIALS AND METHODS: Specimens were allocated to six groups based on the composition of studied denture base materials, HP acrylic resin, milled resins (AvaDent and IvoCad), and 3D-printed resins (ASIGA, FormLabs, and NextDent). Ten specimens per group were used for each test (n = 10/test). Surface roughness and contact angles were analyzed using profilometer and goniometer, respectively. Adhesion of C. albicans was counted using colony-forming unit (CFU/mL). Means and standard deviations were calculated, and then one-way analysis of variance (ANOVA), followed by Tukey's post hoc test. Correlation of Candida adhesion and surface parameters was determined by using Pearson's correlation analysis. RESULTS: No statistically significant difference was noted in surface roughness between HP, milled, and 3D-printed denture base resins except NextDent, which showed significantly higher roughness in comparison to all other resins (p = 0.001). In terms of contact angle, milled resins had the lowest value, followed by HP, ASIGA, and FormLabs, whereas NextDent showed the highest contact angle (p = 0.001). C. albicans adhesion showed no significant difference between all denture base resins. A positive and significant correlation was found between C. albicans adhesion and contact angle (p = 0.003), while no correlation was reported between C. albicans adhesion and surface roughness (p = 0.523). CONCLUSION: Adhesion of C. albicans was similar in all tested specimens. Surface roughness showed no significant difference between all groups except NextDent, which had the highest value. Milled denture base resins had the lowest contact angle among all groups.

Medical Admission Prediction Score (MAPS); a simple tool to predict medical admissions in the emergency department.

INTRODUCTION: Overcrowding in the emergency departments (ED) is linked to adverse clinical outcomes, a negative impact on patient safety, patient satisfaction, and physician efficiency. We aimed to design a medical admission prediction scoring system based on readily available clinical data during ED presentation. METHODS: In this retrospective cross-sectional study, data on ED presentations and medical admissions were extracted from the Emergency and Internal Medicine departments of a tertiary care facility in Qatar. Primary outcome was medical admission. RESULTS: Of 320299 ED presentations, 218772 were males (68.3%). A total of 11847 (3.7%) medical admissions occurred. Most patients were Asians (53.7%), followed by Arabs (38.7%). Patients who got admitted were older than those who did not (p <0.001). Admitted patients were predominantly males (56.8%), had a higher number of comorbid conditions and a higher frequency of recent discharge (within the last 30 days) (p <0.001). Age > 60 years, female gender, discharge within the last 30 days, and worse vital signs at presentations were independently associated with higher odds of admission (p<0.001). These factors generated the scoring system with a cut-off of >17, area under the curve (AUC) 0.831 (95% CI 0.827-0.836), and a predictive accuracy of 83.3% (95% CI 83.2-83.4). The model had a sensitivity of 69.1% (95% CI 68.2-69.9), specificity was 83.9% (95% CI 83.7-84.0), positive predictive value (PPV) 14.2% (95% CI 13.8-14.4), negative predictive value (NPV) 98.6% (95% CI 98.5-98.7) and positive likelihood ratio (LR+) 4.28% (95% CI 4.27-4.28). CONCLUSION: Medical admission prediction scoring system can be reliably applied to the regional population to predict medical admissions and may have better generalizability to other parts of the world owing to the diverse patient population in Qatar.

Prevalence and Knowledge of Respiratory Symptoms Among the General Public in the Southern Area of Najran, Saudi Arabia: A Cross-Sectional Health Survey Study.

Objective: To investigate the knowledge, prevalence of chronic respiratory disorders, and utilization of their medications among the adults at Najran region, Saudi Arabia. Methods: An online cross-sectional survey was carried out in Najran region, Saudi Arabia. A self-administered questionnaire was distributed among a random sample of the general population, aged 18 or above between March and December 2022. The survey instrument included questions regarding history and exposure, physician diagnosed-disorders, respiratory symptoms, allergy, use of medications and possible risk-related factors. Results: This research had a total of 712 individuals. Nearly one-third of the participants in the survey (n = 218; 30.6%) said that they or a member of their family suffer from respiratory ailments. The majority of research participants (n = 167; 76.8%) identified asthma as their primary respiratory condition. A total of 32.0% of participants (n = 70) reported dealing with dust or chemicals such as paints, fertilizers, and cleaning products on a daily basis at work or at home. Around 62.0% of the participants (n = 134) said that exposure to gases, fragrances, and other such substances negatively impacts their health. Almost 78.0% (n = 169) of them indicated that summer weather affects their health, whereas 63.0% (n = 138) reported that winter cold affects their health. Participants aged 41-50 years were 38.0% less likely to have CRDs compared to others (p < 0.05). Conclusion: This study is among the first few studies that explored the knowledge, prevalence of chronic respiratory disorders, and utilization of their medications among the adults at Najran region, Saudi Arabia. In the southern area of Najran, respiratory symptoms are frequent among the inhabitants of Saudi Arabia. More research is required to discover avoidable risk factors and create countermeasures for them. It is recommended that healthcare personnel increase their efforts to educate their patients about respiratory illness prevention methods.

Arabic version of the Extended Nordic Musculoskeletal Questionnaire, cross-cultural adaptation and psychometric testing.

BACKGROUND: The Extended Nordic Musculoskeletal Questionnaire (NMQ-E) had never been adapted into Arabic. We culturally adapted the NMQ-E to Arabic in five stages and investigated its psychometric properties. METHODS: After translating and cross-culturally adapting the NMQ-E into Arabic, through forward translation, translation synthesis, backward translation, expert committee review, and pilot testing, the psychometric properties were investigated. The construct validity was assessed by having the participants completing the Arabic version of the NMQ-E with four Arabic scales that measured musculoskeletal pain in all regions covered in the NMQ-E. Participants' baseline records were also used to evaluate internal consistency (Cronbach's α). Seven days later, participants completed the Arabic NMQ-E again to evaluate its test-retest reliability employing intraclass correlation coefficient (ICC) and standard error of measurement (SEM) for the age questions, and Cohen's kappa coefficient (κ), the proportion of observed agreement (Po), the proportion of positive agreement (Ppos), and the proportion of negative agreement (Pneg) for the dichotomous items. RESULTS: A total of 127 participants, 70 males and 57 females with mean age 32.5 ± 12.2 years, were included. Significant differences were found between participants with and without musculoskeletal pain in the corresponding scales, signifying the content validity of the questionnaire. Cronbach's α for both the prevalence and consequences pain sections combined ranged from 0.30 to 1.00. The test-retest reliability of the age questions was excellent, with ICC values ranging between 0.995 and 1.00. The SEM was 0.77 for the neck region and 0 for the rest of the regions. The prevalence questions demonstrated almost perfect agreement, with κ values ranging between 0.82 and 1.00, the Po between 0.94 and 1.00, the Ppos between 0.80 and 1.00, and the Pneg between 0.93 and 1.00. The consequences of pain questions showed moderate-to-perfect agreement, with κ values ranging between 0.57 and 1.00, between 0.83 and 1.00 for the Po, between 0.50 and 1.00 for the Ppos, and between 0.86 and 1.00 for the Pneg. CONCLUSIONS: The results suggest that the Arabic NMQ-E is a valid and reliable tool that can be used to screen Arab adults for the prevalence and consequences of musculoskeletal pain.

Occurrence and dietary exposure assessment of heavy metals in baby foods in the Kingdom of Saudi Arabia.

Early childhood exposure to heavy metals like arsenic (As), cadmium (Cd), and lead (Pb) through baby foods unfolds many concerns about their toxic effects on growth and health. In this study, occurrence and dietary intake of As, Cd, and Pb in stage 1 infant formula (0-6 months), stage 2 infant formula (7-12 months), cereal-based meals, and biscuits were estimated. First, the levels of As, Cd, and Pb were determined with ICP-MS, followed by the calculation of estimated daily intake (EDI), target hazard quotient (THQ), and hazard index (HI) for As and Cd, and margin of exposure (MoE) for Pb. Mean levels of As, Cd, and Pb were the highest in cereal-based meals and biscuits as 15.5-11.1, 5.18-8.76, and 35.2-53.8 µg/kg, respectively. Newborns to 6 months old infants were estimated to be the highest exposed population to Cd and Pb (0.08 and 0.36 µg/kg bw/day), while infants aged 7-12 months old were exposed the highest to As. Based on the THQ, HI, and MoE findings, the current exposure levels from the selected baby foods to As, Cd, and Pb pose low potential chronic risks to both infant age groups. This research provides a roadmap for future investigations in chemical contaminants often detected in baby foods consumed regularly by Saudi infants.

Risk and diagnostic factors and therapy outcome of neonatal early onset sepsis in ICU patients of Saudi Arabia: a systematic review and meta analysis.

Background: Neonatal early onset sepsis (NEOS) is a serious and potentially life-threatening condition affecting newborns within the first few days of life. While the diagnosis of NEOS was based on clinical signs and symptoms in the past, recent years have seen growing interest in identifying specific diagnostic factors and optimizing therapy outcomes. This study aims to investigate the diagnostic and risk factors and therapy outcomes of neonatal EOS in ICU patients in Saudi Arabia, with the goal of improving the management of neonatal EOS in the country. Methods: This method outlines the protocol development, search strategy, study selection, and data collection process for a systematic review on neonatal early onset sepsis in Saudi Arabian ICU patients, following the PRISMA 2020 guidelines. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) is a well-established guideline that provides a framework for conducting systematic reviews and meta-analyses in a transparent and standardized manner. It aims to improve the quality and reporting of such research by ensuring clear and comprehensive reporting of study methods, results, and interpretations. The search strategy included electronic databases (PubMed, Embase, Google Scholar, Science Direct, and the Cochrane Library) and manual search of relevant studies, and data were extracted using a standardized form. Results: The systematic review included 21 studies on neonatal sepsis in Saudi Arabia, with varying study designs, sample sizes, and prevalence rates of sepsis. Group B streptococcus and E. coli were the most commonly isolated pathogens. Various diagnostic factors and risk factors were reported, including hematological parameters, biomarkers, and blood cultures. The quality of the included studies was assessed using the Newcastle-Ottawa Scale and Joanna Briggs Institute critical checklist. Conclusions: The review identified a number of risk and diagnostic factors and therapy outcomes for neonatal sepsis. However, most of the studies were having small scale cohort groups. Further research with controlled study designs is needed to develop effective prevention and management strategies for neonatal sepsis in Saudi Arabia.

Ramifications of Heat Stress on Rabbit Production and Role of Nutraceuticals in Alleviating Its Negative Impacts: An Updated Review.

Heat stress has become a widespread concern worldwide, which is a major environmental stress that causes substantial economic loss in the rabbit industry. Compared to other agricultural animals, rabbits are more sensitive to heat stress as they have fewer sweat glands and a thicker coat of fur, increasing the heat dissipation complexity. Thus, heat stress hurts rabbits' productivity, meat quality, reproductive performance, antioxidative properties, immune responsiveness, intestinal histomorphology, and microbiome. Nutraceuticals include vitamins, minerals, antioxidants, organic acids, fatty acids, probiotics, prebiotics, synbiotics, enzymes, and medicinal plants due to the possible impacts on maintaining common biological situations, strengthening immune response, and preventing illness, which ultimately led to an increase in productivity. Nutraceuticals have recently attracted a lot of attention to alleviate the adverse impacts of heat stress in rabbit farms. The objective of the current review is to provide acquaintance with the recent findings about the impact of heat stress on rabbit productivity and the advantages of dietary supplementation of nutraceuticals in mitigating it.

Effect of dextrose prolotherapy on internal derangement of the temporomandibular joint.

OBJECTIVE: This study aimed to evaluate the effect of dextrose prolotherapy in treating internal derangement of the temporomandibular joint. PATIENTS AND METHODS: A total of 20 patients with temporomandibular joint internal derangement were enrolled in the study. The diagnosis of internal derangement was confirmed by magnetic resonance imaging (MRI). The posterior and anterior disc attachment, as well as the most tender part of the masseter muscle, were injected with 12.5% dextrose. Pain, maximum mouth opening, clicking, and deviation were assessed immediately before treatment, as well as at 2-, 4-, and 12- weeks post-treatment. RESULTS: There was a significant improvement in the four clinical variables at the three-time intervals. Pain at two weeks was reduced by 60% (6 vs. 3.75) and by 200% (6 vs. 1.9) at 4 weeks. The maximum mouth opening was increased by 6.4 mm at 2 weeks and 7.85 mm at 4 weeks. The percentage of patients with clicking decreased from 70%, preoperatively- to 50% at 2 weeks, 15% at 4 weeks, and 5% at 12 weeks. The ratio of patients with deviation was decreased from 80% preoperatively to 35% at 2 weeks, 15% at 4 weeks, and 5% at 12 weeks. CONCLUSIONS: Prolotherapy is a safe and effective treatment for alleviating the symptoms of internal derangement of the temporomandibular joint.

Influence of Denture Cleansers on the Retention Loss of Attachment Systems Retained Implant Overdenture.

Background: This study aimed to evaluate the effects of different denture cleansing solutions (DCSs) on the retention of Locator and Locator R-Tx attachment systems of implant retained overdentures (IRO). Methods: Two part acrylic resin blocks were fabricated, upper part contained metal housing and plastic inserts and lower part contained implant analogs and abutments. Eighty pink plastic inserts (40/attachment, 10/solution) were immersed in Corega, Fittydent, sodium hypochlorite, and water for a time simulating upto 1-year of clinical usage. Acrylic blocks were held on a universal testing machine for a pull-out test to record the dislodgement force. Measurements were conducted after 6 months (T1) and 12 months (T2). One-way ANOVA followed by Tukey's HSD test was used to analyze the results (α = 0.05). Results: For both attachments, retention significantly decreased after immersion in different solutions at T2 (P < 0.001). Locator R-Tx attachment in NaOCl showed a significant decrease in retention compared with other solutions at T1. At T2, there was a significant decrease in retention for all DCS compared with water (P < 0.001). Locator R-TX showed higher retention values per solution compared to Locator attachment (P < 0.001). In terms of retention loss %, NaOCl recorded the highest (61.87%) loss, followed by Corega (55.54%) and Fittydent (43.13%), whereas water demonstrated the best retention (16.13%) in both groups. Conclusion: Locator R-TX has better retention with different DCS immersion. The loss of retention varied with different types of DCS and NaOCl recorded the highest retention loss. Therefore, denture cleanser selection must be guided by the type of IRO attachment.

Comparison of static and dynamic in vitro digestibility and bioaccessibility of palm-based emulsions and correlation to a human study: effects of triacylglycerol crystallinity.

The static and dynamic TIM-1 in vitro digestibility of similarly sized Span 60 o/w emulsions containing either liquid palm olein droplets (PO) or palm stearin (PS) droplets tempered to contain different levels of crystallinity (i.e., PS-SE (maximum), PS-SE-INT (intermediate), and PS-LE (undercooled)) were explored. Static in vitro digestion experiments included particle size analysis, and emulsion digestibility and bioaccessibility were compared between the static and dynamic models, respectively. ß-carotene (BC, 0.1 wt%) was also incorporated in the emulsions to determine the influence of triacylglycerol (TAG) crystallinity on BC bioaccessibility and stability during storage under accelerated lighting conditions. TAG crystallinity altered the colloidal fat crystal network properties and ultimately impacted lipid digestion, attenuating early static in vitro lipolysis for the PS emulsions compared to the PO emulsion. This correlated well with TIM-1 bioaccessibility trends and with results from our results of a previous human study wherein the rise in postprandial TAG was delayed when healthy men consumed PS-SE versus PS-LE. The presence of crystalline TAG modestly accelerated BC degradation, and did not improve preservation nor alter BC in vitro bioaccessibility.

Cross-Cultural Adaptation and Psychometric Properties of the Arabic Version of the Fall Risk Questionnaire.

A simple, valid, and reliable self-assessment fall-risk questionnaire in Arabic is needed to significantly promote awareness and develop fall-prevention programs. This study translated and adapted the Fall Risk Questionnaire (FRQ) into Arabic and determined its validity and reliability among Saudi Arabian older adults in two phases: (1) cross-culturally adapting the FRQ into Arabic and (2) assessing the adapted questionnaire's psychometric properties in two sessions with 110 Arabic-speaking participants aged ≥65 years. Pearson's r showed that the Arabic FRQ had a significant moderate negative relationship with the Berg Balance Scale and fair-to-moderate positive correlations with Five Time Sit to Stand and Time Up and Go. The receiver operating characteristic curve indicated a significant area under the curve = 0.81. The cut-off score was 7.5 and associated with 73.7% sensitivity and 73.6% specificity. Internal consistency was estimated as good, with Cronbach's α = 0.77. Deletion of item 1 slightly increased Cronbach's α to 0.78. The Arabic FRQ demonstrated excellent test-retest reliability, with an intraclass correlation coefficient = 0.95 (95% CI: 0.92-0.97). It is highly valid and reliable in providing valuable data for evaluating fall risk in adults aged ≥65 years and for consulting a specialist for further investigation if necessary.

Awareness and Knowledge of Women About Hormone Replacement Therapy in Taif City, Saudi Arabia.

Background It is crucial for women to have a good understanding of menopause from a young age, as this natural transition can have significant effects on their lives. Having this knowledge can help them handle the associated changes and improve their overall well-being. This study aimed to assess the level of awareness, attitude, and misconceptions regarding hormone replacement therapy (HRT) and menopause among women residing in the Taif region. Methodology This was a cross-sectional study conducted on the general population in Taif, Saudi Arabia, using an online self-administered questionnaire through Google Forms (Google Inc., Mountain View, CA, USA) from July 2022 to December 2022. The study included women aged between 40 and 65 years. A previously validated questionnaire was used for data collection, which assessed participants' awareness and knowledge of hormone replacement therapy in Taif. A 2-point system was used to grade each variable, where 2 points were given for a correct answer, 0 for an incorrect answer, and 1 for a neutral answer. Consistent with prior use of the questionnaire, participants who correctly answered 75% were considered to have good knowledge and understanding of HRT. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY, USA). Results A total of 383 participants were enrolled in this study. The mean age of the participants was 48 ± 6.2 years (ranging from 40 to 65 years). The mean knowledge score about hormone therapy during menopause was found to be 1.9 ± 2.4 (ranging from 0 to 9) out of 10. Of these participants, 63 (16.4%) were considered to have good knowledge, while 320 (83.6%) had poor knowledge. Additionally, 95 (24.8%) participants agreed to hormone replacement therapy during menopause, 136 (35.5%) believed that the advantages outweigh the disadvantages, 74 (19.3%) believed that it decreased the risk of cardiovascular diseases, and 113 (29.5%) believed that it decreased the risk of osteoporosis. The study also found that employment status, previous knowledge about hormone replacement therapy, and current use of it were significantly associated with awareness about hormone replacement therapy (p-value = 0.025, <0.001, and 0.003, respectively), with employed participants, those who heard about it, and those who currently use it tending to have higher awareness level compared to others. Conclusion Our study found that there is a poor level of knowledge and awareness about menopause and hormone therapy among the participants. Employment status was found to be associated with the level of knowledge.

Reproducibility and feasibility of a handheld ultrasound device compared to a standard ultrasound machine in muscle thickness measurements.

Objective: To test the feasibility and reproducibility of a handheld ultrasound device (HUD) compared to a standard ultrasound machine for muscle thickness measurements in healthy participants. Methods: A prospective cross-sectional study was designed where two novice operators tested the thickness of the vastus lateralis, rectus femoris, and vastus intermedius muscles on recruited asymptomatic participants with no history of muscle diseases. The anterior-posterior thickness of each muscle was measured three times per operator to evaluate intra-operator reproducibility and using two machines to evaluate inter-system reproducibility. Scanning started using the HUD followed by the standard system. Intraclass correlation coefficients (ICC) and simple linear regression were used to test for reproducibility and proportional bias respectively. Results: A total of 33 male participants volunteered to take part in this study with a mean age of 22.7 years (6.8). Intra-operator reproducibility was almost perfect for both operators on both machines (ICC > 0.80). The measurements difference percentage between the machines ranged from 1.8% to 6.6% and inter-system reproducibility ICC ranged from 0.815 to 0.927 showing excellent reproducibility. Inter-operator reproducibility was poor to moderate on both machines (ICC: 0.522-0.849). Regression analysis showed no proportional bias in the measurements. All measurements were completed successfully using the HUD. Conclusion: The HUD demonstrated excellent accuracy compared to the standard ultrasound machine for measuring thigh muscle thickness.

Reassessment of the Need for Asthmatic Patients for Biologic Treatment in a Tertiary Care Hospital.

BACKGROUND:  Asthma is a common chronic inflammatory airway condition. In difficult-to-treat asthma, poor control can be linked to multiple factors like the presence of uncontrolled comorbidities (e.g. gastroesophageal reflux and allergic rhinitis), as well as to poor inhaler use techniques and adherence. In this study we wanted to evaluate our severe asthma patients already on a biologic treatment with regard to presence of any of these factors.  Method: A questionnaire-based study, filled by investigators through direct interview with patients. We included all asthma patients on biologic treatment at King Abdul Aziz Medical City, Riyadh, KSA. Started in October 2020 and ended in December 2020. The questionnaire had a demographic section and sections for asthma symptoms, compliance, inhaler techniques, and comorbidities. RESULT:  Case series of N=38 severe asthma patients showed that majority had partially controlled or uncontrolled asthma (66%). Some 42% had intermediate/high risk for obstructive sleep apnea (OSA) based on the common screening tool "STOPBANG" score. Some 47% of our patients had uncontrolled gastro-esophageal reflux disease (GERD), and majority (80%) had uncontrolled allergic rhinitis. Only half of them demonstrated appropriate inhaler technique. And none of them was found exposed to asthma triggers at the time of interview. CONCLUSION: Significant number of severe uncontrolled asthmatic patients were shown to be associated with at least one comorbid condition that might be interfering with patients' improvement in asthmatic symptoms. By taking appropriate measures toward management and controlling of those comorbid conditions and also educating patients about technique to use inhalers might show notable improvement in asthmatic patients' condition.

Clinical Diagnosis of Slipped Capital Femoral Epiphysis in a Child With Negative Radiological Findings: A Case Report.

Slipped capital femoral epiphyses (SCFE) is considered to be a very common disorder among adolescent age group. Multiple risk factors have been reported such as obesity, endocrine disorders, vitamin D deficiency, and panhypopituitarism. The diagnosis of SCFE is important especially in its early stages as this would prevent complications and delay in surgical intervention. The diagnosis is mainly done by radiological imaging and clinical evaluation. However, clinical evaluation is often overlooked. Herein, we present a case of a seven-year-old with SCFE that was diagnosed late due to negative radiological imaging and received late surgical intervention. Therefore, it is recommended that orthopedic surgeons use their clinical sense and examination skills to diagnose SCFE promptly, in order to maintain a short follow-up window to prevent any delay in surgical management and to observe for any progression, even if the radiological findings are normal.

Taste Masking of Promethazine Hydrochloride Using l-Arginine Polyamide-Based Nanocapsules.

Promethazine hydrochloride (PMZ), a potent H1-histamine blocker widely used to prevent motion sickness, dizziness, nausea, and vomiting, has a bitter taste. In the present study, taste masked PMZ nanocapsules (NCs) were prepared using an interfacial polycondensation technique. A one-step approach was used to expedite the synthesis of NCs made from a biocompatible and biodegradable polyamide based on l-arginine. The produced NCs had an average particle size of 193.63 ± 39.1 nm and a zeta potential of −31.7 ± 1.25 mV, indicating their stability. The NCs were characterized using differential scanning calorimetric analysis and X-ray diffraction, as well as transmission electron microscopy that demonstrated the formation of the NCs and the incorporation of PMZ within the polymer. The in vitro release study of the PMZ-loaded NCs displayed a 0.91 ± 0.02% release of PMZ after 10 min using artificial saliva as the dissolution media, indicating excellent taste masked particles. The in vivo study using mice revealed that the amount of fluid consumed by the PMZ-NCs group was significantly higher than that consumed by the free PMZ group (p < 0.05). This study confirmed that NCs using polyamides based on l-arginine and interfacial polycondensation can serve as a good platform for the effective taste masking of bitter actives.

Flexural Properties and Hardness of CAD-CAM Denture Base Materials.

PURPOSE: To compare flexural strength, elastic modulus, and surface hardness of computer aided design and computer aided manufacturing CAD-CAM milled, 3D-printed, and heat-polymerized denture base resins. MATERIALS AND METHODS: A total of 120 specimens were fabricated from heat-polymerized acrylic resin (HP), milled resin (Avadent and IvoCad), and 3D-printed resin (ASIGA, FormLabs, and NextDent). The specimens were divided into 6 groups according to the type of denture base material (n = 20/material) (10/flexural properties and 10/hardness). Flexural strength and elastic modulus of the specimens were evaluated by 3-point bending test and surface hardness by Vickers hardness test. To test flexural properties, the specimens were fabricated according to ISO 20795-1:2013 standards (64 × 10 × 3.3 ± 0.2 mm). The dimensions for hardness test were 15 × 10 × 2.5 ± 0.2 mm. Scanning electron microscope was used to evaluate the surface morphology of the fractured specimens. The means and standard deviations were calculated, followed by one-way ANOVA and Tukey post-hoc test (α = 0.05). RESULTS: Milled resins showed significantly higher values for flexural strength, elastic modulus, and surface hardness, followed by HP and then 3D-printed resins (p < 0.001). Within milled groups, flexural strength of AvaDent was significantly higher than IvoCad (p < 0.001), while elastic modulus and hardness didn't show significant difference. Within 3D-printed resins, ASIGA showed the highest flexural strength and elastic modulus, insignificantly with FormLabs (p = 0.595) and significantly with NextDent (p = 0.008). ASIGA also showed significantly the highest hardness among the 3D-printed groups. No significant difference was found between FormLabs and NextDent in flexural strength (p = 0.357), elastic modulus (p = 1.00), or surface hardness (p = 0.987). CONCLUSION: CAD-CAM milled resins had greater flexural properties and hardness compared to heat-polymerized acrylic resin and 3D-printed resins. Although 3D-printed samples showed the lowest values of tested properties, the flexural strength and modulus were above clinically acceptable values.