Heterotopic Cesarean Scar Pregnancy: A Case Report.

Heterotopic pregnancy is a rare condition with an intrauterine pregnancy coexisting with extrauterine pregnancy. It is considered a rare condition, with an incidence of one in 30,000 spontaneous pregnancies. Because of its rarity, there are no international management guidelines. It is associated with increased maternal morbidity and mortality. Heterotopic pregnancy is a challenging condition to diagnose because it can be missed due to the intrauterine pregnancy. The most common signs and symptoms to support and help us reach a diagnosis would be adnexal mass, abdominal pain, and enlarged uterus. In this case report, we aim to compare the clinical course and the outcome of intrauterine gestation while coexisting with scar pregnancy and the management options. This case report concerns a 34-year-old pregnant woman with a heterotopic pregnancy managed in Bahrain Defence Force Hospital.

Predictive Ability of LRINEC Score for Lower Extremity Amputation in Moderate to Severe Diabetic Foot Infection.

OBJECTIVE: To assess the predictive ability of the laboratory risk indicator for necrotising fasciitis (LRINEC) score for lower extremity amputation in patients with moderate to severe diabetic foot infection (DFI). STUDY DESIGN: Observational study. Place and Duration of the Study: Department of General Surgery, Combined Military Hospital, Rawalpindi, Pakistan, from June to September 2023. METHODOLOGY: Patients admitted to the surgical ward with moderate to severe DFI were included by convenience sampling. Patients with severe sepsis, unstable haemodynamics, pressure injuries, and terminal illnesses were excluded. Demographic and clinical data of patients were noted down. LRINEC score was calculated on the day of admission. Final outcome (amputation or otherwise) was recorded on the 30th day the since the day of admission. RESULTS: Two hundred patients with moderate to severe DFI were included. The median age of patients was 56 years (IQR 49-66 years). The median duration of diabetes was 11 years (IQR 4 - 18.75 years). The median LRINEC score at admission was 6 (IQR 3-9). The majority of the patients (65.5%) had some other medical comorbid besides diabetes. Patients who had amputation due to DFI at 30 days post-admission had higher LRINEC scores on admission as compared to those patients who did not have amputation (Median 8 vs. 2, p <0.001). The cut-off point of LRINEC score ≥6.5 at admission had sensitivity of 74% and specificity of 94% in predicting amputation. CONCLUSION: The LRINEC score may be used as an objective scoring system to predict the risk of amputation in patients with moderate to severe DFI in indoor clinical settings. KEY WORDS: Diabetic foot, LRINEC score, Limb loss, Necrotising fasciitis.

Clinical and Immunological Features, Genetic Variants, and Outcomes of Patients with CD40 Deficiency.

PURPOSE: Inherited deficiencies of CD40 and CD40 ligand (CD40L) reflect the crucial immunological functions of CD40-CD40L interaction/signaling. Although numerous studies have provided a detailed description of CD40L deficiency, reports of CD40 deficiency are scarce. Herein, we describe the characteristics of all reported patients with CD40 deficiency. METHODS: The PubMed, Embase and Web of Science databases were searched for relevant literature published till 7th August 2023. Study deduplication and identification of relevant reports was performed using the online PICO Portal. The data were extracted using a pre-designed data extraction form and the SPSS software was used for analysis. RESULTS: Systematic literature review revealed 40 unique patients with CD40 deficiency. Respiratory tract and gastrointestinal infections were the predominant clinical manifestations (observed in 93% and 57% patients, respectively). Sclerosing cholangitis has been reported in nearly one-third of patients. Cryptosporidium sp. (29%) and Pneumocystis jirovecii (21%) were the most common microbes identified. Very low to undetectable IgG levels and severely reduced/absent switch memory B cells were observed in all patients tested/reported. Elevated IgM levels were observed in 69% patients. Overall, splice-site and missense variants were the most common (36% and 32%, respectively) molecular defects identified. All patients were managed with immunoglobulin replacement therapy and antimicrobial prophylaxis was utilized in a subset. Hematopoietic stem cell transplantation (HSCT) has been performed in 45% patients (curative outcome observed in 73% of these patients). Overall, a fatal outcome was reported in 21% patients. CONCLUSIONS: We provide a comprehensive description of all important aspects of CD40 deficiency. HSCT is a promising curative treatment option for CD40 deficiency.

Healthcare Managers' Perception on Patient Safety Culture.

Introduction: This paper takes a detailed look at safety culture, different roles, and powers shared by managers, lessons from which can be applied in any form of management. It also focuses on the job of managers in enhancing safety standards in a health institution. The objective of this paper was to examine the managers' perception of patient safety culture. Methods: This study followed a quantitative cross-sectional design. The research procedure involved all middle-level managers in Aseer Central Hospital in Abha, Saudi Arabia (N = 52). To assess the status of patient safety culture and the role of healthcare managers in the field study, the researchers constructed a study questionnaire; it included questions adapted and modified from the Safety Attitudes Questionnaire, the Hospital Survey on Patient Safety Culture questionnaire, the 10 Mintzberg managerial roles and the six types of power for healthcare managers. Results: Most participants were Saudi nationals (73.1%) aged 31 to 40 years (44.2%). The managerial role practiced frequently was leadership (85%), but the least managerial role was the figurehead (23%). Mangers held positive attitudes toward patient safety culture with 100% positive replies. No significant association was found between sex, nationality, years of experience, and professions concerning patient safety. Additionally, the results indicated that most managers were willing to uphold a safe environment for their patients and ready to involve employees in decision-making strategies to motivate them. Conclusion: The managerial choices in Aseer Central Hospital are based on the culture and tradition of the community, which might negatively undermine the capability of other individuals handling the same office based on their educational backgrounds and competency. Such situations also may demoralize the employees, leading to poor employee performance Suboptimal achievement was exhibited primarily by middle-level healthcare managers of all six power types: resource allocator, negotiator, liaison, spokesperson, figurehead, and entrepreneur. Therefore, there is a pressing need to improve managers' attitudes toward patient safety and activate managerial roles to ensure patients' safety is practiced unequivocally.

A robust prediction model for evaluation of plastic limit based on sieve # 200 passing material using gene expression programming.

This study aims to propose a novel and high-accuracy prediction model of plastic limit (PL) based on soil particles passing through sieve # 200 (0.075 mm) using gene expression programming (GEP). PL is used for the classification of fine-grained soils which are particles passing from sieve # 200. However, it is conventionally evaluated using sieve # 40 passing material. According to literature, PL should be determined using sieve # 200 passing material. Although, PL200 is considered the accurate representation of plasticity of soil, its' determination in laboratory is time consuming and difficult task. Additionally, it is influenced by clay and silt content along with sand particles. Thus, artificial intelligence-based techniques are considered viable solution to propose the prediction model which can incorporate multiple influencing parameters. In this regard, the laboratory experimental data was utilized to develop prediction model for PL200 using gene expression programming considering sand, clay, silt and PL using sieve 40 material (PL40) as input parameters. The prediction model was validated through multiple statistical checks such as correlation coefficient (R2), root mean square error (RMSE), mean absolute error (MAE) and relatively squared error (RSE). The sensitivity and parametric studies were also performed to further justify the accuracy and reliability of the proposed model. The results show that the model meets all of the criteria and can be used in the field.

Genetic characterization of upper respiratory tract virome from nonvaccinated Egyptian cow-calf operations.

Bovine respiratory disease (BRD) is the costliest complex disease affecting the cattle industry worldwide, with significant economic losses. BRD pathogenesis involves several interactions between microorganisms, such as bacteria and viruses, and management factors. The present study aimed to characterize the nasal virome from 43 pooled nasal swab samples collected from Egyptian nonvaccinated cow-calf operations with acute BRD from January to February 2020 using metagenomic sequencing. Bovine herpesvirus-1 (BHV-1), first detection of bovine herpesvirus-5 (BHV-5), and first detection of bovine parvovirus-3 (BPV-3) were the most commonly identified in Egyptian cattle. Moreover, phylogenetic analysis of glycoprotein B revealed that the BHV-1 isolate is closely related to the Cooper reference strain (genotype 1.1), whereas the BHV-5 isolate is closely related to the reference virus GenBank NP_954920.1. In addition, the whole-genome sequence of BPV-3 showed 93.02% nucleotide identity with the reference virus GenBank AF406967.1. In this study, several DNA viruses, such as BHV-1 and first detection BHV-5, and BPV-3, were detected and may have an association with the BRD in Egyptian cattle. Therefore, further research, including investigating more samples from different locations to determine the prevalence of detected viruses and their contributions to BRD in cattle in Egypt, is needed.

A case report of the Hoffa fracture and a review of literature.

The Hoffa fracture is an uncommon fracture. There is a lot of confusion about its diagnosis and management with several conflicting reports in literature. We reported a 25-year-old patient with non-union of Hoffa fracture, and meanwhile tried to develop an algorithm-based treatment for Hoffa fractures. A systematic review of the available literature was performed. Medline, Embase, the Cochrane Library and PubMed were searched for relevant articles. Fifty-five articles were reviewed, and the clinical knowledge base was summarized. The understanding of the mechanism of trauma has become more nuanced. The literature has also evolved to classify the fracture with the purpose of surgical management in mind. This can be used to plan approach and fixation with preservation of blood supply. Classification can also prognosticate the outcomes in Hoffa fracture.

Effect of automobile exhaust on pulmonary function tests among traffic police personnel in Kashmir valley.

Background: Automobile exhaust is an important cause of air pollution, which is a leading health menace and is growing perpetually. Traffic police personnel are exposed to automobile exhaust more than anyone else, and the resulting lung involvement may be asymptomatic. Materials and Methods: This observational cross-sectional study was conducted among 136 traffic police personnel, aged 18-59 years, working for more than 6 months in the traffic police of Kashmir valley. In addition, 140 age- and sex-matched, healthy unexposed Kashmiri's served as controls. Pulmonary functions were measured by RMS Helios 401 PC based spirometer. Results: Sixteen (11.2%) out of 136 traffic police personnel had abnormal pulmonary function test (PFT) as compared to 5 (3.6%) out of 140 controls. Traffic police personnel's had significantly declined forced expiratory volume in 1 s (FEV 1) and forced vital capacity. Eight (5.8%) had obstructive, 7 (5.1%) had restrictive, and 1 (0.7%) traffic police personnel had mixed pattern on PFT. Duration of exposure to automobile exhaust of more than 10 years was significantly associated with pulmonary function abnormality (P = 0.038). Conclusion: Air pollution due to automobile exhaust may be the factor responsible for pulmonary function abnormalities in traffic police personnel. Besides protective measures during duty hours, traffic police personnel should be subjected to periodic assessment of their lung functions.

Understanding Perceptions and Practices for Designing an Appropriate Community-Based Kangaroo Mother Care Implementation Package: Qualitative Exploratory Study.

BACKGROUND: Low birth weight (LBW) is a common outcome of preterm birth, which increases the risk of an infant's morbidity and mortality. Approximately 20 million infants are born with LBW globally per year. Since a significant number of births in Pakistan take place at home, it is important to focus on the use of kangaroo mother care (KMC), the practice of skin-to-skin contact, in communities to prevent neonatal mortality and morbidity. OBJECTIVE: We employed a formative research approach to understand the context of communities and facilities with regard to neonatal care and KMC practice. The broader aims were to inform the design and delivery of culturally appropriate platforms to introduce KMC in communities, and develop effective recruitment and retention strategies of KMC in rural areas of the Dadu district in the Sindh province of Pakistan. METHODS: We conducted focus group discussions, in-depth interviews, and key informant interviews with families of LBW babies, community members, health care providers, and hospital administrators to identify barriers, enablers, and a knowledge base for KMC interventions. RESULTS: Newborn care practices in communities were found to be suboptimal. The community was generally unaware of the KMC intervention for the care of LBW babies. However, facility health care providers, the community, and family members were willing to provide KMC to improve outcomes. We found significant support from the community members and health care providers for KMC practices. Mothers were also ready to provide intermittent KMC. The administrative staff at the hospitals accepted the introduction of KMC practices for LBW babies. CONCLUSIONS: KMC as a method of treating LBW babies is widely accepted in the community. This formative research provides strategically valuable information that will be helpful for developing effective implementation strategies by identifying common community practices for LBW babies, along with identifying the barriers and enablers to KMC practice.

Knowledge and Attitude Regarding COVID-19 among Students from Multiple Professional Background in Riyadh Region, Saudi Arabia: A Cross-sectional Study.

INTRODUCTION: Coronavirus disease 2019 is abbreviated as "COVID-19" caused by the severe acute respiratory syndrome-corona virus 2 first emerged in Wuhan, China, on December 2019. On 15th of March, this disease has been classified by the World Health Organization as a pandemic and a global public health emergency. OBJECTIVE: The study's aim was to evaluate the knowledge and behavior toward the virus among professional students of Riyadh, Saudi Arabia. METHODOLOGY: A cross-sectional study done on 753 students which were invited to complete a Google document using a 20-item electronic questionnaire that was design to gauge knowledge and attitude toward COVID-19. The study was conducted from February 20 to March 18, 2020 in Alkharj and Riyadh region. RESULTS: The predominant sex is male (73%), the common age is <25 years old, more medical students were involved in the study than any other specialty and the predominant educational degree of the participants was bachelors. The awareness of mode of transmission of novel coronavirus infection is less in business administration participants compare to others and is highly significant (P ˂ 0.001). Most of the participants (588 [98%]) were aware of coronavirus but only 302 (50%) of respondents are aware of COVID-19 which is highly significant (P ˂ 0.001). CONCLUSION: The results are mostly uniform among different professional students with the exception of some knowledge-related questions. The Internet was the main source of information, so there is a need to create more awareness about COVID-19 through social media.

Awareness and Knowledge about Sugar Substitutes among Population in Riyadh Region.

BACKGROUND: The food we consume will have sugar in one or the other form, which is not ideal for our teeth. This can be replaced by the use of sugar substitutes available in the market. Sugar substitutes have beneficial and adverse effects on health. In spite of their beneficial effects, long-term use of sugar substitutes is not recommended because of their health-related complications. Therefore, before consuming any sugar substitutes, everyone needs to know about both health benefits and their health hazards; hence, the present study was designed to assess the awareness, knowledge, and utilization of sugar substitutes among the general population in Riyadh Region, Kingdom of Saudi Arabia. OBJECTIVES: The aim is to assess the awareness and knowledge about sugar substitutes. METHODOLOGY: Questionnaire consisting of demographic details, awareness, and knowledge about sugar substitutes were sent through social media and it was in the Arabic and English Language. After completing the questionnaire, participants are requested to send the link to their friends and relatives. RESULTS: About 60.20% of participants were aware of sugar substitutes. Statistically significant difference was observed for gender and awareness of sugar substitutes (P < 0.05). About 31.5% of the participants are of the view that sugar substitutes have got side effects. About 61.9% of participants are of the view that Sugar substitute reduces the chance of occurrence of dental caries. CONCLUSIONS: Overall, 60.2% of study participants were aware of sugar substitutes, but the controversy on most of the artificial sweeteners cannot be ignored. Hence, the safety of these sweeteners is of prime importance for scientists. Any usage of sugar substitutes should be weighed against the adverse effects.

Full-genome sequencing and analysis of DENV-3 serotype isolated from Yemen.

BACKGROUND: Dengue virus causes the dengue fever as well as hemorrhagic fever in tropical and sub-tropical countries. It is now endemic in most parts of the South East Asia. Full-genome information of dengue virus 3 is not available from Yemen. METHODS: In this study, the dengue virus 3 was detected by diagnostic tools like serology and RT-PCR in the samples isolated from a patient in Yemen. The full-genome was sequenced, and the identity, phylogenetic relationship and recombination analysis was performed by using BioEdit, MEGA X and RDP4 softwares. RESULTS: The full-genome of the Yemen isolate was found to be 10,643 nt long with 3390 amino acids. The Yemen dengue virus 3 isolate showed the sequence similarity (98.5-92.4%) with dengue virus 3 isolates from China, Pakistan, India and Bangladesh respectively. The significant non-synonymous substitutions of amino acid in Yemen isolate were observed with selected isolates. The phylogenetic tree of Yemen isolate formed a unique clade within genotype III and sub-clade into lineage III. The Dengue virus isolate from Jeddah formed separated cluster with lineage IV. CONCLUSIONS: This reveals the unique genetic variability among DENV-3 serotypes from Jeddah and earlier reported isolates from other regions.

The quantity of health-related article publications from universities in Saudi Arabia: A bibliometric analysis, 2008-2017.

Several studies have summarized the biomedical publications in Arab countries. However, the quantity of health-related article publications from universities in recent years in Saudi Arabia is unknown. Therefore, this study aimed to perform a bibliometric analysis that showcases the quantitative health-related article publications output from universities in Saudi Arabia between 2008 and 2017. An extensive literature search was conducted using the PubMed database. The search was limited to original research articles, systematic reviews, and meta-analyses published in the English language reporting on humans from medicine and health sciences colleges by researchers affiliated with any university in Saudi Arabia between January 2008 and December 2017. A total of 3172 articles were found published between January 2008 and December 2017. The number of publication output increased significantly (p = 0.0027) from 73 (2.3%) in 2008 to 721 (22.7%) in 2017. The highest quantity of publications came from the Riyadh region (n = 2257), specifically King Saud University (n = 1538). Of specific journals, the BioMed Central journals published the most articles by Saudi Arabian researchers (n = 112). The total number of publications increased from 2% to 24.8% by region. However, approximately 80% of the papers were published in journals with an impact factor (IF) <3. Around 3.8% of the papers were published in journals that had an IF ≥6 and has increased significantly (p = 0.030) from 0% to 1.2% in the past decade. The journal with the highest IF that published a high quantity of articles was the American Journal of Human Genetics. This study has identified a continuous significant increase in the publication of health-related articles from universities in Saudi Arabia. This study extended our knowledge of the quantity of scientific productivity in the field of medicine and health sciences over a recent decade.

Extraarticular extrasynovial solitary osteochondromatosis of the ankle: A rare case report and review of literature.

INTRODUCTION: Synovial chondromatosis (SC) is a relatively common benign condition of the synovial joint characterized by the formation of cartilaginous nodules in synovium. However, extra articular osteochondromatosis is rare and only few have been reported around the ankle joint. We have reported such a presentation and have reviewed the literature extensively. PRESENTATION OF CASE: We present a 26 year old male patient with a painless swelling over the lateral aspect of his left ankle. He was subjected to clinical and radiological examination which revealed a firm to hard swelling around the lateral malleolus and a lobulated juxtacortical cystic lesion with calcification. He underwent a surgical excision and subsequent histopathology was suggestive of SC. DISCUSSION: The subtle clinical and radiological presentation of SC can lead to both a delay in the diagnosis and a diagnostic dilemma if suspicion is low. Early meticulous diagnosis and management can curtail morbidity. CONCLUSION: The degree of suspicion needs to be high to diagnose the condition early to prevent both morbidity and inadequate treatment. Histopathological corroboration is needed to rule out uncommon but possible malignant transformation, notably in long standing cases.

Molecular modelling and dynamics of CA2 missense mutations causative to carbonic anhydrase 2 deficiency syndrome.

Carbonic anhydrase 2 (CA2) enzyme deficiency caused by CA2 gene mutations is an inherited disorder characterized by symptoms like osteopetrosis, renal tubular acidosis, and cerebral calcification. This study has collected the CA2 deficiency causal missense mutations and assessed their pathogenicity using diverse computational programs. The 3D protein models for all missense mutations were built, and analyzed for structural divergence, protein stability, and molecular dynamics properties. We found M-CAP as the most sensitive prediction method to measure the deleterious potential of CA2 missense mutations. Free energy dynamics of tertiary structure models of CA2 mutants with DUET, mCSM, and SDM based consensus methods predicted only 50% of the variants as destabilizing. Superimposition of native and mutant CA2 models revealed the minor structural fluctuations at the amino acid residue level but not at the whole protein structure level. Near native molecular dynamic simulation analysis indicated that CA2 causative missense variants result in residue level fluctuation pattern in the protein structure. This study expands the understanding of genotype-protein phenotype correlations underlying CA2 variant pathogenicity and presents a potential avenue for modifying the CA2 deficiency by targeting biophysical structural features of CA2 protein. Communicated by Ramaswamy H. Sarma.

Incidence of pediatric acute kidney injury in hospitalized patients.

Pediatric acute kidney injury (pAKI) is a common complication associated with high mortality in children. The objective of this study was to determine the incidence of acute kidney injury (AKI) and mortality in hospitalized (critically ill and non-critically ill) patients. This was a retrospective study conducted during the period of June 1, 2013, to May 31, 2014, at the Postgraduate Department of Pediatrics, G. B. Pant Hospital, an Associated Hospital of Government Medical College, Srinagar, Jammu and Kashmir, India. All patients between the ages of one month and 18 years were included in the study, who had AKI. In general, out of 23,794 patients, 197 developed AKI (0.8%). On subgroup analysis, 2460 were critically ill and had Intensive Care Unit (ICU) admission among whom 99 developed AKI (4%), whereas 21,334 had general pediatric ward admissions and 98 developed AKI (0.5%). Infantile age group was the most commonly 91 (46.2%) affected. The common causes of AKI were renal in 73 (37%), neurologic in 38 (19%), septicemia in 35 (18%), and inborn errors of metabolism in 30 (15.2%). Out of 197 pAKI patients, 42 (21.3%) died and all of them were critically sick (ICU admissions). The incidence of pAKI in general was 0.8%, whereas it was 4% in critically ill children and 0.5% in general ward admissions implying an eight-fold increased risk of pAKI in critically ill patients.

The Musculoskeletal Manifestations of Type 2 Diabetes Mellitus in a Kashmiri Population.

OBJECTIVES: Diabetes mellitus (DM), is affecting an ever increasing number of people worldwide. Diabetes is associated with several musculoskeletal manifestations. These may involve, the upper as well as the lower limb. We conducted this study to find out the prevalence of musculoskeletal problems in type 2 diabetics in the Kashmiri population. METHODOLOGY: The study was conducted on 403 patients with diabetes and 300 controls. All patients underwent screening for any musculoskeletal abnormalities. The patients with musculoskeletal abnormalities were further assessed to find the exact diagnosis according to predefined criteria. RESULTS: The hand was involved in 80 patients [19.8%] in the diabetic group and 15 (5%) patients of the control group. The elbow was affected in 56 patients [14%] in the diabetic group and 24 patients [5.9%] in the non-diabetic group. The shoulder involvement was diagnosed in 61 patients [15%] on the diabetic cohort and 15 patients in the non-diabetic cohort. All the upper limb figures showed a statistically significant difference i.e. P value <0.05. CONCLUSION: The prevalence of musculoskeletal complications in type 2 diabetics in Kashmir is quite high.

Taxonomic notes and distribution extension of Durga Das's leaf-nosed bat Hipposiderosdurgadasi Khajuria, 1970 (Chiroptera: Hipposideridae) from south India.

Durga Das's leaf-nosed bat Hipposiderosdurgadasi Khajuria, 1970 is endemic to India, and was known only from Katanga, Katangi, and Richhai villages, in Jabalpur district, Madhya Pradesh. During surveys conducted in Kolar district, Karnataka, India, we successfully mist-netted a few individuals belonging to the bicolor species group which, upon detailed external, craniodental and bacular studies were identified as Durga Das's leaf-nosed bat. This paper reports the presence of this species in southern India, extending its distribution range by almost 1300 km. We also provide a detailed morphological description for this species.

Salvage splenopexy for torsion of wandering spleen in a child.

The wandering spleen is a rare condition characterized by the absence or underdevelopment of one or all of the splenic suspensory ligaments that resulting in increased splenic mobility and rarely torsion. Preventing infarction is the aim of a prompt surgery by splenopexy. We report a case of salvage splenopexy in torsion of a wandering spleen in a three year old girl presented with severe abdominal pain for three days.

Lumbo-costo-vertebral syndrome with congenital lumbar hernia.

Lumbo-costo-vertebral syndrome (LCVS) is a set of rare abnormalities involving vertebral bodies, ribs, and abdominal wall. We present a case of LCVS in a 2-year-old girl who had a progressive swelling over left lumbar area noted for the last 12 months. Clinical examination revealed a reducible swelling with positive cough impulse. Ultrasonography showed a defect containing bowel loops in the left lumbar region. Chest x-ray showed scoliosis and hemivertebrae with absent lower ribs on left side. Meshplasty was done.