Is the myonuclear domain ceiling hypothesis dead?

Muscle fibres are multinuclear cells, and the cytoplasmic territory where a single myonucleus controls transcriptional activity is called the myonuclear domain (MND). MND size shows flexibility during muscle hypertrophy. The MND ceiling hypothesis states that hypertrophy results in the expansion of MND size to an upper limit or MND ceiling, beyond which additional myonuclei via activation of satellite cells are required to support further growth. However, the debate about the MND ceiling hypothesis is far from settled, and various studies show conflicting results about the existence or otherwise of MND ceiling in hypertrophy. The aim of this review is to summarise the literature about the MND ceiling in various settings of hypertrophy and discuss the possible factors contributing to a discrepancy in the literature. We conclude by describing the physiological and clinical significance of the MND ceiling limit in the muscle adaptation process in various physiological and pathological conditions.

Treatment Considerations and Pharmacist Collaborative Care in Diabetic Ketoacidosis Management

Diabetic ketoacidosis (DKA) is a medical emergency caused by the lack of insulin. Metabolic acidosis, hyperglycemia, and ketoacidosis are its defining features. Insulin deficiency can cause DKA either in the presence or absence of a triggering event causing a chain of pathophysiological changes. Normalizing volume status, hyperglycemia, electrolytes, and ketoacidosis are the objectivesof DKA treatment. While hospital pharmacists are involved in managing DKA, community or ambulatory care pharmacists can help to prevent DKA. Depending on the particular field of practice, a p harmacist’s engagement in DKA may involve a number of factors. Inpatient pharmacists are in a good position to help with the acute care of DKA. Because they can recognize patients who are at risk for DKA due to factors including medication nonadherence or insulin pump failure, pharmacists in the community or ambulatory-care environment play a crucial role in its prevention. When a patient finds it challenging to navigate prescription plan coverage or a lack of coverage, community pharmacists can help them obtain insulin. Regardless of the professional environment, patient education is essential. Every pharmacist has the ability to give DKA patients thorough medication education that emphasizes the value of adhering to their drug schedule, addresses any obstacles that may occur, and teaches patients how to correctly monitor their blood glucose levels. Studies showed that pharmacists’ medication counseling and treatment monitoring could improve adherence to insulin medication. The aim of this review is to provide evidence that pharmacists can contribute to optimizing medication adherence and decrease the incidence of DKA.

Hematological and biochemical studies on hemodylitic patients at the Government General Hospital, Wadi Al-Dawaser

Background:Renal failure is a slowly progressive disease of kidney, characterized by low glomerular filtration. One of the most important replacement therapy of renal failure is hemodialysis which helping in the removal of toxic fluids and metabolic end products fromthe body. Methods:This study was carried out on 43 patients with renal failure in the dialysis unit ofWadi Al-Dawaser General Hospital. Patients were 25 males and 18 females, randomly selected for the study between September and November 2018. Blood samples were obtained from all patients pre and post dialysis for serum biochemical analysis including kidney function test, liver function, lipid profile, glucose, electrolytes, while blood sample with anticoagulants collected pre dialysis for complete blood picture.Results:The hemogram parameters recorded significant decrease while leuckogram insignificantly increase specially eosinophils, in pre-dialysis patients. Serum biochemical parameters were significantly high pre-dialysis recorded 83.7%, 97.7%, 21% for urea, creatinine and uric acid respectively, while significantly decrease post dialysis. In contrast serum glucose and magnesium levels were significantly high pre and post dialysis. As result of decrease of the erythropoietin production in chronic renal failure patients lower hematological indices, increase the risk of anemia are main results.Conclusions:Dialysis improve the biochemical parameters of serum especially creatinine and urea while glucose and magnesium not improved.

Public awareness of vitamin " D " deficiency among children in Najran city and the role of primary health care centers in raising their awareness

Background: Vitamin D is one of fat-soluble vitamins. It has of great importance in increasing intestinal absorption of calcium, magnesium, phosphate, and zinc. Sun is the main source for this vitamin and there are few foods that contain it, for example milk and egg. From a long standing, vitamin D deficiency has been a health problem in the world. Vitamin D has great importance in the growth of bone, so the deficiency of it or imbalance of its metabolism inside the body leads to major problems, most notably of them is rickets among children

Objectives: This is a cross-sectional study, aiming to study the awareness of public regarding vitamin D deficiency among children and to reveal the role of primary health care in raising people's awareness of vitamin D deficiency

Materials and Methods: Electronic questionnaires are used to collect data. They contain personal socio-demographic characteristics, information about vitamin D deficiency and the role of primary health care in raising people's awareness of vitamin D deficiency. The study recruits 500 participants; medical field workers were not included in the study. Data were analyzed using SSPS version 22

Results: It was observed that 89% of the total sample size has knowledge on vitamin D where 94.3% of mothers heard about vitamin D, 68% knew that vitamin D is important, and 72.11% believed that vitamin D is manufactured in the body. More than two thirds [69.83%] said that the ultraviolet sun-rays is the main source of vitamin D and 68.88% of parents declared that they had attend a lecture given by a physician in in the primary health care center on the importance of vitamin D where, fathers [40.2%] were more than mothers [26.6%] in getting their information

Conclusion: More research is needed to assess the level of community awareness as it is the best solution to reduce or eliminate the problem. Health education campaigns about vitamin D and its importance with more intensification in Men places as they had a low awareness. Training of primary health care physicians and their supervision for raising awareness of their community

Necrobiosis lipodica diabeticorum as a sign of diabetes

Necrobiosis lipoidica [NL] is a rare chronic disease. The exact cause is unknown, however, different theories suggest that it is due to a vascular disturbance involving immune complex deposition or microangiopathic changes resulting in collagen degeneration. NL has increased prevalence in patients with diabetes and is more common in females aged 30-40 years old. All patients with NLD should undergo screening for diabetes with yearly HbA1c measurements. NLD could be the first presenting sign of diabetes. A thirty-four-year-old Bahraini female, known case of gestational diabetes on diet presented with right leg skin changes. The patient was diagnosed clinically and confirmed by punch biopsy as a case of NLD. The patient was treated with Daivobet and Daflon tablets twice a day, which resulted in noticeable improvement