Association of country economy and socioeconomic factors on risk factor control for primary prevention of cardiovascular disease in patients with diabetes mellitus: Insights from the DISCOVER study

Background: We sought to describe global patterns in achievement of risk factor control for primary prevention in patients with T2D and explore the association of country's GNI/capita with risk factor control. Methods: The DISCOVER study is a prospective, observational study of patients with T2D from 38 countries enrolled at initiation of second-line glucose-lowering therapy. We examined achievement of risk factor control (glycosylated hemoglobin <7%, blood pressure <140/90 mmHg, prescription of a statin) at 3 years among those without optimal control at baseline. Countries were stratified by gross national income (GNI)/capita, from 2017). We examined the impact of country GNI/capita with achievement of risk factor control. Findings: Our cohort included 9613 patients with T2D and without baseline cardiovascular disease (mean age 57.2 ± 8.7 years, 47.9% women). At baseline, 6354/7646 patients (83.1%) had suboptimal glucose control, 3449/9200 patients (37.5%) had suboptimal BP control, and 2800/4221 patients (66.7%) were not on an appropriate statin (sample sizes differed due to missing covariate data). Optimal control at 3 years of follow-up was achieved in 41% (glucose), 56% (blood pressure), and 29% (statins) of patients. There was significant variability in achievement of risk factor control across countries but no association between country GNI/capita with achievement of risk factor control (p > 0.08 for all). Interpretation: In a global, prospective study of patients with T2D, we found that cardiovascular risk factor control achievement was suboptimal despite 3 years of follow-up in specialized health care systems. Neither country-level nor patient-level socioeconomic factors fully explained this finding.

Efectos de la concentración de 25-hidroxi vitamina D sobre la gravedad y el control del asma en pacientes asmáticos en edad escolar / Effects of 25 hydroxy vitamin D levels on the severity and asthma control in school age asthma patients

Objetivo. Determinar la concentración de vitamina D en pacientes de entre 6 y 18 años de edad sometidos a un seguimiento por asma y la relación entre la concentración de vitamina D y el control y la gravedad del asma. Materiales y métodos. Se inscribió en el estudio a pacientes con asma y voluntarios sanos de entre 6 y 18 años de edad, asignados al grupo de pacientes y al grupo de referencia, respectivamente. Se registraron las características demográficas y los hallazgos clínicos de los pacientes, y se les realizó una prueba funcional respiratoria. Se estimaron el índice de masa corporal (IMC) y la concentración de 25-hidroxi vitamina D (25(OH)D), calcio, fósforo, fosfatasa alcalina, inmunoglobulina E total y eosinófilos de todos los pacientes. La gravedad del asma y las condiciones de control se determinaron según los criterios de la Iniciativa Global para el Asma (Global Initiative for Asthma, GINA). Resultados. Se incluyó a 72 pacientes con asma y a 66 niños sanos. En comparación con el grupo de referencia, en el grupo de pacientes se detectó una menor concentración de vitamina D. En 38 (52,8%) niños del grupo de pacientes con asma se observó deficiencia de vitamina D; en este grupo, el control del asma era deficiente y la gravedad, significativamente mayor. No se observó una correlación significativa entre la concentración de vitamina D y el sexo, la obesidad, las pruebas funcionales respiratorias, las pruebas cutáneas, la concentración sérica de eosinófilos e inmunoglobulina E (IgE) total. Conclusión. La deficiencia y la insuficiencia de vitamina D fueron más frecuentes en los niños con asma, en comparación con los niños del grupo de referencia. Una menor concentración de vitamina D se asocia con un control deficiente del asma y una mayor gravedad de esta.

Background. The objective was to determine vitamin D levels in patients between the ages 6 and 18 years, followed for asthma, and the relation between vitamin D levels and asthma control and severity. Materials and Methods. Patients with asthma and healthy volunteers between the ages 6 and 18 years were enrolled into the study as patient and control groups, respectively. Patient demographic information and clinical findings were recorded; a respiratory function test was performed. Body mass index (BMI), 25(OH) D,calcium, phosphorus, alkaline phosphatase, total IgE and eosinophil levels were determined for all patients. Asthma severity and control conditions were established based on GINA (Global Initiative for Asthma) criteria. Results. Seventy two patients with asthma and 66 healthy children were included. Compared to the control group, decreased serum vitamin D levels were detected in patient group. Thirty eight (52.8%) patients in asthma patient group had vitamin D defficiency; in this group, asthma control was poor and asthma severity was significantly higher. No significant correlation was found between vitamin D levels and gender, obesity, respiratory functions, skin test, serum eosinophil and total IgE levels. Conclusion. The frequency of vitamin D deficiency and insufficiency was higher in children with asthma, compared to the controls. Lower levels of vitamin D are associated with poor asthma control and increased asthma severity.

Blastocystis in ulcerative colitis patients: Genetic diversity and analysis of laboratory findings

OBJECTIVE@#To determine Blastocystis frequency and subtypes (ST) in ulcerative colitis (UC) patients and analyse some laboratory findings between Blastocystis positive and negative cases.@*METHODS@#Faecal samples from 150 UC patients in Adnan Menderes University, Training and Research Hospital were examined by direct microscopy and cultivated in Jones medium. Blastocystis positive cultures were subjected to DNA isolation and subtypes were identified by sequencing of barcode region. A retrospective analysis was conducted on C reactive protein (CRP), leucocyte counts (WBC), neutrophil counts, and sedimentation rates.@*RESULTS@#The overall positive rate of Blastocystis was 8% (12 patients) and the most abundant subtype was ST3 (eight isolates, 66.7%), followed by ST1, ST2 and ST7. Laboratory findings between Blastocystis infected and non-infected UC patients were not significantly different. Blastocystis frequency was 3.8% among the patients in active stage, while it was 11.8% among the patients in remission stage.@*CONCLUSIONS@#The present study confirms previous findings that have indicated the predominance of Blastocystis ST3 in humans and contributes additional evidence that suggests the low colonisation of Blastocystis infection in ulcerative colitis patients during active stage.

Blastocystis in ulcerative colitis patients: Genetic diversity and analysis of laboratory findings

Objective To determine Blastocystis frequency and subtypes (ST) in ulcerative colitis (UC) patients and analyse some laboratory findings between Blastocystis positive and negative cases. Methods Faecal samples from 150 UC patients in Adnan Menderes University, Training and Research Hospital were examined by direct microscopy and cultivated in Jones medium. Blastocystis positive cultures were subjected to DNA isolation and subtypes were identified by sequencing of barcode region. A retrospective analysis was conducted on C reactive protein (CRP), leucocyte counts (WBC), neutrophil counts, and sedimentation rates. Results The overall positive rate of Blastocystis was 8% (12 patients) and the most abundant subtype was ST3 (eight isolates, 66.7%), followed by ST1, ST2 and ST7. Laboratory findings between Blastocystis infected and non-infected UC patients were not significantly different. Blastocystis frequency was 3.8% among the patients in active stage, while it was 11.8% among the patients in remission stage. Conclusions The present study confirms previous findings that have indicated the predominance of Blastocystis ST3 in humans and contributes additional evidence that suggests the low colonisation of Blastocystis infection in ulcerative colitis patients during active stage.

Changes in hand hygiene compliance after a multimodal intervention among health-care workers from intensive care units in Southwestern Saudi Arabia

The aim of this study is to measure the degree of compliance with hand hygiene practices among health-care workers [HCWs] in intensive care facilities in Aseer Central Hospital, Abha, Saudi Arabia, before and after a multimodal intervention program based on WHO strategies. Data were collected by direct observation of HCWs while delivering routine care using standardized WHO method: "Five moments for hand hygiene approach". Observations were conducted before [February-April 2011] and after [February-April 2013] the intervention by well-trained, infection-control practitioners during their routine visits. The study included 1182 opportunities [observations] collected before and 2212 opportunities collected after the intervention. The overall, hand hygiene compliance increased significantly from 60.8% [95% CI: 57.9-63.6%] before the intervention to reach 86.4% [95% CI: 84.9-97.8%] post-intervention [P = 0.001]. The same trend was observed in different intensive care facilities. In logistic regression analyses, HCWs were significantly more compliant [aOR = 3.2, 95% CI: 2.6-3.8] after the intervention. Similarly, being a nurse and events after patient contact were significant determinants of compliance. It is important to provide sustained intensified training programs to help embed efficient and effective hand hygiene into all elements of care delivery. New approaches like accountability, motivation and sanctions are needed

Nuances in the Treatment of Malignant Tumors of the Clival and Petroclival Region

Introduction: Malignancies of the clivus and petroclival region are mainly chordomas and chondrosarcomas. Although a spectrum of malignancies may present in this area, a finite group of commonly encountered malignant pathologies will be the focus of this review, as they are recognized to be formidable pathologies due to adjacent critical neurovascular structures and challenging surgical approaches. Objectives: The objective is to review the literature regarding medical and surgical management of malignant tumors of the clival and petroclival region with a focus on clinical presentation, diagnostic identification, and associated adjuvant therapies. We will also discuss our current treatment paradigm using endoscopic, open, and combined approaches to the skull base. Data Synthesis A literature review was conducted, searching for basic science and clinical evidence from PubMed, Medline, and the Cochrane Database. The selection criteria encompassed original articles including data from both basic science and clinical literature, case series, case reports, and review articles on the etiology, diagnosis, treatment, and management of skull base malignancies in the clival and petroclival region. Conclusions: The management of petroclival malignancies requires a multidisciplinary team to deliver the most complete surgical resection, with minimal morbidity, followed by appropriate adjuvant therapy. We advocate the combination of endoscopic and open approaches (traditional or minimally invasive) as required by the particular tumor followed by radiation therapy to optimize oncologic outcomes...

Assessment of quality of life in patients with type 2 diabetes mellitus in Oman

To measure quality of life of type 2 diabetes patients in Oman, and examine which patients' socio-demographic and diabetes-related clinical characteristics are associated with better quality of life. This cross-sectional study of 200 diabetic subjects was conducted in Sultan Qaboos University Hospital, Al-Khod, Oman between April and September 2009. A short form of the diabetes quality of life questionnaire [DQoL] was used to elicit indices of quality of life on subjects [n=200] seeking consultation at the diabetic outpatient clinic. Socio-demographic variables, body mass index [kg/m] and clinical parameters relevant for the diagnosis of type 2 diabetes, including glycated hemoglobin A1c level, [HbA1c], were also sought. The results show that patients with less than 5 years of disease duration and HbA1c less than 8% reported significantly better overall DQoL. Patients with HbA1c less than 8% showed significantly higher glycemic control satisfaction score. The same trend was observed in patients with less than 5 years duration of diabetes. Patients with ages less than 40 years have significantly better self care adherence scores and total score of QoL. Patients' reported moderate DQoL, which appears to be related to demographics, medical history, and management regimens. Patients with HbA1c less than 8% showed significantly higher glycemic control satisfaction score. Furthermore, patients who are less than 40 years of age have significantly better quality of life compared to other age groups

Gemcitabine-induced acute coronary syndrome: a case report

To report a case of metastatic leiomyosarcoma, in which a patient developed chest pain accompanied by acute left bundle-branch block [LBBB] after gemcitabine infusion. Clinical Presentation and Intervention: A 59-year-old woman admitted with bilateral pulmonary nodules had classic risk factors for coronary heart disease and coronary stenosis as demonstrated by previous coronary angiography. She was treated with gemcitabine infusion, and 30 min later she experienced severe chest pain accompanied by acute LBBB confirmed by ECG. We suspected gemcitabine-induced coronary vasospasm exacerbated by the preexisting coronary artery disease as the cause of the acute coronary syndrome. The patient was subsequently treated with antianginal therapy and percutaneous coronary intervention. Her chest pain resolved and LBBB disappeared. She was discharged 2 days later without any further cardiac events. No additional cancer therapy was given and she died 5 months later, due to disease progression. This case showed that chemotherapeutic agents must be administered with intensive cardiac monitoring especially in patients with cardiac disease and well-known risk factors to prevent the development of cardiac complications, despite an agent not being known to be 'cardiotoxic'

Insertion techniques of percutaneous endoscopic gastrostomy in head and neck cancer patients

Percutaneous endoscopic gastrostomy [PEG] has become the most common method of providing enteral nutrition, PEG is usually a safe and easy procedure; however it might be difficult or impossible to introduce the flexible oesophago-gastroscope and the feeding tube in head and neck cancer cases. Authors reviewed in the literature the various insertion techniques to overcome difficulties faced during PEG procedure in head and neck cancer and presented a case of their own

Varicocele primitive et fertilite : evaluation postoperatoire des parametres du spermogramme et de la fecondite

Objectif : Il n'existe pas de consensus concernant la capacite de la varicocelectomie a ameliorer la fertilite et la fecondite. L'objectif de cette etude retrospective etait d'etudier l'evolution postoperatoire de la fertilite masculine (par les parametres du spermogramme) et celle de la fecondite du couplePatients et methodes: Il s'agit d'une etude retrospective de 50 patients porteurs de varicocele palpable operes selon la technique de Palomo au service d'Urologie de l'Hopital Grand Yoff; Dakar; Senegal. Les parametres etudies sont les parametres du spermogramme (densite; mobilite totale a la premiere heure; vitalite) et du spermocytogramme (taux de spermatozoides de morphologie normale); une fois avant l'operation et a deux reprises apres (entre le 3eme et le 8eme mois et a partir du 9eme mois) et la fecondite postoperatoire du couple chez 35 patients. Resultats : L'etude du spermogramme retrouve; pour l'ensemble des patients; une elevation de la valeur moyenne de tous les parametres; sans normalisation; exception faite de la morphologie (spermocytogramme). L'evolution postoperatoire n'etait statistiquement significative que pour la densite. La majorite des patients (76a 92) presentaient des valeurs du spermogramme preoperatoires inferieures a la normale; excepte pour la morphologie (28) (spermocytogramme). Les parametres du spermogramme se sont ameliores pour 48 a 64des patients selon le parametre etudie. L'amelioration des parametres est d'autant plus importante que leur valeur preoperatoire moyenne etait basse. Les facteurs de bon pronostic postoperatoires sont representes par les patients les plus jeunes (moins de 35 ans) et ceux qui presentaient une varicocele bilaterale; une infertilite de type secondaire et une duree d'infertilite moins longue. Nous n'avons pas etudie la correlation entre le grade de la varicocele et la fecondite. Le taux de grossesse postoperatoire etait de 31;4. Les sujets feconds etaient plus jeunes; avaient une duree moyenne de l'infertilite moins longue et des parametres constamment plus eleves par rapport aux patients infeconds. Les ameliorations postoperatoires de la fertilite et de la fecondite dans cette etude etaient relatives et limitees. Conclusion: Par la frequence de la varicocele et ses consequences sur la fertilite; il s'avere necessaire aussi de mieux et de plus informer les populations sur cette affection; ses consequences et les resultats de son traitement sur la fertilite. De plus une collaboration plus etroite entre gynecologues; biologistes de la reproduction; radiologues et urologues-andrologues permettrait une prise en charge integree de l'infertilite du couple. Il est egalement necessaire; concernant l'infertilite; d'ameliorer la prise en charge psychologique du couple; et notamment celle de la conjointe

Experimental Acute Pseudomonas aerugionosa Pneumonia in Rabbits

A rabbit model of bacterial pneumonia induced by intratracheal administration of 1 x 108 cfu P. aeruginosa was developed. Several parameters including bacterial numbers in the lungs, blood and spleen tissues, histopathology, levels of selected cytokines in bronchoalveolar lavage fluids [BALF] and arterial blood gas analyses to compare the severity of pneumonias caused by the wild type P. aeruginosa were measured over 4 h to that of its isogenic OprF mutant. The rabbits were able to clear most of the bacteria from the airways, but both strains were able to disseminate to distant organs as confirmed by the detection of bacteria in peripheral blood samples and splenic tissue. The lungs were free from alveolar edema as judged by the histologic assessment. However, arterial blood gas analyses showed a significant change in O2 saturation and gas exchange, indicating a lower level of lung injury in animals treated with the mutant strain. Likewise, BALF from animals challenged with mutant strains demonstrated lower numbers of white blood cells than the wild type group. While, the histologic appearance of pneumonia induced by the OprF-deficient and the wild type P. aeruginosa was comparable in this model, the observed differences in alveolar gas exchange and inflammatory cell traffic may derive from the presence or absence of OprF at the bacterial surface

Salmonellosis and ulcerative colitis. A causal relationship or just a coincidence

Coincidence of salmonellosis and ulcerative colitis is a rare clinical problem. Salmonella infection was reported to complicate the ulcerative colitis, as either facilitating its occurrence or activation. In this article, we present a case with salmonellosis whose clinicopathological findings also suggested ulcerative colitis. The patient improved rapidly after taking additional mesalazine to norfloxacin treatment. We conclude that salmonella infection might have either been coincidentally present or might have triggered an early ulcerative colitis in this patient who did not have history of inflammatory bowel diseases. In case of persistent severe diarrhea despite appropriate treatment, the possibility of a coincident inflammatory bowel disease such as ulcerative colitis should always be considered, especially in endemic regions for salmonellosis

Gastrointestinal lesions and helicobacter pylori in patients with myeloproliferative disorders

The aim of this study is to investigate the endoscopic lesions, and Helicobacter pylori [H. pylori] positivity in patients with myeloproliferative disorders [MPD]. Thirty patients with MPD and 93 controls with functional dyspepsia were enrolled in this study after informed consent obtained between March 2000 and July 2003. The study was held at the Departments of Hematology and Gastroenterology, Adnan Menderes University Faculty of Medicine, Adnan, Turkey. Physical examination, hemogram, peripheral blood examination, upper endoscopic examinations were performed in all patients. Helicobacter pylori positivity was evaluated by rapid urease test, and by histopathological examination of the biopsies obtained from antrum and corpus. The H. pylori positivity was 46.7% in MPD and 19.4% in control group [p<0.05]. The prevalence of gastritis was much higher in MPD patients than control group [p<0.05]. There was no gastrointestinal bleeding in control group but 8 patients in MPD group [26.7%; p<0.05]. The higher susceptibility of H. pylori infection and high frequency of gastric lesions in patients with MPD suggests a surveillance of these patients. The eradication of H. pylori to avoid probable gastrointestinal problems is advised in MPD patients

Topiramate for the treatment of intractable childood epilepsy

Topiramate [TPM] is a new antiepileptic drug, which has a wide spectrum of activities suggesting a potentially valuable therapeutic profile. Our objective is to report our experience in treating children with intractable epilepsy. Prospective, open label, add on trial of TPM in treating consecutive children with intractable epilepsy [defined as recurrent seizures after at least 3 antiepileptic medication trials] seen between May 1, 1999 and April 28, 2002 at King Faisal Specialist Hospital and Research Centre and King Abdulaziz University Hospital in Jeddah, Kingdom of Saudi Arabia. Follow up by 2 pediatric neurologists was performed. Therapeutic response was recorded as complete [no seizures], good [>50% seizure reduction], fair [<50% seizure reduction], or none. Sixty-two children [36 males and 26 females] aged between 2 months and 16 years [mean 6 years] were treated with TPM and followed for up to 3 years [mean 15 months]. Most children [55%] had daily seizures and were tried on multiple antiepileptic drugs [mean 4.6]. Nineteen [31%] children had Lennox-Gastaut syndrome. After the introduction of TPM, 21 [34%] became completely seizure free and 24 [39%] had >50% seizure reduction. Children with daily seizures were reduced from 55% before TPM to 13% on TPM [p=0.0007]. Side effects were reported in 21 [34%] children in the form of decreased appetite, weight loss, and sedation. The majority was transient; however, TPM had to be withdrawn in 7 [11%] children because of progressive weight loss or seizure worsening. Follow up renal ultrasound was performed on 34 [55%] children and was always normal. Topiramate is a very effective antiepileptic drug with a broad spectrum of antiepileptic activities. Most side effects were transient, however, careful monitoring of body weight is recommended

Clobazam for the treatment of intractable childhood epilepsy

Clobazam is a newer 1,5-benzodiazepine used for the treatment of epilepsy. It is better tolerated and less sedating than other benzodiazepines. It has yet to gain wide use for epilepsy in the Middle East. Our objective is to report our experience with clobazam for the treatment of childhood epilepsy. A cohort of children with intractable epilepsy, defined as recurrent seizures after at least 3 anti-epileptic medication trials, were included prospectively. Clobazam was added to a maximum dose of 2 mg/kg/day. Follow-up by two pediatric neurologists was performed. Therapeutic response was recorded as complete [no seizures], good [>50% seizure reduction], fair [<50% seizure reduction], or none. Thirty one children [21 males - 10 females], aged 2 months-15 years [mean 4.6 years] were followed for 3-12 months. Most children [68%] had daily seizures and were on multiple anti-epileptic drugs [mean 2.3, +/- SD 1]. Fourteen [45%] children had Lennox-Gastaut Syndrome. After the introduction of clobazam, 11 [35.5%] became completely seizure free and 14 [45%] had >50% seizure reduction. Side effects were reported in 7 [22.5%] in the form of excessive sedation, vomiting, irritability, behavioral change, and ataxia. In 4 children these side effects resolved either spontaneously or with dose reduction. Clobazam is a well tolerated, safe, and very effective antiepileptic drug. It has a broad spectrum of antiepileptic activity, minimal side effects, and is relatively inexpensive. Wider use of this drug is recommended in children with intractable epilepsy

Study of the thyroid gland involvement in laryngeal and hypopharyngeal cancers

Twenty case of laryngeal and hypopharyngeal cancers treated with radical surgery were studied. These were 16 males and four females with their ages ranging from 43 to 71 years. The cases included: four supraglattic cancers, five cordal cancers, one case of subglottic cancer, four cases of postcricoid cancer and one case of cancer of the pyriform fossa. All cases were squamous cell carcinomas. Serial sectioning of the thyroid gland showed its involvement in three instances: one case of postcricoid carcinoma that spread to the gland via lymphatic channels; and two cases of transglottic cancers. In one of these, tumor spread through the thyroid cartilage to involve the thyroid gland occured; while in the other case, involvement of the gland was by direct spread from the involved prelaryngeal lymph node. Total thyroidectomy is essential when resecting post-cricoid or subglottic cancers