Diagnostic Lacunae and Implications of an Automated Implantable Cardioverter Defibrillator Implantation in a Child with Type 3 Long QT (LQT3) Syndrome

A diagnosis of congenital long QT interval syndrome based on history and electrocardiogram was made in a child in the absence of readily available genetic testing. A genotype 3 (LQT3) was suspected after exclusion of other variants as the child was non?responsive to beta?blocker and sodium channel blocker medication. As the child continues to show episodic bradycardia, polymorphic ventricular ectopy, and T?wave alternans, a single?chamber automated implantable cardioverter?defibrillator implantation was done successfully. This report highlights how the diagnosis of LQT3 was arrived at as well as the anesthetic challenges in the management of patients with LQTS.

Preemptive pregabalin for postoperative analgesia during minimally invasive hysterectomy: a systematic review and meta-analysis of randomized controlled trials

We aimed to perform a systematic review and meta-analysis of all randomized placebo-controlled trials (RCTs) that examined the analgesic benefits of preemptive pregabalin among patients undergoing minimally invasive hysterectomy. Five major databases were systematically screened from inception until August 29, 2021 Relevant studies were evaluated for risk of bias. Endpoints were analyzed using the random-effects model and pooled as the mean difference or risk ratio with a 95% confidence interval. Four studies with seven treatment arms met the inclusion criteria. The total sample size was 304 patients: 193 and 111 patients were allocated to the pregabalin and placebo groups, respectively. Overall, the included studies revealed a low risk of bias. The summary results revealed that the mean postoperative pain scores at rest were significantly lower in the pregabalin group than in the control group at 0, 2, 4, 6, 12, and 24 hours. Moreover, the mean postoperative pain scores on movement/coughing were significantly lower in the pregabalin group than in the control group at 12 and 24 hours. The rate of patients who were opioid-free postoperatively was significantly higher in the pregabalin group than in the control group. There was no significant difference between the groups in terms of the mean postoperative time to first rescue analgesic and the rates of adverse events. Compared with placebo, preemptive pregabalin was largely safe, and was correlated with superior analgesic effects in terms of lower postoperative pain scores and higher opioid-sparing effects. Additional RCTs are needed to confirm these findings.

Bite envenomation by Latrodectus geometricus (Araneae: Theridiidae) spiders in Malaysia

@#We report two confirmed human bite cases by Lactrodectus geometricus, also known as the brown widow spider. These are the first reported bite envenomation incidents by L. geometricus in Malaysia. The incidents occurred in Tawau, Sabah and Paka, Terengganu. Both men were bitten on their ear while putting on motorcycle helmets. The spiders appeared to have nested in the helmets. The dead specimens were collected and sent to the Invertebrate and Vertebrate Neurobiology Laboratory, Department of Parasitology, Universiti Malaya for identification. The species identity was confirmed by DNA barcoding.

Zika virus modulates blood-brain barrier of brain microvascular endothelial cells

@#Zika virus (ZIKV) is a mosquito-borne Flaviviruses. ZIKV is known to cause birth defect in pregnant women, especially microcephaly in the fetus. Hence, more study is required to understand the infection of Zika virus towards human brain microvascular endothelial cells (MECs). In this study, brain MECs were infected with ZIKV at MOI of 1 and 5 in vitro. The changes in barrier function and membrane permeability of ZIKV-infected brain MECs were determined using electric cell-substrate impedance sensing (ECIS) system followed by gene expression of ZIKV-infected brain MECs at 24 hours post infection using one-color gene expression microarray. The ECIS results demonstrated that ZIKV infection enhances vascular leakage by increasing cell membrane permeability via alteration of brain MECs barrier function. This was further supported by high expression of proinflammatory cytokine genes (lnc-IL6-2, TNFAIP1 and TNFAIP6), adhesion molecules (CERCAM and ESAM) and growth factor (FIGF). Overall, findings of this study revealed that ZIKV infection could alter the barrier function of brain MECs by altering adhesion molecules and inflammatory response.

Nutrigenomics: Opportunities & challenges for public health nutrition

The hierarchical information flow through DNA-RNA-protein-metabolite collectively referred to as 'molecular fingerprint' defines both health and disease. Environment and food (quality and quantity) are the key factors known to affect the health of an individual. The fundamental concepts are that the transition from a healthy condition to a disease phenotype must occur by concurrent alterations in the genome expression or by differences in protein synthesis, function and metabolites. In other words, the dietary components directly or indirectly modulate the molecular fingerprint and understanding of which is dealt with nutrigenomics. Although the fundamental principles of nutrigenomics remain similar to that of traditional research, a collection of comprehensive targeted/untargeted data sets in the context of nutrition offers the unique advantage of understanding complex metabolic networks to provide a mechanistic understanding of data from epidemiological and intervention studies. In this review the challenges and opportunities of nutrigenomic tools in addressing the nutritional problems of public health importance are discussed. The application of nutrigenomic tools provided numerous leads on biomarkers of nutrient intake, undernutrition, metabolic syndrome and its complications. Importantly, nutrigenomic studies also led to the discovery of the association of multiple genetic polymorphisms in relation to the variability of micronutrient absorption and metabolism, providing a potential opportunity for further research toward setting personalized dietary recommendations for individuals and population subgroups.

Healing of Extracted Socket after Surgical Removal of Impacted Mandibular 3rd Molar: A Comparison of PRP VS PRP with Bone Graft

Background: Platelet-rich plasma (PRP) is an autologous concentration of human platelets in a small volume of plasma. Because it is a concentration of platelets, it is also a concentration of the 7 fundamental protein growth factors proved to be actively secreted by platelets to initiate all wound healing. PRP contributes to better healing of soft tissues and bone and is a visible means of growth factor delivery. Aims & Objectives: a) To compare osteo -inductive capacity following surgical removal of impacted mandibular 3rd molar teeth b) to compare the difference in osteoinduction between PRP vs PRP + Bone Graft, c) Establish the potential benefits of these biomaterials in the regeneration of post-extraction alveolar bone. Methods:This is a prospective, randomized clinical trial involving 15 patients (split arch – 30 impacted molar teeth) who visited KKUCOD (Alsamer campus) for surgical removal of symptomatic impactedmandibular third molars. The study was conducted following due clearance from ethical and research committee of the institution (SRC/ETH/2016-17/004). The inclusion criteria included: Female patients aged between 18 and 45, b) Impacted mandibular third molar with similar anatomical position, and similar difficulty index.c Patient informed consent to carry out the intervention and for inclusion in the study. d) No allergies to medicines, non –smokers, non-alcoholics, no drug allergy and patients not under oral contraceptives. Results: The results are compiled as tables for different groups with percentage of bone formation at the end of week 1,3, 6 and at the end of 3rd months. There is not much difference in osteoinduction with the addition of PRP alone when compared to control side. However, addition of graft with PRP definitely enhances osteoinduction and makes a significant contribution in neo bone regeneration Conclusion: 1. PRP contributes significantly to osteogenesis when mixed with bone graft. 2. Healing is better when extracted sockets are supplemented with PRP. 3. There is no incidence of allergic reaction with the use of allogeneic bone grafts.

Periodontal status of adult subjects in relation to other local factors in Jazan region, Saudi Arabia

Background: Information about the distribution patterns of periodontal disease and the possible existence ofhigh-risk groups among adult population in Jazan region is scarce. Aims: This study was designed to explorethe periodontal status and the effects of socio-demographic characteristics and habits among adult populationliving in Jazan region, Saudi Arabia (SA). Materials and methods: This work was a cross-sectional studyconducted among 204 individuals. This population was composed of 172 males and 32 females with a mean ageof 43.9 years. Structured questionnaire, which included general health status and possible risk factors forperiodontal disease, was used for sampling. Clinical periodontal examination was carried out using the schemeused by the National Institute of Dental and Craniofacial Research. Data was analyzed using Statistical Packagefor Social Sciences software version 20. Results: Approximately 46.1% of population presented moderatepocket depths. The clinical attachment loss of ≤4 mm was 57.8%, and the fair oral hygiene was 40.2%. Theeffects of khat chewing, shammah dipping, and smoking on moderate pocketing were 50%, 47.7%, and 41.9%,respectively. The attachment losses of ≤4 mm were high in khat chewers, shammah dippers, and smokers at63.1%, 68.8%, and 50.1%, respectively. The average poor oral hygiene among groups was high at 53.3%.Severe pocket depth and poor oral hygiene were significantly high among old age groups at 22.2% and 66.7%,respectively. Females showed significantly (p=0.05) higher mild gingivitis and better oral hygiene of 65.7% and68.8%, respectively, compared with those of males. Conclusion: The prevalence of periodontal disease is highdue to associated risk factors, including khat chewing, smoking, and poor oral hygiene. The elderly age groupshowed high levels of periodontal pocketing, attachment loss, and poor oral hygiene. Females also presentedbetter oral hygiene and periodontal health than those of males.

Measuring Pressure Interface Of Local Car Seats Under Static And Dynamic Circumstances: A Comparative Study

@# Measuring discomfort towardthe car seat is important as the act of driving requires a driver to remain at the car seat while controlling the car. The seat condition, including sitting position as well as the driver’s posture can lead to discomfort and fatigue. The objective of this study is to investigate a driver’s pressure distribution in static and dynamic circumstances for two types of cars; the sedan and compact car. This study involved both subjective and objective evaluations of 12 respondents. For the subjective evaluation, the Visual Analog Scales (VAS) were used to obtain respondents' perception of discomfort. For the objective evaluation, pressure distribution readings of the seat interface were obtained using piezo capacitive sensors. The findings showed that the highest pressure was recorded for the compact car. Furthermore, the static circumstance showed greater pressure compared to the dynamic state. Subjective evaluation indicated that the right buttocks and the lower back (lumbar)experience the highest discomfort for both types of seats.The type of seat found to contribute to the value of different pressure. Thus, it can be concluded that appropriate seat selection can reduce pressure as well as discomfort.

The Effect Of Grasping The Steering Wheel While Positioning The Shoulder Closer To The Body

@#Discomfort and pain issue at the body part are common complaints reported by car drivers. It is due to driving task require physical demands and need to maintain and adapt several postures in a constrained space while controlling the car. Hence, this study aims to determine the pattern of shoulder activation muscle consisting of the Trapezius muscle in two different driving posture. Respondents were required to grasp the steering wheel at 8 and 4 hand position. The Surface Electromyography was used to get the reading for left muscle’s Trapezius Descendent (TD) at two different positions; i) closest distant from steering wheel and ii) far distant from the steering wheel. Then, Temporal Analysis was used to evaluate the pattern of the driving action. From the experiment, it shows the different value of muscle activation occurred while driving according to turning action. The far seated position depicted greater activation on driving action compared to the closer seated to the steering wheel. In conclusion, the driving posture effects the activation of shoulder and arm’s muscles as early as after 20 seconds of driving activity. Hence, choosing the correct driving posture allowed a comfortable driving environment for the driver.

Educational intervention on knowledge of cervical cancer and uptake of pap smear test among market women in Niger State, Nigeria

Cervical cancer is the most common female genital tract carcinoma worldwide. It is increasingly becoming the leading carcinoma seen among women in the developing world. The aim of our study was to showcase the effect of educational intervention on the knowledge of cervical cancer and subsequently the uptake of Pap smear test amongst market women in Niger state, Nigeria. The state has a rich network of markets in all the local government areas because of the fishing activities, bountiful agricultural produce yearly and its situation to the North of the national capital, Abuja. This was a quasi-experimental study conducted in two groups with pre and post intervention data collection. Sample size was determined based on a previous similar study done in Nigeria. Multi stage sampling technique was used for recruiting the study participants. SPSS statistical software was used for data entry, editing and analysis. Respondents' knowledge of cervical cancer were comparable at pre-intervention but were statistically significantly better (P<0.0001) at post-intervention in the intervention group compared to the control group for every variable measured. However, there was only a (Fisher's exact, P=0.621) compared to the control group. This study showed an increase in knowledge about cervical cancer and Pap smear test however the uptake of Pap smear test remained low even after intervention. This underscores the need for sustained intervention programs to eventually translate knowledge acquired to habitual practice

Mother to child transmission of hepatitis B virus: A cause for concern.

Mother to child transmission of hepatitis B virus (HBV) is an important public health issue. India introduced HBV vaccine in 10 states as part of its Universal Immunization Program (UIP). Here we show evidence of mother-to-child transmission of HBV in three families from Jharkhand and Bihar states where HBV vaccination is not yet included in the UIP. This report illustrates the need for active screening of HBV in pregnant women and implementation of HBV vaccine across all states in India to reduce the burden of disease.

Vulvar extrauterine endometrial stromal sarcoma: a case report and literature review

Endometrial stromal sarcoma [ESS] is an extremely rare neoplasm accounting for only 0.2% of all uterine malignancies and for 15-26% of primary uterine sarcomas. The annual incidence of ESS is 1-2 per million women. Herein, to the best of our knowledge, we present the first reported case of ESS of the vulva in a 50-year-old female presenting with per vaginal spotting over a period of three months. Her past surgical history included a subtotal hysterectomy and left salpingo-oophorectomy for uterine fibroids ten years previously. On examination, a 3.5 x 3 x 2 cm cystic mass was found in the right labia majora. The mass was excised and the diagnosis of endometrial stromal sarcoma was made. Subsequent metastatic workup was negative and the patient was started on megestrol acetate. She has remained disease free with no signs or symptoms of recurrent or advanced disease for 28 months

Multidisciplinary approach for evaluation of neurocutaneous disorders in children in Sohag University Hospital, Upper Egypt

Neurocutaneous syndromes [NCS] are a broad term for a group of neurologic disorders that involve the nervous system and the skin. The most common examples are neu-rofibromatosis type 1 [NF-1] and type 2 [NF-2], tuberous sclerosis [TS], Sturge-Weber syndrome [SWS], ataxia telangiectasia [AT], and Von Hippel Lindau disease [VHL]. These disorders are characterized clinically by neurological manifestations such as convulsions, mental retardation and learning disabilities in addition to cutaneous manifestations, and lastly tubers [benign growths found in different organs of the body]. This study aimed to identify clinical, imaging, and neurophysiological profiles of neurocutaneous disorders. Children presented to the Pediatric neurology and Dermatology clinics, Sohag University Hospital who fulfilled the criteria for diagnosis of specific neurocutaneous syndromes were eligible for this study. All studied patients were subjected to thorough clinical history, full clinical examination, developmental assessment, and dermatological examination. Computed tomography of the brain [CT] and electroencephalography [EEG], ophthalmic, and phoniatric evaluation were also done for all children. Echocardiography was done for only twenty children. During the period of the study we diagnosed 27 cases with neurocutaneous disorders, tuberous sclerosis represented the majority of cases as it was detected in 12 cases [44.45%]. The main complaint was convulsions in 19 cases [70.37%], whereas skin pigmentation was detected in 18 cases [66.66%]. Developmental assessment showed that global developmental delay was found in 20 cases [74%]. CT of the brain showed that 15 cases [55.55%] had intracranial calcifications and abnormal EEG findings were detected in 23 cases [85.2%]. 85% of the studied children had various degrees of mental retardation. Echocardiography showed that three cases [15%] had ventricular wall tumor mostly rhabdomyoma Neurocutaneous disorders had multiple clinical presentations and required a team work approach including various specialties in their evaluation and management

Rapid detection of Salmonella Typhi by loop-mediated isothermal amplification (LAMP) method

An in-house loop-mediated isothermal amplification (LAMP) reaction was established and evaluated for sensitivity and specificity in detecting the presence of Salmonella Typhi (S. Typhi) isolates from Kelantan, Malaysia. Three sets of primers consisting of two outer and 4 inner were designed based on locus STBHUCCB_38510 of chaperone PapD of S. Typhi genes. The reaction was optimised using genomic DNA of S. Typhi ATCC7251 as the template. The products were visualised directly by colour changes of the reaction. Positive results were indicated by green fluorescence and negative by orange colour. The test was further evaluated for specificity, sensitivity and application on field samples. The results were compared with those obtained by gold standard culture method and Polymerase Chain Reaction (PCR). This method was highly specific and -10 times more sensitive in detecting S. Typhi compared to the optimised conventional polymerase chain reaction (PCR) method.

Antiviral efficacy of adefovir dipivoxil in the treatment of chronic hepatitis B subjects from Indian subcontinent.

Adefovir is one of the therapeutic options for the treatment of chronic hepatitis B. A total of 30 adefovir-experienced subjects with the median treatment duration of 12 (interquartile range (IQR) 6-18) months were studied. Virological response was measured by hepatitis B virus deoxyribonucleic acid (HBV DNA) levels. HBV reverse transcriptase (rt) domains were sequenced for the identifi cation of resistance mutations. Among the 30 subjects, two (7%) showed virological response and 19 (63%) were non-responders. The virological response for the remaining nine (30%) subjects was not determined. On sequence analysis, two subjects were identifi ed with rtI169L and rtA181V mutation after 9 months and 18 months of adefovir treatment, respectively. Though the frequencies of adefovir resistance mutations are low, a large majority of subjects showed non-response. Therefore, adefovir in the management of HBV should be used judiciously.

Economic Burden of Drug Therapy in Hypertension Management in a Private Teaching Hospital in Nigeria.

Background: Information on economic burden of hypertension is needed for relevant decisions and policies due to escalating cost of disease management. Aims: The study assessed economic burden of pharmacotherapy in hypertension management on the National Health Insurance Scheme (NHIS) of Nigeria and the economies of antihypertensives selection. Study Design: Cross-sectional study. Place and Duration of Study: Out-patient-department of a private teaching hospital located in Lagos, Nigeria over four-month duration in 2011. Methodology: Two hundred and fifty case notes of hypertensive patients were randomly selected. These were assessed for costs of pharmacotherapeutic management of hypertension. Patients’ details such as demographic data, drug regimens and funding status were extracted from the case notes. Drugs’ prices were obtained from the hospital billing guide. Data presentation was by using descriptive statistics. Results: Two hundred and eight (83.2%) of the selected case notes met the study criteria. Diuretics were the most economical at an average monthly cost per prescription of NGN858.6 ($5.51) followed by the beta-blockers at NGN1,101.1 ($7.07) while fixed dose combinations were the costliest at NGN10,425.0 ($66.93). Health Maintenance Organizations (HMOs) having 104 (50.0%) of the cohort as enrollees incurred most of the cost at NGN446, 325.0 ($2,865.47) followed by NHIS 75 (36.0%) at NGN321, 354.0 ($2,063.14). An average monthly cost of antihypertensives per patient was highest for private patients NGN4, 314.47 ($27.69) and least for NHIS NGN4, 284.72 ($27.50). The national cost implication using the least average monthly antihypertensive cost per patient of NGN4,284 .72 ($27.50) for NHIS implies an average of NGN51,416.64 ($330.10) per annum for each patient and a whooping sum in excess of NGN1.054 trillion (over $6.76billion) for over 20 million affected hypertensive patients in Nigeria. Conclusion: Cost burden of hypertension management is high, incurred mostly by HMOs and NHIS. Diuretics were the most economical of all prescribed regimens.

Incidence of malignant ovarian germ cell tumors [MOGCTs] in Saudi Arabia

Incidence of malignant ovarian germ cell tumors [MOGCTs] in the Saudi Arabian population has not been studied before. Therefore, the primary objective of this study was to define the population-based incidence rates and histopathological types of MOGCTs in the Saudi Arabian population from 1999 to 2008. Our study showed that MOGCTs are a common type of ovarian tumors in the Saudi Arabian population, and the incidence rates and histopathological types are relatively comparable to the international populations with few differences.

The Prevalence and Risk Factors of Sexual Dysfunction in Gynaecological Cancer Patients

Sexual dysfunction is highly prevalent in gynaecological cancer patients. Most of the time, sexual dysfunction in gynaecological cancer is underdiagnosed as there is overlapping of symptoms with other psychological morbidities, interplaying of multiple risks, patients’ reluctance to complain or incompetence of health care provider to assess. Determining the risk factors of sexual dysfunction in cancer patients enables us to pay more attention to those who are vulnerable and to device strategies for early detection, prevention and treatment of sexual dysfunction in them. The main aim of the study was to determine the prevalence of sexual dysfunction and its risk factors in gynaecological cancer patients in Hospital Sultanah Bahiyah, Alor Star, Malaysia. Sexual function of eighty-three gynaecological cancer patients who were married were assessed with self-rated MVFSFI (Malay version Female Sexual Function Index). Self-rated WHOQOL-BREF (World Health Organization- Quality of Life- 26) which assessed the domains of quality of life was used while MINI (Mini International Neuropsychiatry Interview) was used for diagnosis of major depressive disorder. The prevalence of sexual dysfunction among the married gynaecological cancer patients was 65% (54/83). Sexual dysfunction was significantly associated with low education level (OR 3.055, CI 1.009-9.250), shorter duration of cancer(OR 0.966, CI 0.966- 0.998), ongoing chemotherapy (OR 3.045, CI 1.149-8.067),pain perception (OR 3.230, CI 1.257-8.303), absence of sexual intercourse for more than one month (OR 1.862) and three domains of quality of life such as physical health, psychological health and social relationship (OR 0.942, CI 0.908-0.978; OR 0.955, CI 0.916-0.995; OR 0.933, CI 0.894-0.973, respectively). However, sexual dysfunction was not associated with major depressive disorder (χ2 ² = 1.224, p = 0.268). The prevalence of sexual dysfunction in gynaecological cancer patients was comparable to other studies of similar population. Since, the risk factors of sexual dysfunction in gynaecological cancer patients are multidimensional, the process of assessment and management need to be holistic and patient-oriented.

Ameliorative Effects of Magnesium and Copper Sulphates on Blood glucose and Serum Electrolytes Levels in Fructose-induced Diabetic Wistar Rats.

The aim of this study is to evaluate the effects of magnesium and copper sulphates on blood glucose and serum electrolytes levels in fructose-induced diabetic Wistar rats. Diabetes was induced by administration of 20% (20g/100ml) of fructose dissolved in distilled water and administered to the animals for a period of six (6). After which the animals were randomly assigned into 4 groups of 6 rats each. Group I served as diabetic control and were administered distilled water, Group II were administered Magnesium sulphate (250 mg/kg b w), Group III were administered Copper sulphate (250 mg/kg b w) and Group IV administered Metformin (250 mg/kg b w). All treatments were given orally for a period of seven days. The results obtained showed a statistically significant decrease (p<0.05) in the blood glucose levels in groups administered with 250 mg/kg b w of magnesium and copper sulphate after day 3 and 7 when compared to diabetic control group. The results also showed that magnesium and copper sulphates at doses tested i.e 250 mg/kg b w, produced a significantly decreased (p<0.05). With regard to serum levels of sodium, potassium and bicarbonate ions when compared to diabetic untreated control group. However, there was no significant difference in the levels of serum chloride in the groups treated with 250mg/kg b w of magnesium and copper sulphate when compared to diabetic control group.