Predetermined Anti-Diabetic Drug Regimen Adjustments during Ramadan Fasting: An Observational Study of Safety

BACKGROUND: Many Muslim type 2 diabetes mellitus (T2DM) patients choose to fast the month of Ramadan despite the possible adverse health effects brought about by the change in dietary habits, among other things. Clinical data regarding the safety of multi-drug regimens during fasting are particularly scarce. The aim of the study was to evaluate the safety of a drug protocol devised by the authors to accommodate Ramadan's dietary changes, involving dose adjustments of four anti-diabetic drug regimens in T2DM patients fasting Ramadan. METHODS: In this prospective, observational, open-label study, 301 T2DM patients who wished to fast Ramadan were followed during Ramadan and the preceding month. The incidence of hypoglycemia, diabetic ketoacidosis (DKA) and non-ketotic hyperosmolar state (NKHS) was monitored. Patients were classified into four groups: A group (those taking metformin, sulfonylurea and insulin [n=33]); B group (metformin and sulfonylurea [n=89]); C group (metformin and insulin [n=96]); and D group (premixed 70/30, glargine or regular insulin [n=82]). During Ramadan, drug doses were adjusted as percentages of their pre-Ramadan values: 75% for sulfonylureas, 75% for glargine, 75% for premixed insulin 70/30 in two doses, and 75% for regular insulin. Metformin was adjusted to a twice-daily regimen. RESULTS: No cases of DKA or NKHS were reported. Hypoglycemia occurred at a lower rate than pre-Ramadan values in groups C, and D; and a similar rate in groups A, and B. CONCLUSION: The data suggested that using the above protocol to adjust the doses of anti-diabetic drugs is safe in T2DM patients in regards to hypoglycemia, DKA, and NKHS.

Limb-salvage angioplasty in poor surgical chronic liver disease and diabetic patients

Critical limb ischemia [CLI] in high surgical risk patients with chronic liver diseases has a grave prognosis with a one-year mortality rate of 20% and a one- year amputation rate of 25% after the initial diagnosis. According to Trans-Atlantic Inter-Society Consensus [TASC]-II Guidelines, revascularization [surgical and endovascular] is the treatment of choice for patients with critical limb ischemia [CLI]. The primary goal of revascularization is to relieve ischemic rest pain, heal ulcers, prevent amputation, improve patient's quality of life [limb salvage] and secondary goal was the periprocedural complications. Endovascular techniques include balloon angioplasty, stents, stent-grafts, and plaque debulking procedures. Surgical options, identification of patients at risk of postoperative complications could have an impact on the indications for a procedure as well as permitting modifications of treatment to reduce the surgical risk. This study evaluated the treatment out comes after limb salvage angioplasty for patients who otherwise would be candidates for primary amputation due to poor co-morbid conditions as chronic liver disease and diabetes. The clinical evaluation, laboratory investigations and abdominal ultrasonography were performed to all patients to evaluate their liver status. Patients were classified according to Child-pugh classification into child A, B and C. All patients were subjected to either detailed arterial duplex or C.T. angiography to assess their arterial lesions from January 2008- January 2010. 95 patients with critical limb ischemia [Rutherford categories 4, 5, 6] were treated by primary percutaneous transluminal angioplasty [PTA]. No patient was excluded on the basis of the extent of arterial occlusive disease. The primary end points were immediate technical success, clinical improvement and limb salvages rates. Secondary end points were periprocedural complications and mortality. Most of the patients were male [54.7%] with mean age 62 [48-70 years]. Underlying cirrhosis due to HCV was [82.2%], HBV [5.4%], while mixed viral infections was [12.4%]. 54% were categorized as Child B, 32% as child A and 14% as child C. Associated diabetes mellitus was present in 96% of the cases, hypertension in 64.2%, ischemic heart disease in 74% and hyperlipedemia in 32%. Rest pain, tissue loss, or both, were the presenting symptoms in 83% while infection and ulcer were present in the other 17% of patients. The total numbers of interventions were 154; the treated lesions were 89 in the tibial arteries, 12 in the popliteal artery, 44 in the superficial femoral artery, 3 in the common femoral artery and 6 in the iliac arteries with initial technical success rate of 93.6% and periprocedural complications of 12.6%. All patients were in Rutherford clinical category 4, 5, 6 none of these patients had a previous bypass operation. Mean follow-up was 15 months. The limb-salvage rate was 87.4%. Eighty patients [84.2%] of toe amputation sites healed primarily, three patients with rest pain had resolution of their symptoms after angioplasty. All technical failures were due to inability to cross the lesions. Of the 6 technical failures, 4 required amputation, and 2 refused any further therapy

[ study of nasal cavity width change after maxillary expansion using two different techniques]

The constriction of Maxilla is considered a common disorder in daily clinical practice; which is usually accompanied with narrow nasal cavity. Many techniques are used to expand constricted maxilla; such as slow maxillary expansion and rapid maxillary expansion. The aim of this study is to evaluate changes in nasal cavity width after slow maxillary expansion by using Spring Jet II expander in late mixed dentition; and to compare them with changes caused by rapid maxillary expansion using Hyrax expander. The sample of this study consists of 40 patients with narrow Maxilla [age: 9 - 12.2 y]. The sample is divided in two groups: First group consists of 20 patients treated with Nickel Titanium coil springs [Spring Jet II appliance]. Second group consists of 20 patients treated with rapid maxillary expansion [Hyrax appliance]. Frontal cephalometric X-ray is taken before treatment -T1- and after expansion and retention for three months -T2-. The width of nasal cavity increased in both groups. No significant differences were found between them. It is recommended to use maxillary expansion to relief nasal obstruction and improve nasal respiration in patients who are complaining of maxillary constriction

Types of bacteria associated with neonatal sepsis in Al-Thawra University Hospital, Sana'a, Yemen, and their antimicrobial profile

This study was undertaken to investigate the organisms causing sepsis in the Neonatal Unit at Al-Thawra Hospital, Sana'a, Yemen, determine their resistance to antibiotics, and recommend policy for empirical treatment. A total of 158 neonates having one or more signs of sepsis, and aged from 0 to 28 days, were enrolled in this study. A blood sample was taken from each subject, cultured, and then antibacterial susceptibility tests were performed for isolates. 90 [57%] cases yielded positive cultures. Early-onset sepsis showed higher positive culture results [61.7%] than late-onset sepsis [32%]. Significant positive culture results were found among the group with birth weight 0.9-2 Kg [78.6%]. Gram negative bacteria constituted 97.8% of the total isolates, of which Klebsiella pneumoniae was the predominant pathogen [36.7%], followed by Pseudomonas species [30.0%]. The commonest symptoms among the cases were respiratory distress [72.2%], jaundice [62.2%], cyanosis [51.1%], and lethargy [47.8%]; the mortality rate was 27.8%. All Gram negative bacterial isolates were sensitive to imipenem and some isolates were sensitive to fourth-generation cephalosporins, but most isolates were highly resistant to the majority of other antibiotics tested. Gram negative organisms were the most frequent causative agents of bacterial sepsis, which is a significant cause of mortality and morbidity in the newborn, and particularly in those of very low birth weight. It can also be concluded that imipenem and fourth-generation cephalosporins can be used for empirical treatment of bacterial sepsis

Hepatitis B vaccine coverage and the immune response in children under ten years old in Sana'a, Yemen

The study was undertaken, first, to determine the coverage rate of hepatitis B [HB] vaccine and second to evaluate the immune response to HB vaccine among children under 10 years old by measuring the level of circulating anti-HB surface antigen [anti-HBs] antibodies after immunization with three doses. First, 840 children were randomly selected from 4 randomly selected sites in Sana'a city to study the coverage rate of the vaccine; of these, 504 children vaccinated against HBV prior to the study, were tested [56% males and 44% females]. Sera were tested for anti-HBs antibodies by ELISA quantitative technique. Each individual's data was collected in a pre-designed questionnaire including: vaccination date, sex, and age at the time of the study. The coverage rate of HBV vaccine was only 69.9%, being slightly higher among male children [72.1%] than female children [66.8%]. A total of 276 [54.8%] of the 504 children responded to the vaccine with anti-HBs antibody level >/- 10 mIU/ml, while 228 [45.2%] of the 504 children had non-protective anti-HBs antibodies levels [<10IU/ml]. Children of ages 3-5 years had the highest protective rate [63.6%], and the lowest protective rate was in the 9-10 years age group. This study revealed a low coverage rate of HBV vaccine and a low protective rate against HBV infection. A considerable proportion of vaccinated children should be considered for either revaccination or booster doses. There is also the need to complete HBV vaccine coverage among the child population in San'a, Yemen

Asthma knowledge and behaviours among mothers of asthmatic children in Aseer, south-west Saudi Arabia

Mothers of children with bronchial asthma consecutively admitted to Aseer central hospital, Saudi Arabia [n = 171], were interviewed using a questionnaire based on the Chicago Community Asthma Survey to study their knowledge and behaviours concerning bronchial asthma. The least known information among mothers was the complications of bronchial asthma. Breathing exercises during asthma attacks were the least practised behaviour. In a multivariate analysis, significant risk factors for poor knowledge and behaviours among mothers were female sex of the child, illiterate mother and young age of mother [< 30 years]. More education is needed to help the mothers of asthmatic children to acquire the necessary knowledge and practices to care for their chiIdren

Frictional forces of self - legating brakets versus conventional brackets during sliding techniques [a laboratory study]

Ligating between brackets and orthodontic wire is considered one of the important factor affecting the frictional resistance during sliding movements. For these reasons this investigation aimed to compare the friction associating with sliding movement for two types of brackets: self-ligating brackets and conventional brackets ; along stainless steel arch wires. 40 first upper premolar brackets made from stainless steel were tested, 20 of them were self-ligating brackets [Quick brackets] and the rest were conventional [Sprint brackets] with elasting ligature; all of the 40 brackets were tested with two different sizes of stainless steel wires. The frictional resistance was recorded during the tests by instron machine designed specially for this reason. The results showed significant decrease in the magnitude of friction with the self-ligating brackets compared with the conventional one; whatever the orthodontic wire using in the test. This study recommend the importantance of choose the proper type of brackets and the used technique for each orthodontic treatment; and suggest the need of more scientific investigations aiming to know the frictional property of modern types of brackets in the markets

effectiveness of laceback ligatures on upper incisor and anchorage

The purpose of this study is to evaluate the effects of laceback ligatures on the anteroposterior and vertical position of the upper incisors and the mesial position of the upper first molars during the alignment and leveling stage of orthodontic treatment of Class II Division 1 cases which require extraction of upper first premolars. This study was Randomized controlled trial [RCT]. The sample of this study comprised 44 subjects who showed Class II Division 1 malocclusion, and needed extraction of upper first premolars. Subjects were randomly allocated to two study groups. Patients in the first group received Laceback ligature treatment. In the control group, subjects were treated without the application of Laceback ligature. The insertion of rectangular steel arch wires [0.16x0.16] without an exaggerated curve and without generating excessive forces was considered the end of the alignment and leveling stage. All subjects were followed-up and lateral, anterioposterior cephalometeric x-rays were taken before the treatment and by the end of the alignment and leveling stage to detect any changes in the craniofacial complex. The statistical comparison between the laceback group and the control group revealed the following The angle I

N decreased by [4.66°, 2.66°] in the Laceback and control groups, respectively. The distance from I to A-Pog decreased by [1.39 mm, 1.02mm] respectively. The distance distal 16 to line from distal PTM perpendicular to SN plane increased by [0.27mm, 0.60mm] respectively. The distance of distal 26 to line from distal PTM perpendicular to SN plane increased by [0.17mm, 0.66mm] respectively. As well as the distance from I to SN increased by [0.57mm, 0.57mm] respectively. The outcome of this study could lead to the conclusion that Lacebak ligature causes a slight canine retraction followed by incisors retraction. The use of laceback ligatures conveys no statistical or clinical difference in the loss of posterior anchorage, or vertical position of the upper incisors. The use of laceback ligatures decreases the amount of canine retraction and anchorage at next stages

[Local anesthetic effect of bupivacaine in pain relieving after cesarean section]

One of the most common causes of fear from the surgery in patients is post operative pain. Opioid analgesic and NSAIDs are commonly used to relieve pain in patients. Both groups have some side effects. In this study we evaluated the local anesthetic effect of bupivacain in pain relieving after cesarean section. This clinical-trial study was performed on 100 pregnant women who were referred to the Najmiyeh hospital in Tehran, Iran, for cesarean delivery. Pregnant women were randomly divided into two equal groups. Case group was injected bupivacaine 0.5% [10 ml subcutaneously] after the cesarean delivery. Pain Intensity was evaluated in 1st, 2nd, 4th, 6th, 9th and 12th hours after caesarean operation using Visual Analogue Scaling [VAS]. Sedative [Petedin] consumption was measured and was compared in both groups. Results were analyzed using student t-test and Mann- whiney test. The results of this study demonstrated that mean analgesic consumption in case group was 25.63 +/- 16 [mg] and it was 35.05 +/- 13.6 [mg] in control group [P<0.05]. Mann- Whitney test demonstrated that pain intensity is significantly lower in case group in 4th, 6th and 9th hours after cesarean operation compared to the control group. The data of this study shows that bupivacaine 0.5% can have a good sedative effect after cesarean operation

[Comparing the bond strength of four kinds of Ideal-Makoo artificial teeth [Iran] and two Leichtenstein and Italy Ivoclar teeth with prosthetic acrylic base]

This study has been established in order to compare the bond strength of four Iranian artificial teeth which are produced by Ideal Makoo - and two foreign types of Ivoclar [Liechtenstein and Italy] with denture base resins. In this experimental and cross sectional study, 6 teeth from each type of the artificial teeth were selected and on the whole, 36 teeth from each type of the artificial teeth were studied. This study was established according to standard ISO 3336, in which 6 stone molds were prepared using a standard brass block and the molds were used to produce 6 acrylic blocks which were each attached to 6 artificial teeth. Each acrylic block was sectioned in to 6 separate samples, so that each sample consisted of an artificial tooth attached to an acrylic part. The samples were tested by Instron 1195- a tension testing machine with the speed of 5 mm/min until fractured. The results were reported in kilogram and were analyzed using the ANOVA statistical test. The results revealed that Liechtenstein Ivoclar had the highest mean bonding force [67.5 11.7 kg] with and Marjan artificial tooth proved to have the lowest mean bonding force [50.3 9.3 kg]. It should be noted that the difference of mean strength of Super Brelian and Liechtenstein Ivoclar was only 1 kilogram. Regarding the bond strength, Liechtenstein's Ivoclar would be introduced as the most superior specimen. However, Super Brelian had a very slight difference with Liechtensteins' Ivoclar

Groundwater pollutionana its health impact on kafr Hakim village, Giza governorate, West of Nile valley, Egypt

The present work deals with the impact of groundwater quality on human health. The study area was located at one of the highly populated villages, colse to the Egyptian Pyramids. Water demands of 23 thousands population of this village depend on the available groundwater of shallow aquifer [20-60m.depth]. Surface and groundwater samples had been collected, and chemically analyzed for major and trace elements. Evaluation of water quality of drinking water and its health impact are the main objective of the present work. To achieve such goal, GIS technique was used, from GIS maps, it is concluded that Cadmium, Benzene, and Selenium concentrations are over the recommended limits. Fuel station, industrial activities, waste water drainage [house drain] and fertilizers are the main sources of surface and groundwater pollution. Hand pump and governmental drilled wells are situated within almost porous and permeable water bearing formations of Quaternary aquifer. Due to these circumstances, the polluted surface water, canals and drains are directly affecting the shallow groundwater aquifer. Preliminary medical survey indicates that significant population were affected by many diseases, which might be caused by polluted groundwater [particularly Cadmium]. Osteoporosis, renal failure, hepatotoxicity, cancer and diabetes were likely supposed to be due to chronic cadmium toxicity