Factors associated with unrecognized cirrhosis in patients with hepatocellular carcinoma

Background/Aims@#Cirrhosis is the most important risk factor of hepatocellular carcinoma (HCC), and patients with cirrhosis are recommended to receive semiannual surveillance for early HCC detection. However, early cirrhosis is often asymptomatic and can go undiagnosed for years, leading to underuse of HCC surveillance in clinical practice. We characterized the frequency and associated factors of unrecognized cirrhosis in a national sample of patients with HCC from the United States. @*Methods@#HCC patients aged 68 years and older, diagnosed during 2011 to 2015 were included from the SEERMedicare Linked Database. If cirrhosis was diagnosed within 6 months immediately preceding HCC diagnosis or after HCC diagnosis, cases were categorized as unrecognized cirrhosis. Factors associated with unrecognized cirrhosis were identified using logistic regression analyses. Factors associated with overall survival were evaluated using Cox regression analyses. @*Results@#Among 5,098 HCC patients, 74.8% patients had cirrhosis. Among those with cirrhosis, 57.4% had unrecognized cirrhosis, with the highest proportion (76.3%) among those with NAFLD-related HCC. Male sex (aOR: 2.12, 95% CI: 1.83–2.46), non-Hispanic Black race (aOR: 1.93, 95% CI: 1.45–2.57), and NAFLD etiology (aOR: 4.46, 95% CI: 3.68–5.41) were associated with having unrecognized cirrhosis. Among NAFLD-related HCC patients, male sex (aOR: 2.32, 95% CI: 1.71–3.14) was associated with unrecognized cirrhosis. Unrecognized cirrhosis was independently associated with worse overall survival (aHR: 1.17, 95% CI: 1.08–1.27) compared to recognized cirrhosis. @*Conclusions@#Unrecognized cirrhosis is common in NAFLD-related HCC, particularly among male and Black patients, highlighting these groups as important intervention targets to improve HCC surveillance uptake and outcomes.

Effect of Prunetin on Streptozotocin-Induced Diabetic Nephropathy in Rats - a Biochemical and Molecular Approach

In the modern era, chronic kidney failure due to diabetes has spread across the globe. Prunetin (PRU), a component of herbal medicines, has a broad variety of pharmacological activities; these may help to slow the onset of diabetic kidney disease. The anti-nephropathic effects of PRU have not yet been reported. The present study explored the potential nephroprotective actions of PRU in diabetic rats. For 28 days, nephropathic rats were given oral doses of PRU (20, 40, and 80 mg/kg). Body weight, blood urea, creatinine, total protein, lipid profile, liver marker enzymes, carbohydrate metabolic enzymes, C-reactive protein, antioxidants, lipid peroxidative indicators, and the expression of insulin receptor substrate 1 (IRS-1) and glucose transporter 2 (GLUT-2) mRNA genes were all examined. Histological examinations of the kidneys, liver, and pancreas were also performed.The oral treatment of PRU drastically lowered the blood glucose, HbA1c, blood urea, creatinine, serum glutamic-oxaloacetic transaminase, serum glutamic pyruvic transaminase, alkaline phosphatase, lipid profile, and hexokinase. Meanwhile, the levels of fructose 1,6-bisphosphatase, glucose-6-phosphatase, and phosphoenol pyruvate carboxykinase were all elevated, but glucose-6-phosphate dehydrogenase dropped significantly. Inflammatory marker antioxidants and lipid peroxidative markers were also less persistent due to this administration. PRU upregulated the IRS-1 and GLUT-2 gene expression in the nephropathic group.The possible renoprotective properties of PRU were validated by histopathology of the liver, kidney, and pancreatic tissues. It is therefore proposed that PRU (80 mg/kg) has considerable renoprotective benefits in diabetic nephropathy in rats.

The effect of adding nanoparticles to dental porcelain on the fracture resistance and bond strength to zirconia core

Background: Porcelain combined with zirconia core substructure has low fracture toughness. Nanoparticles are incorporated into the porcelain to boost its mechanical properties. Aims: To evaluate the effect of the incorporation of silver oxide and titanium oxide nanoparticles into porcelain powder on the bond strength of porcelain veneer to zirconia core. The flexural strength of nanoparticles?modified porcelain was also evaluated. Materials and Methods: The flexural strength of feldspathic porcelain was measured (according to ISO specifications number 6872) after the incorporation of silver and titanium oxide nanoparticles. For measuring the bond strength at the porcelain?zirconia interface, 70 bars (4 × 4 × 12 mm) of zirconia were cut and fired in a furnace. The control and nanoparticles?modified porcelain powders were built up on the zirconia bars and fired to create veneers of 3 mm height, 4 mm width and 4 mm thickness. The porcelain veneers were de?attached from the zirconia core by the universal testing machine. The failure load was recorded to calculate the bond strength. Statistical Analysis: The data were analysed with one?way analysis of variance followed by Tukey’s test. Results: The addition of 0.5–1.5% silver oxide nanoparticles to feldspathic porcelain increased the flexural strength. The addition of 1.0–4.0% titanium oxide nanoparticles to feldspathic porcelain increased the flexural strength. Either 0.5–1.0% silver oxide or 3.0–4.0% titanium oxide nanoparticles in feldspathic porcelain increased the shear bond strength to zirconia core. Conclusion: The flexural strength of porcelain veneer and the bond strength at porcelain?zirconia interface can be improved by adding either 0.5% silver oxide nanoparticles or 4% titanium oxide nanoparticles to porcelain powder.

Comprehensive investigations of key mitochondrial metabolic changes in senescent human fibroblasts

There is a paucity of detailed data related to the effect of senescence on the mitochondrial antioxidant capacity and redox state of senescent human cells.Activities of TCA cycle enzymes, respiratory chain complexes, hydrogen peroxide (H 2 O 2 ), superoxide anions (SA), lipid peroxides (LPO), protein carbonyl content (PCC), thioredoxin reductase 2 (TrxR2), superoxide dismutase 2 (SOD2), glutathione peroxidase 1 (GPx1), glutathione reductase (GR), reduced glutathione (GSH), and oxidized glutathione (GSSG), along with levels of nicotinamide cofactors and ATP content were measured in young and senescent human foreskin fibroblasts. Primary and senescent cultures were biochemically identified by monitoring the augmented cellular activities of key glycolytic enzymes including phosphofructokinase, lactate dehydrogenase, and glycogen phosphorylase, and accumulation of H2O2 , SA, LPO, PCC, and GSSG. Citrate synthase, aconitase, α-ketoglutarate dehydrogenase, succinate dehydrogenase, malate dehydrogenase, isocitrate dehydrogenase, and complex I-III, IIIII, and IV activities were significantly diminished in P25 and P35 cells compared to P5 cells. This was accompanied by significant accumulation of mitochondrial H2O2 , SA, LPO, and PCC, along with increased transcriptional and enzymatic activities of TrxR2, SOD2, GPx1, and GR. Notably, the GSH/GSSG ratio was significantly reduced whereas NAD+ /NADH and NADP+ /NADPH ratios were significantly elevated. Metabolic exhaustion was also evident in senescent cells underscored by the severely diminished ATP/ ADP ratio. Profound oxidative stress may contribute, at least in part, to senescence pointing at a potential protective role of antioxidants in aging-associated disease.

Deep learning for the classification of cervical maturation degree and pubertal growth spurts:A pilot study / 대한치과교정학회지

Objective@#This study aimed to present and evaluate a new deep learning model for determining cervical vertebral maturation (CVM) degree and growth spurts by analyzing lateral cephalometric radiographs. @*Methods@#The study sample included 890 cephalograms. The images were classified into six cervical stages independently by two orthodontists. The images were also categorized into three degrees on the basis of the growth spurt: pre-pubertal, growth spurt, and post-pubertal. Subsequently, the samples were fed to a transfer learning model implemented using the Python programming language and PyTorch library. In the last step, the test set of cephalograms was randomly coded and provided to two new orthodontists in order to compare their diagnosis to the artificial intelligence (AI) model’s performance using weighted kappa and Cohen’s kappa statistical analyses. @*Results@#The model’s validation and test accuracy for the six-class CVM diagnosis were 62.63% and 61.62%, respectively. Moreover, the model’s validation and test accuracy for the three-class classification were 75.76% and 82.83%, respectively. Furthermore, substantial agreements were observed between the two orthodontists as well as one of them and the AI model. @*Conclusions@#The newly developed AI model had reasonable accuracy in detecting the CVM stage and high reliability in detecting the pubertal stage. However, its accuracy was still less than that of human observers. With further improvements in data quality, this model should be able to provide practical assistance to practicing dentists in the future.

Management and Outcome of a Neurologically Intact Infant with Pierre Robin Sequence and Dandy-Walker Variant Diagnosed with Large Hemispheric Brain Abscess ­ Case Report

Pierre Robin sequence (PRS) is a condition consisting of three essential components: micrognathia or retrognathia, cleft palate, and glossoptosis. It can be part of multiple congenital anomalies. We present the case and outcome of a 3-month-old clinically stable patient who has PRS with Dandy-Walker variant ­ which is a rare presentation in the literature ­ with a large right hemispheric brain abscess, treated with multiple minimally-invasive surgical drainage procedures with adjuvant antibiotics.

Post-traumatic thrombotic microangiopathy: What trauma surgeons need to know? / 中华创伤杂志(英文版)

Thrombotic microangiopathy (TMA) is characterized by systemic microvascular thrombosis, target organ injury, anemia and thrombocytopenia. Thrombotic thrombocytopenic purpura, atypical hemolytic uremic syndrome and Shiga toxin E-coli-related hemolytic uremic syndrome are the three common forms of TMAs. Traditionally, TMA is encountered during pregnancy/postpartum period, malignant hypertension, systemic infections, malignancies, autoimmune disorders, etc. Recently, the patients presenting with trauma have been reported to suffer from TMA. TMA carries a high morbidity and mortality, and demands a prompt recognition and early intervention to limit the target organ injury. Because trauma surgeons are the first line of defense for patients presenting with trauma, the prompt recognition of TMA for these experts is critically important. Early treatment of post-traumatic TMA can help improve the patient outcomes, if the diagnosis is made early. The treatment of TMA is also different from acute blood loss anemia namely in that plasmapheresis is recommended rather than platelet transfusion. This article familiarizes trauma surgeons with TMA encountered in the context of trauma. Besides, it provides a simplified approach to establishing the diagnosis of TMA. Because trauma patients can require multiple transfusions, the development of disseminated intravascular coagulation must be considered. Therefore, the article also provides different features of disseminated intravascular coagulation and TMA. Finally, the article suggests practical points that can be readily applied to the management of these patients.

Treatment of psychological morbidity secondary to benign prostatic hyperplasia: a comparative study

Background: Authors tend to compare the medical treatment of benign prostatic hyperplasia with the surgical option regarding lower urinary tract symptoms (LUTS) and related psychological morbidity.Methods: A retrospective study of (1614) patients who were managed by either transurethral resection of prostate (TURP) or medical treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) over a period of 5 years between (Sep. 2013 and Sep. 2018) carried out in Prince Hussein Urology Center at Jordanian Royal Medical Services. Patients were classified into two groups, group1 (807 patients) who get a medical option and group 2 (807 patients who underwent TURPs. A comparison between both groups according to the effect of minimizing the psychological morbidities was done over a period of 1-year follow-up after reviewing the patient’s medical records.Results: Ages of the patients for group1 and 2 were (47-68 years), (49-73 years), respectively. There were significant differences at the level of depression, anxiety and psychiatric morbidity pre-treatment between both groups p-value <0.05, and no significant differences after treatment in group 1 regarding these levels, p-value>0.05, but significant differences in the level of improvement after treatment between both groups and in group 2 were found, p-value <0.05.Conclusions: The severity of LUTS and psychological morbidity have a positive relationship and were higher in the pretreatment surgical group, but the effect of TURP was superior to the medical group in the management of this morbidity and its causative (LUTS).

Dyslipidemia Relationship with Socioeconomic Status in East Champaran Population

Background: The study was conducted to analyze variabilities in lipid profile in East Champaran, Bihar adultsby age, gender, smoking, BMI, exercise and income. Method: Blood sample of 100 subjects of mean age 27±7were analyzed for Total Cholesterol, HDL-Triglyceride, LDL-C. Mean±SD conc. of the total cholesterol, HDLcholesterol, LDL-cholesterol. Result: Total cholesterol was higher in individuals having blood pressure>120/80 mmHg than individuals having blood pressure (207±100 mg/dl vs 166±76 mg/dl; p=0.03). HDLcholesterol was significantly higher in the younger age group (<30 yrs) than the older age group (>30 yrs)(45±10 mg/dl vs 41±9 mg/dl; p=0.03). The mean conc. of HDL-cholesterol was found significantly higher in theupper-income group (>25,000 Rs pm) than the lower-income group (<10,000Rs pm) (48±11mg/dl vs 40±8mg/dl; p=0.001). The mean levels of triglycerides were significantly higher in males than females (191±88mg/dl vs 154±74 mg/dl; p=0.02). Similarly, the mean value of triglycerides was significantly lower inindividuals performing exercise than individuals who did not exercise (130±42 mg/dl vs 186±87 mg/dl;p=0.01), the mean triglyceride levels also were significantly higher in hypertensive individuals (207±100 mg/dlvs 166±76 mg/dl; p=0.03). Conclusion: This study showed that the level of lipids in blood and atherosclerosisrelation is influenced by various lifestyle factors including smoking, daily physical activity, and socioeconomicstatus of the individual. Developing countries like India should consider these factors in health strategyplanning.

Dengue: experience from a tertiary care centre in Northern Karnataka, India

Background: Epidemiology of dengue infection is evolving, and research gap exists in the region. The clinical features, laboratory parameters, complications and treatment outcomes of patients diagnosed of dengue infection at a tertiary care centre were analysed in the present study.Methods: More than 12 years old patients, presenting with features suggestive of acute febrile illness were subjected to detailed history taking and thorough clinical examination. All the suspected cases were further evaluated with complete blood count, liver function test, kidney function test, along with ultrasonography of abdomen. Blood samples were tested for dengue antibodies (IgG and IgM) by hemagglutination inhibition method for confirmation of the diagnosis. The clinical course was closely monitored during hospital stay and complications and deaths, if any, were noted.Results: Total 140 patients were studied. Fever (100%), headache (80%) and myalgia (73.6%) were the commonest symptoms. Thrombocytopenia (136, 97.1%) was the commonest hematological finding, while severe thrombocytopenia (<50,000/cu. mm) was observed in 38 (27.1%) cases. Hepatomegaly (61, 43.6%), splenomegaly (42, 30.0%), ascites (54, 38.6%), pleural effusion and gall bladder edema (18, 12.9% each) were the commonest findings on ultrasonography. Shock and ARDS were the major complications.Conclusions: Dengue remains an important public health problem even at a tertiary care centre and strong suspicion is needed in adult patients with acute febrile illness. The management should focus on averting shock and ARDS, which would help in larger aim of reduction in mortality.

TpTe and TpTe/QT: novel markers to predict sudden cardiac death in ESRD? / TpTe e TpTe/QT: novos marcadores para prever morte súbita cardíaca na DRT?

ABSTRACT Introduction: Reliable markers to predict sudden cardiac death (SCD) in patients with end stage renal disease (ESRD) remain elusive, but echocardiogram (ECG) parameters may help stratify patients. Given their roles as markers for myocardial dispersion especially in high risk populations such as those with Brugada syndrome, we hypothesized that the Tpeak to Tend (TpTe) interval and TpTe/QT are independent risk factors for SCD in ESRD. Methods: Retrospective chart review was conducted on a cohort of patients with ESRD starting hemodialysis. Patients were US veterans who utilized the Veterans Affairs medical centers for health care. Average age of all participants was 66 years and the majority were males, consistent with a US veteran population. ECGs that were performed within 18 months of dialysis initiation were manually evaluated for TpTe and TpTe/QT. The primary outcomes were SCD and all-cause mortality, and these were assessed up to 5 years following dialysis initiation. Results: After exclusion criteria, 205 patients were identified, of whom 94 had a prolonged TpTe, and 61 had a prolonged TpTe/QT interval (not mutually exclusive). Overall mortality was 70.2% at 5 years and SCD was 15.2%. No significant difference was observed in the primary outcomes when examining TpTe (SCD: prolonged 16.0% vs. normal 14.4%, p=0.73; all-cause mortality: prolonged 55.3% vs. normal 47.7%, p=0.43). Likewise, no significant difference was found for TpTe/QT (SCD: prolonged 15.4% vs. normal 15.0%, p=0.51; all-cause mortality: prolonged 80.7% vs. normal 66.7%, p=0.39). Conclusions: In ESRD patients on hemodialysis, prolonged TpTe or TpTe/QT was not associated with a significant increase in SCD or all-cause mortality.

RESUMO Introdução: Marcadores confiáveis para predizer morte súbita cardíaca (MSC) em pacientes com doença renal terminal (DRT) permanecem elusivos, mas os parâmetros do ecocardiograma (ECG) podem ajudar a estratificar os pacientes. Devido a seus papéis como marcadores para a dispersão miocárdica, especialmente em populações de alto risco, como aquelas com síndrome de Brugada, nós hipotetizamos que o intervalo pico da onda T ao final da onda T (TpTe) e TpTe/QT são fatores de risco independentes para MSC na DRT. Métodos: Revisão retrospectiva do prontuário foi realizada em uma coorte de pacientes com DRT iniciando a hemodiálise. Os pacientes eram veteranos de guerra americanos que utilizavam os centros médicos do Veterans Affairs para atendimento médico. A idade média de todos os participantes foi de 66 anos e a maioria era do sexo masculino, consistente com uma população veterana dos EUA. ECGs que foram realizados dentro de 18 meses após o início da diálise, e foram avaliados manualmente para TpTe e TpTe/QT. Os desfechos primários foram MSC e mortalidade por todas as causas, e estes foram avaliados até 5 anos após o início da diálise. Resultados: Após o critério de exclusão, foram identificados 205 pacientes, dos quais 94 com TpTe prolongado e 61 com intervalo TpTe/QT prolongado (não mutuamente exclusivo). A mortalidade geral foi de 70,2% em 5 anos e a MSC foi de 15,2%. Nenhuma diferença significativa foi observada nos desfechos primários ao se avaliar o TpTe (MSC: prolongado 16,0% versus normal 14,4%, p = 0,73; mortalidade por todas as causas: prolongado 55,3% vs. normal 47,7%, p = 0,43). Da mesma forma, nenhuma diferença significativa foi encontrada para TpTe/QT (MSC: prolongado 15,4% vs. normal 15,0%, p = 0,51; mortalidade por todas as causas: prolongado 80,7% vs. normal 66,7%, p = 0,39). Conclusões: Em pacientes com insuficiência renal terminal em hemodiálise, TpTe ou TpTe/QT prolongados não foram associados a um aumento significativo da morte súbita ou mortalidade por todas as causas.

Does oregano protect against testicular toxicity produced by ethylene glycol in adult male albino rat? / ¿El orégano protege contra la toxicidad testicular producida por etilenglicol en ratas macho albinas adultas?

SUMMARY: Origanum vulgare Linn has traditionally been used as a diuretic and antispasmodic. Therefore, we investigated the active extract of Origanum vulgare for possible andrological effect and preventive effects against testicular damage using ethylene glycol rat model of testicular damage, to rationalize its medicinal use. Male Wistar rats received lithogenic treatment comprising of 0.75 % ethylene glycol injection twice with one day interval, then in drinking water, active extract of Origanum vulgare treatment (20 mg/kg) was given for 3 weeks to prevent toxic damage including loss of body weight gain and appetite, Following oral administration of EGME, a rapid decrease in testis weight associated with testicular cell damage was observed. Origanum vulgare treatment (20 mg/kg) prevented as well as reversed toxic changes including loss of body weight gain.

RESUMEN: Origanum vulgare Linn se ha usado tradicionalmente como diurético y antiespasmódico. Por lo tanto, investigamos el extracto activo de Origanum vulgare por su posible efecto andrológico y efectos preventivos contra el daño testicular utilizando el modelo de rata de etilenglicol de daño testicular. El objetivo del estudio fue racionalizar su uso medicinal. Su utilizaron ratas Wistar macho que recibieron un tratamiento litogénico de una inyección de etilenglicol al 0,75 %, dos veces con un intervalo de un día, y luego se administró en agua potable. Se administró el extracto activo del tratamiento con Origanum vulgare (20 mg / kg) durante 3 semanas con el objetivo de prevenir el daño tóxico, la pérdida de peso corporal y el apetito. Tras la administración oral de EGME, se observó una rápida disminución del peso de los testículos asociada al daño de las células testiculares. El tratamiento con Origanum vulgare (20 mg / kg) logró prevenir y revertir las alteraciones tóxicas, incluyendo la pérdida de peso corporal.

Suppression of high fat diet-induced liver cell injury by swim exercise / Supresión de lesión en células de hígado inducida por dieta alta en grasas con ejercicio de natación

SUMMARY: The rapid rise in obesity, particularly among children is a major public health concern that adversely affects vital organs including the liver. We sought to investigate the effect of exercise on the healing of liver cells from damage induced by high fat diet (HFD) in a rat model of hepatic steatosis. Rats were randomly divided into four groups (n=6 in each group); control group fed on a low fat diet (LFD), LFD plus exercise group (LFD+EX), model group fed on HFD, and swim exercise treated group (HFD+EX). Training swim exercise started from the 11th week up until the end of week 15. Liver index and body mass index (BMI) were determined, and harvested liver tissues were examined using basic histological staining and visualised under light microscopy. In addition, collected blood samples were assayed for biomarkers of liver injury. Histological images from the model group showed accumulation of lipid droplets in the hepatocytes (steatosis) and damaged liver cells that were inhibited by swimming exercise. Compared to control groups, HFD caused an increase in BMI and liver weight but not in liver index. In addition, HFD significantly (p<0.05) increased liver injury biomarkers; high-sensitivity C-reactive protein (hsCRP) and alkaline phosphatase (ALP) that were effectively (p<0.05) decreased by swimming exercise. Furthermore, a negative correlation between these biomarkers and the antioxidant and anti-inflammatory protein adiponectin was observed. Thus, HFD-induced hepatic steatosis is treated by swim exercise.

RESUMEN: El aumento de la obesidad, especialmente entre los niños, es un problema importante en la salud pública que afecta negativamente los órganos vitales, incluyendo el hígado. En este estudio se investigó el efecto del ejercicio en la curación de las células del hígado y el daño inducido por la dieta alta en grasas (HFD) en un modelo de rata de esteatosis hepática. Las ratas se dividieron aleatoriamente en cuatro grupos (n = 6 en cada grupo); grupo control, alimentado con una dieta baja en grasas (LFD); grupo de ejercicio LFD más (LFD + EX); grupo modelo alimentado con HFD; y grupo tratado con ejercicio de natación (HFD + EX). El entrenamiento con ejercicio de natación comenzó a partir de la semana 11 hasta el final de la semana 15. Se determinaron el índice hepático y el índice de masa corporal (IMC). Los tejidos hepáticos recolectados se examinaron mediante tinción histológica básica y se visualizaron con microscopía óptica. Además, se analizaron las muestras de sangre recogidas para identificar biomarcadores de lesión hepática. Las imágenes histológicas del grupo modelo mostraron acumulación de gotitas de lípidos en los hepatocitos (esteatosis) y células hepáticas dañadas que fueron inhibidas por el ejercicio de natación. En comparación con los grupos control, HFD causó un aumento en el IMC y el peso del hígado, pero no en el índice de hígado. Además, HFD aumentó significativamente (p <0.05) los biomarcadores de lesiones hepáticas; la proteína C reactiva de alta sensibilidad (hsCRP) y la fosfatasa alcalina (ALP) disminuyeron efectivamente (p <0.05) con el ejercicio de natación. Además, se observó una correlación negativa entre estos biomarcadores y la proteína antioxidante y antiinflamatoria adiponectina. Por lo tanto, la esteatosis hepática inducida por HFD puede ser tratada mediante el ejercicio de natación.

Tracheostomy in the Intensive Care Unit: a University Hospital in a Developing Country Study

Abstract Introduction Tracheostomy is the commonest surgical procedure in intensive care units (ICUs). It not only provides stable airway and facilitates pulmonary toilet and ventilator weaning, but also decreases the direct laryngeal injury of endotracheal intubation, and improves patient comfort and daily living activity. Objective The objective of this study is to assess the incidence, indications, timing, complications (early and late), and the outcome of tracheostomy on patients in the intensive care units (ICU) at a university hospital in a developing country. Methods This study is an observational prospective study. It was performed at the otolaryngology department and ICU new surgery hospital on 124 ICU admitted patients. We collected patients' demographic records, cause of admission, indications of tracheostomy, mechanical ventilation, and duration of ICU stay. We also gathered patientś tracheostomy records including the incidence, timing, technique, type, early and late complications, and outcome. All tracheostomized patients received follow-up for 12 months. Results The indication for tracheostomy in ICU patients was mostly prolonged intubation (80.5%), followed by diaphragmatic paralysis (19.5%). All tracheostomies were done by the open approach technique. Tracheostomy for prolonged intubation was done within 17 to 26 days after intubation with a mean of 19.4 ± 2.07 days. Complications after tracheostomy were 13.9% tracheal stenosis and 25% subglottic stenosis. Conclusion Prolonged endotracheal intubation is theman indication of tracheostomy, performed after two weeks of intubation. Although there were no major early complications, laryngotracheal stenosis is still a challenging sequel for tracheostomy that needs to be investigated to be prevented.

Low back pain among high school teachers in Kuwait: prevalence, risk factors and level of disability

Objectives: High school teachers in Kuwait are at a risk of developing low back pain [LBP] due to psychosocial and physical factors. The aim of this study was to determine LBP prevalence, and identify its associated factors

Design: A cross sectional study

Setting and Subjects: Three hundred and eighty one high school teachers from 12 randomly selected high schools were included in this study

Intervention: Self administered questionnaire

Main outcome: LBP prevalence and associated risk factors

Results: The life time and one-year prevalence of LBP among high school teachers were found to be 68.5% [95% confidence interval [CI]: 63.3 - 73.1%] and 63.5% [95% CI: 58.4 - 68.3%] respectively. Socio-demographic characteristics such as, gender, marital status, and number of children, were significantly associated with LBP. In addition, obesity, smoking, prolonged standing, carrying heavy weights and mental health score of 4 or more were significantly associated with LBP. The logistic regression analysis showed that marital status [adjusted odds ratio, OR = 3.228, p = 0.022], obesity [OR = 3.207, p = 0.014], being a former smoker [OR = 0.343, p = 0.02], prolonged sitting [OR = 1.981, p= 0.048], and carrying heavy weights [OR = 2.121, p = 0.031] were independently associated with LBP

Conclusion: The prevalence of LBP among high school teachers in Kuwait is higher than other populations. This study managed to identify a number of modifiable associated factors with LBP. Through modifying these factors, the level of disability due to LBP may be improved

Septic sacroiliitis post gluteal intramuscular injection

We report an unusual case of septic sacroiliitis resulting as a complication of a previous gluteal intramuscular injection. A previously healthy young man presented with fever and severe pain in the right hip, with swelling and reduced range of movement. Imaging showed inflammatory changes suggestive of septic sacroiliitis. After treatment, the symptoms completely resolved and a follow-up computed tomography confirmed the complete resolution of the sacroiliitis. We identified that the patient took a gluteal intramuscular injection one week before his symptoms. This case highlights the possible association between septic sacroiliitis and the intramuscular injection and the importance of aseptic technique

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.

Reliability of the universal goniometer for assessing active cervical range of motion in asymptomatic healthy persons

Objective: To determine within-rater and between-rater reliability of the universal goniometer [UG] for measuring active cervical range of motion [ACROM] in asymptomatic healthy subjects

Methods: Nineteen healthy subjects were tested in an identical seated position. Two raters used UG to measure active cervical movements of flexion, extension, right side flexion, left side flexion, right rotation and left rotation. Each motion was measured twice by each of the two raters and was re-measured all over again after one week. Data analysis was performed using the intraclass correlation coefficient [ICC]

Results: The results demonstrated excellent within-session [ICC2,1 = 0.83 to 0.98] and between-session [ICC2,2 = 0.79 to 0.97] intra-rater reliability and excellent inter-rater reliability [ICC2,2 = 0.79 to 0.92]

Conclusion: Considering above results it is concluded that UG is a reliable tool for assessing ACROM in a clinical setting for healthy subjects

Role of macrophage colony stimulating factor and carcinoembryonic antigen in the diagnosis of colorectal cancer

Hematopoietic cytokines [HCs] induce proliferation of hematopoietic progenitor cells. Moreover, the HCs receptors have been found on non hematopoietic tumor cell lines including colorectal cancer [CRC]. Elevated concentrations of several circulating cytokines, among which macrophage colony stimulating factor [M-CSF], have been previously shown in patients with colorectal carcinoma. Elevated serum concentrations of M-CSF have been found in a variety of malignant diseases. The aim of our study was to study the significance of combined M-CSF and carcinoembryonic antigen [CEA] in the diagnosis of CRC and the association between of schistosomiasis endemicity and colorectal cancer

Patients and methods: The serum levels of M-CSF and CEA were assayed in 29 colorectal cancer, 29 colorectal adenoma patients and in 29 healthy subjects [control group]. We defined the diagnostic sensitivity, specificity and areas under ROC curves for the measurands. Complete colonoscopic examination and rectal snip for bilharzial ova were done

Results: Median values of MCSF and CEA were signiJicantIy higher in colorectal cancer patients than those in healthy subjects. The diagnostic specificities and positive predictive value were higher for M-CSF. The highest values of diagnostic parameters were observed when M-CSF and CEA were combined. The M-CSF area under the receiver operating characteristic [ROC] curve was larger than the area of CEA

Conclusions: M-CSF might be useful as a tumor marker, especially in combination with CEA, for diagnosis of colorectal cancer, but not in the differentiation between colorectal cancer and polyps

Seroprevalence of human cytomegalovirus antibodies among children with type I diabetes mellitus in the Aseer Region, Southwest KSA

Objectives: this study is aimed at determining the seroprevalence and possible infectivity factors of human cytomegalovirus [HCMV] in children affected by type 1 diabetes mellitus [T1DM] in the Aseer Region of KSA

Methods: a total of 205 children diagnosed with T1 DM who routinely attended the Diabetic Centre [DC] of Aseer Central Hospital [ACH] in Abha KSA were randomly selected. Another control group of 51 nondiabetic children were also selected. Sera of both groups were tested for HCMV-specific IgG and IgM using an indirect enzyme linked immune-sorbent assay [ELISA]

Results: the recorded HCMV-IgG seroprevalence rates were found to be higher in both groups of children than the IgM responses, which were consistently low. There were no obvious differences between the two groups in terms of HCMV responses. No significant variations were observed between girls and boys in terms of the seroprevalence rates. The highest positive IgG prevalence rates to HCMV were observed among 11- to 15-year-old children, and the least positive rates were noted in children younger than 5 years of age. Children from Abha city and its vicinity showed relatively higher HCMVspecific IgG and IgM responses rates than children from other localities

Conclusions: despite the presence of high HCMV-IgG response rates among the studied group of children, this study could not identify the associated clinical manifestations. There is no correlation between T1 DM and virus infectivity, as this research could not find differences in serological responses to the virus between the diabetic and non-diabetic children