Short-term outcomes among patients with subclinical hypothyroidism undergoing primary percutaneous coronary intervention

Objectives: This study aimed to examine possible associations between previously undiagnosed subclinical hypothyroidism and short-term outcomes and mortality in a sample of Iraqi patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Design: This is a prospective observational cohort study. Setting: The study was conducted in a single tertiary referral centre in Baghdad, Iraq. Participants: Thyroid-stimulating hormone and free T4 levels were measured in 257 patients hospitalised with STelevation myocardial infarction who underwent primary percutaneous coronary intervention between January 2020 and March 2022. Main outcome measures: Adverse cardiovascular and renal events during hospitalisation and 30-day mortality were observed. Results: Previously undiagnosed subclinical hypothyroidism was detected in 36/257 (14%) ST-elevation myocardial infarction patients and observed more commonly in females than males. Patients with subclinical hypothyroidism had significantly worse short-term outcomes, including higher rates of suboptimal TIMI Flow (< III) (p =0.014), left ventricular ejection fraction ≤ 40% (p=0.035), Killip class >I (p=0.042), cardiogenic shock (p =0.016), cardiac arrest in the hospital (p= 0.01), and acute kidney injury (p= 0.044). Additionally, 30-day mortality was significantly higher in patients with subclinical hypothyroidism (p= 0.029). Conclusion: Subclinical hypothyroidism previously undiagnosed and untreated had a significant association with adverse short-term outcomes and higher short-term mortality within 30 days compared to euthyroid patients undergoing primary percutaneous coronary intervention. Routine thyroid function testing during these patients' hospitalisation may be warranted.

Tratamiento quirúrgico de las úlceras por presión sacras con colgajo miocutáneo de gluteus maximus por deslizamiento en V-Y: Técnica quirúrgica / Surgical treatment of sacral pressure ulcers with gluteus maximus myocutaneous flap due to V-Y sliding: surgical technique

Resumen Introducción: La úlcera por presión más frecuente es la sacra. Si compromete el hueso puede provocar osteomielitis por lo que requiere aseo quirúrgico y colgajo miocutáneo de gluteus maximus por deslizamiento en V-Y. Materiales y Método: En el servicio de cirugía plástica del hospital del Salvador entre 2011 y 2020 se han operado 82 pacientes con ulceras sacras grado 4 que requirieron cobertura con colgajo miocutáneo de gluteus maximus en V-Y. De ellas se analizaron los últimos 37 pacientes. Resultados De los 37 pacientes, 12 fueron mujeres, 25 hombres, 17 parapléjicos, 12 tetrapléjicos y 8 deambulaban. 6 pacientes presentaron COVID-19. 24 fueron bilaterales y 13 unilaterales. Los colgajos cicatrizaron bien en 30 pacientes. Las complicaciones fueron de 16% consistente en 2 hematomas, 2 dehiscencias, 2 celulitis y 1 seroma, todas resueltas sin problemas. Seguimiento de entre 3 y 6 meses. Discusión El tratamiento quirúrgico con colgajo miocutáneo de gluteus maximus en V-Y, aparte de aportar volumen para ocluir la úlcera, aporta irrigación excelente con oxígeno, nutrientes y antibióticos que aseguran una óptima cicatrización. Dependiendo del diámetro de la úlcera el colgajo puede ser uni o bilateral. Dado lo complejo del tratamiento, en general, el porcentaje de complicaciones de 16% se considera bajo. Conclusión: El tratamiento quirúrgico de las úlceras por presión sacras con colgajos miocutáneos deslizantes de gluteus maximus ha sido exitoso con buenos resultados quirúrgicos con buen flujo sanguíneo y buena evolución.

Introduction: Pressure sores are the result of the compression of soft tissues in the prominent bones areas, mainly in patients without movement. If the depth of the ulcer compromises the sacral bone, the treatment will be the gluteus maximus myocutaneous flap in V-Y. Materials and Method: In the plastic surgery service of the hospital del Salvador 82 patients with sacral pressure sores grade 4 were operated on between 2011 and 2020 with gluteus maximus myocutaneous V-Y flap. The last 37 patients were analyzed. Results: With this treatment the flaps were doing well in all cases with good blood supply. Complications: dehiscence: 2 patients, cellulitis: 2 patients, hematoma: 2 patients and seroma: 1 patient. The overall complication was 16%. Follow up between three and six months. Discussion: The most important part in pressure sores is their prevention. When the ulcer is in prominent parts of the body, the sore, could be in different grades of depth. The classification of them is in grades 1: erythema, 2: subcutaneous tissue. These two grades are solved with conservative treatment. When the ulcers are in grade 3 or 4, and with little ulcer in the skin but with damage of the deep plane, the treatment will be with surgery. In our casuistic the most frequent pressure sore is in the sacrum treated with gluteus maximus sliding myocutaneous flap in V-Y. With this treatment the flaps were doing well in all cases with good blood supply. The complications of 16% were considered low. Conclusion: The sliding gluteus Maximus myocutaneous flap in V-Y for treatment for sacral pressures sores have been successful for our patients.

Surgical repair of the supraspinatus: pre- and postoperative architectural changes in the muscle

INTRODUCTION@#Shortening of the tendon and muscle is recognised as a strong predictor of surgical failure of supraspinatus tendon tears. Changes in muscle architecture following repair have not been thoroughly investigated. Hence, we aimed to compare the pre- and postoperative architecture of the supraspinatus.@*METHODS@#We recruited eight participants with full-thickness supraspinatus tears. Images of the supraspinatus were captured preoperatively (pre-op) and postoperatively at one month (post-op1), three months (post-op2) and six months (post-op3) in relaxed and contracted states (0º and 60º glenohumeral abduction). Fibre bundle length (FBL), pennation angle (PA) and muscle thickness were quantified. Self-reported function, and maximal isometric abduction and external rotation strengths were assessed.@*RESULTS@#The mean FBL increased from pre-op to post-op1 (p = 0.001) in the relaxed state and from pre-op to post-op2 (p = 0.002) in the contracted state. Decrease in FBL was observed from post-op2 to post-op3 in the relaxed state. The mean PA decreased from pre-op to post-op1 (p < 0.001) in the relaxed state, but increased from post-op2 to post-op3 in both relaxed (p = 0.006) and contracted (p = 0.004) states. At post-op3, external rotation (p = 0.009) and abduction (p = 0.005) strengths were greater than at post-op2. Overall function increased by 47.67% from pre-op to post-op3.@*CONCLUSION@#Lengthening of the supraspinatus occurs with surgery, altering the length-tension relationship of the muscle, which can compromise muscle function and lead to inferior surgical outcomes. These findings may guide clinicians to optimise loads, velocities and shoulder ranges for effective postoperative rehabilitation.

Cierre progresivo de heridas en pacientes con pie diabético / Progressive suture in diabetic foot patients with difficult healing

Resumen Introducción: Los pacientes diabéticos insulino requirientes con heridas del pie, producto de amputaciones con exposición de huesos, cartílagos o tendones, son de difícil manejo por el déficit de irrigación distal. Alternativa de tratamiento a los colgajos pediculados o microquirúrgicos es el cierre progresivo de las heridas. Objetivo: Reportar la técnica de cierre progresivo de heridas de pie en pacientes diabéticos insulino requirientes. Materiales y Método: Con esta técnica se operó a 15 pacientes diabéticos insulino requirientes que, después de amputación, presentaron heridas del pie con exposición de huesos, cartílagos y tendones. Lesiones de talón: 4, lesiones de antepie: 5 y lesiones plantares: 6. Las edades fluctuaron entre 45 y 70 años. Fueron 11 hombres y 4 mujeres operados entre 2014 y 2019. En ambos bordes de la herida se instaló dos placas de Ventrofil® unidas por sutura en U transversa y se tensó cada 3 días hasta obtener cicatrización. Resultados: 14 pacientes obtuvieron cicatrización en un plazo de entre 15 y 21 días y sólo uno presentó sufrimiento de los bordes de la herida por afrontamiento muy seguido. El seguimiento fue de tres meses sin recidiva de las heridas. Discusión: En pacientes diabéticos las heridas, producto de amputaciones y con exposición de huesos, cartílagos y tendones, son de muy difícil tratamiento debido el déficit de irrigación distal. En estas condiciones el uso de complejos colgajos locales o microquirúrgicos es de alto riesgo dada la posibilidad de necrosis. En esta situación, el cierre progresivo con sutura de Ventrofil® es una alternativa viable, segura, reproducible y con buenos resultados. Conclusión: Es un procedimiento rápido, seguro y reproducible.

Introduction: The closure of wounds in diabetic foot patients, after amputation with esposure of bones, is difficult because of lack of blood supply to this area. The progressive suture with Ventrofil® is a good alternative. Aim: Report the technique of progressive closure of foot wounds in insulin-requiring diabetic patients. Materials and Method: 15 patients with diabetic foot were operated on in the Hospital del Salvador, between 2014 and 2019.The ages were among 45 and 70 years. 11 men and 4 women. In those patients two plaques of Ventrofil® were positioned in both borders of the wound an tied through a horizontal suture.This suture was tensioned every 3 days until get the complete wound healing. Results: 14 patients healed very well and in just only one patient there was suffering of the edges of the wound. The follow up was of 3 months without relapse. Discussion: In patients with diabetic foot with wounds after amputation the closure is difficult because of lack of adecuate blood supply. In these case the progressive suture with plaques of Ventrofil® is a good alternative to a more complex flaps like microsurgicals ones. Conclusion: This technique is sure, easy to perfom and safe.

Disección endoscópica submucosa para el tratamiento del cáncer esofágico / Endoscopic submucosal dissection for the treatment of esophageal cancer

Resumen Introducción: El cáncer de esófago (CE) constituye la sexta causa de muerte por cáncer en el mundo. La disección endoscópica submucosa (DES) es una técnica que permite la resección en bloque de lesiones del tubo digestivo. Tiene rol curativo en pacientes seleccionados y potenciales ventajas sobre la esofagectomía. Objetivo: Describir los resultados perioperatorios y oncológicos de la DES como tratamiento del CE en nuestro centro. Materiales y Método: Estudio retrospectivo de pacientes sometidos a DES por CE entre los años 2010-2020. Resultados: Diez pacientes fueron tratados con DES por CE entre los años 2010 y 2020. El 80% eran hombres y la edad promedio fue de 72 años (63-84). La resección en bloque fue lograda en todos los casos y no se presentó morbimortalidad perioperatoria. Todas las disecciones fueron R0 y el 90% cumplió con estándares de curación. El seguimiento promedio fue de 38 meses (3,5-123). La sobrevida global fue de 90%. La sobrevida específica por cáncer y libre de recurrencia fue de 100%. Discusión: La morbimortalidad asociada a la esofagectomía es alta. La DES sería una alternativa más segura, que permite lograr un R0 y eventualmente la curación en pacientes seleccionados con CE limitado a la mucosa o submucosa. Conclusión: La presente constituye la primera serie reportada de pacientes con cáncer esofágico sometidos a DES en nuestro país. Muestra excelentes resultados oncológicos y seguridad del procedimiento, comparables a las grandes series descritas en la literatura internacional.

Introduction: Esophageal cancer is the sixth leading cause of death by cancer worldwide. Endoscopic submucosal dissection (ESD) is a technique that allows en bloc resection of early lesions of the digestive tract. It has curative potential in selected patients and potential benefits over esophagectomy for the treatment of esophageal cancer (EC). Aim: To report the results of ESD for EC in a high-volume center in Chile. Materials and Method: Retrospective descriptive study of patients who underwent ESD for EC at our center. Results: A total of 10 patients were treated with ESD for EC between 2010 and 2020. Eighty percent were male patients, the average age was 72 years (63-84). En bloc resection was achieved in all cases and there were no complications or mortality. All of the dissections were classified as R0 and 90% met curative standards. The mean follow-up was 38 months (3.5-123). Overall survival was 90%. Cancer-specific survival was 100% and recurrence-free survival was 100%. Discussion: The rate of morbidity and mortality of esophagectomy is high. ESD would be a safer technique, which allows R0 resections and eventually curation in selected patients with EC limited to the mucosa or submucosa. Conclusion: This is the first report of ESD for the treatment of EC in our country, it shows excellent oncologic results and safety of the procedure, comparable to those reported in the larger series published to date.

Tratamiento quirúrgico de la gangrena de Fournier / Surgical management of Fournier's gangrene

Resumen Objetivo: Describir el manejo quirúrgico realizado para la reconstrucción genitoperineal (RGP) en pacientes con secuelas de Gangrena de Fournier (GF). Materiales y Método: Corresponde a una serie de casos retrospectiva de pacientes con secuelas de GF a los que se les realizó RGP entre los años 2011 y 2019. Se realizó un análisis descriptivo con las variables de técnica quirúrgica, edad, sexo, comorbilidades, subunidades anatómicas afectadas, origen anatómico de la gangrena de Fournier, número de procedimientos quirúrgicos, procedimiento de colostomía, terapia de presión negativa, Flexi-Seal®, bacterias aisladas, duración de estancia hospitalaria, tipo de procedimientos reconstructivos y complicaciones. Resultados: Se realizó RGP a 43 pacientes (81,1% hombres), con un promedio de edad de 59,1 (17-86 años), 72,7% eran diabéticos. El número de subunidades involucradas se asocia directamente y significativamente en relación al número de intervenciones quirúrgicas. Las técnicas utilizadas para la reconstrucción en orden de frecuencia fueron: colgajos (23%), cierre parcial más injerto dermoepidérmico de grosor parcial (IPP) (20%), cierre parcial (16%) e IPP (16%), cierre por segunda intención (10%), colgajo más IPP (7%) y cierre parcial para cierre por segunda intención de zona restante (5%). Discusión: La elección de reconstrucción se basa en las características del defecto, es decir, el tamaño, la ubicación y profundidad, así como la disponibilidad de tejido local. De preferencia optar por cierres primarios sin tensión, seguido de colgajos y de IPP. Conclusión: La RGP es un desafío para el cirujano plástico. Las técnicas descritas han demostrado ser seguras y reproducibles para el tratamiento quirúrgico de la gangrena de Fournier.

Aim: To describe the surgical management performed for genital-perineal reconstruction (GPR) in patients with sequelae of Fournier gangrene (FG). Materials and Method: It is based on a retroactive series of cases of patients with effects of FG who were given GPR between 2011 and 2019. We performed a descriptive analysis using the variables surgical technique, age, sex, comorbidities, anatomical subunits affected, anatomic origin of the Fournier's gangrene, number of surgical procedures, colostomy procedure, negative pressure therapy, Flexi-Seal®, bacteria isolated, hospital stay, type of reconstructive procedures and complications. We performed GPR on 43 patients (81.1% male), with a mean age of 59.1 (17-86 years); 72% were diabetic. The number of subunits involved was directly and significantly associated with the number of surgical interventions. Results: The reconstruction techniques most used were, in descending order: flaps (23.2%), wound closure and split-thickness skin graft (STSG) (23.2%), primary closure (16.2%), STSG (16.2%), secondary closure (9.3%), flap and STSG (6.9%) and partial wound closure for healing of the remaining area for a second intention (4.6%). Discussion: The reconstruction choice is based on the characteristics of the defect, that is, the size, location and depth, as well as the availability of local tissue. Preferably opt for primary closures without tension, followed by flaps and IPP. Conclusion: The RGP is a challenge for the plastic surgeon. The techniques described have proven safe and reproducible for the surgical treatment of Fournier Gangrene.

Comparison of retrograde ureterorenoscopy (URS) and percutaneous anterograde ureteroscopy for removal of impacted upper ureteral stones >10mm in the elderly population

ABSTRACT Purpose: We aimed to compare the success and complication rates of the anterograde and retrograde Ureterorenoscopy (URS) for impacted upper ureteral stones in patients > 65 years of age. Materials and Methods: Data of 146 patients >65 years of age and underwent anterograde URS (n=68) in supine position or retrograde URS (n=78) for upper ureteral impacted stones>10 mm between January 2014 and September 2018 were collected prospectively. The groups were compared for success and complication rates, duration of operation, hospital stay, and ancillary procedures. Results: Anterograde and retrograde URS groups were similar for demographic and stone related characteristics. The success rate of the anterograde URS group was significantly higher than the retrograde URS group (97.1% vs. 78.2%, p=0.0007). The complication rates were similar for the two groups (p=0.86). Clavien grade I and II complications were observed in 3 patients in each group. The mean hemoglobin drop was 0.5 g/dL in the anterograde URS group and blood transfusion was not performed in any of the patients. The mean duration of operation was 41.2±12.5 minutes in the mini-PNL group and 59.6±15.1 minutes in the RIRS group and the difference was statistically significant (p=0.02). The median duration of hospitalization was 1 day for both groups. Conclusions: Performing anterograde URS in supine position provided better success rates and similar complication rates compared to retrograde URS. Based on these results anterograde URS shall be considered as one of the primary treatment options for management of impacted upper ureteral stones in the elderly population.

Hemodynamic Variations Associated with Ramadan Fasting among Saudi Stroke’s Patients

Background: It was reported that intermittent fasting has several health benefits. Therefore, the present study aimed to assess the hemodynamic variations associated with Ramadan fasting among Saudi Stroke patients. Methodology: Information referring to 61 stroke patients were retrospectively retrieved from King Khalid hospital, Hail, Northern Saudi Arabia. Data relating to patients attended during the period from April 2019 to June 2019. The sample involved two months (Shaban and Ramadan) a full coverage sample. Results: Out of 61 study subjects, 26 patients were fasting during stroke happening and 35 patients were non-fasting. Out of the 61 patients, 35 (57.4%) were females and 26 (42.6%) were males. With the fasting month, hypertension was co-occurrence in 23/49 (47%) fasting patients, hence, it occurred in 26/49 (53%) among non-fasting patients, the risk of hypertension during Ramadan compared to nonfasting month; the relative risk (RR) and 95% confidence interval (95% CI): RR (95%CI)=1.1908 (0.9374 to 1.5128). Conclusion: Ramadan Fasting has some beneficial effects influencing stroke including incidence and severity reduction. Stroke associated hemodynamic variants, which were more apparent among women, were perceived to decline during fasting.

Studies on cytopathic effects of BmNPV infection in three lepidopteran insect cell lines in MGM-448 medium

Three insect cell lines, namely, DZNU-Bm-1, DZNU-Bm-12, and NIAS-MaBr-92, were tested for susceptibilityto Bombyx mori nucleopolyhedrovirus (BmNPV). The cytopathic effects of infection on cultured cells wereobserved. BmNPV was then serially passaged in these cell lines to assess their long-term ability to supportBmNPV replication. The cell lines were cultured in MGM-448 medium supplemented with 10% fetal bovineserum. Virus inoculum was prepared from B. mori larvae infected with BmNPV. The early signs of infectionstarted appearing within 16–36 hours post inoculation (hr pi). DZNU-Bm-1 and DZNU-Bm-12 cells showedheavy clumping. NIAS-MaBr-92 cells lost their motility and tended to form loose aggregations. Cytopathiceffects such as hypertrophy of nuclei and increase in cell size were prominent in all three cell lines. Beginningof occlusion body (OB) formation in DZNU-Bm-1 was first observed at about 36–42 hr pi, whereas, inDZNU-Bm-12, they were observed only after 42 hr pi. NIAS-MaBr-92 cells exhibited OB formation onlyafter 84 hr pi. The large mature OBs were visible in DZNU-Bm-1 cells by 66 hr pi, whereas, in DZNU-Bm-12cells by 72 hr pi. Mature OBs were observed in NIAS-MaBr-92 cells only after 120 hr pi. A number of OBsper cell varied from 12 to 82 in DZNU-Bm-1, 3 to 23 in DZNU-Bm-12, and 3 to 14 in NIAS-MaBr-92 cells.In this study, DZNU-Bm-1 and DZNU-Bm-12 cell lines were found to be better than NIAS-MaBr-92 interms of percentage infection. The yield of OBs per infected cell is also the highest in DZNU-Bm-1, whereasDZNU-Bm-12 and NIAS-MaBr-92 have comparable yields of OBs per cell.

Endoscopic retrograde cholangiopancreatography for acute gallstone pancreatitis: Implementation of an institution safety protocol during the COVID-19 outbreak in Malaysia

@#Coronavirus disease 2019 (COVID-19) is a highly contagious, severe acute respiratory syndrome that poses significant health risks to healthcare providers. A delicate balance is needed between timely intervention for ill patients without apparent COVID-19 infection and the safety of healthcare personnel who provide essential treatment in the midst of the pandemic. We report our experience managing a 70-year-old man who presented with acute gallstone pancreatitis at our hospital during the COVID-19 outbreak in Malaysia. We also describe the safety protocol measures that have been implemented in our institution to protect the healthcare personnel from this disease during endoscopic retrograde cholangiopancreatography. This case illustrates the importance of meticulous planning, risk assessment, effective team communication and strict adherence to recommendations when providing treatment during an unprecedented pandemic.

Electrocardiogram changes in patients with end stage renal disease on chronic haemodialysis

Background: End stage renal disease (ESRD) is irreversible loss of renal function which is physiologically defined by a GFR of less than 15 ml / minute. ESRD is associated with a higher incidence of coronary artery disease and serious arrhythmia especially ventricular arrhythmia. The goal of study is to determine whether ESRD and haemodialysis (HD)are associated with occurrence of significant electrocardiogram (ECG) changes or not.Methods: This is a cross-sectional study design which involved 22 patients with ESRD on regular HD in Al Sadre teaching hospital / Al Najaf. Both sexes was included in this study. All patients underwent full medical history and examination which included the following aspects: Age, Sex, Occupation, BP, HR, RBS, B.urea, S.creatinine , Serum electrolyte (Na+, K+, Cl-, Ca++), Lipid profile (Cholesterol , Triglyceride, HDL, LDL), Duration of CRF, Duration of dialysis, Social history including (smoking, alcohol) and Drug used by the patient. Resting EGC and Hotler ECG.Results: Eighteen patients exhibited emergence of simple ectopic activity premature atrial complex (PAC) and premature ventricular complex (PVC) events and four patients exhibited (ST,T changes). Potentially lethal arrhythmias and other serious ECG changes are not detected in our patient’s sample.Conclusion: In this study, neither ESRD nor haemodialysis were associated with development of serious ECG changes or emergence of significant arrhythmia.

Assessment of diastolic function in patients with aortic valve diseases

Background: Valvular heart disease (VHD) are prevalent and impose significant impact on heart function. Diastolic Dysfunction (DD) is less appreciated than Systolic Dysfunction (SD). The aim of this study was to assess the Diastolic Function (DF) in patients with Aortic Valve (AV) diseases as risk factors predisposing to DD.Methods: Cross-section study that involved 34 patients with AV diseases and other 10 controls. All patients are assessed for diastolic dysfunction by transthoracic echo Doppler study. M-mode echocardiography was used to measure cardiac dimensions and wall thickness. LV mass was measured on echocardiogram at rest.Results: Among the 34-patients, 19 (55.8%) of them were male patients and 15(44.2%) of them were female patients. The data showed that there were 12 patients with Aortic Stenosis (AS), eight patients with AORTIC regurgitation (AR), six patients with Aortic Sclerosis (ASCL) and 8 patients with combined AR-AS. Around third of the patients (35.3%) had Grade II DD followed by grade I and Grade III. However, around 14.7 % didn’t have any dysfunction. Overall, there was 77% of the patients with AV diseases.Conclusions: Author concluded that Aortic Valve diseases is significantly related to- the development of diastolic dysfunction and the DD is influenced by severity of AV diseases.

Health education role in promoting mothers’ beliefs, knowledge and practice of exclusive breastfeeding among King Fahd Armed Forces Hospital population

Background: Breastfeeding is considered an optimal feeding method, as it fulfills the infants' nutritional needs. Exclusive breastfeeding (EBF), which means to feed an infant solely (with some exceptions) on breast milk, is important for the health and well-being of both infant and mother. However, implementing an effective health education program is essential for promoting EBF and improving health awareness. Therefore, the purpose of this study is to measure mothers’ beliefs, knowledge and practice of exclusive breastfeeding before and after implementing the breastfeeding health education program at King Fahd Armed Forces Hospital (KFAFH).Methods: This study employs a quantitative research method and uses a cross-sectional study design. All in-patient and out-patient postnatal women who received information about EBF in their third trimester were evaluated post-delivery. In the period from December 2018 to March 2019, the total number of participants is (n=234).Results: The study indicates a statistically significant positive association between EBF knowledge and practice evaluation scores. Higher levels of breastfeeding (BF) knowledge were found to translate into better BF practice. Knowledge scores also had a significant association with beliefs, with higher knowledge being linked to more positive beliefs in relation to BF.Conclusions: The conducted study reports the major effect of health education intervention on EBF practice among the KFAFH population. As a result, some managerial, and clinical recommendations were addressed. Other recommendations focused on working mothers, as KFAFH may employ some strategies and polices to maximize the use of EBF.

Study the Toxic Effect of Different Doses of Duprost on Spleen of Albino Mice

The intent of this task was to examine the toxic effect of different dosages of Duprost (dutasteride) on the spleen of mice. Total 24 albino mice were purchased and fractioned into 3 parts: control (3 mice), acute group (12 mice) and chronic group (9 mice). The acute group was subdivided to 4 groups, each of which contained 3 mice. Every group was given a lonely oral dose of the following doses: subgroup 1 dosed with 0.25 ml (0.5 mg/kg) of Duprost (dutasteride), subgroup 2 dosed with 0.15 ml (0.12 mg/kg) of Duprost (dutasteride), subgroup 3 dosed with 0.1 ml (0.08 mg/kg) of Duprost (dutasteride) and subgroup 4 dosed with 0.05 ml (0.04 mg/kg) of Duprost (dutasteride) for 24 hours. Whereas the chronic group was subdivided into 3 subgroups and each set was given a daily dose of 0.15 ml, 0.1 ml, and 0.05 ml of Duprost (dutasteride) respectively for 42 days. After the mentioned periods, the mice of all groups were sacrificed and the spleen of each animal was removed, processed, sectioned and stained for histological analysis. In the acute group, all mice that were dosed with 0.25 ml dose passed after 15 minutes of dosing. The histological analysis of spleen in residual mice of acute subgroups showed marked congestion and edema. In comparison with chronic subgroups in which depletion of white pulp had been noticed in addition to the absence of follicles and decreased the size of the periarterial lymphatic sheaths (PALS), irregular bands of fibrosis and early collagen deposition causing distortion of the splenic contour is observed. Moreover, there was an expansion of red pulp with increased cellularity and size of the red pulp. And the separation of splenic cords by irregularly shaped wide sinusoids.

Anal dysplasia among solid organ transplant recipients; a cross sectional study / Displasia anal entre receptores de transplantes de órgãos sólidos - um estudo transversal

ABSTRACT Introduction: The incidence of anal cancer in United States has increased over of the last few decades impacting immunosuppressed populations like solid organ transplant recipients, in particular. The aim of this study was to evaluate the prevalence of anal dysplasia among solid organ transplant patients. We also attempted to identify factors that predispose solid organ transplant recipients to developing anal dysplasia. Methods and materials: Patients presenting to transplant office for routine care were recruited to participate in the study. All anal cytology specimens were collected using standard anal pap technique. The results were assessed using Bethesda classification. Information on perceived risk factors for development of anal dysplasia among our subjects was obtained. Results: Among 80 patients approached, 47 agreed to participate in the study. Of all the samples 19.1% had an inadequate amount of specimen to perform any analysis. Dysplastic cells were found in 10.5% of the specimens available for analysis. We were not able to identify any risk factors including age, gender distribution, smoking, and duration of immunosuppression that were statistically significant different between patients with anal dysplasia versus those without anal dysplasia. Conclusions: The rate of anal dysplasia detectable on cytology is high enough to warrant anal dysplasia screening in transplant recipients, which can then be followed up with high-resolution anoscopy with biopsy. Defining a cohort of patients among solid organ transplant recipients who are at an increased risk for the development of anal dysplasia mandating screening continues to be a challenge.

RESUMO Introdução: A incidência de câncer anal nos Estados Unidos aumentou nas últimas décadas, afetando populações imunossuprimidas, especialmente receptores de órgãos sólidos. O objetivo deste estudo foi avaliar a prevalência de displasia anal entre pacientes que receberam transplante de órgãos sólidos. Os autores buscaram identificar fatores que predispõem os receptores de transplante de órgãos sólidos a desenvolverem displasia anal. Métodos e materiais: Pacientes que se apresentaram ao consultório de transplante para acompanhamento de rotina foram recrutados para participar do estudo. Todos os espécimes de citologia foram coletados usando a técnica padrão de Papanicolau anal. Os resultados foram avaliados usando a classificação de Bethesda. Foram coletados dados sobre os fatores de risco percebidos para o desenvolvimento de displasia anal entre os participantes. Resultados: Dos 80 pacientes abordados, 47 concordaram em participar do estudo. Do total de amostras, 19,1% tinham uma quantidade inadequada para realizar qualquer análise. Células displásicas foram encontradas em 10,5% dos espécimes disponíveis para análise. Não foi possível identificar quaisquer fatores de risco, incluindo idade, distribuição de gênero, tabagismo e duração da imunossupressão, que foram estatisticamente diferentes entre pacientes com displasia anal e aqueles sem displasia anal. Conclusões: A taxa de displasia anal detectável na citologia é alta o suficiente para justificar a triagem em receptores de transplante, que pode então ser acompanhada com anuscopia de alta resolução com biópsia. A definição de triagem para uma coorte de pacientes entre os receptores de transplantes de órgãos sólidos que apresentam risco aumentado para o desenvolvimento displasia anal continua a ser um desafio.

Assessment of Parents Knowledge about Oral Health in National Guard Primary Schools, Riyadh, Saudi Arabia

Aim: Evaluation of parents’ knowledge about oral health in primary schools of the National Guard, Riyadh. Methods: A cross-sectional study was carried out in King Abdullaziz Iskan City. Parents of 257 school children, who completed a self-administrated questionnaire, were involved in this study. Results: It was revealed that there was a lack of knowledge and awareness of the importance of fluoride, regular dental visit, and plaque. In contrast, good knowledge about brushing and the relation between oral health and general health was observed. Also, a mother with a high level of education has knowledge better than mothers who have a low level. In addition, the families with higher income have more knowledge especially about fluoride and dental visits. Conclusion: Parents’ knowledge about the importance of oral health needs to be improved because children mostly gain knowledge about oral health and hygiene from their parents and then start establishing their habits. Coordinated efforts by dentists and other health professionals are required to impart dental health education about oral health and preventive care among parents.

Management issues during postinfarction ventricular septal defect and role of perioperative optimization: A case series

The development of a myocardial infarction ventricular septal rupture is a rare fatal complication, and the surgical repair is the treatment of choice. In most of the scenarios, the operation will be done as an emergency procedure that carries high mortality. Prognosis of these patients depends on prompt echocardiographic diagnosis and the proactive medical and surgical therapy. More recently, various options have been put forward including the timing for surgery, percutaneous closure devices, and the improved outcome with initial stabilization with medical treatment including mechanical support. In this retrospective case series, we are presenting the management of these patients who presented us in different clinical scenarios and trying to identify the risks for the poor outcome and to formulate a strategy to improve the outcome.

Un análisis crítico de los debates acerca del duelo y el trastorno depresivo en la era del Manual Diagnóstico y Estadístico de los Trastornos Mentales / A critical analysis of debates on grief and depressive disorder in the age of the Diagnostic and Statistical Manual of Mental Disorders

RESUMEN Desde la incorporación del trastorno depresivo mayor en el Diagnostic and Statistical Manual of Mental Disorders (DSM-III) de 1980, hasta su actualización en el DSM-IV-TR, el sistema clasificatorio DSM consideró necesario incluir el criterio de "exclusión por duelo", con el objetivo de diferenciar la tristeza normal, vinculada a una pérdida, de un trastorno mental, como el trastorno depresivo mayor. En su última versión (DSM-5), esta excepción fue suprimida, dando lugar a una controversia que se extiende hasta nuestros días. El debate ha confrontado a quienes están a favor de mantener y extender la exclusión a otros estresores y aquellos que han querido erradicarla. Nuestra hipótesis es que estas posiciones darían cuenta de dos matrices clínicas y epistemológicas cualitativamente diversas ligadas a las trasformaciones mayores que han experimentado las ciencias de la salud y la psiquiatría. Mostramos que este debate involucró una renovación profunda del sentido de la práctica psiquiátrica, un cambio en la función del diagnóstico y el modo de concebir la etiología de la enfermedad mental, así como, una reformulación del estatuto del sufrimiento del paciente para el acto médico.

ABSTRACT Since the incorporation of the major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980, and until its update in the DSM-IV-TR, the DSM classification system considered it necessary to include the criterion of "bereavement exclusion", with the aim of differentiating normal sadness linked to a loss, from a mental disorder, such as the major depressive disorder. In its latest version (DSM-5), this exception was removed, giving rise to a controversy that continues to this day. The debate has set those who are in favor of maintaining this exclusion and extending it to other stressors against those who have intended to eradicate it. Our hypothesis is that these positions account for two qualitatively diverse clinical and epistemological matrices, linked to major transformations in health sciences and in psychiatry. We show that this debate involved a profound renewal of the meaning of psychiatric practice, a change in the function of diagnosis and in the way of conceiving the etiology of mental disorders, as well as a reformulation of the patient's suffering status for the medical act.

Especialidades derivadas de la cirugía general: revisión de brechas e intención de residentes de la especialidad en Chile / Gaps between country needs and intentions to obtain a subspecialty among general surgery trainees in Chile

The fragmentation of a general specialty in subspecialties or derived specialties is a widely spread reality. Chilean health care system is becoming more complex, requiring more specialists. On the other hand, doctors in specialty training increasingly choose a subspecialty to continue their training and professional development. This contrasts with the growing need for well-trained general surgeons. We aimed to compare the evidence about the needs for general surgeons and the perspectives of Chilean physicians about their specialty training. A literature review about the intention of specialization in Chilean general surgery residents and the gaps in the Chilean health system, was performed. As of December 2016, there were 2,103 general surgeons in Chile, of whom 598 (28%) also have a subspecialty. Among the latter, 49% are plastic or vascular surgeons, which are also the specialties with the greatest demand in the public system. According to estimates of the Chilean Ministry of Health, on that year there was a deficit of 285 general surgeons and 142 subspecialists. These figures correspond to 18.5% and 23.8% of the existing resources. A survey published in 2009 reported that 78% of trainees in general surgery would prefer to continue studying a subspecialty, following the trend observed in the USA and Europe. Therefore, there is a disproportion between the intentions of general surgery trainees and the needs for these professionals in Chile.