Assessment of cardiac complication in diabetic patient of rural India

Background: Diabetes mellitus (DM) is a common endocrine disorder affecting approximately 382 million people worldwide. Diabetes mellitus (DM) is group of metabolic disorder in which glucose is underutilized, thus producing hyperglycemia resulting from a defect in insulin secretion, action, or both. Cardiovascular disease is the most common cause of death and disability among people with diabetes. The cardiovascular disease that accompany diabetes include angina, myocardial infarction (heart attack), Stroke, peripheral artery disease and congestive heart failure. In people with diabetes, high blood pressure, high cholesterol, high blood glucose and other risk factors contribute to the increased risk of cardiovascular complications.Method:  This study was conducted to determine the cardiac complication in diabetic patient of rural India. It was Cross sectional retrospective study, done in between period of January 2018 to December 2019.Result: In the present study authors found that   47.7% patients have Coronary artery disease (CAD), Silent 21.6% have myocardial ischemia (SMI), 36% Diastolic dysfunction (DF), 28.8% have Systolic dysfunction (SDF).Conclusion: In this study authors found that wide spectrum of cardiac complications in diabetic patients ranging silent myocardial ischemia to heart failure. CAD was the most common complication including silent myocardial ischemia (SMI) which is the one of the major concern of rural diabetic population which need proper screening by exercise treadmill test.

Endocrine disruption and infertility: Circulatory hormone and bisphenol A concentrations in infertile Saudi women

Aim: Human infertility is a public problem and a cause of social and psychological complications affecting more than 50 million couples globally. Bisphenol A (BPA) is a ubiquitous environmental endocrine disrupting chemical and has been associated with infertility problems in women.The aim of the present study was to analyze concentrations of bisphenol A and circulating hormones in infertile Saudi women for evaluating the association of BPA with infertility.Methodology: The present study was done on 43 infertile women for evaluating possible association of systemic BPA concentrations with infertility in Saudi Arabia. The clinical indications were irregular menses, hyper-androgenism, multiple small ovarian cysts, polycystic ovarian syndrome and unexplained infertility. Blood samples from infertile women and a control group of 18 healthy fertile women were analyzed and compared for concentrations of BPA and circulatory hormones. Results: The results showed that BPA concentrations were not significantly different between infertile women and controls. BPA concentrations were also not correlated with systemic hormone concentrations in infertile women. Interpretation: Serum BPA levels had no association with hormone imbalance in this cohort of infertile Saudi women. However, considering the previous studies that have shown a relationship of BPA with female infertility, an argument can be made that there might be lower exposure of Saudi population to BPA in comparison to BPA analogues such as BPS (according to recent reports). Therefore, it is suggested to conduct more infertility studies that include detection of BPA and its analogues in infertile Saudi women

Significance of serum angiogenin assay as a novel marker for diagnosis of hepatocellular carcinoma in liver cirrhosis: a comparative study

Background: Hepatocellular carcinoma [HCC] is the third most common cause of cancer-related death worldwide. Angiogenin [ANG] is a potent angiogenic factor first isolated from the culture medium conditioned by colon carcinoma cells. Many reports have demonstrated an elevated serum ANG level in patients with various malignancies including colorectal carcinoma, melanoma, and pancreatic carcinoma. These results pointed to serum ANG as a novel marker for the diagnosis, progression, and aggressiveness of malignant tumors

Objective: The aim of this study was to evaluate the clinical significance of serum ANG as a novel marker for the diagnosis of HCC in liver cirrhosis and compare it with serum alpha-fetoprotein [AFP]

Patients and methods: The study included 40 patients who were divided into group I and group II. Group I included patients with HCC and group II included those with liver cirrhosis. Group III included age-matched and sex-matched apparently healthy controls. Patients in group I were further classified according to the TNM system into subgroup Ia, which included patients with tumor size less than or equal to 2 cm, and subgroup Ib, which included patients with tumor size greater than 2 cm. All individuals were subjected to an assay for evaluating the serum level of AFP and serum ANG

Results: For the diagnosis of HCC, serum AFP showed a sensitivity of 91.7% and specificity of 80%, whereas serum ANG showed a sensitivity of 95.8% and specificity of 85.7%. In discriminating patients with early hepatic cancer from those with more advanced stages, serum AFP showed a diagnostic sensitivity of 70% and specificity of 89.8%, whereas serum ANG showed a diagnostic sensitivity of 90% and specificity of 85.7%

Conclusion: Serum ANG is a promising marker for the diagnosis of HCC, being superior to serum AFP in both sensitivity and specificity. Moreover, serum ANG efficiently discriminates early from late stages of HCC

Nurses' perception of barriers to research utilization in a public hospital in Saudi Arabia

To explore nurses' perception of barriers to research utilization. A descriptive study was implemented. A total of 243 registered nurses in a public hospital in Riyadh, Saudi Arabia was selected using convenience sampling during the first quarter of 2013. The 29-item BARRIERS scale was used. The top 5 items were rated as great or moderate barriers were either setting- or nurse-related: 'insufficient time to implement new ideas' [n=157, 64.6%]; 'nurse sees little benefit for self [n=150, 61.7%]; 'nurse does not feel she/he has enough authority to change patient care procedures' [n=l46 60.1%]; 'nurse is isolated from knowledgeable colleagues' [n=l45; 59.7%]; and 'nurse does not have time to read research' [n=l43, 58.8%].Setting- and nurse-related items comprised the top 5 barriers. Motivation issues, and knowledge-translation issues appeared to be the themes drawn from this study. Further studies using both quantitative and qualitative methods are needed

Ethnic difference in serum antibodies to oxidized low density lipoprotein in healthy Malaysian subjects.

Background: Some populations are more susceptible to atherosclerotic diseases than others. Indians had a higher mortality due to coronary heart disease (CHD) than Chinese and Malays. Antibodies to oxidized low density lipoprotein (Ab-oxLDL) are produced as an immune response to oxidized low density lipoprotein (oxLDL). The difference in prevalence of CHD among the ethnic groups may be related to the immune response. The objectives of this study were to determine the serum Ab-oxLDL levels and lipid profile among the three major Malaysian ethnic groups. Methods: The participants of this study were 150 healthy subjects consisting of 50 Malays, 50 Chinese and 50 Indians. Serum Ab-oxLDL was measured by enzyme immunoassay method. Serum triglycerides and total cholesterol were measured by enzymatic methods. Serum high density lipoprotein cholesterol (HDL-C) was measured by precipitation method and low density lipoprotein cholesterol (LDL-C) was calculated using Friedewald formula. Results: AboxLDL level [adjusted mean (95% of CI)] was highest in Malays [1404 (1202-1607) mU/mL] followed by Chinese [1026 (829-1223) mU/mL] and Indians [954 (744-1163) mU/mL] (P = 0.006) and HDL-C level was highest in Chinese [1.53 (1.44-1.61) mmol/L] followed by Malays [1.44 (1.35-1.53) mmol/L] and Indians [1.35 (1.26-1.45) mmol/L] (P = 0.035). Conclusion: Our results indicate that Ab-oxLDL and HDL-C levels differed by ethnic and AboxLDL may have antiatherogenic properties among Malaysian ethnic groups.

Women and epilepsy: Sudanese experience

Epilepsy is equally prevalent in men and women. However; for women there are unique concerns related to hormone effects on seizures and the effects of seizures and antiepileptic drugs (AEDs) on reproductive health. Some AEDs reduce the efficacy of oral contraceptive agents; increasing the probability of unplanned pregnancies. Seizure frequency may change during pregnancy; seizures may cause pregnancy complications; and the treatment of a woman with epilepsy must consider all these issues. Objective: To study the clinical presentation of epilepsy among adult Sudanese females and to verify aspects of epilepsy specific to women. Methods: This is a cross sectional descriptive non intervention clinical based study; it was carried out in Elshaab Teaching Hospital and El-shiekh Mohamed Kheir charity clinic; from February-2008 to June- 2008. 630 female patients with epilepsy were included in the study. Results: The study showed that 72of the patients had generalized epilepsy and 28had partial epilepsy; primary epilepsy is more common than secondary epilepsy; 54of our patients had warning symptoms and 39.7had triggering factors; irregular menstrual cycle was observed in 28; 22of our patients had catamenial seizures; 7.1had increased frequency of seizures during pregnancy. Obstetric complications were common among our studied group. The incidence of infertility increased among our studied group. Conclusion: Women had differences in presentation and control of epilepsy that must be understood and considered when treating women with epilepsy

case of castor bean poisoning

Castor beans, sometimes used in traditional therapies, contain ricin one of the most toxic substances known. It may cause an acute and potentially fatal gastroenteritis in addition to neurological and ophthalmological lesions. Poisoning may also lead to delayed visceral damages; however, the latter is quite rare. The toxicity is dose related and depends on the amount of castor beans ingested. There is no specific treatment and symptomatic management to reduce the load of the toxin needs to be initiated quickly and early when a case of poisoning is suspected so that serious complications will be avoided. Increasing the awareness of the population to the dangers of ricin would be a way to avoid the utilisation of castor seeds in traditional therapies. Here we are reporting a case of mild poisoning after ingestion of a single castor bean. The patient, who presented at Nizwa Hospital, Oman, fortunately recovered completely as the ingested dose was quite small

KTP laser debulking of recurrent nasal polyps: a preliminary report

Surgery for recurrent nasal polyposis is a challenging task. Although surgical lasers were introduced more than 30 years ago, their use and popularity in nasal and sinus disease have been limited. This study was conducted in a prospective manner with the aim of reporting the results of the endoscope assisted KTP laser in debulking recurrent nasal polyps. 25 Patients with recurrent nasal polyps complaining of nasal obstruction refractory to medical therapy were subjected to KTP laser debulking of these polyps under local anesthesia. Five patients were lost in the follow-up period. Subjective assessment of the patients symptoms revealed improvement of all patients at 3 months and of 90% of the patients at 6 and 12 months. Endoscopic examination revealed no polyps at 3 months. Recurrent polyps were detected in 4 patients [20%] at 6 months, 2 of them were symptomatic, so they were subjected to further laser debulking of these polyps. None of our patients had recurrent polyps at 12 months. KTP laser has proved to be an effective tool in debulking recurrent nasal polyps with minimal complications, excellent patients tolerability and recurrence rate which is comparable to conventional endoscopic techniques

Radionuclide-assisted sentinel lymph node localization and biopsy in management of early invasive breast cancer

The value of sentinel lymph node[s] [SLN[s]] biopsy rests on the concept that a single lymph node [sentinel node] is the first of a group of lymph nodes that receives drainage of a specific body segment. In theory, by surveying this single node, tumor movement from the primary site can be predicted for the remainder of the lymph node basin. Should the sentinel node be free of tumor, the remaining lymph nodes of the basin are presumed to be negative, and the patient may be spared unnecessary axillary lymph node dissection. This study was conducted at 3 different centers during the period from December 2002 till May 2006. The study involved 60 females with early invasive breast cancer [T[1]-T[2], Clinically N[0] M[0]]. Localization of SLN[s] was performed by the combination of 3 techniques; operative lymphoscintigraphy, and intraoperative isosulfan blue dye mapping and hand-held gamma probe. After localization and excision of sentinel lymph nodes, axillary dissection, as well as, surgical management of the primary tumor was done. The specimens of SLN[s], non-SLN[s], and the primary tumor were examined separately for histopathology. Correlation between SLNs involvement and non-SLN[s] involvement was done. Among the 60 patients with early invasive breast cancer, the overall SLN[s] localization was successful in 90% cases. The sensitivity, the specificity, the predictive value positive test, the predictive value of negative test, as well as the accuracy of the histopathological yield of the SLN[s] biopsy were found to be 91.3%, 100%, 100%, 93.9% and 96.3% respectively. SLN[s] localization and biopsy is a good predictor of the histopathological status of axillary lymph nodes and can prevent unnecessary axillary dissection in early stages with node negative invasive breast cancer. The use of lymphoscintigraphy and gamma probe facilitates localization of SLN [s] and increases its accuracy

Estimation of tissue hypothyroidism in patients with overt and subclinical hypothoidism

The clinical score, and tests that reflect tissue hypothyroidism [ankle reflex relaxation time, serum cholesterol level] were reevaluated in the high of the modern laboratory tests of thyroid function. We analyzed 95 female subjects: 40 overt hypothyroid patients, 25 sub clinical hypothyroidism [SCH], and 30 euthyroid control subjects. The clinical score was defined as the sum of the 2 best discriminating signs and symptom. Beside TSH and thyroid hormones, we measured parameters known to reflect tissue manifestations of hypothyroidism, such as ankle reflex relaxation time and total serum cholesterol. So Classical signs and symptoms of hypothyroidism were present only in patients with sever overt hypothyroidism with low T3, It has been found that the clinical score, showed an excellent correlation with ankle reflex relaxation time p < 0.01 and serum cholesterol level p < 0.001, and CK p < 0.01 but not correlated with serum TSH in patient group with overt hypothyroidism. While in subclinical hypothyrodism the clinical score correlate significantly with ankle reflex relaxation time p < 0.01 with fT4 p < 0.01 with serum TSH p < 0.01 but not correlated other parameters It could be concluded That Scoring of symptoms and signs of hypothyroidism with the new clinical score and measurement of ankle reflex relaxation time in addition to routine thyroid function tests is very useful for the individual assessment of thyroid failure and monitoring of treatment

Genetic role in recurrent acute otitis media

There is increasing interest that a strong genetic component is involved in the predisposition to recurrent acute otitis media [rAOM]. Study of human leucocyte antigens [HLA], as a genetic marker, by microcytotoxicity test and polymerase chain reaction [PCR] of 31 patients of rAOM was done to find out the relation between them for clarifying the pathogenesis of recurrence. The study showed HLA B21 antigen of class I and HLA DR2 antigen of class II were significantly increased p value. This supports the presence of an immunogenetic factor in pathogenesis of rAOM

Adverse effects of chronic exposure to ambient benzene on the cochlea-an experimental study

The enrolled animals in this study were conducted to analyses the possible histological changes in the cochlea on chronic exposure to ambient benzene. The studied animals were 50 albino rats which were divided into two groups, benzene and control groups. The first group included 40 rats and subjected to benzene inhalation with the same criteria of its ambient inhalation. The control group was 10 animals which didn't expose to benzene. Two months later, the animals were sacrificed and the cochleae were processed for histopathological study. Degenerative changes of stria vascular [SV] were reported in 30% of animals of benzene group. Also, cloudy swelling of outer hair cells [OHC] in 20% and hydropic degeneration [OHC] in 10% of benzene group were recorded. No histopathological changes were noticed in control group. The changes were attributed to degenerative rather than inflammatory reactions. The possible mechanism of these changes was discussed. It was concluded that chronic exposure to ambient benzene has noxious effect on the cochlea and sensorineural hearing loss may arise and certain recommendations would be suggested

Valproate associated acute pancreatitis

There is a definitive association between valproate therapy and acute pancreatitis. More than 50 cases have been reported. Most of the reported cases were mild yet there were a few more cases with higher morbidity and mortality. The risk is higher in patients under 20 years of age, during the first year of therapy, on the patient having encephalopathy or chronic renal failure and on patients with anti-epileptic drug polytherapy. The treatment of pancreatitis is supportive, laparotomy should be avoided. Re-challenge is hazardous and should be avoided