It's not always postdural puncture headache: a case report and note to the astute anesthesiologist

Abstract Dural puncture is either diagnosed by unexpectedly profound response to medication test dose or development of a postpartum postural headache. Epidural blood patch is the gold standard for treatment of PDPH when conservative management fails. However, postpartum headaches can be resistant to multiple epidural blood patches. In such cases, preexisting intracranial processes should be considered and ruled out. We report here the unique case of a pregnant patient who developed a resistant headache in the postpartum period related to an incidental intracranial aneurysm. Subsequent treatment with endovascular embolization adequately relieved her symptoms. Early surgical consultation and a multidisciplinary team approach involving neurology and neuroimaging is required for successful management of patients such as the one described here.

Prevalence and Risk Factors of Sarcopenia Among Community Dwelling Older Adults in Klang Valley

@#Introduction: Sarcopenia is one of the geriatric syndromes affecting the ability of older adults to lead an independent living. However, its risk factors among Malaysian older adults are yet to be determined. This study investigated the prevalence and risk factors of sarcopenia among community-dwelling older adults in Klang Valley. Methods: This cross-sectional study involved 393 Malaysians aged 60 and above, residing in urban areas of Klang Valley recruited through convenience sampling. Socio-demographic and food intake information were obtained using validated questionnaires. Cut-off points for sarcopenia screening were obtained from the Asian Working Group of Sarcopenia(AWGS) while body impedance analysis(BIA) was employed to determine skeletal muscle index. A handgrip dynamometer was used to assess dominant handgrip strength and a 6-meter gait speed test was used to determine walking speed. Binary logistic regression analysis was used to determine the risk factors of sarcopenia. Results: Prevalence of sarcopenia was 33.6% and women(35.9%) were more affected compared to men(30.1%). The mean age of women assessed to have sarcopenia(69.1±6.5 years old) was higher compared to men(68.3±5.8 years old) (p<0.05). After adjusting for confounding factors, older adults with one year increased in age and one mg decreased in habitual dietary iron intake were estimated to be 1.08 times and 0.93 times the chances to have sarcopenia respectively. Conclusion: Approximately one-third of community-dwelling older adults in Klang Valley were assessed to have sarcopenia. Older adults aged 60 years and above and those with low dietary iron intake were at an increased risk of developing sarcopenia.

Mechanical and thermal stress analysis of hybrid ceramic and lithium disilicate based ceramic CAD-CAM inlays using 3-D finite element analysis / Análise do estresse mecânico e térmico de inlays de cerâmica hibrida e de cerâmica a base de dissilicato de lítio através da análise em 3D de elementos finitos

Objective: The aim of this study was to analyze mechanical and thermal stresses of hybrid ceramic and lithium disilicate based ceramic of CAD/CAM inlays using 3D Finite element analysis. Material and Methods:A three dimensions finite element model of permanent maxillary premolar designed according to standard anatomy with class II cavity preparation for inlay restored with two different ceramic materials: 1- Hybrid ceramic (Vita Enamic), 2- Lithium disilicate based ceramic (IPS e.max CAD). Totally six runs were performed on the model as: One loading case for each restorative material was tested in stress analysis; seven points of loading with 140N vertically applied at palatal cusp tip and cusp slop, marginal ridges and central fossa while the models base was fixed as a boundary condition in the two cases. Two thermal analysis cases were performed for each restoration material by applying 5ºC and 55ºC on the crown surface including the restoration surface. Results:The results of all structures were separated from the rest of the model to analyze the magnitude of stress in each component. For each group, maximum stresses on restorative materials, cement, enamel, and dentin were evaluated separately. Both ceramic materials generated similar stress distribution patterns for all groups when a total occlusal load of 140 N was applied. Conclusion: Thermal fluctuations of temperature have a great influence on the stresses induced on both restoration and tooth structure. IPS e.max CAD produced more favorable stresses on the tooth structure than Vita Enamic. (AU)

Objetivo: O objetivo deste estudo foi analisar o estresse mecânico e térmico de inlays de cerâmica hibrida e a base de dissilicato de lítio através da análise em 3D de elementos finitos. Material e Métodos: Foi realizado o design de um modelo de três dimensões em elementos finitos de um pré-molar superior de acordo com os padrões anatômicos de um preparo de cavidade classe II para restauração de inlay em dois tipos de cerâmicas diferentes: 1 Cerâmica hibrida (Vita Enamic), 2 ­ Cerâmica a base de dissilicato de lítio (IPS e.max CAD). No total, seis execuções foram realizadas no modelo como: Uma carga para cada material restaurador foi testado para análise de tensão; sete pontos de carga com 140N foi aplicado verticalmente na ponta da cúspide palatina, saliência da cúspide, cristas marginais e fossa central enquanto a base do modelo foi fixada como uma condição de limite nos dois casos. Duas análises térmicas foram realizadas para cada material de restauração, aplicando 5ºC e 55ºC na superfície da coroa, incluindo a superfície da restauração. Resultados: Os resultados de todas as estruturas foram separados do resto do modelo para analisar a magnitude do estresse de cada componente. Para cada grupo, o máximo de estresse nos materiais restauradores, cemento, esmalte e dentina foram avaliados separadamente. Padrões similares de distribuição de estresse foram gerados em todos os grupos para ambos os materiais cerâmicos, quando a carga oclusal de 140 N foi aplicada. Conclusão: As variações térmicas de temperatura têm uma grande influência nas tensões induzidas na restauração e na estrutura dentária. IPS e.max CAD produziu tensões mais favoráveis na estrutura dentária do que o Vita Enamic (AU)

Multi-state outcome analysis of treatment interventions after failure of non-surgical root canal treatment: a 13-year retrospective study

Abstract Objective To examine the factors affecting the transitions through treatment interventions after failure of non-surgical root canal treatment (NS-RCT). Methodology Insurance enrollment and claim information for enrollees of Delta Dental of Wisconsin (DDWI), USA were analyzed for 438,487 initial NS-RCT procedures to determine the effect of initial provider type and other covariates on additional treatments (no additional treatment, nonsurgical retreatment, surgical retreatment and extraction). A multi-state model was created using the "mstate" R package. Transitions between the four states identified by Code on Dental Procedures and Nomenclature were analyzed. Cox proportional Hazards regression stratified by transition type was used to estimate the effect of provider type on the risk of each transition, adjusting for covariates. Results The overall survival rates for all teeth that were treated by NS-RCT was 82.8% [95% CI 82.57%, 83.11%] at 10 years. Approximately, 7% of cases changed from the first state of initial NS-RCT during the 13-year study period with ultimately 0.9%, 0.4% and 5% of cases receiving non-surgical retreatment, surgical retreatment or extraction, respectively. Teeth are more likely to be retreated non-surgically than surgically, and to be extracted than retreated. In general, the probability of a tooth having non-surgical retreatment was higher if the initial provider was not an endodontist (Hazard Ratio (HR)=3.2). Molars were more likely to be non-surgically retreated (HR=2.0) or extracted (HR=2.8) when compared to anterior teeth. The probability of non-surgical retreatment (HR=0.93) or extraction (HR=0.50) was lower when a crown was placed within 90 days after NS-RCT. Conclusion Most teeth remained in the same state after treatment with no additional treatment transitions. When a transition occurred, it was more likely to be an extraction. Type of provider, age, location of the tooth, gender, and time to placement of final restoration significantly influence treatment transitions.

Serum expression of microRNA-16 in a cohort of Egyptian patients with ulcerative colitis and its correlation with disease extent and severity / Expressão sérica do microRNA-16 em uma coorte de pacientes egípcios com colite ulcerosa e sua correlação com a extensão e gravidade da doença

Abstract Ulcerative colitis is one of the IBDs. Its etiology and pathogenesis remain undefined with an interaction between environmental, genetic and immunological factors is the most accepted explanation. Several recent studies have examined microRNA expression in the peripheral blood and tissues from IBD patients. The study aims at assessing the expression of serum miR-16 in ulcerative colitis patients and its correlation with disease extent, activity and severity. It included 30 treatment naïve ulcerative colitis patients of different presentations. Serum miR-16 expression was assessed using reverse transcriptase quantitative real time PCR (RT-qPCR), and then correlated with that of a group of 20 healthy subjects to assess its role in diagnosis of ulcerative colitis. Also, it was correlated with disease extent (proctitis, left sided colitis, extensive colitis) and disease activity and severity indices (Truelove and Witts criteria, fecal calprotectin and UCEIS). Thirty ulcerative colitis patients were enrolled, 53% had mild, 37% had moderate, while 10% had severe disease. Concerning endoscopic extent, 8 had proctitis, 14 had left sided colitis and 8 had extensive colitis. Serum expression of miR-16 in the 30 patients were compared to that of the healthy control subjects. The patients' group showed median serum miR-16 expression of 1.91, 1.13 for the control group with a significant difference between both groups. Correlation between serum miR-16 expression with disease extent, activity and severity showed no significant relation. From the current study we can conclude that increased serum expression of miR-16 is associated with ulcerative colitis despite no significant relation to disease activity extent or severity.

Resumo A colite ulcerativa é uma das DII. Sua etiologia e patogênese permanecem indefinidas; a interação entre fatores ambientais, genéticos e imunológicos é a explicação mais aceita. Vários estudos recentes avaliaram a expressão de microRNA no sangue e tecidos periféricos em pacientes com DII. O presente estudo teve como objetivo avaliar a expressão do miR-16 sérico em pacientes com colite ulcerativa e sua correlação com a extensão, atividade e gravidade da doença. Foram incluídos 30 pacientes de colite ulcerativa, com diferentes apresentações, que ainda não haviam sido submetidos a nenhum tipo de tratamento. A expressão sérica de miR-16 foi avaliada usando transcrição reversa seguida de reação em cadeia da polimerase quantitativa (RT-qPCR) e, em seguida, correlacionada com a de um grupo de 20 indivíduos saudáveis para avaliar seu papel no diagnóstico de colite ulcerativa. Além disso, foi feita uma correlação com a extensão da doença (proctite, colite do lado esquerdo, colite extensa) e com os índices de atividade e gravidade da doença (critérios de Truelove e Witts, calprotectina fecal e UCEIS). Trinta pacientes com colite ulcerativa foram incluídos no estudo, classificada como leve em 53%, moderada em 37% e grave em 10%. Quanto à extensão endoscópica, oito apresentavam proctite, 14 apresentavam colite do lado esquerdo e oito apresentavam colite extensa. A expressão sérica de miR-16 nos 30 pacientes foi comparada à dos indivíduos controle saudáveis. No, grupo de pacientes, a expressão sérica de miR-16 foi de 1,91 (grupo controle: 1,13), uma diferença estatisticamente significativa entre os dois grupos. Não foi observada relação significativa entre a expressão sérica de miR-16 e a extensão, atividade e gravidade da doença. A partir do presente estudo, pode-se concluir que o aumento da expressão sérica do miR-16 está associado à colite ulcerativa, apesar de não haver relação significativa com a extensão ou gravidade da atividade da doença.

Management of chronic anal fissures: a narrative review

Anal fissures are often encountered in surgical practice in both sexes. It is a distressing disease impacting quality of life and causes profound morbidity among those affected. If left untreated, it may lead onto perianal abscess or even malignancy in long standing cases. Surgery is the gold standard management for chronic anal fissures. Recently the widespread use of pharmacologic agents for chronic fissures has increased. The management of chronic anal fissures has migrated to an era of multifaceted approach. This narrative review looks into various studies spanning over a period of 16 years. Various articles were shortlisted and analyzed for efficacy of various treatment methods, their impact in hospital stay, quality of life improvement, recurrence rate and complications among various treatment methods. We concluded from this review, that open lateral internal sphincterotomy is still the gold standard method of treatment for chronic anal fissure. Among pharmacological agents, 2% diltiazem has the best effectiveness with good compliance rate. Modern surgical techniques like VY plasty can be reserved for special situations. We do not recommend the practice of manual anal dilatation.

Device associated infections among neonates in neonatal intensive care units: a single unit survey study in Cairo, Egypt

Background: Device Associated Infection (DAI) namely Ventilator Associated Pneumonia (VAP) and Central Line Associated Blood Stream Infection (CLABSI) is one of the challenges for both neonatal nurses and doctors. Aims of the study were 1) Assess the rate of DAI occurrence among neonates, 2) explore the relationship between DAI rates and certain risk factors such as nurse patient ratio, hand hygiene practice, gestational age (GA), weight, and length of hospital stay among neonates.Methods: Descriptive correlational survey research design. Sample: All neonates admitted in twelve months-duration were included (total number 1090 neonates). Nurses and doctors were observed for compliance to adequate hand hygiene technique. Tools: 1) Center for Disease Control (CDC) criteria to calculate DAI rates, 2) Hand hygiene five points checklist 3) Review of neonates charts to collect data as weight, GA 4) Ballard score and 5) nurse/patient ratio.Results: 24 neonates developed DAI, high significant negative correlations between DAI and infants' weight, GA, nurse/patient ratio and overall compliance to hand hygiene techniques were reported (p-value ?0.05). Length of hospital stay, inadequate hand hygiene technique had strong positive correlations with DAI rate (p-value ?0.05).Conclusions: Factors that could affect DAI were infant's weight, GA, length of hospital stay, inadequate hand hygiene technique and nurse/patient ratio. Recommendations: implementation of infection control programs to raise nurses as well as physicians' compliance to adequate hand hygiene technique and increase number of nurses in the Neonatal Intensive Care Unit (NICU) per shift.

The prophylactic effect of intravenous magnesium infusion on postoperative sore throat after thyroid surgery. A randomized clinical trial / Efecto profiláctico de la infusión de magnesio en dolor de garganta postoperatorio luego de una tiroidectomía. Un ensayo clínico aleatorizado

BACKGROUND: The reported incidence of postoperative sore throat (POST) varies widely from 14.4 to 100% with maximum severity at 4th to 6th postoperative hour. Nonetheless, it has increasingly become a common clinical problem particularly in thyroid surgery. Although POST usually resolves spontaneously in few days, it is likely to be the most common complaint. OBJECTIVES: Driven by the increased number of patients with post-intubation sore throat following thyroid surgery, the aim of the present study was to evaluate the effectiveness of perioperative magnesium infusion in attenuating POST after thyroidectomy. METHODS AND MATERIAL: 80 female patients undergoing thyroid surgery, were preoperatively randomized into one of 2 groups. The magnesium group received magnesium sulfate (30 mg/kg) in 100 ml of isotonic saline over 15 min before induction of anesthesia, followed by a continuous magnesium sulfate infusion (10 mg/kg/h) for the duration of the operation. The control group received the same volume and rate of isotonic saline. RESULTS: This study showed that perioperative magnesium infusion had significantly reduced the overall incidence and severity of POST. The incidence of POST at rest (patients who recorded non-zero POST score after thyroid surgery) in the control group was 75% while the incidence of POST in magnesium group was 37.5% which is lower and that was highly significance. Higher sedation scores were encoun tered on arrival to PACU in Magnesium group when compared to controls. CONCLUSIONS: We concluded that perioperative magnesium sulphate infusion effectively decreased overall POST incidence and severity after thyroidectomy with better hemodynamic stability, albeit higher risk of post operative sedation.

La incidencia reportada de dolor de garganta postoperatorio (POST) varía ampliamente de 14,4 a 100% con severidad máxima en la 4ta a 6ta hora postoperatoria. Sin embargo, se ha convertido cada vez más en un problema clínico común, particularmente en la cirugía de tiroides. Aunque la POST generalmente se resuelve espontáneamente en pocos días, es probable que sea la queja más común. OBJETIVOS: Impulsado por el mayor número de pacientes con dolor de garganta después de la intubación después de la cirugía de tiroides, el objetivo del presente estudio fue evaluar la efectividad de la infusión perioperatoria de magnesio para atenuar la POST después de la tiroidectomía. MÉTODOS Y METERIAL: 80 pacientes mujeres sometidas a cirugía de tiroides, fueron asignadas al azar preoperatoriamente en uno de los 2 grupos. El grupo de magnesio recibió sulfato de magnesio (30 mg/kg) en 100 ml de solución salina isotónica durante 15 minutos antes de la inducción de la anestesia, seguido de una infusión continua de sulfato de magnesio (10 mg/kg/h) durante la operación. El grupo control recibió el mismo volumen y tasa de solución salina isotónica. RESULTADOS: Este estudio mostró que la infusión perioperatoria de magnesio había reducido significativamente la incidencia general y la gravedad de la POST. La incidencia de POST en reposo (pacientes que registraron una puntuación POST distinta de cero después de la cirugía de tiroides) en el grupo de control fue del 75%, mientras que la incidencia de POST en el grupo de magnesio fue del 37,5%, que es menor y de gran importancia. Se encontraron puntajes de sedación más altos al llegar a la UCPA en el grupo Magnesio en comparación con los controles. CONCLUSIONES: Llegamos a la conclusión de que la infusión perioperatoria de sulfato de magnesio disminuyó efectivamente la incidencia general de POST y la gravedad después de la tiroidectomía con una mejor estabilidad hemodinámica, aunque un mayor riesgo de sedación postoperatoria.

Occurrence of antibiotic resistant Campylobacter in wild birds and poultry

Aims@#Campylobacter is a major cause of gastroenteritis in humans worldwide, particularly in developed countries and is reported to show an increased trend in antibiotic resistance. The purpose of this study was to determine the occurrence of Campylobacter in wild birds, poultry and in poultry environments in Selangor, Malaysia as well as to determine the rate of antibiotic resistance among Campylobacter isolates from poultry and wild birds. @*Methodology and results@#The wild birds were trapped near poultry farm areas and in open areas which were more than 5 km away from poultry farms (refered to as open environment). Of 57 wild birds trapped near the farm environment, 17.5% were positive for Campylobacter and out of these, 90% were Campylobacter jejuni. Of a total of 77 birds in the open environment, 22.1% were positive for Campylobacter and of these 88.7% were C. jejuni. The poultry farms consisted of 3 chicken and 2 duck farms. About 60% of the chickens and 44.8% of the ducks were positive for Campylobacter of which 80% were C. jejuni, while 20% were Campylobacter coli. The Campylobacter isolates were subjected to antibiotic susceptibility test using disk diffusion method against 12 antibiotics. All the isolates (100%) from wild birds around poultry houses were resistant to at least one antibiotic. @*Conclusion, significance and impact of study@#The findings showed 93% of the isolates from wild birds were resistant to at least two antibiotics. Campylobacter isolates from poultry in the farms were resistant to at least one antibiotic. The antibiotic resistant Campylobacter is of public health importance.

Functional Levels in Activities of Daily Living and Quality of Life in Older Adults with Diabetes / Jurnal Sains Kesihatan Malaysia

Diabetes is often associated with dysfunction in activities of daily living (ADL), especially among older adults.Hospitalisation of older adults is often followed by decline in functional status affecting their quality of life and well-beingafter discharge. The objective of this study was to determine the functional independence in carrying out basic activitiesof daily living, its relationship with quality of life, and the factors influencing the quality of life in hospitalised olderadults with diabetes. This cross sectional study was carried out on 104 diabetic patients (mean age: 67.5 ± 9.2 years) whowere receiving in-patient treatment. Face-to-face interviews were carried out to determine functional independence usingModified Barthel Index (MBI) as well as quality of life using the World Health Organization’s Quality of Life instrument(WHOQOL-BREF). Results showed that only 37.5% (n = 39) respondents were catergorised as being fully-independent.Among the domains in MBI, using the stairs recorded the lowest score followed by mobility. The physical domain in qualityof life also recorded the lowest score compared to other domains of quality of life. There were significant (p < 0.05),positive correlations between the overall MBI scores and all domains of quality of life; physical (rs = 0.70), psychology(rs = 0.50), social (rs = 0.33) and environmental (rs = 0.25). Hierachical multiple regression analysis showed MBI scoreshad significant influence on all domains of quality of life, with the largest influence on the physical domain i.e. 36% [F(1,92) = 82.14, p < 0.01, R2 = .36]. As a conclusion, hospitalisation reduces the functional independence in carrying outbasic activities of daily living as well as the physical aspect of quality life in older adults with diabetes. Therefore, it isimportant to provide rehabilitation in activities of daily living while the elderly diabetics while undergoing in-patienttreatment in order to maintain quality of life after discharge.

Occurrence of multidrug resistant (MDR) Campylobacterspecies isolated from retail chicken meats in Selangor, Malaysia and their associated risk factors

@#Aims:Campylobacter infection is one of the leading bacterial food-borne illness and most frequently reported in humans in developed countries. This study was designed to determine the prevalence of multidrug resistant (MDR) Campylobacterand the risk factors associated with their occurrence in broiler chicken meat retailed in markets. Methodology and results:A total of 210 samples consisting of 140 chicken meat and 70 swabs from weighing scales and cutting boards were collected. Isolates were cultured by passive filtration method, identified by biochemical tests and confirmed using PCR assay.Thirty-two(32/210) 15.2% were positive for Campylobacterof which (25/210) 11.9%, (6/210) 2.9% and (1/210) 0.5% were Campylobacter jejuni, C.coli andC.upsaliensis respectively. The isolates showed high resistance to ampicillin (62.5%), enrofloxacin (56.3%) and nalidixic acid (50.0%), while only 3.1% were resistant to streptomycin. Multidrug resistant isolates (resistance to at least one antibiotics in three classes or more) was high at 71.9%. The risk factors significantly (p<0.05) associated with Campylobactercontamination on chicken’smeat included poor workers hygiene {OR: 5.250 (95% CI: 0.988-27.895)}, wearing improper work attire {OR: 2.700 (95% CI: 1.144-6.374)}, poor protective equipment {OR 38.50 (95% CI: 2.915-508.463)}, poor environment/stall hygiene {OR 44.00 (95% CI: 2.193-882.66)}, and using tiled counter top surface {OR 6.667 (95% CI: 0.597-74.506). Conclusion, significance and impact of study:The finding of this study affirmed that lack or poor work hygiene, unclean environmental stall and protective equipment are associated with high occurrence of multidrug resistant Campylobacterspecies isolated from chicken meat

Retrospective and statistical study of pattern of acute poisoning among cases presented to emergency department of kafr el - sheikh governorate hospitals

Background: Acute poisoning is a common situation in emergency departments all over the world. It may cause severe complications and death. Treatment of these cases requires great medical care and significant costs. There are many differences with respect to the pattern and cause of acute poisoning between geographical regions, even within the same country

Objective: This study was carried out to assess the pattern of acute poisoning with drugs, chemicals and natural toxins in both adults and children in Kafr El - Sheikh Governorate hospitals

Methods: The study was conducted onacutely intoxicated cases admitted to some of Kafr El - Sheikh Governorate hospitals. The medical records of cases who were admitted due to acute poisoning from January 2015 to January 2017 were reviewed retrospectively

Results: This study included 1046 acute poisoned cases presented to ED. There were 85% less than 6 years old and 15 % more than 12 years old. .Number of males with toxic exposure was 421 while that of females was 625. Pharmacological agents, constituted the highest percentage of the poisoning [28.92%], followed by Insecticides [24.4 %], household products [20.45 %], food poisoning [12.5 %] and animal poisoning [8.03%].The majority of cases of acute poisoning were accidental [78.01%], followed by attempted suicide [21.98%].The majority of cases stayed at the hospital [51.9 %], while [40.8 %] Discharged from ED and about [7.2%] referred to nearest poison centers. 1027 patients [98.18%] recovered, only 1.3% developed complications

Conclusion: Accidental poisoning is still a significant cause of morbidity. Regarding the high prevalenceofpharmaceuticaldrugandhouseholdproductspoisoninginchildren, implementation of legislations to ban over the counter selling of medications and to sell potentially dangerous chemicals in childproof containers is recommended. Improving proper and complete medical record-keeping is also suggested for a better information access

Effect of wet mass on dextromethorphan hydrobromide matrix pellets

Dextromethorphan hydrobromide (DM) sustained release matrix pellets containing 10% w/w drug were prepared by an extrusion/spheronization technique. The effect of mixing different concentrations of ethyl cellulose (EC), hydroxypropyl methylcellulpse (HPMC K10), and Carbopol 934 with Avicel PH101 on the rheological properties of pellet wet mass was evaluated using mixer torque rheometry (MTR). The prepared pellets were characterized for size, drug content, and in-vitro DM release rate. The results showed that increasing the concentration of the hydrophobic polymer (EC) with Avicel PH101 decreased wet mass consistency, represented by mass mean line torque. Lower binder ratio was required for optimum wet massing, while mixing with swellable polymers (HPMC and Carbopol) caused a noticeable increase in both mean line torque and binder ratio. Combinations of HPMC and Carbopol at higher concentrations resulted in controlled in vitro release of DM from the prepared pellets. Furthermore, mathematical treatment of the in vitro release data of DM from the prepared pellets showed that all formulations except those containing 5% Carbopol plus 5% HPMC (F10) follow first order release. n values of these formulation were in the range of 0.09-0.40, which support an anomalous non-Fickian release.

Identification of Older Adults with Sarcopenia: Comparison of Two Methods / Jurnal Sains Kesihatan Malaysia

To compare the ability of methods based on skeletal muscle index (SMI) and another one by the European Working Group on Sarcopenia in Older People (EWGSOP) based on both muscle mass and physical function in identifying older adults with sarcopenia. Anthropometric measurements and physical performance (hand grip strength and gait speed) were performed. In order to determine the value of SMI, body impedance analysis was also carried out. A total of 426 older adults, mostly women (60.8%) with mean age of 68.4 ± 6.2 years participated in this study. Methods based on SMI and EWGSOP identified 50.5% and 32.2% older adults as sarcopenic respectively. Method based on SMI showed a significantly higher percentage of men (70.7%) were sarcopenic as compared to women (37.5%) (p < 0.05). No such difference was noted for EWGSOP method, with 28.7% of men were sarcopenic as compared to women (34.4%). Binary logistic regression indicated that aged 75 years and above (adjusted odds ratio: 3.3, 95% confidence interval: 1.9 – 5.6) and having arthritis (adjusted odds ratio: 2.5, confidence interval: 1.3 – 4.7) to be associated with sarcopenia as assessed using method recommended by EWGSOP. The lower prevalence of sarcopenia by EWGSOP as compared to SMI may be due to the more comprehensive method by EWGSOP. Further research regarding validation of these two screening methods against a gold standard of screening for sarcopenia is needed in order to identify the best method..

In vitro antischistosomal activity of venom from the Egyptian snake Cerastes cerastes

Abstract INTRODUCTION: We studied the potential in vitro antischistosomal activity of Cerastes cerastes venom on adult Schistosoma mansoni worms. METHODS: Live specimens of the horned viper snake, C. cerastes were collected from the Aswan Governorate (Egypt). Venom was collected from snakes by manual milking. Worms of S. mansoni were obtained from infected hamsters by perfusion and isolated from blood using phosphate buffer. Mortality rates of worms were monitored after 3 days of exposure to snake venom at LC50 and various sublethal concentrations (10, 5, 2.5µg/ml). Scanning electron microscopy was used to investigate tegumental changes in treated worms after exposure to LC50 doses of venom. RESULTS: The LC50 of C. cerastes venom was 21.5µg/ml. The effect of C. cerastes venom on Schistosoma worms varied according to their sex. The mortality rate of male and female worms after 48-h exposure was 83.3% and 50%, respectively. LC50 of C. cerastes venom induced mild to severe tegumental damage in Schistosoma worms in the form of destruction of the oral sucker, shrinkage and erosion of the tegument, and loss of some tubercle spines. CONCLUSIONS: The present study demonstrated that C. cerastes venom exerts potential in vitro antischistosomal activity in a time and dose-dependent manner. These results may warrant further investigations to develop novel schistosomicidal agents from C. cerastes snake venom.

Insulin-like Growth Factor Binding Protein-1/ alpha-fetoprotein versus Placental alpha microglobulin-1 for diagnosis of premature fetal membranes rupture.

Objectives: To compare insulin-like growth factor binding protein-1/alpha-fetoprotein (IGFBP-1/AFP) to placental alpha microglobulin-1 (PAMG-1) for diagnosis of premature fetal membranes rupture (PROM). Methods: 220 pregnant women ≥ 37 and < 39 weeks` gestation studied and classified into two groups; study group (PROM) and control group (no PROM). Examination of the studied women followed by abdominal ultrasound (TAS) and sterile vaginal speculum examination to visualize amniotic fluid leaking and for collection of samples for fern, nitrazine, AmniSure® and AmnioQuick® Duo+ tests on admission. Results: The sensitivity and specificity of AmnioQuick® Duo+ test to detect PROM was 93.6% and 86.4%; respectively compared to 95.5% and 89.1%; respectively for AmniSure® test, 72.7% and 80.9%; respectively for fern test and 76.4% and 83.6%; respectively for nitrazine test. PPV, NPV and accuracy of AmnioQuick® Duo+ test to detect PROM were 87.3%, 93.1% and 90%; respectively compared to 89.7, 95.1% and 92.3%; respectively for AmniSure® test, 79.2%, 74.8% and 76.8%; respectively for fern test and 82.4%, 77.97% and 80%; respectively for nitrazine test. AmnioQuick® Duo+ and AmniSure® tests had higher sensitivity, specificity, predictive values and accuracy to detect PROM compared to conventional diagnostic tests. Conclusion: AmnioQuick® Duo+ test for detection of IGFBP-1/AFP was rapid, accurate bedside test better than the individual conventional diagnostic tests and has same accuracy and performance like AmniSure® test.

Formulation and evaluation of orally disintegrating clopidogrel tablets

ABSTRACT Recent advances in drug delivery systems have aimed to achieve better patient compliance. One of these advances is the formulation of orally disintegrating tablets (ODTs) that dissolve instantaneously, releasing drugs within a few seconds without the need of water. The main objective of this paper was to prepare and develop ODTs of clopidogrel. The ODTs were prepared by direct compression. The effect of three superdisintegrants, namely crospovidone, croscarmellose sodium, and sodium starch glycolate, using three different disintegration times on the dissolution rate was investigated. The prepared tablets were evaluated for hardness, friability, disintegration time and in vitro drug release. Furthermore, the interaction of clopidogrel with the formulation excipients was studied using differential scanning calorimetry (DSC). DSC studies revealed that there were no interactions between the drug and the excipients used. All tablets had hardness values in the range 4.0-5.2 kp and friability lower than 1%. The weight and drug content uniformity of all formulations was within official limits according to BP. In vitro drug release studies of the ODTs showed that more than 90% of the drug was released within ten minutes. A palatability test in human volunteers showed acceptable taste and mouth feel. Thus, the obtained results conclusively demonstrated successful rapid disintegration of the formulated tablets and acceptable palatability.

RESUMO Recentes avanC'os em sistemas de liberaC'C#o de fC!rmacos novos visam C obtenC'C#o de melhor adesC#o do paciente. Um destes avanC'os C) a formulaC'C#o de comprimidos de desintegraC'C#o oral (ODTs), que se dissolvem instantaneamente, liberando o fC!rmaco, em alguns segundos, sem a necessidade de C!gua. O principal objetivo deste trabalho foi preparar e desenvolver ODTs de clopidogrel. Os ODTs foram preparados pelo mC)todo de compressC#o direta. Estudou-se o efeito de vC!rias concentraC'C5es de diferentes agentes de desintegraC'C#o, tais como super-crospovidona, croscarmelose de sC3dio, glicolato de amido de sC3dio no tempo de desintegraC'C#o e velocidade de dissoluC'C#o. Os comprimidos preparados foram avaliados quanto C dureza, C friabilidade, ao tempo de desintegraC'C#o e C liberaC'C#o do fC!rmaco in vitro. AlC)m disso, estudou-se a interaC'C#o de clopidogrel com os excipientes de formulaC'C#o, utilizando calorimetria de varredura diferencial (DSC). Estudos de DSC revelaram nC#o haver interaC'C#o entre o fC!rmaco e os excipientes utilizados. Todos os comprimidos possuC-am dureza na faixa de 4,0-5,2 kp e a friabilidade inferior a 1%. A variaC'C#o de peso e o teor de fC!rmaco de todas as formulaC'C5es mostraram-se dentro do limite oficial, de acordo com a BP. O estudo de liberaC'C#o do fC!rmaco in vitro de comprimidos ODTs mostrou que mais de 90% do fC!rmaco foram liberados em10 minutos. O teste de palatabilidade em voluntC!rios humanos mostrou sabor e sensaC'C#o na boca aceitC!veis. Assim, os resultados obtidos demonstraram, conclusivamente, a rC!pida e bem-sucedida desintegraC'C#o dos comprimidos formulados e a palatabilidade aceitC!vel.

Study of Interleukin-18 in chronic Hepatitis C Virus related liver diseases

Background and study aim: ELISA can determine serum Interleukin (IL)-18 level. It is a sensitive; simple and rapid test; thus help to study changes of serum IL-18 levels in chronic HCV related liver diseases during different stages. The objective of this study was to study serum IL-18 levels in chronic HCV related liver diseases. Patients and methods: Sera from 60 patients with HCV related chronic liver diseases at various stages of HCV infection (chronic hepatitis; cirrhosis and complications) and sera of 10 normal controls were subjected to measurements of serum IL-18 level by ELISA assay.Results: There were highly significant increase in the mean values of serum IL-18 in chronic HCV related liver cirrhosis; non complicated and complicated patients in comparison to chronic active hepatitis C patients and healthy subjects and highly significant increase in the mean values of serum IL-18 in complicated patients in comparison to non complicated patients. There was highly significant increase in the mean values of serum IL-18 in decompensated liver cirrhosis patients when compared to compensated patients. Conclusion: Serum IL-18 level shows highly positive significant correlation with severity of liver dysfunction in HCV related liver cirrhosis

role of religious programs in the development of satellite knowledge teenagers prophet's biography

Problem: First, through the media observed intensification in the recent period on religious programs on the biography of the Prophet peace be upon him and offered elders appeared intense images on the TV screens we do not know anything about the religious point of reference. Second, confirm and permit a large number of Muslim scholars and intellectuals and media experts that religious channels-are not all good, but not all evil, but they often do more harm than good. This fact, and warn that those channels and those behind the spread of religious programs

Limits of the study: Time limits The field study was conducted in the period from 11/ 01/ 2014 until 01/ 12/ 2014. The analytical study they were conducted in the period from 2012 to 2015

Sample: The study was applied to a sample of college students [Male, Female] in the age group of age [17-18] years in Ain Shams University and 6 October University. The study population. The research community in the adolescent segment of the [male and female], in the age group of [17-18] years, and in the Ain Shams University and 6 October University

Tools: Questionnaire

Results: Came watch religious programs satellite channels, where the answer is always came by 50% of the study sample, and was chosen sometimes by 50%. came religious programs you are watching satellite TV types in the first place, Biography of the Prophet, an average of 0.76, in second place came sermons an average of 0.45, while in third place, came bezel careful Show Prophetic Biography programs on satellite channels, where the answer is always came up 55.3% of the study sample, and was chosen sometimes by 44.7%

Problems and challenges faced in consumer reporting of adverse drug reactions in developing countries A case study of Yemen, Nepal and Malaysia.

Background: Pharmacovigilance is the “science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug related problems”. The most commonly used adverse drug reaction (ADR) reporting system worldwide is spontaneous and voluntary reporting, which forms the backbone of reporting systems. Aims: To explore the current status of consumer involvement in the pharmacovigilance program in three developing countries, Yemen, Nepal and Malaysia. Method: An analysis was carried out for these three countries based on the current status of pharmacovigilance and involvement of consumers in their pharmacovigilance programs. Results: Malaysia has a good system for involving consumers in their national pharmacovigilance system, whereas Yemen still lacks the well-formed national drug policy. Lack of legislation and regulation which govern the import and distribution of drugs in Yemen is a limiting factor for development of consumer pharmacovigilance. Despite establishment of a pharmacovigilance centre, no reports have been released by the centre. The status of pharmacovigilance in Nepal is still in infancy. The regulatory body is assigned to be a national pharmacovigilance center, and coordinates with seven regional centers for pharmacovigilance activities. Nepal also lacks the involvement of consumers in the national pharmacovigilance program. Conclusion: Consumer reporting may be important for developing countries to implement a proper and effective pharmacovigilance program that can reduce morbidity and mortality rates, as well as reducing the economic burden of ADRs.