Are radiological modalities really necessary for the long-term follow-up of patients having blunt solid organ injuries? A single center study / 世界急诊医学杂志（英文）

@#During the past two decades, management of blunt solid organ injuries had shifted from conventional surgery to more conservative approach, namely nonoperative management (NOM).[1] The non-operative approach mainly depends on the trauma experience of surgeons and the institution, quality of radiographic imaging and its interpretation.[2-5] If the surgeon decides to observe the patients by NOM, close monitoring of vital signs and frequent physical examinations must be done accordingly with radiological evaluations if needed.

Cone-beam computed tomography analysis of accessory maxillary ostium and Haller cells: Prevalence and clinical significance

PURPOSE: This study aimed to evaluate the prevalence of Haller cells and accessory maxillary ostium (AMO) in cone-beam computed tomography (CBCT) images, and to analyze the relationships among Haller cells, AMO, and maxillary sinusitis. MATERIALS AND METHODS: Volumetric CBCT scans from 201 patients were retrieved from our institution's Digital Imaging and Communications in Medicine archive folder. Two observers evaluated the presence of Haller cells, AMO, and maxillary sinusitis in the CBCT scans. RESULTS: AMO was observed in 114 patients, of whom 27 (23.7%) had AMO exclusively on the right side, 26 (22.8%) only on the left side, and 61 (53.5%) bilaterally. Haller cells were identified in 73 (36.3%) patients. In 24 (32.9%) they were present exclusively on the right side, in 17 (23.3%) they were only present on the left side, and in 32 (43.8%) they were located bilaterally. Of the 73 (36.3%) patients with Haller cells, maxillary sinusitis was also present in 50 (68.5%). On using chi-square test, a significant association was observed between AMO and maxillary sinusitis in the presence of Haller cells. CONCLUSION: Our results showed AMO and Haller cells to be associated with maxillary sinusitis. This study provides evidence for the usefulness of CBCT in imaging the bony anatomy of the sinonasal complex with significantly higher precision and a smaller radiation dose.

Cardiovascular risk profiles of adults with type-2 diabetes treated at urban hospitals in Riyadh, Saudi Arabia

Diabetes mellitus substantially increases cardiovascular disease [CVD] risk. Among Saudi Arabian citizens with diabetes, little is known about the prevalence and control of other CVD risk factors. We extracted data from medical records of a random selection of 422 patients seen between 2008 and 2012 at two diabetic clinics in Riyadh, Saudi Arabia. We calculated the proportion of patients who had additional CVD risk factors: obesity [body mass indexP 30 kg/m[2]], hypertension [BPP 140/90 mmHg], elevated cholesterol fractions, and multiple risk factors]. Further, we calculated the proportion of patients meeting the American Diabetes Association's recommended care targets for each risk factor. Of 422 patients [mean age, 52 years], half were women, 56% were obese, 45% had hypertension, and 77% had elevated LDL concentrations. In addition to diabetes, 70% had two or more CVD risk factors. Although 9%met both target HbA1c and BP values, only 3.5% had optimum HbA1c, BP, and lipid values. In Saudi Arabia's best diabetes clinics, most patients have poor control of their disease. This huge disease burden and related care gaps have important health and financial implications for the country

Type-B lactic acidosis associated with progressive multiple myeloma

We report a 64-year-old lady with stage II, Immunoglobulin-G lambda multiple myeloma [MM] [standard risk], who presented with type-B lactic acidosis [LA], and multi-organ dysfunction associating myeloma progression, and ending in imminent death. In the context of literature review of all previously reported similar cases, this report highlights and discusses the association of type-B LA and MM [especially progressive disease], and also emphasizes the poor outcome. Early recognition of this condition with intensive supportive care, and treatment of multiple myeloma may improve outcomes

Toxoplasma gondii infection in patients with schizophrenia

Background and Objectives: Schizophrenia is a complex chronic neuropsychiatric disease of the central nervous system, believed to have multiple etiologies. Toxoplasma gondii has emerged as an interesting candidate as a possible cause of some cases of schizophrenia. As there is scarce information about the seroprevalence of T. gondii infection in psychiatric patients in Erbil; we investigated the seroprevalence of T. gondii in schizophrenic patients and compared with that obtained from control individuals in Erbil correlated with inflammatory marker C-reactive protein

Method: This case control study included 93 schizophrenic patients seeking medical advice at Hawler Psychiatric Hospital and private clinics with 93 non psychiatric control were screened for the presence of anti-toxoplasma IgG, IgM [by ELISA test] and C-reactive protein using qualitative methods. A questionnaire was used to collect socio-demographic and behavioral data among the respondents

Results: In chronic cases anti-Toxoplasma gondii IgG antibodies were seropositive in 30/93 [32.3%] of the schizophrenic patients and 4/93[4.3%] of control [P <0.001]. The seropositive rate of IgM antibodies was 9.7% and 1.1% among schizophrenic patients and control, respectively [P = 0.006]. The result of C-reactive protein positivity among patients and control was 23.6% and 3.22%, respectively [P <0.001]

Conclusion: Our results delineate that association might exist between Toxoplasma gondii infection and schizophrenia etiology

O volume plaquetário médio abaixo do normal está associado com extensão reduzida de doença arterial coronariana / Lower than normal mean platelet volume is associated with reduced extent of coronary artery disease

FUNDAMENTO: A extensão da doença arterial coronariana aterosclerótica em pacientes com angina estável tem importantes implicações prognósticas e terapêuticas. Em modelos atuais de evolução de placas, os trombócitos desempenham um papel importante no crescimento de placas. O volume plaquetário médio é um marcador facilmente determinado, com evidência de correlação com a agregabilidade plaquetária in vitro, além de valores comprovadamente maiores após eventos vasculares agudos. OBJETIVO: No presente estudo, investigou-se a relação entre o volume plaquetário médio e a extensão angiográfica da doença arterial coronariana em pacientes com angina estável. MÉTODOS: Foram analisados prontuários, hemograma completo e dados angiográficos anteriores de 267 pacientes elegíveis com angina estável. A extensão angiográfica da doença arterial coronariana foi avaliada à luz de dados angiográficos, com o uso por um especialista do escore de Gensini em uma cardiologia invasiva. Os valores para o volume plaquetário médio foram obtidos a partir de hemogramas completos, obtidos um dia antes da angiografia. Com relação ao intervalo populacional para o volume plaquetário médio, os pacientes foram agrupados dentro (n = 176) e abaixo (n = 62) do referido intervalo. Foi realizada uma comparação entre grupos e uma análise correlacional. RESULTADOS: Não houve correlação linear entre o escore de Gensini total e o volume plaquetário médio (p = 0,29), ao passo que a contagem total de trombócitos apresentou correlação inversa com o volume plaquetário médio (p < 0,001, r = 0,41). Os pacientes com volume plaquetário médio abaixo do normal apresentaram um escore de Gensini (36,73 ± 32,5 vs. 45,63 ± 32,63; p = 0,023) e doença coronariana triarterial (18% VS. 36%; p = 0,007) significativamente inferiores se comparados com aqueles apresentando valores de volume plaquetário médio dentro dos intervalos populacionais. CONCLUSÃO: Nossas constatações não demonstraram nenhuma relação linear entre o volume plaquetário médio e a extensão da doença arterial coronariana, ao passo que os pacientes com volume plaquetário médio abaixo do normal apresentaram uma extensão reduzida da doença arterial coronariana.

BACKGROUND: Extent of atherosclerotic coronary artery disease in patients with stable angina has important prognostic and therapeutic implications. In current models of plaque evolution, thrombocytes play an important role in plaque growth. Mean platelet volume is a readily obtainable marker that was shown to correlate with platelet aggregability in vitro and increased values were demonstrated after acute vascular events. OBJECTIVE: In this study, we investigated the relationship of mean platelet volume and angiographic extent of coronary artery disease in patients with stable angina. METHODS: Past medical records, complete blood count and angiographic data of 267 eligible stable angina patients were reviewed. Angiographic extent of coronary artery disease was evaluated form angiographic data using Gensini score by an expert in invasive cardiology. Mean platelet volume values were obtained from complete blood counts that obtained one day before angiography. Patients were grouped as those within (n = 176) and lower than (n = 62) population-based range for mean platelet volume. Comparison between groups and correlation analysis was performed. RESULTS: There were no linear correlation between total Gensini score and mean platelet volume (p = 0.29), while total thrombocyte count was inversely correlated with mean platelet volume (p < 0.001; r = 0.41). Patients with lower than normal mean platelet volume had significantly lower Gensini score (36.73 ± 32.5 vs. 45.63 ± 32.63; p = 0.023) and three-vessel disease (18% vs. 36%; p = 0.007) compared with those mean platelet volume values within population-based ranges. CONCLUSION: Our findings show no linear relationship exists between mean platelet volume and extent of coronary artery disease, while patients with lower than normal mean platelet volume had reduced extent of coronary artery disease.

Impact of FLT-3 mutations on clinical features and response to the therapy in acute promyelocytic leukemia patients

FLT3 mutations are associated with poor outcome in acute myeloblastic leukemia [AML] patients. Only limited information is available about effects of FLT3 mutation on Acute Promyelocytic Leukemia [APL]. We investigated the prevalence and impact of FLT3 mutations on the clinical characteristics and the response to treatment in APL patients treated with arsenic trioxide [As[2]O[3]]. Blood samples were collected from 115 untreated APL patients and genomic DNA was extracted by the salting-out method. FLT3-ITD and FLT3-D835 mutations were investigated by PCR-RFLP. Mann-Whitney U test and Chi-square were used for data analysis. FLT3-ITD and FLT3-D835 mutations were detected in 16 [14%] and 13 [11%] of the patients, respectively. Both mutations were identified in two patients, so overall frequency of FLT3 mutations was estimated to be 23.5%. Patients positive for FLT3-ITD mutation had a higher rate of white cell counts [p= 0.005] and more frequent bcr3 type of PML/RARA fusion [p=0.04]. We have not found any significant association between FLT3-D835 mutation and the clinical characteristics of patients. Between the group with FLT3 Mutations and the group without, there was no significant difference in response to therapy. Complete remission induction with As[2]O[3] may be independent of FLT3 mutation status, so As[2]O[3] may be the first choice of APL especially in patients with FLT3 mutations. However, further studies on a large group of patients are necessary to confirm our findings

Outcomes of late corticosteroid withdrawal after renal transplantation in patients exposed to tacrolimus and/or mycophenolate mofetil: meta-analysis of randomized controlled trials

Corticosteroids are increasingly used in renal transplant patients to minimize organ rejection after transplantation. In attempts to reduce corticosteroids adverse effects, transplant professionals are customary attempted to taper off, and permanently stop corticosteroids after few months of administration with other immunosuppressants. To evaluate clinical benefits and risks of late corticosteroid withdrawal in renal transplant patients treated with tacrolimus [TAC] or mycophenolate mofetil [MMF], or both. A meta-analysis was performed of published randomized controlled trials that reported outcomes in kidney transplant patients who were randomized to corticosteroids maintenance or late withdrawal under concomitant immunosuppression by TAC, MMF or both. Outcomes included acute graft rejection; graft failure rate; all-cause mortality; incidence of post-transplant diabetes; change in serum creatinine and total cholesterol; and change in pediatric standardized height z-score. PubMed and Google Scholar were used in literature search between 1999 and April 1, 2010. Data were combined using unweighted random effects model. Nine studies randomized 1907 patients met the inclusion criteria: TAC [n=1]; MMF [n=6]; both [n=2]. Compared to maintenance therapy, late corticosteroid withdrawal was associated with 34% increase in the risk of acute graft rejection [95% CI for OR: 0.47-3.82]; 35% and 5% reductions in the risk of graft failure and patient's all-cause mortality [95% CI for OR: 0.26-1.60; 0.23-3.93, respectively]; and 4% increase in post-transplant diabetes risk [95% CI for OR: 0.45-2.41]. Late corticosteroid withdrawal was associated with substantial reduction in total cholesterol levels [mean difference: 18.1 mg/dL; 95% CI: 7.1-29.0 mg/dL], but did not reduce serum creatinine levels [-0.00 mg/dL; 95% CI: -0.17 to 0.17]. Stopping corticosteroids was associated with better pediatric growth outcomes. Late corticosteroid withdrawal under TAC and/or MMF-lead immunosuppression after kidney transplantation could provide benefits in terms of total cholesterol, patient and graft survival, and pediatric growth. This strategy, however did not reduce the risk of acute graft rejection, post-transplant diabetes mellitus, and deterioration in serum creatinine levels

[Detection of viability and metabolic activity of NB4 cell line treated with AZT]

APL is a Prevalent leukemia that Approximately included 5-10% of patients with acute myeloblastic leukemia. ATRA and recently arsenic is used for treatment. ATRA leads to resistance to treatment and arsenic is toxic in high doses. AZT induce cell death in different ways. The purpose of this study was Assessment of effect of AZT, a telomerase inhibitor, on NB4 cell line [APL cell line] to reduce toxic effect of high dose arsenic. In this study, viability and metabolic activity of NB4 cells, treated by different concentrations of AZT[50,100,200 micro M], was assessed by trypan blue dye method and MTT assay respectively. Treated cells with AZT=50,100,200 micro M showed decreased viability, both in dose-dependent and time-dependent through trypan blue dye method and decreased cell metabolic activity by MTT assay. Considering that AZT is able to induce apoptosis and decrease cell activity, it seems AZT is a suitable drug for inhibiting the growth of tumor cells

[Combination effect of low dose of arsenic trioxide and AZT on viability and metabolic activity of NB4 cell line]

Acute promyelocytic leukemia [APL] is a distinct subtype of acute myeloid leukemia. APL is characterized by a balanced reciprocal translocation between chromosomes 15 and 17, t[5;17]]. Important therapeutic strategies for this disease are ATRA and Arsenic trioxide. To eliminate tumor cells with arsenic, high dose of arsenic is needed. But high dose is toxic for normal tissue. The purpose of this study is Assessment of effect of low dose of arsenic trioxide in combination with AZT on NB4 cell line [APL cell line] to reduce toxic effect of high dose arsenic. In this study after NB4 cell line culture and proliferation, the cells treated with low dose of arsenic trioxide[0.5 micro M] in combination with different doses of AZT[50, 100, 200 micro M] and then viability and metabolic activity was assessed by try pan blue and MTT assay respectively. Low dose of arsenic [0.5 micro m] alone and in combination with dose of 50 micro m of AZT has little effect on viability and metabolic activity but in combination with higher dose of AZT has significant effect on viability and metabolic activity and both viability and metabolic activity significantly reduced. Different apoptosis- induced mechanisms cause apoptosis by arsenic and AZT. Since some of these mechanisms between AZT and arsenic are similar, so maybe these similar mechanisms cause synergic effect and significant reduction of viability and metabolic activity in combination of these two drugs

[ effectiveness of non-myeloablative stem cell transplantation and DLI as a selective treatment in class III beta-thalassemic patients]

At present, the only curative treatment for beta-thalassemia major is allogenic bone marrow transplantation accompanied with considerable mortality and morbidity in class III beta-thalassemia. Regarding few case reports on successful non-myeloablative stem cell transplantation in class III beta-thalassemic cases, we evaluated the effectiveness of this type of allogenic stem cell transplantation, considering less toxic non-myeloablative conditioning regimen. In this prospective study in Shariati Hospital bone marrow transplantation center during 2001-3, 13 class III beta-thalassemia patients [on the basis of history and physical examination and liver biopsy] were transplanted with peripheral blood and bone marrow stem cells from their HLA-identical siblings. Non-myeloablative conditioning regimen included fludarabine; busulan; antithymocyte globulin. Graft versus host disease [GVHD] prophylactic regimen was cyclosporin and metothrexate. In the case of the declining chimerism, the patients were treated with donor lymphocyte infusions [DLI]. The conditioning regimen was tolerated well without any considerable toxicity in hematologic, gastrointestinal and pulmonary systems. Five [38.5%] patients had acute and 2[15.4%] had chronic GVHD. Two patients died after transplantation. While two cases had a thalassemia-free survival. Although associated with high graft failure and the recurrence of disease, nonmyeloablative stem cell transplantation may be used as a curative, less toxic posttransplantation treatment for class III beta-thalassemia

Effects of Olanazapine and haloperidol on serum malondialdehyde, prolactin level, blood glucose and lipid profilein schizophrenic patients

The association of the atypical antipsychotics with hyperglycemia, elevated lipids, and weight gain was recognized soon after the introduction of clozapine and has become of increased concern as the use and uses of atypical antipsychotics have been expanded. The aim of the present study was to investigate the prevalence of diabetes, dyslipidamia, lipid peroxidation and hyperprolactinemia in Olanzepine treated patients in comparison with patients treated with haloperidol. Fifty patients were selected randomly from psychiatric inpatient clinic in Erbil city in Iraqi Kurdistan Region between November 2007 and June 2008. All patients were diagnosed as schizophrenia, and none of them were in acute severe state. Thirty Schizophrenic patients received Haloperidol orally as typical antipsychotic and 20 patients received Olanazapine orally as atypical antipsychotic for a minimum of one month. Fasting blood samples for the assessment of serum malondialdehyde [MDA], lipid profile, fasting blood glucose [FBG] and prolactin levels were obtained after one month of the drug prescribing time. From those fifty patients, 16 patients were selected to follow them prospectively over a mean period of time of 112 days for olanzapine and 75 days for haloperidol. The prospective study includes FBG, lipid profile, BMI and serum MDA. The prevalence of hyperprolactinaemia and lipid peroxidation was higher in Haloperidol treated patients. Whereas, the prevalence of diabetes and dyslipidaemia were higher in Olanazapine treated patients, the mean level of BMI of the Olanazapine group was significantly higher than BMI of the Haloperidol group. There was 6.66% prevalence of D< in Olanazapine treated patients, but there was no prevalence of DM in Haloperidol treated patients. There was no incidence of diabetes mellitus in the prospective study for both Haloperidol and Olanazapine treated patients. No absolute evidence indicates that the atypical antipsychotic Olanazapine is the cause of diabetes, since the glucose levels of all patients were within normal range and there was no incidence of diabetes in the prospective study in spite of their higher weight and body mass index

Seizure characteristics in Aicardi syndrome

We are describing a one year old Bahraini girl with Aicardi syndrome; she has agenesis of the corpus callosum, inter hemispheric cyst, neuronal migration disorder, ocular abnormalities and infantile spasm. She presented initially with focal seizure which later evolved into infantile spasm, her seizures were intractable to different anticonvulsant medications except for Vigabatrin which reduced her seizure episodes dramatically

Risk factors of appendicular perforation in El-Thoura hospital, El-Bieda-Libya

Retrospective study for patients who underwent appendectomy, for appendicitis in El-Thoura Teaching Hospital, EL-beida-Libya. between January to October 2005 to evaluate the affect of the age, and duration of the symptoms on appendicular perforation. A total of 176 patients; 100[57%] males and 76[43%] females with age ranged from 2 to 60 years [mean 22.7 years], presented with right iliac fossa [RIF] pain [100%], anorexia [86.9%], nausea [85.8%] and vomiting [61.9%]. RIF tenderness in [100%]and abdominal rigidity in [55.7%] of patients. Overall appendicular perforation rate was [18.8%] and tend to be higher in children less than 10 years and in adults above 50 years. also perforation rate increase with increasing time interval from onset of the symptoms to time of the operation. The age, late presentation and delay in time of operation are the most risk factors for appendicular perforation

brief discussion complications of thyroid surgery at El-Thoura teaching hospital

As every operation, thyroid surgery carries risk to complications, which may transient or permanent Objective of this study was to explore our expereince in thyroidectomy performed for seventy nine patients in General Surgical Departmen of El-Thoura Central Teaching Hospital El-beida, Libya, for a peroid of two years [from May 2003 to April 2005]. Twenty eight [35.4%] patients of them operated by lobo-isthmoectomy, 39 149.4%] sub-total thyroidectomy, 6 [7.6%] near total thyroidectomy, 4 15.1%] total thyroidectomy and the remaining 2 [2. 5%] patients by enculation of simple cyst Post-operatively; reccurent laryngeal nerve [RLN] injury and hypoparathyroidism were transient for a few months and were not common [3.6% and 2.5% respectively]. Wound infection occurred in two [2.5%] cases and hypothyrodism in one [1.3%] case. Severe primary heamorrhage was not developed in our material. Complications of thyroid surgery are fear to patient and surgeon; can be prevented or minimized when the surgery performed under optimal condition by an experienced hand surgeon with meticulous surgical techniques

Psychiatric and socioenvironmental characteristics of Bahraini suicide cases

The characteristics of suicide victims have not been studied systematically in Arab countries. A questionnaire-guided interview of families of 29 Bahraini suicide cases from 1996 to 2005 was conducted in their homes by a social worker. Medical and psychiatric files were examined to complete the data. More suicide victims were male, young, single or divorced, unemployed and with a low education level compared with the general population. The majority of victims had chronic mental disorders, mainly schizophrenia, depression and substance abuse. The most notable environmental risks were reported to be family problems, family history of suicidal behaviour, and financial and relationship problems. The sociodemographic and clinical risk profile in Bahrain differs from other developed and developing countries

Neurophysiologic evaluation of the temporomandibular joint and related masticatory muscle in rheumatoid arthritis patients

To study the effect of rheumatoid arthritis [RA] on the temporomandibular joints [TMJ] and related muscles using CT scan and neurophysiologic tests. Forty-two RA patients referred from the Maxillofacial Clinic at the Special Surgeries Hospital, Medical City, Baghdad, Iraq from February 2006 to September 2006 were included in this study. Thirty-seven of them underwent CT scan of the TMJ and 25 of these patients were neurophysiologically examined. The data were compared to 30 age-matched control subjects. Fifteen patients showed normal TMJ, whereas, abnormal TMJ on CT scan was present in 22 patients. Of these 22 patients, 6 showed decrease in the intra-articular space, 6 exhibited erosion of the condylar head, and 3 had flattening of the condylar head. The remaining 7 patients had all the abnormalities present. Electromyography [EMG] examination showed reduced interference pattern, poor recruitment of motor unit potentials, shift of the power spectra to the lower frequencies, low mean power frequency, and root mean square values, and prolonged blink reflex component latencies. Rheumatoid arthritis patients with positive CT scan findings have poorer neurophysiologic data than those without CT scan detectable lesions. Trigeminal motor neuropathy is suggested to be the cause of the masticatory muscle weakness. Root mean square voltage as a parameter of the EMG power spectra is of great value in diagnosing such weakness

study of secondary bacterial peritonitis in El-Thoura Teaching Hospital-Albeida Libya

Secondary bacterial peritonitis [SBP] is one of the common surgical emergencies in the world [1,2]. Purpose of the present study was to establish the common cause of SBP in our environment. Prospectively; we studied ninety patients [age: 3 to 63 years] admitted to El-Thoura Teaching Hospital; Al-Beida- Libya, in the period from January to December 2005. Perforated appendicitis was found in 31 [34.4%], followed by; perforated peptic ulcer 25 [27%], acute pancreatitis 9 [10%], acute cholecystitis with peritonitis 8 [8.8%],small bowel perforations 8 [8.8%] [3 cases trauma, 2 ischemia, 2 Crohns disease and one case typhoid perforation], large bowel perforations 6 [6.6%] [3 cases trauma, 2 diverticulitis perforation, one case tumor]. We found that perforated acute appendicitis followed by peptic ulcer perforation is the most common cause of peritonitis in our environment. On other hand; this study abdominal trauma is the main cause of bowel perforation in our environment