Anti-hyperglycemic and anti-hypercholesterolemic activity of Schouwia schimperi in glucose loaded and streptozotocin induced diabetic rats

Background: Diabetes mellitus has assumed epidemic proportion, its incidence is continuously increasing although of that estimates are imprecise, only providing a rough picture, and probably underestimate the disease burden. There were about 150 million cases estimated in the year 2000 which rose to 422 million people worldwide in 2020 according to the World Health Organization statistics. Medicinal plants such as Schouwia schimperi are one of many traditional treatments used in folk medicine by the people of Eastern Sudan for diabetes mellitus but have not been studied or evaluated scientifically. Aims and Objectives: This study evaluates the hypoglycemic and hypolipidemic effect of S. schimperi ethanol extract and compares it with standard glibenclamide in glucose loaded rats and streptozotocin induced diabetic rats. Materials and Methods: Diabetes mellitus was experimentally induced in rats by subcutaneous injection of streptozotocin at a dose of 60 mg/kg. S. schimperi ethanol extract was given orally at doses of 200 and 400 mg/kg and compared with control (2 ml distilled water) and standard (Glibenclamide 10 mg/kg). The same doses were given to glucose loaded diabetic rats as a model for type 2 diabetes mellitus. Results: The 200 mg/kg dose significantly lowered the plasma glucose levels in glucose loaded rats by 31% 2 h after the glucose load (P < 0.05) and by 68% in comparison to the negative control, the 400 mg/kg dose reduced plasma glucose levels by 33% in comparison to negative control (P < 0.05). Reductions in plasma glucose levels were 33.12% and 12.34% after 4 h of the glucose load for the 200 mg/kg and the 400 mg/kg doses respectively. In streptozotocin diabetic rats no significant reductions in plasma glucose levels were seen. However, strong hypocholesterolemic effect was seen after 3 h for both of the 200 mg/kg and 400 mg/kg doses by 85.4% (P < 0.05) and 88.2% (P < 0.05), respectively, and by 89.97% (P < 0.001) and 90.6% (P < 0.001) respectively 6 h after oral administration. Conclusion: Our study concludes that S. schimperi extract has a favorable effect in reducing plasma glucose in glucose loaded rats and excellent hypolipidemic effects.

Coordinating a Postgraduate Orthopaedic Exam During the COVID-19 Pandemic

@#The Coronavirus (COVID-19) pandemic and institution of the Movement Control Order (MCO) had resulted in the cancellation of a major orthopaedic exam in April 2020. The exam is known as the Malaysian Orthopaedic Specialist Committee (OSC) Part I Examinations. It is similar to the British Royal Colleges of Surgeons Membership (MRCS) exams and held twice annually in April and October. There are up to 200 candidates involved. With implementation of new guidelines and standard operating procedures (SOP), the OSC Part I exam was successfully held by Universiti Kebangsaan Malaysia (UKM) from 5th-9th October 2020. Here we highlight the challenges we faced whilst coordinating a major exam at a national level during the COVID-19 pandemic with recommendations for future exams.

Opposite Modulatory Effects of Crataegus aronia Aqueous Extract on Platelet Aggregation in Rats / 中国结合医学杂志

OBJECTIVES@#To reveal the mechanisms behind the dual effects of Crataegus aronia (C. aronia) aqueous extract on platelet aggregation by focusing on function, regulation, expression, and signaling of platelets P@*METHODS@#Adult male Wistar rats (120 ± 10 g) were classified as control received the vehicle, C. aronia (200 mg/kg), and C. aronia (2,000 mg/kg)-treated rats. After treatments for consecutive 7 days, hematological and molecular experiments were conducted to detect alterations in platelet aggregation, thromboxane B2 (THXB2) and intracellular reactive oxygen species (ROS) content; protein levels of P@*RESULTS@#At a concentration of 200 mg/kg, C. aronia inhibited platelet aggregation through multiple interconnected mechanisms including downregulation P@*CONCLUSION@#Oral administration of C. aronia at low dose inhibits platelet aggregation by reducing THXB2 release, expression of P-selectin and activating cAMP and Akt signaling through two major mechanisms including downregulation of P

Epidemiology and Factors Affecting Functional Outcome of Distal Radial Fracture in an Urban Tertiary Medical Centre in Malaysia

@#Introduction: Distal radial fracture is a commonly encountered fracture. This study aims to study the epidemiology of distal radial fracture and factors affecting the patients’ functional outcome one to two years after the injury. Materials and methods: This is a retrospective cohort study. The records of patients, fulfilling the radiographical diagnosis of distal radial fracture, and aged 18 and above, who presented to our Emergency Department from 1st January 2018 to 31st December 2018 were retrieved. According to AO classification, we grouped our patients into A (extra-articular), B (partial articular) and C (complete articular). Patients with congenital abnormalities were excluded. Epidemiological data and relevant medical history were obtained and tabulated. A Malaysian language translation of Disability of the Arm, Shoulder and Hand (DASH) questionnaire was used to assess the functional outcome. Results: Out of 168 patients’ data retrieved, only 110 patients’ data were found complete for purposes of this study. The mean DASH score was 13.7 ± 7.87 approximately one to two years post-injury regardless of treatment method. Increasing age was associated with higher DASH score with r=0.407(p<0.001). Several variables had significantly better functional outcome: male gender (p=0.01), Type A fracture configuration (p=0.007) and non-operational treatment (p=0.03). There was no significant difference between treatment modalities in Type A fracture (p=0.094), but Type B (p=0.043) and Type C (p=0.007) had better outcome without surgery. There was no significant difference between different ethnic groups, open or closed fracture and mechanism of injury. Conclusion: Better functional outcome after sustaining distal radial fracture was associated with young age, male gender, type A fracture and treated non-operatively. Interestingly, more complex fracture pattern had better functionality were observed without surgery.

A Review of Surgically Treated Distal Radius Fractures in a University Hospital

@#Introduction: Distal radius fracture (DRF) is the most common orthopaedic injury with a reported incidence of 17.5%. It is commonly seen in young males and elderly females. Over the last two decades, there is an increasing tendency to treat DRF surgically by open reduction and internal fixation (ORIF) with plate and screws owing to improved device design, better fixation and operative technique. The purpose of this study was to evaluate the demographic characteristics, type and method of fixation, and outcome in all surgically treated DRF cases from 2014 to 2018 in a university hospital. Materials and methods: A retrospective review of all surgically treated DRF cases with one year follow-up in a tertiary hospital in Malaysia was done. Patients who left the follow-up clinic before one-year post-surgery or before fracture union were excluded. A total of 82 patients with 88 DRF were finally included into the study and outcome in terms of union time and need of multiple surgeries were analysed along with the predictors. Results: In this study, mean age of the patient was 46.2 years. Motor vehicle accident was the commonest cause of the fracture and AO Type C fracture was the commonest fracture type. Seventeen (19.3%) out of 88 fractures were compound fracture. Open reduction and internal fixation with volar plate was the most common surgical technique done in this series (93.2%). Three (3.5%) out of 88 fractures required multiple surgeries and eighty-three (94.3%) DRF cases were united before nine months of the surgery in this study. There was statistically significant association between clinical type of the fracture and the union time (p-value <0.05). Conclusion: There was a 1.7:1 male-female ratio with AOC fracture being the most common type of fracture. The most common method of fixation was ORIF with volar locked plate. Patients with closed fractures have a higher rate of union compared to open fractures at nine months.

Suppression of hepatic apoptosis induced by acetaminophen using a combination of resveratrol and quercetin: an association of oxidative stress and interleukin-11 / Suspensión de la apoptosis hepática inducida por acetaminofén mediante una combinación de resveratrol y quercetina: una asociación de estrés oxidativo e interleucina-1

We sought to determine whether the combined polyphenolic compounds, resveratrol and quercetin can substantially protect against modulation of hepatic biomarkers of apoptosis and survival, p53-Bax axis and B-cell lymphoma 2 (Bcl-2) in an animal model of acetaminophen-induced acute liver injury via the association of oxidative stress and interleukin-11 (IL-11). The model group of rats received a single dose of acetaminophen (2 g/kg), whereas the protective group of rats was pre-treated for 7 days with combined doses of resveratrol (30 mg/kg) and quercetin (50 mg/kg) before being given a single dose of acetaminophen. All rats were then sacrificed 24 hours post acetaminophen ingestion. Acetaminophen overdose induced acute liver injury as demonstrated by profound liver parenchymal damage and increased levels of the liver injury enzymes, alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Acetaminophen significantly (p<0.05) modulated malondialdehyde (MDA), p53, apoptosis regulator Bax, Bcl-2, IL-11, interleukin-6 (IL-6), ALT, AST, superoxide dismutase (SOD), and glutathione peroxidase (GPx), which were significantly protected by resveratrol plus quercetin. We further demonstrated a significant (p<0.01) correlation between IL-11 scoring and the levels of p53, Bax, Bcl-2, and MDA. Thus, resveratrol plus quercetin effectively protect against acetaminophen-induced apoptosis, which is associated with the inhibition of oxidative stress and IL-11.

En el estudio se intentó determinar si los compuestos polifenólicos combinados, el resveratrol y la quercetina pueden proteger sustancialmente contra la modulación de los biomarcadores hepáticos de apoptosis y supervivencia, el eje p53-Bax y el linfoma de células B 2 (Bcl-2) en un modelo animal de lesión hepática aguda inducida por acetaminofén, a través de la asociación del estrés oxidativo y la interleucina-11 (IL-11). El grupo modelo de ratas recibió una dosis única de acetaminofén (2 g / kg), mientras que el grupo protector de ratas fue tratado durante 7 días con dosis combinadas de resveratrol (30 mg / kg) y quercetina (50 mg / kg) antes de recibir una dosis única de acetaminofén. Todas los animales fueron sacrificados 24 horas después de la ingestión de acetaminofén. La sobredosis de acetaminofén indujo una lesión hepática aguda, como se observó en el daño profundo del parénquima hepático y el aumento de los niveles de las enzimas en la lesión hepática, alanina aminotransferasa (ALT) y aspartato aminotransferasa (AST). Acetaminofén moduló significativamente (p <0.05) malondialdehído (MDA), p53, regulador de apoptosis Bax, Bcl2, IL-11, interleucina-6 (IL-6), ALT, AST, superóxido dismutasa (SOD) y glutatión peroxidasa ( GPx), los que se encontraron significativamente protegidos por el resveratrol y quercetina. Además se determinó una correlación significativa (p <0.01) entre la puntuación de IL-11 y los niveles de p53, Bax, Bcl-2 y MDA. En conclusión, el resveratrol más la quercetina protegen de manera efectiva contra la apoptosis inducida por acetaminofén, asociada con la inhibición del estrés oxidativo y la IL-11.

Evaluation of Metabolic Syndrome in Primary Health Care

Background: Metabolic syndrome includes atherogenic dyslipidemia, obesity, hypertension, hyperglycemia, andinsulin resistance. This complex of metabolic abnormalities is a risk factor for DM2, stroke, adverse cardiacevents, and hepatic necrosis. In the last few years, studies showed a significant high prevalence of this syndromeamong Saudi males. Central visceral adiposity is thought to be the primary trigger of most pathogenic eventsinvolved in the advent of the syndrome. Objectives: In this paper, our aim is to discuss metabolic syndrome, itsdefinitions, pathophysiology, diagnosis, screening, and the management done for such patients in general withspecial focus to primary healthcare. Methodology: PubMed database was used for articles selection. Conclusion:The syndrome is linked with significant impacts on the patient health; as a result, the health care providers shallbe alarmed on how to screen, diagnose and manage such disease. Prevention of childhood obesity is criticalthrough screening and early diagnosis to save major burden and prevent future complications. Thus, nowadays,the new trend is towards incorporating screening of this syndrome in primary health care centers.

Carotid Artery Angioplasty and Stenting for Carotid Stenosis: A Single-Center Experience from Saudi Arabia / 신경중재치료의학

Purpose@#Atherosclerotic stenosis of the extracranial carotid artery accounts for approximately 20% of all strokes. Both carotid artery endarterectomy and carotid artery angioplasty with stenting (CAAS) are recommended for symptomatic patients with 50% or more stenosis or asymptomatic patients with 70% or more stenosis. CAAS is under-reported in Saudi Arabia, as evidenced by a thorough literature search. In this article, we aim to share our experience of CAAS to call for the necessity of conducting more research on stroke and emphasize the local need of utilizing more endovascular treatments like CAAS. @*Materials and Methods@#A retrospective single-center observational study was conducted at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The inclusion criteria consisted of all adult patients (18 years and above) with carotid stenosis who were treated with CAAS. @*Results@#A total of 16 patients were included in the study. The mean age of the participants was 66.9±13.5 years (range 30–87 years). All patients were symptomatic (had a previous stroke or transient ischemic attack). The procedure was successful in 14 patients (87.5%), while it failed in 2 patients (12.5%) due to technical reasons. All patients had no stroke or myocardial infarction within 30 days of the procedure. @*Conclusion@#Despite the advancement in medicine with free healthcare services in Saudi Arabia, the interventional procedures for secondary prevention of strokes are underutilized. Collaboration between different hospitals will be extremely helpful since few centers in each city are providing such treatments by an expert neurointerventionist and/or strokologist. The good selection of candidates, optimal management of comorbid conditions, and multidisciplinary care may improve outcomes and reduce mortality.

Para Nasal Sinuses are Pneumatized in a Synchronized Pattern, a Study Evaluating Volume of the Maxillary and Sphenoid Sinuses using Cone Beam Computed Tomography

Introduction: The volume of the paranasal sinuses,especially maxillary sinuses is a crucial factor for diagnosingmaxillofacial pathologies, dental implant planning, surgeriesinvolving maxillofacial region etc. Study was done with theobjective to determine the volume of maxillary and sphenoidsinus and to evaluate its correlation with pneumatizationbetween them using cone beam computerized tomography(CBCT)Material and methods: This cross-sectional study wasconducted as a retrospective evaluation of CBCT images of 50maxillary and sphenoid sinuses from patients who reported tothe maxillofacial radiology department of college of dentistry,qassim university, saudi Arabia. The differences amonggender, age, individual volume and volume pattern of the boththe sinuses were statistically analyzed.Results: The mean volume of the maxillary sinus was 10.0cm3 and mean volume of the sphenoid sinus was 8.6 cm3. Thecomparison of the mean volumes of maxillary sinuses andsphenoid sinuses showed a statistically significant correlation.The correlation coefficient shows the value of r = 0.58with a significance of 0.000. The relationship of volume ofthe maxillary sinus and sphenoid sinuses was found highlysignificant. There appears to be a synchronized variation in thevolumes during different age groups.Conclusion: The synchronized display of the pneumatizationpattern of the para-nasal sinuses may be attributable to aconjoint assigning impact on the spatial organization in theentire skeletal ossification and pneumatization.

Demographics of Patients Undergoing Carpal Tunnel Release in an Urban Tertiary Hospital in Malaysia

@#Introduction: Carpal tunnel syndrome (CTS) is the most commonly encountered neuropathy. The entrapment of the median nerve at the wrist can be corrected with a carpal tunnel release (CTR) procedure. The objective of this retrospective study was to determine the demographic, medical, and surgical characteristics of the patients with CTS who presented for CTR surgery in a tertiary hospital in Malaysia. Materials and Methods:Malaysians patients with CTS who had undergone a CTR during the period from 1st June 2017 to 31st December 2017 were enrolled into the study. Each patient had a minimum follow-up of three months. The demographic data of age, gender, race and occupation, and the comorbid illnesses and associated risk factors were recorded. The prevalence and occurrence of CTS in the dominant or non-dominant hand and the effectiveness of surgical intervention were also noted. Data was collected, analysed and stored in Microsoft Excel and SPSS 25. Results: There was a total of 76 cases of CTR surgeries done in 62 patients in the study. Eighty percent of the patients were female, and most of the patients belonged to the age group of 41-60 years. Malays constituted 74.2% of the patients, and 34% were housewives. Hypertension, dyslipidaemia and diabetes mellitus were the three major comorbidities. Cervical spondylosis was seen in one-fourth of the patients. Bilateral hand involvement was present in 54.8% of patients. 59.7% of CTR surgery was done on the dominant hand alone, 17.7 % CTR on the non-dominant hand alone and 22.6% CTR on both hands. Numbness and pain (50%) were the predominant presenting symptoms. The most positive signs were the Durkan test (77.6%), followed by the Tinel sign at the carpal tunnel and the Phalen’s test. At follow-up, three months or more, after the surgery, 75% of the patients showed a satisfactory improvement. Conclusion:Patients, who had undergone CTR, had a higher prevalence of pre-morbid conditions, and a quarter of them presented with associated cervical spondylosis. The most common presentation was a combination of numbness and pain. Many obtained satisfactory improvement post-surgery and thus open surgery could be considered a reliable treatment for CTS.

Cavernous Lymphangioma of the Digits: A Rare Cause of Macrodactyly

@#Cavernous lymphangioma is a congenital malformation of lymphatic system causing dilated lymphatic sinuses that involve the skin and subcutaneous tissues. This was an interesting case of dystrophic macrodactyly of the left ring and little finger in a 18-month-old girl who presented with swollen and sausage like fingers deformity which turned out to be an isolated cavernous lymphangioma. This tumor, although rare to occur in the extremeties, must be differentiated from other congenital vascular lesions of the hand that include arteriovenous malformations and hemangiomas. Diagnosis should be solely based on histopathological analysis of the excised tissue mass. Surgical excision is usually necessary for satisfactory functional and cosmetic outcome.

Outcome of Tendon Transfers for Radial Nerve Palsy in a Malaysian Tertiary Centre

@#Tendon transfers for radial nerve palsy is a common operation with good results. We did a retrospective study on twenty patients with radial nerve palsy who underwent tendon transfer surgery and recovered between January 2008 and December 2012. Outcomes measured were motor power of wrist extension, finger extension, grip strength and DASH scores. There was significant improvement of motor power of wrist and finger extension between the preoperative period and three months post-operatively, between the pre operative period and six months post operatively and between three and six months postoperatively (p = 0.0005). Grip strength improved significantly as well between preoperative, three and six months postoperatively (p = 0.0005). DASH scores reflecting patient satisfaction at six months postoperatively showed only mild or moderate difficulty of function.

Differential therapeutic effects of Crataegus aronia and simvastatin on the hepatocyte ultrastructure in hepatic steatosis / Efectos terapéuticos diferenciales de Crataegus aronia y simvastatina sobre la estructura del hepatocito en la esteatosis hepática

Complications of fat accumulation in liver, hepatic steatosis such as liver cirrhosis and liver failure are among the common public health problems. We sought to investigate the damage to the hepatocyte ultrastructure induced by high fat diets (HFD) and compared the therapeutic effects at the cellular level of two antioxidant and lipid lowering agents; Crataegus aronia extracts and simvastatin on hepatic steatosis. Rats were either fed with HFD (model group) or low fat diets (LFD) (control group) for 15 weeks before being sacrificed and therapeutic groups started the treatment with these agents after week 11 until the sacrifice day. Harvested liver tissues were examined using transmission electron microscopy (TEM) and liver homogenates were assayed for markers of anti-oxidative stress that are known to be modulated in liver injury. TEM examinations of the model group showed a profound damage to the hepatocytes compared to the control group as demonstrated by steatosis, damaged mitochondria and vaculated cytoplasm, disrupted rough and smooth endoplasmic reticulum and nuclear membrane, dilated intercellular space between hepatocytes, and alterations in lysosomes. In addition, HFD ameliorated the anti-oxidant glutathione (GSH) and augmented the oxidative stress TBARS biomarkers. Both Crataegus aronia and simvastatin significantly reduced lipids and TBARS, and treated damage to hepatic cells, but hepatocyte structures were differentially responded to these agents. However, only Crataegus aronia induced GSH (p=0.001). We conclude that HFD-induced hepatic steatosis caused a substantial damage to the hepatocyte's ultrastructures, and Crataegus aronia and simvastatin treatments differentially reversed hepatic injuries.

Las complicaciones de la acumulación de grasa en el hígado, la esteatosis hepática como la cirrosis hepática y la insuficiencia hepática se encuentran entre los problemas comunes de salud pública. Se intentó investigar el daño a la ultraestructura de los hepatocitos inducido por la dieta alta en grasas (DAG) y se compararon los efectos terapéuticos a nivel celular de dos antioxidantes y agentes hipolipemiantes; Extracto de Crataegus aronia y simvastatina sobre esteatosis hepática. Las ratas fueron alimentadas con DAG (grupo modelo) o dieta baja en grasa (DBG) (grupo control) durante 15 semanas antes de sacrificarse y los grupos terapéuticos comenzaron el tratamiento con estos agentes después de la semana 11 hasta el día del sacrificio. Se examinaron los tejidos hepáticos usando microscopía electrónica de transmisión (MET) y se analizaron homogeneizados de hígado para marcadores de estrés anti-oxidativo, que se sabe están modulados en la lesión hepática. Los exámenes MET del grupo DAG mostraron un grave daño de los hepatocitos en comparación con el grupo control, demostrado por esteatosis, daño mitocondrial y citoplasma vacío, retículo endoplásmico rugoso y liso y membrana nuclear, el espacio intercelular dilatado entre hepatocitos y alteraciones en los lisosomas. Además, DAG mejoró el anti-oxidante glutatión (GSH) y aumentó el estrés oxidativo TBARS biomarcadores. Tanto Crataegus aronia como simvastatina redujeron significativamente los lípidos y TBARS, trataron el daño a las células hepáticas, pero las estructuras de hepatocitos respondieron diferencialmente a estos agentes. Sin embargo, sólo Crataegus aronia indujo GSH (p = 0,001). Concluimos que la esteatosis hepática inducida por HFD causó un daño sustancial a la ultraestructura del hepatocito y los tratamientos de Crataegus aronia y simvastatina diferenciaron las lesiones hepáticas.

Medical students' awareness of andcompliance with the hepatitis B vaccinein a tertiary care academic hospital: Anepidemiological study

Background: The hepatitis B virus [HBV] poses a health risk to healthcare workerswho are in close proximity to infected individuals. Medical students are a particularlyhigh-risk group due to the lack of an obligatory vaccination program and a post-vaccination screening program to determine immunity status, which results in alack of awareness of and compliance with the HBV vaccine

Methods: This cross-sectional survey was conducted in King Khalid University Hospi-tal [KKUH], a tertiary care academic hospital in Riyadh, Saudi Arabia, from November2013 to March 2014. Medical students in their second to fifth years [n = 444; 213 menand 231 women] completed a self-administered questionnaire regarding awarenessof HBV and compliance with the HBV vaccination program in KKUH

Results: Medium to low knowledge levels were present in 53.5% of the participants,and 44.3% reported that they were not compliant with the vaccination programprovided by KKUH. While 93.9% received the HBV vaccine upon entry to medicalschool, only 59.5% received all 3 doses, citing forgetfulness and a busy scheduleas common reasons for the low compliance. There was no association between theknowledge and awareness of the participants and their compliance [p = 0.988]

Conclusion: Medical students had a low level of compliance with the HBV vaccinationprogram, regardless of their knowledge and awareness of the disease and vaccination.We recommend that programs and campaigns be developed to increase the overallawareness of this disease. We also suggest that a mandatory HBV vaccination programshould be implemented to improve the compliance rate among medical students

Acute back pain: a survey of primary health care physicians' awareness and knowledge of "red flag" signs

Background: the failure to detect "red flag" signs in patients presenting with acute low back pain can adversely affect the outcome of management. This can seriously affect the quality of life and productivity of the patient

Objective: the present questionnaire-based study was performed to assess the knowledge and awareness of red flag signs among primary health care physicians managing patients with acute back pain in Riyadh, Saudi Arabia

Materials and Methods: the study sample size was comprised of 80 subjects. The level of knowledge was assessed by means of a new structured self-administered questionnaire. The design of this questionnaire was based on the Agency for Health Care Research and Policy [AHCRP] guidelines for detection of red flag signs. Physicians were asked about red flag signs that indicate the presence of tumor, infection, spinal fracture, or cauda equina syndrome

Results: sixty-eight [85% of total] physicians were aware of red flag signs. Of the 68 physicians who were aware of the red flag signs, 58 [72%] were aware of neurological deficit, 36 [45% of total] were aware of extremes of age [<10 years and >50 years], and 33 [41% of total] were aware of and routinely inquired about the history of spinal trauma, whereas only 24 [30% of total] were aware of and inquired about constitutional symptoms in their patients with acute back pain

Conclusion: although low back pain is extremely common, knowledge and awareness of red flag signs of primary health care physicians managing patients with acute back pain in Riyadh appear to be inadequate. This indicates a lack of adherence to the international guidelines. Specific educational programs should target these deficiencies and increase awareness