Coronary Artery Ectasia as a Predictor of Major Adverse Cardiac Events in Patients with Acute ST Elevation Myocardial Infarction

Background: Coronary artery ectasia (CAE) is characterised as localised or widespread non-obstructive lesions of the epicardial coronary arteries with a luminal dilation more than 1.5 times the neighbouring normal segments or vessel diameter. Isolated CAE is CAE in the absence of severe coronary artery stenosis. This aberrant dilatation of coronary arteries can produce angina pectoris and even myocardial infarction in people without coronary artery disease owing to vasospasm, dissection, or thrombus. The purpose of this study was to evaluate the connection between CAE and major adverse cardiac events (MACE) following acute myocardial infarction with ST elevation. Methods: This was a prospective cohort study which was carried out on 300 cases. Cases were divided into two groups: Group I: including about 22 STEMI cases with CAE and Group II: including about 278 STEMI cases without CAE. All cases in this study were subjected to full history taking, clinical examination, laboratory tests, standard 12-leads ECG, resting transthoracic echocardiography (TTE), and coronary angiography. Results: Regarding MACE in the studied groups, Incidence of reinfarction and cardiac death were significant higher in cases with STEMI and CAE than cases with STEMI alone. In univariate regression analysis, CAE (OR: 3.59, p value =0.022) was a significant predictor of cardiac death but age, male sex, and EF were not. Also, in multivariate regression analysis CAE (OR: 3.49, p value =0.029) was a significant predictor of cardiac death but age, male sex, and EF were not smoking with high warfarin consumption. Further, Markis classification 1 and 3 were the most frequent phenotype among cases. In STEMI cases, the incidence of reinfarction and cardiac death were significantly higher in cases with STEMI and CAE than cases with STEMI alone. So, CAE is a significant predictor of cardiac death.

Anesthetic considerations for a patient with myasthenia gravis undergoing deep sedation in an outpatient oral surgery setting

Myasthenia gravis (MG) is a neuromuscular autoimmune disorder which clinically presents as muscular weakness and fatigue due to autoantibody formation against acetylcholine receptors (AChR), leading to their subsequent destruction. Due to the neuromuscular implications of MG, certain considerations must be taken into account when providing anesthesia to MG patients. In the following case report, we have outlined procedural considerations for the anesthetic management of a patient with MG undergoing deep sedation for an elective oral surgery in an outpatient setting, as well as a discussion of relevant literature.

Exopolysaccharide production from Bacillus velezensis KY471306 using statistical experimental design

Abstract Exopolysaccharide (EPS) biopolymers produced by microorganisms play a crucial role in the environment such as health and bio-nanotechnology sectors, gelling agents in food and cosmetic industries in addition to bio-flocculants in the environmental sector as they are degradable, nontoxic. This study focuses on the improvement of EPS production through manipulation of different culture and environmental conditions using response surface methodology (RSM). Plackett-Burman design indicated that; molasses, yeast extract and incubation temperature are the most effective parameters. Box-Behnken RSM indicated that; the optimum concentration for each parameter was 12% (w/v) for molasses, 6 g/L yeast extract and 30 °C for incubation temperature. The most potent bacterial isolate was identified as Bacillus velezensis KY498625. After production, EPS was extracted, purified using DEAE-cellulose, identified using Fourier transform infrared (FTIR), gel permeation chromatography (GPC) and gas chromatography-mass spectroscopy (GC-MS). The result indicated that; it has molecular weight 1.14 × 105 D consisting of glucose, mannose and galactose.

Incidence and risk factors for neonatal jaundice among neonates with urinary tract infection in Abha - Saudi Arabia

Background: Hyperbilirubinemia is one of the presenting signs of bacterial infection in newborns, and the association of neonatal jaundice with urinary tract infection [UTI] has been particularly emphasized. The aim of this study was to determine the prevalence of UTI in asymptomatic jaundiced neonates younger than 4 weeks old

Method: A cross sectional survey has been conducted at Newborn Unit of Maternity and Pediatrics Hospital - Abha from January 2016 to August 2016. A total of 15 patients have been included in the study, who were diagnosed with hyperbilirubinemia due to urinary tract infection [UTI] after exclusion of unrelated criteria

Conclusion: It could be concluded that UTI should be routinely investigated in early [<10 days] idiopathic neonatal jaundice in which all other etiologic factors of neonatal hyperbilirubinemia are ruled out, and the presence of UTI should be considered in case of a poor phototherapy response in cases receiving phototherapy

Evaluation of cardiac sources of embolism

Cerebrovascular disease is a leading cause of mortality and morbidity .20% of cerebral infarcts are due to cerebral embolism of cardiac origin. Conditions associated with cardiogenic emboli are either rhythm abnormalities such as atrial fibrillation (AF) responsible for 50% , or structural abnormalities .Whereas left ventricle thrombus ,left atrium thrombus ,vegetation , tumor and protruding atherosclerotic plaque are considered as direct sources of embolization , others such as valvular disease , wall motion abnormality , atrial septal defect (ASD) , patent foramen ovale(PFO) , atrial septal aneurysm (ASA) and spontaneous echocardiographic contrast (SEC) are considered as indirect cardiac sources of embolization . In this article evaluation of cardiacsources of embolism and the role of echocardiography are discussed. Though both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) play an important role,TEE appears to be more sensitive in identifying potential abnormalities in patients with suspected cardiac sources of emboli

Retreatment of failed regenerative endodontic of orthodontically treated immature permanent maxillary central incisor: a case report

A revascularization procedure was shown to be the best alternative therapy for immature teeth with necrotic pulp and apical infection. A 12 year old female with a history of trauma to her upper central incisor and a sinus tract was referred for endodontic treatment. She was an active orthodontic patient and had undergone regenerative endodontic treatment for the past 2 years. Clinical examination revealed no response to sensibility, percussion, and palpation tests. The preoperative radiograph showed an open apex and apical rarefaction. The case was diagnosed as previously treated tooth with asymptomatic apical periodontitis. Regenerative endodontic retreatment was performed, and the case was followed for 3 years. Clinical, radiographic, and cone-beam computed tomography follow-up examination revealed an asymptomatic tooth, with evidence of periapical healing and root maturation.

interview-based survey to assess the knowledge of peripheral arterial disease among medical students

Objectives: Physicians have poor knowledge of peripheral arterial disease [PAD]. Inadequate exposure to PAD in medical school curricula may by a contributing factor. The objective of this study was to explore the awareness and knowledge of PAD among medical students

Methods: We conducted a descriptive cross-sectional study using an interview-based survey of the medical students in the college of medicine of King Saud University Riyadh, KSA

Results: Of 350 students, 244 students agreed that they had some knowledge about PAD. More students in their clinical years [3-5] had heard about PAD compared to students in their basic science years [1-2; 76.5% versus 65.4%, respectively]; however, the overall scores were low for both groups for recognition of PAD symptoms [mean scores, 2.83 out of 7 for students in years 3-5 versus 1.81 for students in years 1-2; p < 0.001]. The scores of the knowledge of risk factors were 4.86 and 2.77 out of 7 for students in years 3-5 and 1-2, respectively [p < 0.001]; the scores of preventive measures were 4.28 and 3.13 out of 6 for students in years 3-5 and 1-2 years, respectively [p < 0.001]; and the scores of treatments and complications were 4.41 and 3.57 out of 6 for students in years 3-5 and 1-2 years, respectively [p < 0.001]

Conclusion: This study has identified an alarmingly low level of PAD knowledge among medical students. Interventions are needed to address this gap in medical schools' curricula to improve care for patients with PAD in future doctors

beta-alanyl-l-histidine, an anti-oxidant, anti-fibrotic and geno/cytotoxicity inhibitor: a sheild against cc14-induced hepatotoxicity in rats

Hepatic fibrosis is a consequence of chronic liver injury and is characterized by an excessive hepatic connective tissue formation and deposition. p-alanyl-L-histidine [carnosine] is a dipeptide with anti-inflammatory and antioxidant properties in addition to its involvement in many physiological process. Specific treatments to stop progressive liver fibrosis are not available, so that the objective of the present study was to evaluate the hepatoprotective, antioxidant, antifibrotic, cyto/genoprotective effect of p-alanyl-L-histidine against hepatic injury induced by carbon tetrachloride [CCU] in rats. p-alanyl-L-histidine showed significant protection with normalization of liver aminotransferases, increased glutathione S transferase [GST] activity while decreased hepatic hydroxyproline, protein carbonyl, hydrogen peroxide[H[2]O[2]] levels, DNA damage, Cytochrome P450[2]Ei [CYP[2]Ei] activity and transforming growth factor-pi [TGF-pl] mRNA level. In conclusion: P-alanyl-L-histidine possesses hepatoprotective properties through reducing hepatic toxicity markers, oxidative stress, cytotoxicity, genotoxicity, fibrosis and improvement of the histological architecture of the liver

CCl[4] ilnduced hepatotoxicity: protective effects of carnosine on peroxisome proliferator-activated receptor gamma gene expression, genotoxicity and oxidant/antioxidant status in rats

Effect of carnosine as an antioxidant in protection against carbon tetrachloride CCI[4] induced oxidative stress and hepatotoxicity in rats was investigated. Liver toxicity was induced in rat model at which four experimental groups of 20 rats each were constructed: group [1] the control group in which rats were not administrated CCI[4] or carnosine; group [II] CCI[4] group in which rats were subcutaneously injected with CCI[4] in a dose of 2 ml /Kg body weight twice weekly for 4 weeks; group[III] CCI[4] and carnosine group in which rats were also subcutaneously injected with CCI[4] and co-treated with daily intraperitoneal [i.p.] carnosine at a dose of 10 mg / kg body weight and group [IV] received also i.p. repeated daily dose of carnosine. Hepatotoxicity was assessed by measurement of serum aspartate aminotransferase [AST] and alanine aminotransferase [ALT] activities. Hepatic peroxisome proliferator-activated receptor gamma [PPARgammay] mRNA expression, glutathione-S-transferase [GST] activity, paraoxonase 1 [PON1] activity, xantheine oxidase [XO] activity and total anti-oxidant capacity [TAC] level as well as DNA damage in blood were evaluated. The results were confirmed by histopathological examination. Carnosine treatment significantly prevented the CCI[4] induced hepatotoxicity, oxidative stress and DNA damage. In conclusion, our results suggested that carnosine might be a therapeutic antifibrotic/antigenotoxic agent for the treatment of CCI[4-] induced hepatotoxicity due to its antioxidant properties

Is systemic infliximab therapy effective for retinal cavernous hemangioma?

A 10-month-old infant with the diagnosis of retinal cavernous hemangioma involving the macula presented with an outward deviation of the right eye that has been noticed by her parents. Examination revealed a clearing vitreous hemorrhage, and grape-like clusters filled with blood in the posterior pole. After 4 cycles of intravenous infliximab over the period of 3 months, no evident change was noted on the size of the cavernous hemangioma

Pattern of Cervical Dysplasia among Women of Reproductive Age in Zaria; Northern Nigeria

Background : Cervical cancer is a preventable and the most common female genital tract cancer despite the availability of screening services for precancerous lesions of the cervix. This study aims to determine the prevalence of cervical dysplasia in women of reproductive age in Zaria.Methodology: A prospective study of 131 women of child bearing age attending the family planning and Gynaecology clinics in Ahmadu Bello University Teaching Hospital; Zaria - Nigeria were recruited for the study after obtaining their consent. Cervical samples were collected and subjected to pap staining and cytological examination by a pathologist and classified using the Bethesda System. The data were processed using Statistical Package for the Social Sciences (SPSS) version 17. Bivariate analysis was done and the level of significance was set at a P 0.05.Results: Cervical dysplasia prevalence of 7.0 was found out of which High Grade Squamous Intraepithelial Lesion (HSIL) was 2.3 (n

Pattern of Cervical Dysplasia among Women of Reproductive Age in Zaria; Northern Nigeria

Background : Cervical cancer is a preventable and the most common female genital tract cancer despite the availability of screening services for precancerous lesions of the cervix. This study aims to determine the prevalence of cervical dysplasia in women of reproductive age in Zaria. Methodology: A prospective study of 131 women of child bearing age attending the family planning and Gynaecology clinics in Ahmadu Bello University Teaching Hospital; Zaria - Nigeria were recruited for the study after obtaining their consent. Cervical samples were collected and subjected to pap staining and cytological examination by a pathologist and classified using the Bethesda System. The data were processed using Statistical Package for the Social Sciences (SPSS) version 17. Bivariate analysis was done and the level of significance was set at a P 0.05. Results: Cervical dysplasia prevalence of 7.0 was found out of which High Grade Squamous Intraepithelial Lesion (HSIL) was 2.3 (n

Concurrent validity of the malay version perceived stress scale (PSS-10)

This study aimed to assess the concurrent validity of the Malay version of the Perceived Stress Scale (PSS-10) PSS-10 item. Methods: A crosssectional study was conducted among all students in a medical faculty in Malaysia. The questionnaire included three parts; socio-demographic correlates, PSS-10 and the validated Malay version of Depression Anxiety and Stress Scale-21 item (DASS-21). Spearman's correlation coefficient was used in the analysis. Stress subscale of DASS -21 correlated positively with the total score of PSS-10 (r= +0.50, p<0.001), positively with the negative subscale of PSS-10 (r=+0.36, p<0.001) and negatively with the positive subscale of PSS-10 (perceived coping) (r= -0.33, p<0.001). Conclusion: The Malay Version of PSS-10 has fair correlation with the stress subscale of DASS-21. This confirmed the concurrent validity of this scale, which further strengthened the previous evidence that the Malay version of PSS-10 was a valid tool to measure stress in Malaysian university students. ASEAN Journal of Psychiatry, Vol. 15 (1): January – June 2014: 8-13.

Silibinin improves the cytotoxicity of methotrexate in chemo resistant human rhabdomyosarcoma cell lines

To investigate whether silibinin [SDH] could overcome chemoresistance of methotrexate [MTX]-resistant human rhabdomyosarcoma [hRD]. This study was conducted at the Department of Pharmacology and Toxicology, College of Pharmacy, University of Baghdad, Baghdad, Iraq from October 2012 to March 2013. In this in vitro study, resistance to MTX was induced in hRD cell line, the cells were treated with different concentrations of MTX or SDH alone, and in combination. Cell viability was determined by tetrazolium assay. The SDH in a concentration-dependent pattern, enhanced the sensitivity of MTX-resistant cells to the maximum cytotoxic concentration of MTX, and decreased the IC[50] [concentration resulting in 50% inhibition of cell growth] of MTX by 17.8 fold. The decrease in IC[50] of MTX was negatively correlated with increasing SDH concentrations with R[2] = 0.78 and p=0.04. The SDH improves the sensitivity of MTX-resistant hRD cell lines to the cytotoxic activity of MTX in concentration-dependent pattern

What Are The Effects of Silibinin on Testicular Tissue of Mice.

Silibinin (silybin) is one of the structural isomers of the flavonoid silymarin, and it has wide variety of phytotherapeutic applications and the aim of this study was to investigate the effects of different doses of silibinin on testicular tissue of mice. Twenty male Swiss albino mice were divided into four groups. Each group consist of five animal, (Group 1) (negative control) animals were administered single intraperitoneal (IP) daily dose of phosphate buffer for 5 days, Groups ( 2, 3, and 4) were given a single IP daily dose of either (50, 100 or 150 mg/kg B.wt.) of silibinin respectively for 5 days. Microscopic examinations of sperms, histological examinations of testes and serum testosterone level had been measured. It was found that silibinin in doses of (100 or 150) mg/Kg produced a significant increase (P<0.05) in the level of testosterone in comparison with group 1. Also, silibinin in dose of 100 mg/Kg showed a significant increase in the diameter of spermatide, and significant increase was observed in group of animals treated with 150 mg/kg of silibinin concerning the diameter of primary spermatocyte and diameter of spermatide. The results indicate that silibinin can improve some testicular parameters as well as testosterone levels.

Effect of Acarbose on the Bioavailability and Pharmacokinetics of Metronidazole in Healthy and Diabetic Subjects.

Although drug interactions with Acarbose are uncommon, there is a possibility for interference with the pharmacokinetic behaviors of concomitantly administered drugs. The present study was designed to evaluate the possible drug interactions between Acarbose and orally administered MTZ. Twelve healthy volunteers and twelve diabetic patients were enrolled in a randomized controlled crossover study. The effect of Acarbose (single 100mg dose) on the pharmacokinetics of MTZ was evaluated, while the effect of multiple doses was evaluated only in diabetic patients. In both groups, 5ml blood samples were collected into plane tubes at 0, 0.25, 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 4.0, 6.0, 8.0, 12.0, 24.0 and 48.0 hrs; serum levels of MTZ were evaluated using HPLC technique. The results showed that diabetes mellitus significantly altered the pharmacokinetic parameters of orally administered MTZ compared to healthy subjects. Moreover, both single and multiple doses of Acarbose significantly changed the pharmacokinetic parameters of MTZ when used concomitantly. The pharmacokinetics of orally administered MTZ was significantly affected by both diabetes mellitus and concomitant use of single or multiple doses of Acarbose.

Antimicrobial properties of 3 medicinal plants from Saudi Arabia against some clinical isolates of bacteria

To examine the in vitro antibacterial activity of the ethanol extract of fresh fruits of Solanum incanum L., fresh leaves of Ricinus communis L. and Allium ampeloprasum var. porrum L., and to determine and quantify the phenol compounds of the investigated plant parts. This study was carried out at the Faculty of Science, King Khalid University, Abha, Kingdom of Saudi Arabia from July 2011 to September 2011. Nine clinical strains of bacteria and 3 ethanol extracts of 3 plant species were used for the antimicrobial study. Thirty grams of each sample was ground, filtrated, and each filtrate mixed with 100 ml ethanol and placed in a shaker for 48 hours. The ethanol was evaporated from the sample, weighed, and subjected to an antibacterial activity test using the agar diffusion method. The high-performance liquid chromatography was used to identify and quantify the phenols extracts of investigated samples. Ethanol extract of the investigated plant parts showed antibacterial activities against different pathogenic bacteria. Leaf extracts of Ricinus communis showed the highest antibacterial activity, followed by the leaves of Allium ampeloprasum var. porrum, while the fruits of Solanum incanum showed the least activity. The amounts of main phenols detected in Ricinus communis leaves were higher than those of Solanum incanum fruits and Allium ampeloprasum var. porrum leaves. The ethanol extract of the tested plants could be considered as an alternative source of new antibacterial drugs

Violence exposure among health care professionals in Saudi public hospitals. A preliminary investigation

To identify the prevalence, causes, types, and sources of workplace violence among health professionals in public hospitals in the Kingdom of Saudi Arabia. This exploratory cross-sectional survey employed self-administered questionnaires to collect data on aspects of workplace violence against physicians and nurses in Saudi hospitals. The questionnaires were distributed randomly to 600 physicians and nurses, of which 383 [63.8%] completed the questionnaires at 2 public hospitals in Riyadh city between May and July 2011. More than two-thirds [67.4%] of respondents reported they were victims of violence in the previous 12 months. Nurses were more likely to be exposed to violent incidents than physicians [p<0.001]. Males, less experienced, and younger respondents were more likely to encounter violent episodes than their counterparts. Respondents reported that excessive waiting time, shortage of staff, and unmet patients' demands were the most common reasons for violence. Verbal abuse was the most common type encountered. The assailants were mostly the patients' relatives or friends, followed by the patients themselves. Reasons for not reporting violent events included: feel it is a part of the job, previous experience of no action, and fear of consequences. Physicians and nurses are at high risk of violent incidents. Health decision makers need to be aware of the potential consequences of such events. Appropriate preventive measures are needed to make hospitals safer environments