Validation studies on migraine diagnostic tools for use in nonclinical settings: a systematic review / Estudos de validação de ferramentas de diagnóstico de enxaqueca (migrânea) para uso em ambientes não clínicos: uma revisão sistemática

Abstract Background Migraine underdiagnosis and undertreatment are so widespread, that hence is essential to diagnose migraine sufferers in nonclinical settings. A systematic review of validation studies on migraine diagnostic tools applicable to nonclinical settings can help researchers and practitioners in tool selection decisions. Objective To systematically review and critically assess published validation studies on migraine diagnostic tools for use in nonclinical settings, as well as to describe their diagnostic performance. Methods A multidisciplinary workgroup followed transparent and systematic procedures to collaborate on this work. PubMed, Medline, and Web of Science were searched for studies up to January 17, 2022. The QUADAS-2 was employed to assess methodological quality, and the quality thresholds adopted by the Global Burden Disease study were used to tail signaling questions. Results From 7,214 articles identified, a total of 27 studies examining 19 tools were eligible for inclusion. There has been no high-quality evidence to support any tool for use of migraine diagnosis in nonclinical settings. The diagnostic accuracy of the ID-migraine, structured headache and HARDSHIP questionnaires have been supported by moderate-quality evidence, with sensitivity and specificity above 70%. Of them, the HARDSHIP questionnaire has been the most extensively validated. The remaining 16 tools have provided poor-quality evidence for migraine diagnosis in nonclinical populations. Conclusions Up till now, the HARDSHIP questionnaire is the optimal choice for diagnosing migraine in nonclinical settings, with satisfactory diagnostic accuracy supported by moderate methodological quality. This work reveals the crucial next step, which is further high-quality validation studies in diverse nonclinical population groups.

Resumo Antecedentes O sub-diagnóstico e o subtratamento da enxaqueca são tão difundidos que, portanto, é essencial para diagnosticar os portadores de enxaqueca em ambientes não-clínicos. Uma revisão sistemática dos estudos de validação das ferramentas de diagnóstico da enxaqueca aplicáveis a ambientes não-clínicos pode ajudar os pesquisadores e profissionais nas decisões de seleção de ferramentas. Objetivo Revisar sistematicamente e avaliar criticamente estudos de validação publicados sobre ferramentas de diagnóstico da enxaqueca para uso em ambientes não-clínicos, bem como descrever seu desempenho diagnóstico. Métodos Um grupo de trabalho multidisciplinar seguiu procedimentos transparentes e sistemáticos para colaborar neste trabalho. PubMed, Medline e Web of Science foram pesquisados por estudos até 17 de janeiro de 2022. O QUADAS-2 foi empregado para avaliar a qualidade metodológica, e os limites de qualidade adotados pelo estudo da Global Burden Disease foram usados para responder a questões de sinalização. Resultados De 7.214 artigos identificados, um total de 27 estudos examinando 19 ferramentas foram elegíveis para inclusão. Não houve evidência de alta qualidade para apoiar qualquer ferramenta para o uso de diagnóstico de enxaqueca em ambientes não clínicos. A precisão diagnóstica do ID-Migraine, questionário de dor de cabeça estruturada e questionário HARDSHIP foram apoiados por evidências de qualidade moderada, com sensibilidade e especificidade acima de 70%. Deles, o questionário HARDSHIP foi o mais amplamente validado. As 16 ferramentas restantes forneceram provas de má qualidade para o diagnóstico de enxaqueca em populações não-clínicas. Conclusões Até agora, o questionário HARDSHIP é a escolha ideal para o diagnóstico da enxaqueca em ambientes não-clínicos, com precisão diagnóstica satisfatória apoiada por uma qualidade metodológica moderada. Este trabalho revela o próximo passo crucial, que é a realização de mais estudos de validação de alta qualidade em diversos grupos populacionais não-clínicos.

Association of family history of cardiometabolic diseases (CMDs) and individual health behaviours: Analysis of CARRS study from South Asia

Objectives: Family history is considered as an important predictor of cardiovascular diseases (CVDs) and diabetes. Available research findings suggest that family history of chronic diseases is associated with perceived risk of disease and adoption of healthy behaviours. We examined the association between family history of cardio-metabolic diseases (CMDs) and healthy behaviours among adults without selfreported CMDs. Methods: Cross-sectional data of 12,484 adults, without self-reported CMDs, from the baseline survey of Centre for cArdiometabolic Risk Reduction in South-Asia (CARRS) cohort study were analysed. Results: Family history was positively associated with non-smoking and high fruits & vegetables consumption in the age group of 45e64 years and moderate to high physical activity in the age group _x0001_65 years after adjusting for sex, education, wealth index, city and body mass index. Conclusions: Understanding perceived risks and cultural or psychological factors related to family history through ethnographic studies may deepen understanding of these associations.

Transcriptional analysis of Rhazya stricta in response to jasmonic acid

BACKGROUND: Jasmonic acid (JA) is a signal transducer molecule that plays an important role in plant development and stress response; it can also efficiently stimulate secondary metabolism in plant cells. RESULTS: RNA-Seq technology was applied to identify differentially expressed genes and study the time course of gene expression in Rhazya stricta in response to JA. Of more than 288 million total reads, approximately 27% were mapped to genes in the reference genome. Genes involved during the secondary metabolite pathways were up- or downregulated when treated with JA in R. stricta. Functional annotation and pathway analysis of all up- and downregulated genes identified many biological processes and molecular functions. Jasmonic acid biosynthetic, cell wall organization, and chlorophyll metabolic processes were upregulated at days 2, 6, and 12, respectively. Similarly, the molecular functions of calcium-transporting ATPase activity, ADP binding, and protein kinase activity were also upregulated at days 2, 6, and 12, respectively. Time-dependent transcriptional gene expression analysis showed that JA can induce signaling in the phenylpropanoid and aromatic acid pathways. These pathways are responsible for the production of secondary metabolites, which are essential for the development and environmental defense mechanism of R. stricta during stress conditions. CONCLUSIONS: Our results suggested that genes involved in flavonoid biosynthesis and aromatic acid synthesis pathways were upregulated during JA stress. However, monoterpenoid indole alkaloid (MIA) was unaffected by JA treatment. Hence, we can postulate that JA plays an important role in R. stricta during plant development and environmental stress conditions.

Treatment of adult Burkitt lymphoma with the CALGB 1002 protocol: a single center experience in Jordan

Background@#The treatment of adult Burkitt lymphoma with pediatric-based chemotherapy protocols usually results in high cure rates, although with significant toxicity. We report our experience with the Cancer and Leukemia Group B1002 (CALGB 1002) protocol. @*Methods@#The files of adult patients diagnosed with Burkitt lymphoma and treated with the CALGB 1002 protocol at King Hussein Cancer Center between 2008 and 2017 were reviewed.Baseline demographics, clinical laboratory features, treatment details, and responses were collected. The correlations between clinical and laboratory variables with event-free survival (EFS) and overall survival (OS) were determined by univariate and multivariate analyses using backward stepwise Cox regression models. EFS and OS were plotted using Kaplan‒Meier curves. @*Results@#This study included 19 patients with a median age of 33 years (range, 19‒65). Eleven (58%) and two (10.5%) patients had advanced-stage and central nervous system disease, respectively. Among 106 administered cycles, the median interval between cycles was 23 days (range, 19‒84 days). Sixteen patients (84%) achieved a complete response. After a median follow-up of 40.8 months, the 3-year EFS and OS rates were 78.95%. Patients with a low-risk International Prognostic Index (IPI) had better survival than those with intermediate-or high-risk IPI. Grade III‒IV hematological toxicities occurred in 88% of patients, while 73% had grade III‒IV mucositis. @*Conclusion@#In adult Burkitt lymphoma, the CALGB 1002 protocol provides high cure rates and can be administered promptly, but is associated with significant toxicity. Risk-adapted approaches and other, less toxic, chemotherapeutic regimens should be considered.

The impact of omeprazole on mycophenolate pharmacokinetics in kidney transplant recipients

Background@#The absorption rates of mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS) may be influenced by the concomitant use of omeprazole. @*Methods@#One hundred kidney transplant patients were recruited during their outpatient visits, including 50 on MMF and 50 on EC-MPS. At the clinic, a predose mycophenolic acid (MPA) sample (C0) was collected; subsequently, the participants received the proton-pump inhibitor omeprazole along with either MMF or EC-MPS. Two more blood samples were collected at 1.5 and 3.5 hours and used to estimate an area under the curve (AUC) from zero to 12 hours [AUC (0-12)]. @*Results@#The mean number of months after transplant was 92 months. The median AUC (0-12) and C0 results were 62.2 mg·h/L and 2.0 mg/L for the MMF group and 71.9 mg·h/L and 1.8 mg/L for the EC-MPS group (P = 0.160 and 0.225, respectively). Interestingly, 54% of the MMF group and 62% of the EC-MPS group showed AUCs above the target values. The correlation between MPA C0 and the predicted AUC was poor in both groups. @*Conclusion@#Omeprazole can be safely co-administered with either MMF or EC-MPS, as it did not compromise the MPA exposure. Unexpectedly, however, a high percentage of patients presented MPA AUCs exceeding the target value, highlighting the importance of periodically assessing MPA level.

The impact of omeprazole on mycophenolate pharmacokinetics in kidney transplant recipients

Background@#The absorption rates of mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS) may be influenced by the concomitant use of omeprazole. @*Methods@#One hundred kidney transplant patients were recruited during their outpatient visits, including 50 on MMF and 50 on EC-MPS. At the clinic, a predose mycophenolic acid (MPA) sample (C0) was collected; subsequently, the participants received the proton-pump inhibitor omeprazole along with either MMF or EC-MPS. Two more blood samples were collected at 1.5 and 3.5 hours and used to estimate an area under the curve (AUC) from zero to 12 hours [AUC (0-12)]. @*Results@#The mean number of months after transplant was 92 months. The median AUC (0-12) and C0 results were 62.2 mg·h/L and 2.0 mg/L for the MMF group and 71.9 mg·h/L and 1.8 mg/L for the EC-MPS group (P = 0.160 and 0.225, respectively). Interestingly, 54% of the MMF group and 62% of the EC-MPS group showed AUCs above the target values. The correlation between MPA C0 and the predicted AUC was poor in both groups. @*Conclusion@#Omeprazole can be safely co-administered with either MMF or EC-MPS, as it did not compromise the MPA exposure. Unexpectedly, however, a high percentage of patients presented MPA AUCs exceeding the target value, highlighting the importance of periodically assessing MPA level.

Evaluation the Health Impact of Some Heavy Metals in Milk from Markets

This study focuses on the heavy metals concentrations (Fe, Cu, Zn, Pb, and Cd) in certain common milk species are collected from Iraqi markets using Flame Atomic Absorption Spectrophotometer-6300 AA, Shimadzu, Japan, respectively. This study shows the pollution in the environment obtained by heavy metals. The results showed that Cr, Cd, Cu, Zn, and Fe were varying according to the order: Zn>Fe>Cr>Cd>Cu. levels of heavy metals were 0.610(Cr), 0.125(Cd), 0.052(Cu), and 6.902(Zn), and 0.759(Fe). All the heavy metals were observed within maximum limit in milk. Overall, the number of analyzed heavy metals and sample size were limited in present study. Keywords: Heavy metals; Milk; Najaf; Flame atomic absorption; Spectrophotometer This study focuses on the heavy metals concentrations (Fe, Cu, Zn, Pb, and Cd) in certain common milk species are collected from Iraqi markets using Flame Atomic Absorption Spectrophotometer-6300 AA, Shimadzu, Japan, respectively. This study shows the pollution in the environment obtained by heavy metals. The results showed that Cr, Cd, Cu, Zn, and Fe were varying according to the order: Zn>Fe>Cr>Cd>Cu. levels of heavy metals were 0.610(Cr), 0.125(Cd), 0.052(Cu), and 6.902(Zn), and 0.759(Fe). All the heavy metals were observed within maximum limit in milk. Overall, the number of analyzed heavy metals and sample size were limited in present study

A Study On The Dietary Habits And Their Association With The Symptoms In Patients With Hemorrhoids And Fissure-in-Ano: A Case Control Study From A South Indian Tertiary Care Hospital

DOI: 10.21276/aimdr.2018.4.2.SG4 Original Article ISSN (O):2395-2822; ISSN (P):2395-2814Annals of International Medical and Dental Research, Vol (4), Issue (2) Page 11Section: Surgery A Study On The Dietary Habits And Their AssociationWith The Symptoms In Patients With Hemorrhoids And Fissure-in-Ano: A Case Control Study From A South Indian Tertiary Care Hospital. Shaffaf M P1, Kunhi Mohammed K P2, Siddharth Matad3 1Junior Resident, Department Of Surgery, Government Medical College, Manjeri, Kerala, India. 2Assistant Professor, Department Of Surgery, Government Medical College, Manjeri, Kerala, India. 3Senior Resident Department Of Surgery, Government Medical College, Kozhikode, Kerala, India. Received: January 2018 Accepted: January 2018 Copyright:© the author(s), publisher. Annals of International Medical and Dental Research (AIMDR) is an Official Publication of “Society for Health Care & Research Development”. It is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.ABSTRACT Background: Both hemorrhoids and fissure-in-ano contribute to the spectrum of anorectal disorders which generate significant patient discomfort and disability. Etiological factors associated with development of symptomatic hemorrhoids include intake of low fiber diet, inadequate fluid intake, altered bowel habits leading to constipation etc. Aim: 1.To study the dietary habits of patients presenting with haemorrhoids and fissure in ano. 2. To determine the effect of altered dietary habits on the symptomatology. Methods: Case Control study conducted over one year between august 2016 to august 2017 at Department of surgery, Government Medical College, MANJERI. Results: The mean age of patients having hemorrhoids is 42.9years in case group and 44.0years in control group. Where as, the mean age of patients with fissure-in-ano is 37.1years in case group and 39.6years in control group. Majority of patients in the study population of hemorrhoids are male (84%) while female patients (56%) have more anal fissures. The p value of all analysis is <0.05. Conclusion: From this study, it has been concluded that in patients with hemorrhoids, bleeding per rectum gets aggravated with consumption of non vegetarian food items, fasting in the morning and intake of ≤ 1L of oral liquids and reduced consumption of diet containing fibre.

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

Preoperative Imaging Modalities to Predict the Risk of Regional Nodal Recurrence in Well-Differentiated Thyroid Cancers

Introduction Thyroid cancer incidence has increased in the previous 2 decades. Preoperative identification of lymph node metastasis is a suggested risk factor associated with recurrence following thyroidectomy. Objectives We aimed to evaluate the accuracy of preoperative radiologic investigations of nodal status in determining the postoperative risk of regional nodal recurrence in cases of well-differentiated thyroid cancer. Methods This is a case series. We retrospectively reviewed data, including preoperative ultrasonography and/or computed tomography results, on patients who underwent total thyroidectomy for thyroid cancer at our hospital between 2006 and 2012. Prognostic factors for predicting recurrence, including age, sex, tumor diameter, and nodal diameter, were evaluated. Results Total thyroidectomy was performed on 24 male and 74 female patients (median age, 43 years). The median follow-up time was 21 months. Sixty-eight patients had papillary thyroid cancer, and 30 had follicular cancer. Nodal recurrence was evident in 30% of patients, and 4% of patients died. Identification of lymph node involvement during preoperative radiologic investigations was strongly prognostic for recurrence: 35.3% of patients with positive preoperative ultrasonography findings and 62.5% of those with positive preoperative computed tomography findings had recurrence (p = 0.01). Conclusions Preoperative identification of lymph node metastasis on radiologic studies was correlated with an increased risk of regional nodal recurrence in well-differentiated thyroid cancer. Computed tomography was superior to ultrasonography in detecting metastatic nodal involvement preoperatively and is therefore recommended for preoperative assessment and postoperative follow-up. .

Day-case laparoscopic cholecystectomy

To assess the safety and feasibility of laparoscopic cholecystectomy as a day-case procedure. All consecutive patients who were admitted to the day-surgery unit for laparoscopic cholecystectomy at the Department of Surgery, King Saud Medical City, Riyadh, Saudi Arabia from July 2009 to June 2013 were considered for this retrospective study. The medical records were reviewed for age, gender, presenting symptoms, laboratory findings, imaging studies, American Society of Anesthesiology [ASA] grade, anesthesia, conversion to open cholecystectomy, complications, the operating surgeons, pain management, nausea, and vomiting, overnight stay, readmission, morbidity, mortality, and outpatient follow up were collected and analyzed. A total of 487 patients underwent laparoscopic cholecystectomy as a day case [ASA I=316, ASA II=171]. Surgery was performed by high surgical trainees [HSTs] [n=417] and consultants [n=70] with conversion to open cholecystectomy in 4 patients. Twenty-two [5%] patients were admitted for overnight stay for different reasons, while 465 [95%] patients were discharged before 8 pm. Two patients [0.4 %] were re-admitted to the hospital due to abdominal pain. Five patients developed umbilical port site infection [1%]. A total of 443 patients were satisfied [97%], while 14 [3%] were unsatisfied. There was no mortality or intra-abdominal septic collection. Day-case laparoscopic cholecystectomy is safe and feasible with optimal patient selection, education, and planned postoperative antiemetic and analgesia management

Early endoscopic retrograde cholangiopancreatography in mild gallstone pancreatitis with deranged liver function test. A 7-year experience in central Saudi Arabia

To determine the use of liver function tests [LFTs] as a selection tool for preoperative endoscopic retrograde cholangiopancreatography [ERCP] in patients with mild gallstone pancreatitis. All patients admitted with mild gallstone pancreatitis with deranged LFTs in King Saud Medical City, Riyadh, Kingdom of Saudi Arabia between January 2006 and February 2013 were studied retrospectively. Patients' demography, symptoms, laboratory values, imaging studies, ERCP findings, complications and its treatment, surgical intervention, intraoperative and postoperative findings, mortality, and outpatient follow up were collected and analyzed. A total of 245 patients were admitted as mild gallstone pancreatitis with admission day deranged LFTs. Pre-operative ERCP was performed in 74 patients based on admission day LFTs [Group A]. Endoscopic retrograde cholangiopancreatography was normal in 65 patients, revealed stones in 5, and sludge in 4 patients. Six patients developed ERCP complications. Endoscopic retrograde cholangiopancreatography was deferred in 171 patients [Group B] until the LFTs were repeated in 3-4 days. Liver function tests remained persistently high in 8 patients. They were submitted to preoperative ERCP, which revealed stones [n=5] and sludge [n=3]. Patients with normalized LFTs [n=163] were not submitted to ERCP. Three of them developed gallstone related complications. Patients admitted with predicted mild gallstone pancreatitis, deranged LFTs, and no evidence of cholangitis should not be submitted to ERCP unless a repeat LFT within 3-4 days shows persistently deranged LFTs. This will reduce unnecessary ERCP and its complications

Effects of Ethyl acetate and n-Butanol Fractions of Acacia nilotica methanol Leaves Extract on Lipid profile and Liver Enzyme of Alloxan-Induced Diabetic Wistar rats.

This study aimed to evaluate the effects of ethyl acetate and n-butanol fractions of Acacia nilotica methanol leaves extract on lipid profile and liver enzyme on alloxan induced diabetic rats. 30 Wistar rats of both sexes were used for the study. The rats were divided into six groups with five rats in each group. The diabetic rats were treated with n- butanol and ethyl acetate for a period of 12 days. After which the animals were sacrificed and blood serum sample were taken from all the groups for the assessment of lipid profiles and liver enzymes. As regards to the lipid profile there was a significant decrease (P<0.05) in the triglyceride and cholesterol level in ethyl acetate treated group with 50 and 100 mg/kg , while, there was also a significant increase in the levels of high density lipoprotein when compared with the control untreated group. Also there was a significant decrease (P<0.05) in ALT, AST and ALP levels in ethyl acetate fraction treated group with 50 and 100 mg/kg when compared with the control untreated group. In relation to the n-butanol fraction at the two doses tested 100 and 200 mg/kg there was no significant change in the levels of triglyceride when compared with the control untreated. However there was decrease in the levels of cholesterol (p<0.05) and a significant increase in the levels of high density lipoprotein when compared with the control untreated. There was a significant decrease (P<0.05) in the levels of ALT, AST while there was no significant change in the level of ALP treated with the n-butanol fraction when compared with the control untreated group. The phytochemical screening revealed the presences of saponin, flavonoid, tannin and alkaloid. The median lethal dose (LD50) of the ethyl acetate in mice was calculated to be 471.2 mg/kg b.w and n-butanol is 774.5 mg/kg b.w. This results suggest that the Ethylacetate and n-butanol fractions of methanol leaves extract of Acacia nilotica has anti-hyperlipidemic and hepatoprotective effect on alloxan induced diabetic rats.

Anti-diabetic effects of ethyl acetate and n-butanol fractions of Acacia nilotica leaves methanolic extract on alloxan-induced diabetic wistar rats.

Evaluation of hypoglycaemic activity of ethyl acetate and n-butanol fractions of Acacia nilotica on alloxan induced diabetic Wistar rats has been investigated. Two doses of the ethylacetate fraction 50 and 100 mg/kg was administered. As regard to 50mg/kg caused a significant (P<0.05) reduction in the blood glucose levels when compared with control at 3,5,7,9 and 12 days of treatment with percentage glycaemia change of 49.1,54.8,60.5, 58.8 and 69.7 respectively. However, the dose of 100mg/kg ,there was a significant decrease (p<0.05) at 3 5 7, 9 and 12 days treatment when compared to control untreated with percentage glycaemia change of 50.1,56.8, 52.8, 69.9 and 59.6 . Also two doses of n-butanol, 100 and 200 mg/kg fraction was administered to the diabetic rats. The dose of 100 mg/kg, there was a significant decrease (p<0.05) after 7 and 12 days of treatment when compared to untreated control. As regard the dose of 200 mg/kg, there was a significant decrease ( p<0.05) at 3, 5 ,7,9 and 12 days of treatment when compared to control untreated with percentage glycaemic change of 20.7,35.3,52.3, 44.2 and 40.9 respectively. The preliminary phytochemical screening revealed the presences of saponin, flavonoid, tannin and alkaloid. The median lethal dose (LD50) in mice was calculated to be 471.2 mg/kg bodyweight. This result suggests that the Ethylacetate and n-butanol fractions of leaves methanolic extract of Acacia nilotica possess antidiabetic effects on alloxan - induced diabetic Wistar rats.

Modulatory role of Magnesium and Copper Sulphates on Serum Lipid profile and Serum Liver Enzymes in Fructose-induced Diabetic Wistar Rats.

The aim of this study is to determine the effect of magnesium and copper sulphates on serum lipid profile and serum liver enzymes in fructose-induced diabetic Wistar rats. Diabetes was induced by administration of 20% (20g/100ml) of fructose dissolved in distilled water and administered to the animals for a period of six (6) weeks. After which the animals were randomly assigned into 4 groups of 6 rats each. Group I served as diabetic negative control were administered 1ml distilled water. Group II were administered Magnesium sulphate (250 mg/kg b w). Group III were administered Copper sulphate (250 mg/kg b w) and Group IV administered Metformin (250 mg/kg b w) served as positive control. All treatments were given orally for a period of seven days. The results obtained showed a statistically significant decrease (p<0.05) in the serum total cholesterol and triglyceride levels in groups administered with 250mg/kg b w of magnesium and copper sulphate when compared to diabetic control group. However, high density lipoprotein serum level was significantly increased (p<0.05) in groups administered with 250mg/kg b w of magnesium and copper sulphate when compared to diabetic control group. The results also showed that magnesium and copper sulphates at dose of 250mg/kg b w produced a significantly decreased (p<0.05) serum levels of liver enzymes (AST, ALT and ALP) in the treated groups when compared to diabetic untreated control group.

Ameliorative Effects of Magnesium and Copper Sulphates on Blood glucose and Serum Electrolytes Levels in Fructose-induced Diabetic Wistar Rats.

The aim of this study is to evaluate the effects of magnesium and copper sulphates on blood glucose and serum electrolytes levels in fructose-induced diabetic Wistar rats. Diabetes was induced by administration of 20% (20g/100ml) of fructose dissolved in distilled water and administered to the animals for a period of six (6). After which the animals were randomly assigned into 4 groups of 6 rats each. Group I served as diabetic control and were administered distilled water, Group II were administered Magnesium sulphate (250 mg/kg b w), Group III were administered Copper sulphate (250 mg/kg b w) and Group IV administered Metformin (250 mg/kg b w). All treatments were given orally for a period of seven days. The results obtained showed a statistically significant decrease (p<0.05) in the blood glucose levels in groups administered with 250 mg/kg b w of magnesium and copper sulphate after day 3 and 7 when compared to diabetic control group. The results also showed that magnesium and copper sulphates at doses tested i.e 250 mg/kg b w, produced a significantly decreased (p<0.05). With regard to serum levels of sodium, potassium and bicarbonate ions when compared to diabetic untreated control group. However, there was no significant difference in the levels of serum chloride in the groups treated with 250mg/kg b w of magnesium and copper sulphate when compared to diabetic control group.

Ameliorative Effects of Vitamin C and E on Serum Lipid Profiles and Liver Enzymes on Fructose induced hyperglycaemia in Wistar Rats.

The aim of this study is to determine the effect of vitamin C and E administration on serum lipid profiles and liver enzymes on fructose-induced diabetes on Wistar rats. Diabetes was induced by administration of 20% (20g/100ml) of fructose dissolved in distilled water for a period of six (6) weeks to the animals. After which the animals were randomly assigned into 4 groups of 6 rats each. Group 1 (control) administered distilled water, Group 2 administered vitamin C (100mg/kg b w), Group 3 administered vitamin E (100mg/kg b w) and Group 4 administered Metformin (250 mg/kg b w). The results obtained showed a statistical significant reduction (p<0.05) in the level of serum total cholesterol and triglyceride in all groups administered vitamin C (100 mg/kg b w) and E (100 mg/kg b w) when compared to diabetic control group. However, the serum level of high density lipoprotein was significant increase in the group treated with vitamin E (100 mg/kg b w) when compared to diabetic control group. There was a significant decrease (p<0.05) levels of all serum liver enzymes (AST, ALT and ALP) in the groups treated with Vitamin C and Metformin. However, serum AST there was no significant change in the group treated with vitamin E (100 mg/kg b w).

Survey of burnout amongst drug and alcohol unit staff

Burnout has a special significance in healthcare where staff experience psychological, emotional and physical stress. Burnout has major behavioral and health implications. To evaluate the extent to which the staff employed in Drug and Alcohol Unit is affected by burnout. Drug and Alcohol Unit, Psychiatric Hospital, Bahrain. The study is a cross-sectional survey, incorporating a standardized measurement of burnout [Maslach Burnout Inventory: MBI]. All staff in the Drug and Alcohol Unit [N=31] were surveyed using the Maslach Burnout Inventory questionnaire in October 2011. Maslach Burnout Inventory [MBI] is designed to assess the three components of the burnout syndrome: emotional exhaustion, depersonalization and reduced personal accomplishment. Twenty-four [77.4%] responded, their result indicates a medium level of burnout. The degree of burnout among the staff working in the Drug and Alcohol Unit was low compared to the staff working in General Adult Psychiatry Unit. Personal accomplishment was high in Drug and Alcohol compared to General Adult Psychiatry. The degree of burnout as well as emotional exhaustion in the staff working in the Drug and Alcohol Unit was lower compared to the staff working in General Adult Psychiatry. Dealing with patients' psychological problems, feelings of isolation, lack of support, lack of reward, long hours of work and psychological morbidity leads to higher degree of burnout

Knowledge and attitude of health professionals in the Riyadh region, Saudi Arabia, toward complementary and alternative medicine

Complementary and alternative medicine [CAM] is a popular treatment option for many populations. The present work is aimed at studying the knowledge and attitude of health professionals in the Riyadh region, Saudi Arabia, toward CAM. In this cross-sectional survey, a multistage random sample was taken from health professionals working in hospitals in Riyadh city and surrounding governorates. Data were collected through a self-administered questionnaire, from 306 health professionals working in 19 hospitals, on socio-demographic data, knowledge about CAM and their sources, and attitudes toward CAM practices. Of the participants, 88.9% had some knowledge about CAM. Respondents with a doctorate degree [94.74%] and 92.53% of those with a bachelor's degree had significantly higher knowledge of CAM than subjects with a diploma, a fellowship, or a master's degree [68.75%, 76.67%, and 85.41%, respectively, P = 0.004]. Mass media represented 60.1% of sources of the knowledge of CAM followed by family, relatives, and friends [29.08%] and health educational organizations [14.71%]. Participants estimated that prophetic medicine including prayer, honey and bee products, medical herbs, Hijama, nutrition and nutritional supplements, cauterization, and camel milk and urine were the most commonly used CAM practices [90.5%, 85%, 76.9%, 70.6%, 61.4%, 55.9%, and 52.5%, respectively] in addition to medical massage [61.8%] and acupuncture [55%]. One hundred and fifteen [80%] physicians were ready to talk with their patients on CAM. The willingness to improve knowledge and create a positive attitude in health professionals toward CAM has increased. Religious practices, especially those related to prophetic medicine, are more common in the region. Health educational organizations have to play a greater role by being the source of evidence-based knowledge of CAM. Talking on CAM with patients should be improved by rooting them on evidence-based practices

Bilateral asymmetrical traumatic sternoclavicular joint dislocations

Unilateral and bilateral sternoclavicular joint [SCJ] dislocations are rare injuries. The difficulty in assessing this condition often leads to delay in diagnosis and treatment. We report a rare case of bilateral asymmetrical traumatic SCJ dislocations in a 45-year-old male. The right anterior SCJ dislocation was reduced in the emergency room [ER] and resulted in residual instability. The left posterior SCJ dislocation was asymptomatic and unnoticed for six months. It is important for ER physicians and orthopaedic surgeons to be able identify and treat this condition. All suspected SCJ dislocations should be evaluated by computed tomography [CT] scan for confirmation of the diagnosis and evaluation of both SCJs. Posterior SCJ dislocation is a potentially fatal injury and should not be overlooked due to the presence of other injuries. Surgical intervention is often necessary in acute and old cases