Lepidium sativum Seed Extract-Mediated Synthesis of Zinc Oxide Nanoparticles: Structural, Morphological, Optical, Hemolysis, and Antibacterial Studies.

Nanomaterials have unique physicochemical properties compared to their bulk counterparts. Besides, biologically synthesized nanoparticles (NPs) have proven superior to other methods. This work aimed to biosynthesize zinc oxide (ZnO) NPs using an aqueous extract of Lepidium sativum seed. The obtained ZnO NPs were characterized by X-ray diffraction, scanning electron microscopy, Fourier transform infrared, and ultraviolet-visible spectroscopy. The in vitro antibacterial activity of ZnO NPs against Gram-positive (S. aureus) and Gram-negative (E. coli) bacteria was assessed using the disk diffusion technique. The hemolytic impact was quantified spectrophotometrically. The results indicated a 24.2 nm crystallite size, a hexagonal structure phase, and a 3.48 eV optical bandgap. Antibacterial studies revealed a dose-dependent response with comparable activity to the standard drug (gentamicin) and higher activity against S. aureus than E. coli, e.g., the zone of inhibition at 120 mg/mL was 23 ± 1.25 and 16 ± 1.00 mm, respectively. The hemolysis assay showed no potential harm due to ZnO NPs toward red blood cells if utilized in low doses. As a result, it could be concluded that the reported biogenic method for synthesizing ZnO NPs is promising, resulting in hemocompatible NPs and comparable bactericidal agents.

The efficacy of aerobic training on the pulmonary functions of hemophilic A patients: a randomized controlled trial.

OBJECTIVE: The present study investigated the efficacy of a program of aerobic exercise on pulmonary functions in adult males with hemophilia A (HA). PATIENTS AND METHODS: 40 patients with HA who met the eligibility criteria (40 HA; age range: 20-39 years) were invited to participate in the study. The patients were divided into two groups, 20 per each. Participants in the study group (A) underwent selected physical therapy program, along with aerobic training sessions on a cycle ergometer (50-60% heart rate reserve, moderate intensity), while the control group (B) underwent a selected physical therapy program only. The pulmonary functions (FVC, FEV1, FEV1/FVC, PEF, PIF, and MVV) were measured before and after treatment program. RESULTS: There were noteworthy statistical differences between pre- and post-measurements in the study group in all measured variables (p < 0.05). There were also significant statistical differences between the study and control groups in all measured variables post treatment (p < 0.05). CONCLUSIONS: This study has demonstrated that hemophilic A patients' pulmonary functions have improved significantly following aerobic exercise training. As a result, aerobic exercise can be used in addition to medical treatment for hemophilic A patients.

WAO-ARIA consensus on chronic cough - Part III: Management strategies in primary and cough-specialty care. Updates in COVID-19.

Background: Chronic cough management necessitates a clear integrated care pathway approach. Primary care physicians initially encounter the majority of chronic cough patients, yet their role in proper management can prove challenging due to limited access to advanced diagnostic testing. A multidisciplinary approach involving otolaryngologists and chest physicians, allergists, and gastroenterologists, among others, is central to the optimal diagnosis and treatment of conditions which underly or worsen cough. These include infectious and inflammatory, upper and lower airway pathologies, or gastro-esophageal reflux. Despite the wide armamentarium of ancillary testing conducted in cough multidisciplinary care, such management can improve cough but seldom resolves it completely. This can be due partly to the limited data on the role of tests (eg, spirometry, exhaled nitric oxide), as well as classical pharmacotherapy conducted in multidisciplinary specialties for chronic cough. Other important factors include presence of multiple concomitant cough trigger mechanisms and the central neuronal complexity of chronic cough. Subsequent management conducted by cough specialists aims at control of cough refractory to prior interventions and includes cough-specific behavioral counseling and pharmacotherapy with neuromodulators, among others. Preliminary data on the role of neuromodulators in a proof-of-concept manner are encouraging but lack strong evidence on efficacy and safety. Objectives: The World Allergy Organization (WAO)/Allergic Rhinitis and its Impact on Asthma (ARIA) Joint Committee on Chronic Cough reviewed the recent literature on management of chronic cough in primary, multidisciplinary, and cough-specialty care. Knowledge gaps in diagnostic testing, classical and neuromodulator pharmacotherapy, in addition to behavioral therapy of chronic cough were also analyzed. Outcomes: This third part of the WAO/ARIA consensus on chronic cough suggests a management algorithm of chronic cough in an integrated care pathway approach. Insights into the inherent limitations of multidisciplinary cough diagnostic testing, efficacy and safety of currently available antitussive pharmacotherapy, or the recently recognized behavioral therapy, can significantly improve the standards of care in patients with chronic cough.

Current gaps in management and timely referral of cardiorenal complications among people with type 2 diabetes mellitus in the Middle East and African countries: Expert recommendations.

The upsurge of type 2 diabetes mellitus is a major public health concern in the Middle East and North Africa (MENA) and Africa (AFR) region, with cardiorenal complications (CRCs) being the predominant cause of premature morbidity and mortality. High prevalence of cardiometabolic risk factors, lack of awareness among patients and physicians, deficient infrastructure, and economic constraints lead to a cascade of CRCs at a significantly earlier age in MENA and AFR. In this review, we present consensus recommendations by experts in MENA and AFR, highlighting region-specific challenges and potential solutions for management of CRCs. Health professionals who understand sociocultural barriers can significantly increase patient awareness and encourage health-seeking behavior through simple educational tools. Increasing physician knowledge on early identification of CRCs and personalized treatment based on risk stratification, alongside optimum glycemic control, can mitigate therapeutic inertia. Early diagnosis of high-risk people with regular and systematic monitoring of cardiorenal parameters, development of region-specific care pathways for timely referral to specialists, followed by guideline-recommended care with novel antidiabetics are imperative. Adherence to guideline-recommended care can catalyze utilization of sodium glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists with demonstrated cardiorenal benefits-thus paving the way for overcoming care gaps in a cost-effective manner. Leveraging digital technology like electronic medical records can help generate real-world data and provide insights on voids in adoption of newer antidiabetic medications. A patient-centric approach, collaborative care among physicians from different specialties, alongside involvement of policy makers are key for improving patient outcomes and quality of care in MENA and AFR.

WAO-ARIA consensus on chronic cough - Part 1: Role of TRP channels in neurogenic inflammation of cough neuronal pathways.

BACKGROUND: Cough features a complex peripheral and central neuronal network. The function of the chemosensitive and stretch (afferent) cough receptors is well described but partly understood. It is speculated that chronic cough reflects a neurogenic inflammation of the cough reflex, which becomes hypersensitive. This is mediated by neuromediators, cytokines, inflammatory cells, and a differential expression of neuronal (chemo/stretch) receptors, such as transient receptor potential (TRP) and purinergic P2X ion channels; yet the overall interaction of these mediators in neurogenic inflammation of cough pathways remains unclear. OBJECTIVES: The World Allergy Organization/Allergic Rhinitis and its Impact on Asthma (WAO/ARIA) Joint Committee on Chronic Cough reviewed the current literature on neuroanatomy and pathophysiology of chronic cough. The role of TRP ion channels in pathogenic mechanisms of the hypersensitive cough reflex was also examined. OUTCOMES: Chemoreceptors are better studied in cough neuronal pathways compared to stretch receptors, likely due to their anatomical overabundance in the respiratory tract, but also their distinctive functional properties. Central pathways are important in suppressive mechanisms and behavioral/affective aspects of chronic cough. Current evidence strongly suggests neurogenic inflammation induces a hypersensitive cough reflex marked by increased expression of neuromediators, mast cells, and eosinophils, among others. TRP ion channels, mainly TRP V1/A1, are important in the pathogenesis of chronic cough due to their role in mediating chemosensitivity to various endogenous and exogenous triggers, as well as a crosstalk between neurogenic and inflammatory pathways in cough-associated airways diseases.

WAO-ARIA consensus on chronic cough - Part II: Phenotypes and mechanisms of abnormal cough presentation - Updates in COVID-19.

BACKGROUND: Chronic cough can be triggered by respiratory and non-respiratory tract illnesses originating mainly from the upper and lower airways, and the GI tract (ie, reflux). Recent findings suggest it can also be a prominent feature in obstructive sleep apnea (OSA), laryngeal hyperresponsiveness, and COVID-19. The classification of chronic cough is constantly updated but lacks clear definition. Epidemiological data on the prevalence of chronic cough are informative but highly variable. The underlying mechanism of chronic cough is a neurogenic inflammation of the cough reflex which becomes hypersensitive, thus the term hypersensitive cough reflex (HCR). A current challenge is to decipher how various infectious and inflammatory airway diseases and esophageal reflux, among others, modulate HCR. OBJECTIVES: The World Allergy Organization/Allergic Rhinitis and its Impact on Asthma (WAO/ARIA) Joint Committee on Chronic Cough reviewed the current literature on classification, epidemiology, presenting features, and mechanistic pathways of chronic cough in airway- and reflux-related cough phenotypes, OSA, and COVID-19. The interplay of cough reflex sensitivity with other pathogenic mechanisms inherent to airway and reflux-related inflammatory conditions was also analyzed. OUTCOMES: Currently, it is difficult to clearly ascertain true prevalence rates in epidemiological studies of chronic cough phenotypes. This is likely due to lack of standardized objective measures needed for cough classification and frequent coexistence of multi-organ cough origins. Notwithstanding, we emphasize the important role of HCR as a mechanistic trigger in airway- and reflux-related cough phenotypes. Other concomitant mechanisms can also modulate HCR, including type2/Th1/Th2 inflammation, presence or absence of deep inspiration-bronchoprotective reflex (lower airways), tissue remodeling, and likely cough plasticity, among others.

An exploratory randomised controlled trial evaluating text prompts in Lebanon to encourage health-seeking behaviour for hypertension.

AIMS OF THE STUDY: The current study evaluates the effectiveness of an opportunistic mobile screening on the percentage of people who are aware of whether they may be hypertensive (in an observational study) and the effectiveness of reminder prompts on the percentage of people who seek further medical attention (in a randomised controlled trial). METHODS USED TO CONDUCT THE STUDY: The screening of 1227 participants (529 female) was conducted during the registration period of the 2018 Beirut International Marathon in Lebanon. Next, 266 participants whose screening indicated hypertension (64 Female) were randomly allocated to a treatment group or a control group in a 1:1 fashion. The treatment group received a reminder prompt to seek further medical attention for their potential hypertension and the control group did not. The overt nature of the text message meant that participants in the treatment group could not be blinded to their group allocation. The primary outcome is participants' self-reports of whether they sought further medical attention. RESULTS OF THE STUDY: For the opportunistic screening, a 25% prevalence rate and a 24% awareness rate of hypertension was indicated. A McNemar analysis suggested that the screening increased participant awareness (X2 (N = 1227) = 72.16, P < .001). For the randomised controlled trial, 219 participants provided follow-up data via a phone call (82% retention). A Chi-squared analysis suggested that the reminder prompt successfully encouraged more participants to seek further medical attention, 45.5% treatment group vs 28.0% control group (X2 (1, N = 219) = 7.19, P = .007, φ = 0.18). CONCLUSIONS DRAWN AND CLINICAL IMPLICATIONS: Extra support in the form of a brief reminder message can increase the percentage of people who seek further medical attention after attending an opportunistic screening at a marathon event. The discussion reviews how the results align with previous research, strengths and limitations of the current study, and implications for future research and practice.

Immunopathological features of air pollution and its impact on inflammatory airway diseases (IAD).

Air pollution causes significant morbidity and mortality in patients with inflammatory airway diseases (IAD) such as allergic rhinitis (AR), chronic rhinosinusitis (CRS), asthma, and chronic obstructive pulmonary disease (COPD). Oxidative stress in patients with IAD can induce eosinophilic inflammation in the airways, augment atopic allergic sensitization, and increase susceptibility to infection. We reviewed emerging data depicting the involvement of oxidative stress in IAD patients. We evaluated biomarkers, outcome measures and immunopathological alterations across the airway mucosal barrier following exposure, particularly when accentuated by an infectious insult.

Berardinelli-Seip Syndrome and Essential Thrombocytosis: An Unusual Association.

Congenital generalized lipodystrophy (Berardinelli-Seip syndrome) is an autosomal recessive condition, presenting during infancy with generalized loss of fat. We report a 30-year-old female patient with diabetes who has acromegaloid features, prominent umbilicus, prominent muscles, prominent subcutaneous veins, and gross hepatomegaly. Near-total loss of subcutaneous fat was confirmed by whole-body magnetic resonance imaging and laboratory data revealed significant hypertriglyceridemia, uncontrolled diabetes mellitus, and heavy proteinuria with stage IIIa chronic kidney disease. Her blood film revealed thrombocytosis that on further evaluation by bone marrow biopsy was confirmed to be a myeloproliferative neoplasm (MPN); essential thrombocytosis (ET). She also had skin lesions that were proven to be reactive perforating collagenosis and necrobiosis lipoidica diabeticorum. She was managed conservatively and received interferon injections with fair general condition and control of her ET. However, her kidney function deteriorated furthermore to stage V chronic kidney disease requiring regular treatment with hemodialysis. We believe this is a unique case of Berardinelli-Seip syndrome with MPN that could be a coincidental association or part of a new syndrome.

The molecular mechanisms mediating mammalian fertilization.

Fertilization is a key biological process in which the egg and sperm must recognize one another and fuse to form a zygote. Although the process is a continuum, mammalian fertilization has been studied as a sequence of steps: sperm bind and penetrate through the zona pellucida of the egg, adhere to the egg plasma membrane and finally fuse with the egg. Following fusion, effective blocks to polyspermy ensure monospermic fertilization. Here, we review how recent advances obtained using genetically modified mouse lines bring new insights into the molecular mechanisms regulating mammalian fertilization. We discuss models for these processes and we include studies showing that these mechanisms may be conserved across different mammalian species.

Amplification of Trichloroisocyanuric Acid (TCCA) Reactivity for Chlorination of Arenes and Heteroarenes via Catalytic Organic Dye Activation.

Heteroarenes and arenes that contain electron-withdrawing groups are chlorinated in good to excellent yields (scalable to gram scale) using trichloroisocyanuric acid (TCCA) and catalytic Brilliant Green (BG). Visible-light activation of BG serves to amplify the electrophilic nature of TCCA, providing a mild alternative approach to acid-promoted chlorination of deactivated (hetero)aromatic substrates. The utility of the TCCA/BG system is demonstrated through comparison to other chlorinating reagents and by the chlorination of pharmaceuticals including caffeine, lidocaine, and phenazone.

Characteristics of bladder neoplasms in the young population of Saudi Arabia.

CONTEXT: Bladder neoplasms are a well-studied subject in medicine. However, the evidence of bladder neoplasms in children and the young adult population (≤40 years), particularly in Saudi Arabia, is lacking. AIMS: The aims of this study were to identify histopathological characteristics as well as clinical features, prognosis, and treatment of bladder neoplasms in this age group in a single tertiary referral center, Riyadh, Saudi Arabia. SETTINGS AND DESIGN: A retrospective cohort study. MATERIALS AND METHODS: Children and young adults (≤40 years) diagnosed with epithelial and mesenchymal bladder neoplasms from 1994 to 2017. STATISTICAL ANALYSIS USED: Descriptive data are presented as mean (standard deviation) or median (interquartile range) for continuous variables and n (%) for categorical variables. Statistical Package for Social Sciences version 23 was used. RESULTS: Thirty-eight cases were identified. The majority, 71.1% (n = 27) were male. The median age of diagnosis was 33 years ranging from 1 to 40 years. Nearly 45% (n = 17) were smokers. Macroscopic hematuria was present in 57.8% (n = 22). The most common histopathology was papillary urothelial carcinoma (n = 18, 58%). All mesenchymal neoplasms accounted for 18.4% (n = 7). Of all malignancies, 63.2% (n = 24) and 44.7% (n = 17) were low stage and low grade, respectively. Transurethral resection of bladder tumor (TURBT) was conducted for 81.6% (n = 31). The mean length of follow-up was 36.05 months (±39.4 months). Recurrence occurred in 15.8% (n = 6) and 7.9% (n = 3) had progression. Distant metastasis was reported in 5.3% (n = 2). Nearly 8% (n = 3) died during their follow-up. CONCLUSIONS: Bladder malignancies at the early fourth decade of life tend to be a low stage and low grade. The most common histopathology was papillary urothelial carcinoma. Management should be based on the clinical and histopathological features. However, most of the patient underwent TURBT.

Diagnosis and treatment of developmental dysplasia of the hip: A current practice of paediatric orthopaedic surgeons.

BACKGROUND: Developmental dysplasia of the hip (DDH) is one of the prevalent musculoskeletal conditions in young adults and is a leading cause of hip osteoarthrosis in this age group. The optimum age for surgical intervention when needed is not well established in the literature and the lack of management guidelines and standard practice of DDH leads to different practices worldwide. This study aims to investigate the current practice of paediatric orthopaedic surgeons in diagnosing and treating DDH worldwide and identify points of agreement and disagreement. METHODS: A cross-sectional study utilizing an online questionnaire was designed to examine the different points of view and current practice of paediatric orthopaedic surgeons worldwide regarding DDH diagnosis and treatment. RESULTS: Ninety-one surgeons responded, with an overall response of 45.5%. The vast majority of respondents use ultrasonography in children less than 3 months of age and pelvic radiography in over 3 months to diagnose DDH. Pavlik harness is the most popular DDH treatment for children younger than 6 months. For older children, closed reduction with hip spica cast is the most preferable treatment. The maximum duration of first-line treatment has a broad range. The treatment of bilateral DDH varies widely among surgeons. CONCLUSION: This study shows clearly that paediatric orthopaedic surgeons do not agree on the diagnosis and treatment protocol of DDH, hence different approaches to this common disease are practised. The lack of an international guideline should motivate paediatric orthopaedic surgeons to discuss and formulate a uniform and evidence-based protocol for the diagnosis and treatment of DDH.

Leptin and uric acid as predictors of metabolic syndrome in jordanian adults.

BACKGROUND/OBJECTIVES: Metabolic syndrome (MetS) is a set of interrelated metabolic risk factors that increase the risk of cardiovascular morbidity and mortality. Studies regarding the specificity and sensitivity of serum levels of leptin and uric acid as predictors of MetS are limited. The aim of this study was to evaluate the serum levels of leptin and uric acid in terms of their specificity and sensitivity as predictors of MetS in the studied Jordanian group. SUBJECTS/METHODS: In this cross sectional study, 630 adult subjects (308 men and 322 women) were recruited from the King Hussein Medical Center (Amman, Jordan). The diagnosis of MetS was made according to the 2005 International Diabetes Federation criteria. Receiver operating characteristic curves were used to determine the efficacy of serum levels of leptin and uric acid as predictors of MetS in the studied Jordanian group. RESULTS: Study results showed that for identification of subjects with MetS risk, area under the curve (AUC) for leptin was 0.721 and 0.683 in men and women, respectively. Serum uric acid levels in men showed no significant association with any MetS risk factors and no significant AUC, while uric acid AUC was 0.706 in women. CONCLUSION: Serum leptin levels can be useful biomarkers for evaluation of the risk of MetS independent of baseline obesity in both men and women. On the other hand, serum uric acid levels predicted the risk of MetS only in women.

Perception and intentions to quit among waterpipe smokers in Qatar: a cross-sectional survey.

OBJECTIVE: To evaluate the perceptions and attitudes of waterpipe (shisha) smokers in Qatar regarding the health risks associated with addiction and to determine their intentions to quit. METHODS: A cross-sectional survey was conducted among 181 self-reported waterpipe smokers. Participants were approached in public places as well as in shisha cafes in Qatar. The questionnaire included items related to perception, attitude and intention to quit. Both descriptive and inferential statistics were performed for data analyses, with P ≤ 0.05 considered statistically significant. RESULTS: About 44% of the respondents believed that waterpipe smoking was safer than cigarette smoking, and more than 70% would not mind if their children became involved in waterpipe smoking. More than half of the current smokers wanted to quit smoking shisha at some point, and 17% identified health concerns as the main motivating factor for their intention to quit. CONCLUSION: A large proportion of shisha smokers viewed shisha as a safer alternative to cigarettes, yet they admitted to intending to quit. These findings underscore the need to design educational interventions and awareness campaigns as well as impose stringent laws on waterpipe smoking in public places in Qatar.

Objectif : Evaluer les perceptions et attitudes des fumeurs de pipe à eau (shisha) au Qatar en ce qui concerne les risques sanitaires associés à l'addiction et déterminer leurs intentions d'arrêter.Méthodes : Une enquête transversale a été réalisée auprès de 181 fumeurs de pipe à eau. Les participants ont été approchés dans des lieux publics ainsi que dans des cafés à shisha au Qatar. Le questionnaire a inclus des items liés aux perceptions, aux attitudes et aux intentions de s'arrêter. Des études statistiques descriptives et déductives ont été réalisées pour analyser les données, avec P ⩽ 0,05 considéré comme statistiquement significatif.Résultats : Près de 44% des répondants pensaient que fumer une pipe à eau était plus sûr que fumer des cigarettes, et plus de 70% ne verraient pas d'inconvénient à ce que leurs enfants se mettent à fumer la pipe à eau. De plus, plus de la moitié des fumeurs actuels voulaient arrêter de fumer la shisha à un moment ou à un autre et 17% indiquaient qu'une préoccupation relative à leur santé était le facteur de motivation principal dans leur intention d'arrêter.Conclusion : Une large proportion de fumeurs de shisha la considérait comme une alternative plus sûre que les cigarettes, mais ils admettaient volontiers qu'ils avaient l'intention d'arrêter. Ces résultats soulignent la nécessité d'élaborer des interventions à visée éducative et des campagnes de sensibilisation ainsi que d'imposer des lois strictes relatives à l'utilisation de la pipe à eau dans des lieux publics au Qatar.

Objetivo: Evaluar las percepciones y las actitudes de los fumadores de pipa de agua (narguile), con respecto a los riesgos sanitarios asociados con este hábito en Qatar y determinar sus intenciones de abandonar el consumo.Métodos: Se realizó una encuesta transversal a 181 personas autorreferidas como fumadoras de pipa de agua. Los participantes se abordaron en lugares públicos y también en cafés que ofrecen el consumo de narguile en Qatar. El cuestionario comprendió elementos sobre la percepción, las actitudes y la intención de abandonar el hábito. Se aplicaron estadísticas descriptivas y deductivas en el análisis de los datos y se optó por una significación estadística correspondiente a un valor de P ⩽ 0,05.Resultados: Cerca del 44% de quienes respondieron consideró que el consumo de narguile era más seguro que el consumo de cigarrillo y más del 70% no se preocuparía si sus hijos se inician en el hábito. Además, más de la mitad de los fumadores actuales ha deseado abandonar el consumo de narguile en algún momento. El 17% de los encuestados atribuyó a los problemas de salud la principal motivación de su intención de abandonar el consumo.Conclusión: Una gran proporción de fumadores de narguile considera este consumo como una alternativa más segura que los cigarrillos y sin embargo admite tener la intención de abandonarlo. Los resultados del estudio destacan la necesidad de concebir nuevas intervenciones educativas y campañas de sensibilización, además de la aplicación de leyes restrictivas sobre el consumo de narguile en los lugares públicos en Qatar.

Leptin and uric acid as predictors of metabolic syndrome in jordanian adults

BACKGROUND/OBJECTIVES: Metabolic syndrome (MetS) is a set of interrelated metabolic risk factors that increase the risk of cardiovascular morbidity and mortality. Studies regarding the specificity and sensitivity of serum levels of leptin and uric acid as predictors of MetS are limited. The aim of this study was to evaluate the serum levels of leptin and uric acid in terms of their specificity and sensitivity as predictors of MetS in the studied Jordanian group. SUBJECTS/METHODS: In this cross sectional study, 630 adult subjects (308 men and 322 women) were recruited from the King Hussein Medical Center (Amman, Jordan). The diagnosis of MetS was made according to the 2005 International Diabetes Federation criteria. Receiver operating characteristic curves were used to determine the efficacy of serum levels of leptin and uric acid as predictors of MetS in the studied Jordanian group. RESULTS: Study results showed that for identification of subjects with MetS risk, area under the curve (AUC) for leptin was 0.721 and 0.683 in men and women, respectively. Serum uric acid levels in men showed no significant association with any MetS risk factors and no significant AUC, while uric acid AUC was 0.706 in women. CONCLUSION: Serum leptin levels can be useful biomarkers for evaluation of the risk of MetS independent of baseline obesity in both men and women. On the other hand, serum uric acid levels predicted the risk of MetS only in women.

Potassium Permanganate Poisoning: A Nonfatal Outcome.

Acute poisoning by potassium permanganate is a rare condition with high morbidity and mortality. Diagnosis of the condition relies on a history of exposure or ingestion and a high degree of clinical suspicion. Oxygen desaturation and the presence of methemoglobin are also helpful indicators. Since no specific antidote is available, treatment is mainly supportive. Few cases have been reported in the literature following potassium permanganate ingestion, whether intentional or accidental, and most of the patients in these cases had unfavorable outcomes, which was not the case in our patient. Our patient, a 73-year-old male, purchased potassium permanganate over the counter mistaking it for magnesium salt, which he frequently used as a laxative. Several hours after he ingested it, he was admitted to the endocrine department at King Hussein Medical Center, Jordan, with acute rapidly evolving shortness of breath. During hospitalization, his liver function tests deteriorated. Since he was diagnosed early and managed promptly he had a favorable outcome.

EVALUATION OF SEVERAL ANTHROPOMETRIC INDICES OF OBESITY AS PREDICTORS OF METABOLIC SYNDROME IN JORDANIAN ADULTS.

INTRODUCTION: anthropometric indices have all been tested for their relation to metabolic syndrome (MetS), but with no consistent cut-off points are yet established among different population group. OBJECTIVE: this study aims to evaluate the predictive power of several anthropometric indices of central obesity as predictors of MetS in a group of Jordanian adults. METHODS: in this cross sectional study, 630 adult subjects (308 men and 322 women) aged between 20-70 years were recruited at the King Hussein Medical Center in Amman (Jordan). The diagnosis of MetS was defined by the International Diabetes Federation criteria. Anthropometric measurements (waist circumference [WC]; waist to hip ratio [WHpR]; waist to height ratio [WHtR]; body mass index [BMI]) were performed and recorded following standard procedures. Receiver operating characteristic (ROC) curves were used to determine the efficacy of anthropometric measurements as predictors of MetS. RESULTS: the results indicated that, in men for identifying subjects with MetS risk, area under curve (AUC) from the ROC curves for WC was 0.851, AUC for WHpR was 0.842, AUC for WHtR was 0.85, and AUC for BMI was 0.83. In women, AUC for WC, WHpR, WHtR, and BMI were 0.866, 0.871, 0.872, and 0.831, respectively. CONCLUSION: it could be concluded that among anthropometric indices, both WHtR and WC had the strongest predictive power for identifying subjects with MetS in men and women. WHtR appears to be the best indicator of central obesity in women and individuals of short stature.

Introducción: han sido probados diversos índices antropométricos por su relación con el síndrome metabólico (SM), pero sin establecer puntos de corte entre diferentes grupos de población. Objetivo: este estudio tiene como objetivo evaluar el poder predictivo de varios índices antropométricos de obesidad central como predictores del síndrome metabólico en un grupo de adultos jordanos. Métodos: en este estudio transversal, 630 sujetos adultos (308 hombres y 322 mujeres) de edades comprendidas entre 20 a 70 años fueron reclutados en el Centro Médico Rey Hussein en Amman (Jordania). El diagnóstico de síndrome metabólico fue definido por los criterios de la Federación Internacional de Diabetes. Las medidas antropométricas (circunferencia de la cintura [WC]; relación cintura-cadera [WHpR]; relación cintura-altura [RCEst]; índice de masa corporal [IMC]) se realizaron y registraron siguiendo los procedimientos estándar. Se utilizaron curvas características del receptor (ROC) para determinar la eficacia de las medidas antropométricas como predictores de SM. Resultados: los resultados indican que, en los hombres, para identificar a los sujetos con riesgo de SM el área bajo la curva (AUC) de la curva ROC para WC era 0.851, AUC para WHpR era 0,842, AUC para RCEst fue de 0,85 y el AUC del IMC fue de 0,83. En las mujeres, el AUC para WC, WHpR, RCEst y el IMC fueron: 0,866, 0,871, 0,872 y 0,831, respectivamente. Conclusión: se puede concluir que entre los índices antropométricos, tanto RCEst como WC tenían el poder predictivo más fuerte para identificar a los sujetos con síndrome metabólico en hombres y mujeres. RCEst parece ser el mejor indicador de la obesidad central en mujeres y personas de baja estatura.

Evaluation of several anthropometric indices of obesity as predictors of metabolic syndrome in Jordanian adults / Evaluación de varios índices antropométricos de la obesidad como predictores del síndrome metabólico en adultos de Jordania

Introduction: anthropometric indices have all been tested for their relation to metabolic syndrome (MetS), but with no consistent cut-off points are yet established among different population group. Objective: this study aims to evaluate the predictive power of several anthropometric indices of central obesity as predictors of MetS in a group of Jordanian adults. Methods: in this cross sectional study, 630 adult subjects (308 men and 322 women) aged between 20-70 years were recruited at the King Hussein Medical Center in Amman (Jordan). The diagnosis of MetS was defined by the International Diabetes Federation criteria. Anthropometric measurements (waist circumference [WC]; waist to hip ratio [WHpR]; waist to height ratio [WHtR]; body mass index [BMI]) were performed and recorded following standard procedures. Receiver operating characteristic (ROC) curves were used to determine the efficacy of anthropometric measurements as predictors of MetS. Results: the results indicated that, in men for identifying subjects with MetS risk, area under curve (AUC) from the ROC curves for WC was 0.851, AUC for WHpR was 0.842, AUC for WHtR was 0.85, and AUC for BMI was 0.83. In women, AUC for WC, WHpR, WHtR, and BMI were 0.866, 0.871, 0.872, and 0.831, respectively. Conclusion: it could be concluded that among anthropometric indices, both WHtR and WC had the strongest predictive power for identifying subjects with MetS in men and women. WHtR appears to be the best indicator of central obesity in women and individuals of short stature (AU)

Introducción: han sido probados diversos índices antropométricos por su relación con el síndrome metabó- lico (SM), pero sin establecer puntos de corte entre diferentes grupos de población. Objetivo: este estudio tiene como objetivo evaluar el poder predictivo de varios índices antropométricos de obesidad central como predictores del síndrome metabólico en un grupo de adultos jordanos. Métodos: en este estudio transversal, 630 sujetos adultos (308 hombres y 322 mujeres) de edades comprendidas entre 20 a 70 años fueron reclutados en el Centro Médico Rey Hussein en Amman (Jordania). El diagnóstico de síndrome metabólico fue definido por los criterios de la Federación Internacional de Diabetes. Las medidas antropométricas (circunferencia de la cintura [WC]; relación cintura-cadera [WHpR]; relación cintura-altura [RCEst]; índice de masa corporal [IMC]) se realizaron y registraron siguiendo los procedimientos estándar. Se utilizaron curvas características del receptor (ROC) para determinar la eficacia de las medidas antropométricas como predictores de SM. Resultados: los resultados indican que, en los hombres, para identificar a los sujetos con riesgo de SM el área bajo la curva (AUC) de la curva ROC para WC era 0.851, AUC para WHpR era 0,842, AUC para RCEst fue de 0,85 y el AUC del IMC fue de 0,83. En las mujeres, el AUC para WC, WHpR, RCEst y el IMC fueron: 0,866, 0,871, 0,872 y 0,831, respectivamente. Conclusión: se puede concluir que entre los índices antropométricos, tanto RCEst como WC tenían el poder predictivo más fuerte para identificar a los sujetos con síndrome metabólico en hombres y mujeres. RCEst parece ser el mejor indicador de la obesidad central en mujeres y personas de baja estatura (AU)