Investigation of the Effect of Atorvastatin on Skeletal Muscles in Male Rats and the Involved Mechanisms.

It has been approved that atrovastatin is a preferred treatment for hyperlipidemia. One of the atrovastatin drawbacks would be the detrimental effects on skeletal muscles. Therefore, the current study was designed to evaluate all the skeletal muscles alteration in rats' after administration of atrovastatin and identification the mechanisms involved in these structural alterations in the skeletal muscles. A total of 12 healthy adult male rats (Rattus norvegicus) were randomly divided into two groups (n=6). The control group (G1) included rats that received distilled water as the placebo, and the treatment group (G2) included animals that were treated with atorvastatin (80 mg/kg/day) dissolved in distilled water and administrated by a gastric tube for eight weeks. At the end of the experiment, trapezius and vastus medialis muscle tissues were sampled and fixed with 10% formalin for histopathological studies. Atorvastatin administration gave rise to morphological changes in the skeletal muscle fibers and the nerve fibers, including atrophied myofibers, infarction, irregular arrangement of myonuclei, disappearance of nuclei from their normal peripheral position with acute skeletal muscular infarction, and infiltration of accumulated inflammatory cells. Atorvastatin has been revealed to have several adverse effects on the skeletal muscle and the nerve supply. Based on the data in the current study, it is evident that atorvastatin administration for less than two months resulted in some sorts of myotoxic structural changes and apoptosis as evident by deformity and lack of striation degeneration of nuclei, as well as splitting of the muscle fibers in the adult male rats' skeletal muscle.

Efficient removal of Cr (VI) and Co (II) from aqueous solution by activated carbon from Manihot esculenta Crantz agricultural bio-waste.

Heavy metals are one of the most dangerous and critical threats to human and environment. In this study, the adsorption efficiency of activated carbon from cassava peels considered as agricultural waste (CPR) was evaluated for removal of heavy metals Cr (VI) and Co (II) from aqueous media. Cassava peel carbon (CPC) was obtained by acid treatment. Structural and morphological properties were investigated using Fourier Transform Infra-Red (FTIR), Scanning Electron Microscopy (SEM), Brunauer-Emmet-Teller surface area (BET) and X-Ray Diffraction (XRD). The adsorption experiments were conducted in batch mode under natural solution pH and complexation of the heavy metals, which allows the use of UV-Visible spectroscopy technique. CPC adsorbent exhibited a high adsorption capacity, according to Langmuir model, for Cr (VI) (166.35 mg/g) and Co (II) (301.63 mg/g) at 25 °C. Kinetic and adsorption isotherms followed the pseudo second-order and Langmuir isotherm models for both metals, respectively. Thermodynamic study confirmed the spontaneity and endothermic nature of both metals adsorption onto CPC surface.

Exercise for the prevention of low back and pelvic girdle pain in pregnancy: A meta-analysis of randomized controlled trials.

BACKGROUND AND OBJECTIVE: The effect of exercise in prevention of low back and pelvic girdle pain during pregnancy is uncertain. This study aimed to assess the effect of exercise on low back pain, pelvic girdle pain and associated sick leave. DATABASES AND DATA TREATMENT: Literature searches were conducted in PubMed, EMBASE, Cochrane Library, Google Scholar, ResearchGate and ClinicalTrials.gov databases from their inception through May 2017. Randomized controlled trials (RCTs) were eligible for inclusion in the review if they compared an exercise intervention with usual daily activities and at least some of the participants were free from low back pain and/or pelvic girdle pain at baseline. Methodological quality of included studies was evaluated using the Cochrane Collaboration's tool. A random-effects meta-analysis was performed, and heterogeneity and publication bias were assessed. RESULTS: Eleven randomized controlled trials (2347 pregnant women) qualified for meta-analyses. Exercise reduced the risk of low back pain in pregnancy by 9% (pooled risk ratio (RR) = 0.91, 95% CI 0.83-0.99, I2  = 0%, seven trials, N = 1175), whereas it had no protective effect on pelvic girdle pain (RR = 0.99, CI 0.81-1.21, I2  = 0%, four RCTs, N = 565) or lumbopelvic pain (RR = 0.96, CI 0.90-1.02, I2  = 0%, eight RCTs, N = 1737). Furthermore, exercise prevented new episodes of sick leave due to lumbopelvic pain (RR = 0.79, CI 0.64-0.99, I2  = 0%, three RCTs, N = 1168). There was no evidence of publication bias. CONCLUSION: Exercise appears to reduce the risk of low back pain in pregnant women, and sick leave because of lumbopelvic pain, but there is no clear evidence for an effect on pelvic girdle pain. SIGNIFICANCE: Exercise has a small protective effect against low back pain during pregnancy.

The determinants of service complexity in children with intellectual disabilities.

BACKGROUND: To date, little is known about the predictors of healthcare service utilisation in children with intellectual disability (ID). The aim of this study was to identify the factors associated with service complexity in children with ID in Ontario, Canada. METHODS: The population of this cross-sectional study consisted of 330 children with ID ages 4 to 18 years who accessed mental health services from November of 2012 to June of 2016 in four agencies. All participants completed the interRAI Child and Youth Mental Health and Developmental Disability Assessment Instrument, which is a semi-structured clinician-rated assessment that covers a range of common issues in children with ID. The outcome of this study was a service complexity variable based on (1) mental health service utilisation including any services provided to the child and (2) the management involved in providing that care. Eight individual items were summed, resulting in a scale that ranged from 0 to 8. Scores were then dichotomised into two groups: a score of 0-2 identified children with a low service complexity and a score of 3 or higher identified children with a high service complexity. RESULTS: After adjustment for other covariates, gender was not associated with service complexity. Children aged 11-14 years and children with autism spectrum disorder used over twofold higher levels of service complexity than children aged equal to or less than 10 years or children with other causes of ID. Moreover, victims of bullying, high scores on the family functioning scale or learning or communication disorder were associated with greater service complexity. CONCLUSIONS: The findings of this study indicate that a variety of factors are related to service complexity ranged from children's nonclinical (age and experiences of bullying) to clinical (e.g. aggression, learning/communication problems and autism spectrum disorder) characteristics.

The prevalence of antenatal and postnatal co-morbid anxiety and depression: a meta-analysis.

To date, the precise prevalence of co-morbidity of anxiety and depression in the perinatal period is not well known. We aimed to estimate the prevalence of co-morbid anxiety and depression in the antenatal and postnatal periods. Systematic searches of multiple electronic databases were conducted for studies published between January 1950 and January 2016. We included 66 (24 published and 42 unpublished) studies incorporating 162 120 women from 30 countries. Prevalence of self-reported antenatal anxiety symptoms and mild to severe depressive symptoms was 9.5% [95% confidence interval (CI) 7.8-11.2, 17 studies, n = 25 592] and of co-morbid anxiety symptoms and moderate/severe depressive symptoms was 6.3% (95% CI 4.8-7.7, 17 studies, n = 27 270). Prevalence of a clinical diagnosis of any antenatal anxiety disorder and depression was 9.3% (95% CI 4.0-14.7, 10 studies, n = 3918) and of co-morbid generalized anxiety disorder and depression was 1.7% (95% CI 0.2-3.1, three studies, n = 3085). Postnatally between 1 and 24 weeks postpartum, the prevalence of co-morbid anxiety symptoms and mild to severe depressive symptoms was 8.2% (95% CI 6.5-9.9, 15 studies, n = 14 731), while co-morbid anxiety symptoms and moderate/severe depressive symptoms was 5.7% (95% CI 4.3-7.1, 13 studies, n = 20 849). The prevalence of a clinical diagnosis of co-morbid anxiety and depression was 4.2% (95% CI 1.9-6.6, eight studies, n = 3251). Prevalence rates did not differ with regard to year of publication, country income, selection bias and attrition bias. The results suggest that co-morbid perinatal anxiety and depression are prevalent and warrant clinical attention given the potential negative child developmental consequences if left untreated. Further research is warranted to develop evidence-based interventions for prevention, identification and treatment of this co-morbidity.

Identifying women at risk for postpartum anxiety: a prospective population-based study.

OBJECTIVE: To develop a multifactorial model to predict anxiety symptomatology at 8 weeks postpartum. METHOD: In a population-based study, 522 women in a health region near Vancouver, Canada, completed questionnaires at 1, 4, and 8 weeks postpartum. Questionnaires included risk factors measured at 1 week (sociodemographic, biological, pregnancy-related, life stressors, social support, obstetric, and maternal adjustment). Sequential logistic regression was completed to develop a predictive model of anxiety symptomatology at 8 weeks (State-Trait Anxiety Inventory score >40). RESULTS: The prevalence of anxiety symptomatology at 1, 4, and 8 weeks postpartum was 22.6%, 17.2%, and 14.8% respectively. In multivariable models, anxiety symptomatology at 1 week (aOR 2.78, 95% CI: 1.04-7.43), multiparous parity (aOR 3.29, 95% CI: 1.28-8.48), history of psychiatric problems (aOR 3.07, 95% CI: 1.19-7.97), perceived stress (1 SD increase: aOR 4.92, 95% CI: 2.62-9.26), and childcare stress (1 SD increase: aOR 1.63, 95% CI: 1.01-2.64) were independent predictors of anxiety symptomatology at 8 weeks. CONCLUSION: While a significant proportion of women experience anxiety symptomatology following childbirth, multiparous women with a psychiatric history who have high levels of diverse stress are at greatest risk. These key factors may be used to promote early identification and secondary preventive interventions.

Leisure-time physical activity and sciatica: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVE: The role of leisure-time physical activity in sciatica is uncertain. This study aimed to assess the association of leisure-time physical activity with lumbar radicular pain and sciatica. DATABASES AND DATA TREATMENT: Literature searches were conducted in PubMed, Embase, Web of Science, Scopus, Google Scholar and ResearchGate databases from 1964 through August 2015. A random-effects meta-analysis was performed, and heterogeneity and small-study bias were assessed. RESULTS: Ten cohort (N = 82,024 participants), four case-control (N = 9350) and four cross-sectional (N = 10,046) studies qualified for meta-analysis. In comparison with no regular physical activity, high level of physical activity (≥4 times/week) was inversely associated with new onset of lumbar radicular pain or sciatica in a meta-analysis of prospective cohort studies [risk ratio (RR) = 0.88, 95% CI 0.78-0.99, I2  = 0%, 7 studies, N = 78,065]. The association for moderate level of physical activity (1-3 times/week) was weaker (RR = 0.93, CI 0.82-1.05, I2  = 0%, 6 studies, N = 69,049), and there was no association with physical activity for at least once/week (RR = 0.99, CI 0.86-1.13, 9 studies, N = 73,008). In contrast, a meta-analysis of cross-sectional studies showed a higher prevalence of lumbar radicular pain or sciatica in participants who exercised at least once/week [prevalence ratio (PR) = 1.29, CI 1.09-1.53, I2  = 0%, 4 studies, N = 10,046], or 1-3 times/week (PR = 1.34, CI 1.02-1.77, I2  = 0%, N = 7631) than among inactive participants. There was no evidence of small-study bias. CONCLUSIONS: This meta-analysis suggests that moderate to high level of leisure physical activity may have a moderate protective effect against development of lumbar radicular pain. However, a large reduction in risk (>30%) seems unlikely. WHAT DOES THIS REVIEW ADD: Leisure-time physical activity may reduce the risk of developing lumbar radicular pain.

The effect of excess body mass on the risk of carpal tunnel syndrome: a meta-analysis of 58 studies.

We aimed to estimate the effects of overweight and obesity on carpal tunnel syndrome (CTS), and to assess whether sex modifies the associations. Literature searches were conducted in PubMed, Embase, Web of Science, Scopus, Google Scholar and ResearchGate databases from 1953 to February 2015. Fifty-eight studies consisting of 1,379,372 individuals qualified for a meta-analysis. We used a random-effects meta-analysis, assessed heterogeneity and publication bias, and performed sensitivity analyses. Overweight increased the risk of CTS or carpal tunnel release 1.5-fold (pooled confounder-adjusted odds ratio [OR] = 1.47, 95% CI 1.37-1.57, N = 1,279,546) and obesity twofold (adjusted OR = 2.02, 95% CI 1.92-2.13, N = 1,362,207). Each one-unit increase in body mass index increased the risk of CTS by 7.4% (adjusted OR = 1.074, 95% CI 1.071-1.077, N = 1,258,578). Overweight and obesity had stronger effects on carpal tunnel release than CTS. The associations did not differ between men and women, and they were independent of study design. Moreover, the associations were not due to bias or confounding. Excess body mass markedly increases the risk of CTS. As the prevalence of overweight and obesity is increasing globally, overweight-related CTS is expected to increase. Future studies should investigate whether a square-shaped wrist and exposure to physical workload factors potentiate the adverse effect of obesity on the median nerve.

Heart sound segmentation based on homomorphic filtering.

BACKGROUND: Phonocardiography, the digital recording of heart sounds, is becoming increasingly popular as a primary detection system for diagnosing heart disorders and is relatively inexpensive. The electrocardiogram (ECG) is often used when recording the phonocardiogram in order to help identify the systolic and diastolic components. In this study, a heart sound segmentation algorithm has been developed which automatically separates the heart sound signal into these component parts. METHODS: 100 patients with normal and abnormal heart sounds were studied. The algorithm uses homomorphic filtering to produce time-domain intensity envelopes of the heart sounds and separates the sounds into four overlapping parts: the first heart sound, the systolic period, the second heart sound and the diastolic period. RESULTS: The performance of the algorithm was evaluated using 14,000 cardiac periods from 100 digital phonocardiographic recordings, including normal and abnormal heart sounds. In tests, the algorithm was over 93 percent correct in detecting the first and second heart sounds. CONCLUSION: The automatic segmentation algorithm presented uses wavelet decomposition and reconstruction to select a suitable frequency band for envelope calculations and has been found to be effective in segmenting phonocardiogram signals into four component parts without using an ECG reference.

Combining numerical and clinical methods to assess aortic valve hemodynamics during exercise.

Computational simulations have the potential to aid understanding of cardiovascular hemodynamics under physiological conditions, including exercise. Therefore, blood hemodynamic parameters during different heart rates, rest and exercise have been investigated, using a numerical method. A model was developed for a healthy subject. Using geometrical data acquired by echo-Doppler, a two-dimensional model of the chamber of aortic sinus valsalva and aortic root was created. Systolic ventricular and aortic pressures were applied as boundary conditions computationally. These pressures were the initial physical conditions applied to the model to predict valve deformation and changes in hemodynamics. They were the clinically measured brachial pressures plus differences between brachial, central and left ventricular pressures. Echocardiographic imaging was also used to acquire different ejection times, necessary for pressure waveform equations of blood flow during exercise. A fluid-structure interaction simulation was performed, using an arbitrary Lagrangian-Eulerian mesh. During exercise, peak vorticity increased by 14.8%, peak shear rate by 15.8%, peak cell Reynolds number by 20%, peak leaflet tip velocity increased by 47% and the blood velocity increased by 3% through the leaflets, whereas full opening time decreased by 11%. Our results show that numerical methods can be combined with clinical measurements to provide good estimates of patient-specific hemodynamics at different heart rates.

Modeling of cerebral aneurysm using equivalent electrical circuit (Lumped Model).

The circle of Willis (CoW) is a key asset in brain performance as it supports adequate blood supply to the brain. The lumped method (electrical equivalent circuits) is a useful model to simulate the process of the human cardiovascular system. In this study, the whole cardiovascular system is modeled, using an equivalent electrical circuit to investigate an aneurysm in an artery. The cerebrovascular system consists of 29 compartments, which includes the CoW. Each vessel is modeled by a resistor, a capacitor and an inductor. Using MATLAB Simulink, the left and right ventricles are modeled by controlled voltage sources and diodes. The effects of the left internal carotid artery aneurysm (Fusiform) on the pressure of the efferent arteries in the circle of Willis are studied. The modeling results are entirely in agreement with the available clinical observations. The results of the present study may have clinical implications for modeling different cardiovascular diseases, such as arterial stiffness and atherosclerosis.

[Diagnosis and evaluation of hepatitis C virus among haemodialysis patients]. / Diagnostic et evaluation de l'hépatite virale C chez I'hémodialysé.

Hepatitis C is a health problem worldwide. The World Health Organization estimates that 3% of world's population is infected with hepatitis C virus (HCV). In haemodialysis patients, the prevalence reaches 80% in some countries. In Morocco, HCV prevalence is 32% according to the Moroccan register of dialysis. The natural history of hepatitis C infection in chronic haemodialysis patients is characterized by a silent evolution. There are different methods to diagnose HCV and they are becoming increasingly sensitive. There are indirect tests for antibodies to HCV: these are reproducible but false negatives are common and there is direct testing of viral RNA: this is more sensitive but not always available and is more expensive. The use of these tests has been categorized through new recommendations from learned societies. However, the evaluation of liver disease is still controversial and liver biopsy remains the gold standard. This paper reviews the approaches for diagnosing and evaluating hepatitis C in haemodialysis patients.

Diagnosis and evaluation of hepatitis C virus among haemodialysis patients

Hepatitis C is a health problem worldwide. The World Health Organizion world's population is infected with hepatitis C virus [HCV]. In haemodialysis patients, the prevalence reaches 80% in some countries. In Morocco/ HCV prevalence is 32% according to the Moroccan register of dialysis. The natural history of hepatitis C infection in chronic haemodialysis patients is characterized by a silent evolution. There are different methods to diagnose HCV and they are becoming increasingly sensitive. There are indirect tests for antibodies to HCV: these are reproducible but false negatives are common and there is direct testing of viral RNA: this is more sensitive but not always available and Is more expensive. The use of these tests has been categorized through new recommendations from learned societies. However, the evaluation of liver disease is still controversial and liver biopsy remains the gold standard. This paper reviews the approaches for diagnosing and evaluating hepatitis C in haemodialysis patients

[Benign intracranial hypertension in a hemodialysis patient: consider the fistula]. / Hypertension intracrânienne bénigne chez un hémodialysé : penser à la fistule.

UNLABELLED: Benign intracranial hypertension (BIH) is a syndrome characterized by the abnormal elevation of the intracranial pressure in the absence of a mass lesion or hydrocephalus, and with normal composition of the cerebrospinal fluid. We report a case of BIH in a chronic hemodialysis patient with no signs of intraocular inflammation or neurologic abnormalities. Treatment with acetazolamide followed by corticosteroids failed to improve the signs of BIH. However, after correction of the radiocephalic arteriovenous fistula of the left upper extremity, which demonstrated excessive flow, BIH symptoms completely disappeared. CONCLUSION: When managing BIH in a hemodialysis patient, consider the fistula.

Predictors of early vascular-access failure in patients on hemodialysis.

Vascular access management is key and critical in the successful management of hemodialysis patients, and an arteriovenous fistula (AVF) is considered the access of choice. This study was conducted between January 2007 and October 2009 at the Military Hospital in Rabat. Data on 115 patients who underwent 138 AVFs were retrospectively studied. Wrist AVF was the most common site of use. The primary course was uncomplicated in 63% of the patients, while primary failure occurred in 23.9% of the patients. Presence of diabetes was the most important risk factor for primary failure.

Perianal tuberculosis: a case report and a review of the literature.

Extra pulmonary tuberculosis accounts for less than 15% of all cases of tuberculosis whereas the Intestinal one constitutes less than 1% of the extrapulmonary forms of the disease. The lesions of abdominal organs are more common while they rarely occur in the anoperineal area for the spread of the disease to the anus is extremely rare. We report a case of a 37-year-old male patient with large bilateral infected perianal tubercular ulcerations as well as pulmonary and peritoneal tuberculosis. The treatment was both surgical and medical and the therapy lasted for seven months. After six months from the beginning of the treatment, the lesion had totally disappeared and there is still no recurrence after one year of followup. Tuberculosis should generally be taken into consideration in the differential diagnosis of the ulcerative lesions of the anal and perianal regions for these lesions do occur in the said areas despite their rarity. The treatment is usually both surgical and medical so as to get excellent results.

The Kt/V by ionic dialysance: Interpretation limits.

The availability of hemodialysis machines equipped with online clearance monitoring (OCM) allows frequent assessment of dialysis efficiency and adequacy without the need for blood samples. Accurate estimation of the urea distribution volume (V) is required for Kt/V calculated from OCM to be consistent with conventional blood sample-based methods. A total of 35 patients were studied. Ionic dialysance was measured by conductivity monitoring. The second-generation Daugirdas formula was used to calculate the Kt/V single-pool (Kt/VD). Values of V to allow comparison between OCM and blood-based Kt/V were determined using Watson formula (VWa), bioimpedance spectroscopy (Vimp), and blood-based kinetic data (Vukm). Comparison of Kt/Vw ocm calculated by the ionic dialysance and Vw (Kt/Vw ocm) with Kt/VD shows that using VW leads to significant systematic underestimation of dialysis dose by 24%. Better agreement between Kt/V ocm and Kt/VD was observed when using Vimp and Vukm. Bio-impedancemetry and the indirect method using the second-generation Daugirdas equation are two methods of clinical interest for estimating V to ensure greater agreement between OCM and blood-based Kt/V.

[Predictive factors of response to anthracyclines neoadjuvant chemotherapy in breast cancer]. / Chimiothérapie néoadjuvante par anthracyclines dans le cancer du sein : facteurs prédictifs de réponse.

OBJECTIVES: Anthracyclines chemotherapy remains primordial and impossible to circumvent in the treatment of breast cancer, in the adjuvant, metastatic and neoadjuvant setting. But some breast invasive tumors are resistant to anthracyclines. The neoadjuvant model is ideal to test the chemosensibility by selecting the well-responder patients and identifying the predictive factors of this response. PATIENTS AND METHODS: We report a retrospective study of 126 patients treated at our institute during 2 years (January 2003-December 2004) for a breast cancer with primary chemotherapy. All the patients received anthracyclines according to protocol AC60 (doxorubicine plus cyclophosphamide). RESULTS: The clinical objective response rate (RO) was 67 % with a complete clinical response (RC) of 11 %. We found a pathological complete response (pCR) in seven patients (5,6 %) of the 126 cases. The statistical study identifies only two clinical factors as predictive of RC and pCR: tumoral size T2-T3 and clinical nodal status N0-N1, while the SBR grading and the hormonal receptors were not correlated. DISCUSSION AND CONCLUSION: Some clinical and histological factors are recognized as predictive for the benefit of anthracyclines neoadjuvant chemotherapy, and correlated to the pCR; we discuss our results through those of the literature, by exposing the current data.

Post-traumatic arteriovenous fistula of the hepatic pedicle.

Hepatico-portal fistula (HPF) is a rare condition, most often of post-traumatic or iatrogenic origin and occasionally secondary to a ruptured aneurysm of the hepatic artery into the portal vein. HPF in extrahepatic locations often results in portal hypertension (PHT). While Doppler ultrasound, CT angiography, and magnetic resonance angiography are usually demonstrative, arteriography remains indispensable to clarify the exact anatomical configuration. In the treatment of these arteriovenous (AV) fistulas, open surgical approaches have increasingly given way to radiological embolization techniques, especially in intrahepatic locations, but surgery remains indicated for AV fistulas of the hepatic pedicle where maintenance of hepatic arterial flow is a priority of treatment. We report a patient who had an AV fistula of the hepatic pedicle with resultant PHT presenting 5 years after open abdominal trauma. Treatment was surgical; the immediate and long-term postoperative course was uneventful with regression of PHT. Through analysis of this case and a review of the literature, we discuss the clinical, paraclinical, therapeutic, and prognostic features of this lesion.