A cross-sectional study on fear-avoidance beliefs and chronic low back pain in fighter pilots.

BACKGROUND: Chronic low back pain (CLBP) is considered a serious complaint among fighter pilots because the vertebrae of these pilots are exposed to high compression forces from prolonged sitting on a hard ejection seat and frequent sudden fighter aircraft maneuvers. It is yet unknown whether a correlation exists between CLBP and psychosocial/behavioral performance of fighter pilots. METHODS: This was a cross-sectional study of 66 fighter pilots with nonspecific CLBP voluntarily participated in this study. Self-efficacy was measured based on the degree of physical activity and work performance using the fear-avoidance beliefs questionnaire (FABQ). RESULTS: A significant inverse correlation was found between the work subscale of the FABQ (FABQw) (mean score: 27.4 ± 8.4) and both age (mean: 35 ± 4.9 years) and flying experience (mean: 13.2 ± 4.4 years) among fighter pilots with nonspecific CLBP. In contrast, there was no significant correlation between physical activity subscale of the FABQ (mean score: 12.3 ± 6.4) and both age and flying experience. CONCLUSIONS: An inverse correlation was observed between FABQw and both age and flying experience among fighter pilots with nonspecific CLBP. It is important for rehabilitation specialists to understand the role of cognitive/affective components of a pain from tissue injury and nociception to prevent occupational disability and enhance occupational performance.

Spectrophotometric comparison of color stability of microhybrid and nanocomposites following exposure to common soft drinks among adolescents: an in vitro study.

PURPOSE: To compare the color stability of a microhybrid and two nanocomposites after exposure to common soft drinks among adolescents. METHODS: Ninety discs were prepared from a microhybrid (Filtek Z250) and two nanocomposites (Filtek Z350 and Tetric N-Ceram) (n = 30 each). Six discs from each material were then immersed in one of five drinks (iced tea, sports drink, orange juice, cola, and distilled water) for 15 days. Color measurement was performed at baseline and after 15 days using a spectrophotometer according to the CIE L*a*b* system, and the change in color values as well as total color change (ΔE) was calculated and compared. ANOVA and Tukey's HSD test were used to analyze the data (p < 0.05). RESULTS: Significant change in color values and total color (ΔE > 3.3) was observed in the composite materials after immersion in the soft drinks compared to immersion in distilled water (ΔE < 3.3). The highest mean values were those of Filtek Z350, being significantly different from the rest of the materials. Independent of the composite material, iced tea resulted in the highest mean values, being significantly different from the rest of the drinks (p < 0.05). CONCLUSION: All soft drinks resulted in clinically unacceptable discoloration of the composite materials with maximum discoloration being that following immersion of composite materials, particularly Filtek Z350, in iced tea. Consequently, in dental practice, adolescents should be asked about their consumption of soft drinks, particularly iced tea, and made aware of their potential to discolor composite restorations if they are to receive them.

The South Asian Health Foundation (UK) guidelines for managing diabetes during Ramadan.

BACKGROUND: Fasting in the holy month of Ramadan is among the five pillars of Islam and is considered as a religious obligation by the Muslim population. People with diabetes observing the practice of fasts are at a higher risk of complications such as hypoglycaemia, hyperglycaemia and ketoacidosis due to changes in eating patterns and circadian rhythms. With the objective of mitigating these complications, the South Asian Health Foundation (UK) has developed the present guidelines based on robust evidence derived from epidemiological studies and clinical trials. METHODS: We have highlighted the role of pre-Ramadan risk stratification and counselling by healthcare professionals with emphasis on the need for advice on adequate dietary and fluid intake, blood glucose monitoring and awareness of when to break the fast. RESULTS: We reviewed the current literature and have given clinically-relevant recommendations on lifestyle modifications and glucose-lowering therapies such as metformin, sulphonylureas, dipeptidyl peptidase-4 inhibitors, sodium glucose co-transporter-2 inhibitors, thiazolidinediones, glucagon-like peptide-1 receptor agonists and insulin. CONCLUSIONS: An individualised patient-centric treatment plan is essential to not only achieve optimal glycaemic outcomes but also enable people with diabetes to observe a risk-free month of fasting during Ramadan.

Managing People with Diabetes Fasting for Ramadan During the COVID-19 Pandemic: A South Asian Health Foundation Update.

The month of Ramadan forms one of the five pillars of the Muslim faith. Adult Muslims are obligated to keep daily fasts from dawn to sunset, with exceptions. This year Ramadan is due to begin on 23 April 2020 and the longest fast in the UK will be approximately 18 hours in length. In addition, due to the often high-calorie meals eaten to break the fast, Ramadan should be seen as a cycle of fasting and feasting. Ramadan fasting can impact those with diabetes, increasing the risk of hypoglycaemia, hyperglycaemia and dehydration. This year, Ramadan will occur during the global COVID-19 pandemic. Reports show that diabetes appears to be a risk factor for more severe disease with COVID-19. In addition, the UK experience has shown diabetes and COVID-19 is associated with dehydration, starvation ketosis, diabetic ketoacidosis and hyperosmolar hyperglycaemic state. This makes fasting in Ramadan particularly challenging for those Muslims with diabetes. Here, we discuss the implications of fasting in Ramadan during the COVID-19 pandemic and make recommendations for those with diabetes who wish to fast.

Oral semaglutide versus injectable glucagon-like peptide-1 receptor agonists: a cost of control analysis.

Aims: The efficacy and safety of oral semaglutide, the first glucagon-like peptide-1 (GLP-1) receptor agonist developed for oral administration for the treatment of type 2 diabetes, was evaluated in the PIONEER clinical trial program, and a recently published network meta-analysis allowed comparison with further injectable GLP-1 receptor agonists. The present study aimed to assess the short-term cost- effectiveness of oral semaglutide 14 mg versus subcutaneous once-weekly dulaglutide 1.5 mg, once-weekly exenatide 2 mg, twice-daily exenatide 10 µg, once-daily liraglutide 1.8 mg, once-daily lixisenatide 20 µg, and once-weekly semaglutide 1 mg, in terms of the cost per patient achieving glycated hemoglobin (HbA1c) targets (cost of control).Materials and methods: Cost of control was calculated by dividing the annual treatment costs associated with an intervention by the proportion of patients achieving the treatment target with an intervention, with outcomes calculated for targets of HbA1c ≤6.5% and HbA1c <7.0% for all included GLP-1 receptor agonists. Annual treatment costs were accounted in 2019 United States dollars (USD), based on 2019 wholesale acquisition cost.Results: For the treatment target of HbA1c ≤6.5%, once-weekly semaglutide 1 mg and oral semaglutide 14 mg were associated with the lowest costs of control, at USD 15,430 and USD 17,383 per patient achieving target, respectively. Similarly, the cost of control was lowest with once-weekly semaglutide 1 mg at USD 12,627 per patient achieving target, followed by oral semaglutide 14 mg at USD 13,493 per patient achieving target for the target of HbA1c <7.0%. All other interventions were associated with higher cost of control values for both targets.Conclusions: Oral semaglutide 14 mg is likely to be cost-effective versus dulaglutide, exenatide (once weekly and twice daily), liraglutide, and lixisenatide in terms of bringing people with type 2 diabetes to glycemic control targets of HbA1c ≤6.5% and HbA1c <7.0% in the US.

In vitro comparison of microleakge between preformed metal crowns and aesthetic crowns of primary molars using different adhesive luting cements.

AIM: To assess and compare the microleakage extent between preformed metal crowns (PMCs), preveneered PMCs and zirconia crowns using different adhesive luting cements. METHODS: Thirty-six primary first molars were divided into three groups (n = 12) each prepared to receive different crowns (PMCs, preveneered PMCs, or zirconia crowns). Each group was further sub-grouped (n = 4) according to the luting cement (resin cement, resin modified glass ionomer cement, or glass ionomer cement). After cementation, the teeth were thermocycled, placed in 0.5% basic fuchsin, and sectioned to assess dye penetration. The results were analysed using ANOVA and Bonferroni statistical tests. The level of significance was set at p < 0.05. RESULTS: The microleakage recorded in zirconia crowns was significantly worse than that in preveneered PMCs and PMCs (p < 0.001). Regardless of the crown type, resin cement resulted in the least microleakage with statistically significant differences from glass ionomer cement (p < 0.05). CONCLUSIONS: As far as microleakage is concerned, preveneered PMCs seem to be an aesthetic and suitable alternative to PMCs. In addition, resin cement stands to be the most optimum luting cement.

Which patients with gynaecomastia require more detailed investigation?

Gynaecomastia may be due to medication, chronic liver or kidney disease, hypogonadism (primary or secondary to pituitary disease) or hyperthyroidism. Having excluded these aetiologies, it is imperative to be vigilant for underlying malignancy causing gynaecomastia. These include human chorionic gonadotrophin-secreting testicular and extratesticular tumours and oestrogen-secreting testicular tumours and feminising adrenal tumours.

A Case-control Study of Haemorrhagic Septicaemia in Buffaloes and Cattle in Karachi, Pakistan, in 2012.

A retrospective epidemiological case-control study was performed in Karachi, Pakistan, from January to April 2013. The owners of 217 dairy cattle and buffalo farms from six different locations in Karachi were interviewed. The aim of the study was to identify risk factors associated with the presence of haemorrhagic septicaemia (HS). Farms with a history of at least one instance of sudden death in a dairy animal during 2012 and a positive clinical HS diagnosis (made by local veterinarians) were defined as cases. Farms having no history of sudden deaths in 2012 were defined as controls. Univariable analyses were initially conducted, and factors with P ≤ 0.25 were offered to a multivariable logistic regression model to identify putative risk factors. The final multivariable logistic model contained five factors. Vaccination was found to be a protective factor (OR = 0.22) along with the length of time cattle were kept on farm (months). For every extra month cattle were kept, the odds of HS disease were reduced by a factor of 0.9. In contrast, for every extra animal in a herd, the risk of infection increased by a factor of 1.01. Supplying underground water and the presence of foot and mouth disease on the farm increased the risk by 2.90 and 2.37, respectively. To understand the epidemiology of HS in Karachi dairy herds, more in-depth research is required to study the risk and protective factors identified in this survey and to evaluate risk mitigation strategies, where possible.

In vitro toxicity of formocresol, ferric sulphate, and grey MTA on human periodontal ligament fibroblasts.

AIM: This was to assess and compare the in vitro toxicity of formocresol, ferric sulphate and MTA on cultured human periodontal ligament (PDL) fibroblasts. STUDY DESIGN: PDL cells were obtained from sound first permanent molars and cultured in Dulbecco's modified Eagle's medium. METHODS: PDL cells were subjected to different concentrations of formocresol, ferric sulphate, and grey MTA for 24, 48, and 72 h at 37 °C. Cells that were not exposed to the tested materials served as the negative control. In vitro toxicity was assessed using MTT assay. STATISTICS: Statistical analysis of data was accomplished using ANOVA and Tukey statistical tests (p<0.05). RESULTS: The overall toxicity ranking of the tested materials was as follows: formocresol>ferric sulphate>grey MTA. Only grey MTA had comparable cell viability to the negative control, the other tested materials were significantly inferior at the three exposure periods (p<0.05). CONCLUSION: Regarding the viability of PDL fibroblasts, MTA stands as the most promising substitute to formocresol. However, considering MTA's unavailability and high price in Jordan, ferric sulphate may be the best alternative to formocresol in pulpotomy of primary teeth.

In vitro toxicity of grey MTA in comparison to white MTA on human periodontal ligament fibroblasts.

AIM: This was to define and compare the in vitro toxicity of grey MTA with that of white MTA on cultured human periodontal ligament (PDL) fibroblasts. METHODS: PDL cells were obtained from sound first permanent molars and cultured in Dulbecco's Modified Eagle's Medium. Cultures were subjected to different concentrations of grey and white MTA (0.5, 5, 50 and 500 µg/ml) for 24 h at 37 °C. Cells that were not exposed to grey or white MTA served as the negative control. In vitro toxicity was assessed using MTT assay. STATISTICS: The results were compared using ANOVA and Tukey statistical tests (p < 0.05). RESULTS: White MTA presented higher in vitro toxicity than grey MTA. However, the differences were almost insignificant (p > 0.05). CONCLUSION: Both colours of MTA are biocompatible since they were both able to preserve PDL fibroblasts for up to 24 h. MTA is as a promising alternative in pulpotomy of primary teeth.

Prevalence of Depression in Patients with Type II Diabetes Mellitus and its Impact on Quality of Life.

BACKGROUND: Diabetes mellitus (DM) is a frequently encountered chronic metabolic disease with various complications throughout its course, which causes severe restriction and disability in an individual's life. It has been well documented that the incidence of depression is higher in diabetic patients and co-morbid depression causes further deterioration in the quality of life in diabetic patients. AIMS: To study the prevalence of depression and its impact on quality of life in patients with type II DM. SETTINGS AND DESIGN: Single centre, cross-sectional, single interview. MATERIALS AND METHODS: Total 195 type II DM patients are included in this study. To diagnose Depressive Episode Structured Clinical Interview for DSM IV Axis-1 Disorders, Research Version patient edition was applied. All patients were evaluated with a semi-structured socio-demographic proforma to assess socio-demographic characteristics, Hamilton Rating Scale for Depression (HAM-D) and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) SF (Short Form) to measure the quality of life. RESULTS: Among them, 46.15% (N=90; males: 41, females: 49) met the DSM-IV diagnostic criteria for major depressive episodes. Among the depressed group, majority were (36.7%) moderately depressed. QLESQ-SF total and each item scores were significantly lower in the depressed group than in the non-depressed group. Both the HAM-D scores and HbA1c level have significant negative correlations with QLESQ-SF total scores. CONCLUSION: Our study demonstrates that the presence of depression in type II DM further deteriorates the quality of life of the patients. Therefore, treating depression would have a beneficial effect on the quality of life.

The potential for underutilized crops to improve security of food production.

Staple crops face major challenges in the near future and a diversification away from over-reliance on staples will be important as part of the progress towards the goal of achieving security of food production. Underutilized or neglected crops species are often indigenous ancient crop species which are still used at some level within the local, national or even international communities, but have the potential to contribute further to the mix of food sources than they currently do. The most cost-effective and easily disseminated changes that can be made to a crop are changes to the genetics, as these are contained within the seed itself and, for many species, the seed is a pure breeding, self-replicating, resource. This article focuses on the potential of underutilized crops to contribute to food security and, in particular, whether genetics and breeding can overcome some of the constraints to the enhanced uptake of these species in the future. The focus here is on overview rather than detail and subsequent articles will examine the current evidence base.

Integration of participatory approaches into surveillance systems.

Animal health surveillance is essential for protecting public health, enhancing access to international markets for animals and their products, and improving animal health, production and welfare. It is of vital importance for protecting and improving the livelihoods of diverse groups of livestock keepers and stakeholders in livestock value chains. Surveillance systems consist of sets of complementary components which generate information to inform risk assessment, decision-making and policy formulation for both national programmes and international trade. Participatory approaches have the potential to add value to surveillance systems by enhancing their performance, especially their sensitivity and timeliness, and encouraging the inclusion of marginalised groups. This paper summarises key considerations in the assessment and design of animal health surveillance and discusses how participatory approaches can be integrated into comprehensive surveillance systems, leading to a more effective overall outcome for both domestic and international purposes.

Aetiology and outcome of burns in the elderly.

INTRODUCTION: This retrospective study, analyses aetiology and factors affecting the outcome of burns in patients over 65 years of age. METHODS: Sixty-three consecutive patients, over 65 years of age, were admitted to a Burns Unit over a period of 3 years. Retrospective data was analyzed, taking into account aetiology, burn thickness and area, co-morbid factors. Also, surgery as a factor-affecting outcome was examined. RESULTS: There was a significant difference of total body surface area burn (TBSA), Abbreviated Burn Severity Index (ABSI), Baux score and the number of pre-existing co-morbid factors between survivors and non-survivors. Age and surgery were not significant to the outcome. Patients undergoing surgery had increased hospital stay without any difference in mortality. The timing of surgery did not have any impact on hospital stay or survival. CONCLUSION: This study shows a positive correlation between the number of co-morbid conditions and mortality. Early surgery after careful patient selection does not have any negative impact on patient survival.

Self-inflicted burns, outcome and cost.

INTRODUCTION: Self-inflicted burns represent a small number of total admissions to a burns unit, yet they constitute a major workload. METHODS: A retrospective analysis of self-inflicted burns admitted between 1998 and 2002. RESULTS: One thousand six hundred and fifty six patients were admitted with acute burn injuries, of these 56 were self-inflicted. 24 patients had a previous history of self-harming and 22 were unemployed. History of a psychiatric illness was found in 46 patients. Flames caused 46 out of 56 injuries. Mean total body surface area (TBSA) was 27%. Approximately 39% needed admission to intensive care unit (ICU). The mortality rate was 25%. On discharge, 29% of the patients re-self harmed. CONCLUSION: Self-inflicted burns have a poorer outcome. Improving the psychiatric and social support can reduce the incidence of self-harming behaviour, its repetitiveness and subsequently the cost of burn care.

Acute calcific tendinitis of the finger--a case report.

Acute calcific tendinitis of the hand is rare and often misdiagnosed as infection, fracture or periarthritis. It frequently occurs in peri-menopausal women and is caused by deposits of hydroxyapatite crystals. We describe acute calcific tendinitis of the flexor digitorum superficialis insertion in an elderly man taking oral anticoagulants. The differential diagnoses and recommended treatment are discussed.

Free DIEP flap breast augmentation following excessive reduction.

A two-stage procedure using bilateral free DIEP flaps to correct excessive bilateral breast reduction is described. The reconstructive challenge was to achieve satisfactory breast projection on a large torso without recourse to prosthetic implants or extensive back scars. The literature on the use of TRAM and latissimus dorsi flaps in subtotal breast reconstruction for various other breast deformities is reviewed. We have not found a similar case to ours in the literature.

Genetic diversity in bambara groundnut (Vigna subterranea (L.) Verdc) landraces revealed by AFLP markers.

Bambara groundnut (Vigna subterranea (L.) Verdc), an African indigenous legume, is popular in most parts of Africa. The present study was undertaken to establish genetic relationships among 16 cultivated bambara groundnut landraces using fluorescence-based amplified fragment length polymorphism (AFLP) markers. Seven selective primer combinations generated 504 amplification products, ranging from 50 to 400 bp. Several landrace-specific products were identified that could be effectively used to produce landrace-specific markers for identification purposes. On average, each primer combination generated 72 amplified products that were detectable by an ABI Prism 310 DNA sequencer. The polymorphisms obtained ranged from 68.0 to 98.0%, with an average of 84.0%. The primer pairs M-ACA + P-GCC and M-ACA + P-GGA produced more polymorphic fragments than any other primer pairs and were better at differentiating landraces. The dendrogram generated by the UPGMA (unweighted pair-group method with arithmetic averaging) grouped 16 landraces into 3 clusters, mainly according to their place of collection or geographic origin. DipC1995 and Malawi5 were the most genetically related landraces. AFLP analysis provided sufficient polymorphism to determine the amount of genetic diversity and to establish genetic relationships in bambara groundnut landraces. The results will help in the formulation of marker-assisted breeding in bambara groundnut.