Synthetic Cannabinoids-Related Cardiovascular Emergencies: A Review of the Literature.

Synthetic cannabinoids (SCBs) are a group of psychoactive compounds, known to cause a range of multisystem adverse events, including the cardiovascular system. The aim of this review is to provide an overview of the literature on cardiovascular emergencies associated with SCBs. A systematic search of electronic databases was conducted to identify relevant studies published between January 2010 and September 2022. Inclusion criteria were studies reporting on cardiovascular emergencies in individuals with SCB abuse. The search yielded a total of 43 studies, including case reports, case series, and meta-analyses. This review indicates that SCB abuse can lead to a range of cardiovascular emergencies, including acute coronary syndrome, arrhythmias, and hypertension. The onset of these emergencies is often sudden and may occur in previously healthy individuals. The severity of these complications can vary widely, with some cases resulting in cardiac arrest or death. Management strategies for SCB-related cardiovascular emergencies include supportive care, pharmacological interventions, and, sometimes, invasive procedures. There is no specific antidote against SCB to date. In conclusion, SCB abuse is associated with various cardiovascular emergencies, which can be life-threatening in some cases. Early recognition and management of these emergencies are critical for improving outcomes. Further research is needed to better understand the underlying mechanisms of SCB-related cardiovascular complications and to develop effective prevention and management strategies.

Eccentric Versus Concentric Exercises in Patients With Rheumatoid Arthritis and Rotator Cuff Tendinopathy: A Randomized Comparative Study.

OBJECTIVE: To determine the efficacy of concentric vs. eccentric exercise in improving shoulder function, pain, and tendon characteristics for patients with rheumatoid arthritis and rotator cuff tendinopathy. METHODS: Forty patients with rheumatoid arthritis and rotator cuff tendinopathy were divided into either concentric or eccentric exercise groups, with 20 patients in each group. Patients received 12 sessions at a pace of 3 sessions per week. Shoulder Pain and Disability Index (SPADI), the visual analogue scale (VAS), supraspinatus and subscapularis thickness, echo pixels, and the Disease Activity Score-28-erythrocyte sedimentation rate (DAS-28-ESR) were assessed at baseline and post-treatment. RESULTS: There was a significant difference between the concentric and eccentric groups regarding SPADI and VAS scores in favor of the eccentric group. However, there was no significant difference between the two groups regarding tendon thickness, echo pixels, or DAS-28-ESR. CONCLUSION: Eccentric exercises were more effective than concentric exercises in improving shoulder function and pain intensity. However, neither of the two types of exercises was superior in improving tendon characteristics or disease activity.

Effect of Neural Mobilization Exercises in Patients With Low Back-Related Leg Pain With Peripheral Nerve Sensitization: A Prospective, Controlled Trial.

OBJECTIVE: The aim of this study was to investigate the short-term effect of slider and tensioner exercises on pain and range of motion (ROM) of straight leg raise (SLR) and slump tests in patients with low back-related leg pain with peripheral nerve sensitization. METHODS: In this prospective, controlled trial, 51 patients with low back-related leg pain with peripheral nerve sensitization were divided into 3 treatment groups: slider (slider neural mobilization exercise + transcutaneous electric nerve stimulation [TENS]), tensioner (tensioner neural mobilization exercise + TENS), and control (only TENS). Each patient received 6 sessions over 2 weeks. The following outcomes were measured at baseline and after the first, third, and sixth sessions: visual analog scale (VAS) for pain and ROM of SLR and slump tests were performed for the symptomatic side. RESULTS: Compared with controls, patients receiving the slider and tensioner exercises showed a greater decrease in pain at the third and sixth sessions (mean difference: ≥1.54 cm; 95% CI, 0.1-3.9). There was a significant difference in the ROM of the SLR test between the slider and controls at only the sixth session (mean difference: 16.7°; 95% CI, -29.2 to -4.3). Patients in the slider and tensioner groups demonstrated greater improvements in the ROM of slump test at all sessions compared with controls (mean difference: ≥12.5°; 95% CI, -32.1 to -6.4). There were no significant differences between the slider and tensioner groups in any outcome at any session. CONCLUSION: Patients in both slider and tensioner neural mobilization exercise groups demonstrated improvements in pain and ROM in patients with low back-related leg pain with peripheral nerve sensitization compared to those in the control group.

Ustekinumab dose escalation improves clinical responses in refractory Crohn's disease.

BACKGROUND: Clinicians often utilize off-label dose escalation of ustekinumab (UST) in Crohn's disease (CD) patients with disease refractory to standard dosing. Previous studies report mixed results with dose escalation of UST. METHODS: A retrospective observational study of 143 adult patients with CD receiving UST over a 33-month time period was conducted. Patients receiving UST at standard dosage for a minimum of 16 weeks were included in the analysis. Primary outcomes collected were clinical response [Physician Global Assessment Score (PGA) by >1] and remission (PGA = 0). Changes in clinical parameters were calculated for dose-escalated patients beginning with the time of dose switch (~42 weeks) and compared with a group of patients who were classified as "failing" standard dosing at 42 weeks who were not dose escalated. RESULTS: Dose escalation improved PGA by 0.47 ± 0.19 compared with patients remaining on every 8 weeks dosing (Q8 week), who worsened by 0.23 ± 0.23 (p < 0.05). Dose escalation decreased CRP 0.33 ± 0.19 mg/L and increased serum albumin 0.23 ± 0.06 g/dL (p < 0.05). Surprisingly, disease duration and prior CD surgeries inversely correlated with the need for dose escalation. CONCLUSION: Our results support UST Q4 week dose escalation for selected CD patients who fail to achieve remission on standard Q8 week dosing. Dose escalation improves clinical outcomes, prevents worsening disease severity, and positively impacts CRP and albumin levels. Together these data indicate that clinicians should attempt Q4 week UST dosing in refractory CD patients before switching to an alternative class of biologic therapy.

Evaluation of students' experience with Problem-based Learning (PBL) applied at the College of Medicine, Al-Jouf University, Saudi Arabia.

OBJECTIVE: To evaluate the students' experience with problem-based learning. METHODS: This cross-sectional, qualitative study was conducted at the College of Medicine, Al Jouf University, Sakakah, Saudi Arabia, in October 2015, and comprised medical students of the 1st to 5th levels. Interviews were conducted using Students' Course Experience Questionnaire. The questionnaire contained 37 questions covering six evaluative categories: appropriate assessment, appropriate workload, clear goals and standards, generic skills, good teaching, and overall satisfaction. The questionnaire follows the Likert's scale model. Mean values were interpreted as: >2.5= at least disagree, 2.5->3= neither/nor (uncertain), and 3 or more= at least agree. RESULTS: Of the 170 respondents, 72(42.7%) agreed that there was an appropriate assessment accompanied with the problem-based learning. Also, 107(63.13%) students agreed that there was a heavy workload on them. The goal and standards of the course were clear for 71(42.35%) students, 104(61.3%) agreed that problem-based learning improved their generic skills, 65(38.07%) agreed the teaching was good and 82(48.08%) students showed overall satisfaction. CONCLUSIONS: The students were satisfied with their experience with the problem-based learning.

Pediatric systemic lupus erythematosus in a single nephrology unit.

Clinical manifestations of systemic lupus erythematosus (SLE) are widely variable, and its course is unpredictable. SLE that begins in childhood has been considered more severe than SLE with onset during adulthood. Our aim was to determine the presentation and the outcome of SLE of 26 children (20 females and 6 males, with a female to male ratio of 3.8:1) with SLE in our center, their ages ranging from 5 - 18 years and followed from 2005 till October 2011. They were diagnosed according to the American Rheumatism Association's revised criteria. Complete blood count, erythrocyte sedimentation rate, C3, urine analysis, 24-h urinary protein, antinuclear antibodies, anti-ds DNA and renal biopsy were obtained for the patients. We found that the most extra-renal manifestation of SLE was fever (57.7%), while lupus nephritis (LN) was the most commonly affected organ (50%). Hemolytic anemia was the most common hematological abnormality (80.8%), while immunological characteristics were positive in all the patients. Remission in patients without LN was more than 5.3-times the remission in LN patients. The outcome of the patients without LN was better than the patients with LN.

Association of postural balance and isometric muscle strength in early- and middle-school-age boys.

OBJECTIVE: The purpose of this study was to evaluate the isometric muscle strength (IMS) and dynamic balance in early- and middle-school-age boys and to assess the strength of association between the dynamic balance scores and 6 different IMS indexes. METHODS: This is a cross-sectional study of a convenience sample of 94 boys who were 6 to 10 years of age and classified into an early school age (6-8 years) group (n = 50) and a middle school age (8-10 years) group (n = 44). Balance was tested using a Biodex Balance System. Anteroposterior Stability Index, Mediolateral Stability Index, and Overall Stability Index were recorded. IMS of 11 muscle groups was measured with a handheld dynamometer and categorized into 6 different muscle strength indices. RESULTS: The mean (SD) values of anteroposterior, mediolateral, and overall stability indexes observed for all study boys were 1.9 ± 1.0, 1.2 ± 0.7, and 2.5 ± 1.2 respectively. In the middle school age group, strong positive relationships were detected between the overall stability index and trunk, lower limb, anti-gravity, pro-gravity, and total strength indexes (r = -0.86/P < .001, r = -0.91/P < .001, r = -0.88/P < .001, r = -0.83/P < .001, and r = -0.84/P < .001 respectively), while no significant relationship was detected with the upper limb strength index (r = 0.159/P = .303). In the early school age group, moderate positive relationships were detected between the overall stability index and anti-gravity, lower limb, and total strength indexes (r = -0.404/P = .004, r = -0.356/P = .011, and r = -0.350/P = .013 respectively). CONCLUSION: Dynamic balance did not appear to be mature by the age of 10 years. Better balance skills were recorded in the mediolateral direction than in the anteroposterior direction. In the middle school age group, the overall stability index had positive relationships with almost all examined muscle strength indexes excepting the upper limb strength index.

Evaluation of isometric muscle strength and magnitude of hand dominance in right-handed school-age boys.

The aim of this study was to examine bilateral isometric muscle strength (IMS) in right-handed boys. To determine the association between the magnitudes of right handedness (MRH) and (a) the interside difference indexes of IMS of certain muscle categories, (b) age, and (c) some anthropometric characteristics. This was a cross-sectional study. A convenience sample of 94 right-handed boys between 6 and 10 years of age was investigated. The Edinburgh Handedness Inventory was used to evaluate hand dominance and its magnitude. IMS of eight muscle groups was measured and the interside difference was determined. Five interside difference indexes were calculated for the upper limb, lower limb, hand grip, key pinch, and total side. All interside difference indexes of IMS were less than 5%, in favor of the dominant right side. The majority (86.1%) of our boys scored high to moderate MRH, whereas the minority (13.8%) scored low MRH. The hand grip interside difference index (ß=0.40, P=0.000), the key pinch interside difference index (ß=0.23, P=0.003), age (ß=0.24, P=0.034), and height (ß=0.33, P=0.039) are the best set of predictors of the dominance score and in turn the MRH. The results of this study, carried out on right-handed boys aged 6-10 years, indicated a standard difference in IMS between dominant and nondominant sides of all studied muscle strength categories. Furthermore, it was found that the hand grip interside difference index, the key pinch interside difference index, age, and height could influence the MRH.

Regression of brown tumor of the maxilla in a patient with secondary hyperparathyroidism after a parathyroidectomy.

Brown tumors or osteoclastomas are erosive bony lesions arising as a complication of hyperparathyroidism. In patients with end-stage renal disease, brown tumors are uncommon skeletal manifestations that are usually seen in severe forms of secondary hyperparathyroidism. Initial treatment involves the correction of hyperparathyroidism, which usually leads to regression of the tumors. We report a case of brown tumors of the maxilla in a 24-year-old female referred to us by a local hospital, where she had been on regular hemodialysis for >10 years. After a complete biochemical and radiological workup, she underwent a total parathyroidectomy, which subsequently resulted in significant regression of her tumor.