Prevalence and Risk Factors of Distal Symmetric Polyneuropathy Among Predominantly Non-Hispanic Black, Low-Income Patients.

BACKGROUND AND OBJECTIVES: Distal symmetric polyneuropathy (DSP) is a disabling, often painful condition associated with falls and reduced quality of life. Non-Hispanic Black people and people with low income are underrepresented in existing DSP studies; therefore, it is unknown whether data accurately reflect the prevalence, risk factors, and burden of disease in these populations. METHODS: Patients older than 40 years presenting to an outpatient internal medicine clinic predominantly serving Medicaid patients in Flint, Michigan, were enrolled in a cross-sectional study. Demographics, clinical characteristics, including medication use, anthropomorphic measurements, fasting lipids, and hemoglobin A1c were collected. DSP was defined using the modified Toronto Clinical Neuropathy Score (mTCNS). Multivariable logistic regression was performed to model DSP and undiagnosed DSP as a function of potential risk factors age, metabolic syndrome, and race. DSP burden was measured using Peripheral Neuropathy Quality of Life Instrument-97. RESULTS: Two hundred participants were enrolled, and 169 (85%) completed all data collection. The population was 55% female of mean age (SD) 58.2 years (10.4) and 69% non-Hispanic Black. Among the population, 50% had diabetes, 67% had metabolic syndrome, and 47% had a household income <$20,000. DSP was present in 73% of the population, of which 75% were previously undiagnosed. Neuropathic pain was documented in 57% of participants with DSP. DSP based on mTCNS criteria was associated with older age (odds ratio [OR] 1.1 [95% confidence interval (CI) 1.03-1.2]) and metabolic syndrome (OR 4.4 [1.1-18.1]). Non-Hispanic Black participants had lower odds of DSP (OR 0.1 [0.01-0.4]) than non-Hispanic White and Hispanic participants. DSP burden was high, including increased pain, health-related worry, and poorer quality of life (all p < 0.001). DISCUSSION: DSP is extremely common and often underrecognized in this predominantly non-Hispanic Black, low-income population and leads to substantial disease burden. Metabolic syndrome is a highly prevalent, modifiable risk factor in this population that should be managed to lower DSP prevalence.

Nail Gun Penetrating Renal Injury: A Case Report.

The kidney is the genitourinary organ most affected by trauma, although the retroperitoneal location provides some protection. Renal injuries are classified according to the mechanism of trauma. Most of the penetrating renal injury cases in the literature are due to knife stabbing or handguns. We present an interesting case of a 22-year-old male with a penetrating renal injury caused by an electric nail gun. There was no report of a similar case in the literature.

Leiomyosarcoma Invading the Vena Cava: A Case Report.

Leiomyosarcoma is an aggressive soft tissue tumor originating from smooth muscle cells typically of the uterus, gastrointestinal, or genitourinary system. The most common site of leiomyosarcoma of soft tissue is the retroperitoneum, accounting for 50% of all cases. The majority of patients are asymptomatic, which may be due to the large retroperitoneal cavity. However, when symptoms do occur, they are vague in nature. The most common growth pattern is an entirely extravascular mass. We are presenting an interesting case of a 65-year-old lady, who was referred to our hospital as a case of large left retroperitoneal mass with left renal vein thrombosis. She was biopsied and diagnosed with leiomyosarcoma with invasion into descending colon and the left renal vein, which led to renal vein thrombus. In the last few decades, there is a lack of studies about leiomyosarcoma invading the renal vein and Inferior Vena Cava (IVC). As far as we know, the leiomyosarcoma of a major blood vessel is extremely rare. Since leiomyosarcoma often has a late presentation with the advanced stage when detected, a high index of suspicion is needed to be detected early and avoid such a complication.

Characteristics and Types of Urolithiasis in the Eastern Region of Saudi Arabia: A Single-Center Retrospective Study.

Introduction Urolithiasis is one of the most common conditions encountered in clinical practice with the prevalence increasing globally in the last few decades. Urolithiasis has been found to be more common in areas with a hot climate, such as Saudi Arabia. The aim of this study was to determine the characteristics and the types of urolithiasis most frequently found in the Eastern Region of Saudi Arabia. Methods This was a single-center retrospective cohort study based on data extracted from an electronic hospital information system (BESTCare) of all patients diagnosed with urolithiasis at King Abdulaziz Hospital, a tertiary care center in Saudi Arabia's Eastern Region. From January 2013 to December 2016, all adult patients aged 18 and up who presented with urinary calculi (renal and ureter) were included in the study. Results A total of 235 patients were reviewed, with a mean age of 48.52 years. Renal calculi were more prevalent in males (74.5%). Calcium oxalate was the predominant type (76%), followed by uric acid calculi (18%) and cystine calculi (4.8%). A small proportion (1.2%) was calcium phosphate calculi. The most frequently associated comorbidity was hypertension (17.9%). The majority (78.5%) had a stone removal through a ureteroscopy and 8.2% by percutaneous nephrolithotomy (PCNL). The mean stone size was 12.2 ± 9.91 mm, with a mean stone Hounsfield unit (HU) of 789.9. The mean urinary PH at stone incident was 6.77, and the mean creatinine level was 92.4mmol. Conclusion This study showed that males were more affected by urolithiasis, compared to females in the Eastern Region. Furthermore, calcium oxalate was the predominant type. These findings are consistent with the literature and they highlighted the necessity for further studies in this area, to provide insight into the pathophysiology and incidence of renal calculi for improving patient care.

Complications of Veress Needle Versus Open Technique in Abdominal Surgeries.

Introduction In any laparoscopic procedure, the first and most important step is abdominal entry. This is followed by the creation of pneumoperitoneum, which is essential for lifting the abdominal wall off of the internal organs and visualizing the entered space. However, the entry and establishment of pneumoperitoneum are not without risks and complications, the most serious of which include vascular injuries and bowel perforations in all the different techniques used. The most commonly used techniques for abdominal entry are the closed (Veress) and open (Hasson) techniques, the choice of which varies according to the surgeon's preference and other regional and local factors. Aim To compare the outcomes between the open technique and the Veress needle for accessing the peritoneum during laparoscopic surgery. Methodology This was a retrospective cohort study that aimed to compare the outcomes between the Veress needle and the open technique for entering the peritoneum in laparoscopic surgeries. A chart review was used as an instrument to collect data. The study was conducted in King Abdul-Aziz Medical City, Riyadh, Saudi Arabia. All patients who underwent abdominal laparoscopic surgery from 2006 to 2016 were included. Results We analyzed 365 patients who underwent laparoscopic abdominal surgery. The mean age of the patients was 32.6 years. The most common postoperative complication occurring during the admission period was abdominal pain (40.5%). Postoperative complications during admission were significantly associated with the type of needle used (χ2=10.641; p=0.001). Conclusion The type of technique used for entry and peritoneal access was associated with the occurrence of postoperative complications in abdominal surgeries. Thus, the choice of open or Veress technique for peritoneal access should be individualized based on factors such as patient sex, clinical diagnosis, and most importantly, the surgeons' experience and preference.

Can the Body Mass Index Predict Varicocele Recurrence Post-Intervention?

Purpose In this study, we investigated the association between the body mass index (BMI) and varicocele recurrence post-intervention in our local Saudi population. We also explored the association between recurrence and other predictors such as age, laterality, indication for surgery, type of intervention, clinical grade, testicular delivery, and method of ligation. Methods We conducted a retrospective cohort study, including all patients who had microscopic varicocelectomy surgery or radiographic embolization for varicoceles over a five-year period. The data included demographic information and intervention-related variables. Descriptive and analytical statistics were used to analyze the data. Results We included 147 patients who had microscopic varicocelectomy surgery or radiographic embolization. We categorized the patients according to their BMI as underweight, normal, overweight, and obese. We found no statistical association between any BMI group and the recurrence of varicocele (P>0.05). However, there was a significant association between the clinical grade and recurrence (P<0.05). Conclusion This study did not show any significant correlation between height, weight, BMI, and varicocele recurrence after an intervention. The only predictor of varicocele recurrence was the clinical grade.

Balanced crystalloids versus isotonic saline in critically ill patients: systematic review and meta-analysis.

OBJECTIVES: Intravenous fluids are one of the most used medical therapy for patients, especially critically ill patients. We conducted a meta-analysis comparing between balanced crystalloids and normal saline in critically ill patients and its effect on various clinical outcomes. DESIGN: Meta-analysis and systematic review of randomized clinical trials (RCTs). METHODS AND DATA SOURCE: Electronic search was performed using PubMed, Cochrane library, and clinical trials.gov from inception through March 1, 2018, with inclusion of prospective studies that investigated one of the primary outcomes which were acute kidney injury (AKI) and in-hospital mortality while secondary outcomes were intensive care unit (ICU) mortality and new renal replacement therapy (RRT). RESULTS: Six RCTs were included. Total of 19,332 patients were included in the final analysis. There was no significant difference in in-hospital mortality (11.5% vs 12.2%; OR 0.92; 95% CI 0.85-1.01; P = 0.09; I2 = 0%), incidence of AKI (12% vs 12.7%, OR 0.92; 95% CI 0.84-1.01; P = 0.1; I2 = 0), overall ICU mortality (OR 0.9, 95% CI 0.81-1.01, P = 0.08, I2 = 0%), or need for new RRT (OR 0.92, 95% CI 0.67-1.28, P = 0.65, I2 = 38%) between balanced crystalloids and isotonic saline in critically ill patients. CONCLUSION: Balanced crystalloids and isotonic saline have no difference on various clinical outcomes including in-hospital mortality, AKI, overall ICU mortality, and new RRT. Further powerful clinical trials are required to determine the relationship between crystalloid fluid type and clinical outcomes.

Investigation of functional properties and color changes of corn extrudates enriched with broccoli or olive paste.

Following the tendency of replacing common food snacks with healthier food products, extruded snacks with corn flour and broccoli (4-10%) or olive paste (4-8%) were investigated in this study. The effect of material characteristics, including feed moisture content (14-19%), and broccoli or olive paste concentration, and extrusion conditions, including screw speed (150-250 r/min), and extrusion temperature (140-180 ℃), on the functional properties (water absorption index, water solubility index, and oil absorption index), as well as color change (ΔE) of the extruded snacks was studied. Regression analysis showed that screw speed did not significantly influence (p > 0.05) the properties. After mathematical modelling it was found that broccoli and olive paste concentration, as well as temperature increment, caused a decrease in water absorption index (minimum of 5.6 and 6.4 g/g sample, respectively) and an increase in water solubility index (maximum of 18.7 and 10.9 g/100 g sample, respectively), while feed moisture presented opposite tendency. Higher extrusion temperature led to an increment of oil absorption index (approximately to 1.2 and 1 mL/g sample) and decrement of color changes. Finally, feed moisture and broccoli concentration lowered oil absorption index and color of corn/broccoli extrudates, while olive paste concentration caused their increment.

A survey of emergency department staff about challenges and recommendations for emergency department care of extended care facility patients.

OBJECTIVES: Extended care facility (ECF) patients who transfer to emergency departments (EDs) can pose problems when complicated health problems require extra resources. Higher numbers of older patients are projected to use EDs, so we aimed to identify problems now to implement solutions before they worsen in the future. DESIGN: This was a prospective survey research study. SETTING: ED in a safety net teaching hospital in the Midwest. PARTICIPANTS: ED personnel. MEASUREMENTS: Confidential, anonymous survey collected views and opinions of ED personnel about problematic issues related to emergency care of ECF residents. The survey targeted communication problems, patient satisfaction concerns, difficult characteristics of patient population, need for education, need for research--and solicited open-ended remarks. RESULTS: ED staff reported concern about flawed communication and poor documentation from the ECF. Based on job title, divergent viewpoints were reported about pharmacological challenges and comfort levels in managing older patients in the ED. Top training priorities were special needs of older adults, detecting abuse in older adults, and specific medical and psychosocial issues associated with older adults. Increased communication among all levels of geriatric care is recommended, especially from extended care facility staff before patient arrival at the ED. CONCLUSION: Because population projections predict an increasing trend of older adults, health care providers must think ahead and prepare for future medical needs. This survey was an inexpensive and effective way to identify next steps. We plan to use the survey results to initiate collaboration with ED staff, EMS providers, and ECF staff to identify specific actions to improve acute care for elderly patients--for the present and the future.

Modeling the nonlinear properties of the in vitro hippocampal perforant path-dentate system using multielectrode array technology.

A modeling approach to characterize the nonlinear dynamic transformations of the dentate gyrus of the hippocampus is presented and experimentally validated. The dentate gyrus is the first region of the hippocampus which receives and integrates sensory information via the perforant path. The perforant path is composed of two distinct pathways: 1) the lateral path and 2) the medial perforant path. The proposed approach examines and captures the short-term dynamic characteristics of these two pathways using a nonparametric, third-order Poisson-Volterra model. The nonlinear characteristics of the two pathways are represented by Poisson-Volterra kernels, which are quantitative descriptors of the nonlinear dynamic transformations. The kernels were computed with experimental data from in vitro hippocampal slices. The electrophysiological activity was measured with custom-made multielectrode arrays, which allowed selective stimulation with random impulse trains and simultaneous recordings of extracellular field potential activity. The results demonstrate that this mathematically rigorous approach is suitable for the multipathway complexity of the hippocampus and yields interpretable models that have excellent predictive capabilities. The resulting models not only accurately predict previously reported electrophysiological descriptors, such as paired pulses, but more important, can be used to predict the electrophysiological activity of dentate granule cells to arbitrary stimulation patterns at the perforant path.

Screening for the effects of antiepileptic drugs on short term plasticity using a time efficient bioassay.

Screening for changes in the short-term plasticity (STP) characteristics induced by antiepileptic drugs (AEDs) can be accelerated using a novel in vitro bioassay. The bioassay is based on the analysis of varying population spike (PS) amplitudes recorded in the CA1 region of the hippocampal slice in response to Poisson distributed random electrical stimuli. Three antiepileptic drugs (phenytoin 100 microM, carbamazepine 100 microM, and valproate 700 microM) were tested at maximal effective therapeutic concentrations. The data were analyzed using an advanced nonlinear approach that is more specific and time-efficient than the conventional paired pulse and fixed frequency train methods. STP was quantified by the first and the second order Volterra kernels. The first order kernel (k1) represented the mean PS amplitude while the second order kernel (k2) quantified the effect on the current PS amplitude of the interaction between the current stimulus impulse and each past stimulus impulse within a time (memory) window mu. The mean PS (k1 decreased by 15%, 10%, and 7% when phenytoin, carbamazepine, and valproate were added respectively. Phenytoin caused an increase in the k2 peak facilitation in the high frequency domain. Carbamazepine impaired frequency facilitation in the theta frequency range by causing a left shift in the second order kernel.

Improving bioassay sensitivity for neurotoxins detection using volterra based third order nonlinear analysis.

Based on a novel analytical method for analyzing short-term plasticity (STP) of the CA1 hippocampal region in vitro, a screening tool for the detection and classification of unknown chemical compounds affecting the nervous system was recently introduced [1], [2]. The recorded signal consisted of evoked population spike in response to Poisson distributed random train impulse stimuli. The developed analytical approach used the first order Volterra kernel and the Laguerre coefficients of the second order Volterra model as classification features [3]. The biosensor showed encouraging results, and was able to classify out of sample compounds correctly [2]. We have taken an exploratory step to investigate the advantage of introducing a third order model [4]. DAP5, an NMDA channel blocker, did not show major changes in the second order kernel and in its corresponding Laguerre coefficients. Data were reanalyzed using a third order model. DAP5 showed discernable changes in the third order kernel as well as in the some of the corresponding Laguerre coefficients. Hence, the third order Volterra based model has the potential to improve the sensitivity and the discriminatory power of the proposed bioassay.

Analysis of malaria cases among United Nations troops in Sierra Leone.

OBJECTIVE: To analyze malaria case presentation admitted to the United Nations hospital in Freetown, Sierra Leone named Choithram Memorial Hospital, a Jordanian Medical Level III Hospital. METHODS: All data from patients admitted to the Choithram Memorial Hospital, Freetown, Sierra Leone, over a 6-month period, 21st January through to 21st July 2002 were tabulated and later analyzed according to clinical presentation. Data such as age, sex, most common complaints, malaria smear and history of malaria prophylaxis together with other variables were recorded. RESULTS: A total of 101 cases were included in this study. Males accounted for the majority of cases n=90 (89.1%), females n=11 (11.9%). Mean age was 34.4+/- 9 and mean stay in hospital was 4.5+/-2 days. Malaria thick smear was positive from the first time in 71.3%, n=72, while in 16.8%, n=17 from the second time, 4%, 5%, 3% were positive from the third, fourth and fifth time. Most common complaints were fever and headache (79.2%, n=80), chills (74.3%, n=75), sweating (72.3%, n=73), arthralgias (56.4%, n=57) and vomiting (43.6%, n=44). Those who were taking anti-malarial prophylaxis were 34.6% (n=35), while the rest were on no prophylaxis. Complicated cases were: 5 cases presented with cerebral malaria, one of them succumbed while the rest recovered completely; 4 presented with uremia and were referred for dialysis, one of them passed away after the first dialysis session. Other clinical presentations were seen such as: upper gastro-intestinal bleeding, diarrhea, pneumonia, pericarditis, angina pectoris, black water fever and abdominal pain. Four consultations were received from the dermatologist on cases of chicken pox not responding to treatment and turned out to be malaria falciparum. CONCLUSION: In an endemic area, malaria falciparum may present in very bizarre and variable clinical pictures. Fever is not necessarily a cardinal sign. High suspicion index must be exerted in unusual presentations. Prophylaxis against malaria must not alter the clinical decision away from the diagnosis. Prompt treatment on presumptive diagnosis will save many patients from the complications of this killing disease.

[Biotypes of Salmonella typhimurium in Iraq]. / Biovars de Salmonella typhimurium en Irak.

207 Salmonella typhimurium strains isolated from childrens below three years (190 strains), adult patients (8 strains), health carriers (7 strains) or animals (2 strains) were studied with the biotyping scheme of Cordano, Richard and Vieu (1971). Five biovars were found and 76.8% of the strains were TTR+, Ino+, Tre+, d. Tar- (biovar d). In Irak the epidemiology of the Salmonella typhimurium human infections is associated with an high frequency of strains of Salmonella typhimurium 0:5- (var. Copenhagen), biovar d.