Impact of combined component separation technique and shoelace repair on big medline abdominal wall defect.

BACKGROUND: Closure of large anterior abdominal wall defects, regardless of their etiology, is challenging. There is no standardized information describing definitive management. Therefore, we conducted this study to illustrate our experience on large midline abdominal wall defect repair using an effective modified reconstructive technique. METHODS: This retrospective study was conducted at Al Naqib Hospital in Aden/Yemen between 2012 and 2019. Twenty-six patients with large midline abdominal wall defects of various etiologies underwent surgical repair using a combination of shoelace repair and the component separation technique. The procedure involved bilateral longitudinal division of the anterior rectus sheet and creation of a posterior layer by approximation of the medial edges of the divided rectus sheet (shoelace abdominoplasty) and anterior external oblique muscle aponeurosis separation (component separation technique) to approximate the lateral edges of the divided rectus sheet and move the rectus muscles toward the midline for constructing the anterior abdominal wall layer. The posterior and anterior layers and bilateral separated sheets were covered with a polypropylene mesh in all patients, except in those who underwent emergency damage control surgery. RESULTS: Four, one, and two patients developed seroma, skin necrosis and chronic pain, and post-surgical wound infection, respectively. No recurrent herniation was recorded during the median follow-up of 5 years. CONCLUSION: This technique is effective in restoring the integrity of the abdominal wall in large midline abdominal wall defects and has an acceptable aesthetic appearance. In our study, minimal complications were reported, and no cases of recurrent hernias were diagnosed during follow-up.

Steps and Challenges in Creating and Managing Quarantine Capacity During a Global Emergency - Qatar's Experience.

BACKGROUND: COVID-19 pandemic has exposed the lack of adequate and appropriate quarantine capacity globally. Most countries lack the knowledge and/or capacity to set up and manage quarantine facilities at a national scale. METHODS: The State of Qatar developed a systematic plan to create and manage quarantine facilities for persons with confirmed or suspected COVID-19 infection or returning travelers and residents. A checklist was developed to streamline the process and to help other institutions requiring such guidance. RESULTS: Three distinct stages were identified: acquisition, commissioning and active operations. Steps required for each stage were identified and added to the checklist. CONCLUSION: We share our experience and a checklist for setting up new quarantine capacity at a national level. Such checklists can serve as a critical tool to quickly and efficiently ramp up capacity in this setting.

MicroRNA-1911-3p targets mEAK-7 to suppress mTOR signaling in human lung cancer cells.

Regulation of mTOR signaling depends on an intricate interplay of post-translational protein modification. Recently, mEAK-7 (mTOR associated protein, eak-7 homolog) was identified as a positive activator of mTOR signaling via an alternative mTOR complex. However, the upstream regulation of mEAK-7 in human cells is not known. Because microRNAs are capable of modulating protein translation of RNA in eukaryotes, we conducted a bioinformatic search for relevant mEAK-7 targeting microRNAs using the Exiqon miRSearch V3.0 algorithm. Based on the score obtained through miRSearch V3.0, the top predicted miRNA (miR-1911-3p) was studied. miR-1911-3p mimics decreased protein levels of both mEAK-7 and mTORC1 downstream effectors p-S6 and p-4E-BP1 in non-small cell lung carcinoma (NSCLC) cell lines H1975 and H1299. miR-1911-3p levels and MEAK7 mRNA/mEAK-7/mTOR signaling levels were negatively correlated between normal lung and NSCLC cells. miR-1911-3p directly interacted with MEAK7 mRNA at the 3'-UTR to negatively regulate mEAK-7 and significantly decreased mTOR localization to the lysosome. Furthermore, miR-1911-3p significantly decreased cell proliferation and migration in both H1975 and H1299 cells. Thus, miR-1911-3p functions as a suppressor of mTOR signaling through the regulation of MEAK7 mRNA translation in human cancer cells.

mEAK-7 Forms an Alternative mTOR Complex with DNA-PKcs in Human Cancer.

MTOR associated protein, eak-7 homolog (mEAK-7), activates mechanistic target of rapamycin (mTOR) signaling in human cells through an alternative mTOR complex to regulate S6K2 and 4E-BP1. However, the role of mEAK-7 in human cancer has not yet been identified. We demonstrate that mEAK-7 and mTOR signaling are strongly elevated in tumor and metastatic lymph nodes of patients with non-small-cell lung carcinoma compared with those of patients with normal lung or lymph tissue. Cancer stem cells, CD44+/CD90+ cells, yield elevated mEAK-7 and activated mTOR signaling. mEAK-7 is required for clonogenic potential and spheroid formation. mEAK-7 associates with DNA-dependent protein kinase catalytic subunit isoform 1 (DNA-PKcs), and this interaction is increased in response to X-ray irradiation to regulate S6K2 signaling. DNA-PKcs pharmacologic inhibition or genetic knockout reduced S6K2, mEAK-7, and mTOR binding with DNA-PKcs, resulting in loss of S6K2 activity and mTOR signaling. Therefore, mEAK-7 forms an alternative mTOR complex with DNA-PKcs to regulate S6K2 in human cancer cells.

Ultra-Thin Platinum Deposits by Surface-Limited Redox Replacement of Tellurium.

Platinum is the most employed electrocatalyst for the reactions taking place in energy converters, such as the oxygen reduction reaction in proton exchange membrane fuel cells, despite being a very low abundant element in the earth's crust and thus extremely expensive. The search for more active electrocatalysts with ultra-low Pt loading is thus a very active field of investigation. Here, surface-limited redox replacement (SLRR) that utilizes the monolayer-limited nature of underpotential deposition (UPD) was used to prepare ultrathin deposits of Pt, using Te as sacrificial metal. Cyclic voltammetry and anodic potentiodynamic scanning experiments have been performed to determine the optimal deposition conditions. Physicochemical and electrochemical characterization of the deposited Pt was carried out. The deposit comprises a series of contiguous Pt islands that form along the grain interfaces of the Au substrate. The electrochemical surface area (ECSA) of the Pt deposit obtained after 5 replacements, estimated to be 18 m²/g, is in agreement with the ECSA of extended surface catalysts on flat surfaces.

A screening tool for attention deficit hyperactivity disorder in children in Saudi Arabia.

BACKGROUND AND OBJECTIVES: A clinically validated attention deficit hyperactivity disorder (ADHD) scale in Arabic for evaluating children in Saudi Arabia who might be suspected of having ADHD is lacking. Thus, we studied the validity of an Arabic version of the ADHD Rating Scale in discriminating children with an ADHD diagnosis from normal children or from those with non-ADHD psychiatric diagnoses, including mental retardation. METHODS: The guardians of 119 children provided demographic data and completed the standardized Arabic version of the ADHD Rating Scale on their children, who were either normal, had a diagnosis of ADHD, or had a non-ADHD psychiatric diagnosis. The mean rating scores of the groups were compared, and the cutoff points were calculated for both sexes. RESULTS: The scores discriminated children with ADHD diagnosis (mean and [SD], 28 [6.288]) from normal children (10.93 [8.009]), and those with a non-ADHD psychiatric diagnosis (16.63 [8.865]). ADHD cutoff points were obtained for male (23.5) and female (22.5) children. Psychosocial characteristics associated with children having ADHD were not associated with the diagnosis of ADHD. CONCLUSION: The ADHD Rating Scale (Arabic version), in terms of either the grand total score or the total score of each of its two subscales, demonstrated concurrent and discriminant validity by discriminating children with ADHD from other clinical and non-clinical children groups. The study obtained cutoff points for both sexes based only on the grand total score of the scale because of the relatively small sample size. Replication of the study, utilizing a larger sample and eliciting ratings from both parents and teachers, is recommended.

Munchausen syndrome by proxy and child's rights.

Munchausen syndrome by proxy (MSBP) is an extreme form of child abuse in which perpetrators induce life-threatening conditions in their children. A case of MSBP is described in detail. Difficulties in diagnosis and management in this part of the world are presented. Until now, no national legal guidelines exist in the Kingdom of Saudi Arabia (KSA) to child abuse in general and MSBP in particular. Urgent guidelines, policies, and legal system are required in the KSA.

Parental attitudes toward the prescription of psychotropic medications for their children.

OBJECTIVE: To explore parental attitudes towards the prescription of psychotropic medication for their children. METHOD: A questionnaire built to collect socio-demographic data of parents and their attitudes was distributed among parents. RESULTS: One thousand and ten questionnaires were filled by parents. Fathers who completed the questionnaire were double the number of mothers. Eight hundred and eighteen parents (84.3%) agreed to the dispensing psychotropic medication to their children if necessary. About 83.5% preferred to start with psychotherapy before trying medication. Fathers are more than twice likely than mothers to agree to the use of psychotropic drugs. Older parents more easily agreed to give their children psychotropic drugs. Parents who used psychotropic drug themselves were more likely to agree to the use of psychotropic drug by their children. Having a child with a psychiatric illness is the most significant factor in making parents accede to giving children psychotropic medication. Other factors such as pressure from schools and the side effects of drugs could also modify decision of parents. CONCLUSION: Although most parents agreed to give their children psychotropic drugs if necessary, they preferred to start with psychotherapy sessions before giving them the drugs. Fear and worries about such issues as side effects of drugs or addiction should be considered. Pressure from school should also be considered when deciding on drug therapy.

Assessment of pediatricians' need for training in child psychiatry.

BACKGROUND: Psychosocial problems are common health concerns in children. Therefore, it is essential for pediatricians to be able to identify psychiatric disorders. This depends on the knowledge, practice and attitudes towards psychiatric disorders in childhood. METHODS: A constructed questionnaire of items about knowledge, practice and attitudes of pediatricians toward psychiatric disorders in childhood was used. Four hundred and fifty questionnaires were distributed and collected from pediatricians in seven main governmental hospitals in Riyadh over a period of three months (between March 1 and May 30 2005). Findings were analyzed statistically. RESULTS: About 88.8% of the samples had not had any training in child psychiatry during their residency. Forty-eight percent were hesitant in diagnosing psychiatric disorders in children, 76.5% were not confident enough to treat these children, 48.5% were not confident enough to follow them up after being managed by a child psychiatrist and 49.9% were not confident to treat common side effects of psychotropic medications. About 88.8% of the pediatricians thought that pediatricians needed training in child psychiatry during pediatric residency programs. CONCLUSION: A significant number of pediatricians reported a lack of training in child psychiatry during residency programs. This has an adverse impact on their knowledge, attitudes and possibly practices in dealing with childhood psychiatric disorders.

Establishing a consultation-liaison psychiatry service. Impact on clinical indices.

OBJECTIVE: To show prospectively the impact of establishing a consultation-liaison (C/L) psychiatry model on the consultation clinical indices. METHODS: A structured, organized model of C/L psychiatry was established in 1990 at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia and all clinical indices of the psychiatric consultations were compared prospectively over the first 3 years after January 1990 with those over the previous 2 years retrospectively before January 1990. RESULTS: Three hundred and two patients were referred over 3 years after January 1990, group A and 99 patients were referred over the 2 years before January 1990, group B and the male to female ratio were similar in both groups 1:1.99 and 1:2.1. Referred cases were found more to be females, married and living in urban areas and referred from the Department of Medicine. Positive influences of establishing the C/L service were; nearly double rate of referral, more selectivity of cases, more referred cases for assessment of competence and with past psychiatric history, and more patients referred with informed consent. Depressive disorder was more common in both groups. CONCLUSION: A well structured C/L psychiatry model, with clearly defined aims, has had a definite positive impact on the clinical indices of the psychiatric consultations promoting close cooperation for the excellence of patient care. This opens room for future research to explore specific developments in proposed models of C/L psychiatry.

Survey of inpatients child and adolescent psychiatric referrals in a teaching hospital in Saudi Arabia.

OBJECTIVE: To answer the question of which specialties utilize the service of child and adolescent liaison psychiatry and what are the problems that are likely to bring a child or an adolescent to the attention of psychiatry. METHODS: The case records of all inpatient children and adolescents younger than 18 years, who were referred to the psychiatric team at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia over a period of 6 years between July 1992 and July 1998, were retrospectively reviewed in regard to sociodemographic data, referring specialties and reason for referral. RESULTS: Seven percent of referred patients were younger than 18 years. Most were Saudi nationals. Females outnumbered males. Most of the referrals were by the neurologists, endocrinologists and gastroenterologists. The most common reasons for referral were behavioral disturbances and absence of physical findings that could explain the complaint. CONCLUSION: Low utilization of child and adolescent liaison psychiatry, reflecting the ability of pediatricians and physicians to recognize psychiatrically disturbed children and adolescents compared to adults, may explain the small number of referrals.

Escolaridade materna: correlaçäo com os indicadores obstétricos / Maternal educational level: correlation with obstetric indicators

O objetivo é estimar as associaçöes entre a escolaridade materna, como variável dependente, e algumas variáveis constantes na Declaraçäo de Nascido Vivo (DNV) do Ministério da Saúde. Em uma análise de 3.843 DNV da regiäo de Guaratinguetá, Säo Paulo, relativas a partos hospitalares e nascimentos únicos, ocorridos no ano de 1998, foram encontradas associaçöes estatisticamente significativas entre a menor escolaridade e ocorrência de baixo peso ao nascer; número de filhos vivos igual ou maior que três; história pregressa de filhos mortos; maior número de partos e consultas médicas no pré-natal em número até seis. Näo se observaram associaçöes entre escolaridade e aborto e tempo de gestaçäo, citadas em outros trabalhos. Assim, a escolaridade materna pode ser considerada um marcador obstétrico de risco para a gestante e o recém-nascido.