Characterization of extracorporeal ablation of normal and tumor-bearing liver tissue by high intensity focused ultrasound

Treatment parameters of extracorporeal high intensity focused ultrasound (HIFU) were analysed in normal and tumor-bearing rabbit liver. HIFU was generated with a 1 MHz transducer and energy was provided by a 7.5 kW power amplifier. In vivo experiments were conducted on 74 New Zealand rabbits. Normal rabbits and rabbits bearing an intrahepatic VX2 tumor were used. In group 1, spatial peak temporal peak (SPTP) intensities ranging from 1470 to 5500 W cm⁻² and exposure times from 0.5 to 5 s were tested at a constant depth in the liver; in group 2, the output power was adjusted as a function of the target depth in order to keep constant the focal in situ intensity in the liver; in group 3 (liver tumors), the focal in situ intensity was 1365 W cm⁻² in eight rabbits and 500 W cm⁻² in nine. In groups 1, 2 and 3, rabbits were sacrificed 48 h after the treatment. Groups 4 and 5 were designated for analysis of the lesion in the normal liver 4 weeks after treatment at 1000 W cm⁻² and 3000 W cm⁻² SPTP intensities, respectively. In normal rabbits, the lesion volume increased with exposure time at constant intensity; there was a negative correlation between intensity and exposure time (group 1). When the output power was adjusted as a function of the path length, the lesion size was nearly constant (group 2). In VX2 rabbits, tumor destruction rates were significantly higher in rabbits treated at 500 W cm⁻² than in rabbits treated at 1365 W cm⁻² (p < 0.05; group 3). As in the normal liver, the lesion volume increased with the exposure time at constant intensity. HIFU lesions treated at 1000 W cm⁻² (SPTP) healed as thin fibrous scars, and no severe complication occurred (group 4); at 3000 W cm⁻² (SPTP), scars were larger and perforation of a neighboring organ was seen in 7 of 11 rabbits (group 5).     

A systematic review on efficacy and safety of the current hypoglycemic agents in patients with diabetes during Ramadan fasting

The fasting in the holy month of Ramadan is passionately practised among the Muslims population around the world. Patients with diabetes are generally considered to have various risks with fasting. The recent pharmacologic and technical advances in the management of diabetes may have enabled these patients to practice safe fasting. The purpose of this review is to scientific evidence on the safety and efficacy of the current hypoglycemic agents during Ramadan.MethodsAn extensive Electronic search via PubMed and Google scholar was accomplished through using different search terms. The eligible studies were limited to only published Randomised controlled trial (RCT) and prospective observational studies from 2007 to 2018 on patients with all types of diabetes on any pharmacological management, who intended to fast in Ramadan.Results and ConclusionsThe current era witnessed a gradual shift in the management of these patients with diabetes who elected to fast in Ramadan, despite the variable health-related risks with fasting. Results from available RCTs and observational studies in patients with type 2 diabetes showed lower risk of hypoglycemia, similar or better efficacy for glycemic and weight control with SGLT2 inhibitors, incretin mimetics and the newer insulin analogues compared to Sulfonylurea. Gliclazide is a relatively safer option among all sulfonylurea. Patients requiring insulin did better with insulin analogues, especially the newer premixed formulation at the time of breaking fast compared to the former insulin formulation. Current commonly used newer hypoglycemic agents are generally safe during Ramadan, however, their safety in the higher risk diabetes patients is highly needed.     

Growth, puberty, and final height in children with Type 1 diabetes

OBJECTIVE: The aims of this study were to assess the physical growth and pubertal development in a group of diabetic children and to evaluate the effect of height at diagnosis, duration of illness, and degree of glycemic control on final height and sexual maturation. RESEARCH DESIGN: A cohort of 72 Sudanese diabetic children, 7-13 years of age at diagnosis, was followed longitudinally from the onset of diabetes until the attainment of final height. RESULTS: The mean height standard deviation scores (SDS) at diagnosis were 0.04 in boys and -0.15 in girls, which was greater than their genetic target height (GTH). The growth velocity between diagnosis and final height was slow, with significant reduction in pubertal growth spurt. The mean final height attained by these children was lower than their GTH, a finding that contradicts most of the recently published reports. The average age at menarche in girls (15.1 years) and the mean age of full sexual maturation in boys (17.2 years) were significantly delayed in this group of diabetic patients. This retardation in physical growth and pubertal development was positively correlated with the duration of diabetes before the onset of puberty and glycated haemoglobin (HbA1c) concentration. The majority of these patients were thin at diagnosis of diabetes, with median body mass index (BMI) <22, but showed a remarkable, progressive weight gain during puberty, which was more evident in girls. The weight gain was independent of weight at diagnosis and duration of diabetes, but was positively correlated with the daily dose of insulin and HbA1c concentration. CONCLUSION: Conventional therapy of diabetic children is associated with impairment of physical growth and delayed sexual maturation.     

Hormonal therapy and sex reassignment: a systematic review and meta‐analysis of quality of life and psychosocial outcomes

Objective To assess the prognosis of individuals with gender identity disorder (GID) receiving hormonal therapy as a part of sex reassignment in terms of quality of life and other self‐reported psychosocial outcomes. Methods We searched electronic databases, bibliography of included studies and expert files. All study designs were included with no language restrictions. Reviewers working independently and in pairs selected studies using predetermined inclusion and exclusion criteria, extracted outcome and quality data. We used a random‐effects meta‐analysis to pool proportions and estimate the 95% confidence intervals (CIs). We estimated the proportion of between‐study heterogeneity not attributable to chance using the I² statistic. Results We identified 28 eligible studies. These studies enrolled 1833 participants with GID (1093 male‐to‐female, 801 female‐to‐male) who underwent sex reassignment that included hormonal therapies. All the studies were observational and most lacked controls. Pooling across studies shows that after sex reassignment, 80% of individuals with GID reported significant improvement in gender dysphoria (95% CI = 68–89%; 8 studies; I² = 82%); 78% reported significant improvement in psychological symptoms (95% CI = 56–94%; 7 studies; I² = 86%); 80% reported significant improvement in quality of life (95% CI = 72–88%; 16 studies; I² = 78%); and 72% reported significant improvement in sexual function (95% CI = 60–81%; 15 studies; I² = 78%). Conclusions Very low quality evidence suggests that sex reassignment that includes hormonal interventions in individuals with GID likely improves gender dysphoria, psychological functioning and comorbidities, sexual function and overall quality of life.     

Relationship between insulin resistance and left ventricular diastolic dysfunction in patients with impaired glucose tolerance and type 2 diabetes

AIM: The aim of this study was to explore the relationship between insulin resistance (IR) and the left ventricular diastolic function in patients with type 2 diabetes and subjects with impaired glucose tolerance (IGT). METHODS: The study included 119 subjects who underwent oral glucose tolerance test (OGTT). IR was assessed using Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and Quantitative Insulin Sensitivity Check Index (QUICKI). Left ventricular diastolic function was assessed using trans-thoracic Doppler echocardiography. RESULTS: Based on the OGTT results, 29 subjects had normal glucose tolerance (NGT), 20 subjects had impaired glucose tolerance (IGT), and 70 patients had type 2 diabetes. There were significant differences among the patients in groups with NGT, IGT and diabetes regarding HOMA-IR (4.20 +/- 1.20 vs. 6.45 +/- 3.83 vs. 8.70 +/- 6.26; P < 0.001) and QUICKI (0.54 +/- 0.11 vs. 0.49 +/- 0.08 vs. 0.47 +/- 0.08; P < 0.001). In subjects with NGT, IGT and patients with diabetes, the pulsed Doppler transmitral variables were: E-wave (0.72 +/- 0.16 cm/s vs. 0.62 +/- 0.13 cm/s vs. 0.58 +/- 0.17 cm/s; P < 0.001), A-wave (0.61 +/- 0.13 cm/s vs. 0.62 +/- 0.11 cm/s vs. 0.71+/- 0.14 cm/s; P = 0.006) and E/A ratio (1.22 +/- 0.33 vs. 1.02 +/- 0.24 vs. 0.85 +/- 0.26; p < 0.001). The proportion of subjects with an E/A ratio <1 was 27.6% in the group with NGT, 55% in the group with IGT and 75.7% in the group with diabetes (P < 0.001). The E/A ratio correlated with HOMA-IR (r = -0.30, p = 0.001) and QUICKI (r = 0.37, p < 0.0001). Multiple linear regression model showed that IR (assessed by QUICKI) was an independent correlate of diastolic dysfunction (P = 0.034). CONCLUSIONS: In subjects with impaired glucose tolerance and patients with type 2 diabetes, insulin resistance is associated with impaired diastolic function of the left ventricle.     

Third molar impaction in the Jazan Region: Evaluation of the prevalence and clinical presentation

ObjectiveTo provide information on the prevalence and clinical features of impacted third molar teeth in the South-Western region of Saudi Arabia.Material and methodsIn this cross-sectional study, 1200 panoramic radiographs (50% males and 50% females) were retrieved from the electronic clinical records of patients at the College of Dentistry, Jazan University from December 2014 to December 2016, and impacted third molars were evaluated. Data on clinical and radiographic presentation were analyzed.ResultsOverall, there were 291 (24.3%) patients with impacted third molars among 1200 radiographs. The distribution of impacted third molars according to the number of impacted teeth was as follows: one impaction in 121 (41.6%); two impactions in 90 (30.9%); three impactions in 42 (14.4%); and four impactions in 38 (13.1%) patients. There was a high prevalence of all impaction types among females (54.5%). Maxillary vertical angulation was most common (50%) followed by mandibular mesioangular angulation (48.3%). The depth of impaction in maxillary teeth was higher than in mandibular teeth. Pain was uncommon (4.5% of patients).DiscussionClinically, vertical impaction in the maxilla was present in 50% of patients because of limited posterior space, and mesioangular angulation in the mandible was present in 48% of patients because of inadequate space between the ramus and the second molar. These findings are similar to other reports. Vertical impaction of the maxillary wisdom tooth is mostly related to the discrepancy between the mesiodistal size of the tooth crown and the limited retromolar space.ConclusionNoiseless presentation of an impacted third molar requires raising the population’s awareness about the need for diagnosis and treatment of the problem to avoid any further complications. The study can be to guide surgical procedures. This study documented the prevalence, pattern, and clinical features of impacted third molars in South Western region of Saudi Arabia.     

Childhood allergic disorders in Samsun, Turkey: discrepancy between reported and diagnosed

Schoolchildren (n = 1310) randomly selected from 32 schools in Samsun, Northern Turkey, were screened using the International Study of Asthma and Allergies in Childhood questionnaire. The prevalence of wheezing and current (last 12 months) wheezing were 21% and 14%, respectively: 2.3% of this group had received the diagnosis of asthma by a physician. Allergic skin rash was described in 17.3% and rhinitis in 44.7%, while 2.6% had been diagnosed with eczema and 10.5%, with allergic rhinitis. Respiratory symptoms were more common among 6-7-yr-old children compared with those aged 13-14 yr, and tended to be more prevalent in urban and coastal regions. The discrepancy between the rate of allergic symptoms and diagnosed allergic disorders may indicate a need for increased public and professional awareness and screening for allergic disorders in this area.     

Haemodialysis without anticoagulant: haemostasis parameters, fibrinogen kinetic, and dialysis efficiency

Background. Haemodialysis without anticoagulant is an alternative to systemic anticoagulation of patients at high risk of bleeding. However, reports have suggested that heparin-free haemodialysis might results in blood defibrination, and fibrin deposition in dialytic membrane with possible reduction in dialyser efficiency. Methods. Haemostasis parameters, fibrin-fibrinogen kinetic assessed by ¹²⁵-fibrinogen (¹²⁵I-F) turnover and ¹²⁵I-fibrinogen deposition within the dialyser membranes, and dialytic efficiency were studied in 10 stable chronic uraemic patients. Each patient was dialysed on two consecutive 4-h dialyses, once with each of two dialysis strategies: haemodialysis without anticoagulant and conventional haemodialysis using heparin as anticoagulant. Results. No significant changes were seen in mean platelet count, plasma fibrinogen, prothrombin time, and antithrombin II during haemodialysis without anticoagulation, and these parameters were not different from those in patients who underwent conventional haemodialysis. Compared with the predialysis values, a shortening of the mean aPTT from an initial mean value was noted (P <0.05) in haemodialysis without anticoagulation at 60, 120 and 240 min. Fibrin-fibrinogen degradation products remained unchanged during conventional haemodialysis, but were increased after the 30th minute of haemodialysis without anticoagulation (P <0.05), although all values were in normal range. The biological half-life of ¹²⁵I-F in uraemic patients before the haemodialysis was 5.02±0.43 days (control). There was a significant fall in ¹²⁵I-F half-life during haemodialysis without anticoagulation (2.56±0.58 days; P <0.01) but not during conventional haemodialysis (4.77 ±0.97, NS). After use each dialyser was dismantled and ¹²⁵I-F deposition within the membranes (M#5, M#12 and M#19) was measured. During haemodialysis without anticoagulation mean fibrin deposition in M#5 (28.74±10.50x10³ counts), M#12 (26.42±9.06x10³ counts), and M#19 (21.97±8.33x10³ counts) was greater (P <0.001) than that during conventional haemodialysis (1.70±0.92x10³, 1.33±0.65x10³, and 1.59±1.03x10³ counts respectively). However, this greater deposition of fibrin on membranes during haemodialysis without anticoagulation did not change dialyser efficiency as assessed (haemodialysis without anticoagulation vs conventional haemodialysis) by change in serum urea (- 53.96 ± 3.38% vs -51.96 ± 5.20%, NS), serum creatinine (-48.65 ± 5.99% vs -49.59 ± 6.65%, NS), serum potassium (-30.06 ± 4.46% vs -27.64 ± 2.81%, NS), serum bicarbonate (+3.20 ± 3.99% vs 2.15 ± 2.01%, NS) and haematocrit (+3.20 ± 3.99% vs 2.15 ± 2.01%, NS) The mean Kt/V was similar for conventional haemodialysis (0.870 ± 0.107). Conclusion. In conclusion, although conventional haemostasis parameters remained unchanged during haemodialysis without anticoagulation, some degree of activation coagulation system occurs, haemodialysis without anticoagulation was associated with greater decline in ¹²⁵I-F half-life and greater fibrin deposition on dialyser membranes, but with no change in dialyser efficiency.     

Disposition of oral metronidazole in hepatic cirrhosis and in hepatosplenic schistosomiasis.

The pharmacokinetics of metronidazole 500 mg orally were determined in patients with hepatosplenic schistosomiasis and normal controls in the Sudan, and in cirrhotics and normal controls in Bristol. Plasma metronidazole levels were above the minimum inhibitory concentration of most susceptible anaerobic bacteria for four to six hours post-dose in all groups. Liver disease did not markedly influence the disposition of single oral doses of metronidazole. Cirrhotics showed some prolongation of metronidazole half-life, and somewhat greater metronidazole concentrations 24 hours after the dose. Concentrations of the oxidative metabolite of metronidazole were lower in Sudanese patients and normal controls than in normal British subjects. In chronic liver disease adjustment of metronidazole dosage is probably not required provided renal function is unimpaired.