Leptin levels in relation to marital status and neuroendocrine function in Iraqi females with polycystic ovary syndrome

The present study was designed to evaluate the relationship between serum leptin levels and the hormones related to fertility in Iraqi females with polycystic ovary syndrome (PCOS) and marital status. This study was conducted during the period from July to December 2007. Twenty-four women (12 married and 12 unmarried) with PCOS and not maintained on any type of therapy were included in the study. Twelve healthy and normal ovulatory women with an age range matched with that of PCOS women were included. After an overnight fasting, blood samples were drawn from all women at random days. While in those with regular menstrual cycles, blood samples were obtained during the follicular phase of the cycle, except for samples utilized for the assay of progesterone that performed in the day 21 of the cycle (luteal phase). After preparation of serum, the levels of leptin, luteinizing hormone (LH), follicle-stimulation hormone (FSH), progesterone, testosterone and prolactin were analyzed. Both groups of PCOS patients showed significantly lower levels of serum leptin, while prolactin, LH and FSH and testosterone were significantly elevated compared to controls. No significant differences were reported among PCOS patients with different marital status. In conclusion, impaired plasma leptin levels in PCOS women were associated with impaired endocrinological parameters related to fertility.     

Risk of adrenal crisis in dental patients: Results of a systematic search of the literature

BackgroundThe authors performed a systematic search of the literature to identify the frequency of, risk of experiencing and factors associated with adrenal crises in dental patients.MethodsThe authors searched PubMed and Ovid MEDLINE (1947-June 20, 2012) and Embase (1974-2012) for English-language articles related to cases of adrenal crisis in dentistry and extracted and analyzed data from the articles. The six authors determined whether the cases identified met a consensus definition of adrenal crisis.ResultsOf 148 articles identified in the initial screening, 34 articles were included in the final review, from which six cases met the criteria of adrenal crisis. The authors categorized four cases as “suggestive of adrenal crisis” and two cases as “consistent with adrenal crisis.” Risk factors were significant adrenal insufficiency, pain, infection, having undergone an invasive procedure, having received a barbiturate general anesthetic, and poor health status and stability at the time of presentation. The authors estimated risk to be less than one in 650,000 in patients with adrenal insufficiency.ConclusionsAdrenal crisis is rare in dental patients, with only six reports of it having been published in the past 66 years. Risk is associated with unrecognized adrenal insufficiency, poor health status and stability at the time of treatment, pain, infection, having undergone an invasive procedure and having received a barbiturate general anesthetic.Clinical ImplicationsRisk of adrenal crisis is reduced through proper evaluation of the patient, identification of risk factors and following appropriate preventive measures.     

Necrobiosis lipoidica: a case with histopathological findings revealed asteroid bodies and was successfully treated with dipyridamole plus intralesional triamcinolone

The significance of necrobiosis lipoidica (NL) includes its relationship with insulin-dependent diabetes mellitus, its tendency to break down into painful ulcers, an albeit tenuous association with squamous cell carcinoma and, by no means least, its cosmetic impact, occurring as it does on the shins of young and middle-aged women. Necrobiosis (degeneration of collagen) and granulomous inflammation are well-documented histological findings in NL; however, to see an asteroid body in an area of NL is rare. To the best of our knowledge, there is only one such report of NL described so far. We report the case of a NL patient whose histopathological examination revealed asteroid bodies. The patient had suffered persistent NL for a period of more than 2 years. She was successfully treated with dipyridamole plus intralesional triamcinolone and the lesions healed completely after 2 months of therapy. The patient has remained free of lesions since discontinuing therapy.     

Anthropometric Determinations of Umbilical Position in Iraqi Adults

Introduction  Umbilicus is an important surface landmark on the anterior abdominal wall in addition to its aesthetic and psychological effect. Objectives  The objective of the study is to determine the position of umbilicus in Iraqi adults to provide a guide for the neoumbilicus in abdominoplasty. Subjects and Methods  This is an observational study performed on 100 volunteers with no abdominal wall abnormality. Measurements included weight, height, body mass index (BMI), distance from xiphoid to umbilicus, distance from xiphoid process to pubic symphysis, distance from xiphoid process to both anterior superior iliac spine (ASIS), distance from pubic symphysis to umbilicus and from pubic symphysis to xiphisternum, distance of umbilicus to both ASIS, and distance of umbilicus to interspinous line and to inter-anterior hypochondrium line. Results  The study included 100 volunteers, with 50% male and 50% female whose age ranges between 18 to 60 years. The results were a follows: distance from xiphoid process to umbilicus and distance from xiphoid process to pubic symphysis were 18.03 ± 3.25 cm and 32.21 ± 4.64 cm, respectively; distances from xiphoid process to right ASIS and left ASIS were 25.95 ± 5.72 cm and 25.84 ± 6.02 cm, respectively; distance from pubic symphysis to umbilicus was 17.66 ± 3.12 cm; distance of umbilicus to interspinous line was 9.25 ± 1.84 cm. The distance from umbilicus to inter anterior hypochondrium line was 9.905 ± 2.19 cm. Conclusion  These measurements can determine the neoumbilicus position, reduce practical mistakes, and improve postsurgical outcomes.     

HbA1c over 8.5% is not predictive of increased infection rate following penile prosthesis implant surgery in diabetic patients with erectile dysfunction

Diabetes mellitus is associated with increased risk of erectile dysfunction. Penile prosthesis implantation is an efficient therapeutic option for erectile dysfunction, but not without risk, as infection remains a prominent concern. This study investigates diabetes mellitus as a risk factor for penile prosthesis implantation infection and the relationship between haemoglobinA1c levels and infection rates. All diabetic patients with erectile dysfunction who underwent penile prosthesis implantation surgery between January 2012 and November 2019 at Hamad Medical Corporation, Qatar, were included in this retrospective observational study. A total of 599 diabetic patients with erectile dysfunction had penile prosthesis implantation. Mean age was 59.69 ± 31.19. Penile prosthesis implantation infection rate was 0.83% (5/599), while the mean haemoglobinA1c level was 7.58 ± 1.45 mmol/l (range: 4.1–12.6). A comparison between diabetic patients with penile prosthesis implantation infection and those without infection revealed no significant difference in the level of haemoglobinA1c between the two groups with mean haemoglobinA1c in patients with infected implants 7.14 and 7.59 for noninfected (p = 0.491). Limitations include retrospective single-centre design and low-infection rates reducing sample number. Penile prosthesis implantation infection rate in a large series of diabetic patients was low with no significant association between haemoglobinA1c level and penile prosthesis implantation infection observed.     

Safety of not withholding clopidogrel therapy during the immediate several days pre- and post-trans-urethral resection of prostate (TURP): a retrospective cohort study

Background and aim

Benign prostatic hypertrophy or hyperplasia (BPH) is a frequent urological complain particularly in old-aged individuals. Those patients usually have other risk factors (such as ischemic cardiovascular diseases) for which they might be treated with anti-thrombotic agents chronically. These medicines may induce blood thinning and raise the incidence of hemorrhage. Thus, if those patients needed operative treatment for BPH, they may be at high risk of hemorrhage or its related adverse effects with the usage of anti-thrombotic drugs during the peri-operative time. On the other hand, dis-continuation of these agents can lead to ischemic events in susceptible individuals.

Therefore, this research aims to assess the safety of the continuation of using anti-thrombotic agents throughout the peri-operative duration in patients with prostate surgery in form of Transurethral Resection of Prostate (TURP) only for Benign Prostatic Hypertrophy (BPH).

Methods

Patients’ notes were reviewed retrospectively. The entire participants were categorized into two categories. First category was on clopidogrel therapy (CTC) for prolong time and the usage of these agents was carried on throughout the peri-operative period. The second category was not on clopidogrel therapy at all (NCTC). Both of these categories had Transurethral Resection of Prostate (TURP) for Benign Prostatic Hypertrophy (BPH). A comparison had been conducted between the two categories with regards to: (i) the amount of blood lost intra-operatively (ii) the duration of operation (iii) hematocrit concentration per-operatively (iv) transfused packed red blood cells (PRBC) if needed (v) clearance of hematuria postoperatively (vi) secondary hemorrhage and clot retention after discharge. Pearson Chi-square test, Independent sample t test and test for numeric variables were used as appropriate.

Results

The study identified 329 patients. One hundred and sixty five participants in the CTC (clopidogrel therapy category) and 164 in the NCTC (non-clopidogrel therapy category). It had been revealed that there was no statistically significant difference between the CTC and NCTC regarding: (i) the amount of blood lost intra-operatively (ii) the duration of operation (iii) hematocrit concentration per-operatively (iv) transfused packed red blood cells (packed RBC) if needed (v) clearance of hematuria postoperatively (vi) secondary hemorrhage and clot retention after discharge (P?>?0.65).

Conclusion

The continuation of usage of anti-thrombotic therapy (clopidogrel) during peri-operative period in patients with TURP for BPH is a safe practice. It is not associated with high probability of hemorrhage or PRBC transfusion or other adverse effects.

     

Parenteral aluminum induces liver injury in a newborn piglet model

Purpose

Parenteral nutrition-associated cholestasis remains a significant problem, especially for the surgical neonate. Aluminum is a toxic element known to contaminate parenteral nutrition. We hypothesize that parenterally administered aluminum causes liver injury similar to that seen in parenteral nutrition-associated cholestasis.

Methods

Twenty 3- to 6-day-old domestic pigs were divided into 5 equal groups. A control group received daily intravenous 0.9% sodium chloride. Each subject in experimental groups received intravenous aluminum chloride at 1500 μg/kg per day for 1, 2, 3, or 4 weeks. At the end of the study, blood was sampled for direct bilirubin and total bile acid levels. Liver, bile, and urine were sampled for aluminum content. Liver tissue was imaged by transmission electron microscopy for ultrastructural changes.

Results

Transmission electron microscopy revealed marked blunting of bile canaliculi microvilli in all experimental subjects but not the controls. Serum total bile acids correlated with the duration of aluminum exposure. The hepatic aluminum concentration correlated with the duration of aluminum exposure.

Conclusions

Parenterally infused aluminum resulted in liver injury as demonstrated by elevated bile acids and by blunting of the bile canaliculi microvilli. These findings are similar to those reported in early parenteral nutrition-associated liver disease.     

Sensitivity and specificity of patient-entered red flags for lower back pain

Background Context

Red flags are questions typically ascertained by providers to screen for serious underlying spinal pathologies. The utility of patient-reported red flags in guiding clinical decision-making for spine care, however, has not been studied.

Dexmedetomidine in intensive care unit: a study of hemodynamic changes

BACKGROUND: Dexmedetomidine is a potent new alpha-2 adrenoceptor agonist with an alpha-2 to alpha- ratio more than 7 times that of clonidine. Its potent sedative, analgesic and sympatholytic effects blunt the cardiovascular responses (hypertension, tachycardia) without unexpected toxicity. Many reports confirmed its pharmacological properties if given by infusion. Recent report confirmed favorable non-depressant effect on respiration and blood gases. SETTING: ICU patients at King Khalid University Hospital. PATIENTS AND METHOD: Open label clinical evaluation on ten surgical patient ASA I class received dexmeditomidine infusion to the sedative effect level of Ramsy scale of 3 for ventilated patients and 2 for spontaneously breathing patient. The clinical observation and analgesic requirement as well as the hemodynamic parameters and hemoglobin oxygen saturation were observed for the period of ventilation and weaning till discharge from the ICU. These records were subjected to paired t test for values measured at preinfusion period compared to 10 minutes and 6 hours measurement after infusion. RESULTS: The study confirmed the previous findings of previous reports regarding the cardiovascular stability and non depressive effect on respiration. It also confirmed the sparing effect on the use of analgesics which indicates its analgesic effect. The sedation quality is unique in that the patient is easily arousable. This was reported favorably by the nursing staff. Bradycardia was observed in one patient who was treated effectively by stopping the infusion. CONCLUSION: We concluded that dexmedetomidine is useful sedative agent with analgesic properties which reduce the analgesic requirement of the patient. The patient were ventilated, weaned, then breathed spontaneously in a satisfactory manner.