Relation between peak knee flexion angle and knee ankle kinetics in single-leg jump landing from running: a pilot study on male handball players to prevent ACL injury

Objectives: The relationship between knee kinematics and knee-ankle kinetics during the landing phase of single leg jumping has been widely studied to identify proper strategies for preventing non-contact ACL injury. However, there is a lack of study on knee-ankle kinetics at peak knee flexion angle during jumping from running. Hence, the purpose of this study is to establish the relationship between peak knee flexion angle, knee extension moment, ankle plantar flexion moment and ground reaction force in handball players in order to protect ACL from excessive stress during single leg jumping. In addition, the study also clarifies the role of calf muscles in relieving part of ACL stresses with different knee flexion angles during landing.

Methods: Fifteen active male elite handball players of Saudi Arabia have participated in this study (Age = 22.6 ± 3.5years, Height = 182 ± 3.7 cm, Weight = 87.5 ± 10.2 kg). The players performed three successful landings of single-leg jump following running a fixed distance of about 450cm. The data were collected using a 3D motion capture and analysis system (VICON).

Results: Pearson product moment correlation coefficients showed that greater peak knee flexion angle is related significantly to both lesser knee extension moment (r = -.623, P = .013) and vertical component of ground reaction force (VGRF) (r = -.688, P = .005) in landing phase. Moreover, increasing the peak knee flexion angle in landing phase tends to increase the ankle plantar flexion moment significantly (r = .832, P = .000).

Conclusion: With an increase of the peak knee flexion angle during single leg jump landing from running, there would be less knee extension moment, low impact force and more plantar flexion moment. As such, the clinical implication of this study is that there may be a possible protective mechanism by increasing the knee flexion angle during landing phase, which tends to protect the ACL from vigorous strain and injuries.     

The prevalence of thyroid cancer in patients with hyperthyroidism

Objectives:

To determine the prevalence of thyroid cancer in patients with hyperthyroidism.

Methods:

This is a retrospective observational study using the data of 71 Omani patients with a diagnosis of hyperthyroidism due to Grave’s disease, toxic multinodular goiter, and solitary toxic adenoma. These patients underwent thyroidectomy at the Royal Hospital (RH), Muscat, Oman, and were followed up at the National Diabetes and Endocrine Center (NDEC) between 2007 and 2013. The details were collected from the medical records of both the RH and the NDEC. Patients who underwent thyroidectomy for other reasons like non-toxic goiter and hypothyroidism with cancer were excluded from the study.

Results:

Thyroid cancer was identified in 32.8% (n=23) of patients with hyperthyroidism. Half of these patients 52.1% (n=12) had papillary micro-cancer (intra-thyroidal), and 3 patients with Grave’s disease (13%) had lymph nodes metastasis (loco-regional infiltration. The cancer preponderance was higher in young (n=21, 91.3%) and female patients (n=18, 73.9%). Most patients with thyroid cancer had abnormal ultrasound neck findings and thyroid scintigraphy (99 mTc uptake).

Conclusion:

Many patients with hyperthyroidism in Muscat, Oman, especially those with Grave’s disease, show malignancy, and hence a proper initial evaluation of these patients is required as part of long-term management.Hyperthyroidism is a state of over-functioning of the thyroid gland due to an autoimmune process as seen in Grave’s disease, or autonomous secretion as in toxic multi-nodular goiter or toxic adenoma. The association between thyroid cancer and hypothyroidism in Hashimoto’s thyroiditis is well known.1 The coexistence of thyroid cancer and hyperthyroidism was previously studied.2 These studies have demonstrated both an increased incidence of thyroid nodules and of thyroid cancer in patients with thyrotoxicosis. The role of the autoimmune processes in the origin and clinical course of thyroid cancer is still a subject of debate.3 The prevalence of palpable thyroid nodules in Grave’s disease is around 15.8%, and its detection may extend up to 33.6% using neck ultra-sonography.3 This raises concerns regarding the possible presence of thyroid malignancy. The incidence of thyroid cancer is probably high in patients with Grave’s disease presenting with a palpable nodule.4 However, micro cancer is discovered as an incidental finding in patients with Grave’s disease.5 There is controversy surrounding the disease course of thyroid cancer in hyperthyroid patients. Some studies suggested that thyroid cancer is more aggressive in Grave’s disease,6,7 though this is not a universal phenomenon.8 The discrepancies in the results seen are probably due to environmental, racial or other unknown factors.9 The published data on thyroid cancer with solitary toxic nodule or toxic multi-nodular goiter is scanty and anecdotal. To understand the association of thyroid cancer and thyrotoxicosis, this study retrospectively reviewed patients who had undergone thyroidectomy for hyperthyroidism.     

An Investigation into Formulation and Processing Strategies to Drive Gastroretention of Gabapentin Tablets

Purpose

The aim of the present work was to develop gastroretentive drug delivery system of gabapentin from different matrices prepared by hot melt or conventional wet granulation, which may enhance drug bioavailability. The influence of core type, granulation process, and coating level on the drug release rates was investigated.

Methods

Tablet cores were prepared from hydrophilic system of hypermellose, carboxy melthyl celloulse, and Avicel or hydrophobic system of ethyl cellulose, alginic acid, and stearic acid. The tablets were coated by Eudragit RL with triethyl citrate and compressed directly. These tablets were evaluated according to their in vitro dissolution profiles and release mechanisms.

Results

Hydrophobic matrices allowed the control of drug release. Hot melt granulation was an effective tool over wet granulation or coating for slowing release rates from hydrophobic tablets. Both hydrophobic polymer ratio and coating level influenced the drug release mechanism. The drug release of samples with minor proportion of ethyl cellulose and stearic acid or low Eudragit RL level was driven by anomalous transport and the increase of their proportions contributed to the erosion of the matrix.

Conclusions

Hydrophobic core tablet prepared from hot melt granulation and coated by Eudragit RL has shown to be a promising formulation intended to gastroretentive gabapentin delivery system.

     

Cutaneous Leishmaniasis in Kuwait

Twenty-four patients suffering from single or multiple lesions of cutaneous leishmaniasis were included in this study. Most of the lesions were on the extremities. The patients were randomly divided into two groups. Most of the patients in the first group who were given oral itraconazole for a period of 6-8 weeks showed excellent clinical response. On the other hand, only one patient in the second control group who was given placebo showed good clinical improvement. Systemically administered itraconazole may prove to be a valuable modality for the treatment of cutaneous leishmaniasis.     

Factors associated with clinical and sub-clinical anal human papillomavirus infection in homosexual men.

OBJECTIVES--(I) to determine the relative sensitivities of clinical examination, cytology and HPV DNA hybridisation for the detection of anal human papillomavirus infection; and (ii) to examine various factors which may influence presentation of anal human papillomavirus infection in homosexual men. METHODS AND RESULTS--112 unselected homosexual men attending a Sydney STD clinic for routine screening underwent a complete anogenital and physical examination, during which blood samples (for haematological, serological and immunological investigations), rectal swabs (for culture of anal pathogens) and anal scrapes of the dentate line (for cytology and HPV DNA hybridisation) were collected. Papanicolaou-stained anal smears were examined for cytological abnormalities, including those indicative of HPV infection or anal intraepithelial neoplasia (AIN). HPV DNA was detected by high stringency dot hybridisations using radiolabelled HPV 6, 11, 16 and 18 DNA probes. Visible anal condylomata, situated either externally or in the anal canal, were present in 26% of these men; 46% had cytological evidence of HPV infection, and 19% of the smears showed evidence of mild to moderate dysplastic changes (AIN I-II). Detectable HPV DNA was present in 40% of the anal scrapes. By combining these results, a total of 73 men (65%) were found to have at least one of the indicators of HPV infection. These data, together with that relating to HIV antibody, immune status and past or present infection with other STDs, was correlated with information obtained from a questionnaire administered to the patients at the time of their clinical examination. CONCLUSIONS--In this study cytology was found to be slightly more sensitive than HPV DNA dot hybridisation for the detection of HPV infection in the anal canal, providing the full range of HPV-associated cytological changes were accepted as a basis for diagnosis. Clinical anal lesions were more likely to be detected in young men, men who had symptomatic HIV infection and those with a history of past anal wart infection. The latter group also had a higher incidence of cytologically apparent HPV infection in their anal smears. There was a significant association between the detection of HPV 16/18 and the presence of anal dysplasia, but there were no significant correlations between HPV infection or anal dysplasia and HIV antibody, immune function status, sexual practices or history of other STDs.     

Colistin effectiveness and nephrotoxicity: experience from a tertiary care burns unit in Oman

Background

The emergence of multiple drug-resistant (MDR) Gram-negative bacteria and the lack of new antibiotics to combat them have led to the revival of colistin, a drug which was abandoned because of its toxicity. Recent reports showed the drug is effective and relatively safe in burns patients. In this article, we present our experience with the drug.

Methods

A retrospective study over a period of 2 years was carried out. Forty-eight patients treated with colistin were reviewed and the outcome and nephrotoxicity were assessed.

Results

The most prevalent MDR organism in our burns unit was Acinetobacter species. MDR Pseudomonas aeruginosa was seen in few cases and it was always associated with Acinetobacter species infection. The maximum cumulative dose was 193,000,000 international units. The maximum duration was 45 days. The mortality was 33.3 %. Renal function test impairment or worsening was seen in 14 patients (29%). There was no statistically significant impairment of renal function. The P value for creatinine was 0.1236.

Conclusions

Colistin is useful for treating multidrug-resistant organism infections in burns patients when no alternative is available. Renal impairment is a major side effect of this antibiotic and the risk maybe higher in burns patients because the burn itself can cause acute kidney injury. Level of Evidence: Level IV, therapeutic study     

Climate and season: the effects on ophthalmic diseases

Seasonal changes and climate have a significant impact on human health. Diseases influenced by temperature and climate conditions are likely to undergo dynamic pattern shifts with consequent impact on human health. A number of infectious and non‐infectious ophthalmic diseases are influenced by temperature and seasonality. Awareness of this is important from public and global health perspective in addition to resource allocation strategies. We examine the evidence for a seasonal pattern to ophthalmic diseases and assess the possible impact of climate change.