Clinical practice guidelines in multisystem inflammatory syndrome(MIS-C) related to COVlD-19:a critical review and recommendations

Background Multisystem inflammatory syndrome in children (MIS-C) is a serious health condition that develops from and is linked to coronavirus disease 2019.MIS-...     

Pulsatile versus nonpulsatile cardiopulmonary bypass flow: an evidence-based approach

OBJECTIVE: To derive evidence-based recommendations for the use of pulsatile perfusion (PP) technique for the reduction of mortality and nonfatal complications after elective coronary artery bypass grafting surgery (CABG). OUTCOMES: Incidence of total mortality, myocardial infarction (MI), stroke, and renal failure during hospital stay. EVIDENCE: Medline, Embase, and the Cochrane controlled trial register (CCTR) on the Cochrane library were searched from the earliest achievable date of each database to March 2005. No language restrictions were applied. Retrieved reprints were evaluated according to a priori inclusion criteria, and those included were critically appraised using established internal validity criteria. BENEFITS AND HARMS: Only one fair quality randomized controlled trial demonstrated the beneficial effect of PP in reducing the incidence of total mortality and MI. No studies demonstrated the beneficial effect of PP in reducing the incidence of stoke or renal failure. One randomized controlled trial demonstrated that PP was associated with increased hemolysis compared to nonpulsatile (NP) perfusion. CONCLUSION: The evidence is conflicting and therefore does not support making recommendation for or against routinely providing the PP to reduce the incidence of mortality or MI. The evidence is insufficient to recommend for or against routinely providing the pulsatile profusion to reduce the incidence of stroke or renal failure.     

Mechanisms of the antihyperglycemic activity of Retama raetam in streptozotocin-induced diabetic rats

Retama raetam (RR) fruits are used in Saudi traditional medicine for the treatment of diabetes. Current study aimed at evaluating the potential and mechanisms of the antidiabetic activity of the RR methanolic extract in streptozotocin-induced diabetic rats. Oral LD₅₀ of the extract was found to be 1995 mg/kg. The extract was administered once orally to STZ-diabetic rats at three dose levels; 100, 250 or 500 mg/kg/day for 4 consecutive weeks. RR extract at 250 or 500 mg/kg significantly lowered blood glucose levels at the 3rd and 1st week of treatment, respectively. Meanwhile, oral glucose tolerance test indicated that the same two doses significantly lowered glucose levels at 30 and 60 min after glucose challenge. Administration of RR extract at 500 mg/kg/day for 4 consecutive weeks significantly increased serum insulin level. In vitro studies indicated that the extract significantly inhibits glucose absorption by rat isolated intestine. The extract neither altered glucose uptake by rat isolated psoas muscle nor the activity of hepatic microsomal glucose-6-phosphatase. In conclusion, the methanolic extract of RR improves STZ-induced diabetes in rats. This can be attributed, at least partly, to stimulating pancreatic insulin release and reducing intestinal glucose absorption.     

Influence of type of final restoration on the fracture resistance and fracture mode of endodontically treated premolars with occluso-mesial cavities

IntroductionThe aim of this study was to compare the fracture resistance of endodontically treated premolars after the application of three restorative materials (i.e., direct composite, indirect composite, and computer aided design/computer aided manufacturing CAD/CAM ceramic inlays) to restore a conservative occluso-mesial cavity preparation.Materials and methodssixty sound maxillary premolars were divided into four experimental groups; group A: the control group, where neither root canal treatment nor preparation were performed; group B: teeth were restored with a direct Filtek Z250 composite restorative material; group C: teeth were restored with an indirect inlay Filtek Z250 composite restorative material; group D: teeth were restored with IPS E.Max CAD/CAM monolithic ceramic inlays. Access cavities and root canal treatment procedures were conducted using standard techniques. Then, the cavities were restored with direct composite restorative materials following manufacturer’s instructions. Each group received mesial-occlusal cavities and restored according to the designated group.Teeth from all groups were exposed to a thermocycling regimen of 500 cycles in water baths at 5–55 °C. Then, each specimen was mounted on a special fixture on a computer controlled Instron Universal Testing Machine. An axial compressive load was applied to the palatal cusp up to failure at an angle of 45°. The force was applied at the rate of 2 mm/min until visible or audible evidence of fracture was observed. The force at fracture was measured in MPa, and the fracture mode was recorded as either favorable [restorable adhesive fracture above the cemento-enamel junction (CEJ)] or unfavorale (non-restorable fractures under CEJ). The obtained data were analyzed using the SPSS version 21.0 statistical software. One-way ANOVA and Tukey's test were used to compare the mean values of maximum load of the four groups. Pearson's Chi-square test was used to compare the distribution of failure mode among the four groups. The p-value of ≤ 0.05 was used to report the statistical significance of results.     

Complementary and alternative medicine use among ischemic stroke survivors in Jeddah,Saudi Arabia

Objectives:To determine the prevalence and pattern of complementary and alternative medicine (CAM) use and the CAM types used by stroke patients in Jeddah, Kingdom of Saudi Arabia.Methods:This cross-sectional study included 152 ischemic stroke survivors who visited King Fahad Hospital, Jeddah, Kingdom of Saudi Arabia, between January 2018 and December 2019. Phone-based and face-to-face surveys were conducted. Data on the patients’ demographic characteristics, their use of CAM, and their pattern of CAM use were gatheredResults:Ninety (59.2%) stroke patients used CAM, mainly cauterization (29.61%) and Quran recitation by a religious sheik (28.95%). Most of the patients (72.22%) used CAM post-hospitalization and within less than one month from stroke onset (62.22%). A minority (6.67%) of the patients stopped their medication while on CAM. Some patients (25.56% to 31.11%) discussed with their physician their use of CAM. The CAM users reported a subjective improvement in their physical weakness (45.6%) and psychological wellbeing (62.2%). The patients learned about CAM mainly from their relatives and friends (96.7%), and the most common reason for their CAM use was their belief in this intervention (42.22%).Conclusion:The CAM use was prevalent among our cohort of Saudi ischemic stroke patients, and cauterization and Quran recitation were the most commonly used CAM interventions. An effective communication was lacking between the medical professionals and the stroke patients as regards CAM use despite the interest of the patients in this intervention.

Over the past 2 decades, the burden of stroke has increased globally.1 Stroke is the second leading cause of morbidity and mortality; the annual incidence of stroke is approximately 15 million, and over 5.5 million stroke-related deaths occur annually.2–4 Also, the prevalence of the modifiable risk factors of stroke is increasing, and the burden of stroke increases with the aging of the population.5 Adults aged >25 years have an estimated lifetime stroke risk of 24.9%.6 Despite the advancements in acute stroke care, highly effective treatments for the later phases of stroke are lacking. This shortcoming in the stroke care leads patients and their relatives to seek other treatment options, such as complementary and alternative medicine (CAM).7 The CAM is defined by the United State of America National Institutes of Health as “a group of diverse medical and health care systems, practices, and products that are not generally considered conventional medicine.”8 The CAM has been used for a long time now,9 and people widely practice CAM for various health conditions, such as cancer, epilepsy, multiple sclerosis, infertility, surgical procedure, dermatological conditions, hypertension, pain, and other types of illnesses.1,9–11 The prevalence of CAM use varies by country. For example, the prevalence of CAM use is 82% in the United States,12 61% in Australia,13 51% in Malaysia,14 and 61% in Turkey.15 Religion, cultures, and values influence the types and patterns of its use.16 People in Western countries practice herbal medicine, reflexology, aromatherapy, massage, osteopathy, meditation, and spiritual healing;10,17–19 by contrast, those in Asian countries such as China, India, and Taiwan commonly use therapies such as traditional Chinese medicine, Ayurvedic medicine, physical exercises, acupuncture, Tai Chi, yoga, and homeopathy.20–23 In Saudi Arabia, different types of CAM are used including the Quran recitation therapy, honey consumption, plant-based traditional medicine (e.g., Murrah and black seed consumption), cupping (“Hojamah”), and cauterization (“skin ironing”)9,24–27Research highlighted that aside from their potential benefits, some types of CAM have many side effects and potential toxicities, and patients are commonly unaware of these possible dangers.28 One study reported 2 cases wherein the cauterization led to severe complications, such as skin burn.29 Another study that investigated the components of herbal medicines in Saudi Arabia indicated that 15.7% of the tested samples contain toxic amounts of heavy metals, including arsenic and mercury.30 Despite the potential risk of many CAM interventions, it has been noted that many patients do not inform their physicians about their practice of CAM.31Stroke patients in many countries, including the United States (30.6%–46%)32,33 and South Korea (54%), use CAM.34 In Riyadh, Saudi Arabia, 67% of patients with neurological problems use CAM,9 and most of them use cupping (Hojamah) (45.4%), herbal medicine (42.3%), cauterization (33.7%), and Quran recitation (20.4%).9 However, no available study has analyzed the use of CAM particularly by stroke patients in Saudi Arabia. Thus, this study aimed to determine the prevalence and pattern of CAM use and the types of CAM being practiced by ischemic stroke patients relation to their demographic data.     

Routine Laboratory Testing Every 4 Versus Every 6 Weeks for Patients on Maintenance Hemodialysis: A Quality Improvement Project

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Autoinflammatory Disease-Associated Vasculitis/Vasculopathy

Purpose of Review

Autoinflammatory diseases (AIDs) constitute several disorders that share similar characteristics, clinical features, disease course, and prognosis. They are characterized by the presence of recurrent episodes of unprovoked inflammation due to dysregulated innate immune system in the absence of autoantibodies or infections. AIDs include periodic fever syndromes and other less commonly growing list of syndromes. In this review, vasculitis associated with different AIDs will be highlighted.

Recent Findings

Vasculitis is inflammation and necrosis of the blood vessels causing impaired blood flow, ischemia, and infarction of the dependent tissues. It is a very rare manifestation of AIDs and when it occurs, the skin is the most affected tissue than any other organs such as kidneys, lungs, or CNS.

Summary

Although vasculitis and AIDs share similar manifestations such as fever, skin rashes, and neuropathy, vasculitis is not a characteristic feature of AIDs and still not clear if it represents a main clinical feature or a manifestation of other disease process.