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Abstracts of "Institute for Research and Medical Consultations (IRMC) - Summer Research Program for Undergraduate Students – 2019" presented at Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, on October 6, 2019
(2020)
Background: Doxorubicin is an antineoplastic commonly used in chemotherapy. Its major side effect is the cumulative resultant cardiomyopathy. Polycaprolactone (PCL) is a compatible, degradable, core-shell polymer. PCL nanoparticles <600 nm have shown the ability to accumulate in solid tumors in comparison to healthy tissues, possibly because of their defective vasculature. Objectives: The aim of this study is to prepare PCL nanoparticles loaded with doxorubicin and study the effect of encapsulation on the drug’s efficacy, solubility and anticancer activity against MCF-7 cells. Materials and methods: The single emulsion method was used to prepare PCL nanoparticles; doxorubicin was incorporated during the synthesis. Nanoparticles were characterized by SEM to determine the size and morphology and by FTIR to confirm encapsulation. UV spectrophotometer was used for study the drug release. ELISA microplate reader was used to study the anticancer activity against MCF-7 (American Type Culture Collection, USA) cell line at different concentrations. Results: SEM showed uniform microspheres with a size 3 µm. FTIR showed defined bands for PCL and doxorubicin at 3400, 3000, 1650, 1450 and 1100 cm−1. Drug release was slow because of the insolubility of PCL in PBS. MTT assay showed a 49% decrease in cell viability at 100 µM. Conclusion: Polycaprolactone nanoparticles are potentially useful carriers for doxorubicin. The single emulsion method was not effective for nano-size particle preparation and different methods could be used to obtain a smaller particle size. PCL may be copolymerized with a hydrophilic polymer to increase the drug release rate.
Alterations of mitochondria and related metabolic pathways in leukemia: A narrative review
(2020) Al Ageeli, Essam
Dysregulation of mitochondrial function often precedes malignant transformation of hematopoietic stem cells (HSCs). Mitochondria have a direct role in the maintenance of HSC functions. For example, D-2-hydroxyglutarate, generated due to the activity of mutated mitochondrial isocitrate dehydrogenase (IDH), has been implicated in the pathogenesis of leukemia. Furthermore, disturbances in the fatty acid breakdown and pyruvate oxidation are often seen in leukemic cells. These and other abnormalities expedite leukemogenesis and chemoresistance of leukemic cells. However, it needs to be elucidated whether these aberrations are the result or cause of leukemogenesis. Accordingly, for this review, a search was carried out in PubMed and Google Scholar databases until June 2019 to assess the relationship between metabolic pathways in altered mitochondria and leukemia development. In the present review, an overview of mitochondria-related mechanisms and their abnormalities in leukemia is presented, with mitochondrial pathways and factors, such as mitophagy, intermediary metabolism enzymes, oncometabolites and reactive oxygen species' generation, discussed as potential diagnostic and therapeutic targets in leukemia.
Amyloid goiter: A case report and review of the literature
(2020) Jakubovic-Cickusic, Amra; Hasukić, Begzada; Sulejmanović, Maja; Čičkušić, Alma; Hasukić, Šefik
Amyloid goiter is a very rare manifestation of amyloidosis. Here, we describe the case of a 40-year-old male, who presented with upper airway obstructive symptoms including hoarseness and breathing difficulty, to highlight the clinical and pathological features of secondary amyloidosis of the thyroid gland and the difficulties in making a preoperative diagnosis. The patient had previously been wounded in the war in Bosnia, which resulted in the right kidney being surgically removed. Further, he had undergone two surgical interventions on both hips due to osteomyelitis and was on a chronic dialysis program due to a progressively poor left kidney function that had eventually resulted in complete loss of renal function. Thyroid function tests were normal, and the patient clinically was euthyroid; biochemical investigations were within normal limits. Results from sonography, computed tomography scan of the neck, scintigraphy and fine-needle aspiration cytology were nondiagnostic. Therefore, a thyroid biopsy was carried out, and amyloid deposits were found. After preoperative work-up, total thyroidectomy was performed with no complications. We conclude that amyloid goiter may have no major impact on thyroid function even when a substantial amount of amyloid has replaced the normal thyroid parenchyma, as was the case in our patient. Amyloid goiter should be suspected in all patients with a progressive, rapidly growing bilateral thyroid enlargement with concomitant inflammatory processes or in patients undergoing hemodialysis treatment.
Antibacterial activity of Ritchiea albersii Gilg and Cynoglossum amplifolium leaves extracts against selected bacteria
(2020) Engiso, Hizkel; Worku, Teshale; Nureye, Dejen; Salahaddin, Mohammed; Woldeselassie, Workineh; Hambisa, Solomon; Sharief, Nymathullah
Background: The increase in antimicrobial resistance worldwide has necessitated the search for alternative therapeutic agents. The leaf extracts of Ritchiea albersii and Cynoglossum amplifolium have been used as traditional medicine for the management of eye, ear and wound infections in Ethiopia. Objective: The objective of the study was to evaluate the antibacterial activity of R. albersii and C. amplifolium against three common bacteria. Materials and Methods: In this experimental study, the antimicrobial properties of 80% methanol, chloroform and acetone extracts of R. albersii and C. amplifolium were evaluated against two Gram-positive bacteria (Staphylococcus aureus ATCC 25923 and Streptococcus pneumoniae ATCC 49619) and one Gram-negative bacterium (Escherichia coli ATCC 25922) using the agar-well diffusion method. Ciprofloxacin 0.05 mg/disc was used as a positive control. Furthermore, a preliminary phytochemical study was carried out. Results: The zones of inhibition shown by all extracts of the two plants against the tested bacteria were significantly lesser (P < 0.05) than the standard drug. E. coli and S. aureus were the most susceptible strains for most extracts studied. The acetone extract of R. albersii exhibited a higher inhibitory effect (P < 0.05) against S. pneumoniae (16 mm) and E. coli (19 mm) compared with its methanol extract. The chloroform extract of R. albersii was more effective than its methanol extract (P < 0.05) against all tested bacteria. The acetone extract of C. amplifolium displayed a higher inhibitory effect (20 mm) against E. coli than its methanol and chloroform extracts. Conclusions: The leaf extracts of R. albersii and C. amplifolium exhibited broad-spectrum antimicrobial activity, highlighting their potential as phytotherapeutic drugs in preventing and treating infections caused by S. aureus, S. pneumoniae and E. coli. Further investigations for isolating specific compounds and elucidating mechanisms are required to address the need for novel antibacterial drugs.
ARABIC ABSTRACTS
(2020)
التأثير السريري للتعديل الضوئي على التكامل العظمي لزرع األسنان. يعتبر اختالل وظيفة الميتوكوندريا غالبا ً ما يسبق التحول الخبيث للخاليا الجذعية المكونة للدم. تمتلك ً. خلصت هذه الميتوكوندرياهدفت هذه المراجعة المنهجية لتقييم فعالية التعديل الضوئي على زراعة األسنان سريريا ً على التكامل العظمي لزراعة األسنان، إال أنه قد المراجعة إلى أن، التعديل الضوئي لم يثبت فعاليته االيجابية سريريا ً، عندما يستعمل بعد العملية الجراحية. وينصح إجراء دراسات موثوقة وعشوائية للتأكد ً ايجابيا سريريا يكون له تأثيرا من هذا التأثير-----. دراسة سالمة وفعالية دوائين لعالج الضغط. هدفت هذه الدراسة المستقبلية لتقييم فعالية دوائين مختليفن على عالج الضغط للمرضى الذين يعانون منه، في العيادة وخالل اليوم. أظهرت هذه الدراسة أن دواء الضغط )azilsartan ) أدى بشكل كبير للتحكم بضغط المريض مقارنة بالدواء اآلخر )telmisartan )وعليه فان الدواء )azilsartan )يمتلك فعالية أكثر للسيطرة على الضغط مقارنة بالدواء اآلخر )telmisartan ،)وقد بينت هذه الدراسة ان قياس ومراقبة ضغط المريض خارج المستشفى والعيادات طريقة مجدية لمثل هذه الدراسات.------ التحليل المنهجي إلنزيم الطحال )SYK( )expression kinase tyrosine )والنتائج جرى هذا التحليل المنهجي لتقييم وإبانة إنزيم )SYK )و قيمته االنذارية وحالته الجينية في سرطانات مختلفة وذلك خالل استعمال األدوات المعلوماتية الحياتية. تشير نتائج هذه الدراسة إلى احتمال استخدام انزيم )SYK )كهدف تشخيصي وعالجي في سرطانات مختلفة. ومع ذلك يحتاج هذا االستنتاج إلى مزيد من الدراسات والبيانات التجريبية للتحقق من هذه النتائج قبل استعمال هذا اإلنزيم )SYK )في الممارسات السريرية.----- شيوع وتوقع االكتئاب واعراض القلق والضغط العصبي عند المسعفين هدفت هذه الدراسة لتحديد شيوع وتوقع االكتئاب ولمعرفة اعراض القلق والضغط العصبي بين المسعفين في مراكز ً، ومن بين الهالل األحمر السعودي في مدينة الرياض. شملت هذه الدراسة االستبانية المستعرضة )240 )مسعفا هؤالء )%5.30 )كانوا يعانون من الضغط العصبي، بينما )%40 )يشتكون من اضطرابات القلق، أما االكتئاب فأصاب )%7.26 .)أوضحت هذه الدراسة أن الضغط العصبي، والقلق واالكتئاب يشكلون معظم اعراض المسعفين، فعلية يوصي الباحثون بمراقبتهم والتدخل العالجي اذا دعت الضرورة---- دراسة تجريبية الستجابات التردد التقليدي والمضخم للسماعات لقياس دقات القلب. هدفت هذه الدراسة المستقبلية لتقييم التحليل الصوتي الستجابات التردد لثالث سماعات، تقليدي ومضخم لقياس محاكات أصوات القلب توصلت هذه الدراسة بعد تحليل النتائج بان السماعات المضخمة قدمت تضخيم أفضل ً على ذلك يجب على المهنيين الصحيين ألصوات القلب الطبيعية وغير الطبيعية عبر الترددات المقاسة. وبناءا تفسير مطالبات الشركة المصنعة فيما يخص الكسيت والتردد بحذر. أما هؤالء الذين يعانون من فقدان السمع فيجب يفحصون بعناية األداء الصوتي للسماعات. ينصح الباحثون بإجراء بحوث تركز على هذه التأثيرات خالل االقتران مع مساعدات السمع.---- انتشار النمط السريري لمرض دهون الكبد غير الكحولية لدى مرضى التهابات الكبد المزمنة في هدفت هذه الدراسة االسترجاعية لتقصي انتشار مرض دهون الكبد غير الكحولية عند مرضى التهابات الكبد المزمنة في المستشفى الجامعي في جدة، أظهرت الدراسة أن مرض دهون الكبد غير الكحولية شائع بين مرضى الكبد المزمن وله ارتباط بعمر المريض ومتالزمة االيض. كما بين البحث إن ثلث المرضى يعانون من تليف أو تشمع في الكبد.---- انتشار اإلرهاق والضغوطات عند طلبة الطب بين المنهج التقليدي والحديث في جامعة سعودية. أجريت هذه الدراسة المستقبلية لتقييم انتشار اإلرهاق والضغوطات المرتبطة به لدى طالب الطب بين المنهج الجديد القائم على التعليم لحل المشكالت والمنهج التقليدي في جامعة االمام عبدالرحمن بن فيصل بالدمام، خلصت الدراسة إلى أن انتشار اإلرهاق بين طالب الطب موجود في كلى المنهجين، وال يوجد فروق ذات داللة إحصائية، كما ينصح الباحثون بإجراء دراسة طولية لمعرفة التأثير طويل المدى للمنهجين على انتشار اإلرهاق.---- سوء اإلطباق وعالقته بأمراض اللثة. هدفت هذه الدراسة المستقبلية الى دراسة العالقة بين سوء اإلطباق وأمراض اللثة بأنواعها المختلفة. أجريت هذه الدراسة في كلية األسنان. جامعة الملك خالد في أبها وبعد تحليل النتائج توصل الباحثون إلى انه يوجد عالقة بين سوء اإلطباق ووجود أمراض اللثة ونسبة المرضى الذين يبحثون لعالج تجميلي وتقويمي لألسنان وينصح الباحثون بتقييم دقيق لصحة الفم واللثة، قبل القيام بالتقويم.----- تقييم وعالج األلم في العناية المركزة لحديثي الوالدة في المنطقة الشرقية. هدفت هذه الدراسة لتقييم المعرفة وطرق أطباء األطفال والممرضات عن كيفية التعامل مع هؤالء األطفال الذين يعانون من األلم . اجري هذا االستبيان المستعرض في ثالث مستشفيات في المنطقة الشرقية وشملت كل أطباء األطفال وأطباء حديثي الوالدة والممرضات. بينت هذه الدراسة االستبيانية أن استعمال المسكنات لتخفيف اآلالم منخفض بين األطباء المشمولين في هذا االستبيان وعليه ينصح الباحثون الحاجة لمعالجة هذه الفجوة المعرفية.---- متالزمة كروزن : تقرير حالة. تعتبر هذه المتالزمة اضطراب وراثي يتمثل في إلتحام مبكر لبعض عظام الجمجمة ويؤدي هذا اإللتحام المبكر إلى منع الجمجمة للنمو بشكل طبيعي ويؤثر هذا على شكل الرأس والوجه. يناقش الباحثون حالة طفل يبلغ من العمر .ً عشرة اسابيع ويعاني من هذه المتالزمة وكيفية التعامل معه عالجي---- تضخم الغدة الدرقية النشواني : تقرير حالة . يعتبر تضخم الغدة الدرقية النشواني مظهر نادر في المرض النشواني الذي يتمثل في تخزين االميلويد في أعضاء كثيرة من الجسم . يناقش الباحثون حالة مريض يبلغ من العمر 40 سنة ادخل إلى المستشفى لمعاناته من ضيق في التنفس وبحة في الصوت ، وكيفية تشخيص المرض المختلفة وطرق العالج المتوفرة ، وبعد التأكد من التشخيص أجريت للمريض عملية إزالة الغدة الدرقية بعد مراجعة األدبيات المختلفة عن هذا المرض---- التهاب الحوض والكلية : تقرير حالة. ً ، أدخلت المستشفى تعاني من ارتفاع في الحرارة وتسمم يناقش الباحث حالة رضيعة تبلغ من العمر )12 )شهرا بكتيري دموي أجريت للمريضة الفحوصات الالزمة بما فيها مزرعة للبول وبعد معرفة البكتيريا المسببة تم عالجها بالمضاد الحيوي. وبعد ذلك أجريت للطفلة فحص للتأكد من عمل الكليتين وتبين أن الكلية اليمنى ال تعمل إال بنسبة )%5 .)وعلى أساس هذه النتيجة تقرر إجراء عملية إزالة الكلية وتعافت الطفلة تماما بعدها.----
Arabic Abstracts
(2020) Arabic Abstracts
Arabic Abstract
Association between hepatitis C virus viremia and the rs12979860, rs2228145 and rs1800795 SNP (CT/AC/GG) genotype in Saudi kidney transplant recipients
(2020) Alkharsah, Khaled; Alzahrani, Alhussain; Obeid, Obeid; Aljindan, Reem; Guella, Adnane; Al-Ali, Amein; Al-Turaifi, Hussain; Sallam, Talal
Background: Hepatitis C virus (HCV) is a major health problem, particularly in high-risk groups such as kidney transplant recipients, where it can adversely affect graft survival and increase the relative risk for mortality. Recently, the role of genetic variation among HCV patients in determining the outcome of infections has been under investigation. Objective: To investigate the association of single-nucleotide polymorphisms (SNPs) rs12979860 (located within the interleukin-28B locus), rs2228145 (interleukin-6 receptor) and rs1800795 (interleukin-6 promoter) with HCV viremia in renal transplant patients. Materials and Methods: In this analytical cross-sectional study, 149 kidney transplant recipients, 82 males (median age: 41 years) and 67 females (median age: 45 years), were screened for HCV RNA in blood using real-time polymerase chain reaction and genotyped by sequencing (rs12979860) and restriction fragment length polymorphism (rs2228145 and rs1800795). Results: HCV RNA was detected in 17 (11.41%) of the 149 patients. There was no statistically significant association between the studied SNPs and HCV viremia. However, a combination of the CT/AC/GG genotype was significantly associated with HCV viremia (odds ratio: 5.4). The genotype AA of rs2228145 in the IL-6 receptor was associated with viremia levels of >10⁵ copies/ml (odds ratio: 5.96). Conclusion: To the best of the authors' knowledge, this is the first study that has shown that the CT/AC/GG genotype has an impact on HCV viremia in kidney transplant patients. Therefore, such SNP genotypes may potentially be used to identify transplant patients at risk of HCV infection.
Association of four missense SNPs with preeclampsia in Saudi women
(2020) Aljuaid, Nada; Muharram, Ebtesam; Loqtum, Nouf; Al-Amoudi, Reem; AlMahdi, Hadiah; Salama, Mohammed; Banaganapalli, Babajan; Shaik, Noor; Elango, Ramu; Bondagji, Nabeel
Objective: The objective of this study was to investigate the association of rs1051740, rs2234922 (in microsomal epoxide hydrolase 1; EPHX1), rs268 (in lipoprotein lipase; LPL) and rs6025 (in Factor V Leiden; F5) genetic variants with the risk of preeclampsia development in Saudi women. Materials and Methods: This case–control study recruited 233 Saudi women (94 preeclampsia cases and 139 healthy controls) who visited the Gynecology and Obstetrics Departments of two hospitals in Jeddah, Saudi Arabia, for routine postpregnancy clinical follow-ups. All the women underwent thorough clinical and biochemical investigations conducted according to the standard clinical guidelines. Genotyping of the study participants was done using real-time polymerase chain reaction-based TaqMan allelic discrimination assay. The strength of the association between genetic variants and disease development was assessed using chi-square, odds ratio, 95% confidence interval and multifactor dimensionality reduction tests. Result: The minor alleles “G” in rs268 (LPL) and “A” in rs6025 (F5) were absent in Saudi women. The frequencies of rs1051740 and rs2234922 of EPHX1, both in the homozygous and allelic forms, were not significantly different between preeclampsia patients and healthy controls (for all tests, P > 0.05). The multifactor dimensionality reduction analysis also indicated that the interaction between the four studied single-nucleotide polymorphisms (SNPs) had no significant association with preeclampsia risk. Conclusion: This study found that none of the studied genetic variants (neither the single SNP nor the SNP–SNP interactions) explain the development of preeclampsia in the Saudi population. These findings not only underscore the disease heterogeneity but also highlight the need to develop population-specific diagnostic genetic biomarkers for preeclampsia.
Asymptomatic falciparum malaria and its effects on type 2 diabetes mellitus patients in Lagos, Nigeria
(2020) Udoh, Bernice; Iwalokun, Bamidele; Etukumana, Etiobong; Amoo, Joseph
Background: Asymptomatic malaria (ASM) constitutes a reservoir of malaria parasites that sustain transmission and threaten elimination efforts. Studies have also shown a significant relation between insulin resistance and malaria infection. However, data on the clinical effects of ASM and its patterns of carriage among adult malaria patients is limited. Objectives: To determine the prevalence of ASM due to Plasmodium falciparum among adult type 2 diabetes (T2DM) patients in Lagos, Nigeria; to assess the diagnostic performance of light microscopy and histidine-rich protein 2 rapid diagnostic test (HRP-2 RDT); and to determine the effects of ASM on glycemic control and anemia. Materials and Methods: This cross-sectional study enrolled 208 afebrile, nonobese, nonhypertensive T2DM patients, aged 40–70 years, undergoing treatment (adherence, ≥95%) at six private health facilities in Lagos, Nigeria, between March and August 2015. Sociodemographic data were obtained using a semi-structured questionnaire and clinical case files. Venous blood samples were collected and processed for fasting blood sugar estimation, packed cell volume determination and malaria parasite detection by HRP2-RDT, light microscopy and polymerase chain reaction (PCR). Results: The mean age of the patients was 54.5 years. ASM was diagnosed in 16.8%, 7.2% and 4.3% of the patients by PCR, light microscopy and HRP2-RDT, respectively. ASM was significantly ( P < 0.05) associated with poor glycemic control, anemia and insulin resistance. The overall parasitemia ranged from 85 to 3789 parasites/μL (median, 1580 parasites/μL). Benchmarking against the PCR results, light microscopy and rapid diagnostic tests were found to have a sensitivity (95% confidence interval) of 42.9% (26.5–59.3) and 22.9% (12.1–39), respectively, in diagnosing ASM. Conclusion: This study revealed that T2DM patients in Lagos, Nigeria, are potential reservoirs of asymptomatic Plasmodium falciparum , which has a significantly negative effect on glycemic control and anemia. The study also found PCR to be the most effective diagnostic method.
Barriers to preparation of case reports among Japanese general practitioners
(2020) Kenzaka, Tsuneaki; Kamada, Momoka
Letter to the Editor
Burnout prevalence and associated stressors in medical students of traditional and problem-based learning curricula in a Saudi University
(2020) Al-Jehani, Yasser; Althwanay, Aldanah; Buainain, Hessah; Abuhaimed, Abdulaziz; Almulhim, Abdulaziz; Abusrir, Fatima; Alkhabbaz, Fatimah; Almustafa, Salam; Abdel Wahab, Moataza
Background: Medical students are prone to burnout, and several stressors have been associated with it. From the literature, it is yet unclear if type of curricula in medical schools plays a role in burnout among students. Aims: To assess the prevalence of burnout and its associated stressors in medical students in problem-based learning and traditional curricula at Imam Abdulrahman Bin Faisal University. Subjects and Methods: The analytical, cross-sectional study was conducted between February and May 2017 and included all third- to sixth-year medical students of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. In the 2016–2017 academic year, third- and fourth-year students were in problem-based learning, whereas fifth- and sixth-year students were in traditional learning. All eligible students were verbally invited to complete a 56-item questionnaire comprising three sections eliciting sociodemographic information, level of burnout (using a modified Copenhagen Burnout Inventory with personal, medical school- and faculty-related subsections) and stressors associated with burnout. Burnout was measured using a Likert-type scale, and scores of >50 were considered as high burnout. Chi-square and logistic regression analysis were used for statistical analysis. Results: Of 947 eligible students, 593 (62.6%) completed the questionnaire: 317 (53.5%) were in problem-based learning and 276 (46.5%) in traditional learning. Of these, 329 (55.5%) had high burnout, with no difference between type of curricula (problem-based learning = 178 [56.2%]; traditional = 151 [54.7%]; P = 0.73). All measured stressors were significantly associated with high burnout, including lack of sleep (odds ratio [OR] = 2.139, P = 0.005) and perceiving teaching staff as inflexible and unsupportive (OR = 2.995, P < 0.001). Conclusions: This study found high prevalence of burnout among medical students in a university from Saudi Arabia, but no significant difference between students in problem-based learning and traditional curricula. A longitudinal study is recommended to better understand the long-term effect of type of curricula on burnout.
A case report of intraparenchymal neurocysticercosis in a postpartum female in Saudi Arabia
(2020) Alshamrani, Foziah; Alsulaiman, Abdulla; Shareefi, Ghadah; Turkistani, Alaa
Neurocysticercosis is a neurologic disease caused by infection with larvae of Taenia solium . It is most commonly transmitted by consumption of pork, water contaminated with T. solium or poor hygiene habits. As only few cases of neurocysticercosis have been documented in Saudi Arabia, the authors report a case of neurocysticercosis in a young Indian female residing in Saudi Arabia who presented with generalized tonic–clonic seizures 6 days after a normal vaginal delivery. Her physical and laboratory investigations as well as chest X-ray and electroencephalogram were all normal. Computed tomography of the head revealed multiple calcified nodular lesions, and magnetic resonance imaging showed ring-enhancing lesion in the left frontoparietal area. Serum enzyme-linked immunosorbent assay (qualitative) was positive for immunoglobulin G antibodies for cysticercosis. A diagnosis of neurocysticercosis was made, and the patient was treated with dexamethasone and levetiracetam for 4 days before discharge. At the 3-month follow-up, the patient's condition had significantly improved, and her seizures had not recurred. This report recommends considering neurocysticercosis as a differential diagnosis in patients presenting with new-onset seizures, even if the symptoms do not initially indicate neurocysticercosis or if the patient resides in an area where the disease is rare.
A case report of twin pregnancy with hydatidiform mole and co-existing live fetus
(2020) Ray, Alokananda; Kumari, Sarita
Complete hydatidiform mole with co-existing live fetus (CHMF) is a rare and high-risk pregnancy usually seen with ovulation induction protocols. These pregnancies are complicated with vaginal bleeding, pre-eclampsia, miscarriage, preterm delivery, fetal demise and the risk of gestational trophoblastic neoplasia (GTN). Here, we describe a case of CHMF and a second case of monozygotic twins: partial mole with live fetuses. The pregnancies were conceived after clomiphene citrate ovulation induction. Both cases presented with vaginal bleeding and hyperemesis in the early mid-trimester. The diagnosis was based on history, examination, ultrasound findings and high serum beta-human chorionic gonadotropin (βHCG) levels. A CHMF can be differentiated from a singleton partial molar pregnancy with similar ultrasound appearance by amniocentesis and karyotyping of the live fetus, which is a normal diploid. After adequate counseling, both women refused prenatal karyotyping and underwent the termination of pregnancy. The method of termination needs to be carefully decided. Surgical evacuation maybe difficult due to the well-formed fetus in the second trimester, and uterotonic agents can be associated with the risk of trophoblastic embolization and GTN. Termination with misoprostol followed by ultrasound-guided suction evacuation was successfully done in both cases. Histopathology and karyotyping confirmed the diagnosis of CHMF in the first and partial mole in the second case. βHCG normalized within 7 weeks postevacuation in both, with no increased risk of trophoblastic embolization or GTN. More studies are needed on the methods of termination in such pregnancies. Medical termination with misoprostol appears to be a viable option, though the optimal dosage is yet to be defined.
Clinical efficacy of photobiomodulation on dental implant osseointegration: A systematic review
(2020) Zayed, Sara; Hakim, Ahmed Adel
Background: Photobiomodulation (PBM) has been shown to have a positive effect on dental implant osseointegration and stability in in vitro and animal studies; however, its usefulness in dental implant clinical practice is yet unclear. Objective: The objective was to assess the clinical effectiveness of PBM on dental implants' osseointegration. Methods: Two reviewers independently conducted a comprehensive electronic search of articles published from inception up to January 10, 2020, in PubMed, Cochrane Library and Embase databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized clinical trials (RCTs) and nonrandomized clinical studies that compared the effect of PBM on dental implant stability with control groups were included. Animals and in vitro studies studies as well as studies with confounders such as application of orthodontic were excluded. Risk of bias (using Cochrane Risk of Bias tool for RCTs and Risk of Bias in Non-Randomized Studies of Interventions tool for nonrandomized studies) was assessed by both authors. Owing to substantial heterogeneity, only a narrative synthesis of the included studies is presented. Results: Seven relevant clinical studies were included, and they used a variety of PBM parameters and devices. The posterior region of the jaw was found to be more frequently evaluated. For assessing the effect of PBM on implant stability, five studies used resonance frequency analysis and two used periotest; three studies additionally used biomarkers for assessment. Four studies found that PBM has a potential positive effect on the outcome of dental implant stability, whereas three studies reported that PBM has no effect on implant stability. Conclusion: The findings of this systematic review suggest that postoperative application of PBM may potentially have some positive effect on dental implant's osseointegration and stability. However, additional studies are required with uniformity in methods to provide a more robust assessment of this effect.
Crouzon syndrome in a ten-week-old infant: A case report
(2020) Gupta, Sangeeta; Prasad, Arun; Sinha, Upasna; Singh, Ramji; Gupta, Gaurav
Crouzon syndrome is a rare genetic disorder. We report a rare case of Crouzon syndrome in a very young infant with distinct features of craniofacial malformations. A 10-week-old male child presented with features of craniofacial dysostosis with abnormal shape of the skull, proptosis, hypertelorism, curved nose and frontal bossing. Radiological findings revealed a predominant premature fusion of sagittal sutures. The infant had airway obstruction. Features of hydrocephalus, papilledema and optic atrophy were not evident. We chose to manage the symptoms and prevent complications, and the surgery was deferred for later, depending on the degree of malformation and psychological needs. Diagnosis of this rare condition at an early stage can help in preventing the development of complications. A careful follow-up and appropriate surgical intervention can improve the prognosis of this condition, which carries the risk of respiratory complications, poor vision and, in some cases, mental retardation as the age advances.
Curcumin-loaded mesoporous silica particles as wound-healing agent: An In vivo study
(2020) Hamam, Fayez; Nasr, Abdulrahman
Background: Curcumin likely has wound-healing properties, but its poor pharmacokinetic attributes inhibit its potential. To overcome these limitations, a novel nanoformulation was previously developed, wherein curcumin was loaded into mesoporous silica particles. Objectives: The objective of the study is to assess the efficiency of this nanocurcumin formulation as a wound-healing agent in an animal model. Materials and Methods: Curcumin was loaded onto mesoporous silica particles. Eighteen healthy, test-naive male Wistar rats were randomly separated into two groups of 9: Group 1 (control) rats were treated topically with a standard drug (sulfadiazine) and Group 2 with 1% curcumin formulation. A circular excision wound was made, and topical application was performed twice a day. The excision diameters were measured on days 3, 6, 9, 12, 15, 18 and 21 of treatment. Three rats from each group were sacrificed on days 7, 14 and 21, and a cross-section from skin specimen in the excision injury was obtained for histological assessment of inflammation, angiogenesis, fibroblast proliferation, presence of collagen and reepithelization. Results: Wound contraction percentage in rats treated with curcumin nanoformulation was nonsignificantly higher than that in the control group ( P > 0.05). In both groups, inflammatory reactions considerably reduced by day 21 of treatment, the angiogenesis process was almost complete by day 7, fibroblast proliferation noticeably rose by day 14, and a high degree of wound reepithelization was achieved by day 21, with no significant differences between the groups. Interestingly, by day 21, the level of collagen significantly increased in curcumin nanoformulation-treated rats compared with those treated with sulfadiazine. Conclusions: Curcumin nanoformulation likely enhanced wound repair by inhibiting the inflammatory response, stimulating angiogenesis, inducing fibroblast proliferation as well as enhancing reepithelization and synthesis of collagen. Therefore, the curcumin nanoformulation used in this study may have potential as a wound-healing ethnomedicine.
Diagnostic accuracy of ultrasonography in classifying thyroid nodules compared with fine-needle aspiration
(2020) Al-Ghanimi, Ibrahim; Al-Sharydah, Abdulaziz; Al-Mulhim, Saqar; Faisal, Sarah; Al-Abdulwahab, Abdulrahman; Al-Aftan, Mohammed; Abuhaimed, Abdulrahman
Background: Classifying thyroid lesions is challenging; nonetheless, using ultrasonography may allow for accurate diagnosis, differentiation and management of thyroid lesions and help avoid unnecessary biopsy. Objectives: The main objective of the study is to determine the diagnostic accuracy of ultrasonography in classifying thyroid nodules compared with fine-needle aspiration. Materials and Methods: This retrospective study included all 68 patients diagnosed with thyroid nodules at King Fahd Hospital of the University, Al Khobar, Saudi Arabia, between June 1, 2014, and November 30, 2016. Parameters were selected based on the Society of Radiologists in Ultrasound criteria. Ultrasonographic features, namely, nodule margins, echotexture, vascularity and calcifications, and fine-needle aspiration cytology (FNAC) results were reviewed by two radiologists blinded to each other's findings and validated by another experienced interventional radiologist. Ultrasonography results were compared against that of FNAC to calculate sensitivity and positive- and negative-likelihood ratios, and the nodule types were compared using Fisher's exact test. Results: Of the 68 nodules analyzed, 59 were reported as benign using FNAC (specificity = 95%; P &< 0.001). Of these 59, 56 were also reported as benign using ultrasonography. The specificity of ultrasonography in determining benign nodules was 94.9%, and the positive- and negative-likelihood ratios were 13.0 and 0.35, respectively. Six of the nine suspicious nodules were confirmed as malignant using FNAC, and the ultrasonography and FNAC findings were strongly associated ( P = 0.001). According to the Society of Radiologists in Ultrasound criteria, FNAC and ultrasonography findings were significantly associated for nodule calcification ( P = 0.001) and echogenicity ( P = 0.001). Conclusion: The diagnostic specificity of ultrasonography and FNAC in this study are consistent with those reported previously, indicating that ultrasonography reliably classifies thyroid nodules, and thus can assist in the decision-making regarding need for biopsy.
Dynamic thiol/disulfide balance in patients with seborrheic dermatitis: A case–control study
(2020) Emre, Selma; Kalkan, Göknur; Erdoǧan, Serpil; Akta, Aktaş; Ergin, Merve
Background: Seborrheic dermatitis is a chronic, inflammatory skin disease, in which many endogenous and exogenous factors play a role. Recent studies have shown that oxidative stress increases in these patients. The role of the dynamic thiol/disulfide homeostasis, an important component of the oxidative stress, in the pathogenesis of seborrheic dermatitis has not yet been investigated. Objectives: The objective was to investigate the relationship between the dynamic thiol/disulfide balance in the plasma of seborrheic dermatitis patients and disease severity. Methods: In this case–control study, 70 seborrheic dermatitis patients and 61 age- and sex-matched healthy controls were included. Thiol/disulfide homeostasis was calculated from venous blood samples, and tests were performed by automated spectrophotometric method. The thiol/disulfide balance between the patient and control groups was compared. In addition, disease severity and other demographic characteristics and thiol/disulfide balance parameters were compared. Results: Native and total thiols were significantly higher in the patient group than that in the control group ( P < 0.001). Disulfide levels were nonsignificantly lower in the patient group than controls ( P = 0.821). Patients' age and age at the onset of disease were found to have a negative correlation with native and total thiol levels. Conclusion: Higher levels of thiols in the serum may be responsible for the increased proliferation of seborrheic dermatitis lesions. To the best of the authors' knowledge, this is the first report on the correlation between thiol/disulfide homeostasis in patients with seborrheic dermatitis.
Efficacy and efficiency of papacarie versus conventional method in caries removal in primary teeth: An SEM study
(2020) AlHumaid, Jehan
Background: Chemomechanical methods such as Papacarie were developed as alternate dental caries removal methods to overcome major disadvantages of the conventional drilling technique. However, few studies have demonstrated the efficacy of Papacarie for caries removal using scanning electron microscope (SEM). Objectives: The purpose of this study was to compare the efficacy and efficiency of Papacarie and the conventional bur method in caries removal from primary teeth. Materials and Methods: In this in vitro study, 30 freshly extracted, human primary molars with dentinal caries were obtained from the outpatient clinics at the Dental Hospital of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Each tooth was sectioned mesiodistally into two halves through the center of the lesion, and each half was randomly subjected to caries removal by Papacarie (Group I) and excavation using the conventional bur method (Group II). Time taken (efficiency) for removal of caries was noted using a stopwatch. Samples were then examined under SEM for presence of bacterial colonies (efficacy). For efficiency, data were analyzed using chi-square, and for efficacy, using t -test. Results: There was no significant difference in the presence of bacteria in both groups under SEM (Papacarie = 23.3%; conventional method = 16.7%; P = 0.52). However, significantly more time was taken for caries removal with Papacarie (mean = 351.56 s) than with the conventional bur method (mean = 158.41 s) ( P < 0.0001). Conclusion: Papacarie is as effective in removing dentinal bacteria as the conventional caries removal method but is less efficient, as the time taken for excavation was longer.
Efficacy and safety of azilsartan medoxomil and telmisartan in hypertensive patients: A randomized, assessor-blinded study
(2020) Garg, Megha; Manik, Geetesh; Singhal, Alok; Singh, V; Varshney, Rohit; Sethi, Aseem
Background: Few studies have compared the safety and efficacy of azilsartan medoxomil (AZL-M) and telmisartan in hypertensive patients, especially using ambulatory blood pressure monitoring (ABPM). Objective: The objective of this study was to compare the efficacy and safety profile of AZL-M and telmisartan in hypertensive patients using ABPM and clinic blood pressure (BP) monitoring. Materials and Methods: This prospective, randomized, open-label, blinded endpoint, parallel-arm study included 700 patients, aged 18–70 years, with clinic and 24-h mean ambulatory systolic BP (SBP) of 150–180 mmHg and 130–170 mmHg, respectively. They were randomized equally into two groups: Group A received AZL-M 40 mg and Group T received telmisartan 40 mg; the dose was force titrated to 80 mg after 2 weeks if the response rate was not achieved. BP (clinical and ambulatory) was measured after 12 weeks and compared with baseline measurements. Results: AZL-M significantly reduced the 24-h mean ambulatory SBP (Group A: 112.74 ± 7.58 mmHg; Group T: 113.96 ± 8.52 mmHg; P < 0.0001) and diastolic BP (Group A: 71.39 ± 5.89 mmHg; Group T: 67.29 ± 6.79 mmHg; P < 0.0001) compared with telmisartan at week 12. The clinic SBP significantly decreased in Group A at weeks 4 (−30.69± −0.33 mmHg) and 12 (−39.69± −1.09 mmHg) (for both, P = 0.0001). Dose titration was done in 99 and 128 patients from Group A and Group T, respectively ( P = 0.012). Headache was the most common adverse drug reaction (Group A: 21; Group T: 27) and fatigue the least. Conclusion: This study found that AZL-M has greater antihypertensive efficacy than telmisartan, with comparable side effects. In addition, ABPM was shown to be a feasible method for such studies.

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