Large Subcapsular Hematoma of the Liver Due to Faja Corset: A Rare Case Report

Background: Subcapsular hematoma of the liver is a potentially life-threatening but extremely rare condition. It is often caused by a blunt trauma or other predisposing conditions such as a liver tumor, intra-tumor hemorrhage, surgery, preeclampsia, liver biopsy, and hemodialysis. Predisposing causes of liver hematoma include its large size and proximity to fixed structures. To date, there have been no reported cases of subcapsular liver hematoma caused by tight clothing such as corsets. Our case report is about an extremely rare case of subcapsular hematoma of the liver caused by wearing a tight faja corset in a young healthy female. Case presentation: A forty-five-year-old Spanish female without any underlying health problems presented with sudden onset epigastric and right upper quadrant abdominal pain after wearing a faja corset the night prior to the hospital presentation. CT abdomen was noted for subcapsular hematoma of the liver. Her symptoms persisted and repeat CT abdomen showing worsening of the liver hematoma. Patient had interventional radiology (IR) guided drainage and was subsequently discharged home. Conclusions: Subscapular liver hematomas need to be considered in patients presenting with acute onset abdominal pain after wearing certain tight clothing. The necessity of an early and accurate diagnosis is vital for management as hemodynamically stable patients can be managed conservatively. Our patient was managed with IR-guided aspiration drainage of the hematoma. Surgery can be considered a last resort in case of life-threatening hemodynamic instability, peritoneal signs, free abdominal fluid, and failure of arterial embolization. Our case highlights the importance of early recognition of traumatic subcapsular hematomas to prevent life-threatening complications

Knowledge, attitude and practices towards eye care, among primary health care workers in District Ckakwal.

Introduction: Despite the fact, that an estimated 80% of worldwide blindness is preventable or treatable, the number of individuals living with blindness or impaired vision is on a rise. According to epidemiological data, worldwide over 2.2 billion people are blind or have impaired vision and 90% of them live in underdeveloped countries. A large number of people consult primary health care workers for their health issues, whether it is general illness or eye problems. Objectives: To assess the Knowledge, Attitude, and Practices (KAP) of Primary Health Care workers with regard to Primary Eye Care (PEC) in District Chakwal, Pakistan. Methodology: A Quantitative Cross-sectional study design, using a Random Sampling technique was employed. Participants in the study were given a standardized semi-structured questionnaire to fill out. The questionnaire included questions on primary health care providers’ knowledge, attitudes, and practices about PEC. The data were analyzed by using the statistical package for social sciences (SPSS) version 26. Results: Among the total of 232 Primary Health Care workers 73.7% were below 40 years of age. The majority of primary health care workers were female (60.8%). About 40.9% were having diplomas. The majority of workers (58.6%) had less than 5 years of experience as a Primary Health Care worker. Most of them (60%) had sufficient knowledge about the causes of eye diseases or injuries and (40.8%) had knowledge about conditions that may result in eye illnesses or injuries. The attitude toward referral of patients to medical doctors was 51.2%. The practices regarding method and approach for the treatment of eye diseases, of the majority of workers (58.9%) were not satisfactory. Conclusion: Knowledge regarding causes of eye diseases, diagnosis, and methods of treatment were not satisfactory amongst the primary health care workers. A positive attitude was noted for the will to improve the knowledge of eye care. The research revealed, the requirement for a training program for primary health care workers regarding modern primary eye care

Use of Dark Chocolate for Diabetic Patients: A Review of the Literature and Current Evidence

Dietary changes are a major lifestyle factor that can influence the progression of chronic diseases such as diabetes. Recently, flavanols, a subgroup of plant-derived phytochemicals called flavonoids, have gained increasing attention, due to studies showing an inverse correlation between dietary intake of flavanols and incidence of diabetes. Flavanoids in the cocoa plant may ameliorate insulin resistance by improving endothelial function, altering glucose metabolism, and reducing oxidative stress. Oxidative stress has been proposed as the main culprit for insulin resistance. The well-established effects of cocoa on endothelial function also points to a possible effect on insulin sensitivity. The relationship between insulin resistance and endothelial function is a reciprocal one. Overall, the evidence from these studies suggests that cocoa may be useful in slowing the progression to type 2 diabetes and ameliorating insulin resistance in metabolic syndrome. Additionally, results from several small studies indicate that cocoa may also have therapeutic potential in preventing cardiovascular complications in diabetic patients. Studies highlighting the potential of cocoa-containing diets, in large-randomized controlled trials should be performed which might give us a better opportunity to analyze the potential health-care benefit for reducing the risk of complications in diabetic patients at molecular level

Smokeless tobacco initiation, use and cessation in south Asia: A qualitative assessment

Introduction: Smokeless tobacco (ST) is a significant South Asian public health problem. This paper reports a qualitative study of a sample of South Asian ST users.Methods: Interviews, using a piloted topic guide, with 33 consenting, urban dwelling adult ST users explored their ST initiation, continued use and cessation attempts. Framework data analysis was used to analyse country specific data before a thematic cross-country synthesis was completed.Results: Participants reported long term ST use and high dependency. All reported strong cessation motivation and multiple failed attempts because of ease of purchasing ST, tobacco dependency and lack of institutional support.Conclusions: Interventions to support cessation attempts amongst consumers of South Asian ST products should address the multiple challenges of developing an integrated ST policy, including cessation services.Implications: This study provides detailed understanding of the barriers and drivers to ST initiation, use and cessation for users in Bangladesh, India and Pakistan. It is the first study to directly compare these three countries. The insight was then used to adapt an existing behavioural support intervention for ST cessation for testing in these countries

Accuracy of procalcitonin levels for diagnosis of culture-positive sepsis in critically ill trauma patients: A retrospective analysis

Background: Abdominal trauma and intra-abdominal sepsis are associated with significant morbidity and mortality. Microcirculation in the gut is disrupted in hemorrhagic and septic shock leading to tissue hypoxia, and the damaged gut acts as a reservoir rich in inflammatory mediators and provides a continual source of inflammation to the systemic circulation leading to sepsis. Sepsis is defined as the presence (probable or documented) of infection together with a systemic inflammatory response to infection. Blood culture is commonly considered to be the preferred approach for diagnosing sepsis, although it is time-consuming, that is, reports are normally available only after 12-48 hours. Procalcitonin levels (PCT) have recently emerged as a promising biomarker in the diagnosis of sepsis. The aim of the present study is to determine the diagnostic accuracy of PCT levels in predicting sepsis in critically ill trauma patients.Methodology: This was designed as a validation study conducted in the Indoor Department of General Surgery, Liaquat National Hospital, Karachi. The sample size was calculated by taking the estimated frequency of sepsis in suspected patients at 62.13%, expected sensitivity of PCT at 70.83%, and specificity at 84.21% and the desired precision level of 12% for sensitivity; the calculated sample size was 96. The non-probability consecutive sampling method was used to recruit participants who were diagnosed with sepsis on clinical assessment. Blood culture samples were sent for the enrolled patients and a final diagnosis was made on the blood culture report. PCT levels were measured in these suspected patients on the same day of sending blood culture. Diagnostic accuracy of PCT size was measured using the receiver operating characteristic (ROC) curve. ROC curve was formulated for PCT levels against culture-proven sepsis to determine the ideal cut-off value of PCT levels. Two different cut-offs were determined to obtain the highest sensitivity and highest specificity accordingly.Results: A total of 97 individuals met the inclusion criteria with a mean age of 34.89 ± 10.52 years. Mean PCT levels were 0.96 ± 0.59, with a gender predilection towards females (p \u3c 0.001). No age difference was documented among gender (p = 0.655). The mean duration of intensive care unit stay was 11.73 ± 3.56 days. Culture-proven sepsis was identified in 67.0% of the study participants with a higher PCT level (p \u3c 0.001). Among the 52.6% males included in the study, half were reported to have culture-positive sepsis, but among the 47.4% females culture was positive in 87% (p \u3c 0.001). ROC revealed PCT was predictive for culture-positive sepsis at a cut-off value 0.47 ng/mL (p \u3c 0.001), with a sensitivity of 92.3%, specificity of 68.7%, positive predictive value (PPV) of 85.7%, and negative predictive value (NPV) of 81.5%. By increasing the cut-off value to 0.90 ng/mL at area under the curve of 0.816, the specificity increased to 81.3% and sensitivity became 66.2%, with a PPV of 87.8% and NPV of 54.2%.Conclusion: Our study determined two cut-values for PCT to predict sepsis, one with the highest sensitivity and the other with better specificity. Other than that, higher PCT levels were significant in female trauma patients. We conclude that PCT is a reliable marker for culture-proven diagnosis of sepsis and may aid physicians/surgeons to promptly manage patients accordingly

Correlation of Immunoglobulin G With Severity Of Psoriasis

Objectives:  To find the correlation of immunoglobulin G with severity of psoriasis. Methodology: This cross-sectional descriptive study was conducted at Sir Ganga Ram Hospital Lahore/Niazi Teaching Hospital Sargodha. Study duration was six months from January 2020 to June 2020. One hundred patients of psoriasis (confirmed by Dermatologist) were included in the study. Questionnaire based on age, gender, duration of illness, type and severity of problem etc and biochemical test including immunoglobulin G were filled by consented patients. The study comprised into patients and controls groups. Fifty age matched Subjects with no history of skin disease were taken as controls. For immunological assessment, IgG was measured by the technique of ELISA. Results: Mean age of developing of disease was in the range of 36 to 43 years. A few patients have family history with a problem of asthma. High severity of index (59 to 61) in both genders with duration of disease was 4 to 6 years. A direct correlation between level of IgG and disease severity was observed. Conclusion: Increased level of immunoglobulin G and its direct correlation with severity of psoriasis may suggest an activation of 2nd immune defense that try to reduce the severity of disease

Comparison of Body Composition Bio Electrical Impedance Analysis of Type-1 Diabetes vs. Non-Diabetes in Children and Adolescent

Background: Analyzing the body composition of children and adolescents with diabetes is becoming more and more popular. For managing weight changes that may emerge from treatment and evaluating treatment response, it is essential to comprehend the body composition of diabetic children. Objective: To compare body composition by Bioelectrical Impedance Analysis (BIA) among T1DM versus healthy children and adolescents in Pakistan. Methods: This comparative cross-sectional study was performed during Jan-March, 2023. Type 1 diabetic children and adolescents were enrolled from the pediatric endocrinology outpatient clinic of the National Institute of Child Health whereas healthy children and adolescents were enrolled from a nearby school to the hospital location. Evaluation of anthropometry indices and bioelectrical impedance analysis was performed after obtaining the consent of parents. Results: A total of 100 subjects were enrolled in the study, 50 each in the diabetic and healthy group. The mean age of participants was 10.4 ± 2.4 years. The majority of study subjects were females (61%). The mean duration of T1DM was 4.7 ± 0.8 years. Height (127.4 ± 11.7 versus 139.5 ± 15, p<0.001), Waist-hip ratio (0.8 ± 0.1 versus 0.7± 0.3, p=0.037) and resistance (686.2 ± 90.7 versus 651.1 ± 96.6, p=0.002) were significantly higher among T1DM group than healthy group. Percentage of muscle mass (45.1 ± 8.2 versus 50.3 ± 7.6, p=0.008), body cell mass (47.1 ± 3.8 versus 50.6 ± 4.5, p=0.045), reactance (56.3 ± 9.8 versus 62.4 ± 4.2, p=0.017) and phase angle (4.3 ± 0.9 versus 5.7 ± 0.6, p=0.012) were significantly lower in T1DM patients than healthy individuals. Conclusion: BIA analysis showed that body composition parameters and body functional status were lower among T1DM children and adolescents than in the healthy group in terms of resistance, reactance, and phase angle

Variants of CTGF are associated with hepatic fibrosis in Chinese, Sudanese, and Brazilians infected with Schistosomes

Abnormal fibrosis occurs during chronic hepatic inflammations and is the principal cause of death in hepatitis C virus and schistosome infections. Hepatic fibrosis (HF) may develop either slowly or rapidly in schistosome-infected subjects. This depends, in part, on a major genetic control exerted by genes of chromosome 6q23. A gene (connective tissue growth factor [CTGF]) is located in that region that encodes a strongly fibrogenic molecule. We show that the single nucleotide polymorphism (SNP) rs9402373 that lies close to CTGF is associated with severe HF (P = 2 × 10−6; odds ratio [OR] = 2.01; confidence interval of OR [CI] = 1.51–2.7) in two Chinese samples, in Sudanese, and in Brazilians infected with either Schistosoma japonicum or S. mansoni. Furthermore, SNP rs12526196, also located close to CTGF, is independently associated with severe fibrosis (P = 6 × 10−4; OR = 1.94; CI = 1.32–2.82) in the Chinese and Sudanese subjects. Both variants affect nuclear factor binding and may alter gene transcription or transcript stability. The identified variants may be valuable markers for the prediction of disease progression, and identify a critical step in the development of HF that could be a target for chemotherapy

Assessment of the prevalence of radix entomolaris and distolingual canal in mandibular first molars in 15 countries: a multinational cross-sectional study with meta-analysis

Aim: The aim of this study was two-folded: i) to assess the prevalence of Distolingual Canal (DLC) and Radix Entomolaris (RE) in Mandibular First Molars (M1Ms), using Cone Beam Computed Tomography (CBCT) images and ii) to assess the impact of sociodemographic factors on the prevalence of these conditions worldwide. Methods: CBCT images were scanned retrospectively and the ones including bilateral M1Ms were included in the study. The evaluation was performed by 1 researcher in each country, trained with CBCT technology. A written and video instruction program explaining the protocol to be followed step-by-step was provided to all observers to calibrate them. The CBCT imaging screening procedure consisted of evaluating axial sections from coronal to apical. The presence of DLC and RE in M1Ms (yes/no) was identified and recorded. Results: Six thousand three hundred four CBCTs, representing 12,608 M1Ms, were evaluated. A significant difference was found between countries regarding the prevalence of both RE and DLC (P .05). Conclusion: The overall prevalence of RE and DLC in M1Ms was 3% and 22%. Additionally, both RE and DLC showed substantial bilaterally. These variations should be considered by endodontic clinicians during endodontic procedures in order to avoid potential complications