Change of size and type of patent ductus arteriosus in a one year old infant during routine echocardiographic study

There are only very few publications which document reactivity of patent ductus arteriosus. This report documentes the reactivity of a patent arterial duct in a one year old infant, 6.5 kg weight during a routine echocardiographic color Doppler study. Echocardiographic images were obtained during conscious sedation.peer-reviewe

Heat Shock Protein 47: A Novel Biomarker of Phenotypically Altered Collagen-Producing Cells

Heat shock protein 47 (HSP47) is a collagen-specific molecular chaperone that helps the molecular maturation of various types of collagens. A close association between increased expression of HSP47 and the excessive accumulation of collagens is found in various human and experimental fibrotic diseases. Increased levels of HSP47 in fibrotic diseases are thought to assist in the increased assembly of procollagen, and thereby contribute to the excessive deposition of collagens in fibrotic areas. Currently, there is not a good universal histological marker to identify collagen-producing cells. Identifying phenotypically altered collagen-producing cells is essential for the development of cell-based therapies to reduce the progression of fibrotic diseases. Since HSP47 has a single substrate, which is collagen, the HSP47 cellular expression provides a novel universal biomarker to identify phenotypically altered collagen-producing cells during wound healing and fibrosis. In this brief article, we explained why HSP47 could be used as a universal marker for identifying phenotypically altered collagen-producing cells

The impact of alternative pricing methods for drugs in California Workers’ Compensation System: fee-schedule pricing

Introduction California’s Workers’ Compensation System (CAWCS) Department of Industrial Relations questioned the adequacy of the current Medi-Cal fee-schedule pricing and requested analysis of alternatives that maximize price availability and maintain budget neutrality. Objectives To compare CAWCS pharmacy-dispensed (PD) drug prices under alternative fee schedules, and identify combinations of alternative benchmarks that have prices available for the largest percentage of PD drugs and that best reach budget neutrality. Methods Claims transaction-level data (2011–2013) from CAWCS were used to estimate total annual PD pharmaceutical payments. Medi-Cal pricing data was from the Workman’s Compensation Insurance System (WCIS). Average Wholesale Prices (AWP), Wholesale Acquisition Costs (WAC), Direct Prices (DP), Federal Upper Limit (FUL) prices, and National Average Drug Acquisition Costs (NADAC) were from Medi-Span. We matched National Drug Codes (NDCs), pricing dates, and drug quantity for comparisons. We report pharmacy-dispensed (PD) claims frequency, reimbursement matching rate, and paid costs by CAWCS as the reference price against all alternative price benchmarks. Results Of 12,529,977 CAWCS claims for pharmaceutical products 11.6% (1,462,814) were for PD drugs. Prescription drug cost for CAWCS was over $152M;$63.9M, $47.9M, and$40.6M in 2011–2013. Ninety seven percent of these CAWCS PD claims had a Medi-Cal price. Alternative mechanisms provided a price for fewer claims; NADAC 94.23%, AWP 90.94%, FUL 73.11%, WAC 66.98%, and DP 14.33%. Among CAWCS drugs with no Medi-Cal price in PD claims, AWP, WAC, NADAC, DP, and FUL provided prices for 96.7%, 63.14%, 24.82%, 20.83%, and 15.08% of claims. Overall CAWCS paid 100.52% of Medi-Cal, 60% of AWP, 97% of WAC, 309.53% of FUL, 103.83% of DP, and 136.27% of NADAC. Conclusions CAWCS current Medi-Cal fee-schedule price list for PD drugs is more complete than all alternative fee-schedules. However, all reimbursement approaches would require combinations of pricing benchmarks. We suggest keeping primary reimbursement at 100% of Medi-Cal and for drugs without a primary Medi-Cal price calculating the maximum fee as 60% of AWP and then 97% of WAC. Alternatively, we suggest using NADAC as a primary fee-schedule followed by either 60% AWP and 97% WAC or AWP-40% for drugs with no NADAC price. Fee-schedules may not offer the best price and a formulary approach may provide more flexibility

Practices and complications of pubic hair removal among Saudi women

Source at: http://doi.org/10.1186/s12905-018-0661-6Background: Pubic hair grooming, including the complete removal of pubic hair, has become an increasingly common practice, particularly among young women. Although widespread, there is limited data regarding the methods, products, reasons, and complications of pubic hair removal, particularly among Saudi women. The objective was to examine pubic hair removal practices and the prevalence of its complications among Saudi women living in Jeddah, Saudi Arabia. Methods: In this cross-sectional study conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, Saudi women between 16 and 60 years of age who had the ability to read and speak Arabic, were eligible to complete an anonymous and self-administered survey on pubic hair removal practices and its complications. Results: Between December 2015 and September 2016, 400 Saudi women completed the survey. The age was 26. 3 ± 6.9, 16–58 (mean ± SD, range) years. About three quarters (77.0%) self-removed their pubic hair, while the remainder made use of professional personnel in medical clinics (15.5%), beauty salons (5.3%), and professional services at home (2.2%). Many women (41.8%) used a combination of hair removal methods, with non-electric razor as the most common single method used (33.5%), followed by laser (8.7%), sugaring (6.0%), waxing (4.5%), trimming (2.0%), electric razor (2.0%), and cream (1.5%). Three-quarters of women (75.5%) reported complications, and although they were mostly minor injuries, treatment had to be sought for 17.9% of complications. Multivariable analyses showed that no variables remained correlated with the occurrence of complications (age of starting hair removal, income, BMI, level of education, mode of removal, advice on removal). Conclusions: Saudi women initiate pubic hair removal in early adolescence. While most complications are minor, close to one in five women experience complications

2-{[(2-Methyl­prop-2-en-1-yl)­oxy]meth­yl}-6-phenyl-2,3,4,5-tetra­hydro-1,2,4-triazine-3,5-dione

The 1,2,4-triazine ring in the title compound, C14H15N3O3, is approximately planar (r.m.s. deviation = 0.019 Å); the C atom at the 6-position deviates by 0.026 (2) Å from the mean plane whereas the C atom at the 2-position deviates by 0.166 (4) Å in the opposite direction. The triazine ring is oriented at 8.60 (13)° with respect to the phenyl ring. The imino group is hydrogen-bond donor to the exocyclic O atom at the 3-position of an adjacent mol­ecule, the hydrogen bond generating an inversion dimer

Neisseria meningitidis nasopharyngeal carriage during the Hajj: A cohort study evaluating the need for ciprofloxacin prophylaxis

Background The annual Muslim pilgrimage has the potential of increase risk for acquisition of Neisseria meningitidis. Here, we evaluate the Hajj impact on the prevalence of N. meningitidis carriage in a paired and non-paired cohort of pilgrims. Secondary objectives were to calculate the compliance with recommended vaccination. Methods This is a prospective paired (arriving and departing), non-paired arriving and non-paired departing cohort study with the collection of nasopharyngeal samples at the start and the end of the Hajj. Results The study included unpaired arriving pilgrims at King Abdul Aziz International Airport (N = 1055), unpaired departing cohort (N = 373), and a paired cohort (N = 628) who were tested on arrival and departure. Meningococcal vaccination was received by all pilgrims, 98.2% received quadrivalent polysaccharide vaccine (ACWY), and 1.8% received meningococcal quadrivalent conjugate vaccine (MCV4). Only 1.61% and 23.03% received pneumococcal and influenza vaccines, respectively. Of the 1055 arriving unpaired pilgrim, 36 (3.4%) tested positive for nasopharyngeal carriage of N. meningitidis, and 24 (66.7%) of these were serogroup B, the remainder were non-groupable. Haemophilus influenza was detected among 45 (4.3%), and 11 (1%) carriers were positive for both N. meningitidis and H. influenzae. Out of 373 in the unpaired departing cohort, 6 (1.61%) tested positive for N. meningitidis, and 34 (9.1%) were positive for H. influenzae. Of the 628 paired cohort pilgrims, 36 (5.7%) pilgrims were positive for N. meningitidis at arrival and 16 (2.5%) pilgrims were positive after the hajj. Conclusion This the largest study of the epidemiology of N. meningitidis among pilgrims. The study showed a significant difference in the carriage between pilgrims from high endemicity and other pilgrims with a predominance of serogroup B. The continued use of ciprofloxacin as prophylactic antibiotics should be reconsidered as well as the consideration to add serogroup B as a required vaccination

Prevalence of Energy Drinks Consumption among Adolescents and Young Adults in Makkah, KSA

Energy drinks are a carbonated beverage containing high amount of caffeine and sugar as well as added vitamins and other substances. Objective: to estimate the prevalence of energy drink consumption among adolescents and young adults in Makkah, KSA. Methods: cross sectional study was conducted during the academic year 1437 H. The study included 1190 participants. A convenience sample of 1190 participants (521 female – 669 male) were recruited of the study. They were categorized into two groups based on their age; group 1: 575adolescents (12-19 year) and group 2: 615young adults, aged (˃19-25 year). Self-administered questionnaire was used to assess the prevalence of energy drink consumption. Questionnaire included five items: a) Demographic characteristics; b) Anthropometric measurements; c) Food Habits; d)Knowledge and believes; and E) Medical history. All analyses were conducted using the Statistical Package for the Social Sciences (SPSS) program, Version 20.0.Differences between males and females in respect of frequency of energy drinks intake were assessed by conducting a Chi-Square test. P- Value of less than 0.05 was considered to indicate statistical significance. Results: nearly half of the participants (46.73%) were consume energy drink. About (33.33%) from young adults male were consumed energy drinks while driving. Among young adult male who consumed energy drink, about 27.2% were drank more than 2 cans per day. 43.88% of young adult male were drank energy drink in the exam period. The most favorite energy drink was Code Red. Conclusion: energy drinks consumption is common practice among adolescents and young adults in Makkah, Saudi Arabia. We recommend further studies to evaluate the side effects of energy drinks consumption and factors that increase the consumption between adolescents and young adults. Also we recommend that handling of energy drinks to be under the supervision of the Ministry of Health. Keywords: Energy drinks, Adolescents, Young adult

2-Benzyl­sulfanyl-4-pentyl-6-(phenyl­sulfan­yl)pyrimidine-5-carbonitrile

In the title pyrimidine derivative, C23H23N3S2, the phenyl­sulfanyl and benzyl­sulfanyl benzene rings are orientated away from the carbonitrile group and are twisted out of the plane of the central ring with dihedral angles of 77.66 (6) and 64.73 (5)°, respectively. The n-pentyl group has an extended trans conformation. In the crystal, supra­molecular layers in the ab plane are sustained by C—H⋯π and π–π inter­actions [pyrimidine–phenyl­sulfanyl centroid–centroid distance = 3.8087 (7) Å]

Attitudes and perceptions towards hypoglycaemia in patients with diabetes mellitus: A multinational cross-sectional study

BACKGROUND: Preventing hypoglycaemia is an essential component of diabetes self-management that is affected by patients' attitudes and perceptions. This study aimed to explore the hypoglycaemia problem-solving ability of patients who have diabetes mellitus and factors that determine their attitudes and perceptions towards their previous events. METHODOLOGY: A cross-sectional study was conducted between October 2017 and May 2018 in three Arab countries (Jordan, Saudi Arabia and Kuwait) in patients with diabetes mellitus, who were prescribed antidiabetic therapy and had experienced hypoglycaemic events in the past six months. The Hypoglycaemia Problem-Solving Scale was used in this study. This scale contains two subscales, problem orientation (six questions) and problem-solving skills (eighteen questions), using a five-point Likert scale (range 0-4). Multiple linear regression analysis was used to identify predictors of hypoglycaemia problem-solving abilities. RESULTS: A total of 895 patients participated in this study from the three countries (300 in Jordan, 302 in Saudi Arabia, and 293 in Kuwait). The average age of the patients was 53.5 years (standard deviation = 13.7) and 52.4% (n = 469) were males. Patients had moderate overall problem-solving ability with a median score of 63.00 (interquartile range = 13.00). Patients' problem-solving skills score (68.1%) was better than their problem-orientation skills score (58.3%). The highest sub-scale scores were for detection control, setting problem-solving goals, and evaluating strategies, 75.0%. The lowest sub-scale score was for problem-solving perception and immediate management, 50.0%. Older age, being educated, being married, having T2DM, prescribed insulin therapy, and not having been admitted to hospital for hypoglycaemia were important predictors of patients' problem-solving ability (p < 0.05). CONCLUSIONS: Healthcare professionals are advised to provide more education to patients on how to self-manage hypoglycaemic events. Specifically, they should focus on the overall problem-solving perception of hypoglycaemia and its immediate management