Investigating impacts of altered central metabolism on ovarian function

Mammalian reproduction is highly dependent on the ovary. Ovarian health is crucial for the health of the female and the offspring. Observations of the timing of puberty and ovarian function reveal a major role for the metabolic status of the female on reproductive function. Many metabolic signals such as leptin, insulin, and LPS influence ovarian function as they participate in metabolic stress. All of these signals cross pathways at PI3K. Obesity, the accumulation of excessive fat, is an international health concern of wide prevalence. It causes an increase in circulating leptin, insulin, and LPS, and is associated with numerous reproductive disorders. Here, we investigated the effects of increasing systemic leptin during gestation on the offspring, and observed that gestational hyperleptinemia can alter the ovarian capacity to metabolize toxicants later in the offspring\u27s life. Heat stress is a condition of increased core temperature, and it impedes the reproductive performance of production animals during summer, making it an increased threat to food security, climate change only worsening it. Heat stress causes increased circulating insulin and LPS. We heat stressed gilts cyclically after synchronizing their estrous cycles, and observed decreased phosphorylation of AKT and increased TLR4 abundance in their ovaries. This demonstrates that, during heat stress, ovarian TLR4 signaling is upregulated and that the ovary might be initiating a stress response as indicated by reduced AKT phosphorylatio

Caffeine consumption among Zayed University students in Dubai, United Arab Emirates: A cross-sectional study

Background: Over the past decade, the global caffeine consumption rate has increased dramatically. Coffee and tea are among the common sources, but energy drinks are becoming an important contributor to total caffeine consumption. Recommendations for daily caffeine intake is not being followed due to the perceived benefits of caffeine which include mood improvement, concentration, social factors, and energy boosting. This study was important to add to the limited data about caffeine consumption in the Gulf region and mainly in the UAE. Objectives : The objectives were to determine the prevalence of caffeinated beverage consumption among university students and perceived benefits in addition to the estimation of daily caffeine consumption (mg/day). Design: Data was collected through a self-reported questionnaire from a total of 175 participants (129 females and 46 males) who were conveniently selected from different settings at Zayed University - Dubai. Usual Caffeine intake was calculated from all caffeine containing beverages.  Results: Eighty-six percent of the 175 participants, both males and females, at Zayed University-Dubai consumed caffeinated beverages with an average intake of 249.7±235.9 mg. The intake among the 150 caffeine consumers varied from 4.2 mg/day to 932.2 mg/day. Average intake of caffeine was not significantly different between genders (P=0.125). Thirty-five percent of the population consumed more than 400 mg/day of caffeine, with no statistical difference between males and females (P=0.202). Coffee was the most commonly consumed drink among both genders, followed by tea. Most perceived benefits of caffeine consumption were not significantly different except for the relationship between caffeine and improved exercise performance (P=0.018) and caffeine in relation to weight loss (P=0.001) among males. Conclusion: The prevalence of caffeine consumption at Zayed University was high among both males and females. Further research is necessary to estimate the total caffeine intake from all dietary sources, mainly the cultural foods and beverages, and to determine the relationship between accessibility to caffeine containing beverages and caffeine consumption among University student

Caffeine Consumption among Zayed University Students in Dubai, United Arab Emirates: A Cross-Sectional Study

Background: Over the past decade, the global caffeine consumption rate has increased dramatically. Coffee and tea are among the common sources, but energy drinks are becoming an important contributor to total caffeine consumption. Recommendations for daily caffeine intake is not being followed due to the perceived benefits of caffeine which include mood improvement, concentration, social factors, and energy boosting. This study was important to add to the limited data about caffeine consumption in the Gulf region and mainly in the UAE.Objectives: The objectives were to determine the prevalence of caffeinated beverage consumption among university students and perceived benefits in addition to the estimation of daily caffeine consumption (mg/day).Design: Data was collected through a self-reported questionnaire from a total of 175 participants (129 females and 46 males) who were conveniently selected from different settings at Zayed University - Dubai. Usual Caffeine intake was calculated from all caffeine containing beverages.  Results: Eighty-six percent of the 175 participants, both males and females, at Zayed University-Dubai consumed caffeinated beverages with an average intake of 249.7±235.9 mg. The intake among the 150 caffeine consumers varied from 4.2 mg/day to 932.2 mg/day. Average intake of caffeine was not significantly different between genders (P=0.125). Thirty-five percent of the population consumed more than 400 mg/day of caffeine, with no statistical difference between males and females (P=0.202). Coffee was the most commonly consumed drink among both genders, followed by tea. Most perceived benefits of caffeine consumption were not significantly different except for the relationship between caffeine and improved exercise performance (P=0.018) and caffeine in relation to weight loss (P=0.001) among males.Conclusion: The prevalence of caffeine consumption at Zayed University was high among both males and females. Further research is necessary to estimate the total caffeine intake from all dietary sources, mainly the cultural foods and beverages, and to determine the relationship between accessibility to caffeine containing beverages and caffeine consumption among University student

Dual Antiplatelet Regimens for Transcatheter Aortic Valve Replacement and Corresponding Cardiac CT Evaluation of the Leaflets: Single-center Experience

Background: Transcatheter aortic valve replacement (TAVR) is a globally established therapy. However, there is significant variability in the antithrombotic management post-procedure. The data on antiplatetet and direct antithrombin agents suggest antiplatelet agents suffice. The degree of leaflet thickening on cardiac CT and the clinical implications of this finding remain poorly understood. Here, the authors aim to examine a low-risk cohort treated with dual antiplatelet therapy and the corresponding cardiac CT and clinical findings. Methods: This is a descriptive single center study examining patients who received dual antiplatelet therapy post-TAVR from 2017 to 2019. Patients underwent clinical, echocardiographic and cardiac CT follow up. Signs and symptoms of ischemic stroke, valve function, gradient, and cardiac CT findings of hypo-attenuated leaflet thickening and reduced leaflet mobility were recorded for all those who completed 6 months of follow-up. The study was registered and approved by the Ethics Committee. Results: A total of 116 patients were included. Hypo-attenuated leaflet thickening was detected in 11 patients. Only one had accompanying reduced leaflet mobility and an increase in gradient. This patient did not have any evidence of stroke or valve dysfunction. After switching to rivaroxaban, the gradient improved and a repeat cardiac CT demonstrated resolution of the leaflet thickening. Conclusion: This study illustrates the utility of cardiac CT in detecting leaflet thickening and restricted mobility post-TAVR in low-risk individuals treated with dual antiplatelet therapy. However, its role in guiding antithrombotic regimens cannot be ascertained from this study and additional larger scale studies comparing different regimens in both symptomatic and asymptomatic patients are necessary. Trial Registration: N/A

Left Main Coronary Artery Interventions

The management of left main coronary artery (LMCA) disease has evolved over the past two decades. Historically, coronary artery bypass grafting (CABG) surgery has been the gold standard for the treatment of LMCA disease. However, with the advancements in percutaneous coronary interventions (PCIs) and stent technology, PCI in select patients has achieved comparable outcomes to CABG. As such, this has led to changes in the American College of Cardiology and European Society of Cardiology guidelines, which recommend that PCI might be an alternative to CABG in select patients. In this review article, we describe the historical perspective and early experience with coronary interventions of LMCA disease, landmark clinical trials and their effect on guidelines, and the role of intravascular imaging in the management of LMCA lesions

Primary Gastric Yolk Sac Tumour

Primary gastric yolk tumours are extremely rare. We report a 52-year-old male who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in 2017 after having undergone a gastrectomy abroad due to a suspected poorly-differentiated adenocarcinoma. The patient subsequently returned to Oman to receive chemotherapy. However, while undergoing chemotherapy, an abdominal computed tomography scan revealed a lobulated mesenteric mass. Microscopic examination of the resected lesion confirmed a diagnosis of a yolk sac tumour. The mass was diffusely positive for α-fetoprotein (AFP) and a gastric carcinoma stain was negative. Gastrectomy slides from the patient’s previous surgery were examined retrospectively. The morphology was typical for a yolk sac tumour and was negative for epithelial markers. An AFP stain showed diffuse immunoreactivity. Thus, the patient was deemed to have had a primary gastric yolk sac tumour which had later metastasised to the mesocolon. Germ cell tumour protocols were initiated and the patient responded well to treatment. Keywords: Yolk Sac Tumor; Germ Cell Tumor; Gastrectomy; Metastasis; Diagnostic Errors; Case Report; Oman

Cost-effectiveness Analysis of Ibuprofen versus Indomethacin or Paracetamol for the Treatment of Patent Ductus Arteriosus in Preterm Neonates.

This was a first-time evaluation that sought to analyze the cost-effectiveness of oral paracetamol and intravenous (IV) indomethacin as alternatives to ibuprofen for PDA in neonates. Decision-analytic, literature-based, economic simulation models were constructed, to follow up the use and consequences of oral/IV ibuprofen versus IV indomethacin, and oral/IV ibuprofen versus oral paracetamol, as first-line therapies for PDA closure. Model outcomes of interest were 'success', defined as PDA closure with/without adverse events, or 'failure' due to no response to the first course of treatment, death or premature discontinuation of therapy due to AEs. Oral ibuprofen is dominant/cost-effective over IV indomethacin in 97.9% of simulated cases, but oral paracetamol was 75.2% dominant/cost-effective over oral ibuprofen. Against IV ibuprofen, IV indomethacin was 55.3% dominant/cost-effective, whereas oral paracetamol was dominant/cost-effective in 98.5% of the cases. Sensitivity analyses confirmed the robustness of the study results. For PDA closure, while IV indomethacin was cost-effective against IV ibuprofen, oral paracetamol was cost-effective against both oral and IV ibuprofen