A Systemic Review of the Clinical Management in Diagnosis and Treatment of the Iron Deficiency Anemia in Adults

With a systematic review, this study aimed at exploring the clinical management in diagnosis and treatment of the iron deficiency anemia in adults, as the iron deficiency is the most frequent cause of anemia worldwide. And it impairs quality of life, increases asthenia and can lead to clinical worsening of patients. In addition, iron deficiency has a complex mechanism whose pathologic pathway is recently becoming better understood. This review summarizes the current knowledge regarding diagnostic algorithms for iron deficiency anemia. The majority of aetiologies occur in the digestive tract, and justify morphological examination of the gut. First line investigations are upper gastrointestinal endoscopy and colonoscopy, and when negative, the small bowel should be explored; newer tools such as video capsule endoscopy have also been developed. The treatment of iron deficiency is aetiological if possible and iron supplementation whether in oral or in parenteral form

Analytical Study of the Effects of Stress on Surgeons and Surgical Performance

This study aimed at exploring the effects of stress on surgeons and surgical performance, as the researchers adopted the methodology of descriptive analytical statistics by conducting a semi structured interviews on fourteen surgeons in Jordan. The aim of this study also was to investigate surgeons’ perceptions of surgical stress, highlight key stressors and their impact on performance, and identify coping strategies. Stress poses a serious risk for training surgeons since their performance and well‐being in reflected in patients' health. This study focuses on measuring the stress on surgeons and at the same time evaluates prospectively the results of practices that uses alternative techniques to combat the effects of stress. The study concluded that these interviews provided valuable insights into stressors, stress responses, and coping strategies used by surgeons and allowed us to categorize sources of stress. Although surgeons characteristically enjoy the stimulating features of their work, high levels of stress can affect performance adversely

Oral versus topical carbonic anhydrase inhibitors in ocular hypertension after scleral tunnel cataract surgery

Abdulmoghni Al-Barrag1, Motaher Al-Shaer1, Nabil Al-Matary2, Mahfoud Bamashmous11Ophthalmic Department, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Republic of Yemen; 2Ophthalmic Department, Military Hospital, Sana’a, Republic of YemenPurpose: To compare the effect of oral acetazolamide and topical 2% dorzolamide in prevention of ocular hypertension after scleral tunnel cataract surgery.Setting: Ophthalmic department, Sana’a University, Yemen Sana’a from March 2007 to October 2007.Methods: This prospective double-blind, randomized study included 150 eyes undergoing scleral tunnel cataract surgery with hard posterior chamber intraocular implantation. Methylcellulose was used as the viscoelastic in all surgery cases. Patients were assigned to one of three groups: group 1: topical gentamicin eye drops (control; n = 52); group 2: systemic acetazolamide 250 mg (n = 45); and group 3: topical 2% dorzolamide (n = 53). Acetazolamide patients received one 250 mg tablet, one hour before surgery, then half a tablet every eight hours. A topical dorzolamide 2% or gentamicin was applied in one drop one hour before surgery then every eight hours, for three days postoperatively. Intraocular pressures (IOP) were measured by Goldman applanation tonometry one hour preoperatively and 16, 24, and 48 hours postoperatively. Results: At 16 hours, IOP between the three groups increased significantly with a statistically significant p-value of 0.008, but the mean IOP of acetazolamide patients was less than other groups. IOP nearly returned to the normal level 24 and 48 hours postoperatively, but this was not statistically significant (p = 0.452 and 0.138, respectively).Conclusion: Acetazolamide offers better IOP control than topical dorzolamide 2% in preventing ocular hypertension after scleral tunnel cataract surgery. Keywords: cataract surgery, ocular hypertension, viscoelastic, dorzolamide, intraocular pressur

5-Fluorouracil for the treatment of intraepithelial neoplasia and squamous cell carcinoma of the conjunctiva, and cornea

Abdulmoghni Al-Barrag1, Mutahar Al-Shaer1, Nabil Al-Matary2, Mohammed Al-Hamdani21Ophthalmic Department, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Republic of Yemen; 2Ophthalmic Department, Military Hospital, Sana’a, Republic of YemenObjective: To evaluate the efficacy and risks of complications of pulse dosing of topical 5-fluorouracil (5-FU) in the treatment of corneal intraepithelial neoplasia (CIN), and conjunctival squamous cell carcinoma (SCC). Design: Prospective, noncomparative case series. Participants: Fifteen patients with histological evidence CIN or SCC of the conjunctiva and cornea were identified by tumor biopsy. Methods: All patients clinically evident of CIN, or SCC were evaluated, with maximum 30 months of follow-up were treated with pulsed dosing of 1% 5-FU. Treatment cycles were defined as four times per day for 4 days using the medication followed by 30 days without medication. The number of initial treatment was six cycles. Results: The mean age of the 15 patients was 50.8 years (range 25–78 years). Excision biopsy proved seven cases as CIN, and eight cases as locally invasive SCC. All patients remained disease free with a mean follow-up of 14.53 months (range 6-30 months). Additional chemotherapy was given after the initial treatment cycles, only for one case. 5-FU caused mild temporary local irritation, but no long-term intraocular or extra ocular complications. Conclusions: Adjuvant 1% topical 5-FU appears to be effective in the prevention of recurrence of conjunctival or corneal CIN and SCC after excision biopsy. Our results indicate that at least six cycles of topical 1% 5-FU is required to prevent local recurrence in the long term. It is well-tolerated and an effective method of treatment. No complications that would preclude use of our dose regimen were noted.Keywords: chemotherapy, fluorouracil, neoplasia, treatment cycle

Marc-Amédée Gromier, du linceul au drapeau blanc

En avril 1872, fraîchement sorti de la prison de Sainte-Pélagie où il a purgé six mois pour outrage au chef du pouvoir exécutif, le publiciste Marc-Amédée Gromier (1841-1913) réclame l’amnistie générale qui, seule, pourrait « tourner à l’avantage du pays et de l’humanité » l’« extrême surabondance de divisions sociales ». Il écrit alors :Il y a, par bonheur, dans les vaincus, dans les ouvriers, l’avenir le prouvera, des forces incompressibles dont on n’aura satisfaction qu’en les dirigeant, ..

Selenium: a brief review and a case report of selenium responsive cardiomyopathy

BACKGROUND: The authors review the role of selenium and highlight possible low selenium levels in soil that may result in deficient states in Saudi Arabia. CASE PRESENTATION: The authors report a case of selenium-responsive cardiomyopathy in a 15-month old Saudi Arabian boy. This case of selenium deficiency causing dilated cardiomyopathy is presented with failure to thrive, prolonged fever and respiratory distress. The investigations revealed selenium deficiency. Selenium supplementation along with anti-failure therapy [Furosimide, Captopril] was administered for 6 months. Following therapy the cardiac function, hair, skin and the general health of the patient improved significantly. CONCLUSION: The patient with dilated cardiomyopathy of unknown etiology, not responding to usual medication may be deficient in selenium. Serum selenium measurements should be included in the diagnostic work-up to ensure early detection and treatment of the disease. The selenium level in the Saudi population needs be determined. Vulnerable populations have to undergo regular selenium measurements and supplementation if indicated. Dependence on processed foods suggests that the Saudi population fortify themselves with nutrient and micronutrient supplements in accordance to the RDA

Complete genome sequencing and antibiofilm activity of an endophytic bacterium associated with marine sponge Hyrtios erectus collected from the Red Sea

Genome sequences of sponge bacterial endophytes will be useful for understanding the bioactive compound synthetic potential and molecular mechanisms of sponge-bacteria interactions. In this study, the complete genome of the bacterium E9 isolated from the Red Sea sponge species was sequenced and its antibiofilm activity was assessed through laboratory assay. Experiments indicated the strong antibacterial and antibiofilm activity of the extracts of bacterium E9. Complete genome sequencing reveals that genome assembly generated a single chromosome of 2123451 base pairs with a guanine-cytosine (GC) content of 32.9% with 2420 protein coding sequences and a gene/genome ratio of 83.7%. The bacterial strain was identified as Staphylococcus epidermidis based on phylogenetic analysis. A total of 9 biosynthetic gene clusters were identified in the genome using the open-source platform AntiSMASH. The observed antibacterial and antibiofilm activity of the strain E9 may be due the presence of gene clusters such as nonribosomal peptides, lasso peptides and terpenes. Overall, the whole genome analysis indicated the bacterium’s capability to adapt in diverse environments including invertebrate hosts, and bioactive compound synthesis

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Progressive familial intrahepatic cholestasis—outcome and time to transplant after biliary diversion according to genetic subtypes

BackgroundProgressive familial intrahepatic cholestasis (PFIC) is a heterogeneous disease characterized by progressive cholestasis in early childhood. Surgical therapy aims at preventing bile absorption either by external or internal biliary diversion (BD). Several different genetic subtypes encode for defects in bile transport proteins, and new subtypes are being discovered ongoingly. Overall, the literature is scarce, however, accumulating evidence points to PFIC 2 having a more aggressive course and to respond less favorable to BD. With this knowledge, we aimed to retrospectively analyze the long-term outcome of PFIC 2 compared to PFIC 1 following BD in children at our center.MethodsClinical data and laboratory findings of all children with PFIC, who were treated and managed in our hospital between 1993 and 2022, were analyzed retrospectively.ResultsOverall, we treated 40 children with PFIC 1 (n = 10), PFIC 2 (n = 20) and PFIC 3 (n = 10). Biliary diversion was performed in 13 children (PFIC 1, n = 6 and 2, n = 7). Following BD, bile acids (BA) (p = 0.0002), cholesterol (p &lt; 0.0001) and triglyceride (p &lt; 0.0001) levels significantly decreased only in children with PFIC 1 but not in PFIC 2. Three out of 6 children (50%) with PFIC 1 and 4 out of 7 children (57%) with PFIC 2 required liver transplantation despite undergoing BD. On an individual case basis, BA reduction following BD predicted this outcome. Of the 10 children who had PFIC 3, none had biliary diversion and 7 (70%) required liver transplantation.ConclusionIn our cohort, biliary diversion was effective in decreasing bile acids, cholesterol levels as well as triglycerides in the serum only in children with PFIC 1 but not PFIC 2. On an individual case level, a decrease in BA following BD predicted the need for liver transplantation

Thalassemias in South Asia:clinical lessons learnt from Bangladesh

Abstract Thalassemias are emerging as a global public health concern. Due to remarkable success in the reduction of childhood mortality by controlling infectious diseases in developing countries, thalassemias are likely to be a major public health concern in the coming decades in South Asia. Despite the fact that Bangladesh lies in the world’s thalassemia belt, the information on different aspects (epidemiology, clinical course, mortality, complications and treatment outcomes) of thalassemias is lacking. In this comprehensive review, the aim is to to depict the epidemiological aspects of thalassemias, mutation profile and current treatment and management practices in the country by sharing the experience of dealing with 1178 cases over 2009–2014 time periods in a specialized thalassemia treatment centre. We have also discussed the preventative strategies of thalassemias from the context of Bangladesh which could be effective for other developing countries