Atypical Clinical Manifestations of Graves' Disease: An Analysis in Depth

Over the past few decades, there has been an increase in the number of reports about newly recognized (atypical or unusual) manifestations of Graves' disease (GD), that are related to various body systems. One of these manifestations is sometimes the main presenting feature of GD. Some of the atypical manifestations are specifically related to GD, while others are also similarly seen in patients with other forms of hyperthyroidism. Lack of knowledge of the association between these findings and GD may lead to delay in diagnosis, misdiagnosis, or unnecessary investigations. The atypical clinical presentations of GD include anemia, vomiting, jaundice, and right heart failure. There is one type of anemia that is not explained by any of the known etiological factors and responds well to hyperthyroidism treatment. This type of anemia resembles anemia of chronic disease and may be termed GD anemia. Other forms of anemia that are associated with GD include pernicious anemia, iron deficiency anemia of celiac disease, and autoimmune hemolytic anemia. Vomiting has been reported as a presenting feature of Graves' disease. Some cases had the typical findings of hyperthyroidism initially masked, and the vomiting did not improve until hyperthyroidism has been detected and treated. Hyperthyroidism may present with jaundice, and on the other hand, deep jaundice may develop with the onset of overt hyperthyroidism in previously compensated chronic liver disease patients. Pulmonary hypertension is reported to be associated with GD and to respond to its treatment. GD-related pulmonary hypertension may be so severe to produce isolated right-sided heart failure that is occasionally found as the presenting manifestation of GD

Evaluation of Cold Weather Performance of Rubber Modified Asphalt Placed in Ontario

Canada has close to 900,000 km of roads, which are key to supporting the Canadian economy as they enable for efficient transportation of goods and services. The Canadian road network should be well maintained and perform to a high standard to ensure the function and growth of the economy and the Country. It is also important to consider sustainability, and more specifically, recycling, when designing the roads. In order to improve on the performance while being sustainable, research is being conducted on the feasibility of using recycled materials in asphalt pavements. One of these materials is crumb rubber, obtained from recycled rubber tires, used as an additive to conventional Hot Mix Asphalt (HMA) to produce Rubber Modified Asphalt (RMA). These tires would otherwise end up in landfills, which is undesirable when considering sustainability. The Ontario Tire Stewardship (OTS), along with the Centre for Pavement and Transportation Technology (CPATT), the Ontario Ministry of Transportation (MTO), and the Ontario Hot Mix Producers Association (OHMPA) have combined their efforts in order to carry out a pilot study on paving roads in Ontario with crumb tire rubber. Three highways, Highway 7, Highway 35, and Highway 115, have been paved using RMA, along with a section paved with conventional HMA to conduct a comparative study on the performance of the RMA sections. During the paving, samples were collected from the pavers in order to conduct laboratory testing on the materials to determine their performance. The material was used to test the performance using the Thermal Stress Restrained Specimen Test, which introduces a stress in the sample material by cooling it to the point of failure while restraining the specimen, preventing it from relaxing. The specimen is cooled until failure, and the temperature at failure, along with the stress in the specimen is recorded for comparison. This test was conducted to determine the ability of the mixes to withstand the low temperatures that pavements in Ontario would have to endure. A structural evaluation was also carried out on the pavement mixes using the AASHTOWare software (formerly the Mechanistic Empirical Pavement Design Guide, MEPDG). Although there are limitations to the software, it was still important to determine the structural capacity of the mix within a pavement structure to withstand the stresses of traffic and climate. The results of the AASHTOWare software determines the performance of the rubber mixes, as compared to the conventional mixes, to ensure that utilizing the rubber mixes does not hinder the performance of the pavement

A Kinetic Analysis of the Iodination of Pyruvic Acid and Pyruvate Esters

In the present work the relative rates of iodination of pyruvic acid and ethyl and methyl pyruvate have been compared at 25.0° C. These studies allow the determination of the respective free energies of activation for these processes. Measurements have also been carried out at various temperatures to determine the enthalpies and entropies of activation for the spontaneous and base catalysed iodinations of these pyruvate systems. The present thesis also includes a comparison of the solvent deuterium isotope effects associated with the spontaneous rate of iodination of pyruvic acid and the alkyl pyruvates. Also, the catalytic rate coefficients associated with the basic components of various buffers have been determined for the iodination of methyl pyruvate. These values together with the spontaneous rate of iodination allow the determination of the Brønsted coefficient, S, associated with this process. From these kinetic results, we hope to delineate the mechanism of catalysis for the enolization of pyruvate systems: by distinguishing between intra- and intermolecular catalysed pathways and by accessing the relative importance of carbon-hydrogen bond breaking, and oxygen-hydrogen bond making in the transition states of these enolization processes

Neoadjuvant chemotherapy versus primary surgery in advanced ovarian carcinoma

BACKGROUND: Patients with advanced ovarian cancer should be treated by radical debulking surgery aiming at complete tumor resection. Unfortunately about 70% of the patients present with advanced disease, when optimal debulking can not be obtained, and therefore these patients gain little benefit from surgery. Neoadjuvant chemotherapy (NACT) has been proposed as a novel therapeutic approach in such cases. In this study, we report our results with primary surgery or neoadjuvant chemotherapy as treatment modalities in the specific indication of operable patients with advanced ovarian carcinoma (no medical contraindication to debulking surgery). PATIENTS AND METHODS: A total of 59 patients with stage III or IV epithelial ovarian carcinomas were evaluated between 1998 and 2003. All patients were submitted to surgical exploration aiming to evaluate tumor resectability. Neoadjuvant chemotherapy was given (in 27 patients) where optimal cytoreduction was not feasible. Conversely primary debulking surgery was performed when we considered that optimal cytoreduction could be achieved by the standard surgery (32 patients). RESULTS: Optimal cytoreduction was higher in the NACT group (72.2%) than the conventional group (62.4%), though not statistically significant (P = 0.5). More important was the finding that parameters of surgical aggressiveness (blood loss rates, ICU stay and total hospital stay) were significantly lower in NACT group than the conventional group. The median overall survival time was 28 months in the conventional group and 25 months in NACT group with a P value of 0.5. The median disease free survival was 19 months in the conventional group and 21 months in NACT group (P = 0.4). In multivariate analysis, the pathologic type and degree of debulking were found to affect the disease free survival significantly. Overall survival was not affected by any of the study parameters. CONCLUSION: Primary chemotherapy followed by interval debulking surgery in select group of patients doesn't appear to worsen the prognosis, but it permits a less aggressive surgery to be performed

TOPOLOGY OPTIMIZATION OF A MEMS RESONATOR USING HYBRID FUZZY TECHNIQUES

This paper introduces a new methodology for the design of structures by geometry and topology optimization accounting for loading and boundary conditions as well as material properties. The Fuzzy Heuristic Gradient Projection (FHGP) method is used as a direct search technique for the geometry optimization, while the Complex Method (CM) is used as a random search technique for the topology optimization. In the proposed method, elements are designed such that they all have the same amount of stresses using the Fuzzy Heuristic Gradient Projection method. On the other hand, the complex method is used for the topology optimization step satisfying any constraint other than the stress constraint. The developed hybrid fuzzy technique is applied for different applications ranging from micro-scale to macro-scale applications. The method is applied to a micro-mechanical resonator as a microelectro-mechanical system (MEMS). The resonator is solved for minimum weight and is subjected to an equality frequency constraint and an inequality stress constraint. The proposed method is compared with the Multi-objective Genetic Algorithms (MOGAs) on solving the MEMS resonator. Results showed that the proposed hybrid fuzzy technique converges to optimum solutions faster than (MOGAs). The time consumed is improved by a 77%

Vitamin D status, receptor gene BsmI (A/G) polymorphism and breast cancer in a group of Egyptian females

Background: Vitamin D is involved in a wide variety of biological processes including bone metabolism, modulation of the immune response, and regulation of cell proliferation and differentiation. The present study aimed to investigate vitamin D status and the genetic polymorphism BsmI (A/G) of vitamin D receptor (VDR) among a group of Egyptian female patients with breast cancer.Methods: The current study included 60 female patients diagnosed as breast cancer (BC) attending Mansoura Oncology Center, Mansoura University, and 60 age-matched healthy control females. Serum 25(OH) vitamin D level was measured using Enzyme-linked immunosorbent assay (ELISA) kit. A polymerase chain reaction-based restriction fragment length polymorphism (PCR-RFLP) method and fragment analysis were performed to determine the VDR BsmI (A/G) polymorphism.Results: 25(OH) vitamin D levels were significantly lower in the patients with BC (22.1 ± 10.9 ng/ml) compared to controls (41.2 ± 11.22 ng/ml) (p 6 0.001). Vitamin D deficiency- insufficiency was reported in 76.7% of BC patients and 20% of the controls (P 6 0.001, OR = 13.1, 95%CI = 5.5 31.4). Bb genotype was statistically higher in the BC patients than in the healthy controls (P 6 0.001). 81.2% of BC patients were of Bb genotype, 10.9% of BB genotype and 4.3% of bb genotype, while in controls, 33.3% for each genotype. No statistically significant difference in allele frequency was observed between the two studied groups. Carriers of Bb genotype had 4.6 times increased risk of developing breast cancer (95% confidence interval of 2.0–10.3) when compared to other genotypes.Conclusion: A significant association exists between vitamin D deficiency and the risk of breast cancer. B allele or Bb genotype of VDR may be a susceptibility risk factor for BC development

Epidemiology of and Risk Factors for Type 2 Diabetes in Egypt

Background: Diabetes is a fast-growing health problem in Egypt with a significant impact on morbidity, mortality, and health care resources. Currently, the prevalence of type 2 diabetes (T2D) in Egypt is around 15.6% of all adults aged 20 to 79. Objective: To describe the epidemiology, principal causes, associated risk factors, cultural aspects, and challenges that may contribute to the rapid rise in T2D in Egypt. Methods: Review of papers in PubMed and relevant gray literature. Findings: The International Diabetes Federation (IDF) has identified Egypt as the ninth leading country in the world for the number of patients with T2D. The prevalence of T2D in Egypt was almost tripled over the last 2 decades. This sharp rise could be attributed to either an increased pattern of the traditional risk factors for T2D such as obesity and physical inactivity and change in eating pattern or other risk factors unique to Egypt. These include increased exposure to environmental risk factors like pesticides and increased prevalence of chronic hepatitis C.. Conclusions: Prevention, early identification, and effective intervention are integral components of effective T2D care in Egypt. These strategies may reduce the expanding economic burden associated with T2D care

Fatty-acid binding protein 4 gene variants and childhood obesity: potential implications for insulin sensitivity and CRP levels

<p>Abstract</p> <p>Introduction</p> <p>Obesity increases the risk for insulin resistance and metabolic syndrome in both adults and children. FABP4 is a member of the intracellular lipid-binding protein family that is predominantly expressed in adipose tissue, and plays an important role in maintaining glucose and lipid homeostasis. The purpose of this study was to measure FABP4 plasma levels, assess FABP4 allelic variants, and explore potential associations with fasting glucose and insulin levels in young school-age children with and without obesity.</p> <p>Methods</p> <p>A total of 309 consecutive children ages 5-7 years were recruited. Children were divided based on BMI z score into Obese (OB; BMI z score >1.65) and non-obese (NOB). Fasting plasma glucose, lipids, insulin, hsCRP, and FABP4 levels were measured. HOMA was used as correlate of insulin sensitivity. Four SNPs of the human FABP4 gene (rs1051231, rs2303519, rs16909233 and rs1054135), corresponding to several critical regions of the encoding FABP4 gene sequence were genotyped.</p> <p>Results</p> <p>Compared to NOB, circulating FABP4 levels were increased in OB, as were LDL, hsCRP and HOMA. FABP4 levels correlated with BMI, and also contributed to the variance of HOMA and hsCRP, but not serum lipids. The frequency of rs1054135 allelic variant was increased in OB, and was associated with increased FABP4 levels, while the presence of rs16909233 variant allele, although similar in OB and NOB, was associated with increased HOMA values.</p> <p>Conclusions</p> <p>Childhood obesity is associated with higher FABP4 levels that may promote cardiometabolic risk. The presence of selective SNPs in the FABP4 gene may account for increased risk for insulin resistance or systemic inflammation in the context of obesity.</p

Characterization of Sidr (Ziziphus spp.) Honey from Different Geographical Origins

The current investigation was conducted to assess the melissopalynological, physicochemical, and biochemical properties, antimicrobial and antioxidant activities as well as total phenolic and total flavonoid contents of 794 Sidr honey samples collected from the Saudi market that had been imported from 12 different countries. Testing Sidr honey from different countries showed different levels of growth suppression observed against five drug resistant bacterial strains. The pathogenic strains were Staphylococcus aureus, Streptococcus mutans, Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa. The antimicrobial activity showed growth suppression levels which varied according to the origin of the honey. The comparative study of Sidr honeys revealed a strong correlation between total polyphenol and flavonoid contents and significant radical scavenging activities in particular Egyptian and Saudi Arabian honeys. The melissopalynological and physicochemical properties of different Sidr honeys complied with the recommendations of the WHO Codex Alimentarius, the European Union standards for honey quality, and the Gulf Technical Regulation on honey (GSO 147:2008-Standards Store-GCC Standardization Organization). It was concluded that Sidr honey from different geographical areas has the capacity to suppress the growth of pathogenic bacteria and perform significant radical scavenging activities