Diagnostic importance of platelet parameters in patients with acute coronary syndrome admitted to a tertiary care hospital in southwest region, Saudi Arabia

AbstractObjectiveIdentifying risk factors for acute coronary syndrome (ACS) is important for both diagnostic and prognostic purposes. Abnormal platelet parameters, mainly platelet count (PC), mean platelet volume (MPV) and platelet distribution width (PDW) are thought to be among these risk factors. In this study, the associations between PC, MPV and PDW and ACS were investigated in patients admitted to the tertiary care hospital in the south west region of Saudi Arabia.Materials and methodsA retrospective cohort of 212 patients with the diagnosis of ACS admitted to Aseer Central Hospital during the period extending from February 1, 2008 to October 31, 2008 were included. The control group consisted of 49 matched subjects who were admitted for chest pain investigation and subsequently found to be non-cardiac chest pain after performing relevant investigations. Blood samples were taken at the time of admission for platelet parameters. Statistical analysis was made using SPSS software and P-values were considered significant if <0.05.ResultsA total of 212 patients with acute coronary syndrome (80 patients with MI and 132 patients with UA) and 49 matched controls were studied. The PC was not statistically different among the three groups (283.3±94.8×109L−1 for MI cases, 262±60.8×109L−1 for UA cases and 275.8±58.9×109L−1 for controls). The MPV was significantly larger in MI cases compared to controls (8.99±1.5fl vs. 8.38±0.51fl, respectively, P<0.009), similarly, the MPV was significantly larger in UA cases compared to controls (9.23±1.19fl vs. 8.38±0.51fl, respectively, P<0.001). The PDW was significantly higher in MI cases compared to controls (15.88±1.5fl vs. 11.96±1.8fl, respectively, P<0.001), similarly, the PDW as also significantly larger in UA cases compared to controls (18.1±18fl vs. 11.96±1.8fl, respectively, P<0.019).ConclusionPlatelet parameters mainly MPV and PDW are readily available and relatively simple and inexpensive laboratory tests which we detected to be significantly raised in patients who have suffered an acute coronary syndrome compared with controls

Clinical and statistical correlation of various lumbar pathological conditions

AbstractCurrent clinical evaluations often rely on static anatomic imaging modalities for diagnosis of mechanical low back pain, which provide anatomic snapshots and a surrogate analysis of a functional disease. Three dimensional in vivo motion is available with the use of digital fluoroscopy, which was used to capture kinematic data of the lumbar spine in order to identify coefficients of motion that may assist the physician in differentiating patient pathology. Forty patients distributed among 4 classes of lumbar degeneration, from healthy to degenerative, underwent CT, MRI, and digital x-ray fluoroscopy. Each patient underwent diagnosis by a neurosurgeon. Fluoroscopy was taken as the patient performed lateral bending (LB), axial rotation (AR) and flexion-extension (FE). Patient specific models were registered with the fluoroscopy images to obtain in vivo kinematic data. Motion coefficients, CLB, CAR, CFE, were calculated as the ratio of in-plane motion to total out-of-plane motion. Range of motion (ROM) was calculated about the axis of motion for each exercise. Inter- and Intra- group statistics were examined for each coefficient and a flexible Bayesian classifier was used to differentiate patients with degeneration. The motion coefficients CLB and CFE were significantly different (p<0.05) in 4 of 6 group comparisons. In plane motion, ROMLB, was significantly different in only 1 of 6 group comparisons. The classifier achieved 95% sensitivity and specificity using (CFE, CLB, ROMLB) as input features, and 40% specificity and 80% sensitivity using ROM variables. The new coefficients were better correlated with patient pathology than ROM measures. The coefficients suggest a relationship between pathology and measured motion which has not been reported previously

Involved-site radiation therapy by volumetric modulated arc therapy versus 3D- conformal radiotherapy for treatment of stages I and II supra-diaphragmatic Hodgkin’s lymphoma

Purpose: Based on the observation that recurrences of Hodgkin's lymphoma (HL) typically occur in sites of initial nodal involvement the need to concise radiotherapy to only involved nodes that was termed as involved nodal radiotherapy (INRT) or of involved site lymph nodes, involved-site radiation therapy (ISRT) is starting to be widely accepted to use in early stage HL. We aimed in our study to compare between volumetric modulated arc therapy (VMAT) and 3D-conformal radiotherapy (3D-CRT) in radiation of early stage supra-diaphragmatic HL.Methods: The clinical and dosimetric data of 34 patients affected with stages I and II supra-diaphragmatic HL, treated between January 2011 and September 2015 with combined modalities therapy in a single institution were analyzed. Patients received 2-8 cycles of combination chemotherapy ABVD (Adriamycin, Bleomycin, Vinblastine &amp; Dacarbazine) on days 1 and 15 repeated every 28 days. The clinical target volume (CTV) was contoured based on the pre-chemotherapy CT and PET-CT scans. Modification of the CTV was done according to post-chemotherapy anatomical changes. The radiation dose given was 30 Gy/15 fractions.Results: After a median follow up period of 30 months, the progression free survival (PFS) and overall survival (OS) in both groups were 100%. Oropharengeal mucositis was the commonest toxicity in both groups. There was no statistically significant deference between the acute radiation toxicities in both groups. The Dmean valuefor lung was higher in 3D-CRT than VMAT (12.0 ± 6.1 Gy vs. 9.9 Gy ± 8.6 Gy). For the breasts volume, the V5Gy was slightly higher for 3D-CRT compared with VMAT at, 7.6% and 6.5% respectively. For the heart, V5Gy and V10Gy valueswere higher for the RA than for 3D-CRT accounting for (51.9 ± 28.9%) and (41.0 ± 24.6%) versus (40.0 ± 25.9% and 30.7 ± 22.5%) respectively. Thyroid gland mean dose was lower for VMAT (21.8 ± 7.7 Gy) than for 3D-CRT (26.8 Gy ± 4.1 Gy) but did not reach statistically significant value (P = 0.06).Conclusion: Involved-site VMAT technique is safe and effective in term of providing excellent local control and survival following ABVD-based chemotherapy

Effects of Electrohydraulic Therapy of Shock Waves on Pain and Lymphedema Measurement Post-Radical Mastectomy

Background: Lymphedema post-mastectomy remains a challenging problem. This study aimed to investigate the efficacy of shock wave electrohydraulic treatment (ESWT) for patients with pain and lymphedema. Methods: Thirty patients (30 women) with pain & lymphedema post-radical mastectomy were evaluated to participate in this Clinical trial. They were recruited from the Minia Cancer Institute- Minia University and Deraya University outpatient clinics. Their ages varied between the ages of 40 and 50 years. They were divided into two groups. Group (1) 'Group of studies': 15 patients seeking ESWT in addition to conventional medical care. Group (2) 'Control group': 15 people seeking conventional medical care only. Patients of the study group (1) were treated with a number of impulses, at least 500 shocks at E2 at 4Hz (equivalent to 0.11mJ/mm square energy). Treatment sessions were delivered twice weekly for six treatments (3 weeks). The assessment used a Visual analogue scale (VAS) for pain and arm circumference midway between the shoulder and elbow for lymphedema measurement. Results: showed that (ESWT) on pain and lymphedema measurement post-radical mastectomy effectively decreased pain as evidenced by the highly significant decreases in the visual analogue scale. These results revealed a substantial VAS reduction (P<0.0001). Effects of the ESWT on lymphedema measurement via the arm circumference measurement at the point where the shoulder and the elbow meet post-radical mastectomy were investigated. These results revealed a notable reduction in the mean value of the arm circumference measurement (ACM) (P<0.0001). Conclusion: The significant reductions in VAS and assessment of the ACM arm range show that the ESWT, in addition to conventional therapy, significantly impacted upper limb structural components following radical mastectomy

Preparation and in vivo Assessment of Nystatin-Loaded Solid Lipid Nanoparticles for Topical Delivery against Cutaneous Candidiasis

Solid lipid nanoparticles (SLNs) have gained great attention for the topical treatment of skin associated fungal infection as they facilitate the skin penetration of loaded drugs. Our work deals with the preparation of nystatin loaded solid lipid nanoparticles (NystSLNs) using the hot homogenization and ultrasonication method. The prepared NystSLNs were characterized in terms of entrapment efficiency, particle size, zeta potential, transmission electron microscopy, differential scanning calorimetry, rheological behavior and in vitro drug release. A stability study for 6 months was performed. A microbiological study was conducted in male rats infected with Candida albicans, by counting the colonies and examining the histopathological changes induced on the skin of infected rats. The results showed that SLNs dispersions are spherical in shape with particle size ranging from 83.26±11.33 to 955.04±1.09 nm. The entrapment efficiencies are ranging from 19.73±1.21 to 72.46±0.66% with zeta potential ranging from -18.9 to -38.8 mV and shear-thinning rheological Behavior. The stability studies done for 6 months showed that nystatin (Nyst) is a good candidate for topical SLN formulations. A least number of colony forming unit/ ml (cfu/ml) was recorded for the selected NystSLN compared to the drug solution and the commercial Nystatin® cream present in the market. It can be fulfilled from this work that SLNs provide a good skin targeting effect and may represent promising carrier for topical delivery of Nyst offering the sustained release and maintaining the localized effect, resulting in an effective treatment of cutaneous fungal infection

Nutritional Habits and Weight Status among Jazan University Students: Eating Patterns and Healthy lifestyle Assessment

Objectives The purposes of this study were to assess the prevalence of underweight, overweight, and obesity and to evaluate the nutritional habits, and related factors among the Students of Jazan University. Methods This cross-sectional study was carried out during the academic year 2014/2015 in Jazan University, Gizan, South West Saudi Arabia. A total of 436 students 19–25 y of age were examined. The questionnaires, including items on eating habits, lifestyle, and socio-demographic characteristics, were completed by the students. Data on weight, height were also collected.&nbsp; The data were analyzed using descriptive statistics and chi-square test. Differences were considered statistically significant at&nbsp;P. value &nbsp;&lt; 0.05. Results The mean weight for males and females were 67.84 and 54.79 kg respectively, with significant differences between males and females (P. value &lt;0.05). The mean BMI for all study participants was reported as 23.31 (kg/m²), also with significant difference between the males and females groups. About 45% of the students were of normal weight; the rate of obesity and underweight among students was very high (33.6% and 21.1% respectively), and their dietary habits were unhealthy. Regularity of meals was found only among (16.5% and 20.4%) males and females respectively. 83.3% of males and 95.1% of females reported eating snacks during the day. Conclusion The results of this study suggest that the prevalence of overweight and obesity were very high among the studied students. The study showed the need for health education programs on nutritional education in universities in order to increase awareness of students towards healthy eating and lifestyle. &nbsp

MRI characterization of 124 CT-indeterminate focal hepatic lesions: evaluation of clinical utility

Objective. To evaluate the diagnostic yield of MRI performed for characterization of focal hepatic lesions that are interpreted as indeterminate on CT. Patients and methods. In a retrospective investigation, 124 indeterminate focal hepatic lesions in 96 patients were identified on CT examinations over 5 years from 1997 to 2001. All patients had MRI performed for the liver within 6 weeks of their CT examination. CT and MR images were reviewed independently by two separate groups of two radiologists. The value of MRI in characterizing these lesions was assessed. Diagnoses were confirmed based on histology, characteristic imaging features, and clinical follow-up . Results. MRI definitely characterized 73 lesions (58%) that were indeterminate on CT. MRI was accurate in 72/73 of these lesions. MRI could not definitely characterize 51 lesions (42%). Ten lesions were not visualized on MRI, and follow-up imaging confirmed that no lesion was present in eight of these cases (pseudolesions). Conclusion. MRI is valuable for the characterization of indeterminate focal hepatic lesions detected on CT.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75168/1/13651820701216950.pd

Thermal decomposition kinetics of the antiparkinson drug “entacapone” under isothermal and non-isothermal conditions

© 2017 Akadémiai Kiadó, Budapest, Hungary The thermal decomposition kinetics of entacapone (ENT) have been investigated via thermogravimetric analysis under non-isothermal and isothermal conditions which provide useful stability information for their processing in the pharmaceutical industry and also for predicting shelf life and suitable storage conditions. The determination of the kinetic parameters for the decomposition process under non-isothermal conditions in a nitrogen atmosphere at four heating rates (5, 10, 15, and 20 °C min −1 ) was performed. Kinetic parameters of the decomposition process for ENT were calculated through Friedman, Flynn–Wall–Ozawa, Kissinger–Akahira–Sunose, and Li–Tang methods. This work demonstrates that the activation energies calculated from the decomposition reactions by different methods are consistent with each other. Moreover, the thermodynamic functions of the decomposition reaction were also calculated

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised