KINETIC CHANGES OF KIDNEY FUNCTION TESTS AMONG PATIENTSWITH KIDNEY FAILURE IN ROYAL MEDICAL SERVICES

Introduction: Kidney function tests are requested to monitor the general status of kidney health in general, and particularly to assess renal failure status. Objectives: To investigate the efficacy of therapeutic options for renal failure patients through studying changes in selected laboratory investigations.. Methodology: A retrospective study design was involved to review files of patients with kidney failure at Royal Medical Services. A total of 263 files were reviewed for kidney function tests over a period of three months. After the end of data collection, data were analyzed employing SPSS V20. The representation of data was as means and standard deviations. Kinetic changes were tested using paired T-test. Significance between variables was considered at an alpha < 0.05. Results Among study variable including Hematocrit (HCT), mean cell volume (MVC), blood urea nitrogen (BUN), creatinine, phosphorous, calcium, albumin, sodium, and potassium, there were insignificant changes except for BUN (p=0.004), sodium (p=0.013), and potassium (p=0.000). Conclusion From the results, following changes in the level of kidney function tests help in assessment of renal failure status as the progression of disease can be monitored. Understanding and comparing various laboratory findings help in better monitoring of clinical status of patients

FREQUENCY OF BLOOD GROUPS AMONGA SAMPLE OF PATIENTSWITH RENAL FAILURE AT ROYAL MEDICAL SERVICES

Introduction: Renal failure underlies various etiologies among which are infectious and autoimmune origins which may link directly or indirectly with blood groups. Objectives: To determine the frequency of blood groups among a sample of patients with renal failure at Royal medical services, and to investigate the association of renal function tests with blood groups. Methodology: A retrospective study design was followed to collect data from files of patients with renal failure. Files of renal patients was included if blood groups were written and kidney function tests were provided. A data sheet was made for each patient that included relevant information about renal patients. A total of 197 files were reviewed. Data were entered into excel sheet to make raw data for all patients. Data analysis was conducted using SPSS V20. Data were presented as frequencies and percentages. The relationships between blood groups and renal function tests were investigated using T-independent test. Significance was considered at alpha level < 0.05. Results: the most prevalent blood group among renal failure patients was blood group A (45.7%), blood group O (30.4%), blood group B (17.3%), and blood group AB (6.6%). When biochemical tests including renal function tests were compared between renal failure patients according their blood groups, results showed slight variations, which were not statistically significant (p>0.05), except for potassium level which was observed in its maximal level among patients with blood group A, and its minimal levels were observed among patients with blood group AB (p=0.032). Conclusions: The present study showed that renal failure patients exhibited more frequency with blood groups A and O and agreed with other studies in which blood group AB is the least associated blood group with renal failure. The level of potassium was highest in patients with blood group A and lowest in patients with blood group AB and this was statistically significant (p=0.032)

A mathematical modeling of the mitochondrial proton leak via quantum tunneling

The mitochondrion is a vital intracellular organelle that is responsible for ATP production. It utilizes both the concentration gradient and the electrical potential of the inner mitochondrial membrane to drive the flow of protons from the intermembrane space to the matrix to generate ATP via ATP-synthase. However, the proton leak flow, which is mediated via the inner mitochondrial membrane and uncoupling proteins, can reduce the efficiency of ATP production. Protons can exhibit a quantum behavior within biological systems. However, the investigation of the quantum behavior of protons within the mitochondria is lacking particularly in the contribution to the proton leak. In the present study, we proposed a mathematical model of protons tunneling through the inner mitochondrial membrane and the mitochondrial carrier superfamily MCF including uncoupling proteins UCPs and the adenine nucleotide translocases ANTs. According to the model and its assumptions, the quantum tunneling of protons may contribute significantly to the proton leak if it is compared with the classical flow of protons. The quantum tunneling proton leak may depolarize the membrane potential, hence it may contribute to the physiological regulation of ATP synthesis and reactive oxygen species ROS production. In addition to that, the mathematical model of proton tunneling suggested that the proton-tunneling leak may depolarize the membrane potential to values beyond the physiological needs which in turn can harm the mitochondria and the cells. Moreover, we argued that the quantum proton leak might be more energetically favorable if it is compared with the classical proton leak. This may give the advantage for quantum tunneling of protons to occur since less energy is required to contribute significantly to the proton leak compared with the classical proton flow

Reversal of Status Dystonicus after Relocation of Pallidal Electrodes in DYT6 Generalized Dystonia

Background: DYT6 dystonia can have an unpredictable clinical course and the result of deep brain stimulation (DBS) of the internal part of the globus pallidus (GPi) is known to be less robust than in other forms of autosomal dominant dystonia. Patients who had previous stereotactic surgery with insufficient clinical benefit form a particular challenge with very limited other treatment options available. Case Report: A pediatric DYT6 patient unexpectedly deteriorated to status dystonicus 1 year after GPi DBS implantation with good initial clinical response. After repositioning the DBS electrodes the status dystonicus resolved. Discussion: This case study demonstrates that medication-resistant status dystonicus in DYT6 dystonia can be reversed by relocation of pallidal electrodes. This case highlights that repositioning of DBS electrodes may be considered in patients with status dystonicus, especially when the electrode position is not optimal, even after an initial clinical response to DBS

Deletion variants of middle east respiratory syndrome coronavirus from humans, Jordan, 2015

We characterized Middle East respiratory syndrome coronaviruses from a hospital outbreak in Jordan in 2015. The viruses from Jordan were highly similar to isolates from Riyadh, Saudi Arabia, except for deletions in open reading frames 4a and 3. Transmissibility and pathogenicity of this strain remains to be determined

Development of Hyperkinesias after Long-term Pallidal Stimulation for Idiopathic Segmental Dystonia

Background:&nbsp;Chronic deep brain stimulation (DBS) of the globus pallidus internus (GPi) has become an established treatment for dystonia. While bradykinetic symptoms may occur on chronic stimulation, the appearance of hyperkinetic movements has not been well characterized.Case Report:&nbsp;We report on the development of hyperkinesias after more than 10 years of GPi DBS.Discussion:&nbsp;Hyperkinesias may evolve upon long-term GPi DBS in dystonia. This might be related to a combined effect consisting of a reduced threshold for effective GPi stimulation for dystonia and spread of current to the globus pallidus externus.&nbsp;</p

Human centromedian-parafascicular complex signals sensory cues for goal-oriented behavior selection

Experimental research has shown that the centromedian-parafascicular complex (CM-Pf) of the intralaminar thalamus is activated in attentional orienting and processing of behaviorally relevant stimuli. These observations resulted in the hypothesis that the CM-Pf plays a pivotal role in goal-oriented behavior selection. We here set out to test this hypothesis with electrophysiological recordings from patients with electrodes implanted in CM-Pf for deep brain stimulation (DBS) treatment of chronic neuropathic pain. Six patients participated in (1) an auditory three-class oddball experiment, which required a button press to target tones, but not to standard and deviant tones and in (2) a multi-speaker experiment with a target word that required attention selection and a target image that required response selection. Subjects showed transient neural responses (8-15 Hz) to the target tone and the target word. Two subjects additionally showed transient neural responses (15-25 Hz) to the target image. All sensory target stimuli were related to an internal goal and required a behavior selection (attention selection, response selection). In group analyses, neural responses were greater to target tones than deviant and standard tones and to target words than other task-relevant words that did not require attention selection. The transient neural responses occurred after the target stimuli but prior to the overt behavioral response. Our results demonstrate that in human subjects the CM-Pf is involved in signaling sensory inputs related to goal-oriented selection of behavior

Sensory Alterations in Patients with Isolated Idiopathic Dystonia: An Exploratory Quantitative Sensory Testing Analysis

Abnormalities in the somatosensory system are increasingly being recognized in patients with dystonia. The aim of this study was to investigate whether sensory abnormalities are confined to the dystonic body segments or whether there is a wider involvement in patients with idiopathic dystonia. For this purpose, we recruited 20 patients, 8 had generalized, 5 had segmental dystonia with upper extremity involvement, and 7 had cervical dystonia. In total, there were 13 patients with upper extremity involvement. We used Quantitative Sensory Testing (QST) at the back of the hand in all patients and at the shoulder in patients with cervical dystonia. The main finding on the hand QST was impaired cold detection threshold (CDT), dynamic mechanical allodynia (DMA), and thermal sensory limen (TSL). The alterations were present on both hands, but more pronounced on the side more affected with dystonia. Patients with cervical dystonia showed a reduced CDT and hot detection threshold (HDT), enhanced TSL and DMA at the back of the hand, whereas the shoulder QST only revealed increased cold pain threshold and DMA. In summary, QST clearly shows distinct sensory abnormalities in patients with idiopathic dystonia, which may also manifest in body regions without evident dystonia. Further studies with larger groups of dystonia patients are needed to prove the consistency of these findings

Centromedian–Parafascicular and Somatosensory Thalamic Deep Brain Stimulation for Treatment of Chronic Neuropathic Pain: A Contemporary Series of 40 Patients

Introduction: The treatment of neuropathic and central pain still remains a major challenge. Thalamic deep brain stimulation (DBS) involving various target structures is a therapeutic option which has received increased re-interest. Beneficial results have been reported in several more recent smaller studies, however, there is a lack of prospective studies on larger series providing long term outcomes. Methods: Forty patients with refractory neuropathic and central pain syndromes underwent stereotactic bifocal implantation of DBS electrodes in the centromedian–parafascicular (CM–Pf) and the ventroposterolateral (VPL) or ventroposteromedial (VPM) nucleus contralateral to the side of pain. Electrodes were externalized for test stimulation for several days. Outcome was assessed with five specific VAS pain scores (maximum, minimum, average pain, pain at presentation, allodynia). Results: The mean age at surgery was 53.5 years, and the mean duration of pain was 8.2 years. During test stimulation significant reductions of all five pain scores was achieved with either CM–Pf or VPL/VPM stimulation. Pacemakers were implanted in 33/40 patients for chronic stimulation for whom a mean follow-up of 62.8 months (range 3–180 months) was available. Of these, 18 patients had a follow-up beyond four years. Hardware related complications requiring secondary surgeries occurred in 11/33 patients. The VAS maximum pain score was improved by ≥50% in 8/18, and by ≥30% in 11/18 on long term follow-up beyond four years, and the VAS average pain score by ≥50% in 10/18, and by ≥30% in 16/18. On a group level, changes in pain scores remained statistically significant over time, however, there was no difference when comparing the efficacy of CM–Pf versus VPL/VPM stimulation. The best results were achieved in patients with facial pain, poststroke/central pain (except thalamic pain), or brachial plexus injury, while patients with thalamic lesions had the least benefit. Conclusion: Thalamic DBS is a useful treatment option in selected patients with severe and medically refractory pain

Foramen of Monro choroid plexus papilloma: An extremely rare location managed by endoscopic resection

Choroid plexus papillomas are rare brain neoplasms, primarily observed in children, and typically manifest with symptoms indicative of heightened intracranial pressure and cerebral irritation. In addition, the tumor's localization varies with the patient's age, and diagnostic and therapeutic approaches predominantly rely on imaging findings and surgical interventions, with histopathological examination being essential for confirmation. This study outlines a unique instance of choroid plexus papilloma in a 30-year-old female, who presented with severe headache and vomiting, subsequently revealing hydrocephalus on Brain CT. Remarkably, the tumor was identified in the Foramen of Monro, an exceedingly rare and unreported location in adults. Notably, the patient underwent successful endoscopic resection without complications, a technique sparsely documented in similar cases. Choroid plexus papilloma, predominantly afflicting children, displays varied tumor locations depending on the patient's age. Our report highlights an exceptional case with an atypical tumor location that was not reported before to our knowledge, and addressed through an innovative endoscopic resection method that was recently used in the management of such cases. This underscores the importance of considering diverse tumor presentations, as it has a favorable prognosis achievable through management, especially with the increasing number of reported cases. Moreover, it advocates for the adoption of emerging endoscopic approaches, which exhibit promising outcomes