The Best Time for Completion Thyroidectomy on Differentiated Thyroid Carcinoma: A Literature Review

Background: Completion thyroidectomy is performed for high-risk differentiated thyroid carcinoma; however, the timing of the completion  thyroidectomy is a matter of controversy. The current review aimed to assess the best time for completion thyroidectomy in patients with differentiated thyroid carcinoma.Methods: An electronic search was conducted in various databases, such as Pub Med, Google Scholar, Scopus, and Medline, for relevant articles assessing the timing of completion thyroidectomy from the first published article to October 2019. Keywords, “completion thyroidectomy” and “timing” were used. The search was limited to articles published in the English language. Among the 190 articles retrieved, only 11 fulfilled the inclusion criteria.Results: Of the 11 articles included, two were from Europe, one from Africa, one from Australia, and seven from Asia, and all were retrospective studies with the mean duration of studies being 12.71 ± 12.31 years. Five studies (45.5%) showed no effect of timing on the outcomes, two (18.2%) recommended both early and late operation, another two (18.2%) concluded that late operation is better, one (9.1%) found that early surgery is better, while one study (9.1%) stated that the timing of operation should be based on the category of the patient.Conclusions: The results were mixed with some studies recommending late completion thyroidectomy, some observing that both early and late  thyroidectomy are safe, while some finding no effect of time on the completion thyroidectomy. Welldesigned controlled trials will resolve the issue. Keywords: early completion thyroidectomy, late thyroidectomy, timing&nbsp

The Cross-talk Relationship between Metformin and Gut Microbiota

Background: Metformin is the first-line oral therapy for type 2 diabetes mellitus. However, its mode of action is poorly defined. There is an increasing awareness regarding the cross talk of gut microbiota and metformin. The current review aimed to assess the bidirectional relationship between metformin and gut microbiota. Methods: Electronic search was conducted in Pub Med and the first 100 articles in Google Scholar published until November 2019. However, only randomized controlled trials on humans published in the English language were included.  The terms “gut microbiota,” “gut flora "and “ metformin” were as keywords to perform the search. Although 124 articles were retrieved, only six met the inclusion criteria of the study. Results: Of the six full texts of randomized controlled trials included in the study, two-thirds were published in Europe, one in the USA, and one in China. Six hundred-thirty five patients were included and the duration of the studies ranged from seven days to six months. The studies concluded that microbiota modulates some metformin actions on plasma glucose; while metformin enhances the abundance of microbiota that positively affect insulin resistance and plasma glucose. Conclusion: The current review showed that microbiota dysbiosis may mediate metformin antidiabetic effects. Whereas metformin shifted the gut microbiota toward the beneficial species ameliorating insulin resistance. The present study might provide insights into a novel therapeutic approach to treat type 2 diabetes mellitus. Key words: gut microbiota, metformin, type 2 diabete

Pattern and severity of childhood unintentional injuries in Ismailia city, Egypt

In 2009, more than 746 000 injury cases were registered in the Ministry of Health hospitals in Egypt, with an injury rate of 1 004/100 000 population. Around 38% of all injuries occur among children and young adults less than 20 years of age. Furthermore, more than 20 000 people lose their lives to injuries every year (27/100 000). However, these data lack information on injury pattern, severity, provided care and outcome of injuries, which are essential data for planning injury control programmes.The aim of this study was to determine the frequency, nature and risk factors of childhood injuries in the Suez Canal University Hospital Emergency Department.The study included a total of 551 children of 12 years of age. The most common causes of injuries among those children were falls (60%), road traffic injuries (15%) and burns (7%). The most commonly sustained injuries were fractures (23%), cuts or open wounds (21%), sprains (20%) and burns (13%). Overall injury severity scores (ISSs) were low across all injury types, except road traffic injuries (RTIs). The majority of patients were treated and discharged without disability (50.5%), while 7.4% had long-term temporary disability that lasted for more than 6 weeks, and 1.9% sustained permanent disability. There were two deaths (0.4% proportionate mortality); both of them were due to falls from a height.In conclusion, the study confirms the feasibility of documenting the burden of childhood injuries on health systems in Egypt. It also confirmed the need for tailored injury-prevention research in Egypt. The resulting data should encourage interventional trials to be conducted, appropriate injury-prevention strategies to be implemented and timely interventions to be planned.Keywords: Childhood unintentional injuries, Egypt, risk factors

Reproductive and lactation performance of Kenana and Butana crossbred cows, Gezira State, Sudan

Kenana and Butana cattle are the main indigenous dairy breeds in the Sudan. However, their productive performance is generally low compared to exotic breeds. This necessitates the crossbreeding with high milk producing breeds to meet the increasing demand for milk and dairy products through improving the genetic potential of the indigenous dairy cattle breeds. The objectives of this study were to determine the overall performance of Kenana and Butana 50% crosses with Friesian bulls, to estimate selected reproductive and lactation traits and to study the effects of dam breed, parity, lactation number, season and year of calving on those traits. A total number of 120 records for 30 dairy cows, each for four lactation seasons were used. Data were collected from the master records of Elbashaier dairy farm, about 10 km south of Wadmedani. They covered the years 1990- 2005. The overall means of crossbred dairy cows (days) for age at first calving, calving interval, open period, dry period and lactation period were 970, 400, 122, 65 and 332, respectively. Lactation, daily and standard yields (kg) were 3771, 12 and 3505, respectively. Kenana crossbred cows had higher calving interval, open, dry, lactation periods and lactation yield. Butana crossbred cows had higher age at first calving, daily and standard lactation yields. However, the effect of dam breed was not significant. Dam parity had significant effects (P≤0.05) on all traits except dry period. Age at first calving increased gradually while calving interval and lactation period decreased gradually with parity. Lactation yield was higher in the first and second parities, and daily and standard lactation yields were higher in the fourth parity. Lactation number had significant effects (P≤0.05) on all traits, except open period. Lactation period was higher in the first lactation, while dry period, lactation, daily and standard yields were least in the first lactation and increased with advanced lactation. Season of calving had significant effects (P≤0.05) on calving interval, open period, daily and standard lactation yields. Calving interval, open and lactation periods were longer, while, daily and standard lactation yields were lower during winter. Year of calving had significant effects (P≤0.05) on all traits except dry period. Age at first calving increased gradually with age

Favourable outcome of thrombotic thrombocytopenic purpura despite delayed presentation

Delayed presentation of thrombotic thrombocytopenic purpura (TTP). We report a female patient presenting with a headache and dizziness for two weeks, her past medical history is notable for epistaxis otherwise unremarkable. On examination she was pale with a tinge of jaundice. She was vitally stable, other systems were unremarkable. A peripheral blood smear showed evidence of microangiopathic haemolytic anaemia (MAHA) and thrombocytopenia. No evidence of organ dysfunction. Plasma exchange and corticosteroids were started with dramatic response. This case illustrates the efficacy of plasmapheresis in late TTP

The relationship between statins and diabetic retinopathy: A review of literature

BackgroundTreatment with statins is a robust strategy in reducing cardiovascular complications among patients with diabetes mellitus and chronic kidney disease. There is an increasing awareness regarding the association of statins with diabetic retinopathy.AimsThe current review aimed to assess the relationship of statins therapy to diabetic retinopathy.Methods The literature in PubMed and Google Scholar was searched for relevant articles from the first available article up to present using the terms statins, simvastatin, atorvastatin, pravastatin, and diabetic retinopathy. Among the 169 articles retrieved, 26 full-texts were assessed for eligibility and only sixteen studies (four from the USA, another four from Europe, six from Asia, and one from Australia and Brazil each) met the inclusion criteria for the systematic review. The author name, year of publication, country, type of study, number of patients, and the duration of the study were reported.ResultsThe studies reviewed showed that statins reduce the development of diabetic retinopathy, retard the progression of hard exudates and micro-aneurisms, reduce retinopathy and macular oedema.ConclusionStatins prevent and reduce the progression of diabetic retinopathy and macular oedema

Expanding Aquatic Observations through Recreation

Accurate observations of the Earth system are required to understand how our planet is changing and to help manage its resources. The aquatic environment—including lakes, rivers, wetlands, estuaries, coastal and open oceans—is a fundamental component of the Earth system controlling key physical, biological, and chemical processes that allow life to flourish. Yet, this environment is critically undersampled in both time and space. New and cost-effective sampling solutions are urgently needed. Here, we highlight the potential to improve aquatic sampling by tapping into recreation. We draw attention to the vast number of participants that engage in aquatic recreational activities and argue, based on current technological developments and recent research, that the time is right to employ recreational citizens to improve large-scale aquatic sampling efforts. We discuss the challenges that need to be addressed for this strategy to be successful (e.g., sensor integration, data quality, and citizen motivation), the steps needed to realize its potential, and additional societal benefits that arise when engaging citizens in scientific sampling

Expanding aquatic observations through recreation

This is the final version. Available on open access from Frontiers Media via the DOI in this recordAccurate observations of the Earth system are required to understand how our planet is changing and to help manage its resources. The aquatic environment-including lakes, rivers, wetlands, estuaries, coastal and open oceans-is a fundamental component of the Earth system controlling key physical, biological, and chemical processes that allow life to flourish. Yet, this environment is critically undersampled in both time and space. New and cost-effective sampling solutions are urgently needed. Here, we highlight the potential to improve aquatic sampling by tapping into recreation. We draw attention to the vast number of participants that engage in aquatic recreational activities and argue, based on current technological developments and recent research, that the time is right to employ recreational citizens to improve large-scale aquatic sampling efforts. We discuss the challenges that need to be addressed for this strategy to be successful (e.g., sensor integration, data quality, and citizen motivation), the steps needed to realize its potential, and additional societal benefits that arise when engaging citizens in scientific sampling.UK National Centre for Earth ObservationSmartfin/Lostbird FoundationDefr

The relationship between periodontitis and diabetic retinopathy: A cross-sectional longitudinal study

BackgroundPeriodontal disease is regarded as the sixth complication of diabetes mellitus. The association of periodontitis with diabetic retinopathy is controversial.AimsThe study aimed to assess the association of periodontitis with diabetic retinopathy.Methods This is a cross-sectional descriptive study conducted at a diabetes centre in Omdurman, Sudan during the period from July to September 2018. One hundred and fifty-nine patients with type 2 diabetes were interviewed using a structured checklist. The demographic data and diabetes complications including retinopathy were recorded. An experienced dentist assessed the participants for periodontitis. The Statistical Package for Social Sciences (SPSS, version 20, New York) was used for data analysis. A P-value of > 0.05 was considered significant.Results Out of 159 patients with type 2 diabetes mellitus (65.4 per cent females), their age mean±SD was 58.13±9.96, periodontal diseases were found in 22.0 per cent of patients, and retinopathy was present in 34.6 per cent, while the number of lost teeth was 3.86±3.05. Between patients, periodontal disease (+) vs. (-), the incidence rate of the followings did not differ retinopathy, neuropathy, nephropathy, and coronary history. However, those with periodontal disease, compared with those without, had significantly more lost teeth P-value < 0.05.ConclusionThe number of lost teeth was higher among patients with diabetic retinopathy. However, a cause and effect cannot be withdrawn. Further larger multi-centre studies assessing the association of retinopathy with the severity of periodontal disease and controlling for other causes of teeth loss are needed

Assessing emergency medical care in low income countries: A pilot study from Pakistan

Background: Emergency Medical Care is an important component of health care system. Unfortunately it is however, ignored in many low income countries. We assessed the availability and quality of facility-based emergency medical care in the government health care system at district level in a low income country - Pakistan. Methods: We did a quantitative pilot study of a convenience sample of 22 rural and 20 urban health facilities in 2 districts - Faisalabad and Peshawar - in Pakistan. The study consisted of three separate cross-sectional assessments of selected community leaders, health care providers, and health care facilities. Three data collection instruments were created with input from existing models for facility assessment such as those used by the Joint Commission of Accreditation of Hospitals and the National Center for Health Statistics in USA and the Medical Research Council in Pakistan. Results: The majority of respondents 43/44(98%), in community survey were not satisfied with the emergency care provided. Most participants 36/44(82%) mentioned that they will not call an ambulance in health related emergency because it does not function properly in the government system. The expenses on emergency care for the last experience were reported to be less than 5,000 Pakistani Rupees (equivalent to US$ 83) for 19/29(66%) respondents. Most health care providers 43/44(98%) were of the opinion that their facilities were inadequately equipped to treat emergencies. The majority of facilities 31/42(74%) had no budget allocated for emergency care. A review of medications and equipment available showed that many critical supplies needed in an emergency were not found in these facilities. Conclusion: Assessment of emergency care should be part of health systems analysis in Pakistan. Multiple deficiencies in emergency care at the district level in Pakistan were noted in our study. Priority should be given to make emergency care responsive to needs in Pakistan. Specific efforts should be directed to equip emergency care at district facilities and to organize an ambulance network