Association of inferior vena cava filter placement for venous thromboembolic disease and a contraindication to anticoagulation with 30-day mortality

Importance: Despite the absence of data from randomized clinical trials, professional societies recommend inferior vena cava (IVC) filters for patients with venous thromboembolic disease (VTE) and a contraindication to anticoagulation therapy. Prior observational studies of IVC filters have suggested a mortality benefit associated with IVC filter insertion but have often failed to adjust for immortal time bias, which is the time before IVC filter insertion, during which death can only occur in the control group. Objective: To determine the association of IVC filter placement with 30-day mortality after adjustment for immortal time bias. Design, Setting, and Participants: This comparative effectiveness, retrospective cohort study used a population-based sample of hospitalized patients with VTE and a contraindication to anticoagulation using the State Inpatient Database and the State Emergency Department Database, part of the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality, from hospitals in California (January 1, 2005, to December 31, 2011), Florida (January 1, 2005, to December 31, 2013), and New York (January 1, 2005, to December 31, 2012). Data analysis was conducted from September 15, 2015, to March 14, 2018. Exposure: Inferior vena cava filter placement. Main Outcomes and Measures: Multivariable Cox proportional hazard models were constructed with IVC filters as a time-dependent variable that adjusts for immortal time bias. The Cox model was further adjusted using the propensity score as an adjustment variable. Results: Of 126 030 patients with VTE, 61 281 (48.6%) were male and the mean (SD) age was 66.9 (16.6) years. In this cohort, 45 771 (36.3%) were treated with an IVC filter, whereas 80 259 (63.7%) did not receive a filter. In the Cox model with IVC filter status analyzed as a time-dependent variable to account for immortal time bias, IVC filter placement was associated with a significantly increased hazard ratio of 30-day mortality (1.18; 95% CI, 1.13-1.22; P \u3c .001). When the propensity score was included in the Cox model, IVC filter placement remained associated with an increased hazard ratio of 30-day mortality (1.18; 95% CI, 1.13-1.22; P \u3c .001). Conclusions and Relevance: After adjustment for immortal time bias, IVC filter placement was associated with increased 30-day mortality in patients with VTE and a contraindication to anticoagulation. Randomized clinical trials are needed to determine the efficacy of IVC filter placement in patients with VTE and a contraindication to anticoagulation

Enhancing the Knowledge of Cervical Cancer Screening among Female Nursing Students: An Interventional Educational Program

Background: Cervical cancer is a growing health risk facing women worldwide with the human papillomavirus (HPV) as the primary underlying cause. Pap smear is a simple screening test that can detect early changes in cervical cells, which might develop into cancer cells. Raising awareness of cervical cancer prevention has a significant impact on decreasing the burden of the disease. The aim of the study is to assess female nursing students' knowledge on early detection and screening of cervical cancer, and to determine the effectiveness of an educational program. Methods: A quasi-experimental research design (one group for pre- and post-tests) was utilized with a convenience sample of 130 female nursing students in one of the nursing colleges in Saudi Arabia. The study’s educational intervention included information about anatomy of genital tract and the importance of regular check-ups. The pre- and post-tests were applied to identify changes after intervention measures. Results: The mean age of the participants were 21.32 years (SD: 1.34). The findings revealed a significant improvement of post-test students’ knowledge in all items related to risk factors, signs and symptoms, occurrence, identification of HPV as causative agent, vaccination against HPV, and finally Pap smear for early detection and screening of cervical cancer. Conclusion: The study results support implementing educational intervention to improve nursing students' knowledge and awareness about cervical cancer prevention. Furthermore, it is imperative that cervical cancer awareness education modules should be developed and integrated within the nursing curriculum. Further studies with large sample size are recommended to increase generalization of the results.  Key words: cervical cancer, education program, primary prevention, nursing students, Saudi Arabi

Association Between Lipid Profile and Glyceamic Control in Sudanese Children with Type 1 Diabetes Mellitus at Gezira State, Sudan

Introduction: Diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both. Objectives This study aimed to assess the metabolic control of type 1 diabetes mellitus (T1DM) in Sudanese children. Methods: One hundred and seventy four children with type 1 diabetes mellitus were enrolled in this study; 56 healthy non-diabetic children served as a control group. Glycosylated hemoglobin (HbA1c), total cholesterol (TC), triacylglycerol (TG), low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C) were measured, very low density lipoprotein-cholesterol (VLDL), and LDL-C/HDL-C ratio were calculated. Results: HbA1c,TC, LDL-C LDL-C/HDL-C ratio and TG were significantly higher among diabetic group compared to non-diabetic group (P<0.001 and P<0.05 for TG).In the diabetic group, there was a positive significant correlation of: HbA1c with TC, TG, HDL- C, LDL-C, VLDL and LDL/HDL ratio; TC with TG, HDL- C, LDL-C, VLDL and LDL/HDL; TG with LDL- C, VLDL and LDL/HDL ratio; HDL-C with LDL-C;LDL-C with VLDL and LDL/ HDL;VLDL-C with LDL/HDL ratio. A significant negative correlation was observed between HDL- C and LDL/HDL ratio. Diabetic group with poor metabolic control (HbA1c level >8).had significantly higher levels of TC and LDL-C (P<0.001),TG and VLDL (P<0.01), HDL-C and LDL-C/ HDL-C ratio (P<0.05) compared with diabetic group with good metabolic control (HbA1c <8%). Conclusion: 85.63% of diabetic patients were found to have poor metabolic control (HbA1c level >8). يوصف مرض السكري بأنه من المسببات المرضية المتعددة التي تتميز بفرط  سكر الدم المزمن واضطراب في التمثيل الغذائي ( اضطرابات من الكربوهيدرات والدهون واستقلاب البروتين) الناتج عن نقص في إفراز الأنسولين، عمل الانسولين أو كليهما.هدفت هذه الدراسة لاستخدام التقييم الكيموحيوي لمعرفة مدي التحكم لضبط السكر عند مرضي السكري النوع الاول. إشتملت هذه الدراسه علي 174طفل مصابين مرض السكري و56 أصحاء من نفس العمر.تضمنت هذه الدراسة  القياسات الكيموحيويه الأتيه: خضاب الدم المسكر، الكوليستيرول ، ثلاثي أسيل الجليسرول و الكوليستيرول المرتبط  بالبروتينات الشحميه منخفضة وعاليه الكثافة والبروتينات الشحميه المنخفضة جدا ونسبة البروتينات الشحميه منخفضة الكثافة الي البروتينات الشحميه عالية الكثافة. وجد أن تركيز كل من خضاب الدم المسكر، الكوليستيرول ، الكوليستيرول المرتبط  بالبروتينات الشحميه منخفضة الكثافة ونسبة البروتينات الشحميه منخفضة الكثافة الي البروتينات الشحميه عالية الكثافة وثلاثي أسيل الجليسرول يرتفع إرتفاعا ذا معني عند مجموعة مرضي السكري.مستوي خضاب الدم المسكر يرتبط إرتباطا موجبا ذا معني مع كل من الكوليستيرول ، ثلاثي أسيل الجليسرول والبروتينات الشحميه عالية ومنخفضة الكثافة والبروتينات الشحميه المنخفضة جدا ونسبة البروتينات الشحميه منخفضة الكثافة الي البروتينات الشحميه عالية الكثافة، الكوليستيرول مع كل من ثلاثي أسيل الجليسرول والبروتينات الشحميه عالية و منخفضة الكثافة والبروتينات الشحميه المنخفضة جدا ونسبة البروتينات الشحميه منخفضة الكثافة الي البروتينات الشحميه عالية الكثافة ، يرتبط ثلاثي أسيل الجليسرول مع كل من البروتينات الشحميه منخفضة الكثافة والبروتينات الشحميه المنخفضة جدا ونسبة البروتينات الشحميه منخفضة الكثافة الي البروتينات الشحميه عالية الكثافة . كما أن  مستوي البروتينات الشحميه عالية الكثافة يرتبط إرتباطا ذا معني مع نسبة البروتينات الشحميه منخفضة الكثافة الي البروتينات الشحميه عالية الكثافة.طبقا لتقسيم مجموعة الدارسين لمرض السكري العالميه الأمريكيه أظهرت هذه الدراسه أن نسبة (85.63)  من المرضي يبلغ معدل خضاب الدم المسكر عندهم أكثر من  8% (ضبط غير مقبول) بينما  (%14.37) يبلغ معدل خضاب الدم المسكر عندهم أقل من  8% (ضبط مقبول).  وجدت هذه الدراسة ان مرضي السكري والذين لديهم ضبط غير مقبول لخضاب الدم المسكر ترتفع عندهم مستويات الكوليستيرول ، ثلاثي أسيل الجليسرول و الكوليستيرول المرتبط  بالبروتينات الشحميه منخفضة وعاليه الكثافة والبروتينات الشحميه المنخفضة جدا ونسبة البروتينات الشحميه منخفضة الكثافة الي البروتينات الشحميه عالية الكثافة ارتفاعا ذا معني مقارنة مرضي السكري والذين لديهم ضبط مقبول لخضاب الدم المسكر

Awareness and Regulatory Measures in Caffeine Addiction: Medical Statistical Review

This study aimed at analyzing the degree of awareness and regulatory measures in the caffeine addiction within a medical statistical survey in Jordan, by attempting to answer the study two questions: What are the level of awareness and regulatory measures in caffeine addiction for positive psychological effects (alertness, attention and concentration)?, and: What are the level of awareness and regulatory measures in caffeine addiction for negative psychological effects (anxiety, depression and irritable)? The results of the study showed that there will be a statistically significant differences at the level of significance (α=0.05) of the awareness of caffeine addiction for both positive psychological effects (alertness, attention and concentration) and negative psychological effects (anxiety, depression and irritable) in Jordan. The researchers recommended to educate university students about the importance of controlling their caffeine intakes, and encourage university students to exploit the medical information provided by the medical studies about the risks of high doses of caffeine intakes

glue sniffing neuropathy and review of literature

Glue sniffing neuropathy commonly known as n-hexane neuropathy. It is well documented that industrial exposure to n-hexane causes neuropathy, however it is less well recognized that inhalation of n-hexane present in the vapors can also cause neuropathy However such patients are not seen that frequently. The acute worsening also generates differential diagnosis of GBS. Most of literature is reported from west .We report such case for the first time from Saudi Arabia. A 35 year old male presented to us with progressive numbness followed by weakness in both legs since last three weeks. Over next two week he became chair bound and in the beginning of third week he also stated to feel numbness in both the hands and some weakness was also noted in hands. His past history was significant for carpet cleaning glue sniffing for many years. His exam was significant for distal weakness feet greater than hands, deep tendon reflexes were absent all over. All sensory modalities showed glove and stocking pattern. Nerve conduction velocities showed slowing. His CSF exam was normal. We conclude that n-hexane is neurotoxic when inhaled to excess and, that the neuropathy has characteristic electrophysiological and pathological features

Micro Vascular and Macro Vascular Disease in Systemic Hypertension: The Role of Cardiac Imaging and Nitric Oxide Synthase Gene Polymorphism

Systemic Hypertension (HTN) accounts for the largest amount of attributable Cardiovascular (CV) mortality worldwide. There are several factors responsible for the development of HTN and its CV complications. Multicenter trials revealed that risk factors responsible for Micro Vascular Disease (MVD) are similar for those attributable to Coronary Artery Disease (CAD) which include tobacco use, unhealthy cholesterol levels, HTN, obesity and overweight, physical inactivity, unhealthy diet, diabetes, insulin resistance, increasing age and genetic predisposition. In addition, the defective release of Nitric Oxide (NO) could be a putative candidate for HTN and MVD. This study reviewed the risk stratification of hypertensive population employing cardiac imaging modalities which are of crucial importance in diagnosis. It further emphasized the proper used of cardiac imaging to determine patients at increased CV risk and identify the management strategy. It is now known that NO has an important eff ect on blood pressure, and the basal release of endothelial Nitric Oxide (eNOS) in HTN may be reduced. Although there are diff erent forms of eNOS gene allele, there is no solid data revealing the potential role of the polymorphism of the eNOS in patients with HTN and coronary vascular diseases. In the present article, the prevalence of eNOS G298 allele in hypertensive patients with micro vascular angina will be demonstrated. This review provides an update on appropriate and justified use of non-invasive imaging tests in hypertensive patients and its important role in proper diagnosis of MVD and CAD. Second, eNOS gene allele and its relation to essential hypertension and angina pectoris are also highlighted

Assessing suboptimal health status in the Saudi population: Translation and validation of the SHSQ-25 questionnaire

Background: Suboptimal Health Status (SHS) is realised as a vital feature for improving global health. However, the Arabian world does not have a validated instrument for screening SHS in their population. Therefore, the study aimed to evaluate the psychometric properties of Arabic-translated SHS (ASHSQ-25) in the Saudi Arabian population. Methods: We conducted a cross-sectional study among the conveniently sampled 1590 participants from the Saudi population (with a 97.4% response rate). The data was gathered through an online survey and then exported into SPSS and AMOS version 26.0 for analysis. Mann-Whitney and Kruskal-Wallis tests were used to identify the median difference between demographic groups. The one-tailed 90% upper limit of SHS scores was chosen as the cut-off criteria for SHS. Reliability and confirmatory analysis were performed for the psychometric evaluation of ASHSQ-25 in the Saudi Arabian context. Results: This study demonstrates that the ASHSQ-25 has good internal consistency, interclass correlation coefficient (ICC) = 0.92; 95% confidence interval (CI) = 0.91-0.93) and reliability (Cronbach\u27s α = 0.92). The confirmatory factor analysis (CFA) results indicated a good fit of the databased on the CMIN/degrees of freedom (df) = 4.461, comparative fit index (CFI) = 0.94, Tucker Lewis index (TLI) = 0.93, and Root Mean Square Error of Approximation (RMSEA) = 0.05. The result factor loadings for each item were high ( ≥ 0.55), except for one item from the immune system subscale. The SHS cut-off point for ASHSQ-25 was 33, leading to a 23.7% prevalence of SHS. Conclusions: This study reveals that ASHSQ-25 has appropriate internal consistency and structural validity to assess SHS in an Arabic-speaking population; therefore, it is recommended