Background: Polycystic ovary disease (PCOD) is an endocrine disorder. It leads to menstrual disturbances, infertility, obesity and dermatological manifestations such as hirsutism and acne which leads to impaired health-related quality of life (QOL). Aims: To evaluate the perceived health related QOL in patients with PCOD treated with ethinyl oestradiol (35µg)/cyproterone acetate (2 mg) (EE/CPA) and ethinyl oestradiol (20 µg)/ desogestrel (0.15mg) (EE/DES) alone and in combination with low-dose metformin. Methods: A total of 117 patients with PCOD diagnosed according to Rotterdam Consensus Criteria 2003 with a hirsutism score of 8 or more according to modified Ferriman-Gallway Score (mFGS) were randomised to receive one of four drug combinations (arm A – EE/CPA, arm B- EE/DES, arm C- EE/CPA plus metformin, arm D- EE/DES plus metformin). The outcomes assessed were body mass index (BMI), hirsutism (using mFGS) and health-related QOL (Polycystic Ovary Syndrome Health- Related quality of life Questionnaire (PCOSQ) and a Visual Analog Scale (VAS) score) at baseline and 12 months after treatment. Results: PCOSQ score in relation to the hirsutism, emotions, menstruation, obesity, infertility and VAS score in relation to hirsutism and obesity had improved at the end of 12 months (p< 0.001) in all treatment arms. There was no difference between treatment arms in all measured outcomes at baseline and at the end of 12 months. Conclusion: Treatment with EE/CPA and EE/DES is associated with an improvement in perceived QOL in patients with PCOD. The addition of low-dose metformin did not have a significant benefit.

Background: The REFOCUS intervention was a whole team, complex intervention, designed to increase the recovery support offered by community based, mental health staff. The intervention consisted of two components: Recovery promoting relationships, which focused on how staff work with service users, and Recovery working practices, which focused on what activities and tasks staff and service users could do together. Aim: We aimed to investigate the experiences of community mental health workers using the REFOCUS intervention to support personal recovery. Method: In the context of the REFOCUS Trial (ISRCTN02507940), 28 semi-structured individual interviews and 4 staff focus groups, with 24 participants were conducted and thematically analyzed. Results: Staff valued coaching training and used coaching skills to have tough as well as empowering, motivational conversations with service users. They were positive about the resources within the ‘working practices’ intervention component. The whole team training and reflection sessions helped create team cultures, structures and processes which were conducive to supporting recovery practice. Conclusion: We recommend the wider use of coaching skills, strengths-based assessments, and approaches to support clinicians to broaden their understanding of service users’ values, treatment preferences and to support striving towards personally-meaningful goals. Staff who used these working practices changed their beliefs about what their service users were capable of, and became more hopeful practitioners. A team-based approach to support recovery creates a learning environment in which staff can support and challenge one another, making sustained practice change more likely.

Background: Alcohol and chat use during adolescence is associated with academic and health problems, including abuse or dependence in adulthood. The aim of the present study was to investigate associations between adverse childhood experiences (ACEs) and early initiation of alcohol and chat use among school-going adolescents. Methods: A cross-sectional study was performed with 546 school-going adolescents. The ACE International Questionnaire (ACE-IQ) was used to assess ACEs, Alcohol and chat use was assessed by questions prepared by the authors. Multiple logistic regression models were used to examine the associations between overall ACE score and alcohol use and the potential moderating effects of confounders. Results: prevalence of chat chewing behavior was 26.6% followed by alcohol use 20%. A total of 66.2% of participants reported at least one ACE, and 5.93% reported four or more ACEs. High/Multiple ACEs (ACEs=1-3 and above 3) were significantly associated with increased alcohol use behaviors (AOR=1.491(1.072-3.078) and (AOR=3.171(1.330-7.560) respectively and increased chat use behaviors by 4.92 times (AOR=4.92, 95%CI=2.640-8.432) and 11.022 times (AOR=11.022, 95%CI=1.230-25.560) respectively controlling other factors. Conclusion: ACEs were significantly associated with risk behaviors, alcohol and chat use may lead to poor health, and educational outcomes among adolescent students and numbers of ACEs have graded association. Social support, sex, residence, parent educational status, and current level of depressive symptoms were significant modulating factors, which parents, school teachers, psychologists, and adolescent health care providers should give the concern to decrease the effect on school-going adolescents. 

Background: Corneal abrasions are a common result of eye trauma. Corneal injuries are very common in both the adult and pediatric population and account for a significant proportion of the workload of most emergency departments. Although abrasion heals well with preservative treatment, it still causes pain and job lost. The abrasion result from the scrabble of the corneal epithelium. These injuries cause pain, tearing, lids spasm, light scare, foreign body sensation, decreased visual acuity/blurring, and a gritty feeling. The light, friction & wink was worse the condition. Most abrasion cure within 24-27 hours and seldom proceed to erosion or infection. The study aims to use bandage soft contact lens [BSCL] as a primary treatment for traumatic corneal abrasion [TCA] instead of traditionally use pressure patch [PP]. Patients and methods: The present prospective study has been conducted on 50 patients attending the out-patient department of ophthalmology in an Alyarmouk teaching hospital for six months after taking ethical permission. Before subjecting the patient to the treatment of bandage soft contact lens therapy, a detailed clinical history and thorough local examination have been done. A history indicating the occurrence of recent ocular trauma followed by severe pain, redness, lids spasm, photophobia, and tearing of the involved eye is suggestive of a corneal abrasion. Always we ask about contact lens wear as this can complicate the presence of an abrasion. To confirm the diagnosis of traumatic corneal abrasion we examine the cornea by slit-lamp under cobalt-blue filtered light after the application of tetracaine eye drops & fluorescein strips. The treatment of 50 consecutive patients presenting with traumatic corneal abrasion has been treated with anesthetic eye drop (tetracaine 0.5%) to relieve pain and lids spasm, antibiotic eye drop (ofloxacin 0.3%), therapeutic bandage soft contact lens was applied to provide pain relief and once again act as a splint to promote epithelial healing, then visual acuity was measured by Snellen chart, a cycloplegic eye drop (cyclopentolate 1%) was applied to relieve ciliary spasm & then preservative-free lubricant eye drop were applied lastly. This criterion dramatically relieves most, if not all of the pain the patient may be experiencing (which is a big plus for the patient and earns instantaneous trust), but it also allows the patient to return to work/school or any other daily activities. Patients have been evaluated after 24hours, 72hours and after 1week regarding pain, visual acuity, and complications. Though pressure patch [PP] occasionally advice in abrasion therapy, it does not assist and may prevent recovery. Employ the protective eyewear can preclude the traumatic corneal abrasion. Results: A total of 50 cases were enrolled in our study during the study period of 6 months. Out of 50 patients, there were 30males and 20 females and the male/female ratio was 3:2. The patient’s age was ranged from 5-35years. The commonest cause of injury was direct minor trauma (80% of cases), with cosmetic & optical contact lenses related problems accounting for 20% of presentations, visual acuity was documented correctly in 90% of adult and pediatric group and difficult to documented in children less than 6-year-old 10%. Traumatic corneal abrasion treated with bandage soft contact lens has an apparent advantage over the traditional pressure patch in terms of reduced pain, speedier healing, and an advantage of faster rehabilitation, facilitation epithelial healing, and proper surface hydration. Evaluation of pain revealed sufficient comfort with this regimen, allowing 45 patients (90%) to go back immediately to their occupations. Moreover, visual function is retained without any complication. Healing of the traumatic corneal abrasion occurred within 1 to 3 days in all patients, with minimal or no pain. The infection did not occur at the time of the follow up. We remove the bandage soft contact lens after 1 week to allow epithelial migration and attachment without the interference of the shearing forces of the upper lid. Conclusion: The use of bandage soft contact lens as a primary treatment for a traumatic corneal abrasion is a safe and effective method with anesthetic eye drop (tetracaine 0.5%), antibiotic eye drop (ofloxacin 0. 3%), cycloplegic eye drop (cyclopentolate 1%), preservative-free lubricant drop instead of traditionally pressure patch. Bandage soft contact lens causes dramatic improvement from pain, lid spasm, tearing & visual function is retained without any complication, and patients can immediately resume their regular activities.

Purpose: To evaluate the levels of salusin-beta (β-SAL) in the serum in patients with age-related macular degeneration (ARMD). Methods: Our study was designed as a controlled comparative clinical study. The β-SAL levels in serums of age and sex-matched 20 healthy volunteers as controls (Group 1), 20 patients with dry-age related macular degeneration (d-ARMD) (Group 2) and 20 patients with wet-age related macular degeneration (w-ARMD) (Group 3) were measured with the enzyme-linked immunosorbent assay (ELISA) method. Results: In our study, it was found that age and gender didn’t show a statistically significant difference among the study groups (p > 0. 05). The mean serum β-SAL levels in Group 1, Group 2 and Group 3 were 1372,17 ± 1126.69 pg/mL; 1423,71 ± 1196.84 pg/mL and 940,57 ± 1092.05 pg/mL, respectively. Although the meanβ-SAL levels in w-ARMD seem numerically lower than both the control and d-ARMD groups, this difference among the study groups was not statistically significant (p > 0.05). Conclusion: Our study suggests that β-SAL levels in the patients with ARMD and healthy controls were not different than each other. Further studies with large numbers may reveal possible relationships between β-SAL and ARMD.

Background: An infectious disease caused by a novel coronavirus called COVID-19 has raged across the world since December 2019. The novel coronavirus first appeared in Wuhan, China, and quickly spread to Asia and now many countries around the world are affected by the epidemic. The deaths of many patients, including medical staff, caused social panic, media attention, and high attention from governments and world organizations. Today, with the joint efforts of the government, the doctors and all walks of life, the epidemic in Hubei Province has been brought under control, preventing its spread from affecting the lives of the people. Because of its rapid spread and serious consequences, this sudden novel coronary pneumonia epidemic has become an important social hot spot event. Through the analysis of the novel coronary pneumonia epidemic situation, we can also have a better understanding of sudden infectious diseases in the future, so that we can take more effective response measures, establish a truly predictable and provide reliable and sufficient information for prevention and control model. Methods: We establish different models according to the different developments of the epidemic situation, different time points, and different response measures taken by the government. To be specific, during the period of 2020.1.23-2020.2.7, the traditional SIR model is adopted; during the period of 2020.2.8-2020.3.30, according to the scientific research results, it was considered that the novel coronary pneumonia has a latent period, so in the later phase of epidemic development, the government has effectively isolated patients, thus we adopt the SEIQR model accordingly. During the period of 2020.3.31-2020.5.16, because more asymptomatic infected people were found, we use the SEIQLR model to fit. Finally, through a SEIR simulator, considering the susceptible number, the latent number, the infected number, the cured number, death number and other factors, we simulate the change of various numbers of people from the beginning to the next 180 days of novel coronary pneumonia. Findings: The results based on the analysis of differential equations and kinetic models show that through the prediction of the model established in the first phase, the epidemic situation of novel coronary pneumonia in Hubei Province was controlled at the end of March, which is in line with the actual situation. The rest of Hubei province, except for Wuhan, lifted control of the departure channel from 0:00 am on March 25, and Wuhan was also unblocked on April 8. Through the establishment of the second-phase model, it is found that the epidemic situation will reach its peak in mid-February. For example, the quarantine admission of the hospital declined after mid-February, which is inseparable from the measures to build square cabin hospitals in early February so that more and more patients can be admitted. The model established in the third phase shows that the epidemic had been completely controlled by the end of May, which is also in line with the reality. Because in mid-May, the Wuhan government conducted a nucleic acid test on all the citizens to screen for asymptomatic infected persons to fundamentally control the spread of novel coronary pneumonia. Interpretation: Hubei Province, as the center of the initial outbreak of novel coronary pneumonia, people were forced to be isolated at home during the Spring Festival, the most important Chinese holiday, and the whole society was in a state of suspension of work and study. The Chinese government had taken many measures in response to the epidemic, such as shutting down the city, vigorously building square cabin hospitals, and prohibiting people from gathering. At the beginning of May this year, the epidemic in Hubei Province was finally effectively controlled. For ordinary citizens, we should not cause unnecessary panic about the unknown novel coronavirus. Instead, we should fully understand and be familiar with this virus. In addition to the relevant medical knowledge, we should also understand the spread of infectious diseases through appropriate mathematical models. By mathematical models, we can understand the degree of harm of infectious diseases, when to control it, how to stop it, and use scientific views to reveal the original face of the novel coronavirus to the public without causing social panic.

Four mestranol moieties were chemically linked to Zn(II) phthalocyanine (4) by cycloaddition “Click” reaction using a tetra-azidoethoxy substituted Zn(II)-phthalocyanine (3). The alkyl-azido coupling reaction was realized between azido groups of 3 and alkyl group of mestranol. The alkylation reaction was carried out to obtain cationic Zn(II) phthalocyanine derivative (5). The new compounds were chemically characterized by the known analytical methods. The absorption and fluorescence properties were studied in comparison. The absorption maxima of phthalocyanines 3, 4 and 5 were recorded at approx. shifts of 8 - 12 nm in the far- red region (680 - 684 nm) and the fluorescence maxima (692 - 693 nm) as compared to unsubstituted ZnPc (672 nm, 680 nm) in DMSO. The studies of singlet oxygen generation of 3, 4 and 5 showed relatively high values such as 0.52 for 3; 0.51 for 4 and 0.46 for 5. The fluorescence lifetime of 3.15 ns (3), 3.25 ns (4) and 3.46 ns (5) were determined with lower than the value than for the used standard ZnPc (3.99 ns). The high photo stability was observed for compounds 3, 4 and 5. In addition, the photosensitized oxidation of cholesterol was compared for 3 and 4 with much lower values of oxidation potential than for unsubstituted ZnPc which suggests that the substitution groups influenced on the photooxidation index of the target molecule.

Background: Patients with chronic kidney disease (CKD) are at the risk of increase hospital admission as compared to the general population, due to various reasons. They have increased vulnerability to cardiovascular diseases (CVD) as well as infections, therefore they usually got admit in health care units due to various reasons. The causes of hospitalization in CKD patients in this part of the world are not studied well. Methods: This cross sectional study was conducted in The Kidney Centre Post Graduate Training Institute (TKC-PGTI) of Karachi. Variables included in the study were age, gender, are of residence, ethnicity, smoking status and level of education. Comorbid conditions like causes of CKD and causes of hospitalization. Data analysis performed by using software IBM SPSS 21. Results: Total of 269 patients were enrolled in our study. The male 148(55%), mean age was 55 years. The most common cause of hospitalization in our population was infection148 (55%) and urinary tract infection (UTI) was the most common site of infection 55 (20%) followed by sepsis of unknown origin 29(10.8%). Cardiovascular events like volume overload 32 (11.4%) and acute coronary syndrome 20(7.4%) were the second most important cause of hospitalization. Conclusion: Hospitalization of CKD patients is high, and in our population infection is found to be the leading cause of hospital admission. Infection originating from urinary tract is more common in all stages of CKD patients, while blood born infection originating from double lumen (DL) dialysis catheter or arteriovenous fistula (AVF) cannulation is more common in dialysis population. Cardiovascular events, both acute coronary syndrome and pulmonary edema due to volume overload followed the infections.

Introduction: The phimosis condition is characterized by the inability to retract the foreskin on the glans, making it impossible to expose them. Surgical treatment, although effective, has been questioned by the risk to which the patient is exposed. Therefore, we have opted for the use of topical corticosteroids to resolve this pathology. Goals: To compare the effectiveness of Dexamethasone and Hyaluronidase + Betamethasone Valerate associated with preputial massage in the treatment of infantile phimosis, the degree of regression of phimosis, the time needed to achieve complete efficacy, possible adverse reactions, long-term outcome and parental adherence to treatment in children attending a specialized service in Blumenau, Santa Catarina. Materials and methods: Controlled clinical trial, quantitative, non-blind, prospective and randomized sample analysis through the analysis of 523 patients. Results: After 1 month of treatment, 435 patients presented some degree of regression and 63 children were referred to surgery. The success rate in this period was 45.8% in boys who were taking Hyaluronidase + Betamethasone Valerate and 49.8% in those who used Dexamethasone. In the late evaluation, 398 children reached grade 0, and 213 used Hyaluronidase + Betamethasone Valerate and 185, Dexamethasone; 39 patients were referred to the postectomy. Adherence to treatment was similar in both groups. The average time for degree 0 to be reached similar in both. Conclusion: Both topical corticosteroids were effective in the resolution of phimosis. However, in the evaluation after the first month and in the regression, Dexamethasone proved to be more effective. The time to resolution of the condition was similar for both. The surgical procedure was taken when there was no clinical improvement. No adverse effects were reported in both groups.

Ginseng extracts are often used as adaptogen to improve mental performances and well being, helping to overcome stress. Thus, in our times a lot of ginseng extracts are continuously produced and sold into commercial channels. Both Asian and Korean red ginseng (Panax ginseng) and American ginseng (Panax quinquefolius) are the most extensively used and researched. Both Panax ginseng and Panax quinquefolium contain different types of saponins, also known as ginsenosides, which are the substances that give ginseng medicinal properties. Human and animal studies showed that ginseng extracts can also have hypoglycemic effects. The mechanisms by which ginseng reduces blood glucose levels are unclear; some mechanisms have been proposed to explain its hypoglycemic effect, especially modulating effects on insulin sensitization and/or insulin secretion and regulating actions on digestion and intestinal absorption. We describe a case of hypoglycemia by ginseng in type 2 diabetic patient treated with oral hypoglycemic agents. Although, in order to provide better assessments of a sure anti-diabetic efficacy of ginseng, larger and longer randomized controlled clinical trials will be required, in our case we think that we have enough evidence to believe that the cause of hypoglycemia was ginseng. Obviously, this report should not be taken as a proof of the hypoglycemic effect of ginseng, nor it wants to be a suggestion to use ginseng in the treatment of diabetes; instead, it wants to be an alert for patients and clinicians to avoid hypoglycemia in daily clinical practice.

The etiology of abdominal obesity is multifactorial and has environmental factors as its most expressive risk factors. This study cross-sectional analyzed the association of abdominal fatness with physical inactivity and food inadequacy of 1,557 subjects, both genders, over 35yrs. old, enrolled in an ongoing epidemiological study. Waist circumference (WC) was the primary variable and demographic, social-economic, anthropometric and dietary intake data, were the co-variables. NCEP-ATP III, WHO, IPAQ-long (version 8) and Healthy Eating Index were used for functional definition of variables. Furthermore, longitudinal data from 50 subjects in an exercise protocol for 10 week receiving either regular diet (G1, n=22) or 30g fiber adequacy (G2; =28), were analyzed. The performed statistical analyses used software SAS for Windows, version 9.1 with p=0.05. In a predominantly female sample (74%), 76% aging 35-60yrs, 64% completed elementary school, 73% were living in a low income household, 77.5% overweight. The 62.5% presenting altered WC values were predominantly older, presented higher body fatness, and were consuming low variety-poor quality diet rich in fat (mainly saturated) and lower in fruit. WC correlated negatively with fruit intake and aerobic capacity (VO2max) but only carbohydrate (positive) and fruit intake (negative) were considered independent risk factors for abdominal obesity. In the longitudinal study, both G1 and G2 groups were similar at baseline and G1 maintained the anthropometry values throughout the experiment. Conversely, G2 decreased total body (4%) and WC (7%) fatness, reducing severe obesity by 16%, minimally affecting overweight and eutrophic rates. G2 presented 211% increase in fiber intake and 150% increase in plasma beta-carotene (colorful-fiber marker). Thus, in conclusion, recommended dietary fiber intake (increased fruit and low CHO intake) and physical activity would be the recommended changes against abdominal obesity and, by associating both physical exercises and dietary fiber there was indeed a decrease in abdominal fatness and obesity, predominantly at its higher grade.

Introduction: Obesity may cause progressive chronic kidney disease. Weight loss in the postoperative follow-up of bariatric surgery may improve renal function in these patients. Thus, the purpose of this study was to give insight on the subject using a sensible biomarker. Methods: This cross sectional study was performed in the Obesity Department from Campina Grande – Paraiba, Brazil. It was randomly enrolled 23 postoperative patients (7 bypass and 16 sleeve), with at least two years of follow-up, from the outpatient Department and 29 (18 bypass and 11 sleeve) in the preoperative period for bariatric surgery. They were homogeneously from both genders with ages ranging from 25 to 57 years. Serum levels of creatinine and cystatin C were measured, and the glomerular filtration rate (GFR) was estimated using the CKD Epi (chronic kidney disease epidemiology collaboration) cystatin-creatinine equation. The investigation was approved by the Ethics Committee. Results: The mean body mass index (BMI) of the preoperative group was significantly greater than the postoperative group (p ≤ 0.0001). The mean serum levels of C cystatin was significantly greater in the postoperative group as compared to preoperative (p= 0.0197). However, there was no mean difference between creatinine serum concentrations comparing the two groups (p = 0.3252). The mean glomerular renal function rates of the groups were similar (p = 0.1240). Conclusion: There is no definitive evidence for supporting the hypothesis that there is improvement in the kidney renal function after bariatric surgery in obese patients. Prospective cohorts are necessary to enlighten the answer for this important question.

Understanding the obesity-related genes may provide future therapeutic strategies to modulate disease progression. UCP2 separates oxidative phosphorylation (OXPHOS) from ATP production in the inner mitochondria. Figure 1 shows the differences among UCP1, 2, 3. The main role of UCP2 is controlling the metabolism of energy in the cells [1-3]. Besides that, the expression of UCP2 is associated with chronic inflammation due to reactive oxygen species (ROS). In this regard, in injured cells and tissues, ROS could be decreased by reducing the proton motor force by the anti-inflammatory effect of UCP2 [4].

Oxygen therapy is the main supportive treatment in hypoxemic respiratory failure and has traditionally been delivered using low and high flow devices. However, the maximal flow rates that these devices can deliver are limited because of the insufficient heat and humidity provided to the gas administered. Low flow devices such as the nasal cannula, conventional face mask and reservoir bag deliver a flow rate of up to 15 L/min by administering more variable oxygen fractions (FiO2), depending on the patient’s respiratory pattern, peak inspiratory flow and characteristics of the devices. Conventional high flow devices, such as venturi type masks, utilize a constant flow of oxygen through precisely sized ports, entraining the ambient air, using the Bernoulli principle, providing a more constant inspired oxygen fraction. However, they are less tolerated than nasal cannulas because they are less comfortable and the insufficient humidification and heating of the gas delivered [1]. In the last two decades, new devices have been developed to administer high humidified and heated flow through a nasal cannula (HFNC) that also allows the delivery of oxygen with a known FiO2 up to 100%. In the literature, this technique has also been called mini CPAP (continuous positive airway pressure), transnasal insufflation, high nasal flow ventilation, high flow oxygen therapy, and high flow nasal cannula oxygen therapy [2]. It is considered that high flow nasal cannula has certain benefits compared to those of oxygen therapy previously detailed. HFNC manages a flow of more than 30 L/min, which is able to surpass the peak inspiratory flow of the patient, being able to reach values ​​between 60-80 L/min depending on the flow used. The gas source, which may be delivered by an air/oxygen blender, fans, or a flow generating turbine, is connected by an active humidifier to a nasal cannula and the FiO2 can be adjusted independently of the flow. From a clinical point of view, there is some confusion between venturi and high flow nasal cannula devices. In the literature, both have been considered as high flow oxygen therapy devices. In our opinion this is not appropriate because the high nasal cannula flow is much more than a simple system for administering oxygen therapy [3]. Venturi-type masks provide the patient with a gas mixture with a controlled FiO2, but do not exert additional benefits on the ventilator mechanics of the patient. Nevertheless, HFNC allows the delivery of a high flow, which can also add oxygen therapy, providing a series of physiological effects that imply an active treatment to respiratory failure. Effects related to HFNC include the following: 1. Delivery of higher and more stable FiO2 values, ​​because the flow delivered is greater than the patient’s inspiratory demand. 2. The anatomical dead space decreases by washing the nasopharynx, consequently increases alveolar ventilation. This improves the thoracoabdominal synchrony. 3. Respiratory work decreases because it acts as a mechanical stent in the airway and markedly attenuates inspiratory resistance. 4. The gas administered is warmed and humidified, improving mucociliar clearance, reducing the risk of atelectasis, improving ventilation perfusion and oxygenation ratio. 5. There is a CPAP-like effect. The dynamic positive espiratory airway pressure generated by HFNC reaches a value between 6-8cmH2o depending on the flow and the size of the cannula. This positive pressure distends the lungs and ensures their recruitment. 6. Pulmonary end-expiratory volume is higher with HFCN than with conventional high-flow oxygen therapy. 7. In addition, the technique is considered easy and simple for the medical staff and nurses, and can be used in different areas (emergency, hospitalization, critical care unit, weaning centers) and even at home [4]. Currently available evidence has demonstrated that HFNC therapy is an alternative for the treatment of acute hypoxemic respiratory failure, hypercapnic respiratory failure, acute heart failure, as rescue therapy preventive therapy in post-extubation respiratory failure and in specific conditions such as bronchoscopy [5]. We believe that high-flow nasal cannula treatment should not be confused with high flow oxygen therapy of venturi masks. According to detailed mechanisms of action, HFNC is not limited to being only an oxygen therapy system but also behaves as a true treatment that can be used in different clinical scenarios, generating physiological benefits that result in the reduction of respiratory work. In addition, in venturi type masks, the air is not humidified and complications such as dryness and nasal pain are common, generating a poor tolerance to oxygen therapy. The benefits of proper humidification and heating of the gas delivered with HFNC therapy allow better comfort and tolerance of the patient with easy adherence to the treatment. All this contributes to making HFNC be considered a technique of choice in patients with hypoxemic respiratory failure. The growth in its use associated with easy acceptance for patients and the expansion in its application show us that HFNC is a promising therapy.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death and its prevalence and incidence is also related to smoking behavior [1]. COPD is still a chronic inflammatory and progressive disease caused by multifactorial agents including environmental pollutants [2]. Besides that, it is emerging that endogenous epigenetic factors induced by lifestyle and environment [3] could play a role in the etiopathogenesis of the disease [4]. In the last years, several authors suggested that low vitamin D levels seem to be related with the increase of COPD manifestations [5]. Moreover, a multicentre, double-blind, randomised controlled trial documented that vitamin D supplementation protects against moderate or severe exacerbation of the disease, but not by upper respiratory infections [6]. However, low levels of vitamin D can be extended to many other diseases, including multiple sclerosis, diabetes, colon rectal cancer, headache or drug use [7-11]. Moreover, it is also important to remember that Vitamin D deficiency is common in high latitude regions, such as northern Europe, New Zealand, northern USA, and Canada where weaker ultraviolet B rays is not able to produce enough vitamin D. Finally, methodological factors (using low sensitivity methods) could contribute to misleading evaluation of circulating vitamin D levels. In any case, here we shall remind that vitamin D has a fundamental role in immunity [12]. In particular, it has been reported that vitamin D is able to shift the pro-inflammatory T-helper cell 1 to anti-inflammatory T-helper cell 2 [13]. Therefore, benefits of vitamin D supplementation in chronic diseases which directly or indirectly affect immune system are obvious. Today, the burden of COPD in never smokers is higher than previously believed. Therefore, more research is needed to unravel the characteristics of non-smokers COPD [1]. Notably, vitamin D levels are reported to be significantly lower in smoker’ssubjects than in non-smokers ones [14]. Therefore, low plasma vitamin D levels in COPD seems to be more a causality than a correlation.

Acute pancreatitis forms a major bulk of our inpatient admission due to gall stone disease. Diagnosis of acute pancreatitis remains a challenge even now. Serum amylase remains the most commonly used biochemical marker for its diagnosis but its sensitivity can be reduced by late presentation, hyper-triglyceridemia and chronic alcoholism. We conducted a study to determine the levels of serum and urinary amylase in patients with acute pancreatitis and compared their sensitivity and correlation with CT findings vis-à-vis the severity of the disease. The study was taken as a post graduate research model in the Post graduate Department of General and Minimal Access Surgery, Govt. Medical College Srinagar, J&K, India 2014-2016 and submitted for the award of masters in General Surgery. A total number of 150 patients were enrolled in the studies which were admitted in our unit as acute pancreatitis. 73 (48.7%) belonged to the age group of 30-44 years, 15(10%) patients aged >60 years with 86 (57.3%) males and 64 (42.7%) females. We had 81 (54%) patients with biliary tract diseases, followed by 21 (14%) patients with worm induced, 20 (13.3%) had hyperlipidaemia and only 4 (2.7%) patients had post ERCP etiology. Tenderness in epigastrium was the presenting sign in 111 (74%), followed by chest signs in 25 (16.7%) patients, diffuse tenderness in 19 (12.7%), icterus in 11 (7.3%), low grade fever in 9 (6%) patients, shock in 5 (3.3%). Diabetes mellitus as a comorbidity was observed in 48 (32%) patients followed by hypothyroidism 37 (24.7%) patients. Hypertension was seen in 31 (20.7%) patients, COPD in 19 (12.7%) patients and obesity in 13 (8.7%) patients. Twenty two (14.7%) needed ICU admission; while as 128 (85.3%) were managed in the general ward. All the enrolled patients in our study were managed conservatively. Out of a total of 150 patients, 148 (98.7%) survived while as only 2 (1.3%) of our patients expired. At the time of admission in the hospital, 120 (80%) patients had serum amylase level of >450 U/L, 19 (12.7%) patients had 150-450 U/L levels while as 11 (7.3%) patients had <150 U/L serum amylase levels. CT has been shown to yield an early overall detection rate of 90% with close to 100% sensitivity after 4 days for pancreatic gland necrosis. The correlation of urinary amylase with the CECT Severity Scoring in a patient of acute pancreatitis is still ambiguous.

Objective: The main aim of the study was to compare outcomes based on diabetic control for patients undergoing formation of a new upper limb arteriovenous fistula (AVF). Research design and methods: A prospective cohort study was performed where we obtained baseline HbA1c in 65 patients before undergoing AV fistula formation. Patients were followed up at our clinic 6 weeks after creation to assess fistula maturity. Results: Multiple logistic regression was used to analyze the association between HbA1c status and maturity of AVF at 6 weeks after controlling for possible confounding factors such as age, sex, presence of hypertension and dyslipidaemia. Those with HbA1c less than 6.5 were 22 times likely to have maturity of AVF at 6 weeks as compared to those with HbA1c 6.5 or more (AOR = 22.65, p < 0.005) Conclusion: Good diabetes control, reflected by an HbA1c of less than 6.5, is associated with a very high possibility of AVF maturity at 6 weeks post creation.

The Positive Regulatory Domain (PRDM) protein family gene is involved in a spectrum variety of biological processes, including proliferation, differentiation and apoptosis: its member seem to be transcriptional regulators highly cell type and tissue peculiar, towards histones modifications or recruitment of specific interaction patters to modify the expression of target genes. In this study we analyzed the expression profile of different member of PRDM gene family focusing our attention on the role of PRDM2, PRDM4 and PRDM10 genes in mouse C2C12 cell line, during the differentiation of myoblasts into myotubes and speculate about the role of the protein Retinoblastoma protein-interacting zinc finger protein 1-RIZ1, coded by PRDM2 gene, as a regulator of the proliferation/differentiation switch. Results showed a reduction of PRDM2, PRDM4 and PRDM10 expression level during the commitment of the differentiation of myoblasts into myotubes. The RIZ1 silencing stimulated myoblasts differentiation, similar to the effect of serum deprivation on these cells, associated with an increase of Myogenin expression level, which is considered to be involved in the differentiation of myoblasts into multinucleated myotubes. As demonstrated by chromatin immunoprecipitation experiments, RIZ1 is associated with Myogenin promoter in proliferation condition and after 24h from differentiation induction, negatively controlling therefore Myogenin expression. Moreover RIZ1 silencing induced a reduction in PRDM4 and PRDM10 expression levels leaving us to speculate that the PRDM genes have a redundant role and they are hierarchically organized.

The normal levels of thyroid hormones (THs; thyroxine, T4 & 3,5,3′-triiodo-L-thyronine, T3) are necessary for the normal development [1-48], particularly the fetal and neonatal cardiac growth and development [49]. The actions of THs are facilitated genomically by thyroid receptors (TRs, α and β) and non-genomically at the plasma membrane, in the cytoplasm and in cellular organelles [4,49-55], by stimulation of Na+, K+, Ca2+ and glucose transport, activation of protein kinase C (PKC), protein kinase A (PKA) and mitogen activated and protein kinase (ERK/MAPK) [4]. In addition, the transport of T4 and T3 in and out of cells is controlled by several classes of transmembrane TH-transporters (THTs) [56], including members of the organic anion transporter family (OATP), L-type amino acid transporters (LATs), Na+/Taurocholate cotransporting polypeptide (NTCP), and monocarboxylate transporters (MCTs) [4,49,57,58]. Adding additional complexity, the metabolism of T4 and T3 is regulated by 3 selenoenzyme iodothyronine deiodinases (Ds: D1, D2 and D3) [59-61]. On the other hand, the congenital hypothyroidism can cause the following [49,62-64], (1) congenital heart diseases; (2) diastolic hypertension; (3) reduced cardiac output, stroke volume and a narrow pulse pressure; (4) dilatation and overt heart failure; (5) elevation in the systemic vascular resistance [65-68]. Similarly, the chronic hyperthyroidism can cause the following [49,64]: (1) cardiac hypertrophy; (2) increase in the cardiomyocyte (CM) length rather than width; (3) noticeable diminution in systemic vascular resistance; (4) elevation in the cardiac contractility; (5) systolic hypertension; (6) increase in the cardiac output, venous volume return, blood volume and pulse pressure; and (7) reduction in the systemic vascular resistance [49,69]. T3-therapy can induce DNA synthesis and cardiomyocyte proliferation, and improve the cardiac contractility; though, this action is as still unidentified [49,70-74].

Objective: To describe the presenting clinical findings of patients with acute appendicitis and compare them with those described in the medical literature. To corroborate a common medical myth among Hispanic physicians regarding the presentation of acute appendicitis. Methods: This was a retrospective multicenter chart review of patients diagnosed post-operatively with appendicitis after presenting to five different Emergency Departments in Southern Puerto Rico (PR). Results: A total of 1,540 patients with pathologically confirmed cases of appendicitis were enrolled in our study. Of the study population, 45% were female, and 55% were male, and 43% were over 21 years old. Reported symptoms in our study showed that 98% of the patients had abdominal pain, 47% had nausea, and only 17.6% presented with anorexia. Conclusion: It was our main objective to compare the presenting signs and symptoms of patients with acute appendicitis in our Hispanic population in southern PR with those found in primary medical textbooks and literature. We gathered information regarding signs and symptoms, as well as laboratory and radiographic data of patients with positive pathologic exams for appendicitis. Of the 1,540 patients with confirmed appendicitis, only 17.6% presented with anorexia. Our findings demonstrate that the rate of anorexia in the studied population is significantly lower when compared to current literature. The absence of anorexia, once considered a hallmark of appendicitis, must not lead the physician to rule out this diagnosis in the Hispanic population.