patients

We utilized the training impulses method to numerically quantify the volume of physical exercise to be prescribed to postmenopausal obese women in such a way of obtain the best possible improvement of their health-related quality of life. Nine women (57±4 years, 89±2 kg, 157±9 cm) carried out 3-months of exercise training (3 session/week each lasting 80 min) under the supervision of skilled operators which indirectly calculated the volume of physical exercise by assessing heart rate values while patient exercised and making sure that the workload corresponded to 50-60% of their maximum oxygen uptake. Before and after training anthropometric, functional and biomechanical variables were assessed. After training patients shoved statistically signifi cant (P<0.05) reduction in body mass (-2%) and body mass index (-4%), waist circumference (-4%), total (-6%) and LDL (-26%) serum cholesterol and glycaemia (-8%), diastolic arterial blood pressure (-14%), and oxygen cost (-14%) at the maximum workload during incremental cardiopulmonary test, the sway area from unipedal stance (right leg) of 20 s on a pressure platform (-49%), while increased both free fat body mass percentage (+3%) and space covered during the six minute walk test (+11%). It was concluded that, when an exercise protocol is carried out by postmenopausal obese women and the volume of exercise is instrumentally controlled by experienced operators, it could result in an effective benefi t on the quality of life of these patients since they ameliorate some critical anthropometric and functional parameters.

Gestational diabetes mellitus is becoming a very common medical disorder associated with pregnancy especially so in the Middle East and more so in Saudi Arabia, thus putting the women and fetuses at an increased risk of maternal and neonatal morbidity and mortality. Screening for Gestational diabetes mellitus was recommended because of its asymptomatic nature and good proportion of patients with no classic risk factors. We recommended universal screening because of the beneficial effect of screening, diagnosis and subsequent treatment. The most recent study done in Security Forces Hospital showed a significant decrease in morbidity and mortality with application of the new values of screening, in spite of the increase of incidence of Gestational diabetes mellitus from 14.5 % in 2005 study, to 23.9 % in the recent study in 2015. Objectives: To highlight and determine the best screening method values of FBS and 2hrspp used to diagnose gestational diabetes mellitus. Maternal & neonatal out come and associated risks for patients who had Gestational diabetes mellitus, where scrutinized. The study was done in the period from June 1st 2013-31 of May 2014. Design: Retrospective cohort study. Setting: Tertiary centre (Security Forces hospital _Riyadh_Saudi Arabia). Patients: Out of 6849 patients who had their delivery in Security Forces Hospital between June 2013 and May 2014 (one year), 6340 patients (92.5 %) were screened for gestational diabetes mellitus, and out of these 1516 patients (23.9 %) were labeled as Gestational diabetes mellitus after exclusion of cases of IDDM and NIDDM. Main outcome measured: The purpose of this study is to advise on using new values for diagnosis of gestational diabetes and to assess the outcome of pregnancy after new values are implemented in security forces hospital for diagnosis. The outcome included ages of mothers, parities, number of abortions, associated medical disorders, and estimated blood loss. Control methods were also reviewed, gestational age of induction of labor. Associated intrapartum complications as well as fetal outcome were also reviewed. The weight of babies, congenital abnormalities, admission to neonatal intensive care unit were also studied. The different values used , and percentages of diagnosed values of last 3 studies done in Security Forces Hospital in comparison to the most recent study with new values(2014-2015) as shown in table 11. Results: The incidence of gestational diabetes mellitus increased from 14.5 % in the year 2003 - 2004 to reach 23.9 % in 2014, in the same institute (Security Forces Hospital), where the study was done using different values. In our study in Security Forces Hospital we recorded a significant decrease in morbidity and mortality on applying the new values. A significant reduction in the number of expired babies of mothers who were diagnosed as gestational diabetes with new values with a decrease from 5.6 % in previous years studied to reach 1.5 % in 2014, reflecting the effective control and the good catch for the new values. Conclusion: Universal screening, with whatever values to blood sugar used, is a better method screening than the selective one: Using 75 gram of Oral Glucose Tolerance Test proved to be cost effective, easily accessible, and with good pickup rate of up to 93 % of patients in Security Forces Hospital. Recommendations: To continue using the new values that will be universally implemented, with long term follow-up of mothers and newborn.

Objectives: To check if there is any significant difference in the immediate outcome of pregnancy with diabetes using the new values of FBS & 2hrs post prandial with 75g OGTT for 1 year (from 1st June 2013-31st May 2014) in comparison to the previous data done in the same institute with other values and with international figures. The data in our study included fetal, maternal morbidities, intra partum and postnatal outcomes, in order to help, if possible, on deciding the best values to use for screening for gestational diabetes mellitus. Furthermore, to know the new percentages of gestational diabetes mellitus in SFH by utilizing the new values of Blood Sugar readings. Design: Retrospective cohort study Setting: Security Forces Hospital-Riyadh-Saudi Arabia Patients: Done (from 1st June 2013 – 31st May 2014), on patients who had attended Security Forces Hospital, Riyadh, Saudi Arabia. This chosen year’s data was compared with data collected in the three previous years using different figures. Main Outcome measured: Average age of mother, maternal aspects of parity, history of GDM, number of abortions``````````````````````````````, estimated blood loss in labor, associated medical disorder, complications of previous pregnancies, methods of control of GDM, gestational age for IOL and associated intrapartum complications. Immediate neonatal outcome in cases of GDM, comparison of birth weights of babies & any specific congenital abnormalities and delayed causes of admission to NICU in the 4 years studied were also reviewed. Results: The percentage of diagnosed cases of gestational diabetes mellitus (GDM) after screening was 24 % as compared with 14.5% in previous study of 2003-2004 & with the number of screened patients amounting to 93% out of the total number of deliveries between 2013-2014 (in both years universal method of screening was used). The multidisciplinary set up of our GDM specialized clinic which was composed of dieticians, diabetic educators, endocrinologists and obstetric physicians operating together, helped to reduced the use of insulin in combination with diet to only 24% in comparison to 76% of patient using diet and exercise alone. The study showed a mean age of 33years and weight of 77kg. It was also noted that 16% of the patients diagnosed with GDM were multiparous averaging 1-5 deliveries. Almost 62% of patient didn’t give any history of GDM and no history of previous medical diseases. The majority of the patient with GDM delivered without complications during labor, with 30% having vaginal lacerations & 73% of patient had an estimated blood loss of less than 500cc. NICU admissions secondary to hyperbilirubinaemia averaged almost 17% in comparison to previous studies and only one baby expired in a GDM patient. Our study revealed a good fetal and maternal out come with less delivery complications and less incidence of postpartum hemorrhage (5.7%). Conclusion: It is concluded that Universal Screening of Pregnant women whether with previously used glucose value or new ones for gestational diabetes mellitus is a better option, which has proven to improve both maternal and fetal outcomes. The 75 OGTT test is a cost effective test and with both easy accessibility and good screening pick up number (92.5%) of the patients in Security Forces Hospital, Riyadh. Recommendation: We recommend annual follow up for patients, both the mother and the baby after postpartum, to prevent the development of type 2 diabetes.

Objectives: To highlight and determine the maternal and neonatal outcome and associated risks for patients who have undergone their 6th and more caesarean sections. Design: Case control study. Setting: Tertiary Centre (Security Forces Hospital – Riyadh – Saudi Arabia). Patients: 80 patients selected to study group who have undergone their sixth and more caesarean sections in Security Forces Hospital. Between June 2006 and May 2010. This group was compared to 80 patients who have undergone their third to fifth caesarean sections during the same time period and immediately following the studied case. Main outcome measured: Age and parity of women in study and the control group were correlated with the number of previous caesarean sections. Intra operative and post-operative maternal complications including presence and grade of adhesions, intra partum and postpartum hemorrhage, use of measurement and methods (both medical and surgical) to control bleeding such as Bakry balloon, Internal iliac artery ligation, etc., were highlighted. Bowel injury, blood transfusion, admission to surgical intensive care, incidence of placenta previa and accreta, post-operative complications like paralytic ileus, wound infection were also noted. Further, neonatal outcome including birth weight, Apgar score, and need for neonatal intensive care unit admission were reviewed. Results: Patients in the study group had higher incidence of extensive adhesions (41.25%) compared to (12.25%) in the control group. Bowel injury was (2.5%) in study group with none in the control group. The incidence of placenta previa was (8.75%) in the study group as compared to (2.5%) in the control group, with placenta accreta complicating (28.57%) of placenta previa seen only in the study group. Blood transfusion was higher in the study group (20%) as compared to (5%) in the control group. Neonatal admission to NICU was higher in the study group (27.5%) in comparison to the control group (12.5%). Also birth weight was lower in the study group. Conclusion: The more the number of caesarean sections, the more the maternal and neonatal morbidity. Patients should have proper counselling during antenatal follow up about the risks of repeated caesarean sections, and offered bilateral tubal ligation after the third or fourth caesarean sections.

A malignant tumor has the capacity to grow rapidly and to metastasize to the other parts of the body. Ovary has been a common organ for secondaries caused by hematological spread of the tumor and exhibits the same histopathology as that of the primary tumor. Very rarely, it has been found that the patients suffer from two or more histologically distinct, simultaneously detected malignancies, which are called as synchronous tumors or multiple primaries [1]. These multiple primaries can have an impact on cancer treatment (e.g., surgery) and affect the overall prognosis of the patient. Although there is no consensus on the definition of synchronous cancer, commonly two or more primary tumors that occur in a patient closely with respect to the time interval are termed as synchronous tumors [2]. Simultaneous diagnosis of gall bladder carcinoma with ovarian carcinoma with distinct histopathology is rare. A very few cases have been reported so far in literature. We discuss here a rare case that presented with synchronous tumor of gall bladder and the ovary.

Dry eye or keratoconjunctivitis sicca, is commonly seen in the dog. Veterinary ophthalmologists diagnose this aqueous tear deficiency using the Schirmer tear test (STT), but this measures tear production and does not indicate ocular surface pathology. The vital dye Rose Bengal is commonly used in the diagnosis of dry eye in human patients but until now has not been reported in veterinary patients. Here we corelate the degree of Rose Bengal staining with the STT value and find a reasonable association between dye staining of the ocular surface and tear production, although clearly other factors are also important in the genesis of ocular surface damage in dry eye.

Introduction: Radioiodine therapy is a standard procedure in thyroid autonomy treatment. Discrepancies in the visual comparisons of the scintigraphies prepared for this purpose using Tc-99m-O4- and I-131 have been known for years. In this study a new method is used to calculate and perform a quantitative comparison of both uptakes using subtraction analysis and 3D imaging. The results and their causes are discussed together with practice-relevant conclusions for better clinical results. Material and Methods: The new method was used in 38 patients with thyroid autonomies for the subtraction analysis of standardized pretherapeutic and intratherapeutic scintigraphies. The parametric distribution of activity was calculated absolutely and as a percentage and displayed three-dimensionally. These results were compared with the visual assessment of the different scintigraphies by the experts. Inclusion criteria were pretherapeutic and intratherapeutic hyperthyroidism without medication affecting the thyroid. The time difference between acquiring the scintigraphies was 28 days maximum. Results: Activity distribution was visually discrepant in 39.5% of cases. 60.5% displayed comparable uptake. The calculated values showed reversed results after applying the new method. The results using our method show a higher rate of calculated discrepancies compared with visual analysis. Conclusion: Accurate functional imaging of the thyroid is next to further aspects very important in establishing the diagnosis and deciding about the therapy activity for thyroid treatment. In combination with clinical symptoms and laboratory values, Tc-99m-O4 - scintigram can be used for an orientated, preliminary assessment of functional disorders of the thyroid. But because of the higher rate of found discrepancies, the solely use of Tc-99m-O4 - scintigram is not always capable for exact and reliable diagnosis. The known reason for this is most probably due to the different biokinetics of both radiopharmaceuticals, which can be imaged more sensitively with this method. Consequently, a scintigram should be performed in the pretherapeutic radioiodine uptake test. Despite higher costs and radiation exposure, alternatively, pretherapeutic use of other diagnostic iodine isotopes like I-123 or -124 should be discussed, because they could overcome the limitation of the different biokinetics. Following this approach the preliminary assessment using Tc-99m-O4 - scintigraphy can be precised and double checked to improve diagnostic confi dence and treatment results for a better outcome of the patients.  

Canine Distemper have become a major concern within the veterinary clinical work. Thus, the appearance of many cases of canine distemper in adult animals with their vaccination plan up to date has alarmed veterinarians. Many cases of canine distemper have become a major concern within the clinical veterinary task. The purpose of this work was to detect the gene of hemagglutinin of the virus canine distemper, by using the Polymerase Chain Reaction associated with Reverse transcription (RT-PCR), as confirmation of the clinical diagnosis of disease. For this, peripheral blood samples of animals were used clinically patients and were grouped according to their date of extraction and using vaccines commercial as control. The results allow to demonstrate a high sensitivity of the technique, besides allowing the use of samples up to seven days of storage at 4°C, despite the fragility of RNA viral. Detection of canine distemper virus haemagglutinin gene in field samples and its high sensitivity, suggests studying its use as a diagnostic tool complementary to the clinical diagnosis of canine distemper in our country.

Aim: The aim of this study was to determine the sensitivity of the tumor markers and diagnostic methods used in the preoperative period for dermoid cysts, the most common benign neoplasm of the ovary. Material and Methods: 136 patients who were operated for any reason and reported as ovarian dermoid cyst in the Department of Obstetrics and Gynecology, Ankara Atatürk Training and Research Hospital between January 2004 and September 2005 were included in the study. The medical records of the cases were obtained retrospectively from Ankara-Atatürk Training and Research Hospital, HIS, archive files and patient numbers where necessary. Results: In the preoperative period, 119 patients underwent ultrasonographic examination, 33 underwent Computed Tomography, and 17 underwent Magnetic Resonance Imaging.10 of the cases only underwent CT, while 3 of the cases underwent only MRI 22 of them underwent both USG and CT, USG and MRI were performed on 13 cases and only 1 case underwent all three of the imaging methods. Tumor markers were CEA, CA 125, CA 19-9, CA 15-3 and AFP. Conclusions: The reviews of ultrasonography and / or computed tomography and / or magnetic resonance imaging (n = 132) revealed that 103 of the cases were put into operation and the sensitivity of the preoperative screening methods were calculated to be 75.5%. The sensitivity of the tumor marker CA 19-9 was calculated to be 31%.

Objective: To determine the complications (infection, perforation and expulsion rate) of immediate postplacental insertion of intrauterine contraceptive device (Multiload Copper375) in postnatal patients. Methods: A case series study was conducted between October 28, 2014 to April 30, 2018 in obstetrics and gynaecology department, Civil Hospital Karachi,-+ Informed consent was taken. Intrauterine contraceptive device (Multiload) was inserted immediately within 10 min after delivery of placenta. These women were observed to determine outcome (infection, perforation and expulsion) at the time of discharge and 6 weeks postpartum. Absence of all these were taken as satisfactory outcome. Results: A total of 435 women were included in this study. 165 (38%) were delivered through cesarean section and 270 (62%) were delivered through vaginally. There were 36 (8.3%) cases of infection. The cumulative rate of expulsion and perforation at the end of sixth week of post insertion was 39 (9%) and 0% respectively and 360 (82.8%) had satisfactory outcome. Post-placental placements during cesarean delivery are associated with lower expulsion rates than post-placental vaginal insertions without increasing rates of postoperative complications like perforation, slightly increase infection rate following vaginal delivery. Conclusions: Immediate postpartum insertion of IUCD is an effective, safe and easily reversible method of contraception. Rates of the complications (Infection, expulsion and perforation) are remarkably low.

Respiratory tract infections in dogs pose a significant problem and often require prolonged treatment. The effectiveness of pharmacological therapy can be improved through the administration of nebulized compounds to liquidize mucus and promote its evacuation from the respiratory tract. The aim of this study was to evaluate the effectiveness of nebulized 0.9% NaCl in dogs with respiratory tract infections. Respiratory functions were assessed based on the results of arterial blood gas analyses, and the patients’ clinical status was determined by evaluating the severity of symptoms on a point grading scale. Inhalation of nebulized 0.9% NaCl significantly accelerated improvement in the patents’ clinical status (normalization of body temperature, decreased cough frequency, decrease/elimination of nasal and ocular discharge, improved appetite) and improved pulmonary gas exchange by reducing partial pressure and total content of carbon dioxide and increasing partial pressure and total content of oxygen in blood.

Prostate specific membrane antigen, a type II transmembrane protein is an excellent target for the radionuclide therapy in advanced prostate cancer patients due to its high expression in the prostate cancer cells. We present the case of a 69-year old man with advanced metastatic castration resistant prostate cancer. In view of rising serum PSA levels despite hormonal and chemotherapy, we decided to perform a 68Ga-PSMA-HBED-CC PET/CT scan (prostate specific membrane antigen). It revealed intense radiotracer uptake in the prostate, lymph nodes and multiple skeletal sites. Five cycles of 177Lu-PSMA-DKFZ-617 radioligand therapy were administered in the patient followed by an intrim 68Ga-PSMA-HBED-CC PET/CT. Intrim 68Ga-PSMA-HBED-CC PET/CT scan demonstrated a near complete remission of disease with a corresponding decrease in the sPSA levels. During the follow-up duration of 12 months, the patient did not develop haematological, kidney and liver toxicity during the course of treatment and follow-up. 177Lu-PSMA-DKFZ-617 is a promising therapeutic option in metastatic castration resistant prostate cancer (mCRPC) patients.

NMDA receptor encephalitis is a rare disease first described in 2007. Anti-NMDA receptor encephalitis affects mostly young women as neoplasms, mostly ovarian teratomas, are the underlying cause. The disease is caused by antibodies binding to extracellular epitopes of neuronal cell-surface, which leads to an internalization of NMDA-receptors. The characteristic syndrome of patients with anti-NMDAR as well as its recovery follows a certain pattern. Treatment includes immunotherapy and removal of the immunologic trigger. This case report describes a young woman with anti-NMDA receptor encephalitis caused by an ovarian teratoma. 

The greater risk of hypernatremia in patients over 65 years old are associated with impaired mental status and physical disability which may result in impaired sensation to thirst, impaired ability to express thirst, and/or decrease access to water [1,2]. Normally, anti-diuretic hormone (ADH, also known as arginine-vasopressin, AVP) is secreted in response to 1-2% increase in osmolality which stimulate thirst, as do hypovolemia and hypotension.

Breast cancer is a complex disease and one of the main causes of cancer-related mortality in women worldwide. In case of approximately 15% of all breast cancers, three markers i.e. estrogen receptors (ER), progesterone receptors (PR) and human epidermal growth factor receptors-2 (HER2) are not expressed, and is commonly termed as triple-negative breast cancer (TNBC). Particularly, TNBC is associated with a higher percentage of breast cancer related mortality, which is often aggressive and most frequently found with a BRCA1 mutation or increased basal marker expression. However, due to the limitations of chemotherapy and radiation based treatment; the current challenge is to establish a new strategy of diagnosis and treatment of TNBC. The deregulation of a number of microRNAs (miRNAs) in breast cancer has been widely reported. Therefore, this review is directed towards enhancing our understanding of the involvement of various miRNAs in the pathology of TNBC, their upregulations and downregulations and the effects on various factors. From recent studies a number of miRNAs are found to be related with TNBC, which have great potential to be used as a biomarker to determine the disease prognosis and predict the fate of disease. Again miRNA can be targeted to be applied as a therapeutic to provide a great benefit to the patients of TNBC by finding a new, safe, and effective treatment strategy.

Oral cancer has a tendency to be detected at late stage which is detrimental to the patients because of its high mortality and morbidity rates (survival rate 15-50% [1]). The incidence of oral cancer worldwide is approximately 3% of all malignancies, thus creating a significant worldwide health problem [2].

Aim: To evaluate sexual dimorphism in horizontal lip position in adults with different skeletal patterns. Material and Methods: The sample comprised of 120 patients (Females 18 years and above, Males 21 years and above) with no history of previous orthodontic treatment or functional jaw orthopaedic treatment. They were divided into different groups based on the ANB angle and gender. Group I and II included 30 males and 30 females with skeletal class I malocclusion (ANB 0-4 degree). Group III and IV included 30 males and 30 females with skeletal class II malocclusion respectively (ANB above 4 degree). Results: When comparison between males and females (Class I+Class II) was done S-line (p<0.001), B-line (p<0.001), E-line (p<0.001), Holdaways angle (p<0.001) and Merrifield angle (p<0.001) were found to be statistically significant. S-line (p<0.001), E-line (p<0.001) and Holdaways angle (p<0.001) were found to be statistically significant when comparison was done between males and females (Class I). When comparison was done between males and females (Class II) only Holdaways angle (p<0.001) showed a significant statistical difference. Conclusion: Sexual dimorphism was found in various lip parameters. Significant amount of differences were found between Class I and Class II (male and female) subjects.

Introduction: Several treatment options are available for the optimal treatment for orbital fractures, depending on aesthetic and functional results after orbital wall reconstruction. The objective of this study is to compare the effect and safety of large orbital floor fractures with titanium mesh combined with poly-L-lactic acid/polyglycolic acid copolymer implants (Lactosorb®) vs. autologous costochondral graft. A wide range of permanent and biodegradable materials have been used successfully for orbital floor reconstruction, however they present with disadvantages for reconstruction of large defects, even if combined. Patients and Methods: A retrospective cohort study of patients from Estado de México, México, with access to ISSEMYM health care service, presenting with orbital floor fracture treated at Department of Plastic & Reconstructive Surgery/Maxillofacial Surgery at ISSEMYM Medical Center Toluca between January 2007 and July 2010. Age, sex, etiology, clinical findings, fracture pattern, and treatment modality (Titanium mesh with absorbable implant vs. costochondral graft) were considered. Predictor and outcome variables as complications, inpatient, trauma- surgery interval, surgical time and donor site pain are considered. Results: Follow up of 21 patients (12 weeks) 17 male, 4 female, ages 22-63 was made. Enophthalmos, main objective of this study, was identified with statistical significance presenting 0% (n=0) post-op Group B patients and 30% (n=3) for Group A (p=0.049). Statistical significance was found referring to inpatient days between two groups being less for costochondral reconstruction patients (p=0.02). No pain in patients undergoing alloplastic surgery. An interesting result was that donor area analogue pain scale for costochondral graft was 2.9/10. Conclusion: Surgical outcome and complications where evaluated comparing different materials for orbital floor reconstruction. Costochondral graft is a suitable choice when orbital reconstruction is indicated.

Objectives: The aim of the study was to develop a mathematical model for the visualization and evaluation of transversal palatal soft tissue changes; and to carry out a statistical evaluation of the changes in vertical and sagittal dimensions after rapid maxillary expansion treatment. Material and Methods: 33 Caucasian children with posterior crossbite, 10 boys and 23 girls, aged 7 to 10 years (median 8 years 8 months) were treated with tooth-borne Haas type expander. Dental casts were digitalized by scanner and on the basis of quantitative mesh shape CPD-DCA analysis, coloured morphometrical maps were created. The statistical significance of individual vertex displacements was calculated by performing Hotelling’s T2 paired test. To determine the significance of the vertical and sagittal profile changes, the paired t-test and Wilcoxon signed rank test were carried out in 20 patients Results: Visualization of the palatal soft tissue widening showed it to be greatest in the areas of the second deciduous and first permanent molars with maximum of 0.75 mm for each palatal side. Hotelling’s T2 paired test showed significant differences of p<0.01 in transversal width dimension. Cephalometric measurements of the changes to vertical and sagittal dimensions were statistically evaluated using the Wilcoxon and paired t-tests, and were shown to have insignificant values of p>0.05. Conclusion: The expansion appliance in children resolved the crossbite and led to palatal widening, which was clearly visualized by creating mathematical morphometric models. The cephalometric measurements carried out did not reveal statistically significant relevance in changes to facial vertical or sagittal dimensions.

Clowning is a form of humour. It is an art form that invites play, interaction, and laughter. Clown Care is a programme in hospitals and medical centres involving visits from specially trained hospital clowns. Clowning helps patients to focus on something other than their illness. Olsson et al. and Spitzer suggested that clown care could create a warm climate, promote good interpersonal relationships, and relieve feelings of frustration, anxiety, or hostility. Hospital clowns work worldwide as a health humanization resort, providing interplay with patients, family and staff creating a positive emotional state that fosters affirmative environmental conditions. This type of activity varies greatly in terms of professionalism, accountability and artistic methods. Promotion of emotional and psychosocial well-being of patients transcends opportunities for oral health promotion activities in hospitals, schools and community. Previous research reports on clown training reflects attitude-building potential for the healthcare students provided that it is performed in a deep, essential, strict and continuous fashion in a facultative manner rather than mandatory allowing the student to build his own artistic, professional and personal path. Thus, the prospect of introducing training curriculum of this underrated non-technical skill for dental students in Indian dental education system needs to be harnessed.