Role of C-reactive protein and gamma-glutamyl transferase in the diagnosis of metabolic syndrome

Previous studies have reported that metabolic syndrome (MetS) is associated with an increased risk of major cardiovascular events and levels of C-Reactive protein (CRP) can be considered as markers of MetS and its constituent components. Oxidative stress plays a major role in the development of MetS, and levels of gamma-glutamyl transferase (GGT) change with response to oxidative stress are also associated with MetS, which may be modulated by CRP. This study was conducted to identify the role of GGT and CRP as biomarkers in the diagnosis of MetS, a high-risk factor for cardiovascular diseases. One hundred and fifty patients meeting the diagnostic criteria of MetS and an equal number of controls were included in the study. The cases were selected from pathology and molecular biology laboratories, Karachi, while the controls came from the general population. Anthropometric indices of adiposity and blood pressure were recorded for both cases and controls. Blood samples were taken from all subjects to determine the levels of CRP and GGT. All those cases and control height, weight, hip waist circumference were noted and the comparison of CRP and GGT by applying students' t-test as markers for detection of metabolic syndrome. p-value 0.001 was considered as significant. This study suggests that in patients with metabolic syndrome were found to have raised the basal metabolic rate, C-reactive protein and GGT were synergistically associated with MetS independently of another confounding factor in the general population. Keywords: C-reactive protein (CRP), gama glutamyl transferase (GGT), metabolic syndrome, (Met-S), inflammation, body mass index.

Evaluation of public knowledge and attitude towards how to use, store and discard expired pharmaceutical drugs in Saudi Arabia

This study aimed to evaluate the public knowledge and attitude toward how to use, store and discard unused and expired pharmaceutical drugs among the Saudi population. A descriptive cross-sectional study design was used to evaluate the knowledge, attitude, and practice of participants toward the usage and disposal of expired pharmaceutical products among the Saudi population via an online survey distributed throughout social media sites during the period of two months from March 2020 to May 2020. Microsoft Excel and graph pad software analyzed the cleaned data. Descriptive statistics on sample characteristics were computed in frequencies and percentages and presented using tables and figures. 650 participants enrolled in the study. 75% of the participants had unused medicine stored at home during study time. The common types of medications kept in households were analgesics (90%) and antibiotics (67%). Most participants showed a well understanding of medication waste (70%) and the potential risks associated with improper drug disposal (85%). There was a lack of received information about safe usage, storage, and disposal practice. About 55% of the participants discarded the unused and expired medications by throwing them in the trash. In light of this study's results, which showed a large percentage of participants kept unused or expired medications in their homes despite their knowledge of the seriousness of this situation. Therefore, it is essential to plan educational programs about the rational use and expiry date of drugs to improve their awareness, attitudes, and practices regarding the safe disposal of unused and expired medications. Guidelines on safe disposal are required, and an organized method of collecting unused and expired pharmaceuticals such as the "drug take-back program" is needed. The pharmacist also has a significant role as a drug expert in educating patients about the drug's uses and how to store and discard it. Keywords: Knowledge, attitude, expired pharmaceutical drugs.

Modern environmental and lifestyle risk factors, oxidative stress, perturbed epigenetic processes, and increasing incidence of neurodevelopmental, neurodegenerative and neurological disorders

Our goal is not to describe a single harmful environmental or lifestyle risk factor in great detail, as most scientific articles do. In contrast, we aim to point out that human beings are continuously and simultaneously exposed to countless kinds of harmful environmental and lifestyle risk factors. First, we briefly review and evaluate several environmental, technological, and lifestyle risk factors. We point out that each of these can be associated with perturbed oxidative and epigenetic processes, and the onset of various diseases, including neurodevelopmental, neurodegenerative, and neurological disorders, with a worldwide increasing prevalence. In addition, disturbed epigenetic changes by modern technological innovations and lifestyle risk factors can be inheritable to offspring and subsequent generations. Furthermore, disturbed epigenetic changes may also accumulate in the genome. Finally, diverse environmental and lifestyle risk factors may enhance vulnerability and decrease the resilience of modern humans. Keywords: Modern environmental and lifestyle risk factors, oxidative stress, perturbed epigenetic processes, neurodevelopmental, neurodegenerative and neurological disorders.

Hyperkalemic circulatory shock and cardiac arrest altered by therapeutic management: A case report

Hyperkalemia is one of the few potentially lethal electrolyte disturbances. Severe hyperkalemia (Serum potassium concentration > 6.5 mmol/L) occurs most commonly from renal failure or the release of potassium from cells and can cause circulatory shock, cardiac arrhythmias or cardiac arrest. Current BLS (Basic Life Support) and ACLS (Advanced Cardiovascular Life Support) protocol should be used to manage cardiac arrest associated with hyperkalemia. But early consideration should be given to using the selective method of therapeutic management in addition to standard ACLS protocols that can be provided rapidly, effectively in patients with cardiovascular instability. We describe here a case of chronic kidney disease and congestive heart failure who developed circulatory shock and eventually cardiac arrest due to hyperkalemia managed with Calcium Gluconate, Sodium Bicarbonate and Insulin along with standard advanced cardiovascular life support protocol. Keywords: Potassium, hyperkalemia, acidosis, calcium, insulin, cardiac arrest.

Disuse syndrome in Japanese older adults due to instructions to stay at home during the COVID-19 pandemic

This study aimed to reveal the extent of the adverse effects caused by the restrictions on going out due to the COVID-19 pandemic on physical function. The participants were 129 healthy older adults, aged 65 years and older, who lived independently without the need for long-term care. The presence or absence of disuse syndrome was investigated using a partially modified “Disuse Syndrome Inventory.” The address, age, and gender of the participants were also surveyed in a factor analysis of disuse syndrome. The effective response rate was 90.6% (n = 117). Disuse syndrome was observed in 38.5% (n = 45) of the participants, which was significantly higher in women compared to men, and in medium-sized to depopulated cities compared to large cities. It has become clear that a large number of older adults have disuse syndrome because of the travel and commute restrictions due to the COVID-19 pandemic. To return to normal life sooner, it is necessary to consider countermeasures as soon as possible. Keywords: Coronavirus disease 2019, infection, physical function, restrictions on going out.

Talo-calcaneal smile osteotomy as a treatment of rigid residual equinus deformity

Foot deformities are usually complex. Equinus deformity can be a residual foot deformity element or isolated. A rigid type is the most difficult for treatment. The aim of work is the treatment of rigid equinus deformity by a minimally invasive technique using Ilizarov fixator to restore plantigrade foot and to prevent further recurrence. 17 feet in 14 patients with stiff ankles and rigid equinus after failed surgical correction of club feet, with mean age 6.6 years (4 to 10 years), all treated by smile talocalcaneal osteotomy and Ilizarov ring fixator with a mean follow up 20.9 months (5 to 30 months). 5 feet (29.9%) had excellent results, 8 (47.1%) had good results, 1(5.9%) had a fair result and 3 feet (17.6%) had poor results and underwent revision surgery. In conclusion, our technique Talo-calcaneal smile osteotomy based on distraction osteogenesis method appears to provide similar or better results compared to other literature results without discrimination of foot size, provide some range of motion and plantigrade foot. Keywords: Clubfoot- equinus- rigid -deformity, Ilizarov- Smile osteotomy.

Effect of pelvic girdle stability training on functional sitting control in children with hypotonic cerebral palsy

The aim of this research was to examine the impact of pelvic girdle stability training in children with hypotonic cerebral palsy on functional sitting control. Thirty children with hypotonic cerebral palsy in both sexes, with their ages ranging from two to four years were used in the study. There were fifteen children in the experimental group and fifteen children in the control group. The study group received pelvic girdle stability training program in addition to a selected program for upper limbs and trunk muscles strengthening exercises, while the control group received only the selected program for upper limbs and trunk muscles strengthening exercises. Results revealed significant difference of GMFM88 (sitting domain) (P < 0.01), stationary raw scores and stationary standard scores of PDMS-2 (P < 0.05) but no significant difference of age equivalent of PDMS-2 (P > 0.05). GMFM88, on the other hand, had a significant difference (sitting domain) (P < 0.05) but no significant difference of stationary raw scores, stationary standard scores and age equivalent of PDMS-2 (P > 0.05) in the control group. Paired t-test were conducted for comparison between pre and post treatment mean values of sitting domain and stationary scores in each group. From the obtained results of the present study, we conclude that pelvic girdle stability training program was more effective in generating core muscle activity for functional sitting control compared to traditional physical therapy of upper limbs and trunk muscles strengthening exercises in children with hypotonic cerebral palsy. Keywords: Pelvic girdle stability, functional sitting control, hypotonic cerebral palsy.

Pregabalin abuse and toxicity and related factors

Pregabalin is one of a group of gabapentinoids approved by the Food and Drug Administration (FDA) in 2004. It is a capsule medication taken by mouth that is used for the treatment of neuropathic pain. It is a structural analogue of the neurotransmitter gamma-aminobutyric acid (GABA), and it appears to have a spectrum of benefits and harms similar to those of other adjuvant analgesics used to treat neuropathic pain. The most common side effects mentioned in peripheral neuropathy studies are dizziness and somnolence. Pregabalin could cause liver toxicity by increasing the levels of liver enzymes. It can potentially cause vasodilatation and fluid retention in the heart and blood vessels. It may also lead to addiction. The use of Pregabalin is common among patients with a history of substance abuse and psychoactive drug dependence, as euphoria is one of its main side effects. However, abrupt discontinuation from using Pregabalin may cause nausea, insomnia, or headache. The present review evaluates the significant impact of Pregabalin toxicity on liver and heart in patients and misusers. Keywords: Pregabalin, liver toxicity, alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatine kinase (CK), heart failure, addiction.

p16 immunostaining can avoid overdiagnosis in postmenopausal cervical cytology

Senile (atrophic) colpitis is microscopically characterized by the predominance of parabasal squamous cells and the paucity of superficial cells. The activated parabasal cells or dyskeratotic superficial cells may be confused with squamous intraepithelial lesion (SIL) in the routine cytology practice. A total of 29 cervical cytology specimens diagnosed as atypical squamous cells (ASC) or SIL were retrospectively sampled from 24 postmenopausal women (age range: 56–84 years, mean: 65.5, median: 65). Cytological diagnoses in the routine services included ASC-US 20, ASC-H 2, LSIL 4 and HSIL 3. All the specimens showed an atrophic background (senile colpitis). There were two microscopic patterns of senile colpitis with atypia: 1) parabasal cells were clustered (n = 23) and 2) dyskeratotic superficial cells were seen in a highly inflamed background (n = 6). Immunostaining for p16-INK4a (p16 in short) was performed, after the cells were transferred to trimethoxy[3-(phenylamino)propyl]silane-coated glass slides. Only three of the 29 cytology specimens (two of the 24 cases) judged as HSIL cytologically revealed p16 positivity in clustered atypical parabasal cells. Biopsy was performed in 11 cases, and chronic cervicitis without p16 expression was seen in nine. Two lesions showed p16-positive dysplasia (one mild dysplasia and another moderate dysplasia). In one lesion in an 84 year-old female, both cytology and histology specimens showed p16 positivity (HSIL). Discrepancy of p16 expression between the cytology and histology specimens was encountered in two lesions, representing sampling errors. It is of note that the overcytodiagnosis is avoidable with the aid of p16 immunostaining. Keywords: Atypical squamous cells (ASC), cell transfer technique, p16-INK4a, senile colpitis, squamous intraepithelial lesion (SIL).

Analysis of the readiness of medical professionals from Bulgaria, Croatia and Slovenia on the need for continuing online training on matters relating to drug policy

The purpose of the study is to examine the opinion of the medical community on the need for further training on matters relating to drug policy (as a dynamic and rapidly changing area of healthcare policy bearing on the work of a number of healthcare specialists) and the attitudes to web-based forms of further training. The study was conducted among healthcare professionals (healthcare professionals means graduates in medicine and/or pharmacy – physicians, dentists, pharmacists and healthcare professionals and managers etc. who practice their occupation applying the set of regulatory standards governing drug policy) from three Balkan countries – Bulgaria, Slovenia and Croatia – who have completed a dedicated survey. Participation in the survey was voluntary and the polling was conducted on the basis of the ‘snowballing’ technique for survey dissemination and recruitment of respondents. The statistical processing of collected data relied on a correlational descriptive and regression analysis. The results reveal that respondents are aware of the need and are willing to pursue possibilities for further training on matters relating to drug policy. The correlational analysis has revealed interesting further data. A statistically significant negative correlation has been established between knowledge assessment and the method of updating and upgrading knowledge on matters relating to drug policy. The data suggests that according to the respondents self-learning and attending courses led by trainers who are subject-matter experts increases the evaluation of knowledge in the area of drug policy (rho = 0.-631, р = 0.002). Furthermore, the greater frequency of additional training events to improve current levels of knowledge is also a factor that increases self-assessment of being up to date on the latest developments in this area (rho = 0.577, р = 0.006). There is a need for further training in the area of drug policy and the preferred form of this type of training are the online and physical training events by guest trainers conducted by medical schools. In order to ensure that training conforms to a high-quality standard, a test should be taken at the end and a certificate attesting to the training should be issued as a quality assurance guarantee. Keywords: Postgraduate training/drug policy, medical specialists.