Correlations between serum kidney injury molecule-1,cystatin C and immunosuppressants:A cross-sectional study of renal transplant patients in Bahrain

Renal transplant patients receive several immunosuppressive drug regimens that are potentially nephrotoxic for treatment.Serum creatinine is the standard for monitoring kidney function;however,cystatin C(Cys C)and kidney injury molecule-1(KIM-1)have been found to indicate kidney injury earlier than serum creatinine and provide a better reflection of kidney function.Here,we assessed Cys C and KIM-1 serum levels in renal transplant patients receiving mycophenolate mofetil,tacrolimus,sirolimus,everolimus,or cyclosporine to evaluate kidney function.We used both the Chronic Kidney Disease Epidemiology Collaboration(CKD-EPI)2021 equation,which is based on creatinine and combined creatinine with Cys C,and the CKD-EPI 2012 equation,which is based on Cys C alone,to estimate glomerular filtration rate(GFR).Then,we assessed the association between serum KIM-1 and GFR<90 mL per minute per 1.73 m2.We observed significantly higher serum Cys C levels in patients with the elevated serum creatinine,compared with those with normal serum creatinine.The estimated GFRs based on creatinine were significantly higher than those based on the other equations,while a significant positive correlation was observed among all equations.Serum KIM-1 levels were negatively correlated with the estimated GFRs by the CKD-EPI Cys C and the combined creatinine with Cys C equations.A serum KIM-1 level above 0.71 ng/mL is likely to indicate GFR<90 mL per minute per 1.73 m2.We observed a significant correlation between serum creatinine and Cys C in our renal transplant patients.Therefore,serum KIM-1 may be used to monitor renal function when using potentially nephrotoxic drugs in renal transplants.

Systemic right ventricle complications in levo-transposition of the great arteries: A case report and review of literature

BACKGROUND Congenitally corrected levo-transposition of the great arteries(L-TGA)is a congenital heart disease in which the ventricles and great arteries are transposed from their typical anatomy.In L-TGA,the double discordance,atrioventricular and ventriculoarterial,create an acyanotic milieu which allows patients to survive their early decades,however,progressive systemic right ventricle(sRV)dys-function creates complications later in life.sRV dysfunction and remodeling predisposes patients to intracardiac thrombus(ICT)formation.CASE SUMMARY A 40-year-old male with L-TGA presented with symptoms of acute decom-pensated heart failure.In childhood,he had surgical repair of a ventricular septal defect.In adulthood,he developed sRV dysfunction,systemic tricuspid valve(sTV)regurgitation,and left-bundle branch block for which he underwent cardiac resynchronization therapy.Transthoracic echocardiogram showed a sRV ejection fraction of 40%,severe sTV regurgitation,and a newly identified sRV ICT.ICT was confirmed by ultrasound-enhancing agents and transesophageal echocardio-graphy.Our patient was optimized with guideline-directed medical therapy and diuresis.Anticoagulation was achieved with a vitamin K antagonist(VKA)and he was later referred for evaluation by advanced heart failure and heart transplant services.CONCLUSION Anticoagulation with VKA is the mainstay of treatment in the absence of conclusive data supporting direct oral anticoagulant use in ICT in patients with congenital heart disease.This case illustrates the natural history of L-TGA and highlights the importance of surveillance and monitoring with dedicated cardiac imaging to identify complications.

The good,the bad,and the ugly of consumer sleep technologies use among athletes:A call for action

1.Introduction For athletes,the quality and quantity of sleep are essential elements for optimizing recovery and subsequent performance.1 Unfortunately,athletes frequently face challenges getting sufficient,high-quality sleep.2 A recent systematic review and meta-analysis of 81 studies involving 1830 athletes concluded that compared to healthy non-athletes,athletes'sleep duration was shorter with poorer sleep efficiency.

Non-invasive assessment of choledocholithiasis in patients with gallstones and abnormal liver function

AIM:To find a non-invasive strategy for detecting choledocholithiasis before cholecystectomy,with an acceptable negative rate of endoscopic retrograde cholangiopancreatography.METHODS:All patients with symptomatic gallstones were included in the study.Patients with abnormal liver functions and common bile duct abnormalities on ultrasound were referred for endoscopic retrograde cholangiopancreatography.Patients with normal ultrasoundwere referred to magnetic resonance cholangiopancreatography.All those who had a negative magnetic resonance or endoscopic retrograde cholangiopancreatography underwent laparoscopic cholecystectomy with intraoperative cholangiography.RESULTS:Seventy-eight point five percent of patients had laparoscopic cholecystectomy directly with no further investigations.Twenty-one point five percent had abnormal liver function tests,of which 52.8%had normal ultrasound results.This strategy avoided unnecessary magnetic resonance cholangiopancreatography in 47.2%of patients with abnormal liver function tests with a negative endoscopic retrograde cholangiopancreatography rate of 10%.It also avoided un-necessary endoscopic retrograde cholangiopancreatography in 35.2%of patients with abnormal liver function.CONCLUSION:This strategy reduces the cost of the routine use of magnetic resonance cholangiopancreatography,in the diagnosis and treatment of common bile duct stones before laparoscopic cholecystectomy.

The Prevalence of Adrenal, Parathyroid and Cardiac Dysfunction in Patients with Beta Thalassemia Major

Background: Adrenal and parathyroid insufficiency are uncommon in patients with transfusion dependent Beta Thalassemia (β-TM). Further, myocardial echocardiographic abnormalities are recognized but with a variable outcomes Aim: The aim is to determine the prevalence of adrenal and parathyroid insufficiency in patient with transfusion dependent β-TM. And to assess left ventricle systolic and diastolic function using Pulsed Doppler (PD) and Tissue Doppler (DT) echocardiogram. Methods:The study was conducted on patients with β-TM (n = 99, age 15.92 ± 8.92 years) and compared with an age-matched controls (n = 98 age 15.79 ± 8.94 years). In all participants echocardiographic indices of M mode and PD and TD were performed. Blood samples were withdrawn for measuring the serum cortisol, parathyroid and Ferritin. Correlation between the level of cortisol and ferritin level was evaluated. Results: Patients with β-TM compared with controls, had significantly thicker LV septal wall index of 0.65 ± 0.26 vs 0.44 ± 0.2190, p 0.001 and LV posterior wall of 0.65 ± 0.235 vs 0.43 ± 0.214, p ± 5.5 vs 5.0 ± 5.6, p = 0.23. Furthermore patients with β-TM had higher E/A ratio (1.54 ± 0.18 vs 1.23 ± 0.17, p 0.01) and shorter deceleration time (DT) (170.53 ± 13.3 vs 210.50 ± 19.20 m sec, p 0.01). The ratio of transmitral E wave velocity to the tissue Doppler E wave at the basal septal mitral annulus (E/Em) was significantly higher in β-TM group (19.68 ± 2.81 vs 13.86 ± 1.41, p 0.05). The tissue Doppler systolic wave (Sm) velocity and the early diastolic wave (Em) were significantly lower in β-TM group compared with controls with Sm, of 4.82 ± 1.2 vs 6.22 ± 2.1 cm/sec, p 0.05 and (Em) of 3.51 ± 2.7 vs 4.12 ± 2.5 cm/sec p 0.05, respectively). The tricuspid valve velocity was significantly higher in β-TM patients compared with controls (2.85 ± 0.56 vs 1.743 ± 0.47 m/sec, respectively, p 0.01). The prevalence of adrenal insufficiency in patients with β-TM was 16%, hypoparathyroidism of 4.5% weak negative correlation between serum level of cortisol and the serum Ferritin. Conclusion: Patients with β-thalassemia major had a high prevalence of subclinical adrenal insufficiency of 16%, hypoparathyroidism of 4.5% with weak negative correlation between the low level of cortisol ≤160 nmol/L and high serum ferritin. Echocardiographic Pulsed Doppler showed a restrictive LV diastolic pattern suggestive of advanced diastolic dysfunction but preserved left ventricle systolic function.

Prevalence of Atrial Fibrillation in Systolic Heart Failure, Pulsed and Tissue Doppler Echocardiographic Abnormalities

Background: Heart failure (HF) is a common clinical syndrome mostly due to the impaired ability of the Left Ventricle (LV) to eject blood with reduced cardiac output. Heart failure is called systolic (SHF) if left ventricle ejection fraction on echo-cardiogram is low (LVEF of ≤50%). Aim: To assess the echocardiographic characteristics of patients with SHF with Atrial Fibrillation (AF) and compare with those with Sinus Rhythm (SR) on 12 leads ECG. Furthermore, to evaluate the clinical and biochemical markers for the prediction of AF in SHF. Method: Over two years duration, each patient diagnosed with SHF was enrolled in the study (n = 354) based on admission code. AF or sinus rhythm on 12 leads ECG was documented on each patient. Multiple logistic regression analysis was applied to assess the risk ratio of different clinical and Doppler derived variables for the development of AF in SHF. Results: Out of the total hospital medical admissions of 14,674 patients, there were 354 patients with diagnosis of SHF, a prevalence of 2.4%. The incidence of AF on ECG was 109 (31%) patients in the whole study population and 245 (69%) in SR. M Mode echocardiogram in patients with SHF and AF compared with those in SR showed significant dilation of LV cavity in systole with LVESD of 5.72 ± 0.63 vs. 5.23 ± 0.76 cm, P < 0.001 and in Diastole LVEDD of 6.83 ± 0.51 vs. 6.58 ± 0.63 cm, P < 0.001. Pulsed Doppler echocardiogram showed a severe restrictive-pattern with shorter Decellration Time (DT) of 163.73 ± 7.42 vs. 214.9 ± 31.81msec, P < 0.001 and higher Pulse to Tissue Doppler ratio of E/Em of 14.26 ± 1.34 vs. 9.99 ± 1.27, P , and the serum level of Brain Natriuretic Peptide (BNP) hormone of 723.72 ± 13.45 vs. 686.98 ± 72.57 pg/ml, P < 0.001. The predictive risks (odd ratio) of different clinical variables for the development of AF in SHF were positive for high BNP > 500 pg/ml of 2.8, history of hypertension of 1.8, history of DM of 1.7, BMI > 28 of 1.4, LV hypertrophy on ECG of 1.3. Conclusions: The prevalence of Systolic Heart Failure in the study population was 2.4%. The prevalence of AF in the study population was 31%. The best predictors of AF in SHF were high BNP > 500 pg/ml, history of hypertension, Diabete Mellitus and LV Hypertrophy on ECG.

Glycation Induced Physicochemical Changes in Low-Density Lipoprotein and Its Role in Promoting Cholesterol Accumulation in Macrophages along with Antiglycation Effect of Aminoguanidine

The present study aimed at investigating physicochemical changes in modified LDL by sugars specifically fructose due to recent reports on its involvement in cardiovascular diseases and also glucose and their role in subsequent in vitro accumulation of cholesterol in macrophages. Antiglycation action of aminoguanidine was also investigated. LDL isolated from human blood was incubated with fructose or glucose and aminoguanidine where indicated. The physicochemical changes in modified LDL were detected by electrophoretic, spectroscopic and chemical analysis. Accumulation of cholesterol and its inhibiton in human monocyte-derived macrophages incubated with modified LDL was determined by HPLC. Results showed increased relative electrophoretic mobility, hyperchromicity at 280 nm, development of AGE fluorescence, decrease in free amino groups and increased carbonyl content in glycated LDL as compared to native LDL. Also total cholesterol accumulated in macrophages was more for glycated LDL as compared to native LDL. The magnitude of changes was more prominent in case of fructose as compared to glucose. Aminoguanidine showed remarkable restriction of glycation-induced alterations in LDL and also in accumulation of cholesterol in macrophages. The study thus proclaims that LDL-AGEs formed by fructose may contribute to accelerated initiation of diabetes induced atherosclerosis via foam cells generation and aminoguanidine may have therapeutic potential against it.

Effects of cumulative COVID-19 cases on mental health:Evidence from multi-country survey

BACKGROUND Depression and anxiety were both ranked among the top 25 leading causes of global burden of diseases in 2019 prior to the coronavirus disease 2019(COVID-19)pandemic.The pandemic affected,and in many cases threatened,the health and lives of millions of people across the globe and within the first year,global prevalence of anxiety and depression increased by 25%with the greatest influx in places highly affected by COVID-19.AIM To explore the psychological impact of the pandemic and resultant restrictions in different countries using an opportunistic sample and online questionnaire in different phases of the pandemic.METHODS A repeated,cross-sectional online international survey of adults,16 years and above,was carried out in 10 countries(United Kingdom,India,Canada,Bangladesh,Ukraine,Hong Kong,Pakistan,Egypt,Bahrain,Saudi Arabia).The online questionnaire was based on published approaches to understand the psychological impact of COVID-19 and the resultant restrictions.Five standardised measures were included to explore levels of depression[patient health questionnaire(PHQ-9)],anxiety[generalized anxiety disorder(GAD)assessment],impact of trauma[the impact of events scale-revised(IES-R)],loneliness(a brief loneliness scale),and social support(The Multidimensional Scale of Perceived Social support).RESULTS There were two rounds of the online survey in 10 countries with 42866 participants in Round 1 and 92260 in Round 2.The largest number of participants recruited from the United Kingdom(112985 overall).The majority of participants reported receiving no support from mental health services throughout the pandemic.This study found that the daily cumulative COVID-19 cases had a statistically significant effect on PHQ-9,GAD-7,and IES-R scores.These scores significantly increased in the second round of surveys with the ordinary least squares regression results with regression discontinuity design specification(to control lockdown effects)confirming these results.The study findings imply that participants’mental health worsened with high cumulative COVID-19 cases.CONCLUSION Whist we are still living through the impact of COVID-19,this paper focuses on its impact on mental health,discusses the possible consequences and future implications.This study revealed that daily cumulative COVID-19 cases have a significant impact on depression,anxiety,and trauma.Increasing cumulative cases influenced and impacted education,employment,socialization and finances,to name but a few.Building a database of global evidence will allow for future planning of pandemics,particularly the impact on mental health of populations considering the cultural differences.

QT Dispersion and QTc Interval in Patients with Adult Sickle Cell Disease: Electrocardiographic (EKG) and Echocardiographic Evaluation

Background: QT dispersion (QTd) varies according to heterogeneity of recovery time in the myocardium, and the impact of iron overload on the QTd in adult patients with Sickle Cell Disease (SCD) is not clear. Aim: This cross-sectional study was designed to evaluate corrected QTc interval and QTd on 12 leads ECG in patients with SCD, and assess the LV systolic and diastolic function using Pulsed Doppler Echocardiogram. Method: All patients were evaluated clinically with pulse Doppler echocardiography. Twelve leads ECG were taken to measure QTd and QTc. Blood samples withdrawn to assess the blood level of ferritin and hemoglobin. Pearson correlation coefficient was used to measure the linear relationship between serum ferritin and QTd. Results: The study included patients with SCD (n = 70, age 15.7 ± 8.9 years), compared with age-matched healthy control group (n = 70, age 15.9 ± 8.9 years). In patients with SCD compared with healthy control group the QTc (msec) 416 ± 23.21 ms vs. 401 ± 24.12 (p = 0.75), and the QTd were slightly longer in SCD compared with the control of 43 ± 22.1 vs. 38 ± 20.16 msec, (p = 0.071) with no significant difference. M mode echo showed that SCD patients compared with control had higher LVMI gm/M2 of 105 ± 10.3 vs. 83 ± 7.1, P = 0.001, larger LV end diastolic dimension (cm) of 5.5 ± 0.32 vs. 4.72 ± 0.35, p = 0.03, RV diameter (cm) of 2.8 ± 0.42 vs. 2.4 ± 0.31, (p = 0.041) and RV wall thickness (mm) of 0.31 ± 0.06 vs. 0.28 ± 0.03, (p = 0.024). Pulsed Doppler showed high LV transmitral E wave velocity of 85.23 ± 1.92 vs. 62.43 ± 1.67 m/s (p = 0.001), A wave (msec) 46.26 ± 4.7 vs. 56.24 ± 3.2 m/s, p = 0.032, with E/A ratio of 1.86 ± 0.01 vs. 1.10 ± 0.03, (p = 0.024) and DT of E wave (msec) of 156.43 ± 23.5 vs. 189.87 ± 19.5, (p = 0.031). Left ventricle ejection fraction percentage was similar between both groups, but SCD had significantly higher right ventricle tricuspid annular plane systolic excursion TAPSE (cm) of 1.23 ± 0.21 vs. 1.11 ± 0.23 cm (p = 0.02), and the tricuspid valve velocity showed significant higher velocity (m/s) in the SCD patients of 2.9 ± 0.14 vs. 1.7 ± 0.09, p = 0.004 indicating higher pulmonary artery pressure with calculated right ventricle systolic pressure of 38.64 vs. 16.56 mmHg. Conclusion: SCD patients compared with control have higher but not significant QT dispersion and corrected QT interval with a significantly larger LV mass and LV diastolic filling indices suggestive of restrictive diastolic pattern. These data indicate that LV diastolic abnormalities compromised initially in patients with SCD.

Management of granulomatous lobular mastitis: an international multidisciplinary consensus(2021 edition)

Granulomatous lobular mastitis(GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patients with inflammatory disorders of the breast. This consensus is summarized to establish evidence-based recommendations for the management of GLM. Literature was reviewed using PubMed from January 1, 1971 to July 31, 2020. Sixty-six international experienced multidisciplinary experts from 11 countries or regions were invited to review the evidence.Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Experts discussed and concluded 30 recommendations on historical definitions,etiology and predisposing factors, diagnosis criteria, treatment, clinical stages, relapse and recurrence of GLM. GLM was recommended as a widely accepted definition. In addition, this consensus introduced a new clinical stages and management algorithm for GLM to provide individual treatment strategies. In conclusion, diagnosis of GLM depends on a combination of history, clinical manifestations, imaging examinations, laboratory examinations and pathology.The approach to treatment of GLM should be applied according to the different clinical stage of GLM. This evidencebased consensus would be valuable to assist front-line surgeons and medical specialists in the optimal management of GLM.

High prevalence of bla_(CTX-M) in Enterobactcriaceac isolates from the Kingdom of Bahrain

Objective:To determine the molecular epidemiology of extended-spectrumβ-lactamase （ESRL） by testing a cohort of clinical ESBL-producing bacterial isolates that were isolated in the Kingdom of Bahrain.Methods:ESBL producing Enterabacleriaceae isolates（based on phenotypie tests） were collected from Microbiology Laboratory ot the Salmaniya Medical Complex,Bahrain between January-June 2006.Antibiotic susceptibility to a panel of antibiotics was performed and blaCTX-M genes were detected by multiplex PCR.Results:A total of 230 isolates（Escherichia coli.n=180:Klebsiella pneumoniae,n=50） were studied.98%were CTX-M type.For Escherichia coli isolates.65（36.1%） harbored CTXM+TF.M combination and 68（37.8%） had CTX-M alone.In contrast,for Klebsiella pneumoniae isolates only 5（10.0%） harbored the CTX-M combination,and none had CTX-M only.The blaCTX-M gene was found predominantly in urine isolates（n=145/230;63.0%）.Sensitivity to imipenem and nitrofurantoin was 100%and 60%.respectively.CTX-M carriage was associated with the resistance lo fluoroquinolones, trimethoprim-sulfamethoxazole and aminoglycosides.Conclusions:Our study documentes high prevalence of CTX-M ESBL type among Escherichia call and Klebsiella from the Kingdom of Bahrain.The apparent dissemination of CTX-M producers could represent a substantial barrier in the treatment of community-acquired infections.The use of extended-Spectrum cephalosporins. quinolones,and aminoglycosides is compromised,leaving carbapenems as the therapeutic option for severe infections caused by ESBL producers.

Pulsed and Tissue Doppler Echocardiographic Abnormalities in Patients with Diastolic Heart Failure with and without Atrial Fibrillation

Background: Symptoms of heart failure (HF) are identical in both systolic (SHF) and diastolic hear failure (DHF). The prevalence of atrial fibrillation (AF) in heart failure varies in different studies depending on the criteria of enrollment and the use of echocardiographic parameters in the definition of HF. Aim: To assess the clinical characteristic of pa- tients with DHF complicated by AF and compare with those with SHF in regard of echocardiographic abnormalities and causative agents. Furthermore, evaluate the clinical and biochemical markers for the prediction of AF in HF. Method: Over the duration of 12 months, each patient diagnosed as HF based on admission code was enrolled in the study. Patients were classified into two groups: group 1: DHF, with preserved LVPEF% > 50%, n = 204 (60%), and group 2, with SHF, with LVREF% ≤ 50%, n = 140 (40%). The presence or absence of AF on ECG was recorded. The predictive value of different clinical and biochemical variables for the development of AF was evaluated using logistic multiple regression analysis. Results: Three hundred and forty four eligible patients were admitted to hospital with heart failure out of 7650 who had other medical problems. The prevalence of HF in this population was 4.5%, those with DHF were 2.7% and SHF of 1.8%. The incidence of AF on ECG was 35% in the whole study population and 65% were in sinus rhythm (SR). The occurrence of AF was twice higher in DHF patients of 22% compared with 11% in SHF. Echo pulsed Doppler in DHF and AF compared with those in SR showed a severe restrictive pattern with significantly thick septum wall, higher LV mass index, shorter DT and higher E/e? ratio of 12.4 vs. 9.73, P 0.05. The predictive risk (odd ratio) of different clinical variables for development of AF in HF was positive for LV hypertrophy on ECG of 2.4, history of hypertension of 1.6, history of DM of 1.4, BMI > 28 of 1.7. Conclusions: The prevalence of HF was 4.5% in the study population, with SHF of 1.8% and DHF of 2.7%. Patients with DHF and AF were older with a higher female ratio with severe restrictive pattern compared with those of SHF. The incidence of AF in the whole study was 35%. The best predictor of AF in HF was left ventricle hypertrophy followed by history of hypertension and DM.

A Case Report of Rare Acute Ischemic Stroke Due to Meningeal Irritation

Stroke is a rapidly developing symptom or sign of loss of cerebral function secondary to interruption of the blood supply due to a thrombus or hemorrhage. These diseased vessels are usually affected by well-recognized risk factors, but in some cases other rare conditions may be related to stroke development. Herein, we introduce one of these rare stroke conditions in a 37-year-old previously healthy male who presented to the emergency department with misleading symptoms and signs of reduced level of consciousness, isolated medical 3rd nerve palsy and possible drug overdose. A thorough neurological examination and investigation demonstrated a case of acute ischemic stroke as a consequence of meningeal irritation with an underlying inflammatory response. The patient was treated simultaneously for both conditions and responded dramatically with full recovery upon discharge. Thus, consideration of acute stroke in patients with no previous known risk factors is highly recommended especially with unusual neurological findings.

沙特阿拉伯动物传染性皮肤利什曼病的临床和病理学特征

Background: Zoonotic cutaneous leishmaniasis (ZCL) caused by Leishmania major is a growing public health problem and endemic in many parts of the Kingdom of S audi Arabia. The vector is Phlebotomus papatasi and the animal reservoirs are ma inly desert rodents. Methods: In this prospective study, the clinical and histop athological features of ZCL in 120 patients are described and classified. The ma jority of these patients (n =84) were non-Saudi expatriate workers who suffered mostly from multiple and severely inflamed nodulo-ulcerative lesions on the ex posed parts of the body. Saudi patients were mainly children (n=21) with few1-3 lesions on their limbs or sometimes unique erysipeloid facial lesions. Results: Histopathological grouping of ZCL lesions showed four types of granulomatous re actions based on the predominant types of inflammatory cells, presence or absenc e of necrosis and ranking of parasitic index. Conclusion: A possible correlation between histopathologic evolution of ZCL lesions and the immune status of the h ost is discussed.

沙特阿拉伯白癜风患者对PUVA治疗的反应

Background: Vitiligo is not uncommon in southern Saudi Arabia. The response of Saudi patients to PUVA therapy has not been previously assessed. The aim of this study was to evaluate this response. Methods: This is a retrospective study for the period of 1990- 2001 in which 32 patients were included: Data were collected from the patients’ records, including: age, sex, age at onset of disease, type of vitiligo, cumulative dose, maintenance dose, total number of sessions, number of sessions to induce pigmentation, treatment duration, and response rate. Results: The overall response rate was 59.4% . The most sensitive sites were the face, trunk, arms, and legs, while the most resistant sites were the hands, feet, and perioroficial areas (perioral and periorbital). Acute complications occurred in 59.4% , while chronic complications occurred in 78.1% . Analysis of the factors that affect the response rate showed that age, sex, the disease duration, and the treatment duration did not affect the response rate, while the surface area and the number of sessions to induce pigmentation showed a positive relation. Conclusions: PUVA is still considered as the most appropriate and effective treatment for vitiligo. Saudi patients showed good response to treatment in general. Some sites such as the face, trunk, arms, and legs showed sensitivity to therapy, while hands, feet, and periorificial areas showed resistance to therapy. Generalized type was the best type to respond, followed by the periorificial type. Acral and segmental types were very resistant to therapy.

巴林的镰状细胞贫血病与妊娠

Objective: To determine the morbidity and outcome of pregnancies complicated by homozygous sickle cell disease (SCD) in Bahrain. Methods: A controlled study was conducted of all the pregnancies of women with SCD who were delivered at Salmaniya Medical Complex and affiliate hospitals in Bahrain between January 1, 1998, and December 31, 2002. Results: There were 351 pregnancies with SCD, giving an incidence of 0.67% . The mean ± S.D. age of women with SCD was 28.8 ± 5.7 years. These women, who were mostly from Shia villages, had more spontaneous abortions than the 351 controls (32% and 12% , respectively). Compared with the control group, the mean ± S.D. number of pregnancies among women with SCD was 5.0 ± 1.9 vs. 5.7 ± 3.1; birth weight, 2965 ± 540 g vs. 3457 ± 497 g; rate of preterm deliveries, 25.9% vs. 12% ; incidence of intrauterine growth restriction, 10% to 13% vs. 4% to 7% ; Apgar scores at 1 and 10 min, 8.1 ± 0.8 and 8.8 ± 0.8; and cesarean section rate, 19.0% vs. 12.7% . There were no differences in the rates of pre-eclampsia, antepartum and postpartum hemorrhage, or stillbirth. There were 4 maternal deaths directly related to SCD complications. Hemoglobin analysis was performed in 86% of the women with SCD. Of these women, 60.6% had homozygous SCD with raised levels of fetal hemoglobin (more than 5% HbF); 9.6% had sickle cell hemoglobin with β -thalassemia disease; and 1.4% had sickle cell hemoglobin only. Vaso-occlusive crises were the most common cause of hospital admissions during pregnancy (42.2% ), while hemolytic and sequestration crises accounted for 28.0% and 0.6% of admissions. Conclusion: Mortality, morbidity, and perinatal loss are still considerable among women with SCD in Bahrain. To reduce mortality and morbidity, there is a need for a multidisciplinary team able to deal with pregnancy complications due to SCD.

Peripheral Hematological Parameters in Sudanese Women with Polycystic Ovary Syndrome

The aim of this study is to assess the association between polycystic ovarian syndrome (PCOS) and hematological parameters [hemoglobin, red cell parameters, white blood cells (WBCs), platelets volume (MPV)]. This is a matched case-control study (60 women in each arm of the study) which was conducted in Saad Abualila infertility center Hospital in Khartoum, Sudan. Infertile women with PCOS were the cases and healthy non pregnant women were the controls. The gynecological characteristics were gathered through questionnaire and blood samples were analyzed for different blood parameters by automated hematology analyzer. While the two groups were matched in their age;body mass index was significantly higher in women with PCOs compared to the normal control. The investigated different hematological parameters (hemoglobin, RBCs, RDW, WBCs, platelets and MPV) showed no statistical difference between the women with PCOS and the controls.

Rationales and uncertainties for aspirin use in COVID-19:a narrative review

Objectives To review the pathophysiology of COVID-19 disease,potential aspirin targets on this pathogenesis and the potential role of aspirin in patients with COVID-19.Design Narrative review.Setting The online databases PubMed,OVID Medline and Cochrane Library were searched using relevant headlines from 1 January 2016 to 1 January 2021.International guidelines from relevant societies,journals and forums were also assessed for relevance.Participants Not applicable.Results A review of the selected literature revealed that clinical deterioration in COVID-19 is attributed to the interplay between endothelial dysfunction,coagulopathy and dysregulated inflammation.Aspirin has anti-inflammatory effects,antiplatelet aggregation,anticoagulant properties as well as pleiotropic effects on endothelial function.During the COVID-19 pandemic,low-dose aspirin is used effectively in secondary prevention of atherosclerotic cardiovascular disease,prevention of venous thromboembolism after total hip or knee replacement,prevention of pre-eclampsia and postdischarge treatment for multisystem inflammatory syndrome in children.Prehospital low-dose aspirin therapy may reduce the risk of intensive care unit admission and mechanical ventilation in hospitalised patients with COVID-19,whereas aspirin association with mortality is still debatable.Conclusion The authors recommend a low-dose aspirin regimen for primary prevention of arterial thromboembolism in patients aged 40-70 years who are at high atherosclerotic cardiovascular disease risk,or an intermediate risk with a risk-enhancer and have a low risk of bleeding.Aspirin’s protective roles in COVID-19 associated with acute lung injury,vascular thrombosis without previous cardiovascular disease and mortality need further randomised controlled trials to establish causal conclusions.

Is fat-free mass-based gentamicin dosing regimen preferable than whole-body weight in neonates?

Importance:Body fluid dynamics and renal maturation status vary during the neonatal period.We hypothesized that differences in peak and trough gentamicin concentrations could be expected.Objective:To predict the peak and trough gentamicin concentrations in critically ill neonates and to predict the changes in the predicted peak plasma concentrations of gentamicin following fat-free mass dosing.Methods:Critically ill neonates that received gentamicin and have gentamicin concentration measured were recruited.Fat mass was estimated using skinfold thicknesses.Changes in the peak plasma concentrations(Cmax)using whole-body weight(estimated using the current dosing regimen)and predicted concentrations following the fat-free mass-based dosing were the outcome measures.Results:Eighty-nine critically ill neonates were recruited.Sub-therapeutic Cmax was estimated using the current dosing regimen in 32.6%,and 22.5%neonates following the first and second doses of gentamicin.Preterm neonates had significantly higher fat mass compared to term neonates.All except one had Cmax above 12μg/ml after the first dose and all had after the second gentamicin dose following the predicted fat-free massbased gentamicin dosing.The recommended doses are as follows:extreme preterm:7.95 mg/kg every 48 h;very preterm:7.30 mg/kg every 36-48 h;late preterm:5.90 mg/kg every 36-48 h;and term neonates at 5.10 mg/kg every 24 h.Interpretation:Fat-free mass dosing may be considered for obtaining optimal therapeutic effects in the neonatal population.