bluuebunny/crossref_metadata_2025 huggingface dataset:
Successful local thrombolytic therapy in subacute budd-chiari syndrome: Case report and review
Authors: Elsiesy Hussien , Saad Mohamed , Hamed Wael , Alzaabi Saif , Alqahtani Mohamed , Khan Iftikhar , Alsaghier Mohammed , Tawfiq Mansour , Al-Kattan Wael , Selim Khalid
Published: July 2017

Introduction: Management of Budd-Chiari syndrome (BCS) includes different interventions and surgical procedures. There is limited data regarding catheterdirected thrombolysis when treating this condition but it appears to be helpful in the case illustrated below. Case report: A 29 year-old woman was referred to our center with one month history of right upper abdominal pain, progressive abdominal distension and intermittent fever not associated with rigors. There was no history of oral contraceptive use. She had mild right upper quadrant tenderness and abdominal distention with moderate elevation of liver enzymes. Her serology was negative for viral hepatitis, autoimmune or cholestatic liver disease. Computed tomography (CT) angiogram of the abdomen showed a large amount of ascites with extensive thrombosis of the inferior vena cava (IVC) involving the hepatic and left renal veins. There was also complete occlusion of the left common iliac vein confirmed by venogram. An infusion catheter was placed through the thrombosed segment of the IVC and right hepatic artery. Thrombolytic therapy was started with the injection of 5 mg of recombinant tissue plasminogen activator (t-PA) as a loading dose followed by 0.3 mg per hour. Enoxaparin and oral warfarin were started simultaneously and once the target INR was reached, enoxaparin was stopped and warfarin continued indefinitely. Ascites was well controlled with diuretics and large-volume paracentesis. A follow up venogram showed partial recanalization of IVC and hepatic veins. A repeat CT scan after 14 weeks showed complete resolution of the thrombus. After 28 months, she is asymptomatic with normal liver function tests and total resolution of the ascites. Conclusions: The data on local thrombolysis is limited and the agents and doses are not uniform among reported cases. This case report shows that it can be considered in acute BCS with partial obstruction, followed by angioplasty or TIPS if unsuccessful.
Colchicine poisoning: A case of deliberate self poisoning, late presentation and fatal outcome
Authors: Draa Elham , Arebi Ali , Alarabi Safwan
Published: July 2017

Colchicine poisoning is relatively uncommon, but potentially life threatening event due to the high toxicity of the drug and ability to precipitate severe multi-organ failure in overdose. Colchicine is used primarily in the treatment of acute attacks of gout and inflammatory diseases. We report a the first case of a 18 -year-old Libyan female who presented to the emergency department approximately 20-28 hours after ingesting 30 mg of colchicine in a suicide attempt. In spite of gastric lavage, use of activated charcoal and supportive measures, multi-organ system failure developed over the following two days, and patient died on the third day after admission. Salient toxicological and clinical aspects of colchicine poisoning are discussed.
Deferasirox versus deferoxiamine for the treatment of transfusional iron overload in patients with β-thalassemia major
Authors: Ibrahiem Osama , Thabet Ahmad
Published: July 2017

Background: Many patients with transfusional iron overload are at risk of progressive organ dysfunction and early death. Poor compliance with iron chelators is believed to be a major contributing factor. Objectives: The aim of this study is to evaluate the efficacy of Deferasirox in comparison with Deferoxiamine for the treatment of transfusional iron overload in patients with β-thalassemia major. Patients and Methods: We evaluated the oncedaily Deferasirox for 48 weeks in forty patients (older than 2 years) who had β-thalassaemia major with evidence of iron overload. Some had been previously treated with chelating agents. Most patients began treatment with Deferasirox 10 mg/kg/ day and may be increased to 30 mg/kg/day. Serum ferritin level was assessed before and after beginning of Deferasirox treatment at 3 months interval for 48 weeks. Results: Deferasirox was associated with mild adverse events on most occasions. The mean serum ferritin level decreased significantly in all patients treated with Deferasirox compared to those on Deferoxiamine. Conclusions: Administration of Deferasirox as an oral drug may be preferable and more effective than the parentral iron chelating therapy with better compliance and no inconvenience of parenteral infusion regimens.
Neurohistochemical studies of adolescent rats' prefrontal cortex exposed to prenatal nicotine
Authors: Omotoso Gabriel , Adekeye Mercy , Ariyo Abayomi , Ibitolu Josephine , Oyeyemi Olalekan , Enaibe Bernard
Published: July 2017

Background: Exposure to tobacco has frequently been associated with adverse implications on many body organs and systems. Maternal smoking can influence fetal development, causing intrauterine growth restriction, preterm birth, or even fetal death and spontaneous abortion. Objectives: We investigated the effects of prenatal exposure to nicotine on the prefrontal cortex in adolescent rats. Materials and Methods: Twenty-four mature female Wistar rats were time mated and grouped according to Trimester into Control and Treated groups. Nicotine was administered intra-peritoneally to pregnant Wistar rats in the treated groups, while normal saline was given to the control groups, at each of the three Trimesters. The animals were allowed to litter and the pups were allowed to grow till postnatal day 35, when they were sacrificed and the brain removed and weighed. The prefrontal cortex was excised and either fixed in 4% paraformaldehyde for tissue histology or homogenized in sucrose solution for enzyme studies (alkaline phosphatase, lactate dehydrogenase and glucose-6-phosphate dehydrogenase). Results: Enzyme studies showed derangement in biochemical status of the prefrontal cortex of all the nicotine-exposed animals compared with their respective controls, and corresponding morphological and histological alterations, especially in animals exposed to nicotine during their 2nd and 3rd weeks of fetal life. Conclusions: The morphohistological and biochemical derangements that occur during neurodevelopment of nicotine-exposed offspring persist into adolescent life, and could underlie the neurological dysfunctions associated with such individuals.
Bacteria etiological agents causing lower respiratory tract infections in the western part of Nepal
Authors: Khan Salman , Singh Priti , Ansari Mukhtar , Gurung Kishor
Published: July 2017

Objectives: Lower respiratory tract infections (LRTIs) are among the most common infectious disease. We determined the bacterial etiology of LRTIs among patients attending Nepalgunj Medical College teaching hospital in Banke, western Nepal. Materials and Methods: 426 specimens from patients with suspected LRTIs attending out-patients and in-patients departments were studied. The specimens were collected and processed according to standard methodology in the Central Laboratory of Microbiology at Nepalgunj Medical College and Teaching Hospital, Banke, Nepal during the period of January to December 2012. Results: Respiratory pathogens were recovered from 210 cases (49.3%). Bacteria were more commonly recovered from endotracheal secretions (86 cases; 41%) than in sputum (82 cases; 39%) and bronchial washing (42 cases, 20%). In168 cases, growth was monomicrobial while the rest was mixed growth. Gram-negative bacteria were isolated in 246 cases (80.9%) and Gram-positive bacteria in 58 cases (19.1%). Among the Gram-positive organisms isolated, Streptococcus pneumoniae (30, 51.7%) was the most predominant pathogen followed by Staphylococcus aureus (28, 48.3%) and in Gram-negative organisms isolated, Pseudomonas aeruginosa (116, 47.2%) was most predominant pathogen followed by Haemophilus influenzae (68, 27.6%), Klebsiella pneumoniae (36, 14.6%) and Escherichia coli (26, 10.6%). Conclusions: Respectively, Pseudomonas aeruginosa and Streptococcus pnemoniae were the most common Gram negative and Gram-positive bacterial isolates recovered from LRTIs. Close monitoring and surveillance of these pathogens is urged.
Clinical characteristics, management and outcome of patients admitted with acute stroke in Benghazi, Libya
Authors: Bennour Anwaar , Ehmoda Fathia , Bo-Shaala Salah
Published: July 2017

Background: Stroke is the second leading cause of chronic disability and death in the world. Educating the public and physicians about stroke-related symptoms are critical success factors in early stroke treatment. Aim: This study was carried out in order to assess acute stroke management strategies in a teaching hospital. Patients and Methods: The study included all consecutive patients admitted to the general medical ward during the period of March to November 2008 who had a diagnosis of acute stroke. The total number was 217 patients, presumed to have stroke during their initial evaluation in the emergency room. However, ward evaluation confirmed only 193 patients to have a diagnosis of acute stroke (sudden onset of any neurological deficit). Brain imaging was performed in 167 out of the 193 patients. Results were obtained for 140 patients. Results: The age of those with clinical and radiological evidence of acute stroke (n=140) was 65±12 years. Sixty-five were females. The median time elapsed between the onset of symptoms and the arrival to the hospital was 12 hours (range: 1-336 h). Females presented earlier than males (19 hours versus 35 hours; p<0.05). Forty-eight patients (34%) presented within the first four hours and 71 (51%) arrived after eight hours, whilst 8 patients (6%) were not able to determine the time of onset of symptoms. The mean time for brain image from hospitalization was 3.5±2.3 days with no gender difference. Ischemic infarction was reported in 104/140 (74%) patients, intracerebral hemorrhage was reported in 16 (11%) patients and brain ischemia with hemorrhagic transformation was reported in 14 (10%). Normal brain images were found in 6 (5%) patients. 108 patients (78%) received in-hospital aspirin treatment with a mean time to start aspirin 1.2±1.4 days. The mean length of stay in hospital was 7.5±3.7 days. Ninety-nine (80%) of the patients were discharged on aspirin. The in-hospital outcome was assessed by the Rankin Disability Status scale as static course (in 107 patients; 85%), improvement of neurological function (in 10 patients; 8%), deterioration of neurological function (in 1 patient; 1%), or death (in 8 patients; 6%). Conclusion: Hospital arrival and performance of brain image were both delayed. Delayed arrival was attributed to lack of ambulance with direct transportation to the acute care hospital, waiting at the emergency department, and public's unawareness of stroke symptoms. The delay in performing brain image is the limited access to CT/MRI facility on site and out of hours. Public and professional education campaign coupled with an effective acute treatment strategies are urgently needed.
Morphology of papillary muscles in human adults: A cadaveric study
Authors: Hosapatna Mamatha , Souza Anne , Das M , Supriya Supriya , Ankolekar Vrinda , Souza Antony Sylvan
Published: July 2017

Introduction: The papillary muscles (PM) play an important role in ventricular overextension. The variability in the number, shape and location of papillary muscle of the right and the left ventricle is important for the surgeon in reparative procedures, papillary muscle dysfunction, mitral valve replacement and use of mitral valve homograft for mitral/tricuspid replacement. Materials and Methods: The study was conducted using 15 formalin fixed adult human hearts. The presence, number, shapes, length, number of additional heads of the papillary muscles were observed. The presence of moderator band (MB) was noted and its level of attachment to the anterior PM was observed. Results: Double anterior and posterior PM were found in few cases. The length of PM was longer in the left ventricle when compared to the right ventricle which was statistically significant. In the right ventricle cone-shaped PM was observed in the majority of the cases whereas flat topped PM was observed in 2 cases. In the left ventricle all the PM were cone shaped. In majority of the cases (N=13) the MB was attached to the lower third of the PM whereas in one case each it was attached to the upper third and to the middle third respectively. Conclusions: The morphology and morphometry of the papillary muscles of both ventricles and moderator band were defined. These may help cardiac surgeons during surgical procedures conducted for correction of their defects.
Complement C3 and C4 levels in recurrent aborting women with or without antiphospholipid and anticardiolipin autoantibodies
Authors: Yaseen Al-khayat Zakarea , Waheda Nabeel , Shaker Nabaz
Published: July 2017

Background: Accumulating body of evidence suggests a role for the complement system in the etiology of abortion. Objectives: To evaluate levels of complements (C3, C4) in cases of abortion with or without circulating antiphospholipid (APL) and anticardiolipin (ACL) autoantibodies. Patients and Methods: A total of 103 women were enrolled in this case controlled study including 73 patients with a history of three or more abortion and 30 healthy parous women. For all, ACL, APL, C3, C4 levels were estimated. Results: The means and ranges of circulating complements (C3, C4) were as follows [C3 level: (90 ± 9; 39-115 mg/dl versus 109±16;95-138 mg/dl) in patients and controls respectively; C4 level: (18±10; 11-25 mg/dl; versus 36±7; 23-39 mg/dl) in patients and controls respectively]. The differences in the means between patients and controls were highly significant (p . 0.01). In the patients' group, according to the mean, the range of C4, C3 and the elevation of both ACL and APL, three subgroups (A, B, C) were recognizable. Group A included 21 aborting women with high levels of ACL and APL. Their complement levels (mean ± S.D; range) were as follows:[C3: (59.7±11.6; 39-65 mg/dl); C4: (14.7±5.2; 11-16 mg/dl)]. Group B included 34 aborting women with normal levels of ACL & APL. Their complement levels (mean ± S.D, range) were as follows: [C3: (88.6±19.3; 59-90 mg/dl ) and C4:(18.4±7.3; 15-21 mg/dl)]. Group C included 18 aborting women with normal levels of AC & APL and their complement levels (mean ± S.D; range) were as follows:[C3: (102.7± 15.1; 90-115 mg/dl) and C4: (21.4 ± 5.8; 17-25 mg/dl)]. The differences between the means of C3 in these subgroups were highly significant (p < 0.01), while the differences between the means of C4 between B and C were not significant. Conclusion: Low C3 & C4 levels were detected in recurrent aborting women with or without autoantibodies (APL & ACL). These data may suggest a role for these complements in the pathogenesis of recurrent pregnancy loss.
Second clinical congress of the gulf chapter of the american association of clinical endocrinologists, october, 23rd-25th 2014, Abu Dhabi, United Arab Emirates
Authors: Beshyah Salem , Al Zahrani Ali , Khalil Aly
Published: July 2017

These are the advance abstracts of the second clinical congress of the Gulf Chapter of the American Association of Clinical Endocrinologists to be held on 23-25 of October 2014. The declared educational objectives of the congress is to give a “state of the art in endocrine practice”. To this end, the organizing committee invited international and regional key opinion leaders to meet the objectives of the congress. We present the abstracts of the congress as submitted by the authors after minimal restyling and editing to suit the publication requirements of the journal. Many major issues and topical themes with wide interests in the profession were addressed in 5 plenary lectures. A clinical practice debate was included to highlight the pros and cons of the recently published lipid lower guidelines from both sides of the Atlantic. More focused issues were included in 12 clinical practice symposia to suite the specific educational needs of the target audience subgroups. Practical issues were addressed in “Meet the Expert”-type of interactive workshops. A selection of free communications from abstracts submitted by delegates, reflecting mostly the regional epidemiology and clinical practice in diabetes care and endocrinology, were selected for presentation as either oral or poster presentations.

We hope that by publishing them in this journal we extend the benefit to those who could not make it to the live presentations. The focus of this year's congress included bone health, molecular endocrinology, pituitary and adrenal disease, new advances in diabetes care, nuclear medicine in endocrinology and select topical issues in addition to many other day to day concerns in diabetes care and clinical endocrinology.
Unusual presentation of simple virilising congenital adrenal hyperplasia as a testicular adrenal rest tumor
Authors: Deeb Asma , Khan Azaz , Gawhary Amin , Al-Zubaidi Muhannad , Moussa Emad , Hughes Ieuan
Published: July 2017

Testicular adrenal rest tumors are commonly seen in congenital adrenal hyperplasia. The tumors are typically bilateral and arise from ACTH dependent aberrant adrenal cells in the testes. Diagnosis is clinically confirmed by ultrasound imaging. These tumors are characterized by their response to steroid replacement and biopsy is not routinely required. Differentiating the tumor from Leydig cell tumor can be difficult. Management and prognosis for these two pathologies are different, so extensive investigations may be required to confirm the diagnosis. We present a 5 year old boy who had an unusual presentation of a testicular tumor and detail the investigations undertaken to differentiate a testicular adrenal rest tumor from a Leydig cell tumor.
The second Qatar internal medicine congress; 30th of october-1st of november 2014; Doha, Qatar
Authors: Elzouki Abel , Eledrisi Mohsen
Published: July 2017

These are the abstracts of the second Qatar Internal Medicine Congress held between 30th October and 1st of November 2014 in Doha, Qatar. The program of the congress had three different types of sessions, plenary lectures and symposia sessions by invited panel of international and regional experts in addition to free communications selected from submitted abstracts presented as oral or poster communications. The objectives of congress includes a wide ranging update for internal medicine physicians in addition to stimulation of presentation of locally conducted clinical research.
A 36 year old woman with “difficult-to-treat” hypertension: Endocrine or resistant hypertension?
Authors: Bashier Alaaeldin , Al Awadi Fatheya , Thadani Puja , Khalifa Azza
Published: July 2017

A thirty six year old Emirati female who had had hypertension for 5 years is presented. Her blood pressure has been consistently above 160/110 mmHg, despite being treated with more than 5 antihypertensive drugs. Work up for secondary hypertension was repeatedly negative locally and at two world-renowned endocrine units in London. Ultimately, she underwent “catheter guided renal sympathectomy”, which resulted in good blood pressure control readily achievable on single antihypertensive agent. The diagnostic and management challenges of the case are presented and the efficacy of the therapeutic procedure in treating resistant hypertension is discussed. We also appraise the evidence-base for potential place of this procedure in the current guidelines for management of hypertension.
The impact of vitamin E supplementation on urinary bladder contractility in streptozotocin-induced diabetic rats
Authors: Ahmed Marwa , Hassan Asmaa , Ahmed Omyma
Published: July 2017

Background: To determine whether vitamin E protects streptozotocin-induced diabetic rats from diabetic urinary bladder dysfunction and discover its possible mechanism. Materials and Methods: A total of 40 rats were randomly divided into four groups: a control group (A), a diabetic group (B), a group given vitamin Eonly (C), and a diabetic group given vitamin E therapy for 8 weeks (D). Diabetes was induced in the rats by 65 mg/kg streptozosin (STZ) via an intraperitoneal (i.p.) injection. Vitamin E was given in a dose of 50 mg/kg/day i.p. Under urethane anaesthesia (1.2 g/kg) subcutaneously and decapitation, contractile responses to carbachol of detrusor strips in all groups were studied in vitro. The levels of nitrite, nitrate, malondialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) were detected in bladder tissues homogenates. Apoptosis studies were performed by detection of the levels of caspase 3 and cell death detection. Results: The bladder weights were significantly increased (p<0.001) in diabetic groups compared to the other studied groups. Contractile responses to carbachol increased in the diabetic group more than in the other groups (p<0.001). Vitamin E improved the contractile responses of group D and improved them but still significantly higher than those of control group (p < 0.05). Vitamin E treatment decreased the tissue MDA, nitrite, nitrate and GSH levels of group D which were significantly higher in group B than A and C groups (p<0.001). All enzyme activities of group B were significantly lower than those of the other groups, although they increased significantly in group D but still lower than those of A and C groups. However, no significant differences were detected between the levels of GPx and SOD of group D and those of A and C groups.

Conclusions: These data suggest that vitamin E supplementation may be beneficial in delaying the progression of diabetic dysfunction in experimental animal model.
Effect of vagus nerve stimulation on focal transient cerebral ischemia and reperfusion in adult male white new zealand rabbits
Authors: Sayyed Hayam , Idriss Naglaa , Darwish Abeer
Published: July 2017

Background: Oxidative stress has been implicated in the pathophysiology of cerebral ischemia. Pentraxin-3 plays an important role in innate immune responses and in inflammatory diseases. Our aim was to evaluate pentraxin-3 serum level on focal transient cerebral ischemia and reperfusion model in rabbits and to assess the anti-inflammatory and anti-oxidant effects of vagus nerve stimulation. Materials and methods: Focal transient cerebral ischemia and reperfusion was induced by occlusion of the right common carotid artery for 2 hours followed by reperfusion for one hour. Stimulating electrodes were implanted on the cervical part of the right vagus nerve. Vagus nerve stimulation was started 30 min following right common carotid artery ligation for a period of one hour. The stimulation signals were delivered every five minutes for 30 seconds. All the procedures were duplicated but no stimulus was delivered in the control group. Serum level of pentraxin-3, lipid peroxide and total thiols were determined at baseline, at end of ischemia and at end of reperfusion and the animal decapitated and neuronal damage was evaluated. Results: We found that vagus nerve stimulation caused reduction of the ischemic features with revival of the cell shape and size. It also resulted in decreased serum levels of pentraxin-3 and lipid peroxide whereas the level of total thiols was increased. Conclusion: We concluded that the observed diversity in pentraxin-3, lipid peroxide and total thiols serum levels in cerebral ischemia and reperfusion may reflect relative roles in the biology. Anti-inflammatory and anti-oxidant role of vagus nerve stimulation in cerebral ischemia and reperfusion may represent a marker of altered cerebral function, and may provide potential therapeutic applications.
Lateral medullary syndrome: An unusual central cause for unilateral vocal cord palsy
Authors: Ahmed Rania , Shaheen Mahasin , Noshi Mohamed
Published: July 2017

Lateral medullary syndrome, also known also as Wallenberg syndrome, remains an interesting clinical entity with varied presentations of cerebrovascular accidents. The area of the brain stem involved is the posterolateral part of the medulla oblongata receiving arterial blood supply from the posterior inferior cerebellar artery. We present a 60-year-old man presenting with unilateral vocal cord palsy due to an unusual central cause, being part of lateral medullary syndrome. We reviewed the neuroanatomy and clinical aspects of this condition.
Dispensing practices, attitudes and knowledge of pharmacists towards herbal products in palestine
Authors: Sweileh Waleed , Abu Arrah Enass , Abu Taha Adham , Sawalha Ansam , Salah Ola , Jamous Raniah , Adawi Deema
Published: July 2017

Background and Objectives: With the global rise in the use of herbal products; pressure is increasing on pharmacists to have more knowledge about herbal medicine. We assessed pharmacists' dispensing practices, attitudes, and knowledge regarding herbal products. Methods: A cross sectional study was carried out among community pharmacists in north Palestine using a questionnaire. A convenience sample of 100 community pharmacists was included in the study. The mean age of participants was 33±11 years. Results: Dispensing of herbal products was common. The majority of participants (91%) believed that herbal products were beneficial and 61% believed these had fewer side effects than conventional medicines. Most participants thought they have good knowledge of herbal preparations. However, their actual knowledge in response to factual questionnaire was low. The lowest score was observed for herbal drug interactions domain. Conclusions: Although herbal products are commonly dispensed in Palestine, community pharmacists have poor knowledge about these medicines. Continuing pharmacy education in general is needed for community pharmacists to qualify them to provide a better pharmaceutical care.
Analyses of evidence for hierarchy and levels of evidence: An exploratory quantitative synthesis
Authors: Kumar Senthil , Sisodia Vaishali
Published: July 2017

Background: Among the recognized steps in EBP, evaluating and critically appraising research evidence on effectiveness of an intervention is an essential step that acts as a determinant in forming the link between obtained evidence and implementation in practice. Objective: To critically summarize and identify the results of analyses of levels of evidence published in journals indexed in PubMed. Methods: A systematic overview and quantitative analysis of selected 45 published reviews was performed to identify relevant themes in levels of evidence. The types of analyses (specialty-based, practice-based, journal-based, and conference-based) were categorized and sub-categorized for the studies on levels of evidence. Results: Of the 45 included studies, specialty-based analysis for levels of evidence were done in 12 articles, journal-based analysis in 5 articles, practice-based analysis in 25 articles, and conference- based analysis in 3 articles. Among the practice-based articles, 10 were on assessment and 15 were on treatment. Urology had more studies on analysis of levels of evidence, and very few studies analyzed journals and their content for the same. Three studies were analyses of conference abstracts, all of them in the field of orthopedics. Conclusion: There were greater number of studies on practice, in Urology, multiple journals, biomarkers in assessment, and equal representation of pharmacological and allied treatments. There is need for future reviews and analysis of levels of evidence in many unexplored areas of relevance
Knowledge of and adherence to health advice among adults with diabetes in Libya
Authors: Elkharam Walid , Khatri Rose , Wallymahmed Akhtar , Gee Ivan , Elhisadi Tawfeg
Published: July 2017

Background: Non-adherence to medical and health care advice is a common problem, though reasons for non-adherence can differ across different groups and societies as well as between individuals. Objective: to examine diabetes knowledge among people with both type1 and type2 diabetes in Libya and explore any other factors that enhance adherence to treatment and management of the condition. Methods: A cross-sectional survey design was used to collect data from adults with type1 or type2 diabetes who have been diagnosed for 12 months or more, in Benghazi Diabetes Centre, which is one of the oldest and largest diabetes registries in Libya. A total of 855 participants were asked to fill in two questionnaires; the “Michigan Diabetes Knowledge Test” to investigate the level of diabetes knowledge and the Confidence in Diabetes Self-care Scale to assess self-efficacy. For the purpose of the study descriptive statistics and inferential statistical tests were conducted. Results: Diabetes knowledge is very poor especially among females and those classed as illiterate within the sample. The mean HbA1c of 9.4 was higher than the recommended levels. Four variables namely knowledge about diabetes, duration of illness, family history and self-efficacy significantly predicted levels of HbA1c. Conclusion: Based on the above findings, two different program of diabetes education would be recommended. The first would target those with inadequate levels of knowledge about diabetes, particularly women and people with long duration diabetes. The second would be for both healthcare professionals and people with type 1 and type 2 diabetes considering the psychological factors that are involved in diabetes management.
Cardiac risk factors and psychosocial variables in coronary artery disease: A case-control study of the younger population of United Arab Emirates
Authors: Haque Amber , Jamil Gohar , Namawar Azimeh
Published: July 2017

Various psychosocial factors are known to contribute to the development of coronary artery diseases (CAD). However, most of these studies are done in the West and little is known about the contribution of such variables in the younger population of the Arabian Gulf region. Objectives: This study investigated the association of various physical and psychological variables with the development of coronary artery disease among young adults (<45 years old) in the United Arab Emirates. Patients and Methods: A case-control study was conducted with 90 CAD patients who underwent catherization due to heart attack and 90 control subjects selected within public setting during 2011-2012. Patient demographics, personality types, emotional intelligence and stress handling skills were also studied. Results: Eighty eight percent of the CAD patients were expatriates [88% South Asian, 20% Middle Eastern and 1% South East Asian]. Ninety five percent were men and 71% were in their 30s. Ninety two percent came from low socio-economic backgrounds; only 12 % had above high school education and 92% were classified as nonprofessional workers. Majority were married. Patients were more likely to have family history of CAD, diabetes, hypertension, and smoking when compared to controls. Diabetes, hypertension, smoking, and sedentary lifestyle were significantly more frequent among patients. type A personality was more in CAD patients than controls (61% vs 36%; p=<0.01). Patients and controls were significantly different in terms of emotional self-management (p<0.001). All control subjects were classified as emotionally unhealthy whereas 64% of patients were reported being in this category. Only 27% of patients indicated themselves as type D, which did not significantly differ from 29% of the control subjects. There was no significant difference between the two groups in stress handling abilities. Conclusions: This study revealed new findings on the prevalence of psychosocial variables in CAD in this region. Of interest that personality type D, stress handling abilities, and emotional intelligence were not significantly evident as cardiac risk factors in this population. More culturally sensitive measurements are needed to elucidate these findings further.
Late diagnosis of primary hyperoxaluria type 1 despite recurrent kidney stones and positive family history
Authors: Abumwais Qasem
Published: July 2017

Primary hyperoxaluria type 1 (PH1) is the most common form of primary hyperoxalurias. It results in increased synthesis and subsequent urinary excretion of the metabolic end product oxalate and the deposition of insoluble calcium oxalate in the kidney and urinary tract. Individuals with PH1 are at high risk for recurrent nephrolithiasis, nephrocalcinosis, and end-stage renal disease (ESRD). A 13 years-old female presented with fatigue, headache, nausea, vomiting, anorexia, renal colic. Initial clinical and laboratory investigations revealed ESRD and the patient was initiated on hemodialysis. Family history of PH1 and a history of recurrent kidney stones for 4 years was elicited. Subsequently, PH1 was confirmed by, physical examination, medical history, family history, laboratory tests, ultrasound imaging, X- ray, CT scanning and renal biopsy. As this disease is no longer rare in Jenin District of Palestine where this patient was seen, delayed diagnosis can not be justified. In conclusion, early diagnosis and effective treatment of PH1 in areas with high prevalence, such as the Jenin District of Palestine, is warranted as it may delay the progression towards ESRD or systemic oxalosis.
Knowledge, attitudes and practices of health care workers in Benghazi, Libya towards post exposure prophylaxis for HIV
Authors: Saoud Ikram , Elsour Ibtihal , Elbargathi Amna , Elmarak Asma , Ali Emad
Published: July 2017

Background: Health- care workers (HCWs) have a substantial risk of exposure to HIV. Effective post- exposure prophylaxis (PEP) must begin within 72 hours of possible HIV exposure. Objectives: To assess knowledge, attitudes and practices (KAP) among HCWs with regard to HIV post exposure prophylaxix (PEP) in Benghazi, Libya. Methodology: A cross-sectional study was conducted in seven medical centers. A convenience sample of HCWs were surveyed with a based on published international and national HIV/AIDS care guidelines. Demographic characteristics, knowledge about HIV PEP and information on work practices were collected. KAP data scores were classified as good, satisfactory or poor. Results: HCWs had a high level of knowledge about HIV transmission and risk groups. Forty percent of nurses believed that the transmission rate of HIV is lower than HBV& HCV. The majority of HCWs were offered PEP as soon as possible after HIV exposure, and flushed the wound with alcohol or antiseptics, but just over half of the nurses and less than quarter of the doctors had immediate HIV testing after exposure to potentially contaminated blood or body fluid. Nurses were observed to have variable practice in the use of gloves or protective clothing at work. The uptake of hepatitis B vaccine by HCWs was incomplete or absent in 41% of nurses and 59% of doctors. Conclusions: We conclude that the knowledge and attitude of HCWs about HIV PEP varied from satisfactory to good. Some misconceptions exist and need to be corrected. Health education for HCWs regarding HIV is essential to limit risk of transmission and to protecting staff and the welfare of the community. Occupational health clinics should be established in all hospitals to improve these attitudes and practices.
Nosocomial infections in a surgical department, Tripoli central Hospital, Tripoli, Libya
Authors: Rishi Mahjoub , Jrad Samira , Al-Gumati Mohmed , Aboshkiwa Mohamed
Published: July 2017

Background: Pseudomonas. aeruginosa is an established cause of nosocomial infections among surgical patients and infants in neonatal intensive care units. Objective: We aimed, firstly to identify the prevalence of P. aeruginosa and other causative agents from wounds and other body sites (hands, groins, axillae, umbilicus and drains) and secondly to investigate the resistance patterns of antimicrobial susceptibility against various antibiotics. Materials and Methods: The study was carried out in Departments of General Surgery and Medical Laboratory in Tripoli Central Hospital, Tripoli, Libya over a period of 6 months from March through August 2007. A total of 792 clinical samples were taken during the examination from several sites of 150 patients and transported immediately to the laboratory then inoculated directly into selective on MacConkey agar and standard bacteriological media. The isolates were identified and antimicrobial susceptibility testing was performed by the disc diffusion method according to National Committee for Clinical and Laboratory Standards (NCCLS) guidelines. Results: 336 different bacterial isolates were identified in wounds and other body sites. In general, P. aeruginosa was the commonest isolate (35.7%) followed by Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae (29.2%, 9.2%, and 8.9%) respectively. In particular, P. aeruginosa was the most common bacteria isolated in samples from diabetic foot disease reaching 80.6% of total isolates. Conclusion: P. aeruginosa was found to be quite common in our surgical patients and it has emerged as one of the most problematic Gram negative pathogens. Hands of the patients were commonly colonized by different bacteria. Resistance rates to frequently used antibiotics were high. Microbiology sensitivity results should guide the use of proper antibiotic drugs.
“O desenho é uma pronúncia”: Paula Rego e Agustina Bessa-Luís
Authors: Cruz Mariana Andrade da
Published: July 2017

http://dx.doi.org/10.5007/2175-7917.2016v21n1p142O objetivo do presente trabalho é fazer uma análise do livro As meninas, no qual a romancista portuguesa Agustina Bessa-Luís fala sobre vida e obra da pintora Paula Rego, também portuguesa. Embora possua contornos biográficos, focalizando especialmente a infância de Rego e o relacionamento que manteve com Victor Willing, o texto trará reflexões variadas sobre a natureza do fazer artístico em si. Cremos que, ao lê-lo, podemos considerá-lo não só como um relato de apreciação crítica da fortuna artística de Rego, mas também como um livro cujo valor reside em si próprio. Ao apresentar a biografia da pintora, Bessa-Luís encontra pontos de contato com sua própria vivência, e usa-os como ponto de partida para tecer inúmeras reflexões de ordem metalinguística, bem como acerca das relações entre texto e tela. Considerando isso, pretendemos mostrar como o livro muitas vezes indicia um diálogo interartes, além de evidenciar pontos de contato entre a escrita de Bessa-Luís e as imagens que permeiam o volume.
Os Mistérios de Paulo Leminski
Authors: Gessner Ricardo
Published: July 2017

http://dx.doi.org/10.5007/2175-7917.2016v21n1p154Ademais de recorrências estilísticas na poesia de Paulo Leminski (1944-1989), aspecto até o momento largamente estudado pela crítica especializada, também é possível identificar recorrências temáticas. Nesse sentido, este trabalho propõe-se a analisar e interpretar a temática do mistério, articulada em dois poemas: “rio do mistério”, e “Suprassumo da Quintessência”, publicados, respectivamente, em Distraídos Venceremos (1987) e La vie en close (1991). Com isso, serão feitos inicialmente uma análise e uma interpretação de cada poema, verificando em que medida há um diálogo entre eles e, desse modo, conseguir subsídios para constituir uma hermenêutica para o que pode significar a recorrência dessa temática e desenvolvê-la na análise e interpretação do poema “Adminimistério”, também pertencente ao livro Distraídos Venceremos. Para desenvolver o trabalho, o ponto de partida serão os próprios textos poéticos, sendo que referenciais teóricos serão utilizados como apoio para o desenvolvimento da discussão, enfocando, principalmente, a obra ensaística do próprio Paulo Leminski, sobre o que o poeta pensa e desenvolve acerca da temática do mistério.
Pôncio Pilatos: o simulacro
Authors: Guareschi Égide
Published: July 2017

http://dx.doi.org/10.5007/2175-7917.2016v21n1p193
Últimas faces do poeta: prosa e poesia de Cruz e Sousa em "Últimos inéditos"
Authors: Tanus Gustavo
Published: July 2017

http://dx.doi.org/10.5007/2175-7917.2016v21n1p198
Mário de Sá-Carneiro: indícios de um mito, indícios de um corpo
Authors: Schwartzmann Matheus Nogueira
Published: July 2017

http://dx.doi.org/10.5007/2175-7917.2016v21n2p56O presente artigo tem por objetivo propor uma leitura de sobrevoo de alguns elementos da obra de Mário de Sá-Carneiro, buscando apontar, primeiramente, como a sua dimensão mítica, cultivada desde as primeiras edições de sua obra, marcou profundamente a leitura que dela se fez. Nesse sentido, trataremos do seu suicídio, retomado e reafirmado por nomes como Fernando Pessoa, José Régio, Casais Monteiro, por exemplo, e de como esse tema contribuiu para a cristalização do seu mito. Em um segundo momento, levando em consideração determinados temas e figuras que podem ser apreendidos nos textos de Sá-Carneiro, indicaremos outros caminhos de leitura, buscando em poemas, cartas e algumas das suas narrativas elementos que permitam entrever na sua escrita a presença do seu corpo. E é a descrição desse corpo, que repropõe noções como feminino e masculino, que nos parece ser aquilo que devemos considerar como inovador na sua poesia, na medida em que seria justamente uma das suas marcas de modernidade.
Sá-Carneiro: Vontade de morte, saudade de vida
Authors: Campos Maria Elvira Brito
Published: July 2017

http://dx.doi.org/10.5007/2175-7917.2016v21n2p79O presente trabalho contempla a elaboração da ideia de morte no poema "Dispersão" de Mário de Sá-Carneiro. A análise e interpretação pretendem oferecer uma leitura crítica dos aspectos inerentes à inquietação/obsessão do sujeito lírico frente ao tema apresentado. A delicadeza da poesia de Sá-Carneiro, em alguns momentos “preparatória para a morte”, permite uma visão labiríntica, embutida, condicionada à quebra de limites, o que é exemplificado em seus poemas. Daí o cotejo da ideia de morte como perpetuação de um instante, independentemente dos resultados que essa ruptura possa revelar. Assim, trazer a lume o poema Dispersão é entendê-lo como um belo exercício de observação da circularidade, do movimento, da sinuosidade, do eterno retorno. As reticências, a luminosidade, as entradas e saídas em estados de alma controversos, tudo isso constitui a rápida duração da vida do poeta, enquanto sua poesia, como tecelãs de um puzzle que estamos sempre tentando montar, continua a nos entreter, um século após ser escrita, imortalizando o poeta que tanto se recusou a viver.
Lidar ratios of stratospheric volcanic ash and sulfate aerosols retrieved from CALIOP measurements
Authors: Prata Andrew T. , Young Stuart A. , Siems Steven T. , Manton Michael J.
Published: July 2017

Abstract. We apply a two-way transmittance constraint to nighttime CALIOP (Cloud-Aerosol Lidar with Orthogonal Polarization) observations of volcanic aerosol layers to retrieve estimates of the particulate lidar ratio (Sp) at 532 nm. This technique is applied to three volcanic eruption case studies that were found to have injected aerosols directly into the stratosphere. Numerous lidar observations permitted characterization of the optical and geometric properties of the volcanic aerosol layers over a time period of 1–2 weeks. For the volcanic ash-rich layers produced by the Puyehue-Cordón Caulle eruption (June 2011), we obtain mean and median particulate lidar ratios of 69 ± 13 sr and 67 sr, respectively. For the sulfate-rich aerosol layers produced by Kasatochi (August 2008) and Sarychev Peak (June 2009), the means of the retrieved lidar ratios were 66 ± 19 sr (median 60 sr) and 63 ± 14 sr (median 59 sr), respectively. The 532 nm layer-integrated particulate depolarization ratios (δp) observed for the Puyehue layers (δp = 0.33 ± 0.03) were much larger than those found for the volcanic aerosol layers produced by the Kasatochi (δp = 0.09 ± 0.03) and Sarychev (δp = 0.05 ± 0.04) eruptions. However, for the Sarychev layers we observe an exponential decay (e-folding time of 3.6 days) in δp with time from 0.27 to 0.03. Similar decreases in the layer-integrated attenuated colour ratios with time were observed for the Sarychev case. In general, the Puyehue layers exhibited larger colour ratios (χ′ = 0.53 ± 0.07) than what was observed for the Kasatochi (χ′ = 0.35 ± 0.07) and Sarychev (χ′ = 0.32 ± 0.07) layers, indicating that the Puyehue layers were generally composed of larger particles. These observations are particularly relevant to the new stratospheric aerosol subtyping classification scheme, which has been incorporated into version 4 of the level 2 CALIPSO (Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observation) data products.
Synoptic Ozone, Cloud Reflectivity, and Erythemal Irradiance from Sunrise to Sunset for the Whole Earth as viewed by the DSCOVR spacecraft from Lagrange-1
Authors: Herman Jay , Huang Liang , McPeters Richard , Ziemke Jerry , Cede Alexander , Blank Karin
Published: July 2017

Abstract. The EPIC instrument onboard the DSCOVR spacecraft, located near the Earth-Sun gravitational plus centrifugal force balance point, Lagrange-1, measures Earth reflected radiances in 10 wavelength channels ranging from 317.5 nm to 779.5 nm. Of these channels, four are in the UV range 317.5, 325, 340, and 388 nm, which are used to retrieve O3, 388 nm scene reflectivity (LER Lambert Equivalent Reflectivity), SO2, and aerosol properties. These quantities are derived synoptically for the entire sunlit globe from sunrise to sunset every 68 minutes or 110 minutes for summer or winter at the receiving antenna in Wallops Island, Virginia, respectively. Depending on solar zenith angle, either 317.5 or 325 nm channels are combined with 340 and 388 nm to derive ozone amounts. As part of the ozone algorithm, the 388 nm channel is used to derive LER. The retrieved ozone amounts and LER are combined to derive the erythemal irradiance for the sunlit Earth's surface at a resolution of 18 × 18 km2 near the center of the Earth's disk using a computationally efficient approximation to a radiative transfer calculation of irradiance. Corrections are made for altitude above sea level and for the reduced transmission by clouds based on retrieved LER.
Leaf wax n-alkanes in modern plants and topsoils from eastern
Georgia (Caucasus) – implications for reconstructing regional paleovegetation
Authors: Bliedtner Marcel , Schäfer Imke K. , Zech Roland , von Suchodoletz Hans
Published: July 2017

Abstract. Long-chain n-alkanes became increasingly used for paleoenvironmental studies during the last years as they have the great potential to reconstruct past changes in vegetation and climate. They mostly originate from leaf waxes of higher terrestrial plants, are relatively resistant against physical and chemical degradation and can thus serve as valuable biomarkers that are preserved in various sedimentary archives for at least millennial timescales. However, before any robust interpretation of the long-chain n-alkane patterns in sedimentary archives, reference samples from modern vegetation and topsoil material should be investigated at a regional scale. Apart from Central and South-Eastern Europe, such systematic regional studies on modern plant and topsoil material are still largely lacking. To test the potential of leaf wax derived n-alkane patterns for paleoenvironmental studies in the semi-humid to semi-arid southern Caucasus region, we investigated the influence of different vegetation types on the leaf wax n-alkane signal in modern plants and topsoil material (0–5 cm) from eastern Georgia. We sampled (i) sites with grassland that included steppe, cultivated grassland and meadows, and (ii) sites that are dominated by deciduous hornbeam forests. The n-alkane results show distinct and systematic differences between samples from sites with the different vegetation types: n-alkanes derived from sites with grassland are mainly dominated by C31, while n-alkanes derived from sites with deciduous trees show high abundances of C29. Thus, chain-length ratios allow to discriminate between these two different vegetation types and have a great potential when used for regional paleoenvironmental reconstructions. As degradation of organic matter can affect the leaf wax n-alkane distribution, we further present an updated end-member model that includes our results, accounts for degradation effects and enables semi-quantitative reconstruc-tions of past vegetation changes in the southern Caucasus region.