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Reproductive health can be affected by obesity through various mechanisms. Obesity-associated inflammatory markers and altered hormones can have direct and indirect impacts on female reproductive health. However, little is known about obesity prevalence and trend among infertile women and obesity association with infertility in reproductive-age women of the U.S. In a cross-sectional study, we sought to conduct a secondary analysis of National Survey of Family Growth (NSFG) data from 2011 to 2019. A total of 6,035 infertile and non-pregnant fecund women aged 20–44 years were included in a nationally representative sample of the U.S. The weighted prevalence of obesity (BMI ≥ 30) among infertile women was 41.63% for the period 2011–2019. Obese women had 62% higher odds of infertility (95% CI 1.24, 2.17) compared to non-obese women of reproductive age (20–44 years). However, there was no specific trend of obesity among infertile and non-pregnant fecund women aged 20–44 years in the U.S. from 2011 to 2019. Given the negative impact of obesity on female reproductive health and in light of our results, it is important to counsel obese infertile reproductive-age women of the U.S. about behavioral changes that include weight management. Future longitudinal studies are needed to evaluate the risk of infertility among obese women.

Long-term outcomes of SIRC are not well established. Furthermore, SIRC is only now being considered more frequently for patients with independent risk factors for PSH, such as obesity. As such, the paucity of data on longer-term post-surgical outcomes of SIRC is particularly notable as it pertains to obese patients. All patients undergoing cholecystectomy performed by two surgeons at our institution from 2008–2018 were reviewed. Our inclusion criteria were patients who underwent SIRC or multiport laparoscopic cholecystectomy (MPLC) and had at least one month of postoperative follow-up. Patients who underwent additional procedures at the time of cholecystectomy were excluded. Our outcomes of interest were the 30-day POC rate and the long-term PSH rate. Analysis was conducted on an intention-to-treat basis, using logistic regression analysis for POC and time-to-event analysis for PSH. We examined 584 patients who underwent either SIRC (51%) or MPLC (49%). Of the 296 patients who underwent SIRC, 15 (5%) developed a POC and 23 (8%) developed a PSH. Of the 288 patients who underwent MPLC, 11 (4%) developed a POC, and 28 (10%) developed a PSH. Procedure group and obesity was not associated with the risk of POC (p = 0.29, p = 0.21, respectively). Procedure group was not associated with an increased risk of PSH (p = 0.29). Obese patients, however, were 1.94 times more likely to develop PSH compared to non-obese patients overall (p = 0.02). There is no statistically significant difference in POC and PSH rate following SIRC when compared with MPLC in patients in the same BMI group. Male gender and prior abdominal surgery are risk factors for POC, while advancing age and obesity are risk factors for PSH.

Objectives: The current study aimed to investigate the role of of Anti-Müllerian hormone and other hormonal biomarkers and insulin resistance in pathogenesis of polycystic ovarian syndrome of Iraqi women with various ages and BMI. Method: The sublects include 50 cases of polycystic ovarian syndrome obtained from gynecological and obstetric teaching hospital, Kerbala health directorate / Kerbala – Iraq and another 50 apparently healthy women as a control group. with age ranged between (18-37) years during the period from Dec. 2019 to June, 2020 which was divided into two groups depending upon their age; first group with age (18-27) years and the second with age (28-37) years, also they divided into three subgroups depending upon the body mass index, normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), obesity (30-34.9 kg/m2) and measurement of various hormonal levels were performed including LH, FSH, insulin, insulin resistance, total testosterone and anti-müllerian hormone. Results: A significant elevated levels of each of Anti-Müllerian hormone (AMH), insulin, LH, total testosterone, prolactin, fasting blood glucose, FBG and insulin resistance while, a non-significant differences was found in FSH levels in women with PCOS as compared with control group. Conclusion: A significant high levels of the all hormonal parameters including anti-müllerian hormone, LH, prolactin and total testosterone was found in women with PCOS as compared with the control, except the FSH values.

Introduction Rates of obesity amongst children and teens in the United States have tripled since the 1970s, and 18.5% are now considered obese. With smartphone use among children and teens becoming the norm, smartphone applications may be a cost-effective solution to support patients and families motivated to change lifestyle behaviors and reduce obesity. The purpose of this quality-improvement project was (1) to develop an app evaluation tool and star rating system based on scientific evidence and current clinical practice guidelines in managing childhood obesity, and (2) to determine whether an in-service training can increase provider knowledge and efficacy in the use of smartphone apps in managing childhood obesity. Methods An app evaluation tool (Ped-WHAT) was developed that includes evidence-based behavior modification strategies (BMS) and the American Academy of Pediatrics (AAP) guidelines for healthy weight management in pediatrics. Apps were given a rating based on the number of these criteria included in the app. An educational in-service training was developed to assist health care providers in using the app evaluation tool with patients. This training was tested with providers working in a pediatric weight management clinic. Pre- and post-training surveys were administered. Results were analyzed using t tests to assess differences. Results Sixteen commercially available apps were evaluated using the Ped-WHAT tool. Those that included the greatest number of BMS and AAP criteria received the highest rating on a 0-5 scale. Statistically significant improvements in provider knowledge and confidence were found after the in-service training. Discussion In this current digital environment, commercially available weight management apps should undergo evaluation by health care providers to ensure that they follow the standard of care and current practice guidelines/recommendations.

The current study aims to evaluate levels of metabolic hormones and lipid profile in a sample of growth hormone (GH) deficient patients. Seventy five GH deficient patients and twenty healthy subjects used as control group have been participated in this study during their attendance to the National Diabetic Center for Treatment and Research/Al-Mustansiriya University. The studied subjects’ ages were with a range (3-15 years). Blood samples were collected from the studied subjects to determine levels of basal GH, GH2 and GH3 after 1 hr and 1/30 hr provocation with clonidine, respectively; insulin like growth factor (IGF-1); levels of metabolic hormones [thyroid profile: triiodothyronine (T3), thyroxin (T4), and thyroid stimulating hormone (TSH)]; and lipid profile [cholesterol, triglyceride, high density lipoprotein (HDL), low density lipoprotein (LDL) and very low density lipoprotein (VLDL)]. The findings of the anthropometric measurements of the studied groups revealed that a non-significant (P>0.05) difference was found in the weight between the patients and the control, while the mean of height in the patients was significantly (P0.05) difference between the patients and the control. While mean of BMI percentile and mean of BMI Z-score revealed significant (P0.05) difference was found in level of basal GH between the patients and the control, while a high significant (P0.05) difference in serum T3 between the patients and the control, while a high significant (P0.05) difference was found in serum TSH between the patients and the control. The data of serum cortisol showed a significant (P0.05) difference in serum cholesterol between the patients and the control, while triglyceride showed a significant (P0.05) difference was found in serum HDL between the patients and the control, while a significant (P

Background Periorbital cellulitis is a potential sight-threatening complication of sinusitis. The majority of patients improve with medical management. Previous studies have suggested significant variations in practice and lack of evidence regarding the optimal management of this condition. Methods A prospective study was conducted over a 12-month period at 8 centers in the United Kingdom assessing the management of patients requiring inpatient treatment for periorbital cellulitis secondary to sinonasal infections. Results A total of 143 patients were recruited, of whom 40 were excluded. Of the remaining 103 patients, 5 (4.9%) were diagnosed with neurosurgical complications. This resulted in 98 patients admitted with periorbital cellulitis secondary to an upper respiratory tract infection/sinusitis. A total of 72 were children, of whom 12 (16.7%) required surgical intervention; and of 26 adults, 5 (19.2%) required surgery: the most common antimicrobial regimes administered were intravenous ceftriaxone (with or without metronidazole), and co-amoxiclav. The use of both ceftriaxone and metronidazole from admission was associated with the shortest duration of inpatient stay (3.8 days) in comparison to ceftriaxone alone (5.8 days) or co-amoxiclav (4.5 days) and a reduction in number of patients requiring surgical intervention. There was also an association between the early use of intranasal decongestants and steroids and reduction in requirement for surgical intervention. Conclusion For a condition where swab and blood cultures are often negative, this study supports the use of ceftriaxone in combination with metronidazole. The administration of intranasal decongestants and corticosteroids correlated with a smaller percentage of those progressing to surgery in those with and without periorbital abscesses.

The present study aims to evaluate levels of calcium regulating hormones and some biochemical parameters in a sample of growth hormone (GH) deficient patients. Seventy five GH deficient patients and twenty healthy subjects used as a control group have been involved in this study during their attendance at the National Diabetic Centerfor Treatment and Research /Al-Mustansiriya University. The studied subjects were in an age range of 3-15 years. Blood samples were collected from the studied subjects to determine levels of basal GH,GH2. and GH3 after 60 mins. and 90mins. of provocation with clonidine. The study also included the measurement of the levels of insulin like growth factor (IGF-1); calcium regulating hormones [parathyroid hormone (PTH) and vitamin D],and some biochemical parameters [calcium (Ca), phosphorus (P), urea, and creatinine].Distribution of the studied groups according to gender revealed that most of the GH deficientpatients (60 %) were males while 40 % were females,with the difference being statistically significant (P

Aim to measure the sensitivity of SPECT in localising parathyroid adenomas particularly whilst attempting minimally invasive parathyroidectomy. Method 2-cycles prospective study correlating SPECT and operative findings was conducted. All patients underwent ultrasound and SPECT, those with concordant findings on both modalities underwent minimally invasive parathyroidectomy, whilst patients with discordant findings on both modalities had central neck exploration. Following operative findings, recommendations of changing the SPECT reporting method such as surgically relevant structures adjacent to the lesion, such as the thyroid, were implemented. Following which, a second prospective study assessed the outcome of change. Results In the first cycle, 20 patients underwent partial parathyroidectomy, either by open (n = 13), or minimally invasive (n = 7) approach. SPECT sensitivity was 85% (n = 17) in identifying the adenoma. Out of all histologically confirmed adenomas, SPECT identified all adenomas (n = 17) on the correct side and 41% (n = 7) on the correct level (superior vs. inferior parathyroid). In the second cycle following recommendation, 14 patients had surgery, 9 as minimally invasive and 5 as open approach. SPECT sensitivity was 79% (n = 11) for adenoma identification. Of all confirmed adenomas, SPECT identifying adenomas at the correct side increased to 91% (n = 10) and correct level to 91% (n = 10). Conclusions SPECT alone is not yet regarded as gold standard in parathyroid adenoma localisation. The study has demonstrated that feedback to the radiologist of the operative findings may enhance its usefulness, particularly in attempting to proceed with a minimally invasive parathyroidectomy.

Aim The use of transoral robotic surgery (TORS), transoral laser microsurgery (TLM) and more recently reported transoral endoscopic electrocautery (TOEC) in the identification of the primary cancer in CUP patients has gained popularity. This systematic review aims to assess the effectiveness of TORS, TLM and TOEC. Method A systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting methodology was carried out to assess the effectiveness of the three trans-oral surgical techniques. EMBASE, MEDLINE and CINAHL databases were searched from inception to September 2020. Primary outcome measure was detection rates of primary cancer of the different techniques. Secondary outcome measures were complications and length of hospital stay. Results 289 studies were identified of which 30 met the inclusion criteria (28 case series and 2 case reports). The overall combined primary identification rate was 72.3% (567 /777 patients). The primary identification rates were 49.7% and 34.2% in lingual (n = 273) and palatine tonsillectomy (n = 118) respectively. The primary cancer identification rates by surgical techniques are: TORS was 60% (CI 0.49, 0.70), TLM was 80% (CI 0.58, 1.01), TOEC was 41% (CI 0.05, 0.76). The commonest complication was haemorrhage (5.3%). Conclusions This is the largest systematic review in the subject and incorporates the more recently published surgical technique of TOEC. Lingual tonsillectomy is an effective procedure in CUP work up. Further larger, multi-centre, prospective studies of PET CT negative CUP patients is needed to draw conclusive results

The American Surgical Association delineated deficiencies of diversity, equity, and inclusion within academic surgery. Opportunities to increase diversity are membership in surgical societies and leadership development. We hypothesized that surgical society meetings represent additional opportunities, using gender diversity as an example. Published programs from annual meetings of three large surgical societies were reviewed. Participants’ gender was classified by first name. Online search was used for equivocal names. We used JMP Pro 14.1.0 for univariate and multivariate logistic regression. During six meetings (2016–2018), 415 sessions with 4078 participants were included, 61% educational panels with invited faculty and 39% abstract sessions. Across all meetings, 32% of abstracts were presented by women, 22% of panel chairs or invited faculty were women. Fifty-four percent of male meeting participants were invited by their societies as moderator or speaker, and 41% of female participants were invited faculty. Fifty-nine percent of all panel chairs had no woman participant. In both univariate and multivariate regression, women had more than threefold the odds of presenting an abstract than presenting on a panel (p

IF 6.614 (2016); International audience; The vertebrate tongue is a complex muscular organ situated in the oral cavity and involved in multiple functions including mastication, taste sensation, articulation and the maintenance of oral health. Although the gross embryological contributions to tongue formation have been known for many years, it is only relatively recently that the molecular pathways regulating these processes have begun to be discovered. In particular, there is now evidence that the Hedgehog, TGF-Beta, Wnt and Notch signaling pathways all play an important role in mediating appropriate signaling interactions between the epithelial, cranial neural crest and mesodermal cell populations that are required to form the tongue. In humans, a number of congenital abnormalities that affect gross morphology of the tongue have also been described, occurring in isolation or as part of a developmental syndrome, which can greatly impact on the health and well-being of affected individuals. These anomalies can range from an absence of tongue formation (aglossia) through to diminutive (microglossia), enlarged (macroglossia) or bifid tongue. Here, we present an overview of the gross anatomy and embryology of mammalian tongue development, focusing on the molecular processes underlying formation of the musculature and connective tissues within this organ. We also survey the clinical presentation of tongue anomalies seen in human populations, whilst considering their developmental and genetic etiology.

Depression in caregivers of leukaemic children is usually overlooked and hence missed, as doctors mostly focused on patient's evaluation and condition. Early attention to symptoms of depression may help to prevent the development of a more serious depression over time.This study was conducted to estimate the prevalence, assess severity and identify determinants of depressive disorder among caregivers of children with leukaemia in Baghdad, Iraq, 2014.This cross sectional study was conducted on a convenience sample of caregivers of 250 leukaemia children aged15 years admitted to Child Welfare Teaching Hospital, Baghdad, Iraq. Socio-demographic variables were collected and the presence of depressive disorder was assessed using the Arabic Version of Beck Depression Inventory II (BDI-II); those with a score of16 were considered depressed.The prevalence of depression was 72% (95% CI: 66-77.5%); classified to 18.9% having borderline clinical depression, 36.7% moderate depression, 27.8% severe depression and 16.7% extreme depression. Presence of depression was significantly higher among younger age caregivers, disease duration of12 months and frequent hospital admission.The high prevalence of depression among care givers of leukaemia patients urge health care professionals to pay more attention to the psychological aspects of the families of leukaemia patients and ensure referring them for psychiatric support.معدل انتشار الاكتئاب بين القائمين على رعاية الأطفال المصابين بسرطان الدم (اللوكيميا) والعوامل المحددة له في العراق.نور محمد لطفي، فارس العلمي.عادة ما يتم إغفال الاكتئاب لدى القائمين على الرعاية ومن ثمَّ لا يُلاحظ، حيث يركز الأطباء في الغالب على تقييم المريض وحالته. ويساعد الانتباه المبكر لأعراض الاكتئاب على الوقاية من تطوره إلى اكتئاب أكثر شدة على مدار الوقت.أُجريت هذه الدراسة لتقدير معدل انتشار الاضطراب الاكتئابي وتقييم شدته وتحديد العوامل المحددة له بين القائمين على رعاية الأطفال المصابين بسرطان الدم في بغداد، العراق، 2014.أُجريت هذه الدراسة المقطعية على عينة عشوائية من القائمين على رعاية 250 طفلاً مصابًا بسرطان الدم تقل أعمارهم عن 15 عامًا والذين أُدخلوا إلى المستشفى التعليمي لرعاية الأطفال، بغداد، العراق. كما جُعت المتغيرات الاجتماعية والسكانية، وتم تقييم وجود الاضطراب الاكتئابي باستخدام النسخة العربية من التنقيح الثاني لمقياس بيك للاكتئاب (BDI–II) ؛ واعتُبِ الأشخاص الذين حصلوا على أكثر من 16 نقطة مصابين بالاكتئاب.بلغ معدل انتشار الاكتئاب 72% (66% – 77.5% CI: 95%) ؛ حيث تم تصنيفهم إلى 18.9% مصابين بالاكتئاب السريري الحدودي، و 36.7% مصابين باكتئاب متوسط الشدة، و 27.8% مصابين باكتئاب حاد، و 16.7% مصابين باكتئاب شديد. وكانت نسبة الاكتئاب مرتفعة بشدة بين القائمين على الرعاية الأصغر سنًا، حيث امتدت فترة المرض لأكثر من 12 شهرًا وتكرر دخولهم إلى المستشفى.يدعو معدل الانتشار المرتفع للاكتئاب بين القائمين على رعاية الأطفال المصابين بسرطان الدم العاملين الصحيين إلى إعطاء مزيد من الاهتمام للجوانب النفسية لعائلات المصابين بسرطان الدم وضمان إحالتهم للحصول على الدعم النفسي.Prévalence et déterminants de la dépression chez les aidants d’enfants atteints de leucémie en Iraq.La dépression chez les aidants d’enfants leucémiques est souvent négligée et donc non diagnostiquée, les médecins se concentrant la plupart du temps sur l’évaluation et l’état des patients. Une attention précoce accordée aux symptômes de la dépression pourrait permettre de prévenir le développement d’un stade plus avancé de cette affection.La présente étude a été conduite dans le but d’estimer la prévalence, d’évaluer la sévérité et d’identifier les déterminants des troubles dépressifs chez les aidants d’enfants atteints de leucémie à Bagdad (Iraq) en 2014.La présente étude transversale a été réalisée sur un échantillon de commodité de 250 aidants d’enfants leucémiques âgés de moins de 15 ans admis au Centre hospitalier universitaire pour la protection de l’enfance à Bagdad. Les variables socio-démographiques ont été recueillies et la présence de troubles dépressifs a été évaluée à l’aide de la version arabe de l’Inventaire de dépression de Beck II (BDI-II). Les répondants ayant un score supérieur à 16 étaient considérés comme dépressifs.La prévalence de la dépression était de 72 % (IC à 95 % : 66 %-77,5 %), parmi lesquels 18,9 % ont été diagnostiqués en dépression clinique limite, 36,7 % en dépression modérée, 27,8 % en dépression sévère et 16,7 % en dépression extrême. La présence de cette affection était significativement plus élevée parmi les aidants plus jeunes ; elle durait généralement plus de 12 mois et nécessitait des hospitalisations fréquentes.La prévalence élevée de la dépression parmi les aidants de patients leucémiques doit inciter les professionnels de la santé à accorder une attention plus soutenue à l’état psychologique des familles des patients et à s’assurer qu’elles soient orientées en vue de bénéficier d’un soutien psychiatrique.

A new and simple method for the selective and sensitive determination of trace amounts of nitrite in soil samples is developed by a combination of cloud point extraction (CPE) and spectrophotometry technique. The procedure is based on the Griess reaction on 3,3`-dimethyl benzidine with nitrite in the presence of 1-naphthol in acidic media to form a yellow diazo dye, which shows absorption at lambda max 455 nm. The formation of colored diazo dye is followed by extraction into the Triton X-114-rich phase. CPE method parameters such as surfactant amount, temperature, and incubation time are evaluated and optimized. The results showed a very good linear range of 10-1250 µgL-1, with good regression coefficients (R2) ≥ 0.9997 and a preconcentration factor of 12.5. The limit of detection (LOD) describes as 3SDblank/m, and the limit of quantification (LOQ) describes as 10SDblank/m, where ‘m’ is the slope of the calibration curve and they are equal to 7.50 and 22.71 µgL-1 respectively. The recommended method can apply to determine the ultra-trace amount of nitrite in soil samples.

Craniosynostosis is a birth defect occurring in approximately one in 2000 live births, where premature fusion of the cranial bones inhibits growth of the skull during critical periods of brain development. The resulting changes in skull shape can lead to compression of the brain, causing severe complications. While we have some understanding of the molecular pathology of craniosynostosis, a large proportion of cases are of unknown genetic aetiology. Based on studies in mouse, we previously proposed that the ciliopathy geneFuzshould be considered a candidate craniosynostosis gene. Here, we report a novel variant ofFUZ(c.851 G > C, p.(Arg284Pro)) found in monozygotic twins presenting with craniosynostosis. To investigate whetherFuzhas a direct role in regulating osteogenic fate and mineralisation, we cultured primary osteoblasts and mouse embryonic fibroblasts (MEFs) fromFuzmutant mice. Loss ofFuzresulted in increased osteoblastic mineralisation. This suggests that FUZ protein normally acts as a negative regulator of osteogenesis. We then usedFuzmutant MEFs, which lose functional primary cilia, to test whether the FUZ p.(Arg284Pro) variant could restore FUZ function during ciliogenesis. We found that expression of the FUZ p.(Arg284Pro) variant was sufficient to partially restore cilia numbers, but did not mediate a comparable response to Hedgehog pathway activation. Together, this suggests the osteogenic effects of FUZ p.(Arg284Pro) do not depend upon initiation of ciliogenesis.

New drug carriers were synthesised through etherification with sugar moiety and metronidazole drug. Thesynthetic pathway was started with two sugars, ?-D-glucose and ?-D-fructose, which were protected asperacetate and benzoate respectively, then converted to bromo sugar. The bromo sugars were subjected tocoupling with metronidazole drug via Willemenson reaction to afford protected drug carriers. All preparedcompounds were characterised via FT-IR, 1H-NMR and 13C-NMR and HR-MS spectroscopy. These newcarriers were tested against four types of fungi kandida yeast. Some of tested compounds showed moderateactivity while the other showed weak inhibition. Interestingly, two carrier drugs showed high activity againstfungi

Given the rapid spread of the coronavirus disease 2019 (COVID-19) pandemic and its overwhelming effect on health care systems and the global economy, innovative therapeutic strategies are urgently needed. The proposed primary culprit of COVID-19 is the intense inflammatory response-an augmented immune response and cytokine storm-severely damaging the lung tissue and rendering some patients' conditions severe enough to require assisted ventilation. Sex differences in the response to inflammation have been documented and can be attributed, at least in part, to sex steroid hormones. Moreover, age-associated decreases in sex steroid hormones, namely, estrogen and testosterone, may mediate proinflammatory increases in older adults that could increase their risk of COVID-19 adverse outcomes. Sex hormones can mitigate the inflammation response and might provide promising therapeutic potential for patients with COVID-19. In this article, we explore the possible anti-inflammatory effects of estrogen and testosterone and the anabolic effect of testosterone, with particular attention to the potential therapeutic role of hormone replacement therapy in older men and women with COVID-19.

Objectives: To estimate the prevalence of type 1 Diabetes Mellitus in primary school children in Baghdad City, and to evaluate its effect on growth of those children. Methods: This comparative cross-sectional study was conducted in a sample of primary schools in Baghdad city selected by multistage cluster sampling. All primary school students in the selected schools were included. For every diabetic child, we selected a child from the same class who is free from diabetes. Information on disease variables were obtained through sending questionnaire to the children’s parents. The Centers for Disease Control and Prevention growth charts were used. Results: The total number of primary school students in the selected 141 schools was 69,115; 110 of them had T1DM (159/100,000). Female to male ratio was 1.3:1. Obesity and underweight were significantly lower in diabetics than non-diabetic children (P=0.03). Conclusion: The prevalence of type 1 diabetes mellitus was 159 per 100,000, which was approximate to the prevalence in Saudi Arabia, less than that in Al-Kuwait, but higher than that in Turkey. Percentage of underweight and obesity were lower in the diabetics while overweight percentage was slightly higher compared to the non-diabetics.

AIM: The present study was to investigate the effect of a three-month strict oral hygiene phase on key parameters of periodontitis: plaque, bleeding on probing and probing pocket depth.MATERIALS AND METHODS: Forty-four patients with severe periodontal disease were randomly allocated to a test or a control group. The test group completed a three months strict oral hygiene phase. The control group did not receive any instructions or motivation on oral hygiene until after the three months period. Plaque, bleeding on probing and probing pocket depths were registered on four sites of each tooth at baseline and after three months in both groups, as well as after the postponed hygiene phase in the control group.RESULTS: A statistically significant and profound reduction of plaque, bleeding on probing and probing pocket depth was observed after the three months in the test group. No change to the better occurred in the control group.CONCLUSION: A three-month strict oral hygiene phase in patients referred for periodontal therapy reduced plaque, bleeding on probing and pocket depth to such an extent that it could affect therapy planning.

This study aims to prepare special exercises using VertiMax device and to identify the effect of these exercises on the explosive strength and defensive blocking of senior handball players. The researchers have adopted the experimental approach, and the case study is identified by the senior handball players of Al- Dagharah handball club whose number is 16, and their lengths ranged (182.4 ± 3.282 cm), weights (82 ± 4.387 kg) and ages (23 ± 1.846 years). They are divided by a simple random method into two groups by (8) players per group in which the experimental group has used exercise by VertiMax device, while the control group has used team coach exercises. The researchers have conducted the explosive strength and defensive blocking tests of the study sample. The training method has included 3 units per week for a period of 6 weeks using the method of high-intensity interval training. The results of the explosive strength and defensive blocking tests have been presented and analysed. It is concluded that the exercises by using the VertiMax as auxiliary and effective devices can be relied upon in developing the explosive strength and defensive blocking of the handball.

The modern native and foreign literature data on the hip arthroplasty results in patients with overweight including the data on the choice of the material and method of surgical intervention, risk and rate of perioperative complications, rehabilitation results are analyzed.

This study was carried out to prepare and characterize domperidone nanoparticles to enhance solubility and the release rate. Domperidone is practically insoluble in water and has low and an erratic bioavailability range from 13%-17%. The domperidone nanoparticles were prepared by solvent/antisolvent precipitation method at different polymer:drug ratios of 1:1 and 2:1 using different polymers and grades of poly vinyl pyrolidone, hydroxy propyl methyl cellulose and sodium carboxymethyl cellulose as stabilizers. The effect of polymer type, ratio of polymer:drug, solvent:antisolvent ratio, stirring rate and stirring time on the particle size, were investigated and found to have a significant (p? 0.05) effect on particle size. The best formula was obtained with lowest average particle size of 84.05. This formula was studied for compatibility by FTIR and DSC, surface morphology by FESEM and crystalline state by XRPD. Then domperidone nanoparticles were formulated into a simple capsule dosage form in order to study of the in vitro release of drug from nanoparticles in comparison raw drug and mixture of polymer:drug ratios of 2:1. The release of domperidone from best formula was highly improved with a significant (p? 0.05) increase.

Introduction The aim of this study was to determine whether ultrasound alone is sufficient to safely exclude malignancy in thyroid nodules in a district general hospital setting, to comply with the latest British Thyroid Association guidelines. Methods This retrospective study investigated the quality of ultrasound reporting and the correlation between ultrasound report and histology for individual thyroid nodules. Cases were selected from the thyroid multidisciplinary meeting and included all patients having undergone surgery for a thyroid malignancy in a one-year period. Results Forty-seven patients were included in the study. Ultrasound reports were reviewed and assessed, in which 21 clinicians were involved; 36% of scans included a summary of whether the nodule(s) overall appeared benign, equivocal, suspicious or malignant; 4% of reports included a U classification; 81% of reports commented on cervical lymph nodes. Ultrasound was compared with histology. The sensitivity of ultrasound in correctly identifying nodules requiring further investigation was of 56% and specificity was 81%. Positive predictive value was 81% and negative predictive value was 56%. Discussion These findings suggest that, in a district general hospital setting without a dedicated head and neck radiologist, using only ultrasound and limiting fine-needle aspiration cytology to identify suspicious nodules may not be safe, as a high number of nodules appearing benign on ultrasound may ultimately prove to be malignant.

Background The vertebrate tongue is a complex muscular organ involved in mastication, taste sensation, and articulation. The tongue is affected in many syndromes, diseases, and malignancies. It has recently been shown that a cascade of signaling interactions between different cell populations during embryogenesis orchestrates the development of the tongue. In humans, a number of congenital abnormalities affect the gross morphology of the tongue and can occur in isolation or as part of a developmental syndrome such as aglossia, microglossia, macroglossia, and bifid tongue. Objective We present an overview of the gross anatomy and embryology of mammalian tongue development, review the clinical presentation of tongue anomalies, and briefly look at their genetic etiology. We focused on one of the anomalies in mouse models and utilized multiple genetic approaches to investigate local temporospatial requirements for sonic hedgehog (Shh) signaling during tongue development. Results Mice lacking a Shh cis enhancer, MFCS4, with reduced Shh in dorsal tongue epithelium, have perturbed lingual septum tendon formation and disrupted intrinsic muscle patterning, with these defects reproduced following global Shh deletion from E10.5 mouse embryos. Shh responsiveness was diminished in local cranial neural crest cell (CNCC) populations in both mutants. Shh targets these cells through primary cilium. CNCC-specific deletion of orofaciodigital syndrome 1, which encodes a ciliary protein, led to loss of normal myotube arrangement and microglossia. Conclusions We demonstrate the cause of microglossia in syndromes affecting Shh signaling and show that Shh signaling is required in the cranial neural crest cells for lingual tendon differentiation and intrinsic muscle patterning.

The aims of this study were to identify differences in post-operative nausea and vomiting (PONV) and throat pain between throat packed and non-packed patient groups in nasal surgery. This was a prospective, double blind, randomised controlled trial. A water-soaked throat pack gauze was inserted in the mouth to occlude the oropharynx was used in the throat pack group. The second group received no throat pack. A validated PONV questionnaire was completed 6 h post-operatively. Visual analogue scores (VAS) for throat pain were completed in recovery, 2, and 6 h post-operatively. 80 patients were enrolled (40 into each group based on power calculation). With regard to the primary outcome measure, mean PONV score for the throat pack group was 2.75 [median 0, standard deviation (SD 10.86)] and the mean PONV score for the non-packed group was 0.36 (median 0, SD 1.39). The difference in PONV was not statistically significant [P value 0.375, 95% confidence interval (CI) -1.19 to 3.32]. With regard to throat pain VAS scores (our secondary outcome measure), in recovery, the mean throat pain VAS score for the throat packed group was 2.5 (median 1, SD 2.8) and the mean throat pain VAS score for the non-throat packed group was 1.3 (median 0, SD 2.5). Statistical analysis showed a significant difference between the two groups with the throat pack group experiencing more throat pain in recovery (P value 0.018 (95% CI 1.13-2.52). At 2 and 6 h post-operatively, the mean throat pain VAS scores for the throat packed group were 2.1 and 2.3, respectively, and the mean throat pain VAS score for the non-throat packed group was 2.3 and 1.4, respectively. Statistical analysis showed non-significant difference between the two groups at 2 and 6 h post-operatively. The use of throat packs in nasal surgery does not confer PONV reduction benefit. The use of throat pack, however, is associated with a small but statistically significant more throat pain in the initial recovery period from nasal operations.