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Disseminated intravascular coagulation (DIC) is life threatening disease it’s often associated with sepsis, which require ICU management. In individuals with sepsis, the risk of DIC is especially high, DIC affects 30 to 50 percent of these individuals. Also it affects only about ten percent of patients with solid tumors, trauma, or obstetric emergencies. Hematological malignancies, aneurysms, and liver diseases can also cause the disease, the treatment for DIC focuses on resolving the underlying problem that led to this condition in the first place. As a result, antibiotics for severe sepsis, delivery in the case of placental abruption, and exploratory surgical intervention in the case of trauma are the pillars of DIC treatment, Patients with active bleeding or a high risk of bleeding, as well as those who require an invasive surgery, should consider platelet and plasma transfusions. Other anti-coagulant drugs can also be used. Prothrombin complex concentrates should only be administered in an emergency, due to their possible dangers. Recombinant human soluble thrombomodulin rhTM it was developed and licensed for clinical usage in Japan in 2008, and it’s one of the novel treatments for DIC. Anti-Xa agents, Synthetic protease inhibitors, and antithrombin are another options for treatment. In this article we will be making overview of the disease, it’s etiology an what’s the current management options.

The degenerative disease of the intervertebral disc and back pain are chronic conditions that are caused by several factors and represent an important cause of morbidity and mortality in everyday clinical practice. The study aims to summarize the updated evidence regards epidemiology, pathophysiology, clinical manifestation, diagnosis, and management of degenerative disc diseases. The incidence of low back pain, which is the main symptom in Intervertebral Disc (IVD) disease, varies widely among different reports. It is the fifth most common cause for the visit to the doctor and affects 7.6 to 37% of patients. IVD degeneration is attributed to a complex interplay between environmental and genetic factors. DDD is a process that includes a progressive decrease in disk nutrient supply and changes in extracellular matrix (ECM) composition, which weakens the tissue strength and alters the cell metabolism.Degenerative lumb disc disease patients typically present with mechanical lower back pain, which is worse on forward flexion and when carrying heavy load. The pain is relieved with rest. Diagnosis of DDD is done by various methods, computed tomography (CT) scan, magnetic resonance imaging (MRI), and provocative discography. These methods should be used in conjunction with the patient history, physical examination and specific biomarker to monitor the response to treatment. There are three major lines of management of DDD; Treatment Options for Relief of Pain in Conservative Therapy.Treatment with Aims of Restoration, Repair, and Regeneration of Intervertebral Disc Diseases: Molecular Therapy. Reconstructive Strategies: Percutaneous Intervertebral Disc Techniques. Definitive Treatment for Intervertebral Disc Diseases :( surgical management).

Social network analysis has been increasingly employed to study patterns in diverse areas of disciplines such as crowd management, air passenger and freight transportation, business modelling and analysis, online social movements and bioinformatics. Over the years, human disease networks have been studied to analyze Human Disease, Genotype, and Phenotype networks. This study explores human Disease Network based on their symptoms by employing different social network analysis such as centrality measures of network, community detection, overlapping communities. We studied relationships of symptoms with diseases on meso-level in order to detect comorbidity pattern of communities in disease network. This help us to understand the underlying patterns of diseases based on symptoms and find out that how different disease communities are correlated by detecting overlapping communities.

Objective: To describe the technique and results of mucosectomy; A surgical technique that is easy to perform, and has a lower morbidity and complication rate as compared to standard appendectomy in cases of complicated appendicitis. Study Design: Quasi-experimental study. Place and Duration of Study: Surgical - A Unit, Ayub Teaching Hospital, in Abbottabad, from Mar 2017 to Mar 2019. Methodology: Patients included were those who presented with appendicular mass, phlegmon, recurrent appendicitis, appendicitis in uncommon locations, presence of adhesions, those cases of appendicular mass and phlegmon which was either not responding to medical treatment, or diagnosed per operatively being clinically not palpable or not seen on ultrasound. Per operative and post-operative variables were documented and analyzed. In mucosectomy, thesubserosal portion of the appendix i-emuscularis and mucosa of the appendix was dissected out from the serosa after ligation of the appendicular base, or ligation done after delivering the appendix out of the serosa. The serosa that was adherent to the surrounding gut, omentum or other viscera was left intact. Results: A total of 192 patients were included in this study, half of which underwent standard appendectomy and a mucosectomy was performed on the rest. The mean time of surgery was 30 ± 1.2min as compared to the standard appendectomy group (55min ± 3.6). More than half of the patients undergoing standard appendectomy required extension of the incision (56.2%), only 8% required so from those on whom mucosectomy was performed. Per operative hemorrhage was seen in 32.2%, however inmucosectomy group only 1%.

Background: The number of patients who go through dialysis as a consequence of end-stage renal diseases is still increasing through the years. This study aimed to assess the quality of life and demographic factors on the compliance in hemodialysis (HD) and peritoneal dialysis (PD) patients in Qassim province. Methodology: A cross-sectional analytic study was conducted in three cities in Qassim region, with all available responsive patients selected from each center. Data were collected using the kidney disease quality of life instrument (KDQOL) validated and widely used questionnaire over 2 months’ duration. Result: The number of patients who participated in the study was 264. Demographic characteristics revealed that age (p = 0.011) and income (p = 0.017) of HD patients were significantly higher than PD. The quality of life (QoL) score in PD patients was better compared to HD, in which the mental health domain was the highest with a significantly better general health (p = 0.005). Regarding the compliance of the dialysis patients in relation to QoL, emotional role was significantly better (p = 0.054) in non-complaint patients. Females were significantly (p = 0.011) more compliant than males. Conclusion: Based on the study’s findings, these results will be useful to the health services and medical education institutes, which might contribute in the intervention of educational programs directed to increase awareness of healthcare providers and the community of this problem using different media and scientific journals.

Objectives Emergency medical services (EMS) clinicians are on the front lines of the opioid epidemic and are often the first health care personnel system to contact patients experiencing opioid toxicity. Although national educational guidelines include opioid toxicity, no specific standardized prehospital educational objectives or competencies exist. The goal of this project was to identify objectives for an EMS opioid toxicity curriculum that could be used for EMS training. Methods A list of preliminary educational objectives from U.S. EMS training programs was compiled and reviewed by a group of experts. The Delphi method was used to attain consensus on a final list of objectives for an EMS opioid curriculum. Results A total of 107 opioid-related preliminary objectives were identified and then narrowed down to 81 preliminary objectives after accounting for redundancy. After four successive rounds of evaluating/accepting/rejecting objectives, 18 final objectives were identified and unanimously approved by the expert panel. Conclusion We identified 18 objectives to serve as a framework for an opioid toxicity curriculum for EMS clinicians. These objectives can serve as a basis for creating a standardized didactic training program for EMS training programs nationwide. Further evaluation will be needed to explore the best means for educational program delivery.

Aim The aim of this study was to evaluate and compare the antibacterial effect of 0.5% metronidazole, 2% chlorhexidine, and normal saline irrigant solutions against Enterococcus faecalis bacteria in the treatment of root canals of primary anterior teeth. Materials and methods This study was carried out on sixty nonvital primary anterior teeth of Egyptian children diagnosed with (early childhood caries) ECC. These teeth were classified equally into three groups according to irrigation materials. A fresh sample was collected from each root canal after access opening before and 3 days after irrigation with the help of a paper point. The number of organisms (E. faecalis) before and after irrigation was compared for each group. Results The bacterial count of E. faecalis was decreased in all groups however, these differences were statistically insignificant where (p Conclusion Both 0.5% metronidazole and 2.0% chlorhexidine appeared to be superior against E. faecalis bacteria as endodontic irrigants in pulpectomy anterior primary teeth with higher antibacterial efficacy compared to saline. Clinical significance The success of endodontic treatment depends on the removal of microbes, from the root canals and avoidance of reinfection thus; this study provides an insight on the effects of different irrigant solutions to further help dental practitioners in the endodontic management of primary dentition.

Parkinson's disease (PD) is the second-most common neurodegenerative disorder and is characterized by the degeneration of dopaminergic neurons in the substantia nigra pars compacta. Oxidative stres...

Background: Miscarriage is the most common encountered complication of pregnancy. It may be repeated for 3 or more times; a condition called habitual or recurrent miscarriage. Aim: To determine the incidence of miscarriage at Baljurashi General Hospital, the demographic characteristics of women who presented with miscarriage, and the most common gestational age at time of miscarriage. Materials and methods: A self-administered questionnaire was distributed to women attending Baljurashi General Hospital who suffer from miscarriage. Results: The incidence of miscarriage was 10%. Ninety-two women responded to the questionnaire. Most of the respondents aged more than 25 years, had no job, and were in their first trimester. Half of the respondents had secondary education. Approximately one tenth suffered from repeated miscarriages. Conclusion: The incidence of miscarriage, among patients presenting to Baljurashi hospital, was comparable to those reported in other regions. However, the percentage of repeated abortion is high and these cases were not appropriately investigated. We recommend for the introduction of routine genetic studies into the work up of repeated miscarriages.

At 22 years following heart transplantation, a patient presented with incessant atrial flutter. During electrophysiologic study, 2 simultaneous atrial…, At 22 years following heart transplantation, a patient presented with incessant atrial flutter. During electrophysiologic study, 2 simultaneous atrial arrhythmias were mapped, 1 from the donor and 1 from the recipient’s heart. High-density mapping allowed for rapid identification of electrically abnormal areas, which were successfully ablated, thus restoring sinus rhythm. (Level of Difficulty: Advanced.), Graphical abstract

Background: Low back pain (LBP) is a nonspecific condition of acute or chronic pain in or near the lumbosacral spines. It can be caused by inflammatory, degenerative, neoplastic, gynecologic, traumatic, metabolic, or other disorders. The aim of the study was to determine the prevalence and risk factors of low back pain. To show also its symptoms and treatment trials among general population of Arar, Kingdom of Saudi Arabia. Methods: A cross-sectional community based study was carried out on population of Arar city, Northern Saudi Arabia, during the period from 1 January to 30 July 2017. Systematic random sampling technique was followed. Data was collected by personal interview, using pre designed questionnaire which include questions designed to fulfill the study objectives. Results: Among 501 studied individual. The prevalence of low back pain was 23.8%, 57% of them were females (P=0.02) and 30% had family history of low back pain. However 91% of cases doesn’t need vigorous effort in their work. Of the cases 90% doesn’t seek medical care for treatment. Disk problems were found in 6.7% of cases, soft tissue problems in 9.3% and in 84% of cases the cause was not diagnosed. About quarter (25.2%) get medical treatment but only 16.8% improved. While 19.3% get physiotherapy and most of them (18.2%) improved. No ases get surgical treatment. Conclusion and Recommendations: There was a high prevalence of LBP among Arar population (23.8%). Many risk factors were identified that would necessitate multidisciplinary involvement. Disk problemswere found in 6.7% of cases, soft tissue problems in 9.3% and in 80% of cases the cause was not diagnosed. We recommend that educational programs on prevention and coping strategies for musculoskeletal disorders are mandatory to reduce the rate of work-related musculoskeletal disorders.

Background: cataract is the most common age-related eye disease and the most treatable cause of visual impairment and blindness in adults. Aim of the work: this study aimed to assess the knowledge of Saudi population in Albaha city about cataract and its risk factors. Methods: this was a cross-sectional study that included a representative sample of 756 adults of the Saudi population in this region. Participants answered self-administered questionnaires consisting of items assessing the knowledge about cataract. Results: nearly half of the studed sample (50.5%) misunderstood cataract as a white membrane growing over the eye, while only 222 (29.4%) realized it as an increase in eye lens opacity. Moreover, this study revealed clearly deficient knowledge in the studied population about risk factors of cataract. High percent of participants (84%) did not know that incidence of cataract increases with positive family history. Likewise, there was a shortage of knowledge about the relationship of malnutrition, dehydration, hypertension and ultraviolet rays and the development of cataract. Fortunately, considerable numbers considered cataract as an age related disease and recognized that diabetes mellitus is a major precipitating factor to cataract. Conclusion: Saudi population in Albaha city had poor knowledge towards cataract and its risk factors. Hence, great efforts should be made to increase the knowledge and awareness of the general public about this disease.

Parkinson's disease (PD) is a neurodegenerative disorder caused due to the loss of dopaminergic neurons in substantia nigra region of midbrain. The disease is characterized by the accumulation of alpha-synuclein into depositions known as lewy bodies. Till date there is no cure for PD but the limited number of medications may provide temporary relief from the PD symptoms. Flavonoids are a group of polyphenols found in plants. The health benefits of flavonoids have been universally accepted. Tangeritin is a pentamethoxy flavone found in the peels of Mandarin oranges (Citrus reticulata). The present study was conducted to study the effect of tangeritin on the symptoms of PD exhibited by the PD model transgenic flies (Drosophila melanogaster). Tangeritin at a final concentration of 5, 10 and 20 microM was added to the diet and the flies were allowed to feed on it for 24 days. At the same time other set of PD flies were allowed to feed on a diet having 10-3 M of L-Dopa. The effect of tangeritin was studied on the activity pattern, climbing ability, dopamine content, oxidative stress markers (lipid peroxidation, reduced glutathione, glutathione-S-transferase, protein carbonyl content and monoamine oxidase activity) and on the histopathology of the brain of PD model flies. The study showed that the exposure of PD flies to different doses of tangeritin showed a marked delay in the loss of climbing ability and increase in the dopamine content. Tangeritin also showed a reduction in various oxidative stress markers. Hence it is concluded that tangeritin showed a marked reduction in the PD symptoms and thus could be of great importance for further research in treating PD.

The role of Geraniol was studied on the transgenic Drosophila model flies expressing normal human alpha synuclein (h-αS) in the neurons. Geraniol at final concentration of 10, 20 and 40μM were mixed in the diet and the flies were allowed to feed on it for 24 days. The effect of geraniol was studied on the climbing ability, activity pattern, lipid peroxidation, protein carbonyl, glutathione, dopamine content, and glutathione-S-transferase activity in the brains of transgenic Drosophila. The exposure of PD model flies to 10, 20 and 40μM of geraniol results in a significant delay in the loss of climbing ability (p0.05), improved activity pattern reduced the oxidative stress (p0.05) in the brains of transgenic Drosophila as compared to unexposed PD model flies. The results suggest that geraniol is potent in reducing the PD symptoms in transgenic Drosophila model of Parkinson's disease.

We document that Chinese stock returns exhibit early-in-the-week effects opposite-signed to those observed worldwide. The period of analysis is 2001–2016. Dominated by individual investors, Chinese stock markets offer unique out-of-sample insight regarding the source of weekday seasonality, ascribed elsewhere to institutional investors’ trading patterns. High returns to the market and to small, speculative stocks early-in-the-week pose a refuter to the mood explanation for the conventional (negative) Monday effect. A battery of tests suggests that the patterns in the Market, SMB, and RMW factors are jointly associated with Chinese individual investors whose demand is tilted towards small, speculative stocks. Our findings point to a potential role of dominant investor type in driving weekday patterns and the RMW premium.

Parkinson's disease (PD) is a common neurodegenerative disorder characterized by the loss of dopaminergic neurons in the substantia nigra of the midbrain. Dopamine agonists help the patients with PD by reversing the dopamine depletion and related motor deficits. In the present work, cabergoline, a potent ergot dopamine agonist, was given in the form of cabergoline alginate nanocomposite (CANC) to the PD model flies to study its effects on climbing ability, activity pattern, life span, lipid peroxidation, glutathione (GSH) content, glutathione-S-transferase (GST) activity, dopamine content, protein carbonyl content, mean gray-scale values, and caspase-3 and caspase-9 activities. Cabergoline alginate nanocomposite was synthesized by adding the cabergoline solution in the warm aqueous solution of sodium alginate; The synthesized CANC was characterized using fourier transform (FTIR) infrared spectroscopy, transmission electron microscopy (TEM), and UV-Visible spectroscopic techniques. The synthesized CANC having the final doses of 1, 2, and 3 μM was supplemented with diet and the flies were allowed to feed on it for 24 days. Cabergoline alginate nanocomposite significantly increases climbing ability, reduces lipid peroxidation, GST activity, protein carbonyl content, caspase 3/9 activity, mean gray-scale values, and increases the GSH as well as dopamine content in a dose-dependent manner. The results of this study suggest that CANC is potent in delaying and reducing the symptoms of PD.

Objectives: To report rare metastasis in breast from rectal cancer. Case Report: A 47-year-old married lady who presented with rectal bleeding for six weeks and diagnosed as a case of adenocarcinoma with no metastasis underwent neoadjuvent radiotherapy and chemotherapy and then abdominoperineal resection on follow-up found to have left breast mass and skin lesion in upper abdominal wall. Mammogram showed BIRADS-5. Tru cut biopsy showed mucinous/signet ring adenocarcinoma and she underwent lumpectomy and sentinel lymph node biopsy and excision of skin lesion. Histopathology of breast lump and skin lesion came as mucinous adeno-carcinoma of colonic origin, but all axillary lymph nodes were negative for malignancy. Conclusion: Metastatic breast lump is rare entity and every effort to be put to diagnose it using modern diagnostic tools.

It is not well known whether Alzheimer's disease (AD) cerebrospinal fluid (CSF) biomarkers are associated with brain damage in cognitively normal elderly. The combined influence of CSF biomarkers and hypertension (HTN) on the gray matter (GM) is also not well described. One hundred fifteen cognitively healthy subjects (mean age 62.6 ± 9.5%, 62% women) received clinical assessment, a high resolution magnetic resonance imaging (MRI), and a lumbar puncture. The CSF levels of total tau (t-tau), hyperphosphorylated tau (p-tau(231)), amyloid beta (Aβ42/Aβ40), p-tau(231)/Aβ42, and t-tau/Aβ42 were dichotomized as "high" and "low" based on accepted cut off values. Statistical parametric mapping was used to examine MRI scans for regional GM density, studied as a function of the CSF markers, HTN, and combination of both. Global and medial temporal lobe (MTL) GM was also assessed. Voxel based morphometry revealed that higher t-tau was associated with lower GM density in the precunei. Subjects with higher p-tau(231) and p-tau(231)/Aβ42 had less GM in temporal lobes. Low Aβ42/Aβ40 was related to less GM in the thalami, caudate, and midbrain. Subjects with hypertension showed more GM atrophy in the cerebellum, occipital, and frontal regions. Simultaneous presence of elevated CSF AD biomarkers and HTN was associated with more GM atrophy than either marker individually, but no interaction effects were identified. In conclusion, in normal elderly CSF tau markers were associated predominantly with lower GM estimates in structures typically affected early in the AD process. In this presymptomatic stage when no cognitive impairment is present, AD biomarkers and HTN have additive effects on gray matter damage.

The effect of bromocriptine, a dopamine agonist, administered in the form of bromocriptine alginate nanocomposite (BANC) was studied on Parkinson's disease (PD) model flies. The synthesized BANC was subject to characterization and, at a final concentration of 0.5, 1.0 and 1.5 µM, was mixed in diet. The PD flies were allowed to feed on it for 24 days. A significant dose-dependent delay in the loss of climbing activity and activity pattern was observed in PD flies exposed to 0.5, 1.0 and 1.5 µM BANC. The PD flies exposed to BANC also showed a significant reduction in lipid peroxidation and glutathione-S-transferase activity, and an increase in glutathione content. However, no gross morphological changes were observed in the brains of PD flies compared with controls. The results suggest that BANC is effective in reducing the PD symptoms in these transgenic flies., Summary: The results suggest that the bromocriptine alginate nanocomposite is potent in reducing the symptoms of Parkinson's disease in a transgenic fly model of the disease.

BACKGROUND. The treatment of myelodysplastic syndromes (MDS) remains a challenge to the clinician despite recent advances. Many patients will either not respond or will have only limited and/or brief responses to single-agent therapy. Eventually, 30% of patients with MDS will progress and develop acute myeloid leukemia (AML). New strategies are needed for these patients. METHODS. 5-Azacytidine (AZA) and thalidomide were administered to 40 patients with MDS or AML. AZA was given at a dose of 75 mg/m2 subcutaneously for 5 of 28 days together with thalidomide starting at a dose of 50 mg per day and increasing to 100 mg per. Six patients had refractory anemia (RA), 2 patients had RA with ringed sideroblasts, 10 patients had RA with excess blasts (RAEB), 1 patient had RAEB in transformation, 4 patients had chronic myelomonocytic leukemia, 1 patient had chronic idiopathic myelofibrosis, and 16 patients had AML. Thirty-six patients were evaluable for outcome. RESULTS. A hematologic improvement (HI) was observed in 15 of 36 patients (42%), stable disease was observed in 5 of 36 patients (14%), and 10 of 36 patients (28%) had disease progression. Six patients experienced complete remission (CR), 2 patients experienced an erythroid HI (HI-E), 1 patient experience an absolute neutrophil count HI (HI-ANC), 5 patients experienced a platelet HI (HI-P), and 7 patients had bilineage HI (HI-P and HI-ANC or an HI-E and HI-ANC). It was noteworthy that 9 of 14 patients with AML had a history of prior MDS, 2 of 9 patients achieved a CR, 4 of 9 patients had HI (HI-E and bilineage HI), and 1 patient had stable disease and was continuing treatment. DNA microarray analysis of 8 responders and 4 nonresponders revealed that the genes associated with cellular proliferation had higher expression levels in nonresponders. CONCLUSIONS. The current findings indicated that a combination of low-dose AZA and thalidomide was well tolerated and was effective therapy for the treatment of patients with MDS and AML arising from prior MDS. Cancer 2008. © 2008 American Cancer Society.

Explanatory factor for readmission % of Patients identifying factor as a cause of readmission (n5105) % of Readmitting Providers identifying factor as a cause of readmission (n5100) % of Discharging Providers identifying factor as a cause of readmission (n597) Patient vs. Readmitting Provider (McNemar p-value, Kappa statistic, Kappa p-value) Patient vs. Discharging Provider (McNemar p-value, Kappa statistic, Kappa p-value) Discharing Provider vs. Readmitting Provider (McNemar p-value, Kappa statistic, Kappa p-value)

Abstract 3815 Poster Board III-751 Following initial promising clinical results reported at ASH 2008 (Shenoy et al) in RAEB MDS and AML patients treated with the new investigational agent ON 01910.Na, we have initiated a phase 1/2 single arm escalating dose study in advanced MDS patients with a shorter schedule of administration of ON 01910.Na. The first 13 patients enrolled in our ongoing trial (6 high risk, 1 Intermediate-2 and 5 Intermediate-1 according to IPSS classification; 7 females/6 males, age range: 47-83ys), most of them having failed prior MDS therapies were administered ON 01910.Na as a 48 h continuous intravenous infusion weekly for 3 weeks of a 4-week cycle. Ten patients were treated at the 800 mg/m2/day dose level and 3 at the 1500 mg/m2/day dose level for 4 to 27+ weeks (1 to 6 four-week cycles). Most patients had grade 3 or 4 cytopenias at baseline. Overall the therapy was well tolerated and a few patients reported improvements of well being and pain relief. The most frequently reported adverse events were thrombocytopenia, neutropenia, anemia, fatigue and nausea. Serious adverse events were typical of this patient population and none of them was related to ON 01910.Na except for one case of neutropenia. Bone marrow blastic response was evaluated by bone marrow morphology. Five patients had a pretreatment blast count lower than 5% and no worsening of blast count was observed in the 3 patients who had follow-up bone marrow examination. Another six patients had more than 5% pretreatment bone marrow blasts. Among these patients, two had significant decreases in blast counts compared to pre-treatment values, while two showed stabilization and two progressed. Two patients had hematological improvements (neutrophil and erythroid responses). These results are encouraging and the trial is continuing. Patient Bone Marrow Blasts Hematological Improvement Pre-Treatment 4-8 week Follow-up 1 Disclosures: Wilhelm: Onconova: Employment.