Axial spondyloarthritis (ax-SpA) belongs to the most common inflammatory rheumatic diseases. The disease can be subdivided into non-radiographic ax-SpA and radiographic SpA or ankylosing spondylitis. The broad availability of magnetic resonance imaging has enabled us to diagnose this disease earlier. However, the fact that chronic back pain represents one of the most common symptoms and also in a healthy population is a remarkable pitfall for the diagnosis of ax-SpA. Aside from imaging, laboratory parameters, especially HLA-B27 as well as parameters of inflammation in conjunction with the medical history and the clinical examination are required to perform the diagnosis, which still can be challenging. Regarding therapy, biologics and especially tumour necrosis factor blockers have widely broadened our capabilities to treat this disease for patients who are not adequately responding to non-steroidal anti-rheumatic drugs. Interleukin-17 blockade represents a newer option, and Janus Kinase inhibition has shown some promising results in clinical trials. However, despite all efforts that have been achieved in ax-SpA, still the period between the onset of symptoms and diagnosis remains too long and must be further shortened.

Cranial ultrasound (CUS) is a bedside, safe and reliable imaging procedure. It can assist in the early diagnosis, management and prognostication of most preterm and full-term prenatal, perinatal and postnatal neurological insults. Moreover, it is a cost-effective procedure that gives a very high accuracy not far from that of the more sophisticated procedures such as computed tomography and magnetic resonance imaging. However, continuous training and competency assurance are needed, as CUS is operator-dependent imaging that needs a considerable training for the best results. In this article, we reviewed the advantages, applications and accuracy of CUS. In addition, we shed light on the benefit of having CUS in house before exposing the newborn infant to the risks of the other more complicated imaging techniques.

Significant increase in thyroid carcinoma (TC) incidence was registered after the Chernobyl accident among people exposed as children and adolescents. The quantity of radiogenic cases and dose-effect correlations have been overestimated due the screening-effect, improved medical surveillance after the accident, overdiagnosis, recall bias, dose-dependent selection and self-selection. Besides, some non-exposed patients were counted among Chernobyl victims. Before the accident, the registered incidence of paediatric TC was lower in the USSR compared to other industrialised countries. The screening found not only small nodules but also late-stage TC interpreted as rapidly growing radiogenic cancers developing after a short latent period. Some supposed markers of radiogenic malignancy were in fact associated with a later stage of neoplastic progression. In conclusion, the overestimation of Chernobyl consequences may lead to a biased concept about carcinogenicity of low-dose low-rate exposures, especially from radioiodine.

Entamoeba moshkovskii is species of the big genus Entamoeba. This type of parasite rarely causes disease in humans. However, this has been more changed recently. The purpose of the current study was to review all obtainable published data regarding E. moshkovskii infections around the world and provides essential information on the epidemiology, incidence, diagnosis and microbiological information of E. moshkovskii at present, trying to understand if it can be considered as important risk diarrhoeal pathogen. Only studies that depending on polymerase chain reaction as a definitive diagnosis of E. moshkovskii have been included because E. moshkovskii is undistinguished from E. histolytica and E. depress morphologically, so very little information is available concerning the epidemiology and prevalence of E. moshkovskii because few searches have been used molecular diagnostic techniques to identify it. The ability of E. moshkovskii to grow and adapt to the various environmental hard conditions may make its risk of infection higher than the risk of E. histolytica. Reasons beyond E. moshkovskii differentiation from other Entamoeba complexes for stopping dispensable medications in patients infected with nonpathogenic amoebiasis. All E. moshkovskii infections were gastrointestinal tract diseases associated with infectious diarrhea, From available data in this review, E. moshkovskii considered an important and potential risk pathogen with a high rate of residence and prevalence worldwide.

Background: Non-communicable diseases (NCDs) have become a major health problem in the United Arab Emirates (UAE). A number of NCDs share predisposing risk factors related to an unhealthy lifestyle. Aims: The aim of this study is to measure healthy lifestyle awareness in reference to smoking, physical activity and healthy diet among the population of the Northern Emirates of the UAE. Methods: A cross-sectional descriptive study was conducted at primary health-care centres in the Northern Emirates of the UAE. Results: A total of 2373 participants were surveyed. The mean age of participants was 32.9 years (standard deviation ± 10.6), with the majority being females (64%). Almost three-quarters of participants perceived that smoking had harmful effects on their health and 14.2% reported being current smokers. The majority of participants recognised the benefits of physical activity for improving the health of lungs, the heart, weight loss and promoting health. Only 23.9% of participants admitted that they wanted ‘total change’ to their physical activity habits and a high percentage (63.4%) of participants agreed that certain food types could lead to disease. Conclusions: Overall, participants in this study have shown a high level of awareness on the dangers of smoking, the necessity for everyday physical activity, and importance of healthy dietary habits despite the fact that the prevalence of those indices does not match with awareness levels. Further research is recommended to explore and identify the barriers and factors associated with low levels of practice within the UAE community.

Introduction: The most frequent cause of morbidity in India is cardiovascular diseases (CVDs) complicating chronic kidney disease (CKD). Reports suggest that CKD patients with cardiovascular comorbidities are on multiple drugs, which could potentially lead to drug–drug interactions. This study intends to describe the prevalent trends in prescribing drugs for the haemodialysed CKD patients and attempts to explore the cardiovascular complications and the factors influencing them. Methodology: This observational study was conducted on CKD patients on haemodialysis, presenting to the Dialysis Centre of Father Muller Medical College, Mangalore, Karnataka, India. The study recruited a total of 107 patients from whom data were collected at the first visit and at the end of 6 months. Results: Out of the 107 patients on haemodialysis, 38 cases of cardiovascular comorbidities were noted. Hyperkalaemia was observed in 32.4%, hypokalaemia in 10.5% and normal potassium levels in 56.8% of the patients with cardiovascular comorbidities. Hyperphosphataemia was observed in 65.6%, hypophosphatemia in 0.9% and normal serum phosphate in 33.3% of the patients with anaemia. Conclusions: CVDs are common in CKD patients, and concomitant anaemia and hyperglycaemia tend to complicate the management. In such a background, appropriate care has to be exercised in the treatment of CKD.

Background: The factor leading to low Vitamin B12 status in patients with diabetes mellitus (DM) is still controversial. Objectives: The main objective of this study was to explore DM-induced changes in selected biological markers of Vitamin B12 in rats. Materials and Methods: DM was induced in rats by intraperitoneal administration of streptozotocin at 60 mg/kg body weight. The localisation and ultrastructure of pepsinogen (PEP)-containing cells were investigated using immunohistochemistry and transmission electron microscopy. In addition, enzyme-linked immunoassay was used to determine the gastric and serum levels of Vitamin B12, intrinsic factor (IF) and PEP-1. Results: The number of PEP-1-immunopositive cell was significantly (P < 0.05) reduced in the gastric mucosa of diabetic rats when compared to that of normal control. The size of zymogen granules in gastric chief cells of diabetic rats was markedly (P < 0.05) diminished in comparison to normal control. Diabetic rats were associated with significantly (P < 0.05) reduced serum levels of Vitamin B12, IF and PEP-1 when compared to normal control. The gastric tissue level of IF and PEP-I was also markedly (P < 0.05) reduced after the onset of DM. Marked reduction (P < 0.05) in red blood cell count and haematocrit was discerned in DM rats compared with control. Conclusion: DM-impaired chief cell structure, low IF, reduced PEP and deficient B12 level may lead to the development of indigestion and anaemia observed in DM patients.

Purpose: Drug wastage is a major concern in anaesthesia. In addition to increasing the cost on the patient, it can increase the occupational hazard to the health care and sanitary workers and also cause environmental pollution. The principal objective of this study was to ascertain the extent of drug wastage in anaesthetics and ancillary drugs and calculate the financial costs of it at a tertiary care hospital. Methodology: This was a prospective study and was conducted to ascertain the quantity of drug wastage. This pilot study was conducted in the operation theatre between the months of March and April 2016. The prescription of the anaesthetic drugs, the recommended dose, the quantity used and remainder (waste) left were recorded. Costs of the drugs used and wasted were calculated. The financial loss incurred was thus calculated. Results: The results of this study indicated that maximum wastage of the anaesthetic drugs was for atropine sulphate (71.67%), fentanyl (40%), mephentermine sulphate (40%) and bupivacaine (33.62%). The cost analysis indicated that propofol contributed to the maximum as the financial loss was estimated to be 29.27% of the total loss, followed by bupivacaine 18.95%. Conclusion: The results indicate that the quantity and the financial impact of anaesthetic drug wastage were considerable and that efforts should be at minimising the expenditure without risking the patient's life or health.

Aims: The aim of the study was to evaluate the effect of delaying endoscopy on in-hospital mortality, rebleeding, surgery indication, and blood transfusion in bleeding peptic ulcer patients admitted on weekends. Settings and Design: This was a retrospective cohort study. Subjects and Methods: We manually reviewed the medical files of patients with upper gastrointestinal bleeding admitted from January 2015 to June 2017. Two hundred and ninety-five patients were enrolled as weekday group (n = 232) and weekend group (n = 63). We included holiday admissions into the weekend group. Statistical Analysis Used: Statistical analysis was performed using Fisher's exact test for categorical variables and t-test for continuous data. Results: There was no significant difference in the baseline characteristics, comorbidities, or medication between the two groups. We observed that weekday group patients received earlier endoscopy treatment (0.54 ± 0.565 days vs. 1.59 ± 1.34 days; P ≤ 0.0001). They had a shorter hospitalization period (2.88 ± 3.36 days vs. 3.95 ± 4.695 days; P = 0.041). In the weekday and weekend groups, rebleeding rates were 1.7% vs. 3.2%; P = 0.612, mortality rates were 3% vs. 4.8%; P = 0.45, surgery indication rates were 4.7% vs. 3.2%; P = 0.742, and number of transfused blood units was 2.15 ± 3.181 vs. 2.38 ± 1.93; P = 0.58, respectively. Conclusions: Delaying endoscopy in the weekend did not affect the outcome of bleeding peptic ulcers, mortality, rebleeding, surgery indication, or a number of transfused blood units. It increased hospitalization period, which may be predisposed to hospital-acquired infections.

Background: Prosopis cineraria, Prosopis juliflora and Acacia tortilis are widely distributed plants in the United Arab Emirates (UAE). They have beneficial uses in the traditional medicine and animal fodder. The exploration of these plants is of potential value to UAE economy through their large-scale utilisation. The leaves of these plants were collected to study their main antimicrobial constituents. This study highlights the potential utilisation of these plants leaves as antimicrobial agents. Aims: The aim of this study is to explore the antimicrobial activity of the above three plants. Subjects and Methods: Dried leaves of above plants were extracted with aqueous ethanol. Extracts subjected to phytochemical screening and thin-layer chromatographic (TLC) separation to determine the compounds present. Antimicrobial activity tests were performed for the extracts and fractions obtained by preparative TLC. Results: Tannins constitute the major compounds in all three plant extracts. A TLC solvents system was developed for the separation of the phytochemical constituents in the three aqueous plant extracts. P. juliflora aqueous extract presented the highest activity against all tested microorganisms at a concentration of 5 mg dry leaf material/disc; inhibition zones exhibited by P. juliflora were as follows: ZoI (23 mm) against Escherichia coli, ZoI (18 mm) against Staphylococcus aureus and ZoI (12 mm) against Candida albicans. Isolated fraction 1 from P. juliflora aqueous extract, containing two major spots, exhibited intermediate activity followed by fraction 3, fraction 2 had no activity. Conclusions: P. juliflora leaves revealed the significant antimicrobial activity. It is potential for the treatments of infectious diseases. The developed TLC solvent system may further be applied on column chromatographic separation of pure active compounds from P. juliflora.

Background: Nonsyndromic hearing loss (NSHL) is a genetic disorder affecting many populations. Several genes are responsible for NSHL, and their contribution is different amongst ethnic groups. ESPN and ESRRB genes are responsible for the recessive DFNB36 and DFNB35 deafness forms, respectively. Aims and Objectives: In the present study, we aimed to identify the responsible mutations in two different UAE families with autosomal NSHL. Materials and Methods: Whole and clinical exomes sequencing were performed. Potential variants were verified by Sanger sequencing and PCR-RFLP. Bioinformatics tools were used to predict the impact of the new mutations. Results: In two UAE families, whole and clinical exomes sequencing generated several DNA variants. Sanger sequencing, segregation and bioinformatics analyses revealed two new homozygous mutations responsible for deafness. These two novel mutations are ESPN c.2257T>C and ESRRB c.10583 C>A. Conclusion: This study reports for the first time new mutations within ESPN and ESRRB genes responsible for NSHL in the Middle East region.

Among the different mechanisms of cranial traumatism, penetrating head injuries (PHIs) are related with a high mortality, they are especially seen in the military field, the rare civilian cases are related to gunshot or knife stabbing, accidental glass PHIs are rarely reported especially on thick parietal bone. We report a case of accidental penetrating head injury with a piece of sharp glass on the parietal bone.

Foreign body ingestion is a common presentation in clinical practice. Although most ingested foreign bodies pass uneventfully across the gastrointestinal tract, sharp elongated objects pose a greater risk of intestinal perforation. We report here a case of jejunal perforation following the ingestion of fishbone. A 78-year-old female presented with acute onset of generalised abdominal pain for few hours. Examination revealed tenderness, guarding and rigidity all over the abdomen. Erect Abdominal X-ray findings were inconclusive. However, contrast-enhanced computed tomography (CT) showed a thin, linear hyperdense foreign body perforating through the jejunum. Exploratory laparotomy was done, and a fishbone piercing the small bowel 50 cm distal to the ligament of Treitz was retrieved. The perforation hole was closed with primary suture. Postoperatively, the patient recovered well. Small bowel perforation is a life-threatening emergency that necessities urgent surgical intervention. Fishbones are commonly associated with perforations and the most common site of perforation is the terminal ileum. The most important risk factor associated with intestinal perforation by fishbones is the use of dentures which impair protective sensory mechanisms. Clinical presentation can be non-specific, and contrast-enhanced CT is required to establish diagnosis. Intestinal perforation associated with foreign body ingestion should be considered when evaluating patients with acute abdomen.

Tumour emboli are rare and usually end-stage manifestations of malignancy. They generally carry poor prognosis. Even rarer is the tumour emboli presenting as the first manifestation of an underlying malignancy. We take this opportunity to report a case of tumour emboli as the first presentation of a malignancy, occurring in a 58-year-old male, for its rare occurrence.