Bacterial endotoxin lipopolysaccharide (LPS) induces the production of inflammatory cytokines and reactive oxygen species (ROS) under in vivo and in vitro conditions. Acetylsalicylic acid (ASA, aspirin) is one of the most commonly used anti-inflammatory drugs. Our aim was to study the mechanism of aspirin action in the presence of LPS in murine macrophages and human hepatoma cells. We investigated the effects of LPS with a subtoxic concentration of ASA, alone and in conjunction, on oxidative and nitrosative stress using the mouse macrophage cell line J774.2 and human hepatoma HepG2 cells. Apoptosis was measured by flow cytometric analysis. LPS alone markedly induced nitric oxide (NO) production in macrophage cells and moderately in HepG2 cells. When ASA was added to LPS-treated macrophage cells, the increase in NO production was significantly higher than that induced by LPS or ASA alone. However, treatment of HepG2 cells with LPS or ASA alone or in combination exhibited moderate effects on NO production. Similarly, production of ROS after treatment with LPS and ASA was also higher in macrophages than in HepG2 cells. The combination of LPS and ASA also markedly increased the rate of lipid peroxidation in both cell lines. The activity of aconitase, an oxidative stress-sensitive mitochondrial matrix enzyme, was also markedly inhibited in J774.2 cells compared with HepG2 cells. Furthermore, treatment of cells with LPS alone or in combination with ASA also resulted in higher apoptotic cell death in macrophages. These results suggest that macrophages are more sensitive to LPS and that LPS and ASA treatments synergistically increase oxidative and nitrosative stress in these cells.

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A 26-year-old woman was admitted to the emergency department at Mediclinic City Hospital, Dubai, United Arab Emirates (UAE), with complaints of fever, cough and pleuritic chest pain. She had a history of asthma that had been well controlled and she had been taking co-amoxiclav (Augmentin®, GlaxoSmithKline) for the 3 days prior to admission, for treatment of an oral abscess. Her vital parameters were tested on admission, a full blood count was taken and a C-reactive protein test and chest radiography were performed. She was started on intravenous (i.v.) ceftriaxone in the emergency department, pending the results of the blood culture, and was then transferred to the medical ward. Over the next 24 hours, the patient's condition deteriorated and her temperature did not stabilize. She complained of worsening pleuritic chest pain; thus, chest radiography was repeated and showed worsening right middle lobe consolidation and left pleural effusion. Computed tomography (CT) of the thorax was performed and showed multiple thick-walled cavitating nodules that mainly occupied the periphery of both lungs with left lower lobe consolidation and bilateral pleural effusion. The results of the tests were consistent with a diagnosis of septic pulmonary embolism. Her blood cultures tested positive for methicillin-resistant Staphylococcus aureus (MRSA) but were sensitive to vancomycin, linezolid (Zyvox®, Pfizer) and clindamycin, and MRSA was also cultured from the pus drained from the abscess on the patient's face. She was prescribed i.v. vancomycin and within 48 hours her temperature and clinical condition improved considerably. The patient then completed 10 days of i.v. vancomycin as an in-patient and was discharged with a prescription for oral doxycycline for 1 week. She had a follow-up appointment in the clinic 2 weeks after her discharge, at which time she was asymptomatic and repeat CT of the thorax showed considerable improvement.

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Superior vena cava syndrome (SVCS), or superior vena cava obstruction (SVCO), is usually the result of the direct obstruction of the superior vena cava (SVC) by malignancies such as compression of the vessel wall by right upper lobe tumours or thymoma and/or mediastinal lymphadenopathy. The most common malignancy that causes SVCS is bronchogenic carcinoma. SVCO due to tuberculosis is very rare, but here we present such a case in a 65-year-old man.

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Anterior cruciate ligament (ACL) tears are the most common cause of internal derangement of the knee and ACL reconstructions are commonly performed by arthroscopic surgeons as a treatment option. In the scenario of sports medicine, radiologists need to be aware of the critical details of ACL reconstruction. In this study we describe the normal findings and complications of ACL reconstruction.

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Type 2 diabetes mellitus (T2DM) is one of the most prevalent and costly chronic health conditions in the United Arab Emirates (UAE). Early identification of people who are at risk is a pivotal step to initiate preventative measures. The objective of this research was to assess adults' level of risk of developing type 2 diabetes mellitus and to identify the determinants of risk for developing the disease. A cross-sectional study was carried out among adults attending the primary health care (PHC) centres in Dubai, UAE. A total of 515 adults were selected by systematic random sampling and assessed using an interview questionnaire. More than 40% of the participants demonstrated a risk of developing T2DM. It was found that 21.6%, 19.4% and 1.9% of participants were at moderate, high and very high risk, respectively, of developing T2DM within 10 years. The results of stepwise logistic regression revealed 10 predictors associated with the risk of developing T2DM: age ≥ 45 years, positive family history of diabetes mellitus, poor knowledge of T2DM, low perception level about diabetes, eating refined grains on daily basis, eating fried food on a daily basis, history of high blood glucose, < 30 minutes of physical activity per day, BMI ≥ 25 kg/m² and high waist circumference. The overall risk of developing T2DM amongst adults attending the PHC centres was alarming. The participants at risk were characterized by obesity (in particular central obesity), physical inactivity and a positive family history of diabetes. We recommend the use of a diabetes risk assessment questionnaire as initial step for T2DM screening in PHC centres. In addition, we recommend that a structured lifestyle modification programme should be delivered to those at moderate and high risk of developing T2DM, to improve their health and to delay or prevent T2DM.

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The most common rectal disease is haemorrhoids and treatments include medical management and surgical repair. A new method of treatment applies a proctoscope and a Doppler adaptor for haemorrhoid artery ligation (HAL). In this study, patients with haemorrhoid grades 2, 3 and 4 were operated through the common method of haemorrhoid surgery or Doppler-guided haemorrhoidectomy. Patient data were recorded on a checklist and the patients were followed up at week 1 and months 1, 3 and 6 postoperatively. A total of 300 patients participated in this study and were allocated to the HAL (case) group or to the haemorrhoidectomy (control) group. The most common symptom of the disease in both groups was bleeding and the most common postoperative complication was pain during defecation. Overall, 2.3% of the patients in the case group and 15.7% of the patients in the control group underwent reoperation. Doppler-guided haemorrhoidectomy is an effective, minimally invasive method of surgery resulting in mild pain and fewer complications, and can be applied as the treatment of choicein the case of symptomatic haemorrhoids.

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The global prevalence of type 2 diabetes mellitus (T2DM) is rising at a spectacular rate and the prevalence of T2DM in the United Arab Emirates is among the highest in the world. Risk factors for diabetes mellitus include obesity, sedentary lifestyle, unhealthy eating habits, family history of diabetes mellitus, genetics, increasing age, high blood pressure and high cholesterol. A variety of diastolic and systolic dysfunctions have been reported in the hearts of type 2 diabetic patients and the severity of abnormalities is partly dependent on the patient's age and the duration of diabetes mellitus. The Goto–Kakizaki (GK) rat is a genetic model of T2DM and its general characteristics include fasting hyperglycaemia, impaired insulin secretion and insulin resistance. In the GK rat heart, there are a variety of dysfunctions including decreased heart rate, decreased ejection fraction (mainly due to loss of left ventricular longitudinal contraction) and prolonged shortening and/or relaxation in ventricular myocytes. Widespread consumption of sugar-sweetened beverages has been linked to higher incidence of obesity and T2DM. Ventricular myocyte shortening and Ca²⁺ transport in GK type 2 diabetic rats that were fed a sucrose-enriched diet have been investigated. GK and control rats received either water or water enriched with increasing concentrations of sucrose (100–400 mmol/l) for a period of 6 months. Ventricular myocyte shortening and intracellular Ca²⁺ were measured by video edge detection and fluorescence photometry, respectively. Resting cell length, time to peak (TPK) shortening, time to half-relaxation of shortening and amplitude of shortening were not significantly altered in ventricular myocytes from GK/sucrose compared with GK rats and control/sucrose compared with control rats. TPK Ca²⁺ transient was prolonged in myocytes from GK/sucrose compared with GK and control/sucrose rats and amplitude of the Ca²⁺ transient was increased in myocytes from GK/sucrose compared with control rats. Myofilament sensitivity to Ca²⁺ was unaltered in myocytes from GK/sucrose and control/sucrose compared with GK and control rats. In conclusion, ventricular myocyte shortening was well preserved despite some alterations in Ca²⁺ transport in GK rats receiving a sucrose-enriched diet.

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Chronic pelvic pain (CPP) can be a debilitating and sometimes life-changing condition. It affects both sexes, but is more common in women. The socioeconomic cost of CPP is huge and treatment requires a multidisciplinary approach. Treatment of CPP may be lengthy with disappointing results and the management of the condition is an ever-evolving field with some options still in their infancy. We have reviewed the literature on CPP, identified using various internet databases, focusing on the management of CPP in women over the last 15 years and examining the available evidence for the efficacy of the management options of CPP. A review of the relevant literature indicates that the causes of CPP in women may be both gynaecological and non-gynaecological. CPP may be a result of multiple factors and the treatment of this condition can be medical or surgical; other treatment modalities include psychotherapy, physiotherapy and lifestyle modification, and treatment may involve the use of more than one modality. Medical treatment includes the prolonged use of hormonal preparations for specific causes or the non-specific control of pain using analgesics whereas surgical management of CPP targets the specific tissues involved and may include the partial or complete excision of pathological tissues. Physical therapy was found to be helpful in managing symptoms of pelvic floor pain and abdominal myofascial pain and psychological therapy modifies symptoms in CPP, especially if a significant organic cause is present. Further randomized controlled studies are required to determine the efficacy of some of these treatment methods.

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Seropositive arthropathy is a term often used in clinical practice and relates to inflammatory joint conditions in which serum rheumatoid factor (RF) is present. This term probably originates from evolving nomenclatures and classification criteria for inflammatory joint diseases. The alternative, described as seronegative arthropathies, are distinctly different musculoskeletal disorders, often called spondyloarthropathies. The purpose of this article is to selectively describe seropositive arthropathies as a group of conditions rather than to review each condition in depth. To further understand seropositive arthropathies, it is essential to understand RF in more detail. This review article explores the basic clinical sciences and clinical manifestations of seropositive arthropathies with references to key studies.

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The term ‘seronegative arthritis’ has, in recent years, been reinterpreted as ‘spondyloarthritis’ (SpA), a family of conditions with common pathological lesions and genetic basis. The family comprises axial SpA (axSpA)/ankylosing spondylitis, psoriatic arthritis, reactive arthritis, enteropathic arthritis as well as undifferentiated and juvenile forms. Inflammation at the entheses is characteristic of SpA, often occurring at the joints in the spine as well as within peripheral joints and, in cases of psoriatic arthritis, at the nail attachments. Recently, new classification criteria have been introduced for axSpA that reflect the whole spectrum of ankylosing spondylitis and psoriatic arthritis. Recent genetic work has shed further light on the possible role of human leukocyte antigen-B27 and also pointed to important potential roles for other genes including ERAP-1 and the interleukin 23 receptor. Pathogenic roles for both commensal and infective micro-organisms are proposed but clear conclusions about causation cannot yet be drawn. In addition to spinal and peripheral joint lesions, SpA is associated with extra-articular lesions, notably acute anterior uveitis, inflammatory bowel disease and psoriasis and important comorbidities, notably cardiovascular disease and osteoporosis. Treatments of axial and peripheral disease are increasingly tailored according to objective- and patient-reported outcome measures. In all conditions, the range of therapeutic options includes physical exercise, non-steroidal anti-inflammatory drugs, corticosteroids and tumour necrosis factor (TNF) inhibitors. Disease-modifying antirheumatic drugs may be effective for the peripheral disease but not for the axial disease. Patient management should also take into account the actual and potential extra-articular lesions and the possible comorbidities. The introduction of TNF-inhibitor drugs for the treatment of axSpA and psoriatic arthritis has dramatically improved the prognosis for these conditions with the promise of considerable further developments in the foreseeable future.

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Osteoarthritis (OA) is a common and debilitating condition worldwide. Despite the huge variety of treatment options available, many patients live with considerable ongoing pain and disability, even after surgical intervention. The mechanisms underlying structural and symptomatic disease and the relationship between the two are not entirely understood. Increasing use of more sensitive imaging such as magnetic resonance imaging (MRI) has identified further structural targets but, at present, MRI is no better than plain radiography at distinguishing between patients with and without symptomatic disease. Study of the neural processing, both centrally and peripherally mediated, is under way, with the aim of narrowing the discrepancy. The assessment of pain in cases of OA is complex with significant temporal, anatomical and qualitative variation between patients. The simple visual analogue score is not able to capture this information and so more specific techniques are being developed and applied. Similarly, the investigation of the mechanisms for pain in cases of OA has broadened, encompassing the full spectrum of methods from cellular and genetic disposition to the holistic assessment of mood and sociocultural factors. Current management strategies advise thorough assessment of patients with a biopsychosocial model in place. Appropriate therapies can then be selected from the non-pharmacological, pharmacological and surgical options available and applied in combination according to the needs of an individual patient. The identification of formal phenotypes, or clinically important subsets of patients, among this heterogeneous condition is in progress. It is anticipated that this approach will benefit the understanding the underlying aetiology as well as the impact on patient therapy.

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