Introduction: Obesity is a metabolic disease that accumulates an excessive level of fat. It also leads to comorbidities such as cardiovascular diseases, type 2 diabetes, high blood pressure, osteoarthritis and hormonal imbalances. Obesity has also been associated with an increased risk of developing cancers and may also enhance cancer-related mortality. The global prevalence rate of obesity and overweight, especially among children, is on the rise, and the United Arab Emirates (UAE) is no exception. Methods: A recent report suggests that the prevalence of overweight and obesity is 17% and 16%, respectively, in the UAE among children between 6 and 18 years of age. Thus, this is a serious health problem that needs urgent attention. Hence in this review we have analysed the risk factors which influence DNA Methylation in Childhood Obesity by using published literature. Results: Although genetic factors contribute to childhood obesity, epigenetic factors also play a significant role in its development. Discussion: This review article discusses the different risk factors and their contribution/s through epigenetic modification, DNA methylation and the associated changes in gene expression that eventually lead to childhood obesity. Understanding how these risk factors modulate gene expression could help to avoid or reduce the impact of exposures to such factors and thus may help to evolve a healthy future generation.

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Background: The key features of coronavirus disease 2019 (COVID-19) are diffuse alveolar damage and lung failure and also kidney and other organ involvements are reported. However, renal complications are not well explored yet. Aim: In this study, we report distinctive experience with acute kidney injury (AKI) in COVID-19 patients and provide its incidence, risk factors and outcome to improve understanding of this complication. Methods: This retrospective cohort study was conducted in Dubai Hospital from 1 April 2020 to 4 June 2020. We analyse 586 COVID-positive admitted patients' data. Information regarding demographics, comorbidities, medications, clinical and laboratory data and outcomes was collected from patients' electronic medical records. Multivariate analyses were performed to determine the association of AKI with inhospital mortality. Results: The median age was 48.30 (21–92) years; more than 88% of the patients were male. One hundred and thirty-five (23.03%) patients developed AKI during hospitalisation. Male sex, haemodynamic instability, mechanical ventilation, acute respiratory distress syndrome, admission high ferritin, creatinine, D-dimer and low absolute lymphocyte count have identified risk factors for inhospital AKI. The mortality rate in the AKI population was 39.86%, and multivariate analyses reveal that age >75 years, creatinine >1.5 mg/dl at admission, mechanical ventilation and AKI Stage 3 are risk factors associated with high mortality. Conclusion: Incidence of AKI in hospitalised COVID-19 patients is high and associated with high mortality, especially in AKI Stage 3. Planning is needed to handle AKI in COVID patients.

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Background: Skin adnexal tumours (SATs) are tumours that differentiate towards one or more of the adnexal structures of the skin. The aim of this study was to determine the incidence of SATs in Ibadan and to correlate them with age, sex and anatomic location. Methods: This is a 10-year retrospective study of all SATs in the Department of Pathology, University College Hospital, Ibadan. The clinicopathological data were obtained from the department's records for the given period. Haematoxylin and eosin-stained sections obtained from formalin-fixed paraffin-embedded tissue blocks were examined to confirm the diagnosis and special stains such as periodic acid Schiff staining done where necessary. Cases of SATs were further classified into benign and malignant tumours. Results: Twenty-seven cases of SATs were reviewed over the study period. Tumours from the sweat glands formed the largest group (55.6%) with trichoepithelioma being the most common subtype, followed by tumours with follicular differentiation (40.7%) and sebaceous tumours (3.7%). There was a slight female predominance with a male-to-female ratio 1:1.07. The highest number of tumours was seen in the fourth decade of life (23%). Benign tumours made up the majority of cases (85.2%). The most common location was the head and neck with 40.8% of cases. Conclusion: SATs are not uncommon among Nigerian patients. These tumours are mostly benign and are present commonly in the head and neck location.

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Introduction: This article is a narrative review of Russian-language publications on surgical and endoscopic methods applied for tuberculosis in comparison with the international literature. Methods: Search of the international literature was performed predominantly using PubMed. Russian-language professional publications were searched for in the internet and the electronic library of eLIBRARY.ru. Results: After the introduction of efficient drug therapy in the 1950–1960s, surgical treatment of tuberculosis has been partly abandoned in many parts of the world. The role of surgery remains controversial. Priority of the former Soviet Union in this field was pointed out. Besides, the use of bronchoscopy in tuberculosis is briefly overviewed as well as the treatment of patients with alcoholism. Clinical recommendations are not the goal of this paper. The message is that patients should not undergo surgery and other invasive procedures without evidence-based indications. The patients must be objectively informed about potential benefits and risks to be able to make an independent decision according to the principle of informed consent. Conclusion: The factors contributing to the persistence of suboptimal practices included the authoritative management style, disregard for the rules of scientific polemics and insufficient use of foreign literature. Thanks to the Internet, the foreign literature is used increasingly today. However, some papers containing questionable recommendations have remained without due commentaries, so that persistence of suboptimal practices or reversion to them is not excluded.

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Background: Globally, haemodialysis patients using central venous catheters remain at a huge risk for blood stream infections. Most of these infections are caused by skin dormant organisms. Patients suffering from blood stream infections have the risk of seeding the infection into distant organs leading to multiple organ failure, fulminant shock and death. Objectives: our primary objective is to calculate the rate of catheter related blood stream infections (CRBSI) in patients inevitably using central venous catheters (CVC) while waiting for their arteriovenous fistula (AVF) maturation, and compare it to the international benchmark. Our secondary objective is to compare the morbidity and mortality outcomes between patients using central venous catheters vs. patients with arteriovenous fistula. Methods: A retrospective single centre study on Tawam hospital outpatient dialysis patients, who underwent dialysis at the SEHA dialysis service (SDS) centre. Data were obtained from 1st January 2015 till 30th Dec 2015. We only included patients needed to temporarily use CVC while waiting for their AV maturation. Data were obtained from Electronic Medical Records, and analysed using SPSS. Results: The total study population was 219 patients, of them; 175 patients of them were using a CVC for their first haemodialysis session. Out of patients using CVC, 53 (30.3%) patients were admitted at least once for an episode of infection during the first year of initiation of dialysis. The number of overall admission days were higher in the CVC group (2172 days) when compared to patients who started their haemodialysis with AVF directly without using CVC initially (588 days). The rate of CRBSI in our patients using CVC temporarily appeared to be 5.2 episodes per 1000 catheter-days. The number of interventional radiology procedures needed were significantly higher in the patients using CVC. There were 16 mortality cases, of which 15 (93.8%) were in the group using CVC. Conclusion: Dialysis through central venous catheter showed to have an increase in the number of admission days (overall and related to CRBSI), morbidity and mortality when compared to arteriovenous fistula. In the light of these findings, the decision of either waiting for fistula maturation or using CVC temporarily should be carefully tailored on case by case basis. Quality improvement projects are needed to address this important problem hospital wide. Decreasing hospitalization decreases the burden and the stretch on health care services and allows to provide better patient centred care.

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Introduction: The objective of this review is to advance our understanding on the biolecial and psychological perspectives of Chronic Pain. Methods: For research, a PubMed search was conducted on 01.05.2021 using the systematic review filter to identify articles that were published using MeSH terms Chronic Pain, Pain, Psychology of Pain. Systematic reviews or meta-analyses were selected from a systematic search for literature containing diagnostic, prognostic and management strategies in MEDLINE/PubMed. Results: Depression is more common in chronic pain patients (CPPs) than in healthy controls as a consequence of the presence of CP. At pain onset, predisposition to depression (the scar hypothesis) may increase the likelihood for the development of depression in some CPPs. Because of difficulties in measuring depression in the presence of CP, the reviewed studies should be interpreted with caution. Little attention, however, has been given to the development of a comprehensive model that integrates both biomedical and psychological variables in the etiology, maintenance, and exacerbation of chronic pain. The purpose of this article is to propose a dynamic psychobiological model of chronic pain that emphasizes the interaction among psychological and biomedical variables. The experience of pain is viewed as a complex response that incorporates subjective-psychological, motor-behavioral, and physiological-organic components. Moreover, we postulate that there are varying degrees of synchrony among responses measured on these levels determining the development and etiology of chronic pain syndromes.

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Rationale: Small bowel obstruction by bezoars is an infrequent entity encountered in general surgical practice. Early diagnosis and management are paramount to prevent the development of drastic complications. Patient concerns: Bezoar in general and rubber-band-bezoar in particular is an extremely rare case of mechanical small bowel obstruction. We report two cases of bezoar presented as acute surgical emergency in children. A brief review in the context is also presented. Diagnosis: Clinical examination, biochemical parameters and imaging studies showed features of compete small bowel obstruction. Interventions: One patient had bezoar of rubber-bands in the distal ileum and removed via enterotomy. The second had two trichobezoars one in ileum and another in stomach and underwent enterotomy and gastrotomy. Outcomes: Both our patients had uneventful intra-operative period and post-operative recovery and are on regular follow-up. Lessons: Bezoar-induced small bowel obstruction with acute presentation remains a rare diagnosis particularly in children. Accurate pre-operative diagnosis is notoriously difficult and operative intervention remains a rule. High clinical suspicion and proper radiological work-up is necessary to reach a definitive diagnosis.

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Introduction: Insulin resistance (IR) is an independent cardiovascular risk factor. Aim: The study aimed at comparing a potential novel marker, fasting insulin-lipid (FILIP) index, with homoeostatic model assessment of IR (HOMA-IR) and McAuley's index, in terms of IR quantitation and cardiovascular risk predictability. Methods: The study involved 70 individuals (35 females and 35 males) who were previously diagnosed with Type 2 diabetes mellitus. Ethical approval was obtained from the Institution's Ethical Review Committee. Fasting plasma insulin, fasting plasma glucose, plasma triglyceride (TG) and high-density lipoprotein-cholesterol (HDL-C) were determined with appropriate techniques. QRISK 3 was obtained from a validated calculator. FILIP index, HOMA-IR and McAuley's index were obtained from the recommended formulae. SPSS version 22 was used for data analysis. Pearson's correlation was used to compare the indices. Bland–Altman plots comparing FILIP index with HOMA-IR and McAuley's index were done. Receiver operating characteristic (ROC) curve analysis was done to determine the cardiovascular risk predictability of the indices. Results: The mean age was 53.34 ± 9.57 years. FILIP index significantly correlated with HOMA-IR (r = 0.514; P < 0.0001) and McAuley's index (r = −0.830; P < 0.0001). The Bland–Altman plots between FILIP index and HOMA-IR as well as between FILIP index and McAuley's index showed reasonably acceptable limits of difference. ROC curve analysis in determining cardiovascular risk predictability showed that FILIP index had the highest area under curve. Conclusion: FILIP index is a simple derivative of fasting insulin multiplied by TG-HDL-C ratio. As a surrogate marker of IR, FILIP index compared well with HOMA-IR and McAuley's index. In Type 2 diabetes mellitus, FILIP index is a better predictor of cardiovascular risk when compared with HOMA-IR and McAuley's index.

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Introduction: Rhinosporidiosis is a rare, endemic, chronic granulomatous infection caused by protistan parasite Rhinosporidium Seeberi. It affects upper airways, mostly nasal mucosa and sometimes skin and manifests as lesions that appear like strawberry pulp. It is known for post excision recurrences attributed to residual spores or re-inoculation during excision. Beyond the endemic zones it's rare in the developed world. Case Report: We report nasal Rhinosporidiosis in a case from an endemic area in India, who previously suffered from the disease and was successfully treated 20 years ago and was symptom free until his current reinfection and treatment. Conclusion: Though rare, awareness of this disease is important for clinicians in places with a large migrant population and in cases of travel to an endemic area. The disease can recur on visiting an endemic area even after 20 years of previous treatment and cure as might have happened in our case.

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Background: Fascia iliaca compartment block (FICB) is a popular block in patients with hip injuries. It gives good postinjury analgesia and helps in positioning for neuraxial blockade before the surgery. Aims and Objectives : The study aims to compare two approaches (parallel versus perpendicular) of ultrasound (USG)guided FICB in patients undergoing proximal femur fracture surgeries. The primary objective was to compare the time to do ultrasonic imaging, time to perform the FICB, and total block time. The secondary objective was to compare the time to loss of sensation, first rescue analgesia, pain score and occurrence of adverse events. Materials and Methods: Fiftyone patients were allocated into two groups in this prospective observational study. In parallel group (Group A) (n = 25), the USG probe was kept parallel to the inguinal ligament, and in the perpendicular group (Group B) (n = 26), a probe was placed perpendicular to the inguinal ligament. Both groups received equal doses of the drug. The time to achieve ultrasonic imaging, time to perform the block, total block time, loss of sensation within the distribution of lateral cutaneous nerve and the femoral nerve was noted. Time to first rescue analgesia, pain score and adverse events were also noted. Results: Group A approach was quicker to perform than the perpendicular approach (5.1 ± 0.7 vs. 7.3 ± 1.2 min) (P < 0.0001). The imaging time of Group A was shorter than Group B (3.2 ± 0.3 vs. 5.3 ± 0.7 min) (P < 0.0001). The success rate of sensory loss of lateral cutaneous nerve was quicker and better with Group B (88% vs. 100%). No statistical differences were noted in postoperative pain score, time of rescue analgesia, the incidence of complications, and the patient's satisfaction score between the two groups. Conclusion: The perpendicular approach of USGguided FICB may offer a better blocking effect of lateral cutaneous nerve and longer duration of block time, but the parallel approach offers better and quicker ultrasonic imaging.

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Introduction: Impalement injuries are comparatively rarer in nature than other types of injuries. They mostly affect the extremities, whereas the face is rarely involved. They are defined as penetrating injuries, wherein a traumatic object gets impaled in the human body. Impalement injuries of the face present to the emergency. The approach and management of such injuries remain controversial and requires a multi-team approach. We report a case of an impalement injury of the face along with its successful management. Case Report: An interesting case of transorbital penetrating injury is presented. An 8-year-old male child presented in the emergency trauma centre with an alleged history of fall from the first floor of his house resulting in a penetrating injury by a roof tile 'Khaprail' to his face and skull. Conclusions: Impalement injuries to the face and skull require a prompt action, multi-team approach and urgent surgical intervention to prevent damage to salvageable vital tissues. A thorough knowledge of relevant surgical anatomy and a disciplined surgical hand is imperative for optimal results.

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Introduction: Sympathetic stimulation during general anaesthesia (GA) in hypertrophic cardiomyopathy (HOCM) patients poses the risk of sudden intraoperative death. Regional anaesthesia using paravertebral block (PVB) provides an excellent alternative to GA in HOCM patients undergoing carcinoma breast surgery. Case Report: We hereby describe the perioperative management of three patients of HOCM, with PVB as the preferred anaesthetic modality. Conclusion: Thoracic PVB is a safe and efficacious technique which provides good intra-operative haemodynamic stability and a superior postoperative analgesia for breast surgery in HOCM patients.

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Introduction: Ewing sarcoma represents a highly aggressive bone cancer that predominantly occurs during adolescence. Methods: This concise review focusses on the progress that has been made in tumor-directed treatments for Ewing sarcoma with particular emphasis on progress made in medical therapy. Publications in peer-reviewed medical journals and major oncological conferences were screened using the search terms Ewing sarcoma and therapy. Results: Important tumor-directed treatments include surgery, chemotherapy (including high dose chemotherapy followed by autologous stem cell transplantation), and radiotherapy. Major progress has been made in the optimization of chemotherapy regimens and in scheduling of different treatment modalities. Novel medical approaches under development for therapy of Ewing sarcoma include targeted therapies and immunotherapy. Beyond those treatments, adolescents and young adults with Ewing sarcoma also often are in dire need for psychological, social and financial support, fertility preservation measures, nutritionist and many other interventions. Conclusions: Patients with Ewing sarcoma should be treated by an interdisciplinary multi-professional team.

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