Implications of foot ulceration in hemodialysis patients: a 5-year observational study.

Foot ulceration (FU) remains a serious concern for patients worldwide. We analyzed the incidence, risk factors, and outcome of FU in hemodialysis (HD) patients. A retrospective cohort study was conducted for 252 HD patients who were followed up for 5 years.

Cardiovascular complications in diabetic patients undergoing regular hemodialysis: a 5-year observational study.

We aimed to study the vascular outcomes in hemodialysis (HD) patients based on their diabetic status. A cohort observational study was conducted among patients undergoing regular HD with a 5-year follow-up. Of the 252 consecutive HD patients, 60% were diabetic.

Gas sensing studies of pulsed laser deposition deposited WO3 nanorod based thin films.

WO3 nanorod based thin films were deposited via pulsed laser deposition onto quartz conductometric transducers with pre-patterned gold interdigitated transducers (IDT) employing the shortest wavelength (193 nm) ArF excimer laser. Micro-characterization techniques such as scanning electron microscopy (SEM), X-ray diffraction (XRD) and transmission electron microscopy (TEM) were employed to study surface morphology and crystal structure. It was observed that the fabricated films showed nanocolumnar features perpendicular to the surface.

Evaluation of temporal bone cholesteatoma and the correlation between high resolution computed tomography and surgical finding.

Background: Acquired cholesteatomas are commonly seen in patients less than 30 years. There is a typical history of recurrent middle ear infections with tympanic membrane perforation. The diagnosis of cholesteatoma is usually made on otologic examination.

The genetic landscape of autism spectrum disorders.

Autism spectrum disorders (ASDs) are a group of heterogeneous neurodevelopmental disorders that show impaired communication and socialization, restricted interests, and stereotypical behavioral patterns. Recent advances in molecular medicine and high throughput screenings, such as array comparative genomic hybridization (CGH) and exome and whole genome sequencing, have revealed both novel insights and new questions about the nature of this spectrum of disorders. What has emerged is a better understanding about the genetic architecture of various genetic subtypes of ASD and correlations of genetic mutations with specific autism subtypes.

The role of neurosciences intensive care in neurological conditions.

The neurosciences intensive care unit provides specialized medical and nursing care to both the neurosurgical and neurological patient. This second of two articles describes the role it plays in the management of patients with neurological conditions.

The role of neurosciences intensive care in trauma and neurosurgical conditions.

The creation of neurosciences intensive care units was born out of the awareness that a group of neurological and neurosurgical patients required specialized intensive medical and nursing care. This first of two articles describes the role of neurosciences intensive care in the management of trauma and neurosurgical conditions.

Reconstruction of a tibial defect with a previously fractured fibula including the fractured segment as a free osteoseptocutaneous flap.

Introduction: Reconstruction of major bone defects using free fibular transfer provides a good biological option in unsound situations. Most authors recommend selection of the recipient blood vessels outside the zone of injury to achieve successful free fibular transfer. Occasionally, in polytraumatized patients, the surgeon has to use a previously fractured fibula as a graft, with increased risk of inclusion of the injury zone that may lead to failure.

Polarized distribution of AMPA, but not GABAA , receptors in radial glia-like cells of the adult dentate gyrus.

Glial fibrillary acidic protein (GFAP)-positive astrocytes with radial processes [radial glia (RG)-like cells] in the postnatal dentate gyrus share many of the characteristics of embryonic radial glia and appear to act as precursor cells for adult dentate neurogenesis, a process important for pattern separation and hippocampus-dependent learning. Although much work has delineated the mechanisms underlying activity-neurogenesis coupling via gamma-amino butyric acid (GABA)ergic neurotransmission on GFAP-negative transient-amplifying cells and neuroblasts, little is known regarding the effects of neurotransmitters on RG-like cells. Conflicting evidence exists for both GABA and glutamate receptors on these cells.

Quality of anticoagulation with warfarin across Kuwait.

Introduction: Warfarin is widely used in patients with non-valvular atrial fibrillation (AF) because it is effective in reducing thromboembolic complications. However, it has a narrow safe therapeutic window. We aimed to examine the frequency of maintaining this therapeutic window in daily practice.

Clinical audits in a postgraduate general practice training program: an evaluation of 8 years' experience.

Background: Clinical audit can be of valuable assistance to any program which aims to improve the quality of health care and its delivery. Yet without a coherent strategy aimed at evaluating audits' effectiveness, valuable opportunities will be overlooked. Clinical audit projects are required as a part of the formative assessment of trainees in the Family Medicine Residency Program (FMRP) in Kuwait.

Pre-hypertension and hypertension in college students in Kuwait: a neglected issue.

Objective: To determine the proportion of pre-hypertension and hypertension in college students in Kuwait and their related risk factors.

Materials And Methods: A total of 803, randomly selected students aged 17 to 23 years (346 male, 457 female) from different colleges in Kuwait, were included in the study between 2009 and 2010. Systolic and diastolic blood pressure measurements were taken by trained personnel.

Evaluating tools to support a new practical classification of diabetes: excellent control may represent misdiagnosis and omission from disease registers is associated with worse control.

Aims: To conduct a service evaluation of usability and utility on-line clinical audit tools developed as part of a UK Classification of Diabetes project to improve the categorisation and ultimately management of diabetes.

Method: We conducted the evaluation in eight volunteer computerised practices all achieving maximum pay-for-performance (P4P) indicators for diabetes; two allowed direct observation and videotaping of the process of running the on-line audit. We also reported the utility of the searches and the national levels of uptake.

Diabetic retinopathy: a new predictor in patients on regular hemodialysis.

Background: Data evaluating the presence and impact of diabetic retinopathy (DR) in patients on regular hemodialysis (HD) are scarce.

Objective: To assess prevalence and outcomes of DR in HD patients.

Methods: Data were collected from 252 consecutive HD-dependent patients who underwent eye examination for detection of DR in 2007.

D-dimer and portal vein status in splenectomized Egyptian β-thalassemia major patients: a prospective single-thalassemia center experience.

Splenectomy is a recognized cause of portal vein thrombosis. Thirty-six β-thalassemia major (β-TM) patients were followed up for 36 months to evaluate changes in D-dimer levels (as a possible marker for thrombosis development) and portal vein status (by portal duplex ultrasound) at both early and late postlaparoscopic splenectomy periods. They were classified into group I if they were splenectomized in the study period (n = 12), or group II if they were splenectomized during the 5 years preceding the period (n = 24).

Prevalence, predictors, and impact of peripheral arterial disease in hemodialysis patients: a cohort study with a 3-year follow-up.

We evaluated the prevalence, predictors, and outcome of peripheral arterial disease (PAD) among hemodialysis (HD) patients (n = 252) in a prospective study (3-year follow-up) conducted in Qatar. Those with PAD (n = 97; 38.5%) were older and more likely to be males and to have diabetes mellitus, prior coronary artery disease (CAD), or cerebrovascular disease.

Posterior reversible encephalopathy syndrome: a case following reversible cerebral vasoconstriction syndrome masquerading as subarachnoid haemorrhage.

Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic clinico-radiological diagnosis typically presenting with headache, encephalopathy and visual disturbance accompanied by a unique neuroradiological pattern of symmetrical parieto-occipital vasogenic oedema. Here we present the case of a 51-year-old woman who presented to hospital following a thunderclap headache, initially thought to be secondary to a subarachnoid haemorrhage (SAH). A tiny anterior choroidal artery aneurysm was demonstrated on cerebral angiogram.

Audit of physicians' adherence to the antibiotic policy guidelines in Kuwait.

Objective: To audit physicians' adherence to the local antibiotic policy guidelines in government hospitals in Kuwait.

Materials And Methods: The study was a retrospective review of patient records in nine hospitals between July 1 and December 31, 2008. Clinical notes and medication charts of the latest hospital admissions were checked for antibiotic prescribing.

Spontaneous upper limb monoplegia secondary to probable cerebral amyloid angiopathy.

Cerebral amyloid angiopathy is a clinicopathological disorder characterised by vascular amyloid deposition initially in leptomeningeal and neocortical vessels, and later affecting cortical and subcortical regions. The presence of amyloid within the walls of these vessels leads to a propensity for primary intracerebral haemorrhage. We report the unusual case of a 77-year-old female who presented to our emergency department with sudden onset isolated hypoaesthesia and right upper limb monoplegia.

Seizure-induced miosis.

Ictal autonomic pupillary dilation is common; however, miosis is rare. We describe a case of focal seizures secondary to cortical dysplasia presenting with bilateral pupillary miosis, rendered seizure free by resective surgery. The seizure-onset zone was localized within the left middle parietal gyrus by intracranial electrographic recording.

Pituitary apoplexy can mimic acute meningoencephalitis or subarachnoid haemorrhage.

Pituitary apoplexy is an uncommon but life-threatening condition that is often overlooked and underdiagnosed. We report a 45-year-old man who presented to our emergency department with a sudden onset headache, acute confusion, signs of meningeal irritation and ophthalmoplegia. An initial diagnosis of acute meningoencephalitis was made, which was amended to pituitary apoplexy following thorough investigation within the emergency department.

Automated identification of miscoded and misclassified cases of diabetes from computer records.

Aims: To develop a computer processable algorithm, capable of running automated searches of routine data that flag miscoded and misclassified cases of diabetes for subsequent clinical review.

Method: Anonymized computer data from the Quality Improvement in Chronic Kidney Disease (QICKD) trial (n = 942,031) were analysed using a binary method to assess the accuracy of data on diabetes diagnosis. Diagnostic codes were processed and stratified into: definite, probable and possible diagnosis of Type 1 or Type 2 diabetes.