Objective: The aim of this study was to compare highsensitivity C-reactive protein (hsCRP) and Lipoprotein(a) levels [Lp(a)] levels between diabetic and non-diabetic patients with coronary artery disease (CAD). Study Design: Cross sectional Study. Place and Duration of study: This study was conducted in the department of Physiology of College of Medicine & King Khalid University Hospital, King Saud University, Riyadh between August 2006 and December 2007. Methods: One hundred and three individuals with CAD and 30 healthy individuals matched for age and BMI were studied. CAD patients were divided into two groups based on presence (n=62) and absence (n=41) of type 2 diabetes mellitus. Overnight fasting blood samples were collected, and analyzed for total cholesterol (TC), Triglycerides (TG), Low density Lipoprotein (LDL) and High density lipoprotein (HDL), Lp(a) and hsCRP. Data about CAD severity was obtained from medical records. Results: Both groups of CAD without and with DM had significantly higher levels of Lp(a) [mg/dl] (25.58 ± 25.99, 25.90 ± 24.67 respectively) and hsCRP [mg/dl] (0.52 ± 0.71, 0.82 ± 0.78 respectively) when compared with healthy control subjects (Lp(a) =16.93 ± 15.34 & hsCRP=0.27 ± 0.21) [p<0.05]. Lp(a) levels between the two CAD groups were non significant. While, hsCRP levels were significantly high in CAD with DM compared to those without DM [p<0.05]. Gensini Score of CAD severity was also higher in CAD with DM [67.60 ± 45.94] than those without DM [52.05 ± 42.27, p<0.05]. Conclusion: Elevated Lp(a) and hsCRP levels are associated specifically with angiographically defined CAD. However, hsCRP elevation but not Lp(a) is also associated with CAD in type 2 diabetes mellitus. Measurement of hsCRP and Lp(a) may be considered optional markers for better prediction of cardiovascular risk.

A tick in the ear is a very painful condition and removal is difficult because it grips firmly to the external auditory canal or tympanic membrane. Facial paralysis is a rarely reported localised neurological complication of an intra-aural tick infestation. The pathophysiology of localised paralysis is discussed, together with the safe way of handling patients with an intra-aural tick infestation.
Ticks ; Isolated ; physiopathological ; Paralysis ; Membranes

Purpose; Delayed presentation of lateral condylar fractures of the humerus is relatively common in the developing regions of the world. These fractures are difficult to manage because of the displacement and fibrosis around the condylar fragment secondary to the delay. There is a paucity of literature concerning the management of these fractures. An oft repeated finding is the requirement of extensive dissection around the fragment for proper reduction. The purpose of this study was to assess the efficacy of surgical management of lateral condylar fractures with delayed presentation. Methods; We assessed the results of lateral condylar fracture fixation in 20 cases with delayed presentation. Results; The lateral condylar fractures in patients with a delayed presentation can be managed surgically with good results. Conclusions; Open reduction and internal fixation should continue to be the method of choice for the management of lateral condylar fractures which report late for management.
Orthopedic Procedures

PURPOSE: Breast cancer is a significant health problem worldwide, accounting for a quarter of all cancer diagnoses in women. Current strategies for breast cancer treatment are not fully effective, and there is substantial interest in the identification of novel anticancer agents especially from natural products including toxins. Cytotoxins are polypeptides found in the venom of cobras and have various physiological effects. In the present study, the anticancer potential of cytotoxin-II against the human breast adenocarcinoma cell line (MCF-7) was investigated. METHODS: The cytotoxic effects of cytotoxin-II were determined by morphological analysis and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. The mode and mechanism of cell death were investigated via acridine orange/ethidium bromide (AO/EtBr) double staining, flow cytometric analysis of cell death, detection of mitochondrial membrane potential, measurement of intracellular reactive oxygen species (ROS), annexin V/propidium iodide staining, and caspase-9 activity assays. RESULTS: The half maximal inhibitory concentration (IC50) of cytotoxin-II in MCF-7 cells was 4.18+/-1.23 microg/mL, while the value for cisplatin was approximately 28.02+/-1.87 microg/mL. Morphological analysis and AO/EtBr double staining showed typical manifestations of apoptotic cell death (in doses lower than 8 microg/mL). Dose- and time-dependent ROS generation, loss of mitochondrial membrane potential, caspase-9 activation, and cell cycle arrest were observed in their respective tests. CONCLUSION: In conclusion, cytotoxin-II has potent anticancer effects in the MCF-7 cell line, which are induced via the intrinsic pathways of apoptosis. Based on these findings, cytotoxin-II is a suitable choice for breast cancer treatment.
Adenocarcinoma* ; Antineoplastic Agents ; Apoptosis* ; Biological Products ; Breast Neoplasms ; Breast* ; Caspase 9 ; Cell Cycle Checkpoints ; Cell Death ; Cell Line* ; Cisplatin ; Cobra Venoms* ; Cytotoxins ; Diagnosis ; Elapidae ; Female ; Humans ; MCF-7 Cells ; Membrane Potential, Mitochondrial ; Peptides ; Reactive Oxygen Species ; Snakes ; Venoms

BACKGROUND: Increasing the establishment of integrated management systems (IMSs) is done with the purpose of leaving traditional management methods and replacing them with modern management methods. Thus, the present study sought to analyze the events and investigate the impact of IMS on health and safety performance indices in an Iranian combined cycle power plants. METHODS: This case study was conducted in 2012 in all units of the Yazd Combined Cycle Power Plant on accident victims before and after the implementation of IMS. For data analysis and prediction of indices after the implementation of IMS, descriptive statistics and Kolmogorov–Smirnov test, Chi-square, linear regression, and Cubic tests were conducted using SPSS software. RESULTS: The number of people employed in the power plant in an 8-year period (2004–2011) was 1,189, and 287 cases of work-related accidents were recorded. The highest accident frequency rate and accident severity rate were in 2004 (32.65) and 2008 (209), respectively. Safe T-score reached to below −3 during 2010–2011. In addition, given the regression results, the relation between all predictor variables with outcomes was significant (p < 0.05), except for the variable X1 belonging to the accident severity rate index. CONCLUSION: The implementation of safety programs especially that of IMS and its annual audits has had a significant impact on reducing accident indices and improving safety within the study period. Accordingly, health and safety management systems are appropriate tools for reducing accident rate, and the use of regression models and accident indices is also a suitable way for monitoring safety performance.
Accidents, Occupational ; Linear Models ; Power Plants ; Safety Management ; Statistics as Topic

PURPOSE: To evaluate visual and anatomical results and identify factors that influence vitrectomy and silicone oil (SO) injection outcomes in proliferative diabetic retinopathy (PDR). METHODS: This retrospective study included 236 eyes with PDR that were undergoing vitrectomy and SO injection with >3-month follow-up. The primary outcomes were final best-corrected visual acuity (BCVA) and retinal attachment rate. RESULTS: At the final visit (mean, 88 ± 58 weeks), complete, partial, and no retinal attachment were observed in 86.9%, 10.6%, and 2.5% of patients, respectively. A total of 155 eyes had experienced SO removal, while 81 had SO in place. The mean initial BCVA was 1.9 ± 0.7 logarithm of the minimum angle of resolution (logMAR) and significantly improved to 1.7 ± 0.8 logMAR (p = 0.001). Initial macular detachment (adjusted odds ratio [AOR], 0.25), development of iatrogenic break (AOR, 0.25), and use of heavy SO (AOR, 0.13) were independently associated with a lower risk of final retinal attachment, and SO removal was associated with a higher incidence (AOR, 7.55). Better baseline BCVA was associated with a higher risk of final BCVA ≥20 / 200. CONCLUSIONS: Despite an encouraging outcome based on anatomical data in advanced PDR treated with vitrectomy and SO, the functional prognosis was not satisfying for patients. Eyes with better vision at baseline had a more favorable prognosis, whereas eyes with initial macular detachment, intraoperative iatrogenic break, or heavy SO showed more unfavorable outcomes. In selected cases, extending the time of SO use did not worsen the prognosis.
Diabetic Retinopathy* ; Follow-Up Studies ; Humans ; Incidence ; Odds Ratio ; Prognosis ; Retinaldehyde ; Retrospective Studies ; Silicon* ; Silicone Oils ; Silicones* ; Visual Acuity ; Vitrectomy*