Objective: Newly qualified doctors on the wards are sometimes faced with difficult situations and difficult patients on the wards. We report a case and provide insight into management of these patients. Methods: This was only second week into the job. This patient was admitted to psychiatry ward from medical assessment unit because of acute episode of psychosis. Results: The patient was given some medications along with physical restraint. He was first given haloperidol and then lorazepam. He settled after these medications. He was thoroughly assessed by a multidisciplinary team headed by the consultant next day. He was diagnosed as brief psychotic disorder. He stayed on the unit for some time and was then discharged home on regular antipsychotic. He was booked into 1 monthly clinic and was given community support as well. Conclusion: Aggression can happen for a variety of reasons, i.e. acute psychosis and mania. Management varies according to the diagnoses. Physical restraint and medications form an essential part of management. However it is of utmost important to rule out medical causes of aggression. Substance abuse is the most common cause of aggression in developed countries.

Evidence of the association between 25-hydroxyvitamin D (25(OH)D) and metabolic syndrome (MeS) remains uncertain and incongruent. This study aimed to determine the association between 25(OH)D and MeS among Jordanian adults. A complex multistage sampling technique was used to select a national population-based household sample. The present report deals exclusively with adults aged > 18 years who had complete information on all components of MeS (n = 3,234). A structured questionnaire was used to collect all relevant information. Anthropometric, clinical, and laboratory measurements were obtained. MeS was defined according to the International Diabetes Federation (IDF) definition. Of the total, 42.0% had MeS and 31.7% had 25(OH)D < 30 ng/ml. In a stratified analysis, the prevalence of MeS did not differ significantly between subjects with low and normal 25(OH)D levels for men and women in all age groups. In the multivariate analysis, the odds of MeS were not significantly different between subjects with low and normal 25(OH)D levels (OR = 0.85, 95% CI: 0.70, 1.05, P-value = 0.133). The association between 25(OH)D and MeS remained non-significant when 25(OH)D was analyzed as a continuous variable (OR = 1.004, 95% CI; 1.000, 1.008, P = 0.057) and when analyzed based on quartiles. None of the individual components of MeS were significantly associated with 25(OH)D level. This study does not provide evidence to support the association between 25(OH)D level and MeS or its individual components. Prospective studies are necessary to better determine the roles of 25(OH)D levels in the etiology of MeS.
Adult ; Aged ; Family Characteristics ; Female ; Humans ; Jordan ; Male ; Multivariate Analysis ; Obesity ; Prevalence ; Surveys and Questionnaires ; Vitamin D

Objective: To evaluate the antidiabetic and antioxidant effects of aqueous ethanolic extract of Caesalpinia ferrea (C. ferrea) leaf in normal and streptozotocin (STZ) induced diabetic rats. Methods: Male Sprague-Dawley rats divided into 6 groups of 6 rats each were assigned into diabetic and non-diabetic groups. Diabetes was induced in rats by single intraperitoneal administration of STZ (65 mg/kg body weight). C. ferrea extract at the doses of 250 and 500 mg/kg body weight was orally administered to both diabetic and nondiabetic animals for a period of 30 days. After completion of experimental duration serum, liver and pancreas were used for evaluating biochemical and histopathological changes. Results: Oral administration of C. ferrea leaf extract significantly reduced elevated serum glucose, α-amylase, liver function levels and significantly increased serum insulin, total protein and body weight as well as improved lipid profile due to diabetes. Furthermore, the treatment resulted in a marked increase in glutathione peroxidase, superoxide dismutase, catalase and reduced glutathione, and diminished levels of lipid peroxidation in liver and pancreas of diabetic rats. Histopathological studies demonstrated the reduction in the pancreas and liver damage and confirmed the biochemical findings. Conclusions: From the present study, it can be concluded that the C. ferrea leaf extract effectively improved hyperglycaemia while inhibiting the progression of oxidative stress in STZ-induced diabetic rats. Hence, it can be used in the management of diabetes mellitus.

This systematic review evaluates current evidence regarding the feasibility of using needleless jet injection instead of a conventional local anesthetic needle. EBSCO, ProQuest, PubMed, and Scopus databases were used to identify relevant literature published in English from 2005 to 2020. Ten studies were selected. Five of them were randomized clinical trials, 3 case-control studies, and 2 equivalence trials. Using the Critical Appraisal Skills Program checklist, 6 studies scored between 67% and 100%, and 4 studies scored between 34% and 66%. According to Jadad’s scale, 2 studies were considered strong, and 8 studies were considered moderate in quality. The results of the 10 studies showed differences in patient preference for needleless jet injection. Needleless injection technique has been found to be particularly useful in uncooperative patients with anxiety and needle phobia.Needleless jet injection is not technique sensitive. However, with needleless jet anesthesia, most treatments require additional anesthesia. Conventional needle anesthesia is less costly, has a longer duration of action, and has better pain control during dental extraction. Needleless jet anesthesia has been shown to be moderately accepted by patients with a fear of needles, has a faster onset of action, and is an efficient alternative to conventional infiltration anesthesia technique.

Introduction: This study aimed to investigate the prevalence, risk factors, and clinical outcomes of Inflammatory Bowel Disease (IBD) in Mosul Hospital, Iraq, in 2022. Methods: A cross-sectional study design was used to collect data from patients diagnosed with IBD in Mosul Hospital. A questionnaire was used to collect demographic and clinical data, including risk factors, symptoms, and treatment outcomes. Data were analyzed using descriptive statistics and logistic regression. Results: The study included 150 participants, with a mean age of (42.5. ± years and 56% being male. Women were found to be less likely to know the type of Crohn’s disease compared to men. 58.7% of participants did not have any other diseases, while 41.3% had multiple diseases. The CH type was known for 56.8% of participants, and the average disease duration was 70.41 months, ranging from 2 to 360 months. Most participants (72.1%) did not have involvement in a particular place, while 27.9% did. All participants had known involvement. 81.8% of participants did not use drugs, while 18.2% did, with partial or unknown drug usage reported in 39 individuals. Only 7.8% of participants had IBD in their family, while 92.2% did not. Most participants (95.2%) were smokers. Conclusion: The study highlights the need for increased awareness and early detection of IBD in Mosul Hospital. The identification of risk factors and symptoms can aid in the diagnosis and management of the disease. Further research is necessary to understand the underlying causes of IBD and to develop effective prevention and treatment strategies.