Infections caused by Strongyloides stercoralis (S. stercoralis) in human are generally asymptomatic, however in immunocompromised individual, hyperinfection may develop with dissemination of larvae to extra-intestinal organs. The diagnosis could be easily missed due to asymptomatic presentation and insufficient exposure towards the infection itself, which may lead to low index of suspicion as a consequence. In this report, a case of a Malaysian male with underlying diabetes mellitus, hypertension, cerebrovascular ac-cident, bullous pemphigus and syndrome of inappropriate antidiuretic hormone secretion who initially complained of generalized body weakness and poor appetite without any history suggestive of sepsis is presented. However, he developed septicemic shock later, and S. stercoralis larvae was incidentally found in the tracheal aspirate that was sent to look for acid fast bacilli. Regardless of aggressive resuscitation, the patient succumbed due to pulmonary hemorrhage and acute respiratory distress syndrome. It was revealed that the current case has alarmed us via incidental finding of S. stercoralis larvae in the tracheal aspirate, indicating that the importance of the disease should be emphasized in certain parts of the world and population respectively.

PURPOSE: To assess the retention of glass fiber post cemented with self-adhesive resin cement into optimum and over-prepared root canals following obturation in the presence of either eugenol (EB) or calcium hydroxide (CB)-based sealers. MATERIALS AND METHODS: Roots of extracted premolars were endodontically-treated in 5 groups (n = 10). Roots of Group 1 (control) were left with no obturation and then optimally prepared to receive endodontic dowels. Other root canals were obturated with gutta-percha in the presence of either eugenol-based (Groups 2 and 4) or calcium hydroxide-based (Groups 3 and 5) sealer. Dowel spaces were prepared with optimal diameter in Groups 2 and 3, one size larger in Groups 4 and 5. Standardized fiber posts were luted to the prepared spaces using self-adhesive resin cement and itsretention was then tested on an universal testing machine. Both one-way ANOVA and Tukey's HSD comparisons (alpha=0.05) were used to identifythe significance of inter-group retention differences. Scanning electron microscopy (SEM) of both optimally and over-prepared dowel spaces was also considered to figure the nature of their interior out. RESULTS: The post retention was significantly higher to the non-obturated, optimally-prepared dowel spaces of Group 1 compared to the obturated, optimally-prepared ones of Groups 2 and 3. For each dowel space diameter, root canals obturated using CB of Groups 3 and 5 showed significantly higher dowel retention compared to those obturated using EB of Groups 2 and 4. Post retention to the over-prepared dowel spaces of Groups 4 and 5 was significantly higher than that recorded for the optimally-prepared ones of Groups 1-3. SEM images revealed traces of endodontic sealer and gutta-percha on the walls of the optimally-prepared dowel spaces. CONCLUSION: Despite the adverse effect of endodontic sealers on the retention of fiber posts, the over-preparation of dowel spaces helps to improve the retention.
Bicuspid ; Calcium ; Calcium Hydroxide ; Collodion ; Dental Pulp Cavity ; Eugenol ; Glass ; Gutta-Percha ; Hydroxides ; Microscopy, Electron, Scanning ; Resin Cements ; Retention (Psychology)

Elderly abuse and neglect are among the primary public health problems linked to global demographic changes in the population, impacting not only the well-being of the elderly but also the growth of the nation or economy. This article discusses the effects of elder abuse and neglect on population health from the national and international perspectives through a narrative review of previously published articles on the concept of aging, the prevalence of elderly abuse and neglect, its risk factors and effects, and finally measures, legal perspectives, and recommendations to curb it. Interventions in Malaysia and selected nations, including Indonesia, South Korea, the United States, Australia, and Hong Kong, are examined. This issue is important as the majority of countries are moving toward being elderly populations. Improving global surveillance and the monitoring of instances is essential to inform policy actions to prevent elder abuse. In addition, a thorough assessment of the identified risk factors for violence and steps to prevent violence is required.

BACKGROUNDS/AIMS: We report our experience with day-surgery laparoscopic cholecystectomy and assess its feasibility and safety. METHODS: Data was collected on all the patients who underwent day-surgery laparoscopic cholecystectomy between February 2009 and February 2014 at Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. All patients had symptomatic cholelithiasis that was proven on imaging studies with clearance of the common bile duct. The patient biographical data (age, gender, American Society of Anaesthesiology status, medical comorbidities) and surgical outcomes were then obtained. There was an evaluation of the success rate of day-surgery laparoscopic cholecystectomy, reasons for unexpected admission, and the re-admission rate. RESULTS: A total of 1,140 patients were included in this study. The success rate for day-surgery laparoscopic cholecystectomy was 96%. The reasons for unexpected hospital admission for 46 patients (4%) included persistent abdominal pain and postoperative emesis. The postoperative re-admission rate was 0.4% (5 patients). There were no major complications, and the conversion rate was 0.5% (6 patients). CONCLUSIONS: We suggest that day-surgery laparoscopic cholecystectomy is both safe and feasible in a local setting. Careful patient selection is essential in ensuring a high success rate.
Abdominal Pain ; Ambulatory Surgical Procedures ; Cholecystectomy, Laparoscopic* ; Cholelithiasis ; Common Bile Duct ; Humans ; Military Personnel ; Patient Selection ; Postoperative Nausea and Vomiting ; Saudi Arabia

Objective: The basal ganglia (BG) are susceptible to fluctuations in blood urea levels, sometimes resulting in movement disorders. We described patients with end-stage kidney disease (ESKD) presenting with movement disorders associated with bilateral BG lesions on imaging. Methods: We report four patients and systematically reviewed all published cases of ESKD presenting with movement disorders and bilateral BG lesions (EBSCOhost and Ovid). Results: Of the 72 patients identified, 55 (76.4%) were on regular dialysis. Parkinsonism was the most common movement disorder (n = 39; 54.2%), followed by chorea (n = 24; 33.3%). Diabetes mellitus (n = 51; 70.8%) and hypertension (n = 16; 22.2%) were the most common risk factors. Forty-three (59.7%) were of Asian ethnicity. Complete clinical resolution was reported in 17 (30.9%) patients, while 38 (69.1%) had incomplete clinical resolution with relapse. Complete radiological resolution occurred in 14 (34.1%) patients. Conclusion Movement disorders associated with BG lesions should be recognized as a rare and potentially reversible metabolic movement disorder in patients with ESKD.

Objective: DiGeorge Syndrome (DGS) is a common multisystem disorder associated with deletions on chromosome 22q11.2. Our objective is to evaluate the psychiatric comorbidities and demographics of patients suffering from DGS in a nationally representative dataset on inpatient hospitalizations. Methods: The Nationwide Inpatient Sample for the year 2005−2017 was used for this study. Data on patients with DiGeorge syndrome were collected by using the International Classification of Diseases code. Univariate and multivariate logistic regression analysis was performed. Results: In our study, the average age was 30.4 years (n = 6,563), with 59.9% male, and 61.8% of patients were white. There was a high prevalence of mood disorders (24.7%) and anxiety disorders (16.4%), followed by schizophrenia and other psychotic condition (14.0%). In patients with mood disorders, 8% had Major Depressive Disorder, and 7% had bipolar depression. Overall composite of psychiatric comorbidities was present in 2,959 (45.1%) of patients. The mean length of stay was 6.58 days, and 77% of patients had routine discharge to home. In the adjusted analysis, the average length of stay was 8.6 days vs. 6.7 days (p ＜ 0.001) in patients with and without psychiatry comorbidities.In comparison to routine discharge, patients with psychiatry comorbidities were more likely to be discharged to other healthcare facilities (odds ratio [OR]: 1.28, p ＜ 0.001) and discharged against medical advice (OR: 3.45, p ＜ 0.001). Conclusion Patients with DGS have worse outcomes with a higher rate of discharge to other healthcare facilities and a higher rate of being discharged against medical advice. Further large scale randomize studies are indicated.

Infections caused by Strongyloides stercoralis (S. stercoralis) in human are generally asymptomatic, however in immunocompromised individual, hyperinfection may develop with dissemination of larvae to extra-intestinal organs. The diagnosis could be easily missed due to asymptomatic presentation and insufficient exposure towards the infection itself, which may lead to low index of suspicion as a consequence. In this report, a case of a Malaysian male with underlying diabetes mellitus, hypertension, cerebrovascular accident, bullous pemphigus and syndrome of inappropriate antidiuretic hormone secretion who initially complained of generalized body weakness and poor appetite without any history suggestive of sepsis is presented. However, he developed septicemic shock later, and S. stercoralis larvae was incidentally found in the tracheal aspirate that was sent to look for acid fast bacilli. Regardless of aggressive resuscitation, the patient succumbed due to pulmonary hemorrhage and acute respiratory distress syndrome. It was revealed that the current case has alarmed us via incidental finding of S. stercoralis larvae in the tracheal aspirate, indicating that the importance of the disease should be emphasized in certain parts of the world and population respectively.