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   2015| January-February  | Volume 7 | Issue 1  
    Online since July 11, 2017

 
 
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REVIEW
Education and self-management for women with polycystic ovary syndrome; a narrative review of literature
Hamidreza Mani, Kamlesh Khunti, Heather Daly, Janette Barnett, Melanie Davies
January-February 2015, 7(1):1-9
DOI:10.4103/1947-489X.210263  
Polycystic ovary syndrome (PCOS) is the most common endocrine condition in women of reproductive age and is associated with high risk of long term metabolic and psychological conditions such as diabetes, cardiovascular disease and depression. These patients present at a young age to the health care system and seek information about their condition. A structured education program seems to be able to answer these questions. Structured education selfmanagement programs are pragmatic and cost-effective patient-centered group educations which are underpinned by learning theories and empower patients to take control of their management and reduce their associated long term risks. In this paper, we introduce structured education programs and review the evidence of education programs for women with PCOS.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  525 81 1
ARTICLES
Physiological responses during moderate exercise in thermo-neutral and hot environment for normal weight
Khaled Khalifa Doukman, John Sproule
January-February 2015, 7(1):10-16
DOI:10.4103/1947-489X.210264  
Background: Recent research has shown that climatic stress has the ability to cause changes in exercise performance. The purpose of this study was to investigate whether the current exercise prescription guidelines remain appropriate or should be modified, given rise of summer temperatures in the United Kingdom, and to what effect the prescription guidelines had on individuals with different body weights. Subjects and Methods: Twenty healthy normal weight adult males with a body mass index (BMI) 23±1.9, and waist to hip ratio (WHR) 0.89±0.04, age 24±1.4 year were randomly assigned to either cycling for 30 min in a climate chamber at either at 18°C (thermo-neutral) or 30°C (hot environment) (T18, T30), with 24-h between trials. The third trial was performed at 30°C with an adjusted workload (T30a) to determine whether workload adjustment was necessary in order to reduce HR to approximately that of T18 levels 24-h after the second trial. Heart rate (HR), RPE, VO2, CHO and fat utilization; energy expenditure in calorie KCAL (kcal.min-1) and RER were determined. Results: HR at T30 was significantly higher than the HR at T18 and at T30a. Carbohydrate (CHO) and fat utilization; energy expenditure in calorie KCAL (kcal.min-1) and Respiratory Exchange Ration (RER) HR at T30a dropped to a level close to the HR level of T18. No statistical differences were found for KCAL, VO2, RER, CHO and fat between the three trials. Conclusion: Exercising moderately for 30min in a hot environment of 30°C, compared to 18°C, raises the HR and the RPE for normal weight men. Adjusting workload is not required to reduce HR whilst exercising moderately in 30°C.
[ABSTRACT]   Full text not available  [PDF]
  419 82 -
CASE REPORT
Mixed medullary-follicular thyroid cancer treated with surgery and radioiodine ablation: An illustrative case
Alaaeldin MK Bashier, Manal Abdulrahim, Shaheena Dawood, Fauzia Rashid, Fatheya Alawadi
January-February 2015, 7(1):31-36
DOI:10.4103/1947-489X.210267  
Introduction: Differentiated thyroid cancer is the commonest cancer affecting thyroid gland. Medullary thyroid carcinoma (MTC) constitutes only 2-8% of all thyroid cancers. Simultaneous occurrence of mixed medullary and follicular thyroid carcinoma (mixed MTCFTC) is rare. This may pose challenges in diagnosis, treatment, follow up and future prediction of prognosis. Case presentation: A 24 -year-old female presented with a neck swelling that increased in size over 2 months period. She was clinically and biochemically euthyroid. Thyroid Technetium Pertechnetate (99mTcO4) scan showed a cold nodule in the right lobe and ultrasound thyroid confirmed the presence of hypo-echoic well defined lesion. Fine needle aspiration biopsy (FNAB) revealed a medullary thyroid cancer. She underwent total thyroidectomy and lymph node dissection. The histopathology showed a solitary tumor with mixed features, predominantly medullary with areas of follicular architecture, confirmed by immunohistochemical staining as mixed MTC-FTC. Work up for MEN II and RET-proto-oncogen was negative. Postoperative isotope scan showed an increased uptake in the remnant thyroid tissue. She was treated with adjuvant radioactive iodine therapy. Her initial calcitonin level post operatively was 13.4 pg/ml (NR < 5.0), CEA 36 ng/ml (NR <3.8), and thyroglobulin was 0.7 ng/ml (NR <1). On follow up visits, the thyroglobulin as well as calcitonin and CEA levels were all suppressed. Conclusion: Cases of mixed follicular and medullary cancer present significant diagnostic and management challenges. Although we have managed our case surgically as well as by radioactive iodine and we are satisfied that follow up with calcitonin and thyroglobulin did not show any evidence of recurrence, we propose that mixed tumors be included in thyroid cancer management guidelines.
[ABSTRACT]   Full text not available  [PDF]
  431 65 -
Decision making status with older minors: An ethical dilemma
Matthew Vest, Elmahdi A Elkhammas, Britton Rink, Ryan Nash
January-February 2015, 7(1):27-30
DOI:10.4103/1947-489X.210266  
Clinical ethical issues arise on a daily basis for medical clinicians. We report and discuss a case of an older minor. A 16-year old female, with a complicated clinical history following a heart transplant, developed irreversible complications from her underlying medical condition that was largely attributed to noncompliance with recommendations from her medical team. Because of her minor status, she was ultimately unable to make healthcare decisions. The patient's healthcare team collectively agreed that she had minimal chances of surviving. We will discuss the ethical aspects of decision-making regarding her critical care.
[ABSTRACT]   Full text not available  [PDF]
  409 79 -
ARTICLES
The relationship between retinol-binding protein-4 and cardiometabolic risk factors in obese patients with type 2 diabetes mellitus
Naglaa K Idriss, Ahmed Abdel-Galeel, Salwa R Dimitry, Eman A Abdel Aal
January-February 2015, 7(1):17-26
DOI:10.4103/1947-489X.210265  
Background: Retinol-binding protein-4 (RBP4) is an adipocyte-secreted hormone considered to link obesity with cardiovascular complications. The oxidative stress has been implicated in the pathophysiology of obesity. We evaluated serum RBP4 and plasma total thiols (TT) in generalized obesity (GO) and abdominal obesity (AO) in relationship to classical cardiovascular risk factors. Glycated haemoglobin (HbA1c%), C-reactive protein (CRP) and lipid profile were also evaluated. Patients and Methods: Sixty obese patients were recruited [30 abdominally obese (AO) patients, (15 male and 15 female, mean (SD), 49.5 (5.5) years) were measured by waist circumference (WC > 102 cm for men or > 88 cm for women) and waist/hip ratio (WC divided by that of the hips of > 0.9 for men and > 0.85 for women)] and [30 generalized obese (GO) patients (22 male and 8 female; mean (SD); 42.5 (8) years) were measured by body mass index (BMI). [BMI ≥ 30.0-34.9 kg/m2, with normal WC] compared to 20 healthy subjects (14 males and 6 females; mean age (SD); 36.60 (5.97) years). Results: AO had significantly higher circulating RBP4 levels in comparison to GO (p< 0.05). Total thiols levels were significantly lower in AO compared to GO patients (p< 0.05). CRP significantly elevated in AO compared to GO patients (p<0.05). Total serum cholesterol, triglycerides and Hb1Ac% increased with BMI, WC and waist/hip ratio (WHR). Conclusion: The study reveals that RBP4 is autonomously related to visceral fat accumulations and cardiovascular diseases. The study also reveals the beneficial effect of TT against obesity and cardiovascular disease and the potential clinical applicability of RBP4 and total thiols in cardiovascular diseases.
[ABSTRACT]   Full text not available  [PDF]
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