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Caudate nucleus (CN) neurons in camels and humans were examined using modified Golgi impregnation methods. Neurons were classified based on soma morphology, dendritic characteristics, and spine distribution. Three primary neuron types were identified in both species: rich-spiny (Type I), sparsely-spiny (Type II), and aspiny (Type III), each comprising subtypes with specific features. Comparative analysis revealed significant differences in soma size, dendritic morphology, and spine distribution between camels and humans. The study contributes to our understanding of structural diversity in CN neurons and provides insights into evolutionary neural adaptations.

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This article aims to synthesize the existing literature on the implementation of public policies to incentivize the development of treatments for rare diseases, (diseases with very low prevalence and therefore with low commercial interest) otherwise known as orphan drugs. The implementation of these incentives in the United States (US), Japan, and in the European Union (EU) seems to be related to a substantial increase in treatments for these diseases, and has influenced the way the pharmaceutical research & development (R&D) system operates beyond this policy area. Despite the success of the Orphan Drug model, the academic literature also highlights the negative implications that these public policies have on affordability and access to orphan drugs, as well as on the prioritization of certain disease rare areas over others. The synthesis focuses mostly on the United States' Orphan Drug Act (ODA) as a model for subsequent policies in other regions and countries. It starts with a historical overview of the creation of the term "rare diseases", continues with a summary of the evidence available on the US ODA's positive and negative impacts, and provides a summary of the different proposals to reform these incentives in light of the negative outcomes described. Finally, it describes some key aspects of the Japanese and European policies, as well as some of the challenges captured in the literature related to their impact in Low- and Middle-Income Countries (LMICs).

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Background: Several studies documented that metformin use contributes to vitamin B12 deficiency in patients with type 2 diabetes mellitus (T2DM). However, there has been a lack of data assessing this issue in Jordan. Aims: Assess the vitamin B12 serum levels, frequency of vitamin B12 deficiency, and related factors among Jordanian patients with T2DM patients treated with metformin. Methods: a total of 447 subjects attending a primary health care center were included in this cross-sectional study consisting of T2DM patients who use metformin and a control group of non-diabetics. Serum B12 levels were evaluated and B12 deficiency was defined as serum B12 levels ≤ 200 pmol/L. Associations of B12 serum levels or B12 deficiency with other factors like gender, age, and duration of T2DM were analyzed. Results: There was no significant difference in serum B12 levels nor the frequency of vitamin B12 deficiency between T2DM metformin-treated patients and control groups. Among metformin-treated patients there was no difference relating to age, type 2 diabetes mellitus duration, proton pump inhibitors use, and metformin use (duration, dose) between patients with or without B12 deficiency. Conclusion: The prevalence of vitamin B12 deficiency among T2DM patients on metformin treatment in this study was high (48.9%). However, the treatment with metformin and the dose of metformin use was not associated with vitamin B12 deficiency.

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Neurons in the spinal trigeminal nucleus of a camel were morphologically studied by the Golgi impregnation method. The neurons were classified based on the size and shape of their cell bodies, the density of their dendritic trees, and the morphology and distribution of their appendages. At least 12 morphological types of neurons were found in the camel spinal trigeminal nucleus, including the following: stalked, islets, octopus-like, lobulated, boat-like, pyramidal, multipolar, round, oval, and elongated neurons. These neurons exhibited large numbers of various forms of appendages that arise not only from their dendrites but also from their cell bodies. Moreover, neurons with unique large dilatations especially at their dendritic branching points were also reported. The neurons reported in this study displayed an array of different sizes and shapes and featured various forms of appendages arising from cell bodies and dendrites. Such morphologically distinctive neuronal cell types might indicate an evolutionary adaptation to pain and temperature processing pathways at the level of the spinal trigeminal nucleus in camels, which traditionally live in a very harsh climatic environment and are frequently exposed to painful stimuli.

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Background: Dyslipidemia and type 2 diabetes mellitus (T2DM) are growing health problems, particularly in developing countries. This study aimed to determine the prevalence and pattern of dyslipidemia and its associated factors among patients with T2DM. Methods: A cross-sectional study was conducted among patients with T2DM attending Family Medicine Clinics in Jordan between August 2017 and March 2019. The socio-demographics, clinical features, medications, and laboratory findings were collected. These laboratory findings included high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), and triglycerides (TGs). Results: A total of 870 patients with T2DM were included. The prevalence of dyslipidemia among patients with T2DM was 91.4%. The most common patterns of dyslipidemia were low HDL-C (66.2%), high LDL-C (62.1%), and hypertriglyceridemia (58.2%). Female gender, obesity, and hypertension were associated with diabetic dyslipidemia patterns. T2DM duration and poor glycemic control were associated with high LDL-C and hypercholesterolemia. Hypertriglyceridemia was associated with poor glycemic control and smoking. Conclusion: Dyslipidemia is highly prevalent among patients with T2DM. Evidence -based interventions are needed to prevent and control dyslipidemia among patients with T2DM in Jordan.

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BACKGROUND: Para -urethral cysts are rare benign lesions, especially in newborns. They are often asymptomatic but can be present with obstructive sequels. CASES: We present the cases of 3 female newborn infants who were found to have a para-urethral cyst at birth with a characteristic finding of a displaced urethral opening. They were treated with the least invasive technique with total resolution on follow-up and good parental prospective. SUMMARY AND CONCLUSION: Para-urethral cysts are sparsely reported and diagnosis is based on physical examination, although imaging studies sometimes are needed. They are expected to resolve spontaneously; therefore, management aims to prevent obstructive consequences. However, treatment can be conservative or surgical according to the patient presentation. Further reports of this rare disease will improve management planning and outcomes.

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Umbilical catheterization is commonly used as a route to provide medications and fluids to the neonates as well as for blood sampling and continuous monitoring. Although the rupture of umbilical catheters is considered as a rare, preventable complication, it has been reported several times in the literature. Healthcare providers need to be cautious with catheter placement, maintenance, and removal to prevent such a complication. Hereby, we review the literature about this complication after presenting two incidents of umbilical venous catheter rupture in two separate patients in our neonatal ICU. One was removed easily through the umbilical stump, whereas the other required surgical exploration.

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Ventriculo-femoral vein shunts have been described in few case reports as an alternative for treating complex cases of hydrocephalus in which other accesses are discarded. To our best knowledge, only 6 cases have been reported in the literature to date. We present a case of a 2-year-old female patient with hydrocephalus secondary to neonatal sepsis and meningitis. Patient was operated with various types of shunting procedures, such as ventriculo-peritoneal (V-P) shunt, ventriculo-atrial (V-A) shunt, ventriculo-pleural (V-PL) shunt, ventriculo-vesical shunt, ventriculo-superior sagittal sinus (V-SSS) shunt, and ventriculo-caval (V-C) shunt. All previous procedures were unsuccessful in treating the hydrocephalus. Finally, right ventriculo-femoro-caval shunt procedure was performed. Distal catheter was inserted into the right femoral vein and passed toward inferior vena cava under fluoroscopy guidance. The early postoperative period was uneventful. Late postoperative complications consisting of few periods of shunt dysfunction and distal obstruction were managed as an outpatient with injection for diluted heparin in the shunt valve, resulting in recovery of the shunt function. This was the management until the age of 4 when the femoral vein shunt was removed and right ventriculo-pleural shunt was placed. The patient tolerated this surgery and long-term follow-up showed good neurological status without episodes of shunt dysfunction.

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BACKGROUND: Thyroid disorders affect the life quality of patients in various aspects. The present work aims at investigating the effect of thyroid hormonal status on the quality of life (QoL) among patients receiving Levothyroxine at the level of primary healthcare. METHODS: All patients receiving Levothyroxine at an academic primary healthcare center were included in a cross-sectional evaluation. QoL was measured by the Thyroid-Related Patient-Reported Outcome questionnaire (ThyPRO). The conducted analysis was based on the last thyroid hormones level during the last year and questionnaire scores where higher scores indicated lower QoL. RESULTS: We included 127 patients; all domains of their QoL questionnaire were affected. The highest scored domain of the ThyPRO was tiredness, while the least was goiter symptoms. An association between the affected QoL and thyroid hormones could not be built. Certain domains of the ThyPRO were influenced by the existence of comorbid diseases. CONCLUSIONS: QoL was impacted in patients receiving Levothyroxine, regardless of hormonal status. Management of comorbid diseases and patients' concerns are advised to be taken into consideration to achieve a satisfying treatment. We highly recommend the integration of health life quality assessments in primary health care systems.

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Congenital diaphragmatic hernia (CDH) is one of the most common anomalies in neonates. Diaphragmatic agenesis (DA) is rare and is considered at the extreme spectrum of CDH, it is associated with a higher rate of multiple anomalies. A male neonate with antenatal diagnosis of CDH and hydrocephalus was born at estimated gestational age of 36 + 4 weeks by emergency Caesarean section due to fetal distress. Chest x-ray showed a common pleuroperitoneal cavity with the liver, spleen, and stomach seen in the thoracic cavity suggesting the diagnosis of bilateral absence of the diaphragm, the neonate died after an hour and a half. DA associated with hydrocephalus has never been previously reported in the literature.

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INTRODUCTION: Impacted foreign bodies in the esophagus have the potential to cause serious complications. Ingested sharp objects carry the risk of acute complications as: perforation, acute mediastinitis, and acute bleeding. Rarely, such foreign bodies might migrate through the esophageal wall and present as chronic esophageal foreign body. CASE PRESENTATION: We present a case of a 36-month-old girl presented with solid food dysphagia and regurgitation proved to be secondary to esophageal stricture after 26 months of accidental ingestion of aluminum can tab which has migrated through the wall of the upper esophagus into the mediastinum. After two trials of endoscopic treatment; she underwent thoracotomy and partial esophagectomy. Multiple trials of dilation and Mitomycin C injection were followed because of re-stricture. CONCLUSION: Foreign body impaction or secondary stricture needs to be considered in the differential diagnosis of children presenting with new onset dysphagia and regurgitation. Metallic Foreign body might be even radiolucent. Practitioners should keep a high index of suspicion for a retained esophageal FB in the child with gastrointestinal or respiratory symptoms that do not respond to standard therapy.

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To the best of our knowledge, pattern of burn injury was not reported yet at our region, our hospital considered the only tertiary referral center with the only burn unit at the region since 2001 till date, a retrospective analysis of our computerized filing system recorded 527 burn patients between 2001-2016, mean age was 26 years; 1.27:1 was the male to female ratio, 79 patients were found to have major burns, 46% of admissions were below 20 years' age, 92% was at domestic site of affection and 65% due to flame burn followed by scald burn in about 23%. The limbs were the most affected body site, majority of patients were below 15% TBSA and partial thickness, 77 patients found to have inhalational injury. Our mean hospital stay was 16 days and mortality was 8.2%. Mortality was associated with high TBSA affection, depth and flame type. This study shows the pattern of burn at north of Jordan, preventive measures by education and observation will reduce the incidence of burn and its sequel, non-flammable cook plates and stoves will probably help in decrease burn morbidity and mortality.

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OBJECTIVE: Since the loss of the protected arthrotomy knife several years ago, pediatric surgeons have struggled to find a safe, reliable, and inexpensive way to incise the pyloric serosa before spreading the muscle. The most widely accepted method of cutting the serosa is with electrocautery, although some still question its safety. We introduce a novel technique of incising the serosa with a percutaneously inserted needle without the use of electrocautery. DESCRIPTION: In this case series, we describe the experience of a single surgeon with a novel technique of incising the serosa. A retrospective chart review was conducted between January 2012 and September of 2015. In 6 patients, the serosal incision on the pylorus was made using a percutaneously inserted 18 gauge needle to cut the serosa and the superficial hypertrophied muscle fibers. As the body of the needle is not sharp, it protects the mucosa from being lacerated as the incision is carried out given a fixed depth of cut. RESULTS: The last 6 patients with hypertrophic pyloric stenosis underwent this technique. There were no conversions to open. In addition, there were no perforations and no complications related to the alteration in technique. CONCLUSIONS: Although many manufacturers pursue both disposable and nondisposable solutions to this problem, we believe this is a safe, reliable, and very inexpensive solution to this simple problem.

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Quality of life among colorectal cancer (CRC) patients was evaluated using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ) C30 and EORTC QLQ-CR29. We interviewed 74 CRC patients, and our results indicated lower anxiety functional scores and higher abdominal pain and embarrassment symptom scores among patients aged 55 and under. Patients with disease metastasis showed significantly lower global health scores and higher fatigue, loss of appetite, hair loss, and change in taste symptom scores. Scores for emotional functioning were significantly lower among patients with stage IV disease. Fatigue, nausea and vomiting, loss of appetite, abdominal pain, and change in taste symptom scores were significantly higher in patients treated with a combination of surgery and chemotherapy compared to surgery alone. Age, disease metastasis, late disease stage, and combined treatment modalities were associated with lower scores on health-related quality-of-life scales; patients likely to have low scores on these measures should receive special attention from healthcare providers and be targeted by supportive care strategies.

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OBJECTIVES: Parkinson's disease (PD) is a neurodegenerative disorder, caused by the gradual loss of cells in substantia nigra. Nitric oxide (NO) plays an important role in a variety of signal transduction pathways that are crucial for maintaining the physiologic functions of nervous system. The aims of this study are: 1) To investigate the expression of the inducible form of NO (iNOS), and compare it to neuronal nitric oxide (nNOS) in the brain of a chronic mouse model of PD and 2) To study the effect of endurance exercise training on the expression of these markers. METHOD: Mouse models of PD were obtained using 10 doses of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) (25 mg/kg) and probenecid (250 mg/kg) over 5 weeks. Forty C57BL /6 albino mice were randomly divided into four groups: sedentary control (SC, N = 10), exercise control (EC, N = 10), sedentary PD (SPD, N = 10), exercise PD (EPD, N = 10). At the end of training program, nNOS and iNOS were evaluated in the striatum in all animal groups using immunohistochemistry. RESULTS: nNOS showed significant increases in striatum (ST) of SPD mice compared to SC mice (P > 0.03). There was also decreased expression of nNOS in EC group compared to SC mice, but this decrease was not significant (P > 0.8). Exercise training significantly decreased the level of nNOS in the EPD compared to SPD, (P > 0.04). Although, iNOS expression followed almost the same trend as nNOS, but exercise training did not significantly decrease the expression of iNOS in both EC and EPD groups, P > 0.2 and 0.3 respectively. DISCUSSION: The data from this study suggests that 4 weeks of treadmill exercise has a positive impact on the expression of nNOS and iNOS in the striatum of a PD model. This might clear in part the pathogenicity of the diseases and the positive impact of training on PD.

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INTRODUCTION: Video-assisted thoracoscopic surgery (VATS) has gained wide acceptance for the pediatric population. Single-lung ventilation (SLV) has been suggested for thoracoscopic lung resection to provide better surgical exposure, but its role and sequelae compared with double-lung ventilation (DLV) have not been determined. The aim of this study was to investigate the feasibility and effects of SLV and DLV in infants and children undergoing thoracoscopic lung resection. PATIENTS AND METHODS: Written informed consent from all guardians for anonymized data analysis and approval by the Institutional Review Board were obtained. A retrospective study on a consecutive series of infants and children who underwent thoracoscopic lung resection during an 11 years period was performed. SLV was selected mainly in lesions localized in the upper, middle, and/or central lung for reasons of surgical exposure. Patients with lower lobe lesions and those who underwent atypical resections were preferably operated under DLV. End points were conversion rate, duration of postoperative ventilation, and perioperative complications, such as, atelectasis or pneumonia. RESULTS: Of 114 pediatric patients (58 female and 56 male; ratio 1.04:1) with a mean age of 7.1 years (3 days to 18.1 years), 62 patients underwent DLV and 52 patients underwent SLV for thoracoscopic lung resection. There were no significant differences between the two groups for conversion rate (DLV 8.1 vs. SLV 6.1%; p = 0.53), prompt extubation (DLV 50 vs. SLV 34.6%; p = 0.14), and postoperative atelectasis (DLV 35.5 vs. SLV 25%; p = 0.32). No major cardiorespiratory events, such as bleeding or pneumonia, were observed. No perioperative mortality occurred. CONCLUSIONS: This is the first study on safety, effectiveness, and outcome of SLV and DLV in pediatric patients undergoing thoracoscopic lung resection. Our data suggest that both SLV and DLV can be safely performed with similar low rate of surgical complications, when specific selection criteria are applied.

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Variations in the pattern of the hand blood supply are frequently encountered. Awareness and identification of such variations is crucial during hand surgery. Thirty formaline fixed hands of male and female cadavers were dissected. All arteries contributing to the superficial palmar arch (SPA) of the hand were verified. In addition to the frequently encountered types of SPA, three very rare cases were described. In the first case, the superficial branch of the radial artery passed superficial to the thenar muscles with a diameter larger than that of the ulnar artery. In addition to the common palmar digital artery to the second web space, it gave the princeps pollicis and radialis indicis arteries. In the second case, the SPA was formed by the ulnar artery and was completed by a small branch from the deep branch of the radial artery. The palmar digital artery to the ulnar side of the fifth finger and the common palmar digital artery to the fourth web space arose from a common trunk. In the third case, incomplete SPA was formed by the median artery which only gave the princeps pollicis and radialis indicis arteries, while the ulnar artery supplied the rest of the hand except the ulnar side of the third finger and the second web space which were supplied by the deep palmar arch. Therefore, sound knowledge of the pattern of the blood supply of the hand by various techniques is crucial to avoid possible complications during hand surgery.

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The morphological and quantitative features of neurons in the adult human ventral anterior thalamic nucleus were studied in Golgi preparations. Two neuronal types were found and their quantitative features were studied. Golgi-type I neurons were medium to large cells with dense dendritic trees and dendritic protrusions and short hair-like appendages. They have somatic mean diameter of 30.8 microm (+/-9.4, n = 85). They have an average 100.3 dendritic branches, 48.97 dendritic branching points, and 58.85 dendritic tips. The mean diameters of their primary, secondary, and tertiary dendrites were 3.1 microm (+/-1, n = 80), 1.85 microm (+/-0.8, n = 145), and 1.5 microm (+/-0.4, n = 160), respectively. Golgi-type II neurons were small to medium cells with few sparsely branching dendrites and dendritic stalked appendages with or without terminal swellings. They have somatic mean diameters of 22.2 microm (+/-5.8, n = 120). They have an average 33.76 dendritic branches, 16.49 dendritic branching points, and 21.97 dendritic tips. The mean diameters of their primary, secondary, and tertiary dendrites were 1.6 microm (+/-0.86, n = 70), 1.15 microm (+/-0.55, n = 118), and 1 microm (+/-0.70, n = 95), respectively. These quantitative data may form the basis for further quantitative studies involving aging or some degenerative diseases that may affect cell bodies and/or dendritic trees of the Golgi-type I and/or Golgi-type II thalamic neurons.

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Ingestion of aqueous 70% ethanol extract of Ballota nigra (400 mg/kg body weight for 7 days) by albino rats (n=10) was investigated to study its effects on glucose, total cholesterol, triglycerides, aspartate aminotransferase (AST), alanine aminotransferase (ALT), troponin I (TnI), serum creatine kinase (CK), total protein, total bilirubin and blood urea. Ballota nigra extract caused a significant decrease in blood glucose, total serum cholesterol and CK levels. Blood levels of TnI, AST, ALT, triglycerides, total bilirubin, total protein and blood urea were unchanged. The hypoglycemic effect of Ballota nigra extract on albino rats was further investigated by conducting a glucose tolerance test intraperitoneally (IPGTT). Healthy rats that were fasting for 18 hours followed by administration of a dose of 400 mg/kg body weight of the crude extract of Ballota nigra, orally. A significant decrease in blood glucose levels (after 15, 30, and 45 minutes) with a significant increase in serum insulin level (after 15 and 30 minute) was noted. These results suggest that, the crude extract of Ballota nigra have hypoglycemic, insulin-releasing and cholesterol lowering effects in rats.

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