Matrix Science Medica (MSM)

Background: Asthma is a chronic disorder caused by complex interactions between genetic and environmental influences. Objective: Investigatethe possible correlation between interleukin-4 (IL-4) gene polymorphisms and development of specific Chlamydia pneumoniae immunoglobulin (Ig) E levels. Materials and Methods: A total of 87 children, including 57 males and 30 females with asthma with ages between 1 and 16 years, attended the Respiratory Clinic at Karbala Pediatric Hospital, with a nonasthmatic children group which have the same age and gender. Restriction fragment length polymerase chain reaction was performed to determine IL‑4 C‑589T genetic polymorphisms. Total IgE level, C. pneumoniae IgG, and C. pneumoniae IgE antibodies were measured using the commercial quantitative enzyme-linked immunosorbent assay kits. Results: C. pneumoniae IgG and IgE antibodies were significantly increased in patients as compared with controls (P < 0.001 and P = 0.024, respectively). The CT genotype of IL‑4 C‑589T polymorphism was associated with asthmatic children (P < 0.01). A high C. pneumoniae IgE levels were found to be associated with CC genotypes(P = 0.01). On the other hand, there were no significant differences in serum C. pneumoniae IgG levels depending on different IL‑4 C589T genotypes (P = 0.662). Conclusion: The development of C. pneumoniae IgE antibody in asthmatic children did not depend on IL-4 polymorphism.

Background: SIRT6, a chromatin‑associated nuclear protein, exhibits beneficial and pivotal functions in longevity, cardiovascular diseases, and cancer. However, the significant and controversial clinical value of SIRT6 in cancers has not been fully defined. In this manuscript, we performed an updated and comprehensive meta-analysis of all relevant clinical data in order to gain an exhaustive summary of the clinicopathological roles of SIRT6 in various human cancers. Materials and Methods: A systematic literature searching was performed in PubMed, Web of Science, Embase, and CNKI up to April 2019. Studies enrolled in our quantitative meta‑analysis were selected according to inclusion and exclusion criteria. Our meta‑analysis was performed using total effect analyses and subgroup analyses to evaluate the relationship between SIRT6 expression and overall survival, clinicopathological parameters of multiple types in cancer patients including cancer/noncancer tissues, lymph node metastasis, metastasis, distant metastasis, differentiation, tumor stage and tumor node metastasis (TNM) stage, tumor size, gender, estrogen receptor, and progesterone receptor. The hazard ratios (HRs) or odds ratios (ORs) of the 95% confidence intervals (CIs) were calculated to reveal the risk or hazard association. All analyses were conducted using the Cochrane Collaboration Review Manager 5.3 software. Results: A total of twenty studies comprising 2700 patients from five countries who represented nine cancer types were included to assess the association between SIRT6 immunohistochemical expression and overall survival or clinicopathological characteristics. Cancer type subgroup analysis showed that high SIRT6 expression was associated with worse OS in hepatocellular carcinoma (HR: 1.49, 95% CI: [1.22, 1.81], P < 0.0001, I2 = 0%), osteosarcoma (HR: 2.05, 95% CI: [1.28, 3.30], P = 0.003, I2 = 0%), and non‑small cell lung cancer (NSCLC) (HR: 1.88, 95% CI: [1.02, 3.47], P = 0.004, I2 = 73%). In addition, our results demonstrated that SIRT6 expression was statistically significant in noncancer tissues higher than in cancer tissues (OR = 0.32, 95% CI = 0.13–0.79, P = 0.01, random‑effects model). Furthermore, it has been shown that SIRT6 expression was well correlated with lymph node metastasis in patients with breast carcinoma (OR = 1.76, 95% CI = 1.17– 2.66, P = 0.007, fixed‑effects model), the stages of pathological differentiation in cancer patients (OR = 1.53, 95% CI = 1.08–2.18, P = 0.02, fixed‑effects model), tumor stages (I–IV) in NSCLC patients (OR = 0.40, 95% CI = 0.20–0.80, P = 0.01, fixed‑effects model), and TNM stages in colon cancer patients (OR = 2.41, 95% CI = 1.38–4.20, P = 0.002, fixed‑effects model). Nevertheless, there was no detectable correlation between SIRT6 expression and other clinicopathological parameters in total or subgroup analyses. Conclusion: Our current meta-analysis indicates that the expression level of SIRT6 is highly associated with overall survival and clinical features in specific cancers.

The vestibulo‑ocular reflex (VOR) causes movements of the eye that are intended to compensate for head and body movements so that vision remains stable on the retina. VOR helps to stabilize the retinal image by rotating the eyes to compensate for movements of the head. The VOR keeps us steady and balanced even though our eyes and head are continuously moving during the performance of actions. The VORs are driven by signals coming from vestibular labyrinths and use subcortical, short‑latency pathways from vestibular afferents to the extraocular motor neurons. The relatively simple neural architecture of these reflexive responses, coupled with their stereotyped but adaptable nature, makes them ideal to understand simple sensorineural transformations. Without VOR, when an individual walks down the street, it is difficult to read signs or even recognize faces. Even an inaccurate VOR can result in a slip of visual image concerning photoreceptors, causing blurring of the images. If the VOR is injured, the retinal slip occurs which causes instability in gaze during rapid head movements. The disruption of the VOR results in oscillopsia and abnormal nystagmus. Oscillopsia causes blurred vision when the head is in motion and objects appear to jiggle and bounce as this object does not fix at one point in the retina. The objective of this review article is to discuss the anatomy of VOR with its bedside examinations, clinical implications, and management of VOR failure.

Benign paroxysmal positional vertigo (BPPV) is the mos common cause of peripheral vertigo. The pathophysiology of BPPV is canalolithiasis which includes free‑floating otoconial debris within the endolymph of a semicircular canal, or cupulolithiasis comprising otoconial debris adherent to the cupula. The posterior and/or lateral semicircular canals are often affected in BPPV. It is characterized by a brief episode of
rotatory vertigo associated with positional and/or positioning nystagmus, which is elicited by specific head positions or changes in head position relative to gravity. In the case of the posterior canal type of BPPV, torsional nystagmus is induced by the Dix‑Hallpike test. In patients of lateral canal type of BPPV, horizontal geotropic or apogeotropic nystagmus is induced by the supine roll test. The observation of positional and/or positioning nystagmus is needed for the diagnosis of BPPV. The treatment of BPPV includes canalith repositioning procedure (CRP). By series of head position changes, the CRP moves the otoconial debris from the involved semicircular canal to the utricle. This review article presents operational diagnostic criteria for BPPV, formulated by the Committee for Classification of Vestibular Disorders of the Barany Society. This classification reflects the current knowledge of the clinical aspect and pathophysiology of BPPV. These diagnostic criteria will be helpful for the understanding of the disease and will lead to further development in the management of BPPV.

We read the manuscript entitled “Spectrum of Neurological Complications of Pregnancy on Magnetic Resonance Imaging” on the esteemed “Matrix Science Medica” with great interest.[1] Posh et al. assessed the role of neuroimaging in neurological complications of pregnancy. The authors found that posterior reversible encephalopathy syndrome and cerebral venous thrombosis are responsible for more than 60% of the cases. Furthermore, they stated that magnetic resonance imaging is essential for promptly diagnosing possible neurological complications without risking fetal
safety.

Background: Diabetes mellitus is one of the major problems in health systems and a global public health threat and diabetic foot ulcers and lower extremity amputations are common, complex, costly, and disabling complications of diabetes. Poor foot care knowledge and practices are important risk factors for foot-related problems among diabetic people. Aims: The aim of the study is to assess the knowledge about foot care, foot care practices, the prevalence and risk factors of diabetic foot and foot-related complications in adult diabetic patients. Settings and Design: The cross-sectional study was conducted in 204 consecutive diabetic patients attending the outpatient department of a tertiary care hospital. Methods: A questionnaire including demographic details, knowledge questionnaire, attitude, and awareness for foot problems based on the Nottingham Assessment of Functional Foot Care Revised 2015 questionnaire was administered. This was followed by a foot examination for various aspects related to foot care and risk stratification. Statistical Analysis Used: Descriptive analysis with frequency distribution for knowledge and practice scores, univariate analysis, and multiple logistic regressions to find significant variables associated with good foot care knowledge and practice scores. Results: About 30.39% had good knowledge score. Rural background (adjusted odds ratio [OR]: 1.98, 95% confidence interval [CI]: 1.08–3.65), poor education status (adjusted OR: 4.63, 95% CI: 1.04–20.54), poor glycemic control (adjusted OR: 1.46, 95% CI: 0.83–2.58), and previous history of foot ulcer (adjusted OR: 3.05, 95% CI: 1.42–6.65) were significantly associated with poor knowledge on foot care. Conclusion: Our study shows that knowledge and practice of foot care of diabetic patients are still substandard. Poor communication between patients and nurses/physicians, rural background, poor education, and poor glycemic control were significant barriers of foot care. Policymakers should initiate foot care education programs throughout the regional state for increasing awareness about proper foot care practice in diabetic patients to reduce the incidence of complications.

Background: Nasosinus mucoceles are expansile cystic masses originating at the paranasal sinuses by chronic retention of the mucus in a sinus cavity due to ostial obstruction. Aim: This study aims to evaluate the risk factors, clinical presentations, and management of nasosinus mucoceles. Materials and Methods: This is a retrospective study carried out over 5 years from August 2017 to September 2022 at a tertiary care teaching hospital. The diagnosis of nasosinus mucoceles was done by the clinical presentations and imaging of the paranasal sinuses. Results: There were 38 cases of nasosinus mucoceles included in the study. This study included 20 males and 18 females and male‑to‑female ratio of 1.11:1, with a mean age of 52.6 years (age range from 16 to 78 years). Computed tomography (CT) scan and magnetic resonance imaging were the main imaging done among study patients. All patients underwent endoscopic sinus surgery with marsupialization. Out of 38 patients, 2 (5.26%) had recurrence during the follow‑up period. Conclusion: Orbital symptoms were major manifestations found in this study. CT scan was an important imaging performed in preoperative assessment. Endoscopic endonasal surgery is currently the gold standard for the treatment of nasosinus mucoceles. A satisfactory outcome was achieved after endonasal endoscopic marsupialization.

Introduction: Nonhealing ulcers are those that have not proceeded through timely and orderly reparation to produce anatomic and functional integrity. Povidone iodine is widely used ointment among physician and surgeons globally for wound dressings. In texts of Unani medicine literature, Marham‑e‑raal has been described as a potent ointment for gaining timely healing of wounds. The aim of this study is to compare the effects of povidone iodine and Marham‑e‑raal in nonhealing ulcers/chronic wounds. Methods: A randomized controlled study was carried out in the Department of Jarahat (Surgery) in National Institute of Unani Medicine, Bengaluru. A total of 45 subjects were included and randomized into Marham‑e‑raal and betadine dressing groups based on inclusion criteria. Dressing was done on daily basis and subjects were assessed on every 15 day from baseline to day 45 for primary outcomes (appearance of healthy granulation, epithelialization, and reduction in wound surface area) and secondary outcomes (decreases in tenderness score and depth of wound). Results: Nineteen out of 27 subjects in Marham‑e‑raal dressing group achieved complete healing as compared to one in povidone‑iodine dressing group. There was significant reduction in wound surface area, median tenderness score and depth of wounds among subjects in Marham‑e‑raal dressing group at 0.05 level of significance. Conclusion: Marham‑e‑raal is an effective wound dressing and healing agent as compared to povidone‑iodine ointment.

Background: Human blood is precious and its availability and requirement are important elements of a comprehensive health‑care delivery. Healthy voluntary donors are key sources to maintain the supply of human blood, and due care is warranted to ensure that the right blood reaches the right patient. Blood donor screening is standard practice, and the knowledge of ABO and Rh phenotype study is important. Prevalence and pattern of Rh phenotypes in a particular area may be important for various functioning of any blood bank. Materials and Method: Various centers frequently showcase prevalence pattern of Rh phenotype at a specified centre or region. A similar study was undertaken from collected data of voluntary blood donors in our tertiary care center. Results: Out of 2000 donor samples, B, A, O, and AB were in the decreasing order of frequency with 33.3%, 29.6%, 25.7%, and 11.4%, respectively. The most common Rh antigens observed were e (97.1%), followed by D (93.8%), C (88.45%), c (51.05%), and E (18.45%). Out of eight phenotypes in D‑positive donors, R1R1 (DCCee), R1r (DCcee), and R1R2 (DCcEe) were most frequently observed. In D-negative donors, rr (ddccee), r’r (ddCcee), and r’r’ (CCddee) were the most common. Conclusion: The Rh phenotype pattern in our centre had diverse pattern and knowledge of this would guide further studies.

Age-related peripheral vestibular dysfunction is usually associated with an imbalance that has a major impact on morbidity, mortality, and health-care resources. Age-related vestibular hypofunction has been shown to correlate with the age-related reduction in the number of vestibular hair cells and neurons. Progressive disequilibrium of aging is a complex and multifactorial condition leading to dizziness and a higher chance of risk of falls. The stability of the posture and gaze during standing and walking is maintained by the processing of vestibular, visual, and somatosensory inputs in the central nervous systems, followed by outputs to the musculoskeletal and visual systems. Every component in this stem deteriorates as the age increases or in the aging process. Vestibular rehabilitation is an effective treatment option for both unilateral and bilateral vestibular dysfunction in the elderly age group. There are different prosthetic devices developed to enhance the postural balance in the older person. Although there is no definitive medical treatment available for age‑related peripheral vestibular dysfunction, new medical treatments such as mitochondrial antioxidants or caloric restriction which have been useful for preventing age-related hearing impairment should be investigated in the future for treating age-related peripheral vestibular dysfunction.