kinetics of microfilaraemia and antigenaemia status among asymptomatic Bancroftian filariasis before and after treatment

In this study, a total of 54 male patients with asymptomatic cases of lymphatic filariasis were selected from the known endemic governorates; Damietta, Sharkia, Gharbia and Dakahlia. Medical sheets were filled out for each case. Diagnosis was based on detection of circulating microfilariae by specific ELISA. Some were treated with Ivermectin, and Albendazole. The treated cases were parasitologic and serologic evaluated pre-treatment and post-treatment for two years follow-up

Spectrophotometric determination of some drugs acting on the GIT via complexation of the drugs hydroxamate with iron [III]

Simple spectrophotometric method for the determination of trimebutine maleate, mebevrine HCL, diloxanide furoate and oxyphenonium bromide by hydroxamic acid formation either in pure or dosage forms is described. The studied drugs react with hydroxyl amine in alkaline medium to form hydroxamic acid derivatives that were complexed with iron [III] in acidic medium to form brownish violet colored complexes having maximum absorbances at 535 nm for mebevrine HCL. trimebutine maleate and diloxanide furoate and at 510 nm for oxyphenonium bromide, Beer's law was obeyed in the concentration ranges of 50-450, 100-700, 40-200 and 100-700 .microg ml[-1] for mebevrine HCL, trimebutine maleate, diloxanide furoate and oxyphenonium bromide, respectively. Molar absorbtivities and Sandell's sensitivities were calculated and presented. The developed procedures were favorably applied for determination of the studied drugs in their pharmaceutical dosage forms. The obtained results were compared satisfactorily with the official and reported methods. There were no significant differences between the proposed, official and reported methods

Tfg-Mi, a root-knot nematode resistance gene from fenugreek [Trigonella foenum-graecum] confers nematode resistance in tomato

Several root-knot nematode [Meloidogyne spp.] resistance genes have been discovered in different plants. For the first time, the Mi gene from fenugreek [Trigonella foenum-graecum] was detected in this study. A candidate root-knot nematode resistance gene [designated as Tfg-Mi] was isolated from the resistant fenugreek line Giza 3 by degenerate PCR amplification combined with the RACE technique. Also, another two candidate root-knot nematode resistance genes [designated as To-Mi11 and To-Mi12] were isolated from the resistant tomato [Lycopersicon esculentum] line Nemagard. Expression profiling analysis revealed that both genes were highly expressed in roots, leaves and flowers and expressed at a lower level in stems, but are not detectable in fruits. To verify the function of Tfg-Mi, a sense vector containing the genomic DNA spanning the full coding region of Tfg-Mi was constructed and transferred into root-knot nematode susceptible tomato plants. Sixteen transgenic plants carrying one to five copies of T-DNA inserts were generated from two nematode susceptible tomato cultivars. RT-PCR analysis revealed that the expression levels of Tfg- Mi gene varied in different transgenic plants. PCR assays showed that the resistance to root-knot nematodes was significantly improved in some transgenic lines compared to untransformed susceptible plants, and that the resistance was heritable

correlation study of some methods used for insulin sensitivity assessment: the Egyptian experience

Various surrogate methods for the quantification of insulin sensitivity have been proposed. A comparative evaluation is lacking and is relevant for the standardization of investigative methods and comparability of results. A gold standard in measuring insulin sensitivity is the minimal model derived estimates of insulin sensitivity, but this method is difficult to apply in large studies. Therefore, indirect indices of insulin sensitivity were proposed, namely I, In [I], 10[4] [I x G], I/G, HOMA-IR, In [HOMA-IR], QUICKI, AIR, and HOMA-beta cell. The aim of the present study was to compare these simple indices with data from the MINMOD. Forty Egyptian subjects of whom 15 were obese and 25 were nonobese. All subjects underwent an FSIGT. Plasma glucose was determined and serum insulin was measured. The insulin sensitivity, SI was calculated with the MINMOD program. HOMA IR, beta cell function and QUICKI were calculated. In [HOMA-IR] correlated best with the MINMOD-derived SI [r = -0.401, P = 0.010]. This was followed by In [I] and QUICKI which were equally correlated with SI [r = -0.389, P = 0.013 and r = 0.388, P = 0.013, respectively]. This was followed by I/G and HOMA-IR which correlated better with the MINMOD-derived SI than 10[4] / [Insulin x G] and I, respectively [r -0.352, P = 0.026 and r = -0.350, P = 0.027 versus r = 0.343, P = 0.030 and r = -0.343, P = 0.030, respectively]. AIR and HOMA-beta cell did not show any statistically significant correlation with the MINMOD-derived SI. In both obese and nonobese subjects HOMA-IR showed a highly significant negative correlation with QUICKI [r = -0.875, P = 0.000 and r = -0.890, P = 0.000, respectively]. Also, In [HOMA-IR] showed a highly significant negative correlation with QUICKI in both obese and nonobese subjects [r = -0.968, P = 0.000 and r = -0.947, P = 0.000, respectively]. Fasting insulin-derived measures of insulin sensitivity proposed are relatively crude methods for the quantification of insulin sensitivity in comparison to the Minimal Model analysis of the FSIVGTT and are, therefore, of limited value for the assessment of the metabolic status of an individual patient. When used in epidemiologic studies, fasting insulin alone, or the widely used HOMA or QUICKI perform at least as surrogate measures of insulin sensitivity or means for the identification of individuals with the metabolic syndrome in the general population

Metformin improves insulin sensitivity and hyperandrogenemia in Egyptian hirsute patients with polycystic ovary syndrome

PCOS is a heterogeneous clinical syndrome characterized by a spectrum of symptomatology, pathology and laboratory findings. It is now accepted that polycystic ovary syndrome has important long-term health implications, including metabolic disorders and increased risk factors for cardiovascular disease like insulin resistance, abdominal obesity, dyslipidemia, hypertension and markers of abnormal vascular function. The aim of this work was to study the effect of metformin on the clinical, metabolic and endocrine parameters in hirsute women secondary to polycystic ovary syndrome. The study was conducted on 30 Egyptian hirsute patients suffering from polycystic ovary syndrome. Clinical examination included anthropometric measurements [BMI and WHR] and Ferriman and Gallwey scoring for hirsutism. Fasting serum insulin and fasting blood glucose were measured from which insulin resistance [IR] was assessed by HOMA. The glucose to insulin ratio [GIR] was calculated. Lipid profile was estimated. Serum luteinizing hormone [LH] and follicle stimulating hormone [FSH] were estimated in the early follicular phase. Total serum testosterone and sex hormone-binding globulin [SHBG] were measured. Ultrasonographgy was done on the pelvis for examination of the ovaries. The patients were instructed to do diet and physical exercise. They received metformin 1500 mg/day for 6 successive months. Clinical, metabolic and endocrine parameters were reevaluated after the medication. A significant 31% improvement in the frequency of the menstrual cycle was observed. Hirsutism improved by 19%. BMI was reduced by 8%. WHR decreased by 2.3%. Insulin resistance decreased by 54%. Total serum cholesterol, LDL-cholesterol, serum triglyceride and total cholesterol/H DL-cholesterol ratio showed slight decrease [3%, 6%, 9% and 9%, respectively], while HDL-cholesterol showed a slight increase by 7%. Total serum testosterone decreased by 32% and LH/FSH ratio improved by 28%. SHBG levels increased by 9%. There was a positive correlation between BMI and HOMA-IR, serum cholesterol and serum TG. There was a highly significant positive correlation between BMI and FBG as well as fasting serum insulin and HOMA-IR. On the other hand, there was a significant negative correlation between BMI and GIR. A highly significant positive correlation was found between BMI and total cholesterol and TG. Also, there was a significant positive correlation between BMI and total cholesterol/HDL-cholesterol ratio. Again, BMI showed a highly significant positive correlation with LH/FSH ratio. There was a highly significant positive correlation between WHR and the frequency of the menstrual cycle and fasting serum insulin. There was a significant positive correlation between WHR and HOMA-IR, serum total cholesterol and TG. There was a significant negative correlation between WHR and SHBG. HOMA-IR showed a significant positive correlation with GIR. Metformin improves insulin sensitivity and hyperandrogenemia in Egyptian hirsute women with polycystic ovary syndrome. This is associated with improvement in menstrual abnormalities. Metformin has additional benefit in reducing hair growth in Egyptian hirsute young women with polycystic ovary syndrome

Acute spinal epidural abscess: clinical presentations and surgical management

Spinal epidural abscess is a serious condition affecting males more than females causing spinal cord compression. Risk factors include imunocomprimise, septic lumbar puncture, or haematogenous spread of remote infections. The aim of this study was to highlight the common risk factors for epidural abscess and its management based on eliminating these factors. All patients in the present study underwent plain x-ray, CT scan of affected spine, MRI of the affected area of the spine, and bone scanning when needed. Once neurological symptoms appeared urgent decompression and evacuation of the pus with subsequent culture and sensitivity was done. Liver diseases and Diabetes Mellitus. Were the most risk factors among our patients. The lumbar spine was commonly affected than other areas of the vertebral column. Posterior laminectomy and decompression were done for 24 cases. Fluid puss collection was found in 21 patients whereas 3 patients had a fibrous granulation tissue. Discectomy and partial corpectomy were done when affection of the anterior column was found. Staph. Aurues was found in about 60% of the culture obtained from the abscess. Epidural abscess is best treated by urgent decompression and giving the appropriate antibiotic

Comparison of dobutamine stress and atropine exercise stress test myocardial perfusion spect in patients with poor exercise capacity

Exercise stress test [E] is the main diagnostic stress modality used with myocardial perfusion SPECT [MPS]. However, its usefulness and accuracy depends on patient's [pt] ability to achieve target heart rate [THR], limiting its utility in pt with poor exercise capacity. We sought to study the safety and feasibility of atropine administration during exercise myocardial perfusion study [EMPS] as compared to standard dobutamine MPS. Thirty patients aged 51.4 +/- 8.3 years; 80% males referred for a diagnostic MPS study and failed to achieve their THR on E. Patients were divided in to 2 groups [G]; G I 15 pts continued E and atropine was administered in doses of 0.5 mg /min until THR achieved or ischemic ECG changes or a maximum dose of 2 mg. GII 15 patients were subjected to dobutamine MPS from the start. There was no significant difference between the two groups regarding pretest likelihood of ischemia, resting heart rate, systolic and diastolic blood pressures. All pts in GI reached THR after atropine injection. GII experienced more side effects [40% vs 0%, p=0.017]; varying from chest pain 33%, headache 6.7%, nausea and vomiting 6.7%. No difference was found in the frequency of ECG changes [37% vs 47%] or frequency of positive MPS [87% vs 80%]. Use of atropine as an adjunct to standard EMPS in pts with poor exercise capacity allows them to achieve THR and can help decrease the number of inconclusive tests. Atropine EMPS is better tolerated by than dobutamine MPS

Transferrinuria in type 2 diabetes mellitus: An early marker of diabetic nephropathy

Diabetic nephropathy is the commonest cause of end-stage renal failure in the Western world. The incidence of DN rises rapidly over the first 15 to 20 years of diabetes to decline sharply afterwards. The stages of DN progress from normoalbuminuria to microalbuminuria to clinical proteinuria and finally to end-stage renal failure. Several studies proved the applicability of urinary albumin quantification in the early diagnosis of diabetic nephropathy. Several studies of different urinary proteins demonstrated the increased excretion of other high and low molecular mass proteins in different stages of diabetic nephropathy: macromolecular, e.g. transferrin and micromolecular proteins like alpha 1-microalbumin. Elevated urinary transferrin excretion rates have been reported in patients with type 2 diabetes and its complications. Therefore, the aim of the present study was to evaluate the role of transferrin as an early marker for the detection of nephropathy in Egyptian type 2 diabetic patients. Sixty Egyptian type 2 diabetic patients grouped according to the presence or absence of albumin in urine into three groups: group I consisted of 20 normoalbuminuric Egyptian type 2 diabetic patients, group II included 20 microalbuminuric Egyptian type 2 diabetic patients, and group Ill comprised 20 macroalbuminuric Egyptian type 2 diabetic patients. Twenty healthy subjects of matched age and sex were included as a control group. Laboratory investigations included FBG and 2 hours PPBG, HbA[1C] serum albumin, ALT, AST, prothrombin activity, blood urea, serum creatinine and creatinine clearance, and complete urine analysis. Determination of microalbuminuria in fresh urine samples was done using immunoturbidimetry. Estimation of urinary transferrin was done by immuno-nephelometry. Results: Type 2 diabetic patients who had frank proteinuria had a significantly longer duration of diabetes mellitus as compared to micro and norrnoalbuminuric patients. Type 2 diabetic patients with frank proteinuria had significantly higher FBG, PPBG and HbA[1C] levels as compared to normoalbuminuric type 2 diabetic patients and controls. Type 2 diabetic patients with frank proteinuria had significantly higher blood urea and serum creatinine and a significantly lower creatinine clearance as compared to norrnoalbuminuric type 2 diabetic patients and controls. Type 2 diabetic patients with frank proteinuria showed significantly higher urinary albumin and transferrin excretion as compared to normo-and microalbuminuric type 2 diabetic patients and controls. Also, microalbuminuric type 2 diabetic patients had significantly higher urinary albumin and transferrin excretion as compared to normoalbuminuric type 2 diabetic patients and controls. In normoalbuminuric type 2 diabetic patients, a negative correlation was observed between creatinine clearance and transferrinuria. In microalbuminuric type 2 diabetic patients, a strong positive correlation was found between albuminuria and transferrinuria. In type 2 diabetic patients with frank proteinuria, strong positive correlations were obtained between blood urea and serum creatinine and transferrinuria, while a strong negative correlation was observed between creatinine clearance and transferrinuria. However, no significant correlations were found in any of the type 2 diabetic groups between duration of the disease, blood pressure, FBG, PPBG, or HbA[1C] and transferrinuria. Urinary transferrin is a convenient diagnostic parameter of renal impairment in Egyptian type 2 diabetic patients. Transferrinuria could be considered as an early marker of diabetic nephropathy as compared to microalbuminuria

Insulin sensitivity from meal tolerance tests: a computer program

Recently, a new approach was introduced that allows estimation of insulin sensitivity [S[l]] from orally ingested glucose during an OGTT, or a meal glucose tolerance test [MGTT]. S1 from the MGTT was strongly correlated to the S[l] values obtained from an insulin-modified, frequently sampled intravenous glucose test [FSIGT], which is considered as one of the gold standards. This new method makes use of MGTT/OGTT data, which are relatively much easier to obtain. This makes this method of value in the assessment of insulin sensitivity in various circumstances in which the use of clamps or the minimal model is impractical. For epidemiological studies, screening of high-risk populations, and large-scale intervention trials, S[l] calculations would be rather tedious and time-consuming. Therefore, it was thought to develop a computer program to carry out the calculations quickly and accurately. Ten healthy subjects [4 men and 6 women; age 47 +/- 2.6 years; body mass index 25.9 +/- 1.2 kg/m[2]], with normal glucose tolerance. The studied subjects received, on different occasions, a meal tolerance test [MGTT]. The meal was eaten within 10 mm. Blood samples were collected at - 30, - 1, 10, 20, 30, 40, 50, 60, 75, 90, 120, 150, 180, 210, and 240 mm. Plasma glucose and serum insulin were determined in the blood samples. A computer program, COBELLBAS, was developed. It computes the insulin sensitivity SI[oral] from MGTT/OGTT data. Use is made of function AREA to calculate the areas under the curves, and function FUN1 for interpolation. The computer program was tested, and results comparable with the published ones were obtained. The computer program was tested, and satisfactory results were obtained

Removal of surfactant from industrial wastewaters by coagulation flocculation process

Surfactants are among the most widely disseminated xenobiotics that contribute significantly to the pollution profile of sewage and wastewaters of all kinds. Among the currently employed chemical unit processes in the treatment of wastewaters, coagulation-flocculation has received considerable attention for yielding high pollutant removal efficiency. Jar-test experiments are employed in order to determine the optimum conditions for the removal of surfactants, COD and turbidity in terms of effective dosage, and pH control. Treatment with FeCl3 proved to be effective in a pH range between 7 and 9. The process is very effective in the reduction of surfactants and COD, the removals are 99 and 88% respectively, and increased BOD5/COD index from 0.17 to 0.41. In addition to precipitation coagulation process, adsorptive micellar flocculation mechanism seems contribute to the removal of surfactants and organic matters from this rejection

Comparative study between the tubularized incised plate urethroplasty and single faced onlay preputial island flap in the management of mid-penile hypospadias

The tubularized incised plate [TIP] and the single faced Onlay preputial island flap procedures are two popular procedures used for the repair of mid-penile hypospadias deformity. This study was designed to compare these two techniques objectively. Forty five boys with similar mid-penile hypospadias deformities were selected for this study at Cairo University Children Hospital. All were 2 years or more at the time of operation. They were assigned randomly to either a TIP [n=24] or an Onlay procedure [n=21]. Operative details for each patient were recorded and the patients were followed up for a minimum of one year post operatively. Results were compared for three groups of variables: cosmetic outcome, occurrence of complications and function results which was assessed by uroflowmetry studies. Results were compiled and compared statistically. There were no differences between the two techniques as regard incidence of complications and function. On the other hand there was a significant statistical difference regarding cosmetic outcome in favor for the TIP procedure. Due to its easier technique and superior cosmetic results, the authors believe it is indicated whenever suitable urethral plate is present. Both the TIP and Onlay procedures proved to be effective techniques in the management of mid penile hypospadias. However, due to a significantly better cosmetic results and easier technicality of TIP the authors believes it is indicated whenever the suitable urethral plate is available

Anatomical study of rectus abdominis muscle and its clinical application

To study the neurovascular anatomy of the rectus abdominis muscle with reference to their relation to tendinous intersections of the muscle. Eight human cadavers were injected with latex/lead oxide mixture into the superior epigastric artery and external iliac artery. The vascular architecture of the superior and deep inferior epigastric arteries was studied together with the nerve supply of rectus abdominis muscle. The superior epigastric supplied the upper part of rectus muscle. It pierced the rectus muscle between the first and second tendinous intersections. The inferior epigastric artery had 3 patterns of branching; Type I the artery ascended as a single stem parallel to the muscle fibers [in 37.5% of cases]; Type II the vessel divided into 2 branches of different size after giving a perimuscular branch to the lower portion of rectus [in 50% of cases]; The medial branch was short and small to supply the lower medial portion of rectus while the lateral branch was longer with larger diameter. It ran parallel to the muscle fibers to a level above the umbilicus. Type III the deep inferior epigastric artery divided into 3 branches [in 12.5% of cases], the lower one was the smallest. The other 2 branches were of the same caliber, the medial one was short never reach the umbilicus supplying the lower medial portion of the muscle, and the lateral one was longer, ran parallel to the muscle fibers to a level above the umbilicus. The rectus muscle was innervated by lower thoracic spinal nerves in a segmental manner. The muscular perforators arranged in a vertical row from the posterior rectus sheath to the deep surface of rectus. The point of their perforation to the muscle corresponded approximately to the vascular axis which situated at the junction of lateral 1/3 and medial 2/3 of rectus. The perforators of the anterior rectus sheath to skin arranged also in a vertical row lateral to mid line of rectus above the umbilicus and medial to mid line below the umbilicus. Both the superior and deep inferior epigastric arteries supplied the rectus abdominis. The inferior epigastric artery was more reliable than the superior epigastric artery, as it was easily accessible and easily separated from the muscle with minimal damage. It can be used for free tissue transplantation to perineum, genital area and the abdominal wall. A strip of anterior rectus sheath, should be preserved between the intersections to prevent rupture of the vulnerable rectus abdominis and its vessels due to presence of substantial connective tissue within the muscle between the tendinous intersections. During obtaining muscle flaps, denervation of the remaining muscle occurred if more than medial half of the muscle was taken with the flap, due to vertical arrangement of segmental nerve supply of the rectus at the junction of lateral 1/3 with the medial 2/3

Anatomical study of gracilis muscle: arterial findings enhance graciloplasty

To study the neurovascular anatomy of gracilis and to search for different pedicles of suitable size, proximal to dominant pedicle, which could support blood flow to the whole gracilis. Twelve lower limbs obtained from 6 human cadavers were injected with latex/lead oxide mixture into the femoral arteries. The gracilis muscles were dissected, marking the arterial and venous supply, and the nerve entry points. The overall length of the muscle and the length of its tendon were measured. The overall length of musculotendinous unit of gracilis was 42 to 44 cm. The tendon comprised 6 to 8 cm. The main arterial supply to the muscle entered 9-12 cm from the pubic tubercle [diameter, 0.1-0.3 cm]. It arised from the profundafemoris artery and passed between the adductor longus and brevis to enter the upper third of the muscle. The middle pedicle entered the middle of the muscles 19 to 21.5 cm from the pubic tubercle [diameter 0.1 to 0.2cm]. It originated from the femoral artery, passed on the lower border of adductor longus. The distal pedicle was the smallest one, originated from the femoral artery on the lower border of adductor magnus deep to sartorius. It entered the lower part of gracilis. There were additional 2 pedicles found in 2 lower limbs of the same cadaver. One pedicle was proximal to the dominant pedicle and the other was inferior to the middle pedicle. The former was of 0.2 cm in diameter. It originated from the profundafemoris artery in one limb and from the medial femoral circumflex artery in the other limb. Both entered the muscle 3.3 cm or 3.5 cm inferior to the pubic tubercle. The other pedicle arised from the femoral artery. It supplied the sartorius muscle and entered the gracilis below its middle. The motor nerve arised from obturator nerve and entered the muscle in association with the main pedicle. The neurovascular anatomy of gracilis was found to be remarkably consistent from specimen to specimen varying only in the length of muscle and tendon, and the number of minor pedicles supplying it. The existence of proximal pedicle of suitable diameter suggests that it might be able to support the whole gracilis without supply from the main pedicle. This study confirms the suitability of gracilis for segmental functional muscle transfer

Anatomical study of the nervous and blood supply of the internal oblique abdominal muscle with reference to its clinical application

To study neurovascular supply of the internal oblique. Sixteen internal oblique muscles were dissected in 8 human cadavers. The external iliac artery was washed by saline, then injected with latex/lead oxide mixture, followed by dissection of the deep circumflex iliac artery and its branches. Dissection of arterial supply showed that the main arterial supply was through the deep circumflex iliac artery. It had an inguinal straight course and iliac curved course, medial and lateral to the A.S.I.S. Its iliac part coursed between the transversalis fascia and fascia iliaca. It ran on iliacus muscle separated from it by iliacus fascia. It gave muscular branches to internal oblique and iliacus muscle. The main branch of deep circumflex iliac artery was the ascending branch, originated from the main stem either within 1 cm medial to A.S.I.S. [in about 62.5% of dissections] or 2 to 4 cm medial to A.S.I.S. [in 37.5% of dissections]. It coursed between the transversus abdominis and internal oblique to be intimately related to the lower thoracic spinal nerves. The deep circumflex iliac artery ended by piercing the transversus abdominis. In 2 cadavers the deep circumflex iliac artery pierced also the internal oblique to end in the external oblique. The internal oblique was innervated by lower 3 thoracic spinal nerve, subcostal nerve, iliohypogastric and ilioinguinal nerves, arranged in a segmental manner. It was concluded that the internal oblique had a unique neurovascular supply, firstly because: the motor nerves [lower thoracic spinal nerves, subcostal nerve and L[1]] were not accompanied by the main vascular pedicle [ascending branch of deep circumflex iliac artery] as in most skeletal muscles, secondly, the main arterial supply was single pedicle while, the motor nerve supply was multiple and separate with segmental arrangement. The abnormal course of deep circumflex iliac artery passing between the transversus abdominis and internal oblique may be mistaken with its ascending branch. The deep circumflex iliac artery had a long pedicle length with good diameter making it suitable for free tissue transfer

Study of mastoid canals in dried human skulls

To search for vascular tunnels or canals in the mastoid region which may not been reported before in Egyptian population, and may be of surgical importance. The study was carried on 30 complete dried Egyptian skulls, and 20 hemisected skulls or separated temporal bones. Another 10 hemisected heads preserved in formalin, and injected with gelatin/lead oxide mixture were also used. These heads were used to detect structures traversed the mastoid canal if present. Examination of dried bones revealed the presence of canal or tunnel on the outer surface of the mastoid processes in 37.5% of studied specimens. These canals were anterior to the occipitomastoid suture by a distance ranged from 0.5 to 1.8 cm. The canals were anteroinferior to the asterion by a distance ranged from 1 to 2.3 cm. The length of the canal varied from 0.2 to 2 cm. The lower opening of the canal was anterior or anterosuperior to the mastoid foramen. Dissection of injected heads showed that the canals contained a branch of occipital artery. The mastoid canals are not peculiarly confined to Indian population but they also found in skulls of Egyptian population. The presence of these canals in some skulls may be due to ossification of squamotemporal bone over the vessels during development of the mastoid process. The mastoid canals traversed by the auricular branch of occipital artery, which lied anterior to the mastoid foramina. This branch could be injuried if unnoticed by the surgeon. It is necessary for surgeons operating in this area to be aware of this vascular arrangement to anticipate and avoid troublesome bleeding

Angiotensin converting polymorphism in obese patients

Obesity is a complex disorder caused by the interaction of environmental and genetic susceptibility associated with increased risk of morbidity from a variety of disorders. The aim of the present study was to investigate the association between ACE I/D polymorphism and obesity and its contribution to the different risk factors among obese patients which may constitute the basis for strategies to manage this serious problem. Fifty-four male obese patients with BMI >/= 30 kg/m[2] were recruited. Twenty-six healthy men with BMI < 25 kg/m[2] of comparable age were selected as a control group. All patients and controls were subjected to thorough history taking, anthropometric measurements [weight, height, BMI, waist and hip circumference and WHR] and BP measurement. ECG was done. Laboratory investigations included FPG, PPPG, HbA[1c], OGTT, lipid profile and fasting serum insulin. IR was determined by the computer updated 1996 version of HOMA2. ACE I/D polymorphism was determined by PCR. Eighteen and a half percent of obese patients had a family history of CHD and 31.5% were smokers. Nineteen patients were categorized as prehypertensives while 20 had stage 1 or stage 2 hypertension. IHD was diagnosed in five obese patients. Hyperlipidemia, IGT and DM were detected in 61.1%, 50% and 22.2% of obese patients, respectively; 29.6% of patients had grade I obesity, 29.6% had grade II and 40.7% had grade III obesity. Sixty-three percent of patients had a waist circumference> 102 cm and 38.9% had a WHR> 1.0. Obese patients had significantly higher FPG, PPPG, HbA[1c], fasting serum insulin, HOMA2-IR and HOMA2-%B as compared to controls. On the other hand, HOMA2-% S was significantly lower in obese patients. All studied lipid parameters were significantly higher in obese patients except HDL-cholesterol which was significantly lower in obese patients. The distribution of the ACE genotype for obese patients was 38.9%, 46.3% and 14.8%, for the DD, ID and II, respectively. In controls, 34.6% were DD, 46.2% were ID and 19.2% were II genotype. There was no statistically significant difference between obese patients and controls as regards the genotype frequency [Pearson X[2]=0.296; P=0.862]. Relative allele frequencies in both groups were D allele: 0.620 in obese versus 0.577 in controls and I allele: 0.380 versus 0.423, respectively with no statistically significant difference as well. There was a statistically significant difference between the three ACE I/D genotypes of obese patients as regards BMI, waist circumference and WHR. The DD genotype was associated with higher values of these obesity markers. No such differences were observed for control participants. There were no significant differences in age, SBP and DBP among the three ACE genotypes of obese patients. However, there was a tendency towards DD genotype in the older age group and in patients with higher BP. There was no significant difference between DD, ID and II ACE genotypes of obese patients as regards any of the studied metabolic parameters. However, numerically higher values of FPG, PPPG, HbA[1c], fasting serum insulin, HOMA2-IR, serum triglycerides, total cholesterol and LDL-C and lower values of HOMA2-%S and HDL-cholesterol were observed among DD genotypic obese patients. Overall, DD homozygote obese patients showed a tendency for family history of CHD, smoking, abdominal adiposity, hypertension, hyperlipidemia and DM. ACE I/D polymorphism was significantly associated with abdominal adiposity, hyperlipidemia and DM in obese patients when compared with patients having no such risk factors [P=0.021, P=0.049, P=0.045, respectively]. Nine obese patients showed a maximum of five associated risk factors that were added to obesity, while only two obese patients presented with no such associated risk factors at all. Seven of those nine obese patients were DD homozygotes. It was found that the more the number of studied risk factors added to obesity, the more the prevalence of the DD homozygote genotype [LLR=27.153; P=0.002]. The results of the present study could indirectly suggest that the DD genotype contributes a genetic factor for the development of abdominal obesity and that this would predispose obese patients to further risk for development of CHD. ACE inhibitor therapy can induce improvements in atherosclerosis and IR and therefore they are ideal drugs to be used in obese hypertensive patients

Clinical patterns of diffuse parenchymal lung disease in Kuwait: aprospective study

To report our experience of the clinicopathological patterns of diffuse parenchymal lung disease [DPLD]. Subjects and Over a 4-year period, 75 patients [41 males, 34 females], aged 13-76 years, who were referred to Mubarak Al-Kabeer and the Chest Diseases Hospitals, Kuwait with a diagnosis of diffuse lung disease, were included in the study. After a comprehensive history and physical examination, further investigations were done, including hematological and immunological profiles, sputum and bronchoalveolar lavage fluid examination, chest radiograph, high resolution computed tomography [HRCT], pulmonary function test and lung biopsy. Of the 75 patients 60 [80%] were over 40 years of age. The duration of symptoms in 34 patients [45%] was less than 6 months and longer than 1 year in 28 [37.7%] patients. Twenty-five of the patients were cigarette smokers. The mean forced lung capacity [FVC], total lung capacity and diffusing capacity for carbon monoxide were less than 60% of the predicted values in most patients. There was a significant difference in mean FVC value between smokers and nonsmokers [p < 0.05]. The HRCT findings were at an advanced stage in 65 patients, with additional honeycombing in 21 of the 65 patients. Idiopathic pulmonary fibrosis was the most common cause of DPLD, occurring in 52 patients, followed by sarcoidosis and collagen vascular diseases. DPLD was observed predominantly in middle aged and elderly patients, due probably to increasing industrialization in the country. The role of cigarette smoking as a contributory factor remains unclear

Comparative study of diffferent combination of total intravenous anesthesia in different-surgical procedures

Total intravenous anesthesia [TIVA] is a natural extension of balanced anesthesia. Propofol is considered to be the most suitable anesthetic drug for use in TIVA because of its pharmacokinetic properties suitable for this technique. Remifentanyl is the best analgesic component, remifentanyl has an ester linkage in its molecular structure, it has a very short duration of action because of rapid breakdown of the ester linkage by nonspecific plasma and tissue esterases. 30 patients aged between 20-40 years old undergoing surgical-procedures were included in this study. All patients premedicated with oral diazepam [0.2 mg/kg], 90 minutes preoperative patients were divided into three groups propofol fentanyl [P/F], propofol/ remifentanyl [P/R], and ketamine midazolam[K/M] group. We used these drugs in each group for induction and maintenance of anesthesia and we compared the three groups regarding: Hemodynamic changes, hormonal and metabolic changes, recovery pattern, side effect.-The result of this study showed that, remifentanyl in[P/R] group caused hemodynamic stability better than that of the other two groups. There is decrease in plasma cortisol level which was statistically significant during surgery and post operatively [P>0.05] in all patients in [P/R] group. While in [P/F] and [K/M] groups there was significant increase. All patients in the three group showed increase in blood sugar and B-endorphin levels during operation and in recovery room which was statistically significant only for B-endorphin in [K/M] group. There was no significant difference between [P/F] group and [P/R] group for the dose requirement of propofol. The small doses of fentanyl and ketarnin used in this study are not enough to suppress the hormonal and metabolic changes caused by stress response to surgary. Patients in [P/R] group showed shorter recovery period than in the other two group. We can concluded from this study that remifentanyl used with propofol was effective as the primary opioid in TiVA and provided better intra-operative hemodynamic stability during stressliall surgical events than that achieved with the recommended dose of fentanyl

Management of penile fracture

This prospective study was carried out over a period of one year, and included 12 patients presented by penile fracture. Diagnosis was made clinically and there is no need to perform cavernosography in any case. The most common cause of fracture was trauma to the erect penis during intercourse. Mean age of cases was 29.5 +/- 8.96 years, while mean time of presentation was 15.5 +/- 8.04 hours. Sub-coronal circumferential degloving incision was done in all cases. Nine patients had been operated upon, while three patients refused surgery and treated conservatively. Repair consisted of evacuation of hematoma, repair of the tunical defect with absorbable sutures. The mean operative time was 33.9 +/- 28.2 minutes. Preoperative and postoperative antibiotics was used and all operated cases discharged on the second postoperative day. All operated caws were able to achieve full erection with straight penis, except one in whom mild curvature and pain during erection was observed. In conclusion, fracture penis is a true urologic emergency. It should be treated surgically as early as possible to ensure a better outcome