Seroprevalence of Toxoplasma gondii among pregnant women in Almadinah Almunawwarah KSA

Objectives: Given its detrimental obstetric and congential sequelae, the detection of primary toxoplasmosis is most critical during pregnancy. This study aims to detect the seroprevalence of Toxoplasma gondii [Toxoplasma gondii] among pregnant women who either have histories suggestive of toxoplasmosis or may be at risk

Methods: Serum samples of 150 pregnant women aged 18 -45 years were tested by the rapid Toxoplasma test [TOXO IgM/IgG test, InTec]. The results were further confirmed by the enzyme-linked immunosorbent assay [ELISA] technique for IgM and IgG

Results: Serological results of toxoplasmosis seropositivity were statistically analyzed in light of the available epidemiological data. Thirty-two cases [21.3%] were IgG positive, and none was IgM positive, as shown by both tests

Conclusion: Significant relations were observed between seropositivity, maternal age and history of abortion, and probability of delivering a child with a congenital anomaly. Despite the lack of evidence of recent infection in this study, the high rates of T. gondii seropositivity among pregnant women signaled a threat of primary exposure during pregnancy

Crohn's disease. Increasing trend in Saudi Arabia

We attempted, through systematic review to explore the epidemiology and risk factors of Crohn's disease [CD] with special attention to the Kingdom of Saudi Arabia [KSA]. We selected articles that contained population-based, epidemiological, and clinical character studies of CD. We collected data concerned with the prevalence, demographic features, and the possible etiology of CD that might explain its emergence in KSA. The prevalence of CD in Western countries ranged between 11-43/100,000 with flawless evidence of CD prevalence emerging in previously low incidence areas like Asia. Prevalence in KSA has markedly increased over the last 3 decades. Combined ileal and colonic involvement was the most frequently affected site. Diet, smoking, drugs, and westernization of life are assumed to contribute to the pathogenesis. There is convincing evidence of CD emerging in Asia, including KSA. Westernization of lifestyle and smoking is probably the major contributing factors. Genetic studies are warranted

accuracy of multi-detector row computerized tomography in staging rectal cancer compared to endoscopic ultrasound

Our aim was to evaluate the diagnostic accuracy of multi-detector row computerized tomography [MDCT] in staging of rectal cancer by comparing it to rectal endoscopic ultrasound [EUS]. We prospectively included all patients with rectal cancer referred to our gastroenterology unit for staging of rectal cancer from December 2007 until February 2011, 53 patients whose biopsy had proven rectal cancer underwent both MDCT scan of the pelvis and rectal EUS. Both imaging modalities were compared and the agreement between T- and N-staging of the disease was assessed. We staged 62 patients with rectal cancer during the study period. Of these, 53 patients met the inclusion criteria and were evaluated [25 women and 28 men]. The mean age was 57.79 +/- 14.99 years [range 21-87]. MDCT had poor accuracy compared with EUS in T-staging with a low degree of agreement [kappa = 0.26], while for N-staging MDCT had a better accuracy and a moderate degree of agreement with EUS [kappa = 0.45]. MDCT has a poor accuracy for predicting tumor invasion compared to EUS for T-staging while it has moderate accuracy for N-staging

Frequency of low bone mineral density in Saudi patients with inflammatory bowel disease

Metabolic bone disease is common in patients with inflammatory bowel disease [IBD]. Our aim was to determine the frequency of bone loss among Saudi patients with IBD and possible contributing risk factors. We retrospectively reviewed Saudi patients with IBD, between 18 and 70 years of age, who had bone mass density [BMD] determined by dual-energy X-ray absorptiometry scanning at one of three hospitals in the Kingdom of Saudi Arabia from 2001 to 2008. Case notes and BMDs results were carefully reviewed for demographic and clinical data. Low bone mass, osteopenia, and osteoporosis were defined according to the WHO guidelines. Predictive factors for BMD were analyzed using group comparisons and stepwise regression analyses. Ninety-five patients were included; 46% had Crohn's disease [CD] and 54% had ulcerative colitis [UC]. The average age was 30.9 +/- 11.6 years. Using T-scores, the frequency of osteopenia was 44.2, and the frequency of osteoporosis was 30.5% at both lumbar spine and proximal femur. Only 25.3% of patients exhibited a BMD within the normal range. Our both lumbar spine and proximal femur. Only 25.3% of patients exhibited a BMD within the normal range. Our results revealed a positive correlation between the Z-score in both the lumbar spine and the proximal femur and body mass index [BMI] [P=0.042 and P=0.018, respectively]. On regression analysis BMI, age, and calcium supplementation were found to be the most important dependent predictors of BMD. Saudi patients with IBD are at an increased risk of low BMD and the frequency of decreased BMD in Saudi patients with CD and UC were similar. BMI and age were the most important independent predictors of low BMD

Presenting features of childhood-onset inflammatory bowel disease in the central region of Saudi Arabia

To investigate the presenting features of childhood-onset inflammatory bowel disease [IBD] in the central region of Riyadh, Saudi Arabia and to compare with those reported in the literature. This is a retrospective review of medical records of children below 18 years of age at onset of symptoms with confirmed diagnosis of IBD for age, gender, family history, presenting clinical and laboratory findings in the Divisions of Pediatric and Adult Gastroenterology, King Khalid University Hospital [which provides free health care] and the Department of Gastroenterology Al Mofarreh Poly Clinic, Riyadh, Saudi Arabia, between January 1993 and December 2010. Two hundred and eighteen children diagnosed with IBD with predominance of males in Crohn's disease [CD] [56%] and females in ulcerative colitis [UC] [59%]. There was no significant difference between UC and CD regarding age of onset of symptoms [p=0.347]; however, the difference in the age at presentation and age at final diagnosis were significant [p=0.027 and p=0.008]. There was a significant increase of IBD diagnosis from the period 1993-2001 to 2002-2010 [p<0.0001]. The family history was positive in 15.3%. The presenting clinical features and laboratory abnormalities are similar to those reported in other populations. Further studies are needed to establish the incidence and prevalence

role of interleukin-1 beta gene polymorphism in aggressive periodontitis

The primary causal factor for periodontitis is bacteria, but the extent and severity of periodontal lesions can be influenced by environmental factors, acquired diseases, and genetic predisposition. Genetic polymorphisms for IL-1 beta have been proposed as potential genetic marker for periodontal disease susceptibility. To investigate the association of one of the IL-1 beta gene polymorphisms with aggressive periodontitis. The study was performed on a total of 50 individuals that were divided into 3 groups; healthy control group [HC] with clinically healthy periodontium, diseased control group suffering from chronic periodontitis [CP] and patients group suffering from aggressive periodontitis [AgP]. Patients and healthy controls received a full-mouth periodontal examination. Venous blood was taken by standard venipuncture and placed into EDTA-containing tube for DNA extraction and amplification by RFLP-PCR technique. The amplification products were subjected to digestion with Taq I restriction endonuclease enzyme. The resulting fragments were separated by agarose gel electrophoresis and visualized by ethidium bromide staining and UV light. The present study showed that the prevalence of the IL-1 beta positive genotype 1,1 at position+3953 was higher in AgP patients [75%] than in CP [40%] and HC [30%]. By estimating the OR for genotype 1, 1 of AgP and both CP and HC, it was found that it is more likely to develop AgP approximately 4.5 times than CP and approximately 7 times than HC. Thus, there was sufficient evidence to conclude that there is an association between the genotype 1,1 and AgP. These results suggested that this cytokine might predict and be associated with progressive inflammation and attachment loss as IL-1 plays a pivotal role in the inflammatory cascade of the immune response to microbial challenge and can induce several events associated with tissue destruction. From this we could support the association between IL-beta gene polymorphism and aggressive periodontitis. Hence IL-1 beta gene could be used as a genetic marker for early diagnosis of patients at risk

Evaluation of insulin-like growth factor binding protein-1 in cervico-vaginal secretions as an indicator of premature rupture of membranes: a comparison with nitrazine test and amniotic fluid index

Objective: To evaluate the diagnostic potential of insulin-like growth factor binding protein-1 [IGFBP-1] in cervicovaginal secretions as an indicator of premature rupture of membranes [PROM] in comparison with the nitrazine test and amniotic fluid index [AFI]. The predictivity of these tests on the latency of pregnancy in patients with PROM was also studied

Design: Prospective controlled study

Setting: Department of Obstetrics and Gynaecology, Faculty of Medicine, Alexandria University

Subjects: 50 pregnant females [20 continued PROM, 20 suspected PROM and 10 with intact membranes acting as controls]

Interventions: Patients were subjected to sterile speculum examination, the nitrazine test, measurement of IGFBP-1 in cervicovaginal fluid by a rapid dipstick method [PROM test] and ultrasonographic assessment of AFI by the four quadrant method. All patients were followed up for one week to determine who went into spontaneous labour

Results: The mean gestational age did not differ significantly between groups. The sensitivity. Specificity, positive and negative predictive values of the nitrazine test, AF] and the PROM test in diagnosing PROM were 68.75%, 30%, 64.7%, 37.50% and 75%, 89%, 92.31%, 66.67% and 96.90%, 100%, 100%, 94.70%, respectively. Only a positive PROM test was associated with delivery within 1 week

Conclusion: The dipstick immunochromatographic method of detecting IGFBP-l in cervicovaginal fluid [PROM test] is a. rapid, reliable and non-invasive method in diagnosing PROM. It is the most accurate predictor of the latency of pregnancy in patients with suspected PROM

Histological and laboratory features of patients undergoing liver biopsy at a University Hospital in Central Saudi Arabia

To identify the most common liver pathologies seen in our center, to find the prevalence of advanced fibrosis and cirrhosis in patients with chronic hepatitis B and C, and to correlate the histological and laboratory features of the most common diseases and compare between them. Liver biopsy procedures performed in our Gastroenterology Unit at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia were traced from records between the years 1997-2003. Clinical, histopathological, and laboratory features were recorded. We identified 574 liver biopsies during the study period. Of the 502 included patients, males were 58.6%. The mean age of the patients was 43.5 years. Approximately half of the biopsies [49%] were performed for patients with hepatitis C, followed by hepatitis B, for which 17% of the biopsies were performed. Patients with hepatitis B were approximately 10 years younger than patients with hepatitis C [p=0.01]. They were 10% more likely to be males. In terms of fibrosis, only approximately 17% of patients with hepatitis B and 27% of patients with hepatitis C had advanced fibrosis. Most liver biopsies performed in our center are performed for patients with hepatitis C. Rates of advanced fibrosis in our series are significantly lower than what was previously reported in other studies

Comparative experimental and clinical study between sevoflurane and isoflurane renal effects

Sevoflurane is a promising new nonflammable halogenated inhalational agent which produces anaesthesia of excellent quality. This study was performed to investigate experimental and clinical renal effects of sevoflurane versus isoflurane. The expermental part of study included 60 rats divided into 3 equal groups. Group I [control] was exposed to oxgen 4L/min for hours, group II [isoflurane] was exposed to 1.2% isoflueane for 2 hours, group III [sevoflurane] was exposed to 2% sevoflurane for 2 hours. Each group was further subdivided equally into two subgroups. Subgroup [A] in which animals were sacrified 24 hours after exposure, subgroup [B] in which animals were sacrified 7 days from the exposure. Animala blood samples were collected for blood urea nitrogen [BUN] and serum creatinine [Cr.] measurements, then the kidney was removed for histological and histochemical [succinic dehydrogenase enzyme activity] studies. The clinical part of this study was carried out on 40 ASAI and II of adult patients and were divided equally into two groups. Group I received 1.2 isoflurane for 2 hours and group II received sevoflurane 2% for 2 hours. Haemodynamics were assessed by measuring heart rate [HR] and mean arterial blood pressure [MBP], renal function tests [BUN and serum Cr.] was done preinduction, 2, 4,24 hours and 7 days postoperatively. Experimental study results founded that both isoflurane and sevoflurane had no effect on renal enzymes level all-through the study period. Histological examination of the kidney revealed mild congestion of central vein in sevoflurane group in contrast to isoflurane group which had severe congestion of central vein and cellular infiltration. On the other hand succinic dehydrogenase enzyme granules decreased slightly in sevoflurane but showed moderate activity in isoflurane group. The present clinical study showed that sevoflurane group had significantly lower [HR] than isoflurane group intra operatively. Also MBP was significantly lower in sevoflurane group from 5 minutes till 30 minutes intra operatively. No changes were recorded in renal enzymes all through the study period. Analysis of the data obtained from the experimental and clinical studies in this work demonstrated that sevoflurane had no harmful effect on the kidney with cardiovascular stability

Comparative study of spinal, epidural and combined spinal epidural anaesthesia in orthopaedic surgery

This study was carried out to compare spinal, epidural and combined spinal epidural [CSE] techniques of anesthesia on 60 ASA I and II patients of both sexes [35 females and 25 males] scheduled for major orthopedic surgery. They were divided into three groups [each of 20 patients, aged 20-67 years old]: Group I [spinal group] in which 2.5-3 ml heavy bupivacaine 0.5% was injected through a 25 G spinal needle, group II [epidural group] in which 3 ml of 0.5% bupivacaine was injected as a test dose, after that 12-15 ml of 0.5 bupivacaine was received, and group III [group CSE] in which a 25 G spinal needle is inserted through the epidural needle about 1.5 cm further to reach the subarachnoid space. After injection 1.5 ml of 0.5% hyperbaric bupivacaine in the subarachnoid space, the spinal needle was withdrawn then 10-12 ml of 0.5% plain bupivacaine was injected in epidural space. This study compared the onset time of sensory analgesia, the degree of muscle relaxation, changes in respiratory rate [RR], hemodynamic changes [HR, MAP, COP, CI], blood glucose levels as well as the postoperative events produced by spinal, epidural and CSE block. In conclusion, the CSE technique was superior alternative in selected patients for spinal and epidural analgesia. CSE reduced and eliminated some of the disadvantages of both techniques, while preserving advantages of both

Comparative study of propofol versus sevoflurane for facilitation of LMA insertion

This study compared the stages of induction, condition of LMA [Laryngeal Mask Airway], insertion, haemodynamic effects and emergence from anaesthesia of sevoflurane with those of propofol in forty unpremedicated ASA I or II patients aged between 20-52 years old, scheduled for minor elective surgery for which the use of the Laryngeal Mask Airway [LMA] was considered appropriate. Patients were divided equally into two groups of twenty patients each to receive one of the following induction technique: group I [propofol group] received propofol 3 mg / kg mixed with 2 ml 1% lignocaine and group II [sevoflurane group] received 7- 8% sevoflurane gas induction in 50% nitrous oxide in oxygen. After induction of anaesthesia and loss of the eyelash reflex, introduction of the LMA was attempted by an experienced anaesthestist. Jaw opening, ease of LMA insertion, coughing, gagging, airway obstruction and patient movement were graded by anaesthetist inserting the LMA. From this study we found that the time to loss of eyelash reflex was shorter in propofol group 46 +/- 11s vs 58 +/- 16s in sevoflurane group [p > 0.05], time taken for LMA insertion was 86 +/- 22s and 126 +/- 56s in propofol and sevoflurane groups respectively [p < 0.01], sevoflurane has a slightly slower induction time with reduced incidence of apnea. The condition for laryngeal mask insertion was assessed as excellent, satisfactory or poor on the basis of total score in each group. The result was Poor in 3 [15%] patients in propofol group in comparison with 1 [5%] patient in sevoflurane group, satisfactory conditions were observed in 7 [35%] patients in propofol group vs 6 patients [30%] in sevoflurane group and excellent in 10 [50%] patients in propofol group in comparison with 13 [65%] patients in sevoflurane group [p >0.05]. Haemodynamically, sevoflurane produced a minimal decrease in the heart rate and systolic blood pressure. Postoperatively, sevoflurane has a slower emergence from anaesthesia as compared to propofol, but no differences were noted in discharge times. From these results we concluded that 7-8% sevoflurane with 50% nitrous oxide in oxygen may be a useful alternative to propofol for safe induction, laryngeal mask insertion and recovery

Current concept of nutritional support after gastrointestinal surgery

In patients who have had major surgery or trauma, early enteral feeding is safer and more effective than parenteral or nasogastric feeding but is frequently associated with diarrhea. Limited recordings have shown that the patterning of duodenal interdigestive motor activity is frequently abnormal after surgery or in patients who are critically ill. The aim of the present study was to evaluate and compare the effects of postoperative administration of sufficient amounts of protein and calories, provided in the three different methods namely, total parenteral nutrition, total enteral nutrition, and a new method consisting of the combined use of peripheral parenteral nutrition and enteral nutrition. In the combined method, half the calculated total nutritional requirements was provided via the peripheral venous route, and the remaining amount via the enteral route. The three nutritionally supported groups of patients were compared with patients who received the usually administered conventional fluid therapy, where insufficient amounts of calories and no protein were provided

Comparative study between the efficacy of the antiviral [acyclovir] and the epidural local anaesthetic in the prevention of postherpetic neuralgia

Postherpetic neuralgia is the most common and feared complication of herpes zoster. The objective of the present study is to evaluate the relief of acute pain and possible preventive effects on postherpetic neuralgia through the use of IV anitviral acyctovir versus combined usage of epidural blockade kind acyclovir in the acute stage or herpes zoster. Ninety patients were randomly allocated to one of three equal groups [n=30 each]. Group [A]: treated with intravenous acyclovir [5mg/kg/three times /day] for 7 days. Group [B] treated with intravenous acycIovir [5 mg/kg/three times /day] and an epidural btockade for 7 days. Control group [C]: received oral nonsteroidal anti-inflammatory in the form of diclofenae sodium. The changes in intensity of pain in all groups were assessed for 12 months. The mean +/- SD number of days required for relief of pain by 50% and 90%. which was done by using the visual analogue scale of 100 [worst pain] to zero [no pain], was highly significantly lesser [P<0.01] in group B than in groups A and C. The duration of late residual pain was significantly shorter in group B [5.9 +/- 4.8 days] than in group A [11.9 +/- 7.5 days] [P<0.01]. The total duration of pain was also significantly shorter [P<0.01] in group B [51.5 +/- 8.8 days] than in groups A [67.5 +/- 8.8 days] and group C [164.5 +/- 8.8 days]. It was concluded that epidural blockade combined with antiviral agent is a very effective treatment modality for the pain of acute herpes zoster and its use is recommended for the prevention of postherpetic neuralgia, in view of shortening of total duration of pain, especially the late residual pain

Comparative study of some pharmacological and clinical effects of calcium channel blockers: isradipine [Lomir] and diltiazem [Tieldiem]

This work included evaluation and comparison of isradipine and dilitiazem on the cardiovascular system and smooth muscles of experemintal animals. Clinical studies were also performed on hypertensive patients undergoing surgery. Isradipine [50-800 micro g/kg] and dilatiazem [0.75-12 mg/kg] produced sudden and transient fall in blood pressure of anaesthetized cats and this drop was shown to be peripherally. Isradipine was found to be superior in its hypertensive action. No abnormality in the ECG pattern was observed apart from the bradycardia which happended only with high doses of both drugs. Isradipine only in doses ranging from 4-16 micro g while all concentrations of diltiazem [12.5-200 micro g], in the present study, included a significantly dose dependent cardio-inhibitory effect, probably due to a direct action. On isolated rabbit's aortic spiral strip, both isradipine [0.2-3.2 micro g/ml] and diltilazem [2.5-40 micro g/ml] did not alter the basal tone of the strip but they reduced the amplitude of noradrenaline induced aortic contractions significantly. The effect of isradipine was greater than that of diltiazem. On smooth muscles, isradipine and diltiazem elicited a direct spasmolytic action on rabbit's intestinal contractions. This was confirmed by the relief of the drugs to barium chloride-induced spasm of the smooth muscles. The antispasmodic effect of isradipine was found to be highly superior than that of diltiazem and the difference was found to be significant. As regards the effect on tracheal preparations, isradipine [0.25-4 micro g/ml] and diltiazem [2.540 micro g/ml] did not alter the basal tone of tracheal preparations, but in case of histamine-induced contractions, only diltiazem reduced that response. The clinical study was conducted, in the present study, on patients of ASA grade I and II. By comparing the haemodynamic effects of isradipine and diltiazem with the control group of patients, it was found that the reduction of systolic and mean arterial blood pressure was greater in the isradipine treated patients than in those receiving dilitiazem; whereas the decrease of diastolic blood pressure was not different. The cardiac output is slightly increased in both groups. The heart rate remained unchanged in patients treated with isradipine but it was decreased significantly in those receiving diltiazem. As regards the metabolic effect, isradipine produced a decrease in total serum cholesterol with no significant effect on blood sugar level, however diltiazem increased both. Isradipine, in the present study, was better tolerated tam diltiazem and patients under isradipine therapy complained of fewer side effects. So it can be concluded that isradipine can be safely administered to hypertensive patients, regardless of concomitant disease. Unlike diltiazem, it preserves cardiac function and has no negative impact on lipids or blood chemistry. So it can be safely administered to hyperetensive patients with asthma, diabetes or congestive heart failure

Iatrogenic bile duct injuries

Twenty-two patients with postcholecystectomy bile duct injuries were managed in the Surgical Unit in period from June 1989 to June 1992. They were 18 females and 4 males. Their ages ranged between 25-60 years with a mean of 43 years. The timing and mode of presenting manifestation varied. In only two patients injuries were recognized intraoperatively. Thirteen patients [59.1%] presented within one month POP. Recurrent cholangitis was the most frequent presenting manifestation [54.5%]. Preoperative diagnostic work up included US, PTC, ERCP and CT, and when added to operative findings, stricture level and type of injury could be demonstrated. Bismuth types 2 and 3 strictures were found in 16/22 [77.7%], while ligated bile duct was the most frequent type of injury 14/22 [63.6%]. End to side Roux en Y hepaticojejunostomy was performed in 14.22 [63.3%], while end-to-end anastomosis on a T-tube stent wasdone for 2 patients with intraoperative recognition of injury [9.1%]. Choledochoduodenostomy was performed in 2 patients [9%], Roux en Y choledochojejunostomy in 2 patients [9.1%] while, portojejunostomy was done for another 2 patients [9.1%]. The period of postoperative follow up ranged between 12-36 months with a mean of 20.5 months. Only one mortality [4.65%] was met with, while early specific morbidity were encountered in 6 patients. Five patients showed late specific morbidity [one restenosis and 4 mild recurrent cholangitis]

Ankle arthrodesis using the distraction-compression technique: a report on twenty cases

Twenty cases of secondary degenerative arthritis of the ankle joint in whom arthrodesis was indicated are presented. Fusion of the joint was achieved using the distraction - compression technique first published by Chuinard and Peterson in 1963

Acute acalculous cholecystitis

Eighteen patients developed acute acalculous cholecystitis at UCLA during a period of 18 years. Males were about 3 times more affected than females. The average age of patients was 54.8 years. Chronic vascular lesions with possible arteritis and thrombosis of the cystic artery were found in about one half of patients. Stress situations associated with major surgery or major trauma preceeded the development of the condition in one third of cases. Although the condition is rare, yet it is much more serious than acute cholecystitis associated with cholelithiases. Gangrene and perforation is much more frequent [40% of cases] and the postoperative mortality rate is much higher [28%]. More awareness of the condition, early recognition and emergency surgery are recommended to minimise the hazards of perforation

Structural and functional effects of total porta-caval shunt on normal canine liver

Total deprivation of the normal canine liver from portal blood by end to side porta-caval shunt produced significant degenerative and regenerative changes in the liver. The dominant ultrastructural changes were dilatation and diminution in the amount of the rough endoplasmic reticulum with loss of its ribosomes, disorganisation of mitochondria, diminution in glycogen granules, increase in the amount of fat vacuoles and appearance of secondary lysosomes in considerable number. The hepatocytes showed progressive atrophy, fatty degeneration and eventual necrosis. Proliferative changes in the form of nodulation, portal tract fibrosis and cirrhosis occurred later. There was significant loss in the weight of the liver together with considerable loss of body weight and poor health of the animals. Liver function tests were within normal range inspite of the remarkable pathological changes in the liver. The study shows the vital role played by portal venous blood in maintaining the size, structure, architecture and function of the liver and the potential hazards attending total portal blood diversion

Structural and functional effects of porta-caval shunt below the superior pancreatico-duodenal [SPD] vein on normal canine liver

The structure and function of the normal canine liver are still intact after its deprivation from both mesenteric and splenic venous blood by end to side porta-caval shunt below SPD vein. Consequently the hepatic damage caused by total porta-caval shunt is mainly due to deprivation of the liver from the pancreatico-duodenal hormones, contained in the SPD vein. The study indicates that porta-caval shunt constructed below SPD vein allows the pancreatic hormones to perfuse the liver and prevents the serious consequences of total porta-caval shunt. The clinical importance of such a shunt is obvious as it may turn to be the ideal shunt for the surgical treatment of portal hypertension in the future