Audit of physicians' adherence to the antibiotic policy guidelines in Kuwait

To audit physicians' adherence to the local antibiotic policy guidelines in government hospitals in Kuwait. The study was a retrospective review of patient records in nine hospitals between July 1 and December 31, 2008. Clinical notes and medication charts of the latest hospital admissions were checked for antibiotic prescribing. On the audit form, aspects of the prescribed antibiotic were benchmarked to the hospital antibiotic policy guidelines to evaluate adherence. Of 2,232 reviewed records, 1,112 [49.8%] patients had 1,528 antibiotic prescriptions. Patients who received antibiotics were significantly younger than those who did not [median age: 26.3 vs. 29.8 years, p < 0.001] and their hospital stay was significantly longer [median: 4 vs. 2 days, p < 0.001]. The choice of an antibiotic was appropriate and matched the policy in 806 [52.7%] prescriptions. Of such appropriate antibiotics, adherence to route of administration was observed in 768/806 [95.3%], to dose in 758 [94%], to frequency in 746 [92.6%] and to duration in 608 [75.4%]. Full adherence to all aspects of antibiotic choice, dose, route, frequency and duration was achieved in 464 [30.4%] prescriptions. In 382 [25%], the antibiotics administered were not indicated. There was low adherence to the local antibiotic policy guidelines. Physicians' antibiotic prescribing practices should be optimized. Adherence to, and update of, the policy is recommended

Gossypol inhibits proliferation of endometrioma cells in culture / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To evaluate the anti-proliferative activity and mitochondrial toxicity of gossypol in endometrioma cells maintained in short-term cultures.</p><p><b>METHODS</b>(A) Three endometrioma cell lines from patients were treated with 25 or 50 nmol/L gossypol for up to 12 days. The effect of gossypol on the cell growth was recorded. (B) A phosphorescence oxygen analyzer was used to determine the effects of gossypol on mitochondrial oxygen consumption of six endometrioma cell lines from patients. (C) Cellular gossypol accumulations in three endometrioma cell lines from patients were measured by high-pressure liquid chromatography.</p><p><b>RESULTS</b>Proliferation of the endometrioma cells was inhibited by 25 and 50 nmol/L gossypol. Respiration of the endometrioma cells was inhibited by 10 micromol/L gossypol. Cellular gossypol was detected in the endometrioma cell lines that were treated for 24 h with 10 and 0.3 micromol/L gossypol.</p><p><b>CONCLUSION</b>Gossypol invokes a potent toxicity on cultured endometrioma cells.</p>

Diagnostic parameters of minimal hepatic encephalopathy: clinical, electrophysiological, and neuroimaging study

Cirrhotic patients with minimal hepatic encephalopathy [MHE] have subtle cognitive deficits that can be detected by neuropsychometric tests, P300 event related potential, EEG, and increased signal on T1-weighted brain Magnetic Resonance Imaging. The present study was designed to assess the magnitude of cognitive dysfunction, a marker of minimal hepatic encephalopathy [MHE];to evaluate diagnostic usefulness of neuropsychological cognitive tests, EEG, P300 ERP latency, and MRI brain signs; and to investigate the clinical outcome of patients with MHE in terms of progression to overt encephalopathy. A total of 43 well-compensated cirrhotic patients without signs of encephalopathy were studied by neuropsychological cognitive test battery, P300 ERP latency, EEG, conventional MRI brain. The patients were followed-up for 2 yrs. to monitor subsequent episodes of overt encephalopathy. Child-Pugh classification was done throughout the study to assess severity of liver cirrhosis. Forty-six healthy subjects, age, sex, and education matched, served as a control group. Minimal HE was diagnosed in 21[48.8%], out of 43 cirrhotic patients. Inverted sleep rhythm was reported in 85.7%, of cirrhotic with MHE. Delayed P3ERP latency were seen in 38.1% of cirrhotic patients with MHE, while Number Connection Test [NCT-A and B] time were prolonged in 71.4% of the patients. EEG abnormality was detected in 47.6%, while MRI signs were reported in 80.9% of cirrhotic with MHE. Out of 43 patients, 18[41.8%] developed overt encephalopathy, 66.7% of the patients with MHE progressed to overt encephalopathy within a mean duration of 9 months, while only 13. 6% of the non-mHE patients did so. Of the patients who developed overt encephalopathy, 83.3% had abnormal EEG, 77. 8% had abnormal NCT, while 59. 3% had P3ERP latency prolongations. The results of the present study suggest that inverted sleep rhythm, abnormal NCT, slow EEG activity, and delayed P300 latency are valid tools for the screening of MHE in cirrhotic patients as there is a greater likelihood of overt encephalopathy development in patients with an abnormality detected by these tests than in patients without such abnormality. EEG is useful for follow-up screening and prediction of the development of overt hepatic encephalopathy

Perioperative pulmonary function in laparoscopic cholecystectomy versus open cholecystectomy, with preemptive intercostal nerve block

Background: the purpose of this study was to assess the efficacy of open cholecystectomy with right intercostal nerve block as an equivalent or substitute to laparoscopic cholecystectomy as regarding to the effect on the postoperative pulmonary function

Methods: forty female patients included in the study, were allocated randomly into two groups [20 patients in each] group [I] undergone laparoscopic cholecystectomy, while group [II] was subjected for open cholecystectomy with preemptive right intercostal nerve block. VC, FVC, FEVI, PEFR, and ABG were assessed

Results: all measured parameters of pulmonary function were markedly depressed early postoperative with some improvements noticed 4 hours later but still far from the preoperative values. These reductions in pulmonary function were less marked in open cholecystectomy with intercostals nerve block [II] than in laparoscopic cholecystectomy [I]. The operative time and total required dose of meperidine were significantly lower in group [II] than group [I]. There were no changes in AGS between groups or within the same group

Conclusion: open cholecystectomy with preemptive light intercostal nerve block can be less deterious or at least equivalent to laparoscopic cholecystectomy as regards the effect on postoperative pulmonary function and the total 24 hour requirement of meperidine

effect of dexmedetomidine on hemodynamics, platelet aggregation and intraoperative blood loss under sevoflurane anesthesia during total hip arthroplasty

Background: sevoflurane is suggested to exert platelet anti-aggregation effect. Dexmedetomidine which is nowadays progressively used as anesthetic sparing was demonstrated experimentally to impair platelet aggregation. The purpose of the present work was to study the effect of addition of dexmedetomidine to both anesthetics on blood loss and platelet aggregation in total hip arthroplasty [THA] patients

Methods: we prospectively studied thirty adult ASA I-III patients, who were randomly allocated into two groups [15 patients each]. Group [S] received sevoflurane, while group [SD] received sevoflurane anesthesia, with dexmedetomidine infused perioperatively as an adjunct to anesthesia. Hemodynarnics [HR and MAP], bleeding time, platelet count, intraoperative blood loss and platelet aggregation induced by ADP, Adrenaline and Collagen were assessed

Results: there was no statistically significant difference between the two groups as regards the platelet count or bleeding time. Blood loss was found to be statistically significant under sevoflurane/Dexmedetomidine anesthesia, with no clinical deterioration of bleeding time or effect on blood loss. Intraoperative platelet aggregation was found to be impaired under both techniques, though more statistically significant in the Dexmedetomidine group. Dexmedetomimne still exerted inhibition of platelet aggregation 3 hours after anesthetic offset although much less inhibition was observed and limited to Adrenaline induced aggregation

Conclusion: in patients undergone THA, the present study showed that platelet aggregation was markedly depressed with the combination of Dexmedetomidine [as a loading dose of 1micro g/kg/over 20 minutes, then continued at a dose of 0.2- 0.5 micro g/kg/hour] and inhaled anesthetic sevoflurane [1-2 vol. %] which was less significant under sevoflurane only, although clinical deterioration of bleeding time or blood loss was not observed, and this may be related to the relative reduction in blood pressure and heart rate under sevoflurane anesthesia and the more reduction under dexmedetomidine/sevoflurane anesthesia

role of magnesium sulphate as an adjuvant to propofol sedation in ICU patients, a comparative study

The aim of this study was to determine the effect of the concomitant use of magnesium sulphate infusion together with propofol continuous infusion used for sedation of the ICU patients on the total propofol consumption and on the patients' hemodynamics. Thirty mechanically ventilated ICU patients were randomly divided into two equal groups and allocated to receive either magnesium sulphate or placebo together with profolol continuous infusion. Hemodynamic monitoring included heart rate and invasive blood pressure measurements. Biochemical parameters included serum Na+, K+, Ca++. Mg++, total bilirubin and creatinine, and finally total propofol consumption in 24 hours. The use of magnesium sulphate continuous infusion significantly reduced total propofol consumption in group 2 [p<0.05]. This reduction was observed correlating with significant progressive rise of serum Mg++ [p<0.05]. No significant differences were detected in patients' hemodynamics or other biochemical parameters between both groups after the use of magnesium sulphate. The results indicate that the concomitant use of magnesium sulphate with propofol continuous sedation in ICU patients significantly reduced total propofol consumption with no significant derangements of the patients' hemodynamics or chemistry

Can antioxidants prevent preeclampsia?

To investigate the role of superoxide dismutase [SOD] in healthy pregnant women and in pregnant women with preeclampsia. The study was carried out on 80 pregnant ladies selected from the outpatient clinic of the Ain Shams University Maternity Hospital. They were classified into two groups: The control group: Consisting of 50 healthy pregnant ladies. The patients groups: Consisting of 30 ladies diagnosed as preeclamptic patients. All patients were subjected to history taking, clinical examination and blood chemistry for evaluation of SOD level using spectrophotometric assay. Compared with values in normotensive pregnant women. Preeclamptic patients had significantly lower SOD level being 1.54 +/- 0.60 vs. 0.63 +/- 0.36 Units/ml respectively. A cut-off point was detected below which preeclampsia supervenes. This level was calculated to be 1.01 U/ml. The decreased activity of the antioxidant enzyme superoxide dismutase may play an important role in the pathogenesis of preeclampsia and hence the possibility of the use of antioxidant drugs in high-risk patients which may be of a prophylactic value. The presence of a cut-off point of SOD level may be of value in the preeclampsia prediction issue in high-risk patients

Clinical usefulness of cystatin C concentration as a marker of early renal dysfunction in patients with cirrhosis of the liver

As preventive and renoprotective interventions are available, early identification of nephropathy is crucial, and there is a growing demand for a clinically convenient and reliable marker of renal function. Diagnosis of impaired renal function is of particular importance in patients with cirrhosis of the liver. Moderately reduced renal function may be missed by the conventional parameters. Cystatin C is an endogenous marker of glomerular filtration rate independent of muscle mass. Therefore, the aim of this study was to investigate the value of serum cystatin C concentration for the detection of moderately impaired renal function in patients with different stages of cirrhosis in comparison with the conventional methods. Eighty seven patients with cirrhosis were included in this study; All cases in this work had been examined clinically and they are scored according to Child-Pugh score. Calculation of creatinine clearance [CrCl] by determining its concentration in timed urine collections and simultaneously in blood were done for all the patients. All blood samples were obtained on the day of urine collection for CBC, LFTs, pro-thrombin time, serum electrolyte, creatinine, urea, creatinine clearance and Cystatin C concentrations. The patients then divided into two groups depending upon the results creatinine clearance: [groupl] normal creatinine clearance group [creatinine clearance >/= 70 ml/min; n=50] and [group2] reduced creatinine clearance group [creatinine clearance 40n69 ml/min; n=37]. There was no significant difference in urea concentration between the two groups [30.7] group 2 versus [28.3] mg/100 ml, group 1. While serum Cystatin C concentrations [mean [SD]: 1.32 [0.51] v 1.03 [0.34] mg/1 [p=0.008] and creatinine concentrations 1.03 [0.52] v 0.86 [0.22] mg/100 ml [p=0.03] were higher in group 2 than in group 1. To confirm the diagnostic advantage of Cystatin C over creatinine and urea. Receiver-operator characteristics [ROC] shows at equal specificity, the sensitivity of cystatin C was increased almost throughout the ROC plot. At cut off concentrations of 1.0 mg [Cystatin C], 0.8 mg/100 ml [creatinine] and 27 mg/100 ml [urea],cystatin C exhibited significantly higher sensitivity than creatinine and urea [70%, 45.2%, and 43.9%; respectively p<0.05], Specificity and efficiency were not significantly different between parameters. The sensitivity of Cystatin C [88.5%] tended to be higher than that of creatinine [62.0%] and urea [55.3%] at equal specificity of [60%] in Child-Pugh class C patients. The results demonstrated that the diagnostic accuracy of plasma Cystatin C was better than plasma creatinine in identifying liver cirrhotic patients with reduced glomerular filtration rate. particularly with Child-Pugh class C patients, for early diagnosis of renal dysfunction

Correlations between C-reactive protein as an inflammatory component of atherosclerotic process and variable lipid parameters in type 2 diabetic and hyperlipidemic patients

The study aimed to prove any correlations between CRP and different lipid parameters in patients with type 2 diabetes mellitus and hyperlipidemia. The study was conducted on 210 subjects, that were subdivided into three groups [Diabetic group, hyperlipidemic group, appearently healthy controls], each was 70 in number. Measuring of different parameters [serum concentrations of CRP, TC. HDL-C and LDL-C], were done according to standardized enzymatic assay methods. A positive correlations between CRP serum concentrations and that of TC [r = 0.37 and 0.38, P<0.05] and LDL-C [r = 0.39 and 0.35, P<0.05] respectivly in diabetic and hyperlipidemic male patients and the same results in female patients, and an inverse relationship was obtained between CRP serum levels and HDL-C serum concentrations in the diabetic and hyperlipidemic male patients, but statistically was non-significant. Serum CRP concentrations of diabetic and hyperlipidemic patients were significanty higher in both males and females than normal controls. This increase in CRP coincides a significant increase in TC, TG and LDL-C. These results may reflect that a variety of features of the metabolic syndrome are associated with a systemic inflammatory response. The higher CRP concentration in serum could reflect the inflammatory component of the atherosclerotic process that is so prelevant among patients with diabetes and hyperlipidemia

Acut organ failure in septic patients with or without shock

Sepsis and septic shock are life threatening complications of infections with a high incidence and mortality rates. Death is strongly related to types and number of systems failure, beside other risk factors. Aiming to identify the incidence of acute organ failure in relation to presence or absence of shock, retrospective evaluation was done for 170 patients admitted to Intensive Care Unit in a seven months period during 2005-2006. Patients with septic shock had a significantly higher age, APACHE II score [31.39 +/- 09.76 versus 18.6 +/- 5.73, P<0.005], SOFA score [8.42 +/- 3.70 versus 3.73 +/- 2.36, p< 0.0005], and a higher mortality rate [67.08% versus 25.27%, p< 0.0005] compared to those with severe sepsis. The percentage of acute organ failure in septic patients with shock versus those without shock was: pulmonary [86.83% versus 51.65%], renal [59.49% vr 23.07%, P<0.005], hepatic [49.37% vr 25.27%, P<0.005], haematological [54.43% vr 30.77%, P<0.005] and central nervous system [13.92% vr 10.98%, P=NS] respectively. Septic shock patients were more likely to have significantly higher mean SOFA score and a higher mortality rate than non-shocked cases. Mortality increases significantly with age, APACHE II and SOFA scores

Immunohistochemical analysis of the immune cells in bilharzial granuloma of the urinary bladder

Urinary bilharziasis represent a major health problem in Egypt. It is characterized by the formation of localized collection of immune cells i.e. granulomas. In this investigation, we hypothesized that the evolution of the bilharzial ganuloma is associated with recruitment of immune cells of diverse cell lineage. To explore this hypothesis and to fill this existing gap in the literature, We carried out this investigation. Granuloma cell population was immunohistologically examined in thirty cases of cellular bilharzial granulomas using immunoperoxidase staining methods and antibodies targeting antigens for B cells [CD20]. T cells [CD3]. Histiocytes [CFD68] and cytotoxic T cells [Granzyme B]. The mean values of positive cells in the cellular bilharzial granulomas were: 45.5 +/- 5.6 for CD68 cells: 14.8 +/- 1.1 for CD3 T cells; 9.1 +/- 1.1: for CD20 B cells and 1.5 +/- 0.8: for Granzyme B T cells with cytotoxic activity. The numerical dominance of CD68 cells suggests their critical role in the evolution of these lesions. Our study was the first to report immunophenotypic profile of the bilharzial grnauloms

Separation and identification of biologically active compounds of the wild plant, atriplex semibaccata against aphis craccivora koch

Biological and Phytochemical studies were conducted on Atriplex semibaccata to investigate the biologically active compounds of this plant against Aphis craccivora Koch. Results indicate that, fraction A with LC[50 0.036] mg/cm[2] and LC[95 0.096] mg/cm[2] was the most effective against Aphis craccivora in comparison to fractions B and C as well as the crude extract itself. The LC[50] and LC[95] values of the crude extract were 0.057 and 1.523, respectively. However, the corresponding values for fraction B were 0.047 and 0.161 and for fraction C were 0.04 and 0.097, respectively. Data also showed that these fractions consist mainly of fatty acids and their esters, terpenes and hydrocarbons. Fraction A, which is the most potent fraction consists of fatty acids with percent area 32.028, esters [41%], terpenes [11.977%] and hydrocarbons [6.095%]. Fraction C followed fraction A according to the effectiveness against Aphis craccivora. It contains hydrocarbons with percent area 24.103, fatty acids 20.610%, fatty acids esters 24.378% and terpenes 3.865%. On the other hand, fraction B had the lowest toxicity compared with the other two fractions while; it was more toxic than the crude extract. It contains methyl salicylate with percent area 9.535% and phytol 7.00% in addition to the amount of fatty acids esters [6.406%] and high amount of hydrocarbons [53.405%]

Evaluation of the antibilharzial activity of mirazid versus praziquantel against S. haematobium: an experimental study

Mirazid [myrrh] is a new herbal extract [oleo gum resin from the stem of the plant Commiphora molmol with claimed antibilharzial activity. LD16, LD50, and LD84 of Mirazid were determined in albino mice and were found to be 1984, 3138, and 4963 mg/kg respectively. The antibilharzial efficacy of Mirazid, administered orally at a dose of 250X5 mg/kg, in comparison to the schistosomicidal drug of choice praziquantel [PZQ], administered orally at a dose of 250X2 mg/kg, was evaluated in S. haematobium infected hamsters. Treatment was conducted 90 days post infection. Parasitological parameters expressing cure and hepatic histopathological changes were evaluated 4 weeks after treatment. Praziquantel treatment completely eradicated S.haematobium worms, caused disappearance of immature and mature egg stages, with 100% dead eggs. Hepatic and intestinal tissue egg loads were reduced by 79.2% and 99.7% respectively. Mirazid failed to induce any significant change in total number of worms, but induced significant reduction in the 1[st], 2[nd], and 3[rd] immature egg stages with increase in the number of the fourth stage, but this change was not reflected on the total number of immature eggs. Mirazid did not affect tissue egg load. The hepatic histopathological changes induced by S. haematobium infection were improved in praziquantel treated hamsters with reduction in granuloma number and size. Ova degeneration with regression of granulomatous inflammatory reaction was more manifested when compared to infected untreated controls. Mirazid did not results in evident regression of hepatic schistosomal pathology. In conclusion, praziquantel is still the drug of choice for treatment of S. haematobium, while Mrazid cannot substitute PZQ in the treatment of S. haematobium. Further trials using modified preparations may result in better antibilharzial efficacy of this novel herbal extract preparation

Neurotoxicity of the commenest volatile substances abused in El-Minia Governorate: clinical and experimental study

The current study was. performed to investigate the possible neurotoxic effects of chronic solvent abuse of some of the commonest abused substances in El-Minia governorate, namely, acetone and diethyl ether, and whether these changes, if present, are reversible or not. It was carried out as 2 parts: 1[st] part; 50 male persons aging between 20-45 were divided into 5 groups of 10 subjects each: group I; a normal volunteer control group, group II exposed daily to acetone for 1-2 year[s], group III: exposed daily to acetone for 8-10 year[s], group IV: exposed daily to diethyl ether for 1-2 year[s], group IV: exposed daily to diethyl ether for 8-10 year[s]. All subjects were examined thoroughly for any neuropsychiatric disorders 3 times 3 months apart. The 2[nd] part; 180 albino rats divided into 9 groups of 20 rats each as follows: group I: a control group received a daily oral dose of 1.5 ml of physiological saline for 1 month, group II: exposed to a daily dose of acetone [1250 ppm. / 30 min.] for 1 month, then examined immediately, group III: exposed to a daily dose of acetone [1250 ppm. / 30 min.] for 1 month, left for 1 month without any medical intervention, then examined, group IV: exposed to a daily dose of acetone [1250 ppm. / 30 min.] for 3 months, then examined immediately, group V: exposed to a daily dose of acetone [1250 ppm. / 30 min.] for 3 months, left for 1 month without any medical intervention, then examined, group VI: exposed to a daily dose of diethyl ether [2000 ppm. / 30 min.] 1 month, then examined immediately, group VII: exposed to a daily dose of diethyl ether [2000 ppm. / 30 min.] 1 month, left for I month without any medical intervention, then examined, group VIII: exposed to a daily dose of diethyl ether [2000 ppm. / 30 min.] for 3 months, then examined immediately, and group IX: exposed to a daily dose of diethyl ether [2000 ppm. / 30 min.] for 3 months, left without any medical intervention for 1 month, then examined. The results of the 1[st] part of the current study revealed that persons of the groups II and IV had mild neuropsychyatric disorders and that these changes were much more severe in the persons of group III and V as well as the appearance of another serious disorders including parkinsonism, cerebellar dysfunction, and cranial nerve affection. The results of the 2[nd] part revealed that animals of groups II and VI showed profound pathological changes of the cerebral cortex and cerebellum ranging from mild to moderate degrees with higher incidence towards the mild one. In addition, the animals of groups IV and VIII showed similar changes with increased incidence of the moderate degree. Moreover, animals of groups III and VII showed a mild improvement of the reported pathological changes when compared to those examined immediately after the last dose. On the other hand, animals of groups V and IX showed no improvement and nearly were the same when compared to those of groups IV and VIII. It could be concluded that volatile substance abuse induces serious neuropsychiatric and pathological changes, and that severity of the pathological changes increases with the increase of period of abuse, while reversibility becomes less likely

Significance of P21 and C-mye expression in urinary bladder lesions

Immunohistochemical tissue expression of the anti- proliferative marker P21 and the oncogenic marker C-myc were estimated in 40 cases with non-neoplastic and neoplastic urinary bladder lesions with or without schistosomal infection to assess the significance of their expression as a diagnostic tool in patients with higher risk of developing cancer bladder. P21 expression was detected in 50% of simple cystitis cases and all cases with premalignant changes were positive for P21 immunoreactivity expressed into about 16% of urothelial cells. Eighty-five% of malignant cases expressed P21 in 48-55% of urothelial cells without significant variance between different histologic tumor types. Extent of P21 expression inversely correlated with bilharzial association, upgrading of malignancy and tumor invasiveness. C-myc was detected in 80% of simple chronic cystitis cases [75% cytoplasmic, 25% cytoplasmic and nuclear expression] and in all cystitis cases with premalignant changes [as cytoplasmic and nuclear expression]. Eighty-nine% of cancer cases were C-myc positive with predominance of nuclear expression to be seen in 16.74 and mixed with cytoplasmic expression in another 58.3% of positive cases. Malignancy upgrading and invasiveness raised C-myc positivity. It was concluded that P21 expression increases in an attempt to check cellular proliferation, while the increase in the oncogen C-myc goes ahead. Loss of P21 and increased C-myc expression in a malignant lesion is a predictor of malignancy progress to higher grade or stage

Predictors of medically intractable childhood epilepsy: clinical, electroencephalographic and neuroimaging factors

Predicting which children are destined to develop medically intractable seizures would be very helpful in developing treatment strategies that would be more aggressive than in children with easily controlled epilepsy. Little is known about the natural history, particularly the time course of development, of refractory epilepsy. To identify clinical, electroencephalographic [EEC] and neuroradiological factors associated with both seizure control and medical intractability in children with epilepsy and to be acquainted with predictors of uncontrolled seizures. A case-control study to identify predictors of medically intractable epilepsy in children. Cases were children who had an average of one seizure or more a month over a 2-year period and who, during that time, had failed trials of at least three different anti-epileptic drugs [AEDs]. Controls were children who had epilepsy, who had been seizure-free for >/= 2 years, and who had never, before becoming seizure-free, met the definition for intractable epilepsy. Features of clinical findings, EEG and Magnetic Resonance Imaging [MR1] were compared in 20 children with well controlled seizures and 40 with intractable epilepsy using contingency 2x2 tables for inference of associations, odds ratios, predictive values, sensitivity and specificity. Logistic regression -was performed for multivariate analysis. Strong associates of clinical factors with intractability included: age at onset; duration of epilepsy; multiple types of seizures; complex partial, simple partial, tonic, atonic and myoclonic seizures; initial seizure frequency; history of status epilepticus; history of febrile seizures; duration of fit at onset; lapse of time before treatment; receiving more than one A ED; a symptomatic etiology of the seizures, and abnormal magnetic resonance imaging [MRl] of the brain. Strong associates were noted between intractability and several EEG factors: abnormal EEG background including diffuse slowing, asymmetry and high frequency spikes. These factors were predictors of refractory epilepsy. With multiple logistic regression, independent predictors of intractability included: early risk factors, complex partial seizures and multi-focal or focal epileptic discharges with secondary generalization. There are a number of clinical, EEG and neuroradiological features that can be identified early in the course of childhood epilepsy that are predictive of outcome. These findings will need to be verified in a prospective study

Management of spontaneous supratentorial intracerebral hemorrhage a comparative study between surgical and medical treatment

To study and compare the effectiveness and outcome of the surgical treatment versus medical management of patients with spontaneous supratentorial intracerebral hemorrhage [ICH]. A comprehensive review of 35 patients with spontaneous supratentorial ICH is preformed at Benha university hospital and King Fahd general hospital from March 1999 to September 2001. Twenty patients had surgery for clot evacuation through open craniotomy and fifteen received medical management. Inclusion criteria were Glasgow Coma Score> 5 at the time of enrollment, with focal neurological deficits, ICH volume> 20 cc on the initial brain CT scan. The follow up period was three months. Outcome was defined using the Glasgow Outcome Scale [GOS]. A good outcome was defined as GOS score> 3 at 3 months. Overall the results of management of spontaneous supratentorial ICH either by surgical or medical treatment is potentially confounded and inconclusive. Fourty six percent of the patients died [GOS 1], 34% remained severely disabled [GOS 3] and 20% became independent with moderate disability [GOS 4]. The likelihood of a good outcome [GOS >3] for the surgical treatment group differ from the medical treatment group [25% vs 13%]. There was no significant difference in mortality at 3 months [45% vs. 46.6%]. At the end of the follow up period, the median GOS score showed a nonsignificant trend towards a better outcome in the surgical treatment group against the medical treatment group [56% vs. 53%]. Craniotomy with clot evacuation for spontaneous supratentorial ICH may result in functional independence in approximately a quarter of patients [5 out 20]. Despite this, there is no clear indication from this study for the optimal treatment of these patients either through aggressive surgical intervention or conservative medical management

Will recombinant bovine somatotropin and/or PMSG can be used to dissolve the problem of delayed breeding in heifers and post partum cows

Twenty eight Holstein cows [16 heifers and 12 multiparous cows] were used. Heifers were weighed 350-380 kg, and failed to conceive till 2.5 years old. Multiparous cows calved since about 5-6 months and showed no any oestrus signs and low plasma progesterone. Heifers were assigned to three treatment groups in a randomized design. Eleven heifers were treated with a single injection per heifer of rb ST [Somatech]. Two days post injection, all heifers were rectally examined to ensure ovarian activity and follicular development. Seven days later, six of these rbST-treated heifers were injected PMSG. Third group were kept as control. Multiparous postpartum cows were assigned to two groups. First group [n=7] received bST, and second one [n=5] were treated with both rbST and PMSG injections according to the same procedure of heifers. Two weeks before treatment, blood samples were collected from all experimental animals once weekly, and then once daily on day 2, 3, 7 and 12 post injection for determinations of IGF-1 and insulin concentrations. Oestrus was detected in heifers and cows by usual observation and progesterone profile. All heifers and cows that detected in oestrus were artificially inseminated. First-service conception rates and pregnancy percentages were obtained. Postpartum cows were milked twice daily and average daily milk production was calculated before and after injection of bST. Plasma concentrations of IGF-1 and insulin showed significant increases in bST-treated heifers. However, IGF-1 concentrations were decreased after bST injection, and plasma insulin concentrations did not significantly affected in postpartum cows. Treatment with bST caused improving of the reproductive performance of heifers and postpartum cows

Effect of short term dietary supplementation with full fat flaxseed before breeding on fertility of local baladi ewes

This study was conducted to evaluate the effect of short term supplementation of flaxseed on some plasma metabolites and hormones, rumen metabolic profile, and fertility of local Baladi ewes at the late anoestrus season. Twenty non-pregnant, non-lactating mature Baladi ewes of 2.5- 3 years age were randomly assigned to one of two groups from mid September. Ten ewes served as controls fed a maintenance ration [500g concentrate] and received no supplement, and the remainder ewes supplemented with 100g full fat flaxseed per animal daily. After one month, ovarian status had been assessed in all females thorough ultrasonography. All females were then left with mature fertile bucks. Conception rate was recorded and confirmed by lambing. Blood samples were collected and plasma was frozen at 20 C pending analysis. Two hours before feeding, samples of rumen Contents were taken from either control and treated groups for determinations of ammonia N production and volatile fatiy acids, total and individual. Plasma values of urea, total lipids, and glucose were significantly higher due to flaxseed supplementation, while Plasma total Protein, albumin, triglyceride and cholesterol concentrations did not differ significantly between groups. Dietary flaxseed caused an increase in plasma insulin and estradiol values, but did not influence IGF-l. All measured parameters of rumen metabolic profile showed no significant variation. Ultrasonograms of the ovaries that revealed folIicular number and size was included in the paper. In spite of stimulatory effect on the ovaries, dietary flaxseed reduced conception rate indicating its estrogenic effect