Clinical and Safety Outcomes of Endovascular Therapy 6 to 24 Hours After Large Vessel Occlusion Ischemic Stroke With Tandem Lesions / 대한뇌졸중학회지

Background@#and Purpose Effect of endovascular therapy (EVT) in acute large vessel occlusion (LVO) patients with tandem lesions (TLs) within 6–24 hours after last known well (LKW) remains unclear. We evaluated the clinical and safety outcomes among TL-LVO patients treated within 6–24 hours. @*Methods@#This multicenter cohort was divided into two groups, based on LKW to puncture time: early window (<6 hours), and late window (6–24 hours). Primary clinical and safety outcomes were 90-day functional independence measured by the modified Rankin Scale (mRS: 0–2) and symptomatic intracranial hemorrhage (sICH). Secondary outcomes were successful reperfusion (modified Thrombolysis in Cerebral Infarction score ≥2b), first-pass effect, early neurological improvement, ordinal mRS, and in-hospital and 90-day mortality. @*Results@#Of 579 patients (median age 68, 32.1% females), 268 (46.3%) were treated in the late window and 311 (53.7%) in the early window. Late window group had lower median National Institutes of Health Stroke Scale score at admission, Alberta Stroke Program Early Computed Tomography Score, rates of intravenous thrombolysis, and higher rates for perfusion imaging. After adjusting for confounders, the odds of 90-day mRS 0–2 (47.7% vs. 45.0%, adjusted odds ratio [aOR] 0.71, 95% confidence interval [CI] 0.49–1.02), favorable shift in mRS (aOR 0.88, 95% CI 0.44–1.76), and sICH (3.7% vs. 5.2%, aOR 0.56, 95% CI 0.20–1.56) were similar in both groups. There was no difference in secondary outcomes. Increased time from LKW to puncture did not predicted the probability of 90-day mRS 0–2 (aOR 0.99, 95% CI 0.96–1.01, for each hour delay) among patients presenting <24 hours. @*Conclusion@#EVT for acute TL-LVO treated within 6–24 hours after LKW was associated with similar rates of clinical and safety outcomes, compared to patients treated within 6 hours.

Antiplasmodial, Antipyretic, Haematological and Histological Effects of the Leaf Extracts of Moringa oleifera in Plasmodium berghei berghei Infected Mice

Theaqueous and ethanolic extracts of Moringa oleiferaleaf were evaluated for safety, antimalarial and antipyretic activities because it is commonly used for various types of ailments especially malaria and fever. The various concentration of these extracts (0-800mg/kg) were tested against Plasmodium berghei bergheiinfectedalbino mice of either sex, in a Peters’four day antiplasmodialtest while antipyretic activities were evaluated in malaria-induced mice. Their possible effects on haematological parameters of PCV, WBC, neutrophil, lymphocytes count and liver enzymes were also determined as well as on the liver and kidney architecture. All the tested doses of the aqueous extract were comparable in antiplasmodial activity (p>0.05) to each of the tested doses of the ethanolic extract which were significantly different (p<0.05) from the negative control. Only the highest doses of both extracts gave significantly higher (p<0.05) antiplasmodial activity than the standard drug. For the ethanolic extract,a significant antipyretic activity was not observed until at 800mg/kg in time T3while the aqueous extract exerted no significant antipyretic activity at all doses and at all times. The ethanolic extract gave significantly higher PCV values than that of the aqueous. The administration of the aqueous extract gave significantly lower WBC than the ethanolic extract while comparable increase in lymphocyte count was noticeable at each of the doses of both extracts when compared to the negative control. Only 100mg/kg and 800mg/kg of the aqueous extract maintained a relatively high neutrophils count in this study. Also, the aqueous extract elicited higher concentration of ALT (greater than fourfold of normal) but the ethanolic extract produced the highest level of AST at the highest dose of 800mg/kg when compared to the ethanolic extract. Histological examination of the kidney showed progressive degeneration while that of the liver showed recovery when compared to negative control as a result of progressive increase in dosage of the extracts in malarial treatment.In conclusion, though both aqueous and ethanolic extracts of M. oleiferaleaves exert chemosuppressive antiplasmodial activities in Plasmodium berghei bergheiinfected mice and exhibited antipyretic activity with some improved haematological parameters, caution should be taken in its indiscriminate use because of probable toxic effects on thekidney and the liver.

Insights into CYP2B6-mediated drug-drug interactions

Mounting evidence demonstrates that CYP2B6 plays a much larger role in human drug metabolism than was previously believed. The discovery of multiple important substrates of CYP2B6 as well as polymorphic differences has sparked increasing interest in the genetic and xenobiotic factors contributing to the expression and function of the enzyme. The expression of CYP2B6 is regulated primarily by the xenobiotic receptors constitutive androstane receptor (CAR) and pregnane X receptor (PXR) in the liver. In addition to CYP2B6, these receptors also mediate the inductive expression of CYP3A4, and a number of important phase II enzymes and drug transporters. CYP2B6 has been demonstrated to play a role in the metabolism of 2%-10% of clinically used drugs including widely used antineoplastic agents cyclophosphamide and ifosfamide, anesthetics propofol and ketamine, synthetic opioids pethidine and methadone, and the antiretrovirals nevirapine and efavirenz, among others. Significant inter-individual variability in the expression and function of the human CYP2B6 gene exists and can result in altered clinical outcomes in patients receiving treatment with CYP2B6-substrate drugs. These variances arise from a number of sources including genetic polymorphism, and xenobiotic intervention. In this review, we will provide an overview of the key players in CYP2B6 expression and function and highlight recent advances made in assessing clinical ramifications of important CYP2B6-mediated drug-drug interactions.

Seropositivity of Toxoplasmosis in Pregnant Women by ELISA at Minia University Hospital, Egypt

Toxoplasmosis is considered as an important risk factor for bad obstetric history (BOH) and one of the major causes of congenitally acquired infections. The present study aimed to estimate the seropositivity of T. gondii infection and associated risk factors among the attendees of high risk pregnancy and low risk antenatal care clinic of Minia Maternity and Pediatric University Hospital, Minia, Egypt. The study was carried out from April 2013 to April 2014 through 2 phases, the first phase was case-control study, and the second phase was follow-up with intervention. A total of 120 high risk pregnant and 120 normal pregnant females were submitted to clinical examinations, serological screening for anti-Toxoplasma IgM and IgG antibodies by ELISA, and an interview questionnaire. Seropositive cases were subjected to spiramycin course treatment. The results showed that the seroprevalence of toxoplasmosis in high-risk pregnancy group was 50.8%, which was significantly different from that of normal pregnancy group (P<0.05). Analysis of seropositive women in relation to BOH showed that abortion was the commonest form of the pregnancy wastage (56.5%). The high prevalence of T. gondii seropositive cases was observed in the age group of 21-30 years. Post-delivery adverse outcome was observed in 80.3% of high-risk pregnancy group compared to 20% of normal pregnancy group. There was a statistically significant relationship between seropositivity and living in rural area, low socioeconomic level, and undercooked meat consumption (P<0.05). Serological screening for anti-Toxoplasma antibodies should be routine tests especially among high-risk pregnant women.

fMRI resting state time series causality: comparison of Granger causality and phase slope index.

Granger causality and Phase Slope Index (PSI) are recent approaches to measure how one signal depends on another, which gives an indication of information flow in complex systems. We show that the Granger causality and PSI mapping, voxel-by-voxel, for functional magnetic resonance imaging (fMRI) resting state data set. Slow fluctuations (< 0.1 Hz) in fMRI signal have been used to map several consistent resting state networks in the brain. The results demonstrate that PSI influence directions among reference regions and gray matter voxels were more consistent with the relevant previous studies compared with Granger causality. The PSI approach proposed is effective, computationally efficient, and easy to interpret.

Differential expression of alpha-smooth muscle actin and vascular endothelial growth factor in skin biopsy of patients with systemic sclerosis: a histological and immunohistochemical study

Vasculopathy is a hallmark of systemic sclerosis [SSc]. It contributes to many of its clinical manifestations and precedes fibrosis. The aim of this study was to investigate the expression of alpha-smooth muscle actin [alpha-SMA] in skin biopsy of patients with SSc and correlate it with other manifestations of vasculopathy, including those seen on fundus fluorescein angiography and tissue vascular endothelial growth factor [VEGF] expression. This study included 25 patients with SSc and 10 healthy individuals. Patients underwent full history taking and a clinical examination. All participants underwent fundus fluorescein angiography. Skin biopsy was examined by H and E staining, Mallory triple staining, and immunohistochemical staining for alpha-SMA and VEGF. Histological examination showed loss of dermal papillae, hypovascularity of the dermis, and subepidermal fibrosis. Immunohistochemical staining of the vessel wall in skin biopsy samples showed a statistically highly significant increase in VEGF and a highly significant decrease in alpha-SMA in patients as compared with controls. There was a highly significant positive correlation between VEGF and duration of illness, Raynaud's phenomenon, digital ulcers, disease activity score, and modified Rodnan Skin Score. As regards alpha-SMA, there was a highly significant negative correlation with Raynaud's phenomenon, disease activity score, modified Rodnan Skin Score, and VEGF, whereas there was a significant negative correlation with digital ulcers. The strongest correlation [r] for the duration of illness was found with alpha-SMA, followed by VEGF. alpha-SMA was found to be correlated to different manifestations of vasculopathy in SSc. It was found to be one of the early markers of vasculopathy among the other studied variables. Besides its diagnostic role in SSc vasculopathy, it could play a role in impaired vasculogenesis, making it a potential therapeutic target in the management of SSc

Naso-Maxillary extramedullary plasmacytoma: a case report

We report an early case of extramedullary, right maxillary sinus and nasal, plasmacytoma. The patient was a 27 years old female who presented with nasal bleeding and a nasal mass. Imaging studies showed opacities in the nasal cavity and the maxillary sinus but there was no bone involvement. A biopsy from the nasal mass showed a plasmacytoma. She was investigated to rule out systemic disease. The investigations included; serum electrophoresis, urine analysis for Bence Jones proteins, bone marrow aspirates study and radiological skeletal survey. The results of all investigations were negative. After complete excision of the tumour endoscopically the patient was treated with adjuvant radiotherapy. She remained well, without recurrence or spread of the tumour at 4 years follow up. CT scans pre and postoperatively as well as H and E and Immunohistochemistry slides are presented. To our knowledge, this is the first case to be reported in Sudan

Relationship between maternal characteristics and neonatal birth size in Egypt

This study in Egypt investigated the influence of selected maternal factors on neonatal birth size. Data were collected after delivery from 782 apparently healthy pregnant women and their neonates. A questionnaire on personal, medical, socioeconomic status, smoking habits and exposure to smoking was completed. Maternal weight and height, food frequency intake during pregnancy and haemoglobin levels were recorded for 594,234 and 246 of the mothers respectively. Neonatal birth weight, length and head circumferences were measured. A significant positive correlation between maternal anthropometric variables with neonatal birth dimensions was observed and the effect was more evident in girls than boys for BMI and head circumference. Statistically significant negative correlations were found between maternal haemoglobin levels and birth size. Birth size was strongly correlated with maternal consumption of micronutrient-rich food at all stages of gestation. Passive smoking significantly affected birth weight and BMI of girls more than boys

Barriers in controlling glycemic ondition of children suffering from type 1 diabetes

Children with type 1 diabetes have many barriers that prevent them from controlling their blood glucose level. Aim of this study was assess barriers in glycemic control of children suffering from type 1 diabetes. A descriptive design was used for the conduction of the study. The sample of the study consisted of 300 children with type 1 diabetes, their ages ranges from <1 to <18 years, 67.7% of them were males and 32.3% females. A questionnaire sheet was designed by the researcher to collect the demographic characteristics and knowledge about diabetes among study sample in addition to observational check lists to evaluate, the actual practice of the diabetic children regarding insulin preparation and injection, urine and blood testing for glucose and urine testing for ketones. Results and conclusion of the study revealed that barriers of glycemic control include children's characteristics [66.7%], childrens knowledge about diabetes and glycemic control [67.7%], health care facility [53.3%], duration of illness [54.3%] and poor self care practices [68.7%]. There is a relation between the children educational level and barriers of glycemic control and also there is a highly statistical significance difference between barriers of glycemic control and their glycemic condition. The study recommends continuous educational programs which are vital for diabetic children and their care givers to maintain their glycemic control and consequently helping them to identify and manage its barriers

Comparison of Lipopolysaccharide binding protein and C-reactive protein gene expression levels in a Rat model of induced Atherosclerosis

Atherosclerosis is an inflammatory disease characterized by the accumulation of lipids within arterial walls that eventually go on to form plaques, which can cause narrowing, hardening, and/or complete blockage of arteries. This study was designed to examine the cholesterol feeding induction of cardiovascular diseases exemplified by atherosclerosis in rat and induction of CRP, LBP, SAP and P4H on the transcriptional activity of the inflammation / related gene expression by a semi-quantitative RT-PCR in liver and heart tissues, and make comparison between CRP and LBP as biomarker for atherosclerosis. Experimental Rats were fed with cholesterol diet [2.5% pure [wt/wt] cholesterol, 1% cholic acid and 5% oil] and sacrificed after 18 weeks of feeding. Histopathological examination for heart showed fatty cells deposition in atherogenic rats. Expression pattern of CRP, LBP, SAP and P4H genes were investigated, in liver and heart, these genes were highly expressed while some of them showed no expression pattern in heart tissues

suggested algorithm for using serum biomarkers for the diagnosis of liver fibrosis in chronic hepatitis C infection

Hepatitis C virus infection [HCV] is endemic in Egypt. Liver biopsy is the gold standard for diagnosis and staging of fibrosis in chronic hepatitis C patients. However, it is invasive, associated with sampling error and poses potential complications. A non-invasive alternative is needed. This assessed the accuracy of certain biochemical markers and ultaronography in predicting the stage of fibrosis in chronic hepatitis C patients. Sixty five patients with chronic HCV were enrolled. Ultrasonographic examination, complete blood count and liver function tests were done. Serum levels of hyaluronic acid [HA] and YKL-40 [a 40-kDa glycoprotein produced by stellate cells] were determined. Liver biopsy was done. Fibrosis was correlated with biochemical markers and ultrasonographic findings. Histopathological examination showed that 39 patients [60%] had F1, nine [14%] had F2, 17 [26%] had F3 and none had F0 or F4 scores. A value of alanine aminotransferase [ALT] index <0.38, HA <9.7 ng - ml[-1] or portal vein [PV] cross-sectional area <25.8 mm[2] excluded significant fibroses [>/= F2]. A value of aspartate aminotransferase [AST] + ALT<39.5 or ratio of AST index to the platelet count [APRI] <0.235 or HA x 100 per platelet [Plt] < 9.534 excluded the presence of advanced fibrosis with 100% negative predictive value [NPV]. Using these values, advanced fibrosis could be excluded in 72% of our patients. An APRI value of >/= 1.1 can diagnose advanced fibrosis with 100% positive predictive value [PPV] in 10%of our patients. Hence, only 18% of our patients in whom liver biopsy was recommended were not classified by these parameters. YKL-40 did not help in the diagnosis of advanced fibrosis. Applying a simple algorithm based on ALT, AST, platelet count, PV cross-sectional area, in addition to HA level may eliminate the need for liver biopsies in more than 80% of chronic HCV patients

Intensity modulated radiotherapy [IMRT] versus dynamic wedge techniques in radiation therapy of the breast; impact on dosimetric parameters and radiation dose to contralateral breast

New techniques of radiation therapy are being introduced in the management of breast cancer. One of the most rapidly emerging new techniques is intensity modulated radiotherapy [IMRT]. The purpose of the study is to compare between two different techniques of radiation therapy of breast cancer for intact breasts after breast conservative therapy [BCT]; IMRT and dynamic wedge [DW] [standard technique] regarding their impact on dosimetric features of the treated breast and the radiation dose received by the contralateral breast. Fourteen female patients with breast cancer treated with BCT and referred for adjuvant radiation therapy at radiation therapy department of King Abdulaziz University hospital; Jeddah Saudi Arabia during the period January 2007-August 2007 had been studied. Their archived CT scans for breasts were retrieved and the two plans [IMRT and dynamic wedge techniques] were implemented in those CT cuts. The dosimetric parameters [maximum dose; minimum dose, mean dose and homogeneity index] for the treated breast as well as the radiation dose received by the other breast [at 5%, 50% and 95% of its volume] were compared between the two techniques. Fourteen patients had been included in the study; their mean age was 44.9 years; 8 were left sided, and 6 right sided and all of them had been referred for radiation therapy after BCT. The mean radiation dose received by DW technique was 50.68 Gy as compared to 51.23 by IMRT [p value: 0.023], the mean homogeneity index [HI] of dynamic wedge technique was 15.36 [ +/- 39 SD] as compared to 7.02 for IMRT [p value 0.001]. Regarding the radiation therapy dose received by the contralateral breast; it had been found that in DW technique; the 5%; 50% and 95% of the volume of the contralateral breast received a mean radiation dose of 1.16 Gy, 0.31 Gy, and 0.097 Gy respectively as compared to 4.11 Gy, 1.33 Gy and 0.82 Gy respectively; a highly significant difference [p value: 0.0001] with significantly higher dose to contralateral breast by IMRT technique as compared to DW technique. Although the IMRT technique achieved a better dose homogeneity as compared to dynamic wedge technique; however; the radiation dose received by the contralateral [normal] breast was significantly higher in IMRT technique. So we have to be cautious if we want to implement the IMRT technique in radiation therapy of breast to avoid unnecessary radiation exposure to the contralateral breast with its possible impact on late incidence of carcinogenesis

Botanical study of Meryta denhamii seem and its anthelmintic activity against Fasciola gigantica

The anthelmintic activity of the ethanolic extracts of stems and leaves of Meryta denhamii Seem, against adult liver flukes [Fasciola gigantica] was studied in vitro. Although leaves extract was inactive, stems extract exhibited anthelmintic activity and recorded LC[50] and LC[90] values, 16 and 26 gm/1 respectively. The mode of action of the ethanolic extract of the stems on the adult flukes was evaluated by scanning electron microscopy [SEM]. Tegumental sloughing, loss of spines and deformity of suckers were observed. These damages are responsible for the vermicidal effect of the ethanolic extract of the stems. The saponin contents of the stems [4.25%] and leaves [2.45%] were determined using haemolytic index. The plant was identified based on the macro and micromorphological features of the stem and leaf

Head circumference reference data for Egyptian children and adolescents

Data from a cross-sectional study of 27 826 healthy children in Cairo, Egypt, were used to construct standard growth charts of head circumference and reference values of relative head circumference to length/height for each sex. The sample was collected during the Egyptian Growth Curve Project for children and adolescents in 2002. Values were obtained for each month cohort for children aged 1-24 months, then for each year cohort until age 18 years. The values were compared with those of other populations. The constructed growth standards are suitable for growth monitoring programmes throughout Egypt

Waist circumference and central fatness of Egyptian primary-school children

This cross-sectional study of 1283 healthy children [681 boys, 602 girls] aged 6-11 years tested the degree of correlation between waist circumference measurements and adiposity. The children were classified as normal, overweight or obese according to their body mass index [BMI]. For both sexes a highly positive correlation was found between waist circumference and BMI, percentage of body fat, subscapular and suprailiac skinfold thicknesses, and the sum of skinfold measures. Central overweight and obesity were indicators for central fatness for both overweight boys and girls and for obese girls except in age group 6.5 +/- 1 years. Waist circumference was a good indicator of central fatness [overweight and obesity] in children aged 8.5 +/- years and 10.5 +/- 1 years

Endometriosis in the renal area

A case of 34 weeks pregnancy along with a large abdominal mass presented in emergency with a constant dull abdominal pain and premature labour. After delivery of the baby the dull ache persisted, prompting a laparotomy in the first postnatal week. A large cyst, arising from the left renal area and occupying almost the whole left side of the abdomen, was removed. Histopathology showed it to be an endometriotic cyst. The patient made an uneventful recovery

Molluscicidal saponins from leaves of Hedera canariensis

Activity-guided fractionation of the methanol extract of Hedera canariensis [var. Gloire de Maringo] Wild leaves afforded five saponins 1-5. Chemical and spectral methods [MS, [1]HNMR, [13]CNMR] showed that they are glycosides of hederagenin and oleanolic acid. The results showed that 4,5 exhibited molluscicidal properties, compound 1 was inactive. Mortality rate of exposed snails increased by increasing plant extract concentration. Lymnaea cailliaudi was more sensitive to plant extract than Biomphalaria alexandrina. The histopathological study revealed distinct damage in the structure of the stomach and ovotestis of treated L. cailliaudi snails. Saponin content was determined in term of haemolytic index

Egyptian neonatal body physique profile in different economic classes

It is generally accepted that the pattern of future growth and development of any child represent the results of interaction between hereditary and environmental factors. The goal of this study is to determine if there were differences in the body size at birth in the high versus low economic classes. This study was distinctive in the sampling of two economic classes [high and low] in Egypt, and the use of seven anthropometric measurements and indices in addition to birth weight. The sample consisted of 1961 singleton full tern Egyptian neonates of low [n=816] and high [n=1145] economic classes. Egyptian neonates of high economic class are significantly advanced than low economic ones in body length [L], and sub scapular skin fold thickness [Subscap SF], while neonates of low economic have significantly higher values than others in mid-upper-arm circumference [MAC], triceps skin fold thickness [TSF], body mass index [BMI] and mid upper arm circumference [cm]/head circumference [cm] [MAC/HC] ratio in each sex separately, and in birth weight [Wt] for girls only. On the other hand, the values of head circumference [HC] are the same in the two classes. The economic class has an impact on fat distribution [peripheral, trunkal] as well as linear growth of Egyptian neonates, but has no effect on HC at birth. There is a tendency towards increase in nutritional anthropometrical indicators among the Egyptian neonates belonging to the low economic class compared to those of High economic class

Outcome of double burr-hole craniotomy in patients with chronic subdural haematoma

Chronic subdural haematoma [CSDH] is a common condition in late stages of life. Most of the patients are subjected to minor trivial trauma which will end up with a collection of altered blood in the subdural space. This necessitates immediate surgical drainage, with the aim to reduce the mass effect on the brain to alleviate the symptoms and to reverse the condition. To report the experience and outcome of double burr-holes craniotomy in treatment of chronic subdudal haematoma. This study was conducted on 70 patients with CSDHs managed at Omdurman Teaching Hospital Sudan, during the period from November 2004 to November 2006. All patients after clinical assessment and CT scan of the brain proved to have CSDH. The haematoma was removed surgically by double burr-holes craniotomy, irrigation and close system drainage. The study included 70 patients, 50 males and 20 females. The mean age was 69 years. Computed tomography scan, showed unilateral collection in 60% of patients and bilateral in 40%, only 1.8% showed conning of the brain. Unilateral double burr-hole craniotomy was performed in 60% of the patients, while bilateral was done in 35.7%. In the postoperative follow up 87.1% of the patients showed uneventful recovery. Seven patients developed complications in the form of pneumocephallus or postoperative recurrence. The mortality rate was 2.9%. Burr holes craniotomy, irrigation and close system drainage, is effective and favor rapid regression of residual subdural collection and associated with fewer recurrences

Causes postmenopausal bleeding in our population

To evaluate common causes of postmenopausal bleeding in our population. Observational Analytical study. Department of Obstetrics and Gynaecology unit II Lady Willingdon Hospital Lahore from June 2000 to May 2002. Hysteroscopically directed endometrial biopsies were taken from 100 cases of postmenopausal bleeding and were sent for histopathology. The data was collected with the help of Performa which was filled for every patient. In our part of world, Atrophic Endometrium is the commonest cause of Postmenopausal Bleeding [PMB]. Next common being Endometrial Hyperplasias. Out of malignant causes, Carcinoma Cervix is the commonest. Postmenopausal bleeding [PMB] should be taken seriously; no matter how less the bleeding is and malignant causes should be ruled out