Phylogenetic status and diet of red fox (Vulpes vulpes griffithii) inhabiting Ayubia National Park, Pakistan

Abstract The red fox (Vulpes vulpes) is a medium-sized carnivore that occurs in different regions of Pakistan, however, still lacks scientific data on its ecology and distribution. The current study investigated the phylogenetic status and diet of the red fox (V.v. griffithii) occurring in Ayubia National Park, Pakistan. Through camera trapping and molecular analysis, we confirmed the occurrence of red fox in the study area. Based on mitochondrial cytochrome B (304 bp) and limited sampling, nearly all red foxes of Ayubia National Park and surrounding Himalayan ranges fall within Holarctic maternal lineage, whereas red foxes found in plains of Pakistan are part of the basal Palearctic maternal lineage. Using 32 scats, we found that red fox diet comprises of 80% animal-based prey species (both wild and domestic) and 19% plant matter. The wild animal prey species included Cape hare (Lepus capensis) and flying squirrel (Pteromyini sp.), which constituted 17% and 15% of diet, respectively. Red foxes infrequently consumed House mouse (Mus musculus), Himalayan Palm civet (Paguma larvata) and sheep (Ovis aries), each comprising around 6% to 9% of red fox diet. The fox species also scavenged on domestic donkey opportunistically. Based on our sampling, our study suggests that the red fox (V.v. griffithii) that occurs in Ayubia National Park and across the lesser Himalayan ranges belongs to Holarctic maternal lineage. The study also highlights consumption of plant seeds by red foxes, indicating it may play an important ecological role in seed dispersal in Ayubia National Park.

Resumo A raposa-vermelha (Vulpes vulpes) é um carnívoro de médio porte que ocorre em diferentes regiões do Paquistão, porém ainda carece de dados científicos sobre sua ecologia e distribuição. O presente estudo investigou o status filogenético e a dieta da raposa-vermelha (V.v. griffithii) que ocorre no Parque Nacional de Ayubia, Paquistão. Por meio de armadilhas fotográficas e análises moleculares, confirmamos a ocorrência de raposa-vermelha na área de estudo. Com base no citocromo B mitocondrial (304 bp) e amostragem limitada, quase todas as raposas-vermelhas do Parque Nacional de Ayubia e áreas circundantes do Himalaia se enquadram na linhagem materna holártica, enquanto as raposas-vermelhas encontradas nas planícies do Paquistão fazem parte da linhagem materna basal paleártica. Usando 32 fezes, descobrimos que a dieta da raposa-vermelha compreende 80% de espécies de presas de origem animal (selvagens e domésticas) e 19% de matéria vegetal. As espécies de presas de animais selvagens incluíram a lebre-do-cabo (Lepus capensis) e o esquilo-voador (Pteromyini sp.), que constituíram 17% e 15% da dieta, respectivamente. As raposas-vermelhas consumiam raramente ratos domésticos (Mus musculus), algas do Himalaia (Paguma larvata) e ovelhas (Ovis aries), cada um compreendendo cerca de 6% a 9% da dieta da raposa-vermelha. A espécie de raposa também se alimentava de burros domésticos de forma oportunista. Com base em nossa amostragem, nosso estudo sugere que a raposa-vermelha (V.v. griffithii) que ocorre no Parque Nacional de Ayubia e nas cordilheiras menores do Himalaia pertence à linhagem materna holártica. O estudo também destaca o consumo de sementes de plantas por raposas-vermelhas, indicando que pode desempenhar um papel ecológico importante na dispersão de sementes no Parque Nacional de Ayubia.

Improving cardiovascular health with the patient-centered, integrated primary care HEARTS model in Trinidad and Tobago / Mejorar la salud cardiovascular con HEARTS, un modelo integrado de atención primaria centrado en el paciente, en Trinidad y Tabago / Melhoria da saúde cardiovascular com o modelo HEARTS de atenção primária integrada e centrada no paciente em Trinidad e Tobago

ABSTRACT This article describes the introduction of the Pan American Health Organization's HEARTS in the Americas program in Trinidad and Tobago and the successful experiences and challenges encountered in introducing and scaling it up as a strategy for strengthening the health system's response to cardiovascular diseases. Evidence about implementation of the HEARTS program in the World Health Organization's Region of the Americas was reviewed to identify the progress made, barriers, success factors and lessons learned. In 2019, the Ministry of Health commenced implementation of the program in 5 (4.9%) of the 102 primary health care centers, and by the end of 2021, it had been scaled up to 46 (45.0%) centers. The HEARTS program ensures that patients' cardiovascular health is managed in a comprehensive way through providing counseling about a healthy lifestyle, using evidence-based treatment protocols, ensuring access to essential medicines and technologies, and using a risk-based team approach, a monitoring and evaluation system and also a team-based approach to care delivery. The barriers encountered during implementation included the fragmentation of the existing health care system, the paternalistic role assumed by health care professionals, the resistance of some health care workers to change and a lack of team-based approaches to providing care. Successful implementation of the program was enabled through ensuring high-level political commitment, establishing the national HEARTS Oversight Committee, ensuring stakeholder involvement throughout all phases and implementing standardized approaches to care. When implemented in the context of existing primary health care settings, the HEARTS program provides an exceptionally well integrated and comprehensive model of care that embodies the principles of universal health care while ensuring the health of both populations and individuals. Thus, it enables and promotes a strengthened primary health care system and services that are responsive and resilient.

RESUMEN En este artículo se describe la introducción del programa HEARTS en las Américas de la Organización Panamericana de la Salud en Trinidad y Tabago y las experiencias satisfactorias y los desafíos encontrados con su ejecución y ampliación como estrategia para fortalecer la respuesta del sistema de salud a las enfermedades cardiovasculares. Se reunieron datos sobre la ejecución del programa HEARTS en la Región de las Américas de la Organización Mundial de la Salud con el fin de determinar cuáles han sido los avances, los obstáculos, los factores de éxito y las enseñanzas extraídas. En el año 2019, el Ministerio de Salud inició la ejecución del programa en cinco (4,9%) de los 102 centros de atención primaria de salud, y para fines del 2021, se había ampliado a 46 (45,0%). El programa HEARTS garantiza el manejo integral de la salud cardiovascular de los pacientes mediante la prestación de asesoramiento sobre hábitos saludables, la aplicación de protocolos de tratamiento basados en la evidencia, la garantía de acceso a medicamentos y tecnologías esenciales, así como el uso de un enfoque de trabajo en equipo basado en el riesgo, un sistema de monitoreo y evaluación, y un enfoque basado en el equipo para abordar la prestación de la atención. Entre los obstáculos para su ejecución se encontraron la fragmentación del sistema de atención médica, el papel paternalista asumido por los profesionales de la salud, la resistencia al cambio de algunos trabajadores de salud y la falta de enfoques de trabajo en equipo para la prestación de la atención. La ejecución satisfactoria del programa fue posible gracias a un compromiso político de alto nivel, la creación de un comité nacional de supervisión de HEARTS, la participación de las partes interesadas en todas las fases del programa y la aplicación de enfoques estandarizados para la atención. En su ejecución en el contexto de los entornos de atención primaria de salud existentes, el programa HEARTS proporciona un modelo de atención excepcionalmente bien integrado y exhaustivo que encarna los principios de acceso universal a la atención de salud al tiempo que garantiza la salud individual y poblacional. De este modo, este modelo fomenta un sistema de atención primaria de salud fortalecido y unos servicios receptivos y resilientes.

RESUMO Este artigo descreve a introdução do programa HEARTS nas Américas da Organização Pan-Americana da Saúde em Trinidad e Tobago e as experiências bem-sucedidas e os desafios encontrados durante a introdução e expansão do programa como estratégia para fortalecer a resposta do sistema de saúde às doenças cardiovasculares. Analisaram-se evidências sobre a implementação do programa HEARTS na Região das Américas da Organização Mundial da Saúde para identificar os avanços obtidos, os obstáculos, os fatores de sucesso e as lições aprendidas. Em 2019, o Ministério da Saúde iniciou a implementação do programa em 5 (4,9%) dos 102 centros de atenção primária à saúde; no final de 2021, o programa havia sido ampliado para 46 (45,0%) centros. O programa HEARTS assegura que a saúde cardiovascular dos pacientes seja manejada de uma forma abrangente por meio de aconselhamento sobre estilo de vida saudável, uso de protocolos de tratamento baseados em evidências, garantia de acesso a medicamentos e tecnologias essenciais e utilização de uma estratégia de equipe baseada no risco, de um sistema de monitoramento e avaliação e de uma abordagem de atendimento baseado em equipe. Os obstáculos encontrados durante a implementação incluíam a fragmentação do sistema de saúde existente, o papel paternalista assumido pelos profissionais de saúde, a resistência de alguns profissionais de saúde a mudanças e a falta de abordagens baseadas em equipe na prestação do atendimento. Para permitir que a implementação do programa fosse bem-sucedida, obteve-se compromisso político de alto nível, criou-se o Comitê de Supervisão do HEARTS nacional, assegurou-se o envolvimento de interessados diretos em todas as fases e implementaram-se abordagens padronizadas de atendimento. Quando implementado no contexto dos ambientes existentes de atenção primária à saúde, o programa HEARTS oferece um modelo de atenção excepcionalmente bem integrado e abrangente que incorpora os princípios de atenção universal à saúde, ao mesmo tempo em que garante a saúde das populações e dos indivíduos. Dessa forma, viabiliza e promove um sistema de atenção primária à saúde fortalecido e serviços responsivos e resilientes.

Quantitative ethnopharmacological profiling of medicinal shrubs used by indigenous communities of Rawalakot, District Poonch, Azad Jammu and Kashmir, Pakistan

Abstract This paper presents the first comprehensive report on traditional uses of medicinal shrubs of Rawalakot city, district Poonch, Azad Jammu and Kashmir, Pakistan. Ethobotanical data obtained from 120 informants were analyzed by relative frequency citation, use value, family use value, informant consensus factor, fidelity level and Jaccard index. In total, 41 shrubs belonging to 24 families and 34 genera were documented. Rosaceae was reported the most dominant family in the area (six species) and Berberidaceae showed maximum family use value (0.68). Leaves (35%) and fruits (33%) were the most commonly used plant parts and most of the medicines were prepared in the form of decoction. The high informant consensus factor value (0.94) was recorded for diabetic disease category. Medicinal plants with high fidelity level values (100% each) were Berberis lycium, Cydonia oblanga, Ricinus communis, Ziziphus jujuba and Nerium oleander. Berberis lycium was the most significant shrub in the area with highest use value (0.68). Relative frequency citation value was maximum for Rubus ellipticus (0.30), Nerium oleander and Indigofera heterantha (0.10 each). Percentage of similar plant uses ranged from 21.05 to 0.62% and dissimilarity percentage ranged from 32.50 to 0.66%. Out of the 41 shrub species, six were reported with new therapeutic uses and may represent new bioresources. These were Debregeasia salicifolia (diabetes), Desmodium elegans (anti-cancerous), Hibiscus rosa-sinensis (jaundice), Hypericum oblongifolium (arthritis), Sarcococca saligna (tuberculosis), Rubus niveus (chronic cough) and Otostegia limbata (renal disorders). We suggest that species reported with high use value should be involved in cultivation and agricultural practices for their sustainable use and those reported with new therapeutic uses should be employed in further biotechnological, pharmacological and clinical studies in order to validate their traditional uses.

Identification of Gram Positive and Negative Bacteria Microflora Isolated from Hot Water Spring in Bentong, Pahang / Jurnal Sains Kesihatan Malaysia

A study on the isolation and identification of bacterial flora from hot spring was carried out from Bentong hot springwater, Pahang. In general, many of the bacteria identified from the hot spring were from Bacillus sp. due to its abilityto adapt to high temperature mainly by forming endospore. The objective of this study was to identify bacteria otherthan Bacillus sp. that were able to survive this hot spring. Three hot spring pools were identified as A, B and C. Thetemperatures were ranging from 36°C to 52°C and their pH values were between 7.88-8.65. The result shows thattwo species of Gram positive cocci and three species of Gram negatives were isolated. The two Gram positives wereStreptococcus sp. and Staphylococcus sp. The three species of Gram negative rods were identified as Pseudomonas sp.,Klebsiella sp. and Proteus sp. In conclusion, non-sporulating species of bacteria other than Bacillus sp. have adaptedto survive in hot spring

Listening to Sentences in Noise: Revealing Binaural Hearing Challenges in Patients with Schizophrenia

OBJECTIVE: The present, case-control, study investigates binaural hearing performance in schizophrenia patients towards sentences presented in quiet and noise. METHODS: Participants were twenty-one healthy controls and sixteen schizophrenia patients with normal peripheral auditory functions. The binaural hearing was examined in four listening conditions by using the Malay version of hearing in noise test. The syntactically and semantically correct sentences were presented via headphones to the randomly selected subjects. In each condition, the adaptively obtained reception thresholds for speech (RTS) were used to determine RTS noise composite and spatial release from masking. RESULTS: Schizophrenia patients demonstrated significantly higher mean RTS value relative to healthy controls (p=0.018). The large effect size found in three listening conditions, i.e., in quiet (d=1.07), noise right (d=0.88) and noise composite (d=0.90) indicates statistically significant difference between the groups. However, noise front and noise left conditions show medium (d=0.61) and small (d=0.50) effect size respectively. No statistical difference between groups was noted in regards to spatial release from masking on right (p=0.305) and left (p=0.970) ear. CONCLUSION: The present findings suggest an abnormal unilateral auditory processing in central auditory pathway in schizophrenia patients. Future studies to explore the role of binaural and spatial auditory processing were recommended.

The Hyperactivity of Efferent Auditory System in Patients with Schizophrenia: A Transient Evoked Otoacoustic Emissions Study

OBJECTIVE: Electrophysiological studies, which are mostly focused on afferent pathway, have proven that auditory processing deficits exist in patients with schizophrenia. Nevertheless, reports on the suppressive effect of efferent auditory pathway on cochlear outer hair cells among schizophrenia patients are limited. The present, case-control, study examined the contralateral suppression of transient evoked otoacoustic emissions (TEOAEs) in patients with schizophrenia. METHODS: Participants were twenty-three healthy controls and sixteen schizophrenia patients with normal hearing, middle ear and cochlear outer hair cells function. Absolute non-linear and linear TEOAEs were measured in both ears by delivering clicks stimuli at 80 dB SPL and 60 dB SPL respectively. Subsequently, contralateral suppression was determined by subtracting the absolute TEOAEs response obtained at 60 dBpe SPL during the absence and presence of contralateral white noise delivered at 65 dB HL. No attention tasks were conducted during measurements. RESULTS: We found no significant difference in absolute TEOAEs responses at 80 dB SPL, in either diagnosis or ear groups (p>0.05). However, the overall contralateral suppression was significantly larger in schizophrenia patients (p<0.05). Specifically, patients with schizophrenia demonstrated significantly increased right ear contralateral suppression compared to healthy control (p<0.05). CONCLUSION: The present findings suggest increased inhibitory effect of efferent auditory pathway especially on the right cochlear outer hair cells. Further studies to investigate increased suppressive effects are crucial to expand the current understanding of auditory hallucination mechanisms in schizophrenia patients.

Sonographic measurement of renal size in normal North Indian children.

Objective: To determine the renal size in normal North Indian children by renal sonography. Design: Hospital based (outpatient based) cross sectional observational study. Material and methods: Total 1198 normal children aged 1 month to 12 years were included in the study. Sonographic assessment of renal size (length, width and thickness) was performed using Philips, multi frequency (3.5, 5 and 7.5 Mhz) linear and convex probes in B-mode. The mean renal dimensions and volume were calculated for each age group with ± 2SD. The renal length and calculated renal volume were correlated with somatic parameters like age, weight, height, and body surface area (BSA). Linear Regression equations were derived for each variable. Results: A strong correlation was seen between renal size and renal volume with various somatic parameters (age, weight, height, BSA), (coefficient of correlation = 0.9). Conclusion: This study provides values of renal size (mean± 2SD) in normal North Indian children and its correlation with age, weight,height, and BSA. Renal size can be easily calculated by derived linear regression equation.

Anxiety and Depressive Symptoms among Ischaemic Heart Disease Patients in a Malaysian Tertiary University Hospital

Anxiety and depression were known to bring detrimental outcome in patients with ischemic heart disease (IHD). Notwithstanding their high prevalence and catastrophic impact, anxiety and depression were unrecognized and untreated. The aim of this study was to determine the prevalence of anxiety and depression among IHD patients and the association of this condition with clinical and selected demographic factors. This was a cross-sectional study on 100 IHD patients admitted to medical ward in UKMMC. Patients diagnosed to have IHD were randomly assessed using Hospital Anxiety and Depression Scale (HADS) and Perceived Social Support (PSS) Questionnaire. Socio-demographic data were obtained by direct interview. Fifteen percent of IHD patients in this sample were noted to have anxiety, fourteen percent noted to have depression while thirty two percent was noted to have both anxiety and depression. Patients’ age group and the duration of illness were found to have significant association with anxiety. Socio-demographic data were obtained by direct interview. Fifteen percent of IHD patients in this sample were noted to have anxiety, fourteen percent noted to have depression while thirty two percent was noted to have both anxiety and depression. Patients’ age group and the duration of illness were found to have significant association wit¬h anxiety. The other clinical and selected demographic factors such as gender, race, marital status, education level, occupation, co-existing medical illness and social support were not found to be significantly associated with anxiety or depression among the IHD patients. In conclusion, proper assessment of anxiety and depression in IHD patients, with special attention to patients’ age and duration of illness should be carried out routinely to help avert detrimental consequences.​

Dermatofi brosarcoma protuberans of penis: Case report and literature review

Dermatofibrosarcoma protuberans [DFSP] is a rare mesenchymal skin tumor with intermediate to low grade malignancy and occasional distant metastasis and high rate of recurrence locally. It mostly involves trunk, extremities, scalp, and neck. This article describes a middle-aged married male with a DFSP lesion involving ventral aspect of glans and distal shaft of penis who underwent local excision and primary closure. The patient was tumor-free at three years of follow-up

Psychosis in Parkinson's Disease Patients

The objective of this study is to determine the prevalence and factors associated with psychosis in Parkinson’s disease (PD) patients. Method: This is a cross-sectional study of 108 PD patients from neurological clinic UKM Medical Centre and Kuala Lumpur Hospital. The patients were recruited from August to December 2004. Psychosis was determined using SCID, the severity of psychosis was rated using BPRS. The cognitive functions were evaluated with MMSE and the severity of depression was assessed with HAM-D. Results: The result shows that the prevalence of psychosis in Parkinson’s disease patients in this sample was 13%. The psychosis was found to be significantly associated with advancing age, duration of illness, severity of depression and cognitive impairment. Multivariate analysis demonstrates that severity of depression (OR = 1.08, 95% C.I. = 1.01 – 1.16) and advancing age (OR = 4.72, 95% C.I. = 1.37 – 16.29) increased risk of psychosis in PD patients. Conclusion: We found that advancing age and severity of depression increase risk to develop psychosis in patients with PD.

Identification of Bacterial Flora other than Bacillus sp. from Bentong Hot Spring in Pahang, Malaysia / Jurnal Sains Kesihatan Malaysia

A study on the isolation and identification of bacterial flora from hot spring was carried out using water from Bentong hot spring in Pahang. In general most of the bacteria identified from the hot springs were from Bacillus sp. This was due to its ability to adapt to high temperature mainly by forming endospore. The objective of this study was to identify bacteria other than Bacillus that were able to survive in hot springs. Three hot spring pools were identified (A,B and C) with temperatures ranging from 36°C to 52°C and pH values between 7.88-8.65. This study has succesfully isolated two species of Gram positive cocci and three species of Gram negative bacilli. The two Gram positives were Streptococcus sp. and Staphylococcus sp. The three species of Gram negative rods were unidentified and were denoted as X, XI and XII.

Women's attitude and sociodemographic characteristics influencing usage of herbal medicines during pregnancy in Tumpat District, Kelantan.

The objective of this cross-sectional study was to determine whether the use of herbal medicines during pregnancy is associated with women's attitudes towards herbal medicines and their sociodemographic features, such as age, education level, and income. Two-hundred ten women (110 "users," 100 "non-users") were studied. The probability of using herbal medicines among women who had negative attitudes towards the use of herbal medicines was 50.0% less compared to those who had positive attitudes (OR = 0.51, 95% CI = 0.29 - 0.92). Women who had a positive attitude towards the safety of herbal medicines were less likely to use herbal medicines during pregnancy. There were no significant associations between usage and sociodemographic features, such as age, income, race, and education.

Verbal Memory Test Performance In Patients With Bipolar I Disorder Attending A Psychiatric Clinic Of A University Hospital In Kuala Lumpur, Malaysia

Objective: The study aims to determine pattern of verbal memory and learning impairment and its associated factors among patients with bipolar I disorder in a psychiatric clinic of a university hospital. Methods: A case control study comparing verbal memory test performance in 40 patients with bipolar I disorder to that of 40 healthy normal subjects using Rey Auditory Verbal Learning Test (RAVLT). The association between demographic, clinical characteristics and poor verbal memory performance were examined. Results: Up to 92% of patients with bipolar I disorder have impaired short term working memory in this hospital-based study. They also recalled fewer words in all the RAVLT trials and had difficulties learning the word list in comparison to that of normal healthy individuals. Verbal memory and learning impairment are observed in bipolar illness in the absence of active mood symptoms while duration and severity of illness are not found to have any effect on verbal memory and learning. Conclusion: There is consistent verbal memory and learning problems in individuals with bipolar I disorder and their presence in the absence of mania, depression and mixed symptoms during the course of the illness suggests a trait related deficit.

Metabolic Syndrome In Psychiatric Patient With Primary Psychotic And Mood Disorders

Objective: A study was conducted at the Universiti Kebangsaan Malaysia Medical Center (UKMMC) adult psychiatric clinic from June 2006 to December 2006. The aim was to assess the rate of the metabolic syndrome in a group of outpatients with mood disorders and schizophrenia and also to determine the relationship of this condition with sociodemographic factors and psychiatric illness characteristics. Methods: A total of 51 subjects agree to participate of which 100 were approached. The International Diabetes Federation (IDF)(2005) criteria are used for the diagnosis of metabolic syndrome and Diagnostic Statistical Manual Version IV (DSM-IV) criteria are used to made psychiatric diaognosis. Results: The prevalence of metabolic syndrome was found to be 37.2% and was significantly higher amongst mood disorders patient. However the metabolic syndrome is not associated with the anti psychotic therapy (p=0.41). Conclusion: This study suggests that it is important for the psychiatrist to monitor metabolic syndrome in any of their patients.

Ligasure versus clamp-and-tie technique to achieve haemostasis in thyroidectomy: prospective comarative study

This study was carried out to compare postoperative outcomes in patients undergoing thyroidectomy with the use of LigaSure versus clamp and tie technique to assess whether operative time can be reduced without worsening the postoperative outcome. This study included 36 patients who underwent thyroidectomy and LigaSure was exclusively used for haemostasis in 19 patients and clamp and tie technique in 17 patients, both groups were compared regarding operative time, hypoca lcaemia, recurrent nerve palsy, cervical haematoma, hospital stay, postoperative drainage and period for return to normal activity. Both groups were statistically different for age [p=.005] and sex [p=.01] but not for underlying pathology. No mortality was reported in this study. No significant difference between both groups regarding hypocalcaemia, nerve palsy, hospital stay, cervical haematoma, postoperative drainage but there was significant reduction of operative time in LigaSure group in all types of thyroidectomy versus clamp and tie group [p=0.000] as well as the need for extradoses of analgesics and period for return to activity [p=0.000] LigaSure is equally as safe and effective as clamp and tie technique in thyroid surgery, moreover it significantly reduces operative time

The use of herbal medicines during pregnancy and perinatal mortality in Tumpat District, Kelantan, Malaysia.

The objective of this case-control study was to determine the association between herbal medicine use during pregnancy and perinatal mortality in Tumpat District, Kelantan, Malaysia. Cases were mothers who gave birth from June 2002 to June 2005 with a history of perinatal mortality, while controls were those without a history of perinatal infant mortality. A total of 316 mothers (106 cases and 210 controls) were interviewed. The use of unidentified herbs prepared by traditional midwives and other types of herbal medicines during the first trimester of pregnancy were positively associated with perinatal mortality (OR = 5.24, 95% CI = 1.13; 24.23 and OR = 8.90, 95%, CI = 1.35; 58.53, respectively). The use of unidentified "Orang Asli" herbs and coconut oil during the third trimester of pregnancy were negatively associated with perinatal mortality in Tumpat (OR = 0.10, 95% CI = 0.02; 0.59 and OR = 0.48, 95% CI = 0.25; 0.92, respectively). These findings suggest the use of unidentified "Orang Asli" herbs and coconut oil in late pregnancy are protective against perinatal mortality, while the use of unidentified herbs prepared by traditional midwives and other types of herbal medicines in early pregnancy has an increased risk of perinatal infant mortality. Pharmacological studies to confirm and identify the compounds in these herbs and their effects on the fetus should be conducted in the future.

Colostomy closure in pediatric age group. A comparative study between Single and double layer anestomosis

This prospective study involved one hundred patients with colostomies admitted at the Central Pediatric Teaching Hospital for colostomy closure over the period of two years [Jan 2000- Jan 2002]. Patients were divided in to two groups according to the technique of colostomy closure. In the first group, the closure was done by single layer of interrupted non-absorbable suture material; in the second group closure was done by double layer suturing technique. All patients were prepared by the same conventional method including fluid diet for three days followed by two days washing enemas before operation with antimicrobial prophylaxis agents. Of these one hundred patients; [48] presented as cases of Hirschsprung's disease, [50] were cases of ano-rectal malformations, and [2] were cases of traumatic colonic perforation. According to the type of the colostomy there were [62] loop colostomy, and [38] double-barreled colostomy. According to the site of the colostomy; there were [84] patients with right transverse colostomy, [2] with left descending colostomy, [12] with sigmoidostomy, and [2] with cecostomy. Sixteen patients developed complications following colostomy closure; these were [wound infection, fecal fistula, small bowel obstruction, and other systemic infections]. We advise single layer bowel anastomosis for the following reasons: 1- operative time [anesthetic time] theoretically shorter with single layer closure. 2- less tissue handling [less trauma] with single layer closure. 3- less narrowing effect [as less suture material] on the already small bowel lumen. Too many sutures and too many knots leading to comprise blood supply with double layer closure. 4- more cost benefit with single layer closure

Study of increased urinary nitrite excretion as a diagnostic marker for minmal change nephrotic syndrome

Urinary excretion of nitrite [a stable metabolite of nitric oxide] was estimated in children with nephrotic syndrome and healthy children as a control group. Urinary nitrite level was significantly increased in patients with nephrotic syndrome when compared with control group [p < 0.001]. It was significantly higher in patients with minimal change nephrotic syndrome than control group [p < 0.0001]. In contrast it showed no significant change in patients with non minimal change nephrotic syndrome when compared to control group [p > 0.05]. No significant difference could be detected in urinary nitrite level between the attack and remission in patients with minimal change nephrotic syndrome. We concluded that estimation of urinary nitrite level can be considered as a diagnostic marker for minimal change nephrotic syndrome. It is an easy rapid and non invasive test to discriminate it from other causes of nephrotic syndrome

Study of serum angiotensin converting enzyme activity in children with acute and chronic liver diseases

Serum angiotensin converting enzyme [SACE] was determined beside other biochemical hepatic markers in 34 children with liver disease. They were classified into 3 groups: group I: consisted of 12 children suffering from acute viral hepatitis, group II: consisted of 13 children with compensated bilharzial hepatosplenomegally and group III: consisted of 9 children with decompensated bilharzial liver fibrosis. 12 apparently healthy children represented the control group. A significant increase in serum angiotensin converting enzyme activity was observed in all patient groups. This increase was much marked in children of group III with good correlation with other traditional biochemical hepatic markers. We concluded that SACE activity increases in acute and chronic liver disease and could be used as an index of severity of liver impairments especially in chronic liver diseases