Epidemiology of neural tube defects

To find the prevalence of neural tube defects [NTDs], and compare the findings with local and international data, and highlight the important role of folic acid supplementation and flour fortification with folic acid in preventing NTDs. This is a retrospective study of data retrieved from the medical records of live newborn infants admitted to the Neonatal Intensive Care Unit [NICU], Security Forces Hospital [SFH], Riyadh, Saudi Arabia with NTDs spanning 14 years [1996-2009]. All pregnant women on their first antenatal visit to the primary care clinic were prescribed folic acid 0.5 mg daily, or 5 mg if there is a family history of NTD. The pre-fortification prevalence is compared to post-fortification, before and after excluding syndromic, genetic, and chromosomal causes. The results were compared with reports from other parts of Saudi Arabia and internationally, through a literature search using MEDLINE. The prevalence of NTDs during the period was 1.2 per 1000 live births. The pre-fortification of flour with folic acid prevalence was 1.46 per 1000 live births. The post-fortification prevalence was 1.05 [p=0.103]. After excluding syndromic, genetic, and chromosomal causes from calculation of the prevalence, there was a significant reduction in the prevalence, from 1.46 to 0.81 per 1000 live births [p=0.0088]. Syndromic, genetic, and chromosomal causes were identified in 20 cases [19.4%]. Only 2% of mothers received preconception folic acid, and only 10% of them received it during the first 4 weeks of gestation. Conclusion: Despite the implementation of fortification of flour with folic acid since 2001, the prevalence of NTDs in the Kingdom of Saudi Arabia is still high. This is due to the impact of genetic, syndromic, and chromosomal causes of NTD not preventable by folic acid. Other factors like unplanned pregnancy and lack of awareness of the role of folic acid in preventing nonsyndromic causes, play a significant role.

Sirenomelia and severe caudal regression syndrome

To describe cases of sirenomelia and severe caudal regression syndrome [CRS], to report the prevalence of sirenomelia, and compare our findings with the literature. Retrospective data was retrieved from the medical records of infants with the diagnosis of sirenomelia and CRS and their mothers from 1989 to 2010 [22 years] at the Security Forces Hospital, Riyadh, Saudi Arabia. A perinatologist, neonatologist, pediatric neurologist, and radiologist ascertained the diagnoses. The cases were identified as part of a study of neural tube defects during that period. A literature search was conducted using MEDLINE. During the 22-year study period, the total number of deliveries was 124,933 out of whom, 4 patients with sirenomelia, and 2 patients with severe forms of CRS were identified. All the patients with sirenomelia had single umbilical artery, and none were the infant of a diabetic mother. One patient was a twin, and another was one of triplets. The 2 patients with CRS were sisters, their mother suffered from type II diabetes mellitus and morbid obesity on insulin, and neither of them had a single umbilical artery. Other associated anomalies with sirenomelia included an absent radius, thumb, and index finger in one patient, Potter's syndrome, abnormal ribs, microphthalmia, congenital heart disease, hypoplastic lungs, and diaphragmatic hernia. The prevalence of sirenomelia [3.2 per 100,000] is high compared with the international prevalence of one per 100,000. Both cases of CRS were infants of type II diabetic mother with poor control, supporting the strong correlation of CRS and maternal diabetes.

Genetic, chromosomal, and syndromic causes of neural tube defects

To ascertain the incidence, and describe the various forms of neural tube defects [NTDs] due to genetic, chromosomal, and syndromic causes. We carried out a retrospective analysis of data retrieved from the medical records of newborn infants admitted to the Neonatal Intensive Care Unit with NTDs and their mothers spanning 14 years [1996-2009] at the Security Forces Hospital, Riyadh, Saudi Arabia. The cases were ascertained by a perinatologist, neonatologist, geneticist, radiologist, and neurologist. The literature was reviewed via a MEDLINE search. Only liveborn babies were included. Permission from the Educational Committee at the Security Forces Hospital was obtained prior to the collection of data. Out of 103 infants with NTDs admitted during this period, 20 [19.4%] were found to have an underlying genetic syndromic, chromosomal and/or other anomalies. There were 5 cases of Meckel-Gruber syndrome, 2 Joubert syndrome, one Waardenburg syndrome, one Walker-Warburg syndrome, 2 chromosomal disorders, 2 caudal regression, one amniotic band disruption sequence, one associated with omphalocele, one with diaphragmatic hernia, and 4 with multiple congenital anomalies. There is a high rate of underlying genetic syndromic and/or chromosomal causes of NTDs in the Saudi Arabian population due to the high consanguinity rate. Identification of such association can lead to more accurate provisions of genetic counseling to the family including preimplantation genetic diagnosis or early termination of pregnancies associated with lethal conditions.

Molecular variations based on RAPD among oxyurids in Egypt

Pinworms are nuisance parasites of man and animals. In addition to the human pinworm Enterobius vermicularis, Syphacia muris has been reported to infect man. Morphological differences between pinworm species are difficult to determine. Polymerase chain reaction [PCR] based assays including random amplified polymorphic DNA [RAPD] have been used effectively as a complementary approach for fast and simple detection of genomic variability and similarity among parasites. Such information is essential for accurate identification and for finding appropriate experimental models for species under study. The present study seeks to investigate the degree of similarity between the encountered pinworms aiming to find out the closely related species to E. vermicularis to be used as an experimental model. This is evaluated through RAPD-PCR using ten arbitrary primers to differentiate between the encountered pinworm species. The results are statistically evaluated to reveal the significant variations and to specify the degree of similarity and divergence between the encountered species. The pinworms included in this study are: Syphacia obvelata from the house mouse Mus musculus, S. muris from the black house rat Rattus rattus, E. vermicularis from infected children and Aspiculuris tetraptera from the white laboratory rats Rattus norvegicus alba. The degree of similarity between the encountered species was evaluated by PCR-RAPD using the following ten arbitrary primers: OPB-03 [5-CAT CCC CCT G-3], OPB-06 [5- CAT CCC CCT G-3], OPB-19 [5- ACC CCC GAA G-3], OPC-02 [5- GTG AGG CGT C-3], OPC-05 [5- GAT GAC CGC C-3], OPC-14 [5- TGC GTG CTT G-3], OPD-03 [5- GTC GCC GTC A-3], OPD-13 [5- GGG GTG ACG A-3], OPE-07 [5- AGA TGC AGC C-3], and OPE-12 [5- TTA TCG CCC C-3]. PCR-RAPD technique produced common as well as species specific multiband fingerprints with the ten used arbitrary primers for S. obvelata, S. muris, A. tetraptera and E. vermicularis. These variations proved valid for differentiation between the oxyurid species in Egypt. OPC-02, OPC-14 and OPD-3 revealed higher similarity between E. vermicularis and S. muris than with the other pinworm species. Seven of the ten tested arbitrary primers [OPB-03, OPB-06, OPB-19, OPC-05, OPD-13, OPE-07, and OPE-12] revealed that the similarity between A. tetraptera and E. vermicularis is higher than that between E. vermicularis and both Syphacia species. The present study concluded that the primers used in the present study can be used to differentiate between the encountered species and that A. tetraptera and S. muris can be used as experimental models for studying enterobiasis

In-vitro evaluation of antihelminthic activity of Allium sativum against adult Cotylophoron cotylophorum [Paramphistomidae]

Plant-based anti-helminthics have been reported for their safety and eco-friendly properties. They are used as alternatives for toxic chemical drugs. Allium sativum [garlic] has shown antihelminthic action in vitro and in vivo against many helminthes. The present study was designed to evaluate the in vitro antihelminthic activity of A. sativum in comparison with two commonly used antihelminthic drugs; albendazole and niclosamide against the cattle amphistome, Cotylophoron cotylophorum. Live adult C. cotylophorum worms were collected from the rumen and reticulum of slaughtered cattle. Twelve media [natural calf serum, RPMI 1640 in ten formulas and normal saline] were evaluated to choose the most favorable one for incubation of worms during the study. Different concentrations of albendazole, niclosamide and alcoholic extract of A. sativum were tested in vitro against C. cotylophorum. Treated worms were examined after 2, 4, 8, 12 and 24 hours and the mortality rate was calculated in all experiments. The effect of the sub-lethal concentrations of albendazole and A. sativum on the tegument of the worm was evaluated by scanning electron microscopy [SEM]. Albendazole was highly effective against adult C. cotylophorum, where it exhibited dose-dependent lethal activity at different concentrations. Niclosamide was less effective, with high mortality rates recorded at relatively higher concentrations than albendazole. SEM revealed remarkable changes in the tegument and muscles of adult C. cotylophorum treated with a sub-lethal concentration of albendazole [1.5 mg/L] for eight hours. The whole tegument was deformed and papillae were hardly seen as swollen bodies. Numerous blebs and crater-like structures covered the whole tegument. A. sativum alcoholic extract gave high mortality rate at a relatively low concentration. SEM of adult worms treated with a sub-lethal concentration of A. sativum alcoholic extract [1.0 mg/L] revealed moderate changes in the tegument and a more severe effect on the muscle integrity. The mouth appeared flaccid and slightly retracted and the tegument surrounding it appeared feebly damaged and corrugated. The papillae lost their uniform structure. The acetabulum appeared retracted and lost its specific shape. The present study revealed that A. sativum alcoholic extract has an antihelminthic effect against adult C. cotylophorum at low concentrations. Garlic-based antihelminthic product may be used against rumen cattle amphistomes as an alternative for the commonly used chemical drugs

Serum levels of angiopoietin-2 and C-reactive protein in chronic myeloid leukaemia patients: relation to different phases of the disease

Serum levels of Angiopoietin-2 [Ang-2] and C-reactive protein [CRP] were measured in 50 patients with chronic myeloid leukemia [CML] [30 patients in chronic phase [group A] and 20 patients in advanced phase [group B]] and 15 healthy age and sex matched subjects as a control group, to investigate their relation to different phases of the disease. Serum levels of both Ang-2 and CRP were significantly higher [p <0.05] in patients group compared to controls, and in advanced stage compared to chronic phase. Furthermore a significant positive correlation was detected between Ang-2 and CRP in the whole patients group which could support the hypothesis that CRP might play a role in modulating angiogenesis. The present data suggest that both Ang-2 and CRP could play a role in the leukemic process. Understanding their roles may help in follow-up care and in designing new therapeutic strategies for CML. Furthermore the role of CRP in modulating angiogenesis should not be underestimated

Fertility and semen quality of ticket collectors exposed to traffic exhaust in greater Cairo

Objective: To study the effect of exposure to vehicle emissions on male fertility

Patients and Methods: 102 patients were enrolled in the study. They were divided into three groups; group I [n = 13] were mainly from rural areas minimally exposed to environmental urban vehicle emissions, group II [n = 20] composed of indoor workers who are incidentally exposed to risk and group III [n = 69] were occupationally exposed to environmental air pollution. A full questionnaire including socioeconomic data, histories of exposure to pollution, reproductive histories were taken. Cases with overt or questioned infertility were excluded. Two groups of investigations were done; the first included biomarkers of vehicle emission pollution, namely, carboxyhemoglobin in the peripheral blood, sulphur and sulphur dioxide in urine and lead in blood and semen. The second group of investigations was targeted towards the fertility indices including reproductive hormones and semen characteristics

Results: The level of blood carboxyhemoglobin and semen lead were remarkably higher in the exposed group compared to other groups. There were statistically significant decrease in fertility indices [serum testosterone, semen count, motility and sperm morphology] in the highly exposed group III. Blood lead was negatively correlated with serum testosterone [r = - 0.498, p<0.001] and also negatively correlated with semen count and motility [r = - 0.617, p<0.001; r = - 0.537, p<0.001, respectively]. Abnormal sperm morphology was positively correlated with both blood and semen lead [I = 0.347, p<0.001; r=0.296, p<0.05, respectively]. Carboxyhemoglobin level showed a significant negative correlation with both sperm count and motility [r = 0.219, p<0.05; r= 0.308, p<0.05, respectively]. Sulphur dioxide level in urine showed insignificant correlation with reproductive hormones and seminal indices [p>0.05]

Conclusion: The exposed group [group III] showed deterioration and decline in some essential fertility indices and the deterioration is correlated to biomarkers of vehicle induced air pollution

Evaluation of some imported and local wheats for spaghetti-making

FIVE IMPORTED wheats [Australian, French, Canadian, American and Pakistani], and three local wheat cultivars were subjected to physical, chemical, rheological and spaghetti quality evaluation. Results indicated that the local soft wheat grains had higher total physical defects. Flour yields were about 70% for all tested wheat samples except for the local durum wheat, which was as low as 65.5%. A wide range of protein content [8.30 - 13.70%] of flours was recorded. The Canadian wheat flour had the highest protein content and the French wheat flour was the lowest in protein content. Wet and dry gluten contents of wheat flour samples were consistent with their protein contents. Rheological evaluation data indicated that Australian, Canadian, American and Egyptian durum flours had more suitable properties for spaghetti- making than the French and Pakistani flours. Quality evaluation of the manufactured spaghetti samples from the different tested wheat flours indicated that those made from Egyptian durum wheat, Canadian wheat and American wheat flours were superior

Laparoscopic fundoplication in the treatment of gastro-oesophageal reflux disease. an initial experience in Zagazig and Minia University Hospitals

To study the role of laparoscopic surgery in the treatment of chronic gastro-oesophageal reflux disease [GORD], fourteen cases were admitted to the department of surgery of Zagazig and Minia University Hospitals. All patients were selected after failure of medical treatment, full investigations especially motility studies were done. All cases were examined endoscopicaly and for 24 hours pH-monitoring. All cases were operated by the same team of authors. Nissen fundoplication was done. The mean operative time was 120 +/- 12 minutes. There was no mortality recorded in our study. There was marked reduction in the postoperative complications in comparison to the open surgery, and there was significant improvement in the reflux problem. In conclusion laparoscopic fundoplication is a well promising technique that can effectively relieve symptoms of GORD with minimal morbidity and mortality as well as the mild postoperative pain. Short hospital stay and other benefits of laparoscopic surgery. However long term follow up is needed for proper evaluation

Modified pancreatico-gastrostomy after pylorus preserving pancreatico-duodenectomy for cancer head of pancreas

The leakage of pancreatic juice is one of the most serious complications after pancreatico-duodenectomy. In an attempt to lessen the incidence of this complication, we performed a. modified pancreatico-gastrostomy after pancreatico-duodenectomy in 31 patients. The technique was made by implantation of the pancreatic remnant with pancreatic duct stent into the posterior gastric wall after the performing of figure of 8 sutures opposite to each other at the inferior and the superior borders of the pancreas. One layer of the invaginating anastomosis was performed between the pancreas and the posterior gastric wall. The following parameters were assisted: mortality; morbidity; length of the hospitalization and duration of the nasogastric tube and drainage. The range of the patient admission was ranged from 9 to 24 days. The new technique in the present study has proved to be applicable and has many advantages than the previously used methods since, the morbidity and the mortality rates were reduced, no pancreatic leakage was observed in all patients and no delaying gastric emptying was recorded during the hospital period for all cases

Carcinoma of pancreas: an ultrastructural study

20 cases of adenocarcinoma of pancreas were included in this study. They were 13 men and 7 women with age range 36-70 years. These cases were operated in department of General Surgery, Zagazig University.Histopathologic diagnosis revealed 6 cases were well differentiated and 12 cases were moderate while 2 cases were poorly differentiated. E/M study of all cases showed that the most common affected organelle was the mitochondria and the nuclear change were essential as a landmark of malignancy. Light microscopic differentiation between pancreatic well differentiated adenocarcinoma and other pancreatic lesions as chronic pancreatitis was difficult in some cases. So E/M examination is an important modality in diagnosis of such cases

Formulation of metformin HCL as a sustained release tablets

Sustained release tablets are pharmaceutical dosage form comprising a wide range of pharmaceutical products. Metformin HCL is an oral hypoglycemic agent which is prescribed as drug of choice of biguanide class. Many trials were made to formulate this drug in a sustained release dosage form. by employing dispersion [fusion method] with various retardants [Beeswax, Carnauba wax stearic acid] and the channeling agent polyethylene glycol [PEG]. It was found that the most satisfactory tablets could be obtained by incorporating a mixture of carnauba wax stearic acid and PEG 4000 as coated material. Also faster release was obtained when smaller coated granules were used. On the other hand, a comparative study of the physical properties of the prepared formula and glucophage. Retard [R] tablets showed that both products were more or less similar

Role of interleukin 6 level in post splenectomized thalassemic patients in Zagazig University Hospitals

Interleukin-6 [IL-6] plays an important role in megakaryocytopoiesis and platelet production.Thrombocytosis and inappropriate blood clotting occur postsplenectomy, this rebound phenomenon is more common following splenectomy for myeloproliferative disorders. So this study was done to assess levels of interleukin 6 in these patients. Levels of interleukin 6 were studied in 34 nonsplenectomized thalassemic patients [thal/nonsplen], 23 post-splenectomized thaIassemic patients [thal. I postsplen.], 13 splenectomized non thalassemic [non thal. /postsplenectomized] and 18 normal control by enzyme linked immunosorbent assay method. Serum IL-6 concentration in thaI. I postsplenectomized was significantly increased when compared with thal/nonsplenectomized and control volunteers [3.55 +/- 2. 47 pglml vs 2.38 +/- 2.31 pg/ml, P = 0.036 and 3.55 +/- 2.47 pg /ml vs 2.66 + 0.45 pg/ml, P = 0.028 respectively]. There was a trend towards increasing of cytokine levels in thal. / postsplen with higher platelet count although no correlation was observed. This study addresses the possible role of IL-6 in the pathogenesis of reactive thrombocytosis in thal/postsplenectomy

Effect of unilateral nephrectomy on the healthy kidney in the rabbit [an experimental study]

The effect of unilateral nephrectomy on the contralateral kidney were studied functionally and histologically. Twenty normal adult rabbits were used. They were divided into 5 groups, control [1] and experimental from 2 to 5.The nephrectomized animals were sacrificed at regular time, 3 weeks interval between each group after nephrectomy. In group [2], 3 weeks after nephrectomy, the glomeruli showed mild reduction in the size of the glomerular tufts and mild widening of urinary spaces as well as slight elevation of nitrogenous urea. At the ElM level the glomeruli showed marked vaculations, the foot processes became short and thick and the basement membrane started to lose its regularlity in addition to disappearance of some capillary walls. The previous changes were obvious and progressed in correspondence with the period of sacrificed animals after nephrectomy.In addition to oedematous basement membrane, reduction in the number of glomeruli as well as mitochondrial degenerations. These findings suggested that there were marked hypertrophic changes within the glomeruli and marked increase in the level of nitrogenous urea and creatinine

Prevalence of congenital heart disease among school children of Sahafa Town, Sudan

The prevalence of congenital heart disease among schoolchildren aged 5-15 years was studied as part of Phase 1 of the WHO Global Rheumatic Fever/Rheumatic Heart Disease Prevention Programme in Sudan. A total of 13 322 schoolchildren in Sahafa Town, Khartoum, was examined from 1986 to 1990 representing 70% of the total target population. There were 27 cases of congenital heart disease giving a prevalence rate of 2.0 per 1000. Ventricular septal defect, atrial septal defect [ASD], patent ductus arteriosus [PDA] and tetralogy of Fallot made up 85% of the cases. PDA and ASD were twice as common in females as in males. The prevalence rate is comparable to that of similar African countries but lower than European and north American rates

Gastroduodenal changes in adult patients with uncorrected congenital heart disease

The aim of this study is to assess the morphological changes in the stomach and duodenum in a group of adult patients with congenital heart disease who forfeited corrective cardiac surgery during the early part of their life. The study was carried out at Shaab Teaching Hospital, Khartoum, Sudan. All patients who were 15 years or older and referred with congenital heart disease were evaluated by a detailed medical history, physical examination, chest x-ray. electrocardiogram, and echocardiogram. Cardiac catheterization was carried out in 14 patients to confirm the diagnosis. Patients who presented with epigastric pain were further evaluated by double-contrast barium meal and/or upper gastrointestinal endoscopy. Of the 89 cases seen during the period of 1984 to 1990, 23 [26%] had a history of persisting epigastric pain. Upper gastrointestinal abnormalities, proved by endoscopy or barium meal, were seen in 19 [82%] of the 23 patients. Hypertrophic gastritis constituted 61% of the abnormalities; duodenitis, 22%; and duodenal ulcer, 17%. Hypertrophic gastritis was seen in all cases of the cyanosed group and only in 18% of the acyanosed group. This difference is highly significant [P = 0.0001]. Duodenal ulcer occurred exclusively in the cyanosed group. We conclude that hypertrophic gastritis and duodenal ulcer are frequent complications in the long-standing uncorrected cyanotic congenital heart disease. Hypoxia is suggested as a major precipitating factor

Malignant melanoma: a pathological study of 87 cases

Eighty-seven histologically confirmed malignant melanomas of skin and mucosa were reviewed. The overall male: female ratio was 1.02: 1 and the mean age was 48.2 year. Seventy-three melanomas have arisen from the skin, the lower limb being the most common site of involvement [48 65.7%], mainly in the foot [38 52%]. The other 14 cases of mielanomas arised from the mucosal surfaces, six of them were ano rectal [42.8%] and 4 were nasal or naasopharyngeal. Histologically, the majority were nodular in type [5 1.6%], the superficial spreading type was [27.4%] and the acral lentiginous [19.3%], while there was one case of lentigo maligna melanoma [1.7%]. The vast majority of the cases were advanced and showing dermal and subcutaneous invasion [Clark's levels III, IV, and V]. Twenty-six out of 73 skin melanomas [35.6%] have already metastasized to the draining lymph nodes which were pathologically involved at the time of the diagnosis. The clinico-pathological aspects of malignant melanoma in Iraq were briefly discussed

Negative exploration in lumber intervertebral disc surgery

In this study 122 levels in 100 patients were surgically explored for herniated intervertebral disc. These patients were operated between 1972 and 1985. All patients underwent myelography prior to surgery. Negative exploration is considered as the result of diagnostic error, however, surgical error is also a factor leading to negative exploration. Only 7% of the patients underwent negative exploration, however, viewed from a more critical angle this meant that 15% of levels explored were exposed unnecessarily

Long-term results of triple arthrodesis in juvenile cerebral palsy patients

31 patients suffering from cerebral palsy [CP] with 36 deformed feet, were surgically treated by triple arthrodesis. The period of follow up ranged from 6.4 to 14.8 years. There were 80.5% satisfactory results [no residual pain, no pseudarthrosis, no callosities, no joint degeneration and no residual deformity], while only 19.5% were unsatisfactory due to residual pain, moderate deformity, single callosity, multiple callosities, and difficulty in walking. No degenerative changes were recorded in the talocrural and tarsometatarsal joints

Low-back pain and disability pension in patients after lumbar spinal surgery

The frequency of recurrent LBP as well as sciatica among men occupied in the physical work is higher than among those occupied in the intellectual work. The associations revealed by this study give further evidence of the importance of occupational factors in the etiology of low back pain. Physical workers are at high risk of developing LBP as well as of sciatica following surgery. The disability pension following second surgery also is higher than after initial surgery