Drug interactions between phenytoin and rosuvastatin on lipid profile, liver functions and oxidative stress biomarkers in irradiated rats

Phenytoin is one of the most commonly used anticonvulsants for treating generalized tonic-clonic seizures and status epileptics. Rosuvastatin is a new generation HMG-CoA reductase inhibitor. This enzyme converts HMG-CoA to mevalonic acid in the cholesterol biosynthetic pathway which is the rate limiting step in cholesterol synthesis. This study was aimed to investigate the possible interactions between phenytoin and rosuvastatin when used together in irradiated rats. The experiments were carried out to investigate the acute effect of each drug individually and in combination with radiation on lipid profile [Total cholesterol, Triacylglycerols, High density lipoproteins, Low density lipoproteins and Very low density lipoproteins, Risk factor, Atherogenic Index], liver function tests [AST and ALT] and oxidative stress biomarkers [MDA, NO and SOD]. Data revealed that, phenytoin in irradiated rats significantly increased serum total cholesterol compared to normal control. Rosuvastatin significantly decreased serum total cholesterol compared to irradiated control. Combination of two drugs significantly increased serum total cholesterol; triacylglycerols and serum VLDL-c levels compared to normal and irradiated rats and significantly increased Atherogenic Index and Risk factor compared to normal control. Phenytoin significantly increased serum ALT level compared to normal and irradiated rats and significantly increased serum MDA and serum NO levels compared to normal rats. But phenytoin significantly decreased MDA and NO levels and significantly increased SOD activity compared to irradiated rats. Rosuvastatin significantly increased serum ALT level compared to normal control but it significantly decreased MDA and significantly increased SOD activity compared to irradiated rats. Combination phenytoin and rosuvastatin in irradiated rats significantly increased serum ALT level compared to normal and irradiated rats and it significantly increased MDA, NO levels but it significantly decreased SOD activity compared to normal control. It could be concluded that administration of phenytoin concurrently with rosuvastatin not recommended in patients receiving radiotherapy as dangerous side effects may be occurred

Cardiac, pulmonary and other body changes in children with gaucher disease during therapy

Gaucher disease is a multisystemic lipidosis characterized by hematologic problems, organomegally, skeletal involvement with or without neurological affection. The aim of the study is to identify the multisystemic involvements in children with Gaucher disease and to evaluate the effect of enzyme replacement therapy [ERT] on such patients. This study included 40 patients with Gaucher disease attending the Hematology Unit, Pediatric University Hospital during the period from January to December 2012. All cases were subjected to full history taking, thorough clinical examination, complete blood count, abdominal ultrasonography, radiological examination of the chest, distal end of femur and proximal end of tibia, EEC, echocardiography, Doppler echocardiography, tissue Doppler echocardiography and High Resolution C.T chest [HRCT]. Results: Significant differences were detected between cases and controls in weight, height and skull circumference [p value < 0,001]. Patients during ERT showed a significant decrease in frequency of epistaxis and blood transfusion than those before ERT [p value < 0.05]. Patients during ERT showed a significant increase in mean Hb level and platelet count than those before ERT [p value < 0.05]. There were no significant differences between the two groups of patients regarding the radiological bone changes and neurological aspects of Gaucher disease. Conclusion: Gaucher disease must be suspected in any child with organomegally, bone problems, bleeding tendency with or without neurological affection. ERT is effective in the management of hematological and visceral aspects of Gaucher disease. ERT has no role in the neurological aspect of Gaucher disease

Comparison of paralleling and bisecting angle techniques endodontic working length radiography

This cross sectional comparative study was carried out to compare paralleling technique [PT] and bisecting angle technique [BAT] for working length radiography in endodontics. A sample of 120 patients was selected through purposive sampling. The patients were divided into two groups depending on the arch to be radiographed namely Group A for maxillary arch and group B for patients with mandibular teeth requiring endodontic radiography. Each patient underwent two radiographs, one with each paralleling and bisecting angle techniques respectively giving a total of 240 radiographs. Endo Ray II film holder [Dentsply] was used for PT while a hemostat was utilized for BAT. The results showed a higher accuracy in terms of decreased procedural errors with paralleling technique as compared to bisecting angle technique for teeth in maxillary arch [p<0.05], whereas for mandibular arch there was insignificant difference [p>0.05] between the two techniques. Overall paralleling technique was found to have better results than bisecting angle technique, during endodontic working length radiography

Prophylactic role of combined treatment with wheat germ oil and ginseng against radiation injury in male rats

This study was designed to investigate the possible ameliorating effect of combined treatment of rats with wheat germ oil [a rich source of vitamin E, octacosanol, policosanol and the essential fatty acids [linoleic and linolenic]] and the antioxidant properties of panax quinquefolium ginseng on radiation-induced oxidative body damage. Animals received wheat germ oil by gavage at a dose of 80 mg/kg body wt and panax ginseng was intraperitioneally injected with 100 mg/kg body wt for 10 successive days pre as well as during irradiation and supplementation was extended during the period of radiation exposure of rats to fractionated doses 8 Gy [4 x2Gy]. Experimental investigations were performed at 7[th] and 10[th] days after the last dose of irradiation revealed that whole body gamma-irradiation of rats produced a significant rise in the activities of serum markers for liver damage as aspartate aminotransferase [ASAT], alaninetransaminase [ALAT], ammonia and buytryl cholinestase associated with decrease in the serum content of total protein, albumin [A], golublin [G] and A/G ratio indicating acute hepato-toxicity, at the 7[th] and 10[th] days post-irradiation. Also, radiation-induced biochemical disorders manifested by significant elvation in serum creatinine and urea levels. Serum lipid profile as total cholesterol [TC], triglyceride [TG], high density lipoprotein-cholesterol [HDL-C] and low density lipoprotein-cholestrol [LDL-C] levels were significantly higher than normal control rats associated with significant decrease in HDL/LDL ratio. Radiation induced an elevation of lipid peroxidation measured as thiobarbituric acid reactive substance [TARS] in plasma and liver. The rats that received combined treatment with wheat germ oil and panax ginseng supplement showed significantly less severe damage and remarkable improvement in all of the measured parameters when compared to irradiated rats. According to the results obtained it could be concluded that combined treatment with whole germ oil and panax ginseng might be a useful candidate against radiation-induced oxidative stress and metabolic disorders without any toxicity

Which patients wait longer to be seen and when? A waiting time study in the emergency department

We investigated the waiting time for patients before seeing a physician in the emergency department of a tertiary care hospital in Riyadh, Saudi Arabia. Bi- and multivariate analyses of routine data for 2187 patients determined the association between selected patient characteristics and waiting time. The median waiting time between triage and being seen by a physician was 35.0 min [range 1.0-325.0 min]. Age, day of arrival, time of arrival and triage category were significantly associated with waiting time. Older patients and those arriving on Sundays and Wednesdays waited longer. Variability in waiting times could be addressed by more standardized triage policies, but may also be influenced by other clinical or non-clinical factors that require further investigation

Nosocomial bacterial infections and antimicrobial resistance among the elderly in geriatric unit of Ain Shams university hospital

Increasing numbers of elderly people are being treated in hospitals and are additionally at particular risk of acquiring nosocomial infections [Nl] with antibiotic-resistant organisms. Prevalence of Nl had been evaluated in this study in all inpatients in Geriatric Medicine Unit, EL Demerdash Hospital of Ain Shams University from March 2004 till September 2006. The association of Nl with intrinsic and extrinsic risk factors was also assessed, as well as the emergence of antibiotic resistant bacterial strains. All specimens were processed by routine methods and their antibiotic sensitivity was performed using the disc diffusion method in accordance with the Clinical and Laboratory Standards Institute [CLSI] guide lines. A total of 107 NIs were found among 100 of the 1202 hospitalized patients [prevalence 8.2% prevalence varied greatly from 3.3% in the internal ward to 14.2% in the ICU]. Respiratory tract as well as urinary tract infections was the most common NIs [43% each]. The most commonly isolated pathogens from ICU and the internal ward were Klebsiella spp.[25%], Candida spp.[12%], Pseudomonas aeruginosa [12%] and methicillin-resistant Staphylococcus aureus [MRSA] [9%]. They were followed by Escherichia coli and Enterobacter spp. [7.5% each], coagulase negative Staphylococci [6%] and Proteus spp. [5%]. Depending on infection site, the most frequent isolates were Klebsiella spp. [41%], MRSA [22%] for respiratory tract infection; Candida spp. [28%], Klebsiella pneumonie [15%], E.coli and Pseudomonas auruginosa [13% each] for urinary tract infection. Our results showed that 61.9% of studied patients with lower respiratory infections were due to endotracheal intubation and 95.2% of patients had urinary catheters and developed urinary tract infections. About 82.0% of the elderly patients were taking antibiotics, for at least 1 month prior to admission, which have contributed to the emergence of highly resistant pathogens among geriatric patients, including methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus spp., and multiple-drug-resistant Gram-negative bacilli and coagulase-negative staphylococcal strains. Colonization and infection with antibiotic resistant bacteria [ARB] is a rising menace in geriatric medicine. Establishing a surveillance system and developing an antibiotic policy provide the basis for antibiotic therapy and controlling antimicrobial resistance

role of multi-detector computerized tomography in the evaluation and diagnosis of acute bowel ischemia

Acute bowel ischemia [ABI] is a complicated disorder that occurs when blood flow to the intestines is compromised. Multi-detector row CT combines multiple rows of detectors and faster gantry rotation with narrow collimation. Thus, it offers advantages over classic spiral CT for imaging the mesenteric vasculature and small bowel. The aim of this study was to evaluate the sensitivity and specificity of Multi-Detector Row Computerized Tomography technique in patients with suspected mesenteric ischemia. In this study, 72 consecutive patients were prospectively followed and examined at Aseer. Central Hospital [ACH] with clinical suspicion of ABI or having a CT diagnosis of ABI during the period between March 2003 and October 2004. CT scans were evaluated for evidence of criteria suggestive of ABI. Finally, CT findings and radiological diagnoses were compared to the final pathological diagnoses to measure its sensitivity, specificity, predictive value positive and negative predictive values. Acute bowel ischemia was documented in 56 patients. Their ages ranged between 23 and 85 years with the mean age is 62.5 +/- 15.5 years. Patients were divided to two groups [A and B]. From our study, combining the most sensitive and specific criteria; bowel wall thickening, mesenteric stranding, focal lack of bowel wall enhancement and ascities, increased the overall sensitivity of our technique and interpretation to 97% and the overall specificity to 100%. These finding should be considered in the management of acute bowel ischemia. The mortality rate in our study was 26.8% [15/56 patient] regarding patient proved to have ABI during laparotomy. We concluded that biphasic CT with mesenteric CT angiography is a valuable method of diagnosing ABI, with an overall sensitivity of97% and a specificity of 100%. Inspite of the advances and early intervention, the mortality rate of acute bowel ischemia is still high. Moreover, combining diagnostic criteria predicts high mortality rates

Role of CD15 in the diagnosis of lung cancer

The poor prognosis associated with lung cancer is closely related to the fact that most patients are not identified until their malignancy has reached an advanced stage. The aim of this study was to assess the role, sensitivity and of CD15 in the diagnosis of bronchogenic carcinoma as well as its predictive value in smoker's lungs not harboring tumor tissues. Three groups were included: Group I: 15 patients with biopsy proved adenocarcinoma. Group II: 15 patients with biopsy proved squamous cell carcinoma. Group III: 12 smokers with no evidence of malignancy and for whom bronchoscopy was done for other reasons .GI and GII were then pooled into a single group [group of pulmonary malignancy [Gpm]. Patients were excluded if their biopsy proved to be small cell lung cancer. An informed consent was taken from all patients. In addition to complete history, clinical examination, laboratory investigations, chest X-rays and CT chest, all patients were subjected to fibreoptic bronchoscopy for biopsy. Then the biopsy was stained by H and E and immunostained for CD15. The majority of the bronchogenic carcinoma cases were smokers 60% with an incidence of squamous cell carcinoma and adenocarcinoma of [66.7%, 53.3% respectively]. Twenty percent, 50%, and 30% of the patients in group of pulmonary malignancy presented in stages IIIa, IIIb, and IV respectively. Immunostaining for CD 15 was detected in 60% of the biopsies from group of pulmonary malignancy and none of group III with a highly significant difference [P<0.05] and a sensitivity of 73.68%, while it stained 66.7% of adenocarcinoma and 53.3% of squamous cell carcinoma with no significant differentiating value. It stained 33.3%, 38.9%, and 27.8% of tissue specimens from group of pulmonary malignancy in stages IIIa, IIIb, IV respectively with a significant positive correlation between CD 15 positivity and the stage of lung cancer. Immunostaining for CD15 has an important and significant role in the diagnosis of non-small cell lung cancer but it is not able to differentiate between its types. Also, it gives an important and significant clue about the dissemination and prognosis of this type of malignancy

Assessment of bone turnover by measurement of serum estradiol and interleukin-6

This study included twenty-six postmenopausal women and twenty premenopausal ones in a trial to understand how estrogen performs its antiosteoporotic action. Serum estradiol, interleukin 6 [IL-6] and osteocalcin were measured. A highly significant difference in serum estradiol and IL-6 was found between the two groups. It could be concluded that estrogen exerted its antiosteoporotic effect by modulating the production of IL-6, thus inhibiting its stimulatory effect on osteoblasts

Serum atrial natriuretic peptide, lipid profile and lipid peroxidation in adriamycin therapy of leukemia and lymphoma

Serum atrial natriuretic peptide [ANP], triglycerides, cholesterol and lipid peroxides were studied in thirty-one cases of acute lymphoblastic leukemia [ALL] [including fifteen newly diagnosed cases and sixteen relapses cases], twenty-nine cases of non-Hodgkin's lymphoma [NHL] comprised fifteen newly diagnosed cases and fourteen relapsed cases, ten oncogenic controls and ten healthy controls. Adriamycin was included in therapy of studied cases and not in that of oncogenic controls. Beside full clinical examination and routine investigations to diagnose ALL and NHL cases, ECG and echocardiography were done to all cases and controls. Serum ANP, triglyceride, cholesterol and lipid peroxides were measured before adriamycin therapy, three weeks after the first remission, three weeks after the second remission and in serum of the control group. It was concluded that serum ANP in patients treated with adriamycin is helpful diagnostic tool for early detection of myocardial damage and early management even in the absence of echocardiographic changes as the rise in ANP level is related to the drug dose and not related to the malignancy itself. Serial determinations of serum triglyceride, cholesterol and lipid peroxides are helpful for early detection and prevention of myocardial damage

value of serum glycolytic enzymes in diagnosis, prognosis and therapy monitoring of acute childhood leukemia and lymphoma

Serum aldolase [ALD], phosphoglucomutase [PGM], lactate dehydrogenase [LDH] and enolase [ENL] were studied in 34 cases with acute leukemia including 22 cases with acute lymphocytic leukemia [ALL] and 12 cases with acute nonlymphocytic leukemia [ANLL]; 35 cases with lymphomas formed of 29 cases with non-Hodgkins lymphomna [NHL] and 6 cases with Hodgkins lymphoma [HL]; and 25 controls. Significantly higher glycolytic enzyme activities were observed in all disease groups studied before treatment than the controls. Cases with abdominal NHL showed significantly higher serum glyeolytic enzyme activities than either head and neck NHL or mediastinal NHL. There was significant positive correlation between both serum LDH and aldolase activities and the rate of relapse in eases with NHL. Serum LDH showed the highest sensitivity in diagnosing cases with ALL and cases with NHL while serum aldolase showed the highest sensitivity in diagnosing cases with ANLL. Significantly higher serum glycolytic enzyme activities were observed in all disease groups studied before clinical and/or hematological relapse than controls by a period ranged from 2.5 to 6 months [Biochemical relapse]. Serum enolase activity showed significantly higher values in cases of ALL with than without CNS relapse. These glycolytic enzymes appeared to be useful markers in diagnoses, prognosis and early relapse detection of ALL cases, ANLL cases and NHL cases. Serum enolase estimation also may be of value in detecting CNS relapse in cases with ALL

Management of intra-pulpal pins

A study was done on six adult male dogs. Class V cavities were prepared onbuccal surfaces of incisors, canine, fourth premolar and first molar of eachquarter of the oral cavity. Pinhole was drilled in the axial wall of thecavity, until pulp exposure. Gold plated pins were placed in the drilledchannels passing through the exposed pulp. Capping materials used with pinplacement were calcium hydroxide and formocresol mixed with zinc-oxideegenoul. The experiment was extended to five weeks, divided into threeexperimental periods. Two dogs were sacrificed after one week, three weeksand five weeks. Histological examination of pulp tissue revealed that calciumhydroxide capping material with self-treading gold pins is better thanformocresol coating material to preserve pulp tissue against pin proceduralirritation, possible dentin crack formation and accidentally penetration ofpins into pulp tissues