Tracing the effect of antidepressants therapy on handwriting documentaries

Handwriting is an acquired skill that is considered one of the most important parameters of personal identification. The production of handwriting involves a complex physical act between the brain and the moving hand and fingers in an extensive muscle and nerve system coordination to produce the finished writing. Some of the centrally acting drugs such as antidepressants can exhibit some interventions, which interfere with the process of writing. The aim of this work is to study the changes in the individual handwriting after different periods of therapeutic intake of the two main classes of antidepressant drugs from different technical points of view that are important in forensic document examination. In this study, 70 right-handed educated adult males and females were included by their handwritings. They were selected from the outpatients of the neuropsychiatric clinics in Kasr El-Aini hospitals. They were receiving regular antidepressants therapeutic regimen of one of the two targeted classes. Every subject was asked to present a personal handwriting document prior to the start of the treatment. A part of this document [about 4-5 lines] with its exact verbal contents was asked to be written by the same person. In all cases, the writing position was standardized regarding the posture of the writer and his position in front of the desk. The pen used was the same in all cases to facilitate the detection of the fine changes in the handwriting features. Groups were matched according to age, sex, treatment duration and the type of the used drug. It was shown that after drug intake there was a significant increase in tremors, pen pressure and word size in TCA users more than SSRI users. In addition, there were significant retouching and disturbance in word shape in TCA users more than SSRI users. Recorded changes were more obvious in males than females especially in patients aged more than 50 years. The results revealed direct relationship between duration of exposure to antidepressant drugs and their effects on handwriting parameters. Non significant increase in retouching, pen pressure, tremors and word size was recorded in TCA users when compared to SSRI users. [In conclusion, the effect of antidepressant drugs on the handwriting has to be considered while examining a document by the forensic expert, so as not to be misled by the drug intake and judge the document as a forged one

Vancomycin resistant enterococci and detection of responsible genes

Vancomycin-resistant enterococci [VRE] have been increasing especially in hospital acquired infections. The present study was carried out to determine prevalence of VRE in hospitalized patients and detection of their drug resistance genes by molecular technique. The antibiotic susceptibility tests were performed using disk diffusion and E-test. PCR was performed to detect vancomycin resistance genes. Out of 585 enterococcal isolates, 6 [1%] were positive for VRE. 238 isolates [40%] exhibited resistance to high level gentamicin. Among VRE 50% were identified as E. faecium and the entire VRE bacteria posses van A gene. The present study provides the first local data on the prevalence of VRE in Malaysia and would serve as an alert to the clinicians of the emergence of VRE infections and to take appropriate measure to prevent them

[Fat oxidation and energy expenditure at different intensities of exercise during running and cycling in obese adolescent boys]

Running and cycling are two modalities of exercise commonly used to promote fat oxidation in weight loss programs for obese people. In order to design appropriate training programs, the objective of the present study was to compare fat oxidation and energy expenditure at different intensities of exercise during running and cycling in obese adolescent boys. Eleven healthy obese adolescent boys [mean age 13 +/- 1.2 years, mean weight 73.1 +/- 7.6 kg, and body mass index 27.5 +/- 2.5 kg/m2] voluntarily participated in this study. Subjects performed 2 incremental graded exercise tests on a cycle ergometer and a motorized treadmill. Heart rate, mean oxygen consumption and carbon dioxide generation during the last two minutes of each level of test were measured and respiratory exchange ratio was calculated. Energy expenditure and fat and carbohydrate oxidation rates were calculated at different intensity levels. At comparable and similar heart rates, the fat oxidation rate was significantly higher during running, compared to cycling over a wide range of intensities [p<0.05], except at intensities of 20w and 170w, as was the total energy expenditure, compared to cycling [266 +/- 43 vs237 +/- 39 kJ/min] [p<0.05]. Carbohydrate oxidation was, however, significantly higher during cycling compared to running, at intensities of 45w, 70w and 95w. It is concluded that for obese adolescents, in order to lose weight and reduce body fat mass [increased energy expenditure and promoted fat oxidation in a certain level of cardio-vascular responses], moderate intensity of running would be more effective than cycling

[ effective factors on receivers' access to health care services in urban health care centers]

In any country, one of the fundamental goals of health policymakers is to facilitate the people's access to treatment and health care services. Therefore, the aim of this study was to identify factors that influence receivers' access to delivered services in urban health care services. We performed this descriptive and cross sectional study in year 2008. We used the multi-stage sampling method for selecting 57 staffs of urban health care centers as statistical samples. The valid and reliable questionnaire for gathering data was designed. Data was analyzed by SPSS 2 version 13 software. Our findings indicate that mean scores of individual, geographical, financial and structural factor was 2.29 [61.4% with high impact], 2.42 [57.9% with high impact], 2.27 [56.1% with high impact] and 2.58 [86% with high impact], respectively. [Our mean score range was 0 to 3]. According to the assessment of employee's viewpoint of Urban Health Care Centers, all of four individual, geographical, financial and structural factors had high influence on person's access to health care services in Urban Health Care Centers. Consequently this study has presented suggestions [according to the findings] for improving access to delivered services in urban health care centers

[Molecular differentiation between bovine Mycobacterium bovis isolates and human Mycobacterium tuberculosis isolates in Iran through PCR-RFLP method and comparison with 5 standard strains]

Mycobacterium tuberculosis complex is consisted of homogenous organisms. They are slowly growing mycobacteria and their isolation and identification are difficult and time consuming. Differentiation of Mycobacterium bovis, causative mammalian tuberculosis, from other members of Mycobacterium tuberculosis complex is very important in epidemiology and control of disease in humans and animals. The aim of this study was to evaluate a molecular method to differentiate Mycobacteriom bovis from Mycobacterium tuberculosis. DNA human isolates of Mycobacterium tuberculosis [n=6] and Mycobacterium bovis isolates [50] were extracted and used as template in PCR. A 548bp fragment of oxyR pseudogene was amplified and digested with Alul endo nuclease. The nucleotide 285 could be adenine [M. bovis] or guanine [M. tuberculosis]. Such variation produces different restriction site for Alul. There were three incisive fragments in all Mycobacterium bovis and Mycobacterium bovis BCG strains and one incisive fragment in other members of Mycobacterium tuberculosis complex. PCR-RFLP method on 548bp fragment of oxyR gene is a rapid and accurate method to differentiate Mycobacterium bovis and Mycobacterium bovis BCG from other members of Mycobacterium tuberculosis complex

[Discrepancy measurements of copings prepared by three casting methods and two different alloys, on ITI implants]

An important criterion of success assessment of implant-supported prostheses is marginal fit. Vertical and horizontal discrepancy can result in loosing of the prosthetic screw, crestal bone resorption, peri-implantitis and loss of osseointegration. Despite careful attention to waxing, investing, and casting, marginal discrepancies are inevitable. The aim of this study was to evaluate the marginal gap and overhang in three casting methods with two different alloys in ITI implants. In this experimental in vitro study 48 analog abutments were randomly divided into six groups as follows: 1] burn out cap + BegoStar, 2] impression cap+ BegoStar, 3] conventional wax up + BegoStar, 4] burn out cap + Vearbpond2, 5] impression cap + Verabpond2, 6] conventional wax up+ Verabond2. Waxing was done in 0.7 mm thickness verified by a digital gauge and a putty index was made for all groups. Reamer was used for correction of the finish line after casting in all groups. Castings were seated on analog abutments and embedded in acrylic resin. Specimens were sectioned by isomet instrument and polished and cleaned by ultrasonic cleaner for 10 min. The marginal gap and overextended margins of castings were examined under a Scanning Electron Microscope [SEM] [X200]. The mean gap and margin overextension were calculated for each group. Data were analyzed by multivariate analysis and Bonferroni post-hoc test with p<0.05 as the level of significance. No significant difference in gap size was observed among the three casting methods with two alloys [P=0.56]. The marginal gap was not different in the studied casting methods [P=0.092]. Gold alloy crowns showed lower marginal gaps compared to base metal alloy crown [P<0.001]. No significant difference in overhang size was observed among casting methods with two alloys [P=0.093]. Base metal alloy crowns showed less overhang compared to gold alloy crowns [P<0.001]. There was a significant correlation between overhang and use of impression cap in base metal alloys [P<0.001]. Based on the results of this study, vertical discrepancy of frameworks made with gold alloy were less than those made with base metal alloy. Base metal alloy demonstrated less overhang. Conventional wax up or using burn out caps reduced less horizontal discrepancy

[Needle stick and sharp injuries in service workers in hospital]

Hospital is a place of health care and must not be a center of spreading infection. There is a risk of transmission of more than 20 blood pathogens to patients and their health care providers in hospital. The injuries by sharp objects are the most common way of this transmission. Each year 600000 to 800000 needle stick occur in USA sot that the treatment needs many skillful staff. This was a descriptive, cross-sectional study. The subjects were 120 staff in Shahid Sadoughi hospital who were selected by simple random sampling. Data gathering tool was a questionnaire including demographic characteristics, 30 relevant questions and a shape of human body completed by self reporting and interview. Statistical analysis was carried out by SPSS version 11.5. eighty five percent of the subjects reported injuries by sharp objects. They had 2 to 3 injuries per year. In 61.7% of cases, contamination of the injury was unknown. The most common site of injury was on hand [48%] and in 77.4% of causes it was superficial and without bleeding. The most frequent [62.7%] object causing injury was needle, then broken glasses [22.5%] and the least frequent one was surgical constituted [14.7%]. Contamination with body fluids was 48.3% and blood constituted 63.3% of them. The major activity associated with injury was collecting wastes [51.2%]. Wearing glove was the most common [76.7%] precaution applied by the subjects. Sixty nin percent of participants were used to washing and disinfecting site of injury but only [34%] of them had been provided with self-protection teaching programs. Less than half [48.5%] had received complete course of hepatitis vaccine. Service workers are at the risk of injuries that transmit blood - borne pathogens. So they should receive pre-employment learning programs on blood borne diseases, self protection measures and vaccines. Injuries can be decreased by setting up reporting and surveillance systems

Hypothalamic pituitary thyroid axis in critically ill patients

Patient with critical illness has disturbed thyroid function tests sick euthyroid syndrome' in the form of low total and free T 3, T 4 [FT 3, PT 4] and low level of the serum TSH. We investigated the hypothalamic-pituitary-thyroid axis and its relation to the mortality and/or morbidity before and after TRH stimulation. Bas-line serum TSR, free T 3, T 4 and after 200 microgram TRH, stimulated serum TSR, free T 3,and free T 4, were measured in 17 patients presented with acute critical illness, in 24 patients with chronic illness and in 20 healthy control. The results showed significant reduction in baseline and impaired secretion of thyroid hormones [FT 4 and PT 3] as well as TSH level in patients groups compared to control group. In acutely ill patients this reduction is mainly in PT 3, while in chronic patients reduction of both FT 3 and FT 4 were evident. A bolus I.V. injection of TRH in critically ill patients leads to marked increases in the serum TSR without changes in serum FT 3 or FT 4 and outcome of patients. It was found that serum TSH, FT 4 and serum albumin were correlated significantly with the mortality and morbidity of critically ill patients than APACHE II score inspite of its long term used in the prediction of morbidity and mortality in such patients. However follow up measurements of FT 4 and TSH can take it as a marker of recovery of critical illness. The results demonstrated an impairment of the hypothalamic-pituitary-thyroid axis in patients with critical illness and serum levels of FT 4 and TSH can be used in the prediction of morbidity and mortality in such patients

Skull vault defects reconstruction: comparison of different techniques and results and effect on cerebral hemodynamics: evaluation with transcranial Doppler sonography

The present study is a single-institution prospective clinical and radiological study conducted to evaluate the techniques and results of skull vault defects reconstruction and to investigate changes of cerebral hemodynamics after cranioplasty using transcranial Doppler sonography [TCDS]. All patients underwent clinical and radiological evaluation of their skull defects before and immediately after surgery and at least one year later. The cerebral hemodynamics was examined with TCDS pre-operatively and during the first month postoperatively. The average preoperative defect surface area measured 34 cm2 [range 6-110 cm2]. Skull defects were reconstructed using different methods of cranioplasty. Fifteen patients were repaired with fixed autogenous bone grafts [five cases with rib grafts, five cases with iliac grafts and five cases with split-thickness cranial bone grafts], five cases with acrylic, five cases with titanium mesh and five cases with high-density polyethylene implants [medpor implants]. Regarding follow-up, all patients were monitored a minimum of 12 months with a mean of 21 months. The results and complications were evaluated in relation to each technique. Changes in cerebral blood flow [CBF] were recorded. Before cranioplasty, all the velocities ipsilateral to the cranial defect were significantly low, while in the contralateral side they were near normal. Ipsilateral low cerebral blood flow increased and reached normal levels after cranioplasty. During the follow-up, neurological improvements was observed

Adverse effects of self-medication practices and improper eating habits among Egyptian hypertensive females

This study aimed to assess the self-medication practices and improper eating habits of Egyptian female hypertensive adults during their reproductive period. The study was conducted on 300 hypertensive women aged 20-40 years attending the Follow-up Outpatient Clinic for Hypertension as well as the Antenatal Clinic in Cairo, Monoufia and Assiut University Hospitals [100 participants from each hospital]. Half of them were pregnant regularly receiving their antenatal care [150 participants, 50 from each site], while the other half [150 participants, 50 from each site] were not pregnant attending their follow up for hypertension control. Hypertension was uncontrolled in 29% of women. Self-medication was high [18.3%] while 24% consumed food items known to impair blood pressure control. However, during pregnancy, self-medication was less practiced [9.3%] while improper eating habits were more practiced [28.7%]. Self-medication was highest in Cairo [26%], followed by Monoufia [16%] and lastly Assiut [13%]. Improper eating habits did not differ significantly according to governorate. Blood pressure was uncontrolled in 39% of women in Cairo, 22% in Monoufia and 26% in Assiut. Physicians were stated as the source of information for hypertensives in hypertension for 9% of patients only compared with 2.7% for nurses. The present study concluded that failure of health care providers to perform their health education role and the obstacles to receive an affordable health service are clear predisposing factors for losing control over blood pressure among hypertensive women whether pregnant or not. Future studies should be directed to clinician-client communication with regard to over-the-counter [OTC] recommendations made for clients on antihypertensive therapy. Nurses providing care at blood pressure clinics have an ideal opportunity to clarify misunderstandings about OTC medications, nutrition supplements held by their clients with hypertension

Structural abnormalities of the Y chromosome: Genotype-phenotype correlation

The aim of this study was to correlate the structural abnormalities of the Y chromosome to its presenting clinical features to evaluate the phenotype-genotype correlation. The study was performed on 30 patients who had structural Y chromosome abnormalities. The cytogenetic methods included conventional G-banding, diamidino-2-phenylindole [DAPI] and fluorescent in situ hybridization [FISH] techniques. The structural abnormalities of the Y chromosome were a deletion of the long arm [Yq-] in 13 cases, a partial deletion of the short arm [Yp-] in 6 cases, large heterochromatin of Y [Yq+] in 6 cases, pericentric inversion in 4 cases and one case with ring Y. Their phenotypic presentations varied from complete normal male, ambiguous genitalia to complete female phenotype. The clinical presentations and cause of referral of the patients were variable including male infertility and azoospermia, primary amenorrhea, mental retardation, multiple congenital anomalies and/or dysmorphism, short stature, ambiguous genitalia, routine premarital counseling and repeated abortions

Adenosine A10 receptors activity of entrohinal cortex on amygdala bindled seigusrs in rat

The role of adenosine A1 receptors of the entorhinal cortex on amygdaloid kindled seizures was investigated. Material and Animals were kindled by daily electrical stimulation of amygdala. In the full kindled animals, N6-cyclohexyladenosine [CHA; 0.1, 1 and 10 mM], an adenosine A1 receptor agonist, and 8-cyclopenthyle 1,3-dimethylexanthine [CPT], an adenosine A1 receptor antagonist, at concentrations of 1 and 5mM were injected bilaterally into the entorhinal cortex. Animals were stimulated at 5, 15, 60 and 120 min post drug infusion and kindling parameters were measured. Results:Results showed that CHA at concentration of 10 mM reduced amygdala after-discharge duration, entrorhinal cortex after-discharge duration [E-ADD] and stage 5 seizure duration at 5, 15,60 and 120 min post drug injection. It also increased the latency of stage 4 seizure. But, no alteration was observed in seizure stage. At concentrations of 1 and 0.1 mM, CHA reduced E-ADD only at 5 and 15min post drug infusion. Bilateral injection of CPT into the entorhinalcortex did not alter seizure parameters. Intra-entorhinal cortex injection of CPT [5mM], 5 min before CHA [10mM], blocked the anticonvulsant effects of CHA. These results suggest that the entorhinal cortex has a role in seizure propagation from the amygdala and its adenosine A1 receptors activity have anticonvulsant effects on amygdala kindled seizures

value of ultrasonography and serial B. HCG assay in the selection of cases of complete molar pregnancy for chemotherapy

This study included fifty-five patients with complete hydatidiform mole aiming to assess the value of U/S, transabdominal [TAS], transvaginal [TVS] and serial B HCG assay in the selection of cases of complete hydatidiform mole for the use of chemotherapy. All patients were diagnosed by ultrasonography and B HCG assay and managed by suction evacuation under continuous ultrasonic monitoring and then were followed up with serial B HCG assay and ultrasonography. The results concluded that the use of ultrasound, B HCG assay in conjunction with suction evacuation under continues US monitoring in the management of complete molar pregnancy is invaluable to select cases of persistent gestational trophoblastic disease for chemotherapy and helps together with careful follow up to give the standard care in such cases

Evaluation of treponema pallidum hemagglutination test in diagnosis of syphilis

A total of 114 sera from patient with suspected syphilis were included in this study. All sera were screened by the VDRL and TPHA tests. The reactive sera confirmed by FTA-ABS test and quantitatively by TPHA test. The main data obtained can be summarized as follows: -Syphilis was detected in 12.2% by VDRL, 10.5% by TPHA and 9.6% by FTA-ABS. -All specimens which were positive in the two screening tests were also FTA-ABS positive. -Sera found to be positive in TPHA test and negative VDRL also showed 100 percent agreement with FTA-ABS test. The effect of antisyphilitic treatment on serological reaction, the VDRL became negative of and persisted positive in both TPHA and FTA-ABS tests. -TPHA carried out quantitatively and the titre ranged between 1:60 and 1:2560 -Sera from presumed biological false positive reactors, gave negative in both TPHA and FTA-ABS tests