The safety, efficacy and pharmaceutical quality of male enhancement nutraceuticals bought online: Truth versus claim / 中西医结合学报

OBJECTIVE@#Nutraceutical products are widely used for their claimed therapeutic benefits. However, falsified or adulterated nutraceuticals present a major health threat to consumers. This study investigates the pharmaceutical quality, safety and anti-inflammatory effects of six male enhancement nutraceuticals that claim to be 100% natural.@*METHODS@#Three batches of six male enhancement products were tested to detect the presence and levels of adulterants via high-performance liquid chromatography (HPLC). The pharmaceutical quality of the selected nutraceuticals was tested with near infrared spectroscopy (NIR) and SeDeM. The cytotoxic effects of these products on HepG2 cells were determined through cell proliferation (XTT) and lactate dehydrogenase (LDH) cytotoxicity assays. Lastly, the in vitro inflammatory effects of these products were investigated using murine J774 macrophages through cytokine release analysis.@*RESULTS@#HPLC analysis detected the presence of sildenafil citrate, a vasodilator, and the active ingredient in Viagra and Revatio, in all batches of the products we analyzed. Amount of sildenafil citrate ranged from 0.45 mg to 51.85 mg among different batches. NIR assessment showed inter- and intra-batch heterogeneity in product composition. Results of the XTT and LDH assays showed significant cytotoxic effects of the analyzed products. XTT analysis revealed that the viability of HepG2 treated with tested products varied from 27.57% to 41.43%. Interestingly, the male enhancement products also showed anti-inflammatory effects.@*CONCLUSION@#Despite their labeling as 100% natural, all products tested in this study contained levels of sildenafil citrate, which was not reported on the packaging. There was a lack of pharmaceutical uniformity among products of the same batch and across different batches. Additionally, the products we tested had cytotoxic effects. These study findings highlight the adulteration, poor quality and hazard of these nutraceuticals. Therefore, strict regulation of these products and standardization of the definition of nutraceuticals are urgently needed. Further, these falsely advertised products should be withdrawn from the market due to potential adverse effects on the health of their consumers.

Single centre randomized comparative trial of lateral internal sphincterotomy versus 2% diltiazem in chronic anal fissure

Background: Anal fissures are often encountered in surgical practice with surgery the gold standard management for chronic anal fissures. Recently the widespread use of pharmacologic agents for chronic fissures has increased. In our study we compare topical 2% diltiazem with lateral sphincterotomy with respect to symptoms such as relief of pain, ulcer healing, and side effects of treatments.Methods: A prospective comparative study, a total of 80 patients were randomized into 2 groups 40 each. Group A patients were subjected to open internal lateral sphincterotomy and group B to 2% topical diltiazem. The patients in both groups were followed up at 1st, 4th, 14th weeks and 6 months in OPD and were assessed for pain, sphincter tone and complications.Results: In group A (lateral anal sphincterotomy), patients achieved a good pain relief with a mean pain score of 1.98 by one week post procedure whereas group B (2% diltiazem) had taken 14 weeks to achieve similar pain relief (pain score of 1.5). At the end of 6 months, healing of fissure was noted in 100% of group A and in 90% of group B. 4 patients (10%) had recurrences in group B. Flatus incontinence was reported in 2 patients (5%) in group A although transient.Conclusions: Lateral anal sphincterotomy is superior to 2% diltiazem especially in healing of fissure, pain relief, quality of life and recurrence. Pharmacologic agents should be reserved for patients who are unfit or unwilling for surgery or can be used as a bridge therapy till sphincterotomy can be planned.

Management of chronic anal fissures: a narrative review

Anal fissures are often encountered in surgical practice in both sexes. It is a distressing disease impacting quality of life and causes profound morbidity among those affected. If left untreated, it may lead onto perianal abscess or even malignancy in long standing cases. Surgery is the gold standard management for chronic anal fissures. Recently the widespread use of pharmacologic agents for chronic fissures has increased. The management of chronic anal fissures has migrated to an era of multifaceted approach. This narrative review looks into various studies spanning over a period of 16 years. Various articles were shortlisted and analyzed for efficacy of various treatment methods, their impact in hospital stay, quality of life improvement, recurrence rate and complications among various treatment methods. We concluded from this review, that open lateral internal sphincterotomy is still the gold standard method of treatment for chronic anal fissure. Among pharmacological agents, 2% diltiazem has the best effectiveness with good compliance rate. Modern surgical techniques like VY plasty can be reserved for special situations. We do not recommend the practice of manual anal dilatation.

Parents’ Awareness And Perception Of Children’s Refractive Error. A Qualitative Study

@#Uncorrected refractive error is the leading cause of moderate and severe visual impairment across the globe. An important driver for early detection and management of refractive errors among children is appropriate parental awareness. This study aims to understand the awareness and perception among parents of children with refractive errors utilizing the conceptual framework of Health Belief Model. This qualitative study focused to conduct semi-structured interviews of parents who sought eye care for their children. Thirty-five parents who visited an eye care center for refractive error correction of their children between 5 to 15 years of age were purposively selected. The four constructs of the Health Belief Model (perceived susceptibility, perceived severity, perceived benefits and perceived barriers) were applied to prepare the interview guide. The voice records of participants were transcribed verbatim, coded and qualitatively analyzed to generate relevant themes. All participants were well aware of refractive errors and the implications of them on the visual and social development of children if they leave the errors untreated. However,there were varying perception about refractive error leading to serious consequences. The enanced quality of life with proper refractive correction prompted parents to seek timely eyecare for their children.

Ultrasonographic enthesis evaluation in patients with recurrent acute anterior uveitis with and without spondyloarthropathy

Background: spondyloarthritis (SpA) is a group of chronic diseases recognized by arthritis and extraarticular lesions e.g. uveitis, enthesitis, dermatological affection. About 35% of SpA patients may present with recurrent attacks of acute anterior uveitis (AAU). Purpose: it was to detect whether patients with idiopathic recurrent AAU who were positive or negative for Human Leukocyte Antigen B27 (HLA­B27) had a frequency of enthesis lesions compared to that seen in patients with SpA. Patients and Methods: a prospective study of enthesis evident on musculoskeletal ultrasound examination was done on sixty patients and twenty controls, the eighty were categorized into 4 groups; group 1 included 20 patients with known SpA group 2 included 20 with recurrent AAU HLA­B27 positive and didn't have SpA aspects group 3 included 20 with recurrent AAU HLA­B27 negative and didn't have SpA and group 4 included 20 healthy controls. Using Madrid Sonography Enthesitis Index (MASEI) twelve enthesis locations were assessed in each participant. Results: a total of 960 entheses sites were examined by ultrasonography in all 80 participants. The MASEI cut-off limit of ≥18 points was 75%, 60%, 45%, and 10% of the participants in the 4 groups; respectively. The MASEI score was significantly higher in groups 1&2 than in groups 3&4. The differences between the two groups were statistically significant. Conclusion: a high percent of HLA­B27 positive patients with idiopathic recurrent AAU without characteristics of SpA have enthesis lesions with about percent to those seen in patients with known SpA

Pain alleviation in patients undergoing cardiac surgery; presternal local anesthetic and magnesium infiltration versus conventional intravenous analgesia: a randomized double-blind study

BACKGROUND: Magnesium is one of the effective, safe local anesthetic adjuvants that can exert an analgesic effect in conditions presenting acute and chronic post-sternotomy pain. We studied the efficacy of continuous infusion of presternal magnesium sulfate with bupivacaine for pain relief following cardiac surgery. METHODS: Ninety adult patients undergoing valve replacement cardiac surgery randomly allocated into three groups. In all patients; a presternal catheter was placed for continuous infusion of either 0.125% bupivacaine and 5% magnesium sulfate (3 ml/h for 48 hours) in group 1, or 0.125% bupivacaine only in the same rate in group 2, versus conventional intravenous paracetamol and ketorolac in group 3. Rescue analgesia was iv 25 µg fentanyl. Postoperative Visual Analog Scale (VAS) and fentanyl consumption during the early two postoperative days were assessed. All patients were followed up over two months for occurrence of chronic post-sternotomy pain. RESULTS: VAS values showed high significant differences during the first 48 hours with the least pain scale in group 1 and significantly least fentanyl consumption (30.8 ± 7 µg in group 1 vs. 69 ± 18 µg in group 2, and 162 ± 3 in group 3 respectively). The incidence of chronic pain has not differed between the three groups although it was more pronounced in group 3. CONCLUSIONS: Continuous presternal bupivacaine and magnesium infusion resulted in better postoperative analgesia than both presternal bupivacaine alone or conventional analgesic groups.

Clinical intervention for maternal near miss cases in El Galaa teaching hospital

Background: Near miss cases share many characteristics with maternal deaths and can directly inform about obstacles that had to be overcome after the onset of an acute complication, hence providing valuable information on obstetric care. This allows for corrective action to be taken on identified problems to reduce related mortality and long-term morbidity

Objective: The purpose of this study was to determine the efficacy of possible interventions [in the form of monthly clinical audit for new near miss cases and feedback strategy] in reducing maternal near miss cases in El Galaa Teaching Hospital in Egypt and improving WHO indicators of maternal health

Methods: The study was conducted over 3 stages: Stage I [Formative Stage]: Is a retrospective study of maternal near miss cases over 1 year period, based on WHO criteria from 1/1/2016 to 1/1/2017. Stage II [Intervention stage]: This incorporated a monthly clinical audit for new near-miss cases and feedback strategy, using WHO case report forms, as well as engagement of opinion leaders for 1 year from 1/1/2017 to 1/1 2018 with 2 to 3 cases discussed monthly. Stage III [Assessment Stage]: Evaluating the clinical performance and frequency of near miss cases after intervention

Results: In this study, the majority of women with potentially life threatening conditions were referred from private obstetrician clinic, private hospitals and Ministry of Health to El Galaa hospital. The majority of Maternal near miss cases [67.9%] gave birth by Caesarean section, this was because of the severity of these patients' obstetric conditions usually requires urgent action. The main life threatening conditions among women in this study were hypertensive disorders of pregnancy 41% [24% Pre-eclampsia, 15% Eclampsia, 2% chronic hypertension]

Conclusion: Our intervention [near miss clinical audit] helped to improve the performance and quality of care provided to women with complications during pregnancy, as reflected on the maternal health outcome indicators. Therefore we recommend incorporating clinical audit process in all health facilities. The Maternal mortality index and Maternal near miss mortality ratio, two of the indicators recommended by WHO, can be used to monitor and assess the performance and health care level. Health managers and policy makers should use maternal health outcome indicators for allocation of resources and prioritization of investments

Assessment of accuracy of three ultrasound methods for prediction of intrauterine growth restriction

Background: fetal growth restriction [FGR] is one of the most important complications encountered during pregnancy. The growth-restricted fetus is a fetus that fails to reach its growth potential and is at risk for adverse perinatal morbidity and mortality. The American College of Obstetricians and Gynecologists [ACOG] defines an IUGR fetus as a fetus with an estimated weight below the 10th percentile

Objective: the study aimed to assess accuracy of transcerebellar diameter [TCD]/ abdominal circumference [AC] ratio, head circumference [HC]/ abdominal circumference [AC] ratio and hepato-cephalic index [HCI] in predicting intrauterine growth restriction [IUGR] after 20 weeks of gestation in pregnant women at risk of developing IUGR

Materials and Methods: a prospective nested cohort study was conducted on 77 pregnant women at risk for IUGR at Ain-Shams University Maternity hospital. all women were examined by abdominal two-dimensional ultrasound after 20 weeks of gestation to assess the sonographic gestational age [BPD, HC, FL, AC, AFI, degree of placental maturation] in fetuses. The Fetal Liver Length [FLL] and Transcelebellar Diameter [TCD] were measured at the time of the scan. Hepato-cephalic index [HCI] was calculated as Fetal Liver Length [FLL]/ Biparital diameter [BPD]. TCD/AC ratio was calculated by dividing Transcerebellar diameter [TCD] and abdominal circumference [AC]. HC/AC ratio was calculated by dividing Head circumference [HC] and abdominal circumference [AC]. All women were followed up and an abdominal ultrasound was done after 3 weeks to confirm diagnosis of IUGR and the same fetal parameters were measured and documented

Results: in predicting IUGR; TCD/AC and HC/AC have significant excellent diagnostic performance with 95%CI 0.829-1.000 and 0.851-0.974 respectively. HCI has significant moderate diagnostic performance with 95% CI 0.787-0.956. As regards comparison between the three ratios in prediction of IUGR in our study, we found that: TCD/AC with a cut-off value >/=13.77 has the highest diagnostic performance in prediction of IUGR. HC/AC with a cut-off value >/=1.04 has moderate diagnostic characteristics in prediction of IUGR. HCI with a cut-off value

Conclusions: TCD/AC ratio had a better diagnostic validity and accuracy compared to HC/AC and HCI in predicting IUGR

Effect of aqueous extract of tops of date palm leaves on blood glucose of diabetic rats

Present study was carried out to examine the effect of tops of date palm leaves extract on blood glucose of streptozotocin induced diabetic rats. Forty male Sprague Dawely rats [120-130g] were housed individually and randomly allocated to two main groups; diabetic group [n=30], and normal group [n=10] in the animal lab, Faculty of Agriculture and Veterinary Medicine, Qassim University, Saudi Arabia. An aqueous extracts were prepared from tops of date palm leaves [EDPL] and were orally administered to rats. Later, the determination of glucose, BUN, creatinine, uric acid, ALT, and AST was examined. Pancreas sample were taken for histopathological examination. It was clear that the higher the concentration of EDPL the lower the weight gain [P<0.001]. Glucose concentration of normal group changed by - 0.79% and decreased by -20.4% among diabetic control group, while feeding 1% and 2% EDPL had no significant effects, and the higher the amount of EDPL the higher the concentration of blood glucose. The thought that tea made from date palm leaves decrease blood glucose level has been denied by the results of this study and this tea may worsen diabetes patient's status

Trichomonas vaginalis infection in a low-risk women attended in Obstetrics and Gynaecology Clinic, Universiti Kebangsaan Malaysia Medical Centre

Objective To investigate the presence of trichomoniasis among women attending the Obstetrics and Gynaecology Clinic, Universiti Kebangsaan Malaysia Medical Centre. Methods A total of 139 high vaginal swabs were taken from the subjects and sent to the laboratory in Amies gel transport media. The specimens were examined for the presence of Trichomonas vaginalis using wet mount, Giemsa staining and cultured in Diamond's medium. Sociodemographic characteristics and gynaecological complaints were obtained in private using structured questionnaire applied by one investigator. Results The median age was 32 years, with an interquartile interval of 9.96. Most of the subjects were Malays (76.9%) and the remaining were Chinese (15.1%), Indians (2.2%) and other ethnic groups (5.8%). One hundred and thirty eight (99.3%) of the women were married and 98.6% had less than 6 children. More than half (75.5%) of the women's last child birth was less than 6 years ago. Forty seven percent of them were involved in supporting administrative work and 64.7% of the women gave a history of previous or current vaginal discharge. Conclusions The present study reported zero incidence rate of trichomoniasis. The low incidence rate was postulated due to all women who participated in this study were categorized into a low-risk group.

Efficacy of three insecticides on rat flea [Xenopsylla cheopis] infesting rodents in Giza Governorate, Egypt

The extensive use of insecticides in public health and agriculture sectors is the main reason for development of resistance in fleas associated in domestic rodents. The present work was planned to investigate the insecticidal efficacy of Lambda-cyhalothrin, Chlorpyrifos and Fenitrothion against rat flea [Xenopsylla cheopis] infesting rodent species in Giza Governorate, Egypt. The lethal concentration LC[50] and Lc[90] of population percent were obtained from the established regression log concentrate-response lines. Data indicated that the values of lethal concentration [LC[50]] were 0.293, 1.725 and 2.328% for Lambda-cyhalothrin, chlorpyrifos and Fenitrothion, respectively. The values of lethal concentration [Lc[90]] were 0.467, 2.839 and 5.197% for Lambda-cyhalothrin, chlorpyrifos and Fenitrothion, respectively

Usage of Mobile Applications in Diabetes Management: A Review / Jurnal Sains Kesihatan Malaysia

Peer-reviewed articles on the usage of mobile applications in the management of diabetes were reviewed. Studies using mobile device applications for diabetes interventions published between January 2007 and March 2013 were included in this review. Studies related to the developmental processes of the mobile applications were excluded. The characteristics of these studies and the outcomes of the methods used in the management of diabetes were gathered. We retrieved a total of 372 articles from ACM Digital library, PubMed and Proquest Medical Library. After applying the inclusion and exclusion criteria, 8 articles were eligible for further review. Most of the studies included in this review showed the effectiveness of mobile applications in diabetes management. Their major contribution comes from feedback functions of the systems that assist participants in the self-monitoring of their blood glucose and dietary intake. However, the majority of the studies showed the limited use of the mobile phone as a tool to input information into systems which would in turn convey a reminder message to the patient. In conclusion, with its features of portability and convenience, mobile application used in the management of diabetes has the potential to improve glycaemic control, resulting in significant clinical and financial benefits.

Misunderstanding of the term [DNR] in a middle-eastern teaching hospital

Do-not-resuscitate [DNR] order has been practiced for many years; though it is one of the most commonly misunderstood and misinterpreted orders in medical practice. It has many ethical, legal, geographic, religious and cultural aspects that contribute to this misunderstanding. To assess the perception amongst the acute specialties who deal with DNR orders. A Cross-Sectional Questionnaire Type Study. Setting: King Hamad University Hospital, Bahrain. Anonymous questionnaire was designed. Physicians working in the acute specialties were included. The questionnaire included several general questions about when DNR should be implemented and what are the appropriate aspects of management that should be given. Fifty doctors completed the questionnaire; 49 [98%] of the physicians thought that a hospital should have a DNR policy, 23 [46%] of the physicians believed that the DNR decision lies in the hands of the responsible doctor, 10 [20%] of the participants thought that it is a family decision only, whilst 17 [34%] thought that it is a joint decision by the family and the physician. All of the physicians agreed that there should be no code blue activation in case of cardiopulmonary arrest of a DNR labeled patients. The term DNR should not be used as it is confusing and liable to misunderstanding. In addition, we need to educate healthcare professionals about the terminology of the management of end-of-life situations

Are Currently Available Wearable Devices for Activity Tracking and Heart Rate Monitoring Accurate, Precise, and Medically Beneficial? / 대한의료정보학회지

OBJECTIVES: The new wave of wireless technologies, fitness trackers, and body sensor devices can have great impact on healthcare systems and the quality of life. However, there have not been enough studies to prove the accuracy and precision of these trackers. The objective of this study was to evaluate the accuracy, precision, and overall performance of seventeen wearable devices currently available compared with direct observation of step counts and heart rate monitoring. METHODS: Each participant in this study used three accelerometers at a time, running the three corresponding applications of each tracker on an Android or iOS device simultaneously. Each participant was instructed to walk 200, 500, and 1,000 steps. Each set was repeated 40 times. Data was recorded after each trial, and the mean step count, standard deviation, accuracy, and precision were estimated for each tracker. Heart rate was measured by all trackers (if applicable), which support heart rate monitoring, and compared to a positive control, the Onyx Vantage 9590 professional clinical pulse oximeter. RESULTS: The accuracy of the tested products ranged between 79.8% and 99.1%, while the coefficient of variation (precision) ranged between 4% and 17.5%. MisFit Shine showed the highest accuracy and precision (along with Qualcomm Toq), while Samsung Gear 2 showed the lowest accuracy, and Jawbone UP showed the lowest precision. However, Xiaomi Mi band showed the best package compared to its price. CONCLUSIONS: The accuracy and precision of the selected fitness trackers are reasonable and can indicate the average level of activity and thus average energy expenditure.

Efficacy of carbamazepine in treatment of bronchial asthma

The real break-throw in asthma treatment is still unreachable. In many cases drugs are not effective for reaching the control state. To investigate the efficacy of Carbamazepine in treatment of bronchial asthma. A randomized, parallel 6-month trial. Hundred patients fulfilled the inclusion criteria and divided into two groups. Group [1] received Carbamazepine [600-1600 mg/day] in addition to their usual anti-asthmatic treatment and group [2] received only the usual anti-asthmatic therapy. Baseline electroencephalography [EEG] study was done for all patients. Assessment of asthma control according to GINA classification was done before, 3 and 6 months after therapy. The mean age of studied patients was [37.9 +/- 9.47 and 28.6 +/- 11.06], in group 1 and 2 respectively. Two cases in group 1 showed abnormal EEG and no abnormality in group 2. As regards level of asthma control, there was statistically significant difference between first visit and third visit in both groups with high value in group 1 [P value 0.001, 0.04]. In comparing spirometric data of both groups at each visit it revealed statistically significant P value in all parameters [FEV1 0.001, FVC 0.003, PEF 0.01, FEE 25-75 0.001] except FEV1/FVC [P value was 0.264]. The frequency of acute asthma exacerbation in both groups was [0.5 +/- 0.57 and 3.2 +/- 0.98] in group 1 and 2, respectively [95% CI 2.4-3.1] with highly significant P value 0.003. In the Carbamazepine group dizziness was recorded in 6 cases 12%, itching in 2 cases 4%, and increasing sleepiness in 2 cases 4%. Carbamazepine is effective in treatment and in achievement of better asthma control with minimal side effect

Contrast Sensitivity deficit in diabetes mellitus in presence of no or minimal diabetic retinopathy

Contrast sensitivity as a psychophysical measurement was performed with a view to providing an assessment of early neural functional integrity in the presence of no or minimal diabetic retinopathy

The investigation was carried out on a healthy visual system control group and a number of age- and sex-matched non-insulin dependent diabetic groups with different levels of diabetic retinopathy. The psychophysical test used was Pelli-Robson contrast sensitivity chart. Results were considered in terms of the presence of functional changes relative to the severity of retinopathy and the duration of diabetes. The contrast sensitivity test differentiated between normals and those with diabetes but without retinopathy, although this test failed to discriminate between diabetic groups. This finding suggests the contrast sensitivity may be useful as screening test of background retinopathy

Successful pregnancy following resection of recurrent retroperitoneal liposarcoma

Retroperitoneal liposarcoma is rare in pregnancy. Management of recurrent disease following surgical resection remained a challenge especially when it is associated with pregnancy. A 30-year old primigravida conceived spontaneously four months following a second laparotomy for resection of recurrent RPLS. The primary surgery was performed four years earlier with optimum postoperative course in the absence of need for postoperative adjuvant treatment Histology of the recurrent tumor confirmed a well differentiated liposarcoma. She was monitored closely for any worsening of symptoms and underwent a MRI and an ultrasound at 12 and 22 weeks gestation respectively. The pregnancy continues to be uneventful and she safely delivered vaginally at 41 weeks gestation. Small RPLS during pregnancy do not pose great obstetrics management challenges. Early detection with multidisciplmary team management would anticipate possible complications to ensure both maternal and fetal wellbeing

Outcome Of Pregnancy Among Malaysian Women With Diabetes Mellitus - A Single Centre Experience

To observe the maternal and neonatal outcomes among women with diabetes mellitus in pregnancy as compared to healthy control. A case-control study involving 400 women with DM who delivered between 2005 to 2009 was done with age-matched control group. A total of 305 women (76.25%) were gestational diabetes mellitus (GDM) on diet control, 79 (19.75%) were GDM on insulin and 16 (4%) were pre-existing DM. The mean body mass index of the women with diabetes was higher compared to the age-matched healthy women (p <0.001). Approximately one-third of diabetic woman had no antecedent risk factor. About half of the women with diabetes (n=205, 51.3%) had unplanned pregnancy. Women with DM had greater risk of having spontaneous miscarriage and caesarean section (OR 1.4, 95% CI (1.2-1.7), OR 1.3, 95% CI (1.1- 1.5) respectively). Women with diabetes on insulin had higher risk of preterm delivery and caesarean delivery as compared to those with diet control, (OR 1.7, 95% CI (1.2- 2.5), OR 2.5, 95% CI (1.6-4.1) respectively). The incidence of macrosomia, low Apgar score, need for NICU admission, hypoglycaemia and respiratory distress syndrome (RDS) were higher among women with diabetes as compared to healthy control, and especially in those on insulin. Women with higher HbA1c had significantly increased need for caesarean section and NICU admission with higher incidence of macrosomia and RDS. The overall outcome of women with diabetes especially with higher level HbA1c remained poor as compared to a normal pregnancy.

Pheochromocytoma and Pregnancy: A Difficult and Dangerous Ordeal

Pheochromocytoma during pregnancy is potentially disastrous to the mother and fetus. Its ambiguous presentation is often mistaken for pre-eclampsia, although it may imitate other problems during pregnancy. Early diagnosis and timely, appropriate management reduces possible maternal and fetal complications. We identified a case of pheochromocytoma during pregnancy; the condition was initially diagnosed as pre-eclampsia complicated with gestational diabetes. Surgical intervention via left adrenalectomy was successfully performed in the second trimester. After surgery, all of the patient’s medical problems nearly subsided and she did not require further treatment. However, her fetus displayed restricted intrauterine growth, and the patient eventually had premature delivery via a caesarean section. A multidisciplinary team to identify and treat pheochromocytoma is mandatory to ensure optimal conditions for tumour removal and to anticipate any possible catastrophic events.

current status of fleas according to environmental changes in some Governorates in Egypt

A preliminary survey of domestic rodent and their fleas was carried out in different environmental Governorates [Ismailia, Dakahlia, El Fayoum, North Sinai and Matrouh], Egypt. Flea index [number of flea/rodent] and percentage frequency of different flea species were recorded in spring [2009-2010]. The main rodent species found were the Norway rat, Rattus norvegicus, the grey-bellied rat, Rattus rattus alexandrinus, the white-bellied rat, Rattus rattus frugivorus, the house mouse, Mus musculus and the spiny mouse Acomys cahirinus. The common flea species attacking rodents were: the oriental rat flea, Xenopsylla cheopis, the mouse flea, Leptopsylla segnis, the dog flea, Ctenocephalides canis and the sticktight flea Echidnophaga gallinacea. The flea index at Ismailia and Matrouh Governorates showed the highest indices [8.93 and 7.68], while El Fayoum and North Sinai Governorates showed the lowest ones [1.09 and 1.68]. Dakhalia showed moderate flea index [4.52]. The highest number of fleas was recorded on R. norvegicus lives in places that are easy to dig buarrows, which are suitable medium for fleas breeding. The lowest number was recorded on Mus musculus and Acomys cahirinus. The oriental rat flea, Xenopsylla cheopis was the highest frequency distribution for all domestic rodent species, while, the stick-tight flea, Echidnophaga gallinacea was the lowest which recorded at Ismailia and Dakahlia only