Prevalence of and factors associated with increased suicide risk among chronic non-cancer pain patients in zagazig university hospitals

Background: chronic non-cancer pain (CNCP) patients are more likely to experience suicidal ideation and behaviors compared to the general population. To our knowledge, this is the first study in Egypt discussing the prevalence and risk factors of suicide among CNCP patients.Objectives of this study aimed to identify the most important general and pain-related risk factors of suicide in patients with chronic non-cancer pain at Zagagzig University Hospitals. Methods: a total of 179 patients with chronic non-cancer pain were recruited from Outpatient clinics, Zagazig University hospitals, Sharkia. A simple questionnaire was structured for all participants to collect data onsocio-demographic data and pain-related (intensity, duration, interference, sleep problems). Psychometric assessment was done which included; the Visual Analogue Scale (VAS), Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I) and Columbia Scale for the Rating of Suicide Severity(C-SSRS).Results: approximately half of the patients (48.6%) reported lifetime suicidal ideation and only 1.1% reported life time suicide attempts, Suicidal ideation occurred after onset of pain in 26.3% of the participants. Several risk factors for SI in chronic pain were identified, including younger age, previous substance abuse, past history of psychiatric illness and sleep-onset insomnia.Conclusion: results of this study are consistent with the prevailing literature on pain andsuicide demonstrating a high prevalence of suicidal ideation in the chronic pain population. Novel predictive variables were also identified that will provide the basis for developing a risk stratification model that can be further tested prospectively in chronic pain patients

Assessment of the relation between fetal hemodynamic indices in late pregnancy and birth weight in gestational diabetic mellitus mothers: a correlational study

Background: The offspring of women with gestational diabetes mellitus [GDM] are prone to macrosomia. However, birth weight is difficult to be correctly estimated by ultrasound because of fetal asymmetric growth characteristics. This study aimed at investigating the correlations between fetal hemodynamics, fetal growth indices in late pregnancy and birth weight in GDM

Methods: A total of 180 women with GDM and 180 normal controls [NC] with singleton gestation and presented between 38-40 weeks gestation were enrolled in this study. Fetal hemodynamic indices, including the systolic/diastolic ratio [S/D], resistance index [RI], pulsatility index [PI] of umbilical artery [UA], middle cerebral artery [MCA], and renal artery [RA], were collected. Fetal growth indices, including biparietal diameter [BPD], head circumference [HC], abdominal circumference [AC], and femur length [FL], were also measured by ultrasound. Birth weight, mode of delivery and need for Neonatal ICU admission data were collected

Results: The independent samples t-test showed that BPD, HC, AC and FL were larger in GDM than in NC [P < 0.05]. Birth weight was higher in GDM than in NC [P < 0.001]. Among all included women, there was a highly statistically insignificant difference between GDM and NC groups as regard all ultrasound indices including UA_S/D, UA_RI, UA_PI, MCA_S/D, MCA_RI, MCA_PI, RA_S/D, RA_RI and RA_PI [P>0.05]. Pearson's correlation analysis showed in GDM group that there was a highly statistically significant negative correlation between birth weight and the following ultrasound indices: [UA_RI, UA_S/D, UA_PI, MCA_RI and MCA_PI] and that there was a statistically significant positive correlation between birth weight and RA_RI [P<0.01] [r = -0.273, -0.453, -0.537, -0.237, -0.265 and 0.169 respectively, P < 0.05], but As regard NC group there was a highly statistically significant negative correlation between birth weight and the following ultrasound indices: [UA_S/D, UA_RI, UA_PI and MCA_PI] [r = 0.148, -0.360, -0.252 and -0.184 respectively, P < 0.05] but no correlation was found with any of renal artery indices [P > 0.05]

Conclusions: Fetal hemodynamic indices in late pregnancy might be helpful for estimating newborn birth weight in women with GDM

Tight junction protein claudin 4 in gastric carcinoma and its relation to lymphangiogenic activity

Background and study aims: Gastric cancer is the second most common cause of cancer-related death worldwide. Claudins are a family of tight junction proteins that are biologically relevant in many cancer progression steps. This study aimed to investigate the expression of the intestinal claudin [claudin 4] in gastric carcinoma and to evaluate its relation to the different clinicopathologic prognostic parameters, especially lymphangiogenesis [production of new lymphatic vessels, measured by lymphovascular density [LVD]] and lymphovascular invasion [LVI]

Patients and methods: Fifty-five gastric carcinoma specimens were immunohistochemically stained for claudin 4 and D2-40 [for detection of lymphatic vessel endothelium]

Results: High expression of claudin 4 was detected in 26 of 55 [47.3%] cases. Low expression of claudin 4 was related to poorly differentiated type [p = 0.001], non-intestinal [diffuse] type [p = 0.001], deeper tumour invasion [p < 0.001], lymph node metastasis [p = 0.001], and higher stage [p = 0.001]. In addition, higher LVD was related to poorly differentiated types [p = 0.001], non-intestinal type [p = 0.001], lymph node metastasis [p = 0.015], and higher tumour, node, metastasis [TNM] stage [p = 0.001]. LVI was related to lymph node metastasis [p = 0.025], higher TNM stage [p = 0.001], and LVD [p = 0.001]. Claudin 4 significantly correlated with both LVD [p = 0.009] and LVI [p = 0.009]

Conclusions: High expression of claudin 4 was associated with the more differentiated intestinal-type gastric carcinoma and lost in poorly differentiated diffuse type. So, claudin 4 may be used as one of the differentiating markers between the two major types of gastric carcinoma [intestinal vs. diffuse]. LVD and LVI were related to higher incidence of lymph node metastasis and therefore could be used as predictive markers for lymph node metastasis in limited specimens during early gastric carcinoma to determine the need for more invasive surgery. Low expression of claudin 4 was related to lymphangiogenesis. This may shed light on the relation of tight junction protein expression and lymphangiogenesis

Lornoxicam versus tramadol for post-operative pain relief in patients undergoing ENT procedures

Pain following ear-nose and throat surgery is one of the most important complaints for which, several drugs are used. This prospective, randomized, double-blind controlled trial was designed to compare the analgesic effect of tramadol versus lornoxicam for post-operative pain relief in patients undergoing ENT surgical procedures. One hundred and twenty patients of ASA class I-II, who had undergone elective ENT surgical procedures under general anesthesia, were assigned in a randomized manner into three equal groups. Group L received lornoxicam8 mg IV, Group T received tramadol 1 mg/kg IV and Group C received IV saline after induction of anesthesia before the start of the surgery. Post-operative pain was assessed using the visual analogue scale [VAS] and sedation level was evaluated during stay in the post-anesthesia care unit with a four-point sedation scale. Intraoperative blood loss was estimated using the Five-Point Scale. Adverse events in the first 24 h post-operative were recorded. The VAS pain scores were significantly higher in Group C as compared with those in Groups L and T at 30 min and 1, 2, 4and 6 h post-operatively, with no significant difference between Group L and Group T. The amount of morphine consumption post-operatively was significantly lower in Group L [5.2 +/- 2.5 mg] and Group T [5.0 +/- 2.0 mg] as compared with that in Group C [7.4 +/- 2.3 mg] [P = 0.001]. The time for the first analgesic requirement was significantly less in Group L [92.62 +/- 24.23 min] and Group T [88 +/- 21.43 min] as compared with that in Group C [42.82 +/- 25.61 min], with no significant difference between the other two groups. Estimated intraoperative blood loss score by the surgeons showed no significant difference between the three groups. The most frequent side-effects in the three groups were nausea and vomiting, and their incidence was significantly higher in the placebo group as compared with the other two groups. Tramadol 1 mg/kg was comparable to lornoxicam 8 mg for post-operative pain relief in patients undergoing ENT surgical procedures; both drugs helped to reduce the post-operative opioid requirement and consequently minimized the related adverse effects of the opioids

Heme oxygenase-carbon monoxide system in patients with cirrhosis: relation to splanchnic hemodynamics

Carbon monoxide [CO], an end product of the heme-oxygnase [HO] pathway,is a potent vasodilator and an important modulator of vascular cell function. The present work was designed to study the HO-1/CO system in patients with cirrhosis in relation to severity of liver disease, blood viscosity and splanchnic haemodynamics. Plasma HO-1 levels and blood carboxyhaemoglobin [COHB] concentration,an index of CO production were measured in 30 patients with liver cirrhosis and variable degrees of hepatic dysfunction and in 15 healthy subjects as a controls group. Both patients and control were non smokers. Blood viscosity was measured using the red blood cell pipette viscometer. The blood volume of the portal vein,superior mesenteric artery and splenic artery as well as pusatility index of the arteries were measured using doppler ultrasonography. Plasma [HO-1] levels and blood carboxy haemoglobin concentration were significantly higher in patients with liver cirrhosis than in healthy subjects [p< 0.001]. Also, patients who had esophageal varices, history of bleeding varices, portal hypertensive gastropathy and ascites showed significant increase in HO-1/COHB levels compared with those who did not have these complications [p < 0.001]. The increases in plasma HO-1 level and COHB level showed positive correlation with Child-Pugh score, blood viscosity and the increases in the blood flow volume of the portal vein, superior mesenteric artery and splenic artery and inverse correlation with the decreases in the pulsatility index and the resistive index of the arteries in patients with liver cirrhosis [P< 0.05]. Increased HO-1 activity with enhanced endogenous CO generation may play a role in the development of splanchnic vasodilation and serious manifestations of portal hypertension in liver cirrhosis

Kinetic spectrophotometric determination of cefadroxil and cefoperazone sodium in pure and dosage forms

An accurate and simple kinetic spectrophotometric method is described for the determination of cefadroxil [CD] and cefoperazone sodium [CPZ] in pure form and in pharmaceutical preparations. The method is based on the reaction of these compounds with potassium permanganate at room temperature in the presence of sodium hydroxide to produce a bluish-green colored product measurable at 610 nm. The proposed method is valid over the concentration range 1-7 micro g/ml and 2-16 micro g/ml for CD and CPZ, respectively, with minimum detectability of 0.12 micro g/ml and 0.001 micro g/ml [3.14x10[-7]M and 1.52x10[-9]M ] for CD and CPZ, respectively. The proposed method was applied successfully for the determination of CD and CPZ in commercial dosage forms and the results obtained are in good agreement with those obtained by the reference methods

Impact of trimetazidine on doxorubicin-induced acute cardiotoxicity in mice: a biochemical and electron microscopic study

Doxorubicin [Dox] is an effective broadly used anti-tumor drug. However, its therapeutic success is limited due to the development of acute and chronic cardiotoxicity. Therefore, the purpose of this study was to evaluate the effect of trimetazidine [TMZ] on Dox-induced acute cardiotoxicity in mice using biochemical and electron microscopic approaches. Thirty male mice weighing 30 gm +/- 5gm were used. They were equally divided into 3 groups. Group I represented the control group. Animals of group II, were intraperitoneally [IP] injected with a single dose of Dox [15mg/kg]. In group III, the mice were IP injected with TMZ [2.5mg/kg/d] for 5 days before single injection of the same dose of Dox. Thirty hours after Dox injection, animals were anaesthetized. Blood samples were obtained and serum was separated for measurement of cardiotoxicity indices [creatine phosphokinase isoenzyme [CK-MB], lactate dehydrogenase [LDH] and aspartate aminotransferase [AST]]. Hearts were dissected and each was divided into two halves, one half was used for measurement of myocardial oxidative stress [thiobarbituric acid reactive substance [TBARs], nitrate /nitrite [NOx]] and myocardial antioxidant activity [glutathione [GSH]] level. The other half was processed for electron microscopic study [EM]. In group II, there were significant increase in CK-MB, LDH, AST, TBARs and NOx and a significant decrease in GSH. Electron microscopic examination revealed severe toxic effect on the cardiac muscle in the form of myofibrillar lysis, cytoplasmic vacuoles, oedema, dilatation of sarcoplasmic reticulum, mitochondrial damage, increased number of 2ry lysosomes, widening of the junctions forming the intercalated discs and mononuclear cellular infiltrate between the disorganized cardiac myocytes, whereas group III revealed marked improvement in all biochemical parameters and EM study revealed almost a similar myocardial histological profile to the control group. In conclusion, TMZ ameliorates Dox-induced acute cardiotoxicity in mice by reduction of myocardial oxidative stress and preservation of endogenous antioxidant activity

Light and electron microscopic study of the effect of sodium valproate on the quadriceps femoris muscle of rat and the possible protective role of L-carnitine

Sodium valproate [VPA] is a broad spectrum antiepileptic drug. Patients especially children who receive VPA for a long time present with myalgia and exercise intolerance. The aim of the present study was to elicit the effect of VPA on the skeletal muscle and the possible protective role of L-carnitine. Fifty male albino rats were used in this study. The animals were divided into two groups: group A [control group] and group B [experimental group] which was subdivided into 4 subgroups: group B1 and B2 received VPA only [50 mg/kg/day], for 1 and 2 months respectively. Group B3 and B4 received VPA and L-carnitine [300 mg/kg/day] for 1 and 2 months respectively. At the end of the experiment blood samples were collected to evaluate serum VPA levels. Quadriceps femoris muscles [QFM] were dissected and processed for light and electron microscopic [EM] study. In group B1, some QFM fibers showed loss of their striation or longitudinally splitted. Some intermediate muscle fibers appeared to be deficient in succinic dehydrogenase enzyme[S-DH] activity. EM study revealed many lipid droplets and enlarged degenerated mitochondria in-between the myofibrils. The mean serum VPA level was 101.6 +/- 7.88 micro g/ml. In group B2 the majority of muscle fibers were degenerated with mononuclear cellular infiltration and marked decrease in S-DH activity in all types of muscle fibers. Disorganized myofibrils, megamitochondria and lysosomes were seen. The lipid and glycogen granules were increased. There was a non significant increase in the mean serum VPA level [105.01 +/- 6.34 micro g/ml]. On the other hand, there was a highly significant decrease in the mean serum VPA level in group B3 [85.39 +/- 5.93 micro g/ml] and B4 [86.23 +/- 8.39 micro g/ml]. No histological changes were observed in these two groups except that some mitochondria were enlarged in group B4. In conclusion, the use of L-carnitine has a great role in protection against VPA-induced myopathy and it should be prescribed for all patients treated with VPA for long time

Ventilation perfusion lung scan in acute pulmonary embolism, a good negative but a bad positive diagnostic test

Provisional diagnosis of acute pulmonary embolism [P.E.] is based on clinical evaluation Definitive diagnosis however, used to be non invasive with Ventilation Perfusion lung scan [V/Q] considered the test of choice pointing to high, intermediate and low probabilities of PE. Diagnostic pulmonary angiography is obviously the golden standard for establishing the final diagnosis of a highly probable PE. The purpose of the present study is to validate the technique of Ventilation Perfusion lung scan through comparison with the directly proven diagnosis via pulmonary angiography. This study was conducted on a total of 20 pts, all having DVT [proven by duplex], with 10 having symptoms suggestive of pulmonary embolism and 10 asymptomatic. Nine were males and 11 were females with a mean age of 41 +/- 16 [range from 16 to 71y.] Following clinical evaluation, including 12 lead ECG and X-ray chest, all pts were subjected to: routine lab. tests, specific lab, tests including arterial blood gases, plasma D-dimer level, FDPs and fibrinogen, transthoracic echocardiography[M-mode and 2D],V/Q lung scan using Tc99m labeled micro aggregated albumin and pulmonary angiography. The latter was performed under hemodynamic monitoring and O2 supplementation, using the trans- venous approach [Sildenger technique] through the right or the left common femoral vein[Internal jugular veins were an alternative in case of iliac or caval thrombosis]. A 6 F pulmonary catheter [angled pigtail] was used for injection of low osmolar iodinated contrast medium. Two views of each lung were performed [The frontal and 45° ipsilateral posterior oblique projections]. Out of the 10 asymptomatic pts only one [10%] had angiographically proven PE compared to 5 out of 10 symptomatic pts [50%]. Corresponding figures for +ve V/Q were 50% and 90% respectively. Compared to the 14 cases without angiographic evidence of PE, the 6 pts with proven PE exhibited significantly higher incidence of dyspnea and chest pain, lower BP, faster respiratory rate, lower PaO2, significantly higher PAP and higher incidence of cyanosis, pulmonary hypertension, TR, RV dilatation. Considering pulmonary angiography as the standard diagnostic tool, all 6 proven cases had +ve V/Q lung scan, while of the remaining 14 unproven cases, V/Q was +ve in 8 i.e sensitivity 100%, specificity 43%, negative predictive value 100%, positive predictive value 43%. In conclusion, compared with the standard pulmonary angiography, ventilation perfusion lung scan proved to be an excellent negative but a bad positive test [sensitivity 100%, specificity 43%, negative predictive value 100%, positive predictive value 43%]. Because of the non invasive nature, V/Q is to be recommended at least as an initial screening test prior to subjecting pts to the invasive technique of pulmonary angiography. Clinical evaluation and bed side objective assessment should not be under estimated as shown by the 10% true incidence of PE in asymptomatic vs 50% in symptomatic cases

Serum parathormone in diabetic patients on haemodialysis

Chronic renal failure is becoming an increasingly common disease. Diabetes mellitus is a frequent cause of end stage renal disease. Parathyroid disorders are seen commonly in patients with end stage renal disease. [E.S.R.D]. We compared 42 diabetic patients with 36 non-diabetic patients. All of them had ESRD on regular hemodialysis. Diabetic patients were subdivided into two groups: Insulin dependent and non insulin dependent diabetic. In all patients we measured the main biochemical parameters together with plasma calcium, phosphorus, magnesium, intact parathyroid hormone [I.PTH] and insulin level in blood. Diabetic patients showed lower levels of I-PTH than non-diabetic patients on regular haemodialysis [HD]. Also, insulin dependent diabetic patients showed lower but not significant levels of l-PTH than non insulin dependent diabetic patients