Gross Anatomical Study onthe Skull and Mandible ofthe Wild Boar (SusScrofa) In the Caribbean

Introduction:Wild pigs (Susscrofa), which are found throughout the Caribbean island of Trinidad and Tobago, are sometimes used experimentally, in the field of biomedical science, to model the human anatomy. In particular, the skull, which is very important as ithouses vital organs and foramina,has clinical importance in applying regional anesthesia.Subjects and Methods:The present work was conducted on two skulls and mandibles of wild pigsto grossly describe their osteology and foramina. The information garnered can be used for comparative studies of the skulls and mandibles with other similar species. The skulls and mandibles were prepared and cleaned using standard method. All of the characteristic features of various standards views of the skulls bones, including dorsal, lateral, caudal, and the lateral, rostral and caudal views of the mandibles as well as the foramina of the skulls and mandibles were described and discussed.Results:Each skull was divided into long facial and short cranial regions. The tympanic bulla was small. The supraorbital foramina and grooves were present. The zygomatic process of the zygomatic bone and the zygomatic process of the temporal bone formed the large zygomatic arch. The mandible was a paired bone with ossified mandibular symphysis. The dental formula was confirmed and it was 44 teeth.Conclusion:The bones and foramina of the skull and mandible were homologue to that of other mammals

effect of adding dexmedetomidine or fentanyl to levobupivacaine for ultrasound-guided supraclavicular brachial plexus block in upper extremity sugeries

Background: Supraclavicular brachial plexus block is one of the most effective anesthetic procedures in operations for the upper extremity. It has gained importance as regional anesthetic technique for surgical, diagnostic and therapeutic purpose in interventional pain management

Aim: We aimed to study the effect of adding dexamedetomidine or fentanyl to levobupivacaine in ultrasound guided supraclavicular brachial plexus block in upper extremity surgeries as regard to onset and duration of sensory and motor block and postoperative pain

Methods and Material: The study was carried out in Tanta University Hospital on 90 patients of 18-60 years old with ASA physical status I/II scheduled for elective surgery of upper hand. Patients were divided into three equal groups. Group A: was given 30 ml of 0.5% levobupivacaine with fentanyl 100 Mug. Group B: was given 30 ml of 0.5% levobupivacaine with dexamedetomidine 100 Mug. Group C: was given 30 ml of 0.5% levobupivacaine with 1ml normal saline. The following data were measured for each patient: hemodynamic status [HR, MAP], onset of sensory and motor block, and duration of sensory and motor block, visual analogue score [VAS] and incidence of complications

Results: Our results showed that no significant difference between three groups according to hemodynamic changes, while there was significant prolongation in duration of sensory and motor block, significant decrease in VAS score in group B compared to group A and C

Conclusions: We concluded that the addition of dexmedetomidine was better than fentanyl when both used as adjuvants to levobupivacaine in ultrasound guided brachial plexus block as demonstrated by prolongation of duration of sensory block, improved quality of postoperative analgesia and provide of desirable sedation

Alizarin Red-S Protocol for Skeletal Staining during Fetal Period in Rabbit

Background: The main purpose of this study was to give detailed information on the staining protocol of Alizarin Red-S to detect the normal and abnormal skeleton of rabbit fetus. Methods: Eleven (9 females and 2 males) of adult rabbit weighing 3-3.5 kg were used. The female rabbits were left with buck to become pregnant then were classified into a treatment and a control group. The former group received oral doses of 400mg/kg of sodium valproate for 15 days starting from the 6th day after mating until 20th day of pregnancy, while the second received water in the same period. The pregnant rabbit was slaughtered at the 29th day of pregnancy. The live rabbit fetuses were collected. The staining protocol included fixation, dehydration, clearing, staining and preservation. The fetuses were examined under dissecting microscope and photos were taken for documentation. Results: The staining protocol made the rabbit fetuses to be clear enough to see their skeleton through the surrounding tissue. The axial skeleton including skull with mandible, vertebral column, ribs and sternum and the appendicular skeleton including the bones of the fore-and hindlimbs took the stain and became red in color. The macroscopic skeletal disorders of the fetuses of the treatment group were observed. The ossification centres were assessed. Conclusion: This protocol which depended on fixation by 95% ethanol, clearing by 1% potassium hydroxide and staining by 0.001 % Alizarin Red-S was effective in detecting normal and abnormal fetal skeletal morphology

Low prevalence of macroprolactinaemia among patients with hyperprolactinaemia screened using polyethylene glycol 8000

Objectives: Macroprolactinaemia is a known benign cause of hyperprolactinaemia [hyperPRL]. Differentiating macroprolactinaemia and hyperPRL is important, as macroprolactinaemia does not require treatment. This study was conducted to determine the prevalence of macroprolactinaemia among hyperPRL patients through the use of polyethylene glycol 8000

Methods: From 2011 to 2013, a cross-sectional study was conducted on patients diagnosed with hyperPRL in Hospital Universiti Sains Malaysia [HUSM]. Sera from these patients were measured for PRL using cobas e411 [Roche Diagnostics, Indianapolis, USA] [sandwich principle] and the same sera were treated with polyethylene glycol [PEG] 8000 to differentiate true hyperPRL from macroprolactinaemia. PRL recovery of less than 40% was used as an indicator of the presence of macroprolactin

Results: A total of 133 hyperPRL patients, 120 [90%] women and 13 [9.8%] men, aged 18e68 years, with mean [standard deviation] age 34.37 [11.75] years comprised this study cohort. Nine female patients were found to have macroprolactinaemia with an estimated prevalence of 6.8% [95% CI: 2.4%, 11.1%]

Conclusions: The prevalence of macroprolactinaemia detected using PEG 8000 among patients diagnosed as hyperPRL was low. Screening for macroprolactin using PEG 8000 indicated that the majority of patients who presented with hyperPRL in HUSM were true hyperPRL

Portal hypertension treatment with candesartan plus propranolol for nine months restores normal portal circulation hemodynamic pattern

Post HCV liver cirrhosis is one of the most prominent etiologies behind the abnormal portal circulation hemodynamics. It occurs as a result of distorted balance between portal venous flow [PVF] and intrahepatic resistances [IHR]. PVF is partially controlled by using both specific and non-specific beta blockers [NSBBs] that have insignificant effects on IHR. Angiotensin receptor blockers [ARBs] inhibit the activated hepatic stellate cell [HSC] contraction and thought to reduce the dynamic portion of MR. The study aimed to slow down the venous blood flow and to reduce the IHR of portal vein vasculature to control sequelae of the enhanced post cirrhosis portal venous turbulence. We evaluated the effects of Candesartan plus propranolol compared to each of them individually in management of portal hypertension [PH]. Three groups of 25 patients each, presented with chronic HCV infection and grade II- III esophageal varices [OV], were randomly assigned to one of three treatment regimens: Propranolol or Candesartan or both. Subjects were screened every three month by Doppler Ultrasound for a total of nine months. Damping Index [DI], pulse Pulsatility index [PT], Portal Venous Flow [PVF] Volume, Portal Venous Peak Velocity [PVPV], and Portal Vein Diameter [PVD] were evaluated once every third month. Our study concluded that combined therapy [Propranolol + Candesartan] induced highly significant improvements that led to restoration of normal values of DI, PI, PVF volume and PVPV overtime compared to monotherapy regimens [P>0.001]. Data strongly recommended using Propranolol plus Candesartan in overtime management of portal hypertension

Regulatory role of GSK3β in the activation of NF-κB and modulation of cytokine levels in Burkholderia pseudomallei-infected PBMC isolated from Streptozotocin-induced diabetic animals

Increased susceptibility of diabetics to melioidosis, a disease caused by the Burkholderia pseudomallei bacterium is believed to be attributed to dysfunction of the innate immune system. However, the underlying mechanism of the innate susceptibility is not well-understood. Glycogen synthase kinase-3β (GSK3β) plays an important role in the innate inflammatory response caused by bacterial pathogens. The present study was conducted to investigate the effects of GSK3β inhibition by LiCl on levels of pro- and anti-inflammatory cytokines; and the activity of transcription factor NF-κB in B. pseudomallei-infected peripheral blood mononuclear cells (PBMC) derived from diabetic-induced and normal Sprague Dawley rats. In addition, the effects of LiCl on intracellular bacterial counts were also investigated. Infection of PBMC from diabetic and normal rats with B. pseudomallei resulted in elevated levels of cytokines (TNF-α, IL-12 and IL-10) and phosphorylation of NF-κB in both cell types. Intracellular bacterial counts decreased with time in both cell types during infection. However bacterial clearance was less prominent in diabetic PBMC. Burkholderia pseudomallei infection also caused inactivation (Ser9 phosphorylation) of GSK3β in normal PBMC, an effect absent in infected diabetic PBMC. Inhibition of GSK3β by LiCl lowered the levels of pro-inflammatory cytokines (TNF-α and IL-12) in both normal and diabetic PBMC. Similarly, phosphorylated NF- κB (pNF-κB) levels in both cell types were decreased with LiCl treatment. Also, LiCl was able to significantly decrease the intracellular bacterial count in normal as well as diabetic PBMC. Interestingly, the levels of anti-inflammatory cytokine IL-10 in both normal and diabetic PBMC were further elevated with GSK3β inhibition. More importantly, GSK3β in infected diabetic PBMC was inactivated as in their non-diabetic counterparts upon LiCl treatment. Taken together, our results suggest that inhibition of dysregulated GSK3β in diabetic PBMC resulted in the inactivation of NF-κB and modulation of inflammatory cytokine levels. This is evidence that dysregulation of GSK3β is a contributing factor in the molecular basis of innate dysfunction and susceptibility of diabetic host to melioidosis infection.

Generation and characterisation of HCV genotype 1 viruses most recent common ancestor

Background: Hepatitis C virus [HCV] causes acute and chronic liver diseases in humans. Its two envelope glycoproteins, E1 and E2, interact with host cell receptors and provide a target for neutralising antibodies. Past vaccine studies using unmodified E2 proteins have failed to convincingly generate broadly neutralising antibody responses

Objectives: This study sought to generate and evaluate an immune-focused, vaccine candidate for HCV

Methodology: A synthetic construct based on most recent common ancestral sequence [MRCA] of HCV genotype 1 viruses was generated using sequences available from the Los Alamos HCV database [720 sequences [360 subtype 1a and 360 subtype 1b sequences]], after exclusion of epidemiologically-related sequences. Soluble E2 [sE2] proteins were generated by stably transfected S2 cells and purified using Strep- tag purification and size exclusion chromatography. The MRCA construct was subsequently interrogated using a linear [AP33] and conformational [1: 7] monoclonal antibodies directed at E2. A full length E1E2 construct was used for production of HCV pseudoparticles [HCVpp]. The infectivity of the HCVpp was measured in the presence of monoclonal antibodies; AP33 1: 7 and AR3A

Results: Monomeric proteins of the MRCA generated using a Drosophila expression system were conformationally intact when examined by the monoclonal antibody 1: 7 that targets the conformational epitope on E2 responsible for interaction with the CD81 receptors. The full length MRCA E1E2 construct showed functionality in the HCV pseudo-particle [HCVpp] system. The MRCA HCVpp construct was susceptible to neutralisation by AP33, 1: 7 and AR3A, in dose- dependant manner

Conclusion: This study demonstrates the generation of a functional construct that could be used as a vaccine candidate in a potential vaccine approach to minimise the problem of genetic diversity between the vaccine construct and contemporary viruses

[Limits of quantitative coronary angiography [QCA] in intermediate stenosis measuring: a correlation and concordance study with intravascular ultrasound [IVUS]]

Although coronarography is still the gold standard to evaluate coronary lesions, it remains a bidimensional representation of a tridimensional complex structure, which can represent a source of error in measurements. To perform a correlation and concordance study between quantitative coronary angiography [QCA] and intravascular ultrasound measurements for intermediate and ambiguous lesions. We analysed 40 patients' coronary arteries from March 2009 to November 2011 by both QCA and intravascular ultrasound to perform then a correlation and concordance study. The correlation study confirmed the limits of the angiogram in providing accurate measurements. The correlation coefficient was yet high in reference diameters [r=0,78, p<0,001] and minimal lumen diameters [r=0,58, p<0,001], but was middling for stenosis percentages [r=0,23, p=0,03]. This coefficient was also high for lesions lengths [r=0,51, p=0,01]. Bland and Altaman diagrams showed however wide limits of agreement, reflecting possibility of large measurements error and confirming the absence of concordance between the two techniques. Coronarography though being the most widespread mean of evaluating coronary lesions lacks to provide accurate measurements, which can influence patient's management, especially in case of intermediate lesions

[Role of intravascular ultrasound [IVUS] in determining the therapeutic strategy for the patients with intermediate coronary lesions]

Coronarography presents some limits in assessing intermediate stenosis. Intravascular ultrasound provides tridimensional measurements of the artery, with more reliable data guiding revascularization decision. To evaluate the impact of intravascular ultrasound measurements on revascularization decision of intermediate and ambiguous coronary lesions. We prospectively analysed 40 patients' coronary arteries from March 2009 to November 2011 by both quantitative coronary angiography [QCA] then intravascular ultrasound, and compared our decision before and after intravascular ultrasound. In the final revascularization decision after intravascular ultrasound, medical treatment rate raised from 22% to 25%, percutaneous coronary intervention dropped from 55% to 50%, and coronary artery bypass graft slightly raised from 23% to 25%. Therapeutic decision changed after intravascular ultrasound in 47% of patients [p=0,01], which reflects an important impact of this technique in management of intermediate coronary lesions. Intravascular ultrasound provided more accurate measurements which permitted a better detection of ischemia and influenced notably our therapeutic strategies

survey of the practice of regional anesthesia in Saudi Arabia

This survey aimed to assess both the extent of practice and need for training in regional anesthesia among anesthesiologists in Saudi Arabia in 2012. We distributed an electronic survey among 382 anesthesiologists attending the bi-annual meetings of the Saudi Anesthetic Association, enquiring about their practice in regional anesthesia. Questions concerned the practice of regional anesthesia, use of ultrasound guidance, and the need for training workshops. The response rate of anesthetists was 55.2% with most of them were males and had mean age of 25-50 years. Most anesthesiologists [88.2%] were practicing regional anesthesia frequently in the operating rooms [75.3%] rather than designated block room. From the respondents, only 14.2% did fellowship in regional anesthesia, 21.8% and 18.5% were using ultrasound and nerve stimulation guidance, respectively, 11.4% received formal training, and 86.3% were willing to attend training workshops on regional anesthesia. There was a significant negative correlation between the ultrasound users and their institutional positions [r=-0.191] [P=0.026]. We believe that more could be done to improve the practice of regional anesthesia in the Kingdom of Saudi Arabia, including the implementation of formal training and conduction of more frequent specialized courses/workshops in the field of regional anesthesia with special reference to ultrasound regional anesthesia blockade techniques

survey of the current use of neuromuscular blocking drugs among the Middle Eastern anesthesiologists

This survey aimed to assess the extent of practice of the Middle Eastern anesthesiologists in the use of neuromuscular blocking agents [NMB] in 2012. We distributed an electronic survey among 577 members of the Triple-M Middle Eastern Yahoo anesthesia group, enquiring about their practice in the use of neuromuscular blocking agents. Questions concerned the routine "first choice" use of NMB, choice for tracheal intubation, the use of neuromuscular monitoring [NMT], type of NMB used in difficult airway, frequency of using suxamethonium, cisatracurium, rocuronium and sugammadex, observed side effects of rocuronium, residual curarization, and the reversal of residual curarization of rocuronium. A total of 71 responses from 22 Middle Eastern institutions were collected. Most of the Middle Eastern anesthesiologists were using cisatracurium and rocuronium frequently for tracheal intubation [39% and 35%, respectively]. From the respondents, 2/3 were using suxamethonium for tracheal intubation in difficult airway, 1/3 were using rocuronium routinely and 17% have observed hypersensitivity reactions to rocuronium, 54% reported residual curarization from rocuronium, 78% were routinely using neostigmine to reverse the rocuronium, 21% used sugammadex occasionally, and 35% were using NMT routinely during the use of NMB. We believe that more could be done to increase the awareness of the Middle Eastern anesthesiologists about the high incidence of PROC [>20%] and the need for routine monitoring of neuromuscular function. This could be accomplished with by developing formal training programs and providing official guidelines

[Coronary angiographic characteristics in septuagenarian patients with acute coronary syndrome]

Although the prognosis of acute coronary syndrome [ACS] in elderly patients is bleak, elderly population is less well treated both in medical and interventional terms. To analyse angiographic findings in septuagenarian patients admitted with ACS and its impact on the therapeutic strategy. We retrospectively analysed 250 patients 70 years or older hospitalised for ACS who underwent a coronary angiography between January 2006 to september2010. This population was more likely to be male with mean age 74 years and 93% of ACS were inaugural events [60% N STEM, 40% STEMI].Coronary angiograms showed complex, diffuse coronary lesions with a high incidence of multivessel coronary artery disease, bifurcation lesions, and calcified stenosis. Angiographic findings after ACS in elderly were caracterised by multivessel disease and complex lesions .Surgical or percutaneous coronary revascularizaion was possible in the majority of these patients

Efeitos de misoprostol sublingual pré-operatório no tônus uterino durante anestesia com isoflurano para cesariana / Effects of preoperative sublingual misoprostol on uterine tone during isoflurane anesthesia for cesarean section / Efectos del misoprostol sublingual preoperatorio en el tono uterino durante la anestesia con isoflurano para cesárea

JUSTIFICATIVA E OBJETIVOS: Misoprostol reduz o sangramento uterino após o parto cesáreo sem efeitos prejudiciais para a mãe ou o bebê. Nosso objetivo foi avaliar os efeitos de misoprostol pré-operatório no sangramento materno e no tônus uterino e a necessidade de ocitocina após cesariana sob anestesia com isoflurano. MÉTODOS: Depois da aprovação pelo Comitê de Ética, 366 pacientes programadas para cesariana eletiva foram randomicamente designadas para receber 400 µg de misoprostol sublingual (n = 179) ou um comprimido de placebo (n = 187) após intubação. A anestesia foi mantida com CAM de isoflurano a 0,5-0,7 e óxido nitroso. Todas as pacientes receberam infusão de ocitocina (10 UI) após expulsão da placenta. A estimativa de perda sanguínea, do tônus uterino, da necessidade de ocitocina complementar, da contagem de hematócrito, dos escores de Apgar no 1º e aos 5 minutos e os efeitos adversos foram registrados. RESULTADOS: Após a indução, as pacientes que receberam misoprostol sublingual tiveram perda sanguínea perioperatória (202 ± 383,1 vs 708 ± 204,3 mL, p < 0,001), necessidade de ocitocina (p < 0,001), níveis mais elevados de hematócrito (p < 0,001) e tônus uterino (p < 0,02) menos significativos. A incidência de tremores foi maior no grupo misoprostol (p = 0,04). Não houve diferenças entre os dois grupos quanto aos índices de Apgar, náusea e vômito, distúrbios gastrointestinais e febre. CONCLUSÃO: A administração pré-operatória de misoprostol sublingual (400 µg) é segura e eficaz para atenuar o sangramento materno e o efeito no tônus uterino da anestesia com isoflurano em parto cesário.

BACKGROUND AND OBJECTIVES: Misoprostol would reduce the uterine bleeding after cesarean delivery without harmful effects on either mother or baby. We aimed to evaluate the effects of preoperative misoprostol on maternal blood loss, uterine tone, and the need for additional oxytocin after cesarean delivery under isoflurane anesthesia. METHODS: After ethical approval, 366 patients scheduled for elective cesarean delivery were randomly allocated to receive either sublingual misoprostol 400 µg (n = 179) or placebo tablet (n = 187) after intubation. Anesthesia was maintained with 0.5-0.7 MAC isoflurane with nitrous oxide. All patients received intravenous infusion of 10 IU of oxytocin after placental delivery. Perioperative estimated blood loss, uterine tone, need for supplementary oxytocin, hematocrit, Apgar scores at 1 and 5 min and adverse effects were recorded. RESULTS: After induction, patients receiving sublingual misoprostol had significant less perioperative estimated blood loss (202 ± 383.1 vs. 708 ± 204.3 mL, p < 0.001), need for oxytocin (p < 0.001), higher hematocrit levels (p < 0.001) and uterine tone (p < 0.02). The incidence of shivering was higher in the misoprostol group (p = 0.04). There were no differences between the two groups as regarding Apgar scores, nausea and vomiting, gastrointestinal disturbances and pyrexia. CONCLUSION: Preoperative administration of sublingual misoprostol 400 µg is safe and effective in attenuating the maternal bleeding and uterine atony from isoflurane anesthesia for cesarean delivery.

JUSTIFICATIVA Y OBJETIVOS: El Misoprostol reduce el sangramiento uterino después del parto por cesárea sin efectos perjudiciales para la madre o el bebé. Nuestro objetivo fue evaluar los efectos del misoprostol preoperatorio en el sangramiento materno y en el tono uterino, y la necesidad de ocitocina después de la cesárea bajo anestesia con isoflurano. MÉTODOS: Después de la aprobación por el Comité de Ética, 366 pacientes programadas para la cesárea electiva, fueron randómicamente designadas para recibir 400 µg de misoprostol sublingual (n = 179) o un comprimido de placebo (n = 187) después de la intubación. La anestesia se mantuvo con CAM de isoflurano a 0,5-0,7 y óxido nitroso. Todas las pacientes recibieron una infusión de ocitocina (10 UI) después de la expulsión de la placenta. La estimación de la pérdida sanguínea, del tono uterino, de la necesidad de ocitocina complementaria, del conteo de hematocrito, de los puntajes de Apgar en el 1º y a los 5 minutos y los efectos adversos fueron todos registrados. RESULTADOS: Después de la inducción, las pacientes que recibieron misoprostol sublingual tuvieron una pérdida sanguínea perioperatoria (202 ± 383,1 vs 708 ± 204,3 mL, p < 0,001), necesidad de ocitocina (p < 0,001), niveles más elevados de hematocrito (p < 0,001) y tonouterino (p < 0,02) menos significativos. La incidencia de temblores fue mayor en el grupo misoprostol (p = 0,04). No se registraron diferencias entre los dos grupos en cuanto a los índices de Apgar, náusea y vómito, trastornos gastrointestinales y fiebre. CONCLUSIONES: La administración preoperatoria de misoprostol sublingual (400 µg) es segura y eficaz para atenuar el sangramiento materno y el efecto en el tono uterino de la anestesia con isoflurano en el parto por cesárea.

The relationship between genetic variability and the susceptibility of Biomphalaria alexandrina snails to Schistosoma mansoni infection

In the present study, Biomphalaria snails collected from five Egyptian governorates (Giza, Fayoum, Kafr El-Sheikh, Ismailia and Damietta), as well as reference control Biomphalaria alexandrina snails from the Schistosome Biological Supply Center (SBSC) (Theodor Bilharz Research Institute, Egypt), were subjected to species-specific polymerase chain reaction (PCR) assays to identify the collected species. All of the collected snails were found to be B. alexandrina and there was no evidence of the presence of Biomphalaria glabrata. Randomly amplified polymorphic DNA (RAPD)-PCR assays showed different fingerprints with varying numbers of bands for the first generation (F1) of B. alexandrina snail populations (SBSC, Giza, Fayoum, Kafr El-Sheikh, Ismailia and Damietta). The primer OPA-1 produced the highest level of polymorphism and amplified the greatest number of specific bands. The estimated similarity coefficients among the B. alexandrina populations based on the RAPD-PCR profiles ranged from 0.56 (between SBSC and Ismailia snails) to 0.72 (between Ismailia and Kafr El-Sheikh snails). Experimental infection of the F1 of progeny from the collected snails with Schistosoma mansoni (SBSC strain) showed variable susceptibility rates ranging from 15% in the Fayoum snail group to 50.3% in SBSC snails. A negative correlation was observed between the infection rates in the different snail groups and the distances separating their corresponding governorates from the parasite source. The infection rates of the snail groups and their similarity coefficients with SBSC B. alexandrina snails were positively correlated. The variations in the rates of infection of different B. alexandrina groups with S. mansoni, as well as the differences in the similarity coefficients among these snails, are dependent not only on the geographical distribution of the snails and the parasite, but also on the genetic variability of the snails. Introduction of this variability into endemic areas may reduce the ability of the parasite to infect local hosts and consequently reduce schistosomiasis epidemiology.

Risk factors of childhood tuberculosis: a case control study from rural Bangladesh

Background: Childhood tuberculosis (TB) is one of the major causes of childhood morbidity and mortality; however, it is relatively a neglected disease. Hence, we explored the risk factors for childhood TB. Methods: Ninty-five cases and 94 controls were selected during January to May 2011 from DOTS centres located in four sub-districts of Bangladesh. The exposure status of recently diagnosed childhood TB patients (<18-year-olds), who were sputum-positive, were compared with children who were sent to the laboratory with suspected tuberculosis but were found to be sputum-negative. Data were collected by a structured questionnaire. Crude odds ratios (OR), adjusted odds ratio (AOR) and 95% confidence intervals (CI) were estimated. Stepwise logistic regression model was used to identify independent predictors. Results: Children under 14 years of age (AOR: 0.25; 95% CI: 0.10-0.66), having completed primary education (AOR: 0.28; 95% CI: 0.10-0.74), whose fathers’ were in business or service(AOR: 0.24; 95% CI: 0.08-0.72), and who slept in a less crowded room (AOR: 0.32; 95% CI:0.14-0.76), lived in a house with a separate kitchen (AOR: 0.39; 95% CI: 0.16-0.96) had less chance of having TB. Those who had contact with cases of TB among relatives or neighbours were less likely to have TB (AOR: 0.28; 95% CI: 0.16-0.70) compared to those who had contact with a TB case in the family. Conclusion: Age, education, father’s occupation, crowding, kitchen location and intimate contact with a TB case were significantly associated with smear-positive childhood TB.

[Thromboembolic complications of childhood nephrotic syndrome]

Vascular thrombosis in the childhood nephrotic syndrome is a rare event. It poses major diagnostic and therapeutic problems. The prognosis depends on early diagnosis and on precocious anticoagulation. The risk of extension of thrombosis and pulmonary embolism is real. To consider the major thrombotic events associated with childhood nephrotic syndrome and to establish an appropriate preventive approach based on objective clinical and laboratory parameters. This is a retrospective study of all cases of patients suffering from idiopathic nephrotic syndrome, during a period of 20 years, starting from January 1990 to December 2009. We selected six patients with vascular thrombosis. The diagnosis was confirmed by appropriate radiological investigation. Six cases of vascular thrombosis were identified among 260 cases of nephrotic syndrome collected during the period study. Patients are divided into five boys and one girl. The mean age was 13.3 years. The localisation of thrombosis is venous in all cases. One patient presented a massively fatal pulmonary embolism. Sinovenous thrombosis has been objectified in 3 patients who were all treated with a good therapeutic response. Vascular thrombosis remains one of the most serious complications of nephrotic syndrome in children. Early diagnosis and precocious anticoagulation are essential for preventing the extension of thrombosis

[Single versus bilateral internal thoracic artery grafts for multi vessel coronary artery bypass grafting: effects on mortality and event-free survival]

The issue of superiority of single internal thoracic artery grafting versus bilateral internal thoracic artery grafting remains unresolved. The aim of this study was to compare the early results and midterm outcome of single and bilateral internal thoracic artery grafting for multivessel coronary artery bypass grafting. Between January 2005 and March 2010, 196 patients underwent primary coronary artery bypass grafting with at least one internal thoracic artery grafts. Early results and Outcomes of patients undergoing single internal thoracic artery [SIMA] plus saphenous vein grafting [n=145] and bilateral internal thoracic artery [BIMA] plus saphenous vein grafting [n=51] were obtained at a mean follow up of 29 months. Patients with bilateral internal thoracic artery grafting were younger, had less hypertension, higher left main disease and better Euroscore than patients undergoing single internal thoracic artery grafting. In-hospital mortality was similar for the two groups: 6.9% for patients undergoing SIMA versus 5.9% for those undergoing BIMA [p=0.8]. Sternal wound infection was also similar [2.8% versus 3.9% p=0.68]. Mid-term mortality was [4% VS 4.8% p=0.71] and event free survival probability at 28 months was 75% for the single-graft group compared with 85.7% for the bilateral-graft group [P =0.46]. Our study found similar early and mid-term clinical outcomes for patients undergoing SIMA plus saphenous vein grafting and those undergoing BIMA plus saphenous vein grafting for multivessel coronary artery bypass grafting

[Coronary artery bypass grafting in diabetic patients: early and mid-term outcomes]

The outcome of coronary artery bypass grafting [CABG] in diabetic patients has traditionally been worse than in non-diabetic patients. Recent studies have suggested an improvement in outcome in diabetic patients undergoing CABG. However, the direct impact of diabetes on mortality and morbidities following CABG remains unclear. To evaluate the early and mid term outcomes of diabetic patients compared to non-diabetics following CABG. We retrospectively analyzed the data of 228 CABG patients from January 2005 to December 2010: one hundred and twenty-six diabetics and 102 non-diabetic. Diabetic patients were more likely to be female[27% Vs 12.7% P=0.009] were less smoker [55.6% Vs 80.4% P<0.0001] with higher rate of three vessel disease[67.5% Vs 42.2% P=0.005] compared to non-diabetics. Hospital mortality was significantly higher among diabetic patients [16% Vs 4.1% P=0.005].Length of care unit stay was more important [2.3 days Vs 2.1 days P=0.048], but with a similar rate of sternal wound infection even after bilateral internal thoracic artery grafting. After 28 months mean follow- up, mid-term survival of diabetics was significantly decreased compared to no-diabetics [91% Vs 99% p<0.001] .However, Event-free survival was similar in the two groups [76% Vs 80% p=0.82]. These results suggest that diabetes is associated with poorer early and mid-term outcomes following [CABG]