Frequency of acute kidney injury in patients undergoing coronory artery bypass grafting

Objective: To find the frequency of acute kidney injury in patients undergoing coronary artery bypass grafting

Methodology: The study was conducted in cardiovascular unit Lady Read-ing Hospital Peshawar. It was cross sectional study. Sampling technique was non probability convenient sampling. Data was collected from 20.2.2013 to 20.8.2013. Total 179 patients included in the study. All patients with known coronary artery disease were included in the study whom were planned for revascularization in the form of coronary artery bypass grafting [CABG]. Post-operatively all patients' serum creatinine till 48th post op hour was observed to detect acute kidney injury. Acute Kidney Injury [AKI] was defined as more than 50% or elevation of 0.3 mg/dl of creatinine level from base line

Results: A total of 179 patients undergoing coronary artery bypass grafting were included in the study. Average age of the patients was 46.88 years +/- 9.91 with range 20-60 years. Patients were divided into four groups according to age. The acute kidney injury after coronary artery bypass grafting was observed in 14 [7.82%] patients. Acute kidney injury was more common in old age and it was non significantly more common in male gender

Conclusion: In spite of current highly advance cardiac surgery techniques and post operative care still there is high incidence of acute kidney injury following revascularization and subsequent worst outcomes

Foix-chavany-marie syndrome [anterior opercular syndrome] case report

Foix-Chavany-Marie syndrome is a rare cortico-subcortical suprabulbar or pseudobulbar palsy of the lower cranial nerves 5, 7, 9, 10 and 12. This syndrome consists of anarthria, bilateralvolitional paresis of the facial, lingual, pharyngeal, and masticatory muscles bilaterally with preservation of the reflexive, emotional and autonomic innervations of the same muscles. We present the first case report in the Middle East of Foix-Chavany-Marie syndrome

Cgl-SLT2 is required for appressorium formation, sporulation and pathogenicity in Colletotrichum gloeosporioide

The mitogen-activated protein (MAP) kinase pathways has been implicated in the pathogenicity of various pathogenic fungi and plays important roles in regulating pathogenicity-related morphogenesis. This work describes the isolation and characterization of MAP kinase gene, Cgl-SLT2, from Colletotrichum gloeosporioides. A DNA sequence, including 1,633 bp of Cgl-SLT2 open-reading frame and its promoter and terminator regions, was isolated via DNA walking and cloned. To analyze gene function, a gene disruption cassette containing hygromycin-resistant gene was constructed, and Cgl-SLT2 was inactivated via gene deletion. Analysis on Cgl-slt2 mutant revealed a defect in vegetative growth and sporulation as compared to the wild-type strain. When grown under nutrient-limiting conditions, hyperbranched hyphal morphology was observed in the mutant. Conidia induction for germination on rubber wax-coated hard surfaces revealed no differences in the percentage of conidial germination between the wild-type and Cgl-slt2 mutant. However, the percentage of appressorium formation in the mutant was greatly reduced. Bipolar germination in the mutant was higher than in the wild-type at 8-h post-induction. A pathogenicity assay revealed that the mutant was unable to infect either wounded or unwounded mangoes. These results suggest that the Cgl-SLT2 MAP kinase is required for C. gloeosporioides conidiation, polarized growth, appressorium formation and pathogenicity.

Non-steroidal anti-inflammatory drugs and antibiotics prescription trends at a Central West Bank Hospital

We aimed to reliably describe the pattern of outpatient prescription of non-steroidal anti-inflammatory drugs [NSAIDs] and antibiotics [ATBs] at a central hospital in the West Bank, Palestine. This was a retrospective, cross-sectional study investigating a cohort of 2,208 prescriptions ordered by outpatient clinics and the emergency room over one year in Beit Jala Hospital in Bethlehem, West Bank. The orders were analysed for the rate and types of NSAIDs and ATBs utilised, and the appropriateness of these drugs to the diagnosis. Of the total prescriptions, 410 contained NSAIDs [18.6%], including diclofenac [40.2%], low dose aspirin [23.9%], ibuprofen [17.8%] and indomethacin [15.1%]. A minority of these prescriptions contained a combination of these agents [2.5%]. Only one prescription contained cyclooxyeganse-2 inhibitors [0.2%]. The appropriateness of NSAID use to the diagnosis was as follows: appropriate [58.3%], inappropriate [14.4%] and difficult to tell [27.3%]. The rate of ATB use was 30.3% [669 prescriptions]. The ATBs prescribed were amoxicillin [23.3%], augmentin [14.3%], quinolones [12.7%], first and second generation cephalosporins [9.4% and 12.7%, respectively] and macrolides [7.2%]. ATB combinations were identified in 9.4%, with the most common being second-generation cephalopsorins and metronidazole [4.3%]. Regarding the appropriateness of prescribing ATBs according to the diagnosis, it was appropriate in 44.8%, inappropriate in 20.6% and difficult to tell in 34.6% of the prescriptions. These findings revealed a relatively large number and inappropriate utilisation of ATBs and NSAIDs. An interventional programme needs to be adopted to reinforce physicians' knowledge of the rational prescription of these agents

Anterior versus conventional surgical approach for hepatic resection of large hepatocellular carcinoma

Hepatic resection of a large HCC represents a surgical challenge. In patients with large HCC in the right liver, the conventional technique for hepatectomy, i.e., mobilization of the right liver from the retro peritoneum and anterior surface of the inferior vena cava may be difficult because of the tumor volume and local adhesions. Likewise, even if the mobilization can be accomplished, the forceful manipulation of the liver can result in tumor rupture and dissemination of malignant disease. To report the efficacy of using the anterior approach versus the conventional approach, in surgical resection for large hepatocellular carcinoma [HCC] in terms of surgical and long-term outcomes. This was a retrospective study of 126 consecutive patients who underwent hepatic resection with curative intent for large right HCC >/=7 cm between 2000 and 2006. The 36 patients who had anterior approach were compared with the remaining 90 patients who had conventional approach. The median follow-up periods after hepatectomy was 36 months [range, 6 to 132 months]. Clinicopathological features and surgical results were analyzed and prognostic factors were evaluated by multivariate analysis. There was no significant difference between the 2 groups as regard clinical, laboratory and pathological parameters apart from gender. The operative results had shown a comparable proportion of patients experienced massive operative blood loss and postoperative complications in the 2 groups. The AA group had a lower recurrence rate [P = 0015], better disease-free survival [DFS] [P = 0001] and overall survival than the CA group. Our study identified that the anterior approach is a prognostic factor of both overall survival and disease-free survival for large HCC >/=7cm. The anterior approach is a safe and effective technique for right hepatic resection for large HCC and achieves more advantageous long survival outcome over the conventional approach

Serum Resistin Levels in Nonalcoholic Fatty Liver Disease and their Relationship to Severity of Liver Disease

Background: Resistin is a hormone that is linked to the development of insulin resistance (IR); but information on the direct relationship of resistin levels in humans with nonalcoholic fatty liver disease (NAFLD); and their effect on the histological severity of NAFLD; is lacking. Objective: The aim of the current study is to determine the circulating resistin levels obtained from patients with NAFLD and to correlate them with insulin resistance and hepatic histological features. Methods: Blood samples were collected from 30 consecutive patients with liver-biopsy-proven NAFLD and 30 subjects as controls. Serum resistin levels were measured. Body mass index (BMI) was calculated for all subjects; and serum insulin; C-peptide; and lipoprotein levels were also measured. Results: Mean serum resistin level and BMI in the NAFLD group were significantly higher than in the controls (both P 0.001). Both men and women in the NAFLD group had higher mean serum resistin levels than did the men and women in the control group (all P 0.001). Multivariate analysis showed that the percentage of hepatic steatosis; sex; BMI; and homeostasis model assessment of insulin resistance [HOMA(IR)] were related to serum resistin levels. Conclusion: These data suggest increased resistin levels in NAFLD patients which are related to histological severity of the disease. These findings support the link between resistin; insulin resistance and BMI in these patients

Comparison of methods for isolating high quality DNA and RNA from an oleaginous fungus Cunninghamella bainieri strain 2a1

A number of protocols have been reported for efficient fungal DNA and RNA isolation. However, many of these methods are often designed for certain groups or morphological forms of fungi and, in some cases, are species dependent. In this report, we compared four published protocols for DNA isolation from a locally isolated oleaginous fungus, Cunninghamella bainieri strain 2a1. These protocols either involved the use of polyvinyl pyrrolidone (PVP), hexacetyltrimethylammonium bromide (CTAB) or without using PVB or CTAB. For RNA isolation, we tested two published protocols, one of which is based on TRI REAGENT (Molecular Research Center, USA) and another is simple method employing phenol for RNA extraction and LiCl for precipitation. We found that the protocol involving the use of CTAB produced the highest genomic DNA yield with the best quality compared to other protocols. In the presence of CTAB, unwanted polysaccharides were removed and this method yielded an average amount of 816 ± 12.2 μg DNA/g mycelia with UV absorbance ratios A260/280 and A260/230 of 1.67 ± 0.64 and 1.97 ± 0.23, respectively. The genomic DNA isolated via this protocol is also suitable for PCR amplification and restriction enzyme digestion. As for RNA isolation, the method involving phenol extraction and LiCl precipitation produced the highest yield of RNA with an average amount of 372 ± 6.0 μg RNA/g mycelia. The RNA appears to be relatively pure since it has UV absorbance ratios A260/280 and A260/230 of 1.89 ± 2.00 and 1.99 ± 0.03, respectively. Finally, we have demonstrated that this method could produce RNA of sufficient quality for RT-PCR that amplified a 600 bp fragment of Δ12-fatty acid desaturase gene in C. bainieri.

Thrombolysis utilisation in acute myocardial infarction in Bahrain.

We retrospectively studied 114 consecutive patients of acute myocardial infarction diagnosed in the Accident and Emergency department of our hospital, to determine the percentage of eligible patients who actually received thrombolytic therapy, the number of those excluded from receiving such therapy and the various exclusion criteria. We found that 66 patients (57.9%) received thrombolysis with either streptokinase or tissue plasminogen activator (tPA). The remaining 48 (42.1%) were excluded because of delayed presentation to hospital after the onset of symptoms (23.7%), old age or other contraindications. Although the percentage of thrombolysis utilisation in acute myocardial infarction in our centre is much higher as compared to others in the world, we find that there is a scope for improving these figures by reducing the number of patients excluded because of late presentation through health education and improved utilisation of ambulance services.