impact of diabetes on pregnancy in Qatar

To investigate maternal and neonatal outcomes of pregnancies in women with different types of diabetes in Qatar. To identify factors such as age, family history of diabetes and obesity contributing to the increased risk of GD. The design of this study is retrospective. 14 pregnant women with different types of diabetes including 143 [28%] Impaired Glucose Tolerance Test [IGTT], 334[65%] Gestational Diabetes [GD], 26[5%] Insulin Dependent Diabetes Mellitus [IDDM] and 11[2%] Non Insulin Dependent Diabetes Mellitus [NIDDM] who delivered between Jan - June 2004 formed the subject of this study. Data extracted from the files included maternal characteristics, fetal and maternal complications. Eight women had abortions amid two had stillbirths, leaving a final dataset comprising 504 women [141 IGTT, 332 GDM, 21 IDDM and 10 NIDDM]. Two hundred and eighty three [56.2%] were Qatari. 53% [n=267] aged >30 years, 57.5% [n=290] had family history of diabetes, only 16.1% [n=81] treated by insulin. Polyhydramnios was the most common antenatal complication occurred in 15%[n=76]. No maternal mortality .The overall Cesarean section was 6.2% [n=31]. Preterm delivery 5.8%[n=29]. Macrosomia appeared in 7.3% [n=37] infants and congenital malformations in 2% [n=10] infants. We observed that the risk factors for GDM found in other studies are generally valid for our population. Also we found that IDDM has a poorer outcome than NIDDM. However a future prospective study is need it to draw firm conclusions regarding the relative magnitudes of the adverse effects between the different diabetic groups

Hypoadiponectinemia in obese and diabetic subjects in the State of Qatar

Obesity is commonly associated with insulin resistance [IR], and is a common cause of type 2 diabetes. Adiponectin is an adipose tissue protein that enhances insulin sensitivity and has anti-atherogenic properties This study was done to determine the adiponectin level and its relations to key components of the metabolic syndrome in obese diabetic [OD], obese non-diabetic [OB] and control [non-obese, non-diabetic [NOND]] Qatari subjects We examined 64 [OD], 61 [OB] and 72 [NOND] male and female subjects. After a 12 h overnight fasting, blood samples were withdrawn for determination of plasma glucose, insulin, adiponectin, HbA1C, uric acid, total cholesterol, triglycerides, HDL-C and LDL-C Plasma levels of adiponectin in OD [10.60 +/- 3.64microg/mL] and OB [11.21 +/- 3.41microg/mL] were significantly lower than NOND controls [14.73 +/- 4.97microg/mL]. Significant, inverse correlations were observed between adiponectin levels and BMI [r=-0.241, p < 0.05], plasma glucose [r=-0.221, p < 0.05], insulin [r=-0.280, p < 0.05], C-peptide [r=-0.334, P < 0.01], total cholesterol [r=-0.243, p < 0.01,], triglycerides [r=-0.438, p < 0.01], LDL-C [r=-0.214, p < 0.05] and uric acid [r=-0.286, p < 0.05]. In addition, correlated positively with HDL-C[r=0.386, p < 0.01]. In multiple regression analysis, only TG was inversely associated with plasma level of adiponectin in all groups. This study provides the first evidence that adiponectin is reduced in Qatari obese subjects with and without diabetes. The measurement of circulating adiponectin among Qatari obese subjects is suggested to monitor cardiovascular disease [CVD] risks. Whether the plasma adiponectin level could be a suitable biomarker for following the clinical progress of CVD among Qatari obese and diabetic subjects warrants further investigation

endothelial nitric oxide synthase gene intron 4 polymorphism in Egyptian patients with end-stage renal disease

Nitric oxide [NO] synthesized by endothelial cell NO synthase [ecNOS] is a potent regulator of intrarenal haemodynamics. A polymorphism in intron 4 of the ecNOS gene is a candidate gene in renal diseases. The aim of this work is to study the gene polymorphism of ecNOS intron 4 in patients with end-stage renal failure and compared it with that of healthy subjects. The study was performed on 40 patients with end stage renal disease [ESRD] patients on regular hemodialysis, and was classified into 2 groups: Group I ESRD patients with diabetic nephropathy [10 patients] and group II includes 30 patients with ESRD due to different etiologies [all causes except diabetic nephropathy], and group III 15 apparently healthy subjects as control group. ecNOS genotypes were determined using polymerase chain reaction. The results showed that two alleles of ecNOS intron 4, labeled a and b could be detected. The frequencies of aa, ba, bb genotypes were 5% [2/40], 12.5% [5/40] 82.5% [33/40] in all the patients, 3.3% [1/30], 13.3% [4/30], 83.3% [25/30] in-group II patients, and 10% [1/10], 10% [1/10] 80% [8/10] in group I patients respectively, and in the control group all were bb100% [15/15]. There is significant difference in the frequencies of ecNOS genotypes between all ESRD patients and the control group [OR 1.423; 95% CI 1.253-1.615, p<0.01]. Compared with controls; the group I patients had much higher frequency of the ecNOS 4a allele than in-group II patients [OR 2.765, 1.556, 95% CI 1.891-4.042, 1.423-1.615, p<0.001, p<0.01] respectively. There was a significantly higher frequency of the ecNOS 4a allele among ESRD patients both diabetic and non-diabetic than in control subjects. This suggests that the ecNOS gene polymorphism in intron 4 appears to be prognostic of renal failure and the ecNOS gene polymorphism in intron 4 is a useful parameter for studying the relationship between NO and the progression of renal failure. This suggests that the ecNOS gene polymorphism might be associated with an increased risk of chronic renal failure

Abdominal access injuries in laparoscopic surgery, a retrospective study

This study was performed to assess the incidence, diagnosis, management and morbidity and mortality of laparoscopic access injuries. Using available injury based reports,patients documents and some available video tape recording of some laparoscopic procedures, 54 patients were collected and reported of having laparoscopic access injuries out of total 608 laparoscopic surgical and gynecological procedures done in Kasr Elaini teaching hospital during the period from August 2001 to April 2003 representing 8.8% of the total cases in comparison to what was reported in the literature which showed low incidence of these access injuries ranging from 5/10000 to 1.3%. Most of the reported injuries were minor vascular injuries [2.6%] and extraperitoneal gas insufflation [3.7%]. These minor complications caused only some technical difficulties during the procedures but they had no impact upon morbidity and mortality of the patients and were managed conservatively. Major retroperitoneal vascular injuries and visceral injuries, although represented minor incidence in our study 0.5% and 1.3% respectively, yet they were the major source of morbidity and mortality to the patients. Not only so but they also necessitate termination of the primary procedure and conversion to open surgery for their management. It seems that there is no single method of laparoscopic access safer than the other since there was no significant difference between them in inducing injury. In although laparoscopic access injuries seem to be of low incidence, yet they should be minimized. Since access injuries may be the result of integration between patient related factors, surgeons factors and the technique of access, so adoption of good laparoscopic technique, improvement of learning curve of junior surgeons proper site selection and port placement and proper choice of equipment, all may reduce the risk of access complications

novel role of pravastatin in experimental colitis and their mechanisms in rats

Inflammatory bowel diseases [IBDs] are multifactorial processes in which enhanced free radical production in mucosal cells has been implicated in the pathogenesis of these diseases. Free radicals are highly reactive species that have been accused in the pathogenesis of many diseases that can initiate lipid peroxidation. Malondialdehyde [MDA] synthesis and Nitric oxide [NO] are used as markers for increased oxidative and nitrosative stress of tissues in IBD. This study was undertaken to investigate the ameliorative effects of pravastatin on acetic acid-induced colitis and its mechanisms in rats. The colitis model of albino rats was induced by intracolon enema with 8 % of acetic acid. The experimental animals were randomly divided into normal control, model control, 5-aminosalicylic acid [5-ASA] therapy group and pravastatin therapy group. The 4 groups were treated intraperitonealy with normal saline, normal saline, 5-aminosalicylic acid [100 mg/kg] and pravastatin [1 mg/kg] respectively and daily [8: am] for 7 days 24 h following the induction of colitis. At the end of the experiment, animals were sacrificed by decapitation and coionic mucosa was sampled for some tissue biochemical events associated with colitis. Pathological changes of the colonic mucosa were evaluated by the colon mucosa damage index [CMDI] and the histopathological score[HS]. To evaluate the level of oxidative damage in colonic mucosa, colonic levels of malondialdehyde [MDA] and nitric oxide [NO] were measured in colon homogenate using ultraviolet spectrophotometry. Also, colonic contents of prostaglandin E2 [PGE2] was determined by enzyme immunoassay [ELISA] method to assess the level of participation of abnormal arachidonic acid metabolism in the pathogenesis of IBD. Enhanced colonic mucosal injury, inflammatory response and oxidative stress were observed in the animals clystered with acetic acid. Estimation of colonic mucosal injury has revealed significant increase of CMDI, HS activities, MDA and NO levels as well as PGE2 contents compared with the normal control [CMDI: 2.9 +/- 0.6 vs 0.0 +/- 0.0; HS: 4.3 +/- 0.9 vs 0.7 +/- 1.1; MDA: 57.53 +/- 12.36 vs 9.21 +/- 3.85; NO: 331 +/- 92 vs 176 +/- 045; PGE2: 186.2 +/- 96.2 vs 42.8 +/- 32.8 P<0.01]. However, these parameters Were found to be significantly ameliorated in rats treated with pravastatin [1mg/ kg] [CMDI: 1.6 + 0.9, HS: 3.1 +/- 1.0; MDA: 37.34+8.58,NO: 216 +/- 33; PGE2: 58.4 +/- 23.9 [P<0.01]. Moreover, a therapeutic dose protocol of pravastatin was observed as effective as 100 mg/kg of 5-ASA in the amelioration of colonic mucosal injury as evaluated by CMDI and HS In conclusion, these findings indicate that administration of pravastatin may have significant therapeutic effects on the rat model of colitis induced by acetic acid enema, which was probably due to antioxidant effect, and inhibition of arachidonic acid metabolism

Acute appendicitis diagnostic accuracy

Acute appendicitis remains a diagnostic challenge to the surgeon. In part, this is because of the variable presentation of the disease and many other diseases mimicking appendicitis, and in part, there is no absolutely accurate diagnostic test to diagnose acute appendicitis. In this study, we investigated the rate of diagnostic accuracy in patients who underwent emergency appendectomy because of suspicion of acute appendicitis in the emergency department of Kasr El-Aini hospital for a total number of 263 patients. Before operation the symptoms and signs of the patients were recorded on special forms, on which the operative findings, the result of the routine histopathologic examination of the removed appendices, and the laboratory studies of total and differential leucocytic count were also recorded. The patients were grouped into 4 groups according to whether it was simple appendicitis or perforated and whether there was surgical or non-surgical disease with the normal appendix. Based on histopathologic and operative findings, the diagnostic accuracy was 79 percent, 84 cases were found to have negative appendix, 6 of them had other surgical disorders indicating immediate surgery, thus diagnostic accuracy of acute appendicitis is 79 percent, but the overall accuracy for acute surgical disease is 80.5 percent

medial gastrocnemius myocutaneous flap with a laterally extended skin paddle

Eighteen gastrocnemius flaps were used to cover soft tissue defects in legs and feet of seventeen male patients. As defects were larger than the standard medial gastrocnemius myocutaneous flap in eight cases, the skin over the lateral belly was elevated medially based together with the flap to compensate for width discrepancy. Based on survival of these eight modified flaps and on a previous anatomical study [Kamal et al, 1992], we conclude that the skin paddle of the medial flap can safely be laterally extended to include the fasciocutaneous tissue overlying the lateral belly

Surface features and behaviour of human breast primary adenocarcinoma cells in vitro line SW-613

The surface features and the behavior of the cells of human breast carcinoma cell line SW-613 were examined using scanning electron microscope and light microscope. The preliminary observations of utilization of these features for evaluating the effect of some hormones, prolactin, hydrocortisone and insulin were presented

Evaluation of cytological and microbiological methods in diagnosis of vaginal trichomoniasis and candidiasis

600 pregnant women with leukorrhae were examined for the detection of Trichomonus or Candia. Diagnosis was done by cytological [Papanicolaou stained smears] and microbilogical [fresh wet films and culture] procedures, in order to evaluate the best method for diagnosis of these conditions. Trichomoniasis and Candidiasis could be diagnosed by one or more methods in 188 and 150 cases respectively. One single method could diagnose 11.71% of Trichomoniasis and 48.67% of Candidiais, while if two methods were used in comination the percentage were 28.72% and 36% respectively, Moreover, the three methods used together gave the highest diagnositc percentage [59.57% for Trichomoniasis and 14.67% for Candidiasis]. So., it is extremly adisable and important to follow the three methods togther in the diagnosis of these two conditions

Scanning electron microscopy of the architecture of loose connective tissue during adult life, wound healing and normal development

The natural architecture and surface ultrastructure of the various constituents of loose connective tissue in the ventral abdominal walls of 72 albino rat were examined by utilizing the scanning electron and light microscope. The stereoscopic picture of the normal adult loose connective tissue was compared with that of the loose regenerative tissue in experimental wounds during various stages of healing and with that of the loose developing tissue in the aponeuroses during various stages of normal growth. The fiber architecture, thickness and density had a peculiar picture in normal adult tissue, but during wound healing and normal development the picture was almost identical. In each tissue a general direction of fiber orientation could always be detected. The surface ultrastructure of fat and inflammatory cells was also visualized. Fibrillogenesis as polymerization of fibrils from rounded [probably tropocollagen full] vesicles was constantly seen during regeneration and development