Circulating cell free DNA as a predictor of systemic lupus erythematosus severity and monitoring of therapy

Background: Systemic lupus erythematosus [SLE] is the most heterogeneous chronic autoimmune disease; it is characterized by the presence of auto reactive B and T cells, responsible for the aberrant production of a broad and heterogeneous group of autoantibodies. Recent studies using various detection methods have demonstrated the elevations of circulating DNA in SLE patients

Aim of the study: The current study aimed to measure cell-free DNA [cf-DNA] in SLE patients as a potential tool to predict disease activity and treatment follow up

Subjects and methods: 52 of SLE patients with age ranging from 10 to 48 years were randomly selected and 25 healthy subjects with age and gender matched with the patients were included as a control group. Thorough clinical examination stressing on the central nervous system, vascular, renal, rash, musculoskeletal, mucocutaneous manifestations, and fever was done for patients. The following investigations were done: Complete blood count [CBC], kidney function tests, C-reactive protein [CRP], routine autoantibodies for autoimmune diseases, complements [C3 and C4], anti-nucleosome antibodies and cf-DNA by real time PCR [RT-PCR]

Results: The levels of anti-double stranded DNA [anti-dsDNA], anti-nucleosome Ab, and cf-DNA were significantly increased in SLE patients compared to controls. The cf-DNA level was correlated to markers of disease severity namely CRP and anti-nucleosome. A significant reduction in levels of cf-DNA, anti-nucleosome Ab and anti-dsDNA was noticed after therapy

Conclusion: Our findings support that the measurement of cf-DNA appears to be a useful marker in addition to laboratory tests used in SLE diagnosis. High correlation with markers of disease severity suggesting its role in disease pathogenesis and decreasing its level after therapy makes it to be a marker of treatment follow-up

Synthesis and anticonvulsant activity of some newer dihydro-pyrimidine-5-carbonitrile derivatives: part II

Objectives: To synthesize dihydro-pyrimidine-5-carbonitrile derivatives [5-23], as an extension of the previous series, and to evaluate their anticonvulsant potential

Methods: The designed compounds were synthesized and characterized using infrared [IR], nuclear magnetic resonance [NMR] and mass spectroscopy and were evaluated for anticonvulsant activity using the maximal electroshock seizure [MES] and subcutaneous pentylenetetrazole [scPTZ] methods. Compounds with appreciable activity were investigated for their neurotoxicity using the rotarod test

Results: Compounds 17 and 23 were found to be most active at a dose of 30 mg kg[-1] at 0.5 h and 4 h in both models and did not exhibit motor impairment activity, even at higher doses

Conclusion: The newer designed compounds were found to be better than previously reported compounds. This study also shows that increased lipophilicity is directly related to the anticonvulsant activity

[Survival analysis of the patients with Thalassemia major using parametric and semi parametric survival models]

Introduction: thalasemia Major is one of the most common anemia diseases that can be fatal if not promptly diagnosed. The survival analysis of these patients can be an appropriate strategy in determining risk factors for death in these patients. The purpose of this study was to choose the best model to determine the risk factors for death in patients with the thalasemia major using common methods in the survival analysis

Methods: the data of this retrospective cohort study, with 296 patients with thalassemia major, was collected in 2004- 2013 in Zafar Clinic in Tehran. Akaicke information Criterion was used for comparison of the models and the choice 351of the best model. Data analysis was carried out with R3.0.2 software at the significant level of 0.1

Results: the values of the Akaicke information criterion [AIC] for the parametric weibull, frailty weibull, log-normal, log-logistic, Gompertz, gamma and the semiparametric Cox were computed and found to be 27.56, 29.56, 18.73, 23.39, 26.26, 68.10, 24.73, respectively. The mean survival time for men and women were 40.2 and 39.7 years, respectively. The Log-normal model showed that age, age at the first desferal injection, onset of blood injection, the patient's birthplace, mother's education variables were significantly correlated with patient survival

Conclusion: according to the values of AIC, the parametric log-normal model was chosen and suggested as the best model

[Relationship self-efficacy with perception of prognosis among cancer patients]

Introduction: Any change in current procedure of disclosure of cancer prognosis needs studies investigating the relationship of such information with mental status of cancer patients. The aim of the present study was to investigate the relationship between the perceptions of prognosis with self -efficacy among cancer patients

Methods: In this descriptive-correlation study, 200 cancer patients referred to Shahid Ghazi Hospital and private offices of two oncologists in Tabriz were participated. The sampling method was convenience sampling method. Perception of prognosis was investigated by Perception of Prognosis and self-efficacy was investigated by Cancer Behavior Inventory. Data analysis was conducted by SPSS software version 13 using descriptive statistics and Pearson correlation test

Results: The mean age of patients was 44.5 years. One hundred three patients [52.6%] were female. Participants reported positive perception about the prognosis of their disease [score 11 from 15] and rated their self-efficacy as high [score 236 from 297]. There was positive correlation between perception of prognosis and spiritual health among cancer patients [r=0.39, p=0.001]

Conclusion: Patients who have a more negative perception of their prognosis had more negative self-efficacy. Therefore, cultural factors should be considered in disclosure of cancer related information. Nevertheless, approving these results needs further studies

Disease patterns and outcomes of neonatal admissions at a secondary care hospital in Pakistan

This study aimed to determine the disease patterns and outcome of patients admitted to the neonatal unit of a secondary care hospital in Pakistan from January to December 2009. Retrospective data from the medical records of all neonates admitted during the study period were reviewed and analysed for age, weight, sex, reason for admission, duration of hospital stay, diagnosis and final outcome. Trends were examined to identify the indicators of inpatient neonatal deaths. The total number of neonates admitted during the study period was 1,554; 979 were male [63%], and 575 were female [37%]. A total of 891 patients [57.3%] were born in the hospital while 663 [42.7%] were born elsewhere. The majority were admitted during the first 24 hours of life [51.3%]. A total of 13 patients [0.8%] weighed <1 Kg; 85 [5.4%] weighed 1-1.49 Kg, and 587 [37.7%] between 1.5-2.5 Kg. Prematurity and infection were the main reasons for admission [27.9% and 20.33%, respectively], followed by birth asphyxia [13%] and neonatal jaundice [11.3%]. A total of 1,287 patients [82.8%] were discharged, 41 left against medical advice [2.6%], 59 were referred to tertiary care hospitals [3.79%] and 106 [6.8%] died. Prematurity, low birth weight, birth asphyxia and neonatal jaundice were the major causes of neonatal admissions. This could be reduced by appropriate antenatal care, timely intervention, and in-time referral to tertiary care centres for the deliveries of all high-risk pregnancies. The major cause of neonatal mortality was prematurity

Overview of medical schools in the Eastern Mediterranean Region of the World Health Organization

The 22 countries of the Eastern Mediterranean Region [EMR] exhibit considerable diversity, both culturally and economically. This paper collated published data on the status of medical schools in the Region to provide information to assist in future planning. Information about medical schools was obtained from the International Medical Education Directory, the Avicenna Directory, the WHO/EMR Health Professions Education Directory and the Institute for International Medical Education's Database of Medical Schools. The registered number of medical schools in the Region varied according to the different directories. There were variations in the language used for instruction [some used more than one language] and the density of medical schools per million population. The density and number of medical schools in the country were not related to the number of working physicians which ranged from 2.1 per 10 000 population in Afghanistan to 28.3 in Egypt. An updated directory of medical schools in the Region is much needed

New and known mutations associated with inborn errors of metabolism in a heterogeneous Middle Eastern population

To identify the mutations underlying a number of inborn errors of metabolism [IEM] disorders among United Arab Emirates [UAE] residents. Molecular diagnostic and bioinformatics tools were used to identify the causative mutations of IEM disorders from multi-ethnic patients residing in UAE. The study was conducted in Al-Ain, UAE, between April 2009 and September 2010. This is a case series retrospective study where patients attending the metabolic clinic at Tawam Hospital were recruited. Thirty patients and 26 parents were included. We present evidence in the UAE of 7 new mutations and 19 mutations that have previously been reported in other populations, all causing a number of common IEM disorders, including phenylketonuria, maple syrup urine disease, glycogen storage diseases, beta-ketothiolase deficiency, and Zellweger syndrome among many others. Reflecting the diverse ethnic groups residing in the UAE, we found mutations in several different population groups. However, consanguinity is evident in most cases. This report is of utmost importance for taking the necessary steps toward the prevention of inherited disorders, not just in the UAE, but anywhere in the world where these Arab and Asian populations reside, or where consanguinity is a cultural norm

Neutrophil CD64 in diagnosis of infection in systemic lupus erythematosus patients

Infection is one of the major complications as well as cause of death in systemic lupus erythematosus patients [SLE]. Differentiation between early infection and disease flare in these patients is often clinically difficult because both have similar signs and symptoms. To evaluate CD64 expression on neutrophils as an early marker that can discriminate between infection and disease flare in SLE patients. Also, its clinical utility in comparison with traditional laboratory tests used for detecting infection will be studied. The study included 38 subjects; 10 apparently healthy individuals as healthy controls and 28 SLE patients divided into three groups [10 SLE patients with infection, 10 SLE patients with flare and 8 SLE patients without infection or flare]. CD64 on neutrophils was measured using flow cytometry. Total leucocytic count, erythrocyte sedimentation rate and high-sensitive C-reactive protein were also measured. The median of the percentage of neutrophils expressing CD64 was higher in all SLE patients compared to normal control. It was significantly higher in SLE patients with infection than those with disease activity [P 0.001]. Using a cutoff value of >/= 17.6,% of neutrophils expressing CD64; it revealed 100% sensitivity and 100% specificity. The results of the present work showed that measurement of CD64 expression on neutrophils could be used as a sensitive and specific marker for detection of infection in SLE patients and differentiation between infection and disease activity

Pregnancy outcome in women with antiphospholipid syndrome on low-dose aspirin and heparin: a retrospective study

This retrospective review of hospital records analysed pregnancy outcome with 2 different treatments for women with recurrent miscarriage diagnosed with antiphospholipid syndrome in the index pregnancy. Of 64 women, 29 had received aspirin and 35 aspirin plus heparin. Pregnancy-induced hypertension, prematurity, intrauterine growth restriction and neonatal death were considered as maternal and fetal complications. There were no significant differences in antenatal and maternal complications between the groups. However, there were significant differences in mean anticardiolipin IgG antibody levels. Aspirin alone or in combination with heparin was equally efficacious in women with antiphospholipid syndrome and recurrent miscarriage

novel mutation in ARG1 gene is responsible for arginase deficiency in an Asian family

Argininemia is a rare autosomal recessive metabolic disorder caused by a deficiency in the arginase enzyme, which is the final enzyme in the urea cycle and responsible for the hydrolysis of arginine to urea and ornithine. The disease becomes symptomatic during childhood and is characterized by progressive spastic quadriplegia, progressive mental impairment, growth retardation, and periodic episodes of hyperammonemia. At least 19 distinct mutations in the ARG1 gene have been identified indicating the molecular heterogeneity of this condition. We report a homozygous novel mutation [c.93 delG] in the ARG1 gene from 3 affected children of a Pakistani family living in the United Arab Emirates. The mutation is expected to lead to a frame shift after the thirtieth residue and a stop codon at residue 44 [p.T30fsX14]. Therefore, this mutation is expected to result in complete loss-of-function of the arginase enzyme and therefore is the mostly likely cause of argininemia in this family

Effect of lung insufflation with oxygen or air during cardiopulmonary bypass on post-bypass pulmonary dysfunction

Cardiopulmonary bypass [CPB] causes various abnormalities in the physical and functional properties of the lungs that initiate increases in pulmonary capillary endothelial permeability, decreases in lung compliance, and impaired gas exchange during the immediate postoperative period. This prospective randomized clinical trial was designed to investigate the effect of insufflating the lungs with 100% oxygen or air versus totally disconnecting the lungs and leaving them to collapse during cardiopulmonary bypass. Fifty-six adult patients undergoing CABG surgery with total CPB and aortic cross-clamping were included. Patients were randomly allocated to 1 of 3 groups that differed only in respiratory management during CPB; Group I [O [2] group, n=19] received 100% oxygen insufflation at 4 L/min. Group II [Air group, n=19] received air [FiO[2] 0.2] at the same flow rate. Group III [Collapse group, n=18] were totally disconnected from the anesthesia machine, and their lungs were left to collapse. PaO[2]/FiO[2] was significantly reduced in O2and Collapse groups in the post-CPB measurement compared to baseline but not in Air group [p<0.05]. In the postoperative period PaO[2]/FiO[2] was significantly higher in Air group compared to O[2] group, measured at 1 hour and 4 hours postoperatively [473 + 60 vs 407 + 90, and 476 +/- 39 vs 416 +/- 73 respectively, p<0.05] denoting a more rapid recovery of the lungs. Static and dynamic lung compliance were significantly reduced in the post-CPB and postoperative measurements in 0[2] and Collapse groups, but not in Air group [p<0.05]. Bronchoalveolar lavage [BAL] cytolines [TNF-alpha and IL-8] were significantly elevated in the post-CPB measurement in 02 group compared to baseline [12.1 [0 -42.1] vs 1 [0 - 17] pg, and 674 [50 - 8767] vs 217 [<10 - 2076] pg respectively, p<0.05], but not in Air or Collapse groups. TNF-alpha and IL-8 were significantly higher in O[2] group in the post-CPB measurement compared to both other groups [p<0.05]. Lung insufflation with air [without the application of mechanical ventilation or CPAP] during CPB has attenuated post-CPB pulmonary dysfunction compared to insufflation with 100% oxygen or disconnecting the lungs and leaving them to collapse. Oxygen on the other hand has caused an inflammatory response as evident by an increase in BAL cytokines

Antibacterial and antinociceptive activity of Hoya parasitica

The ethanol extract of leaves of Hoya parasitica was tested for its antibacterial and antinociceptive activities. The extract showed moderate antibacterial activity against both gram-positive and gram-negative bacteria. It also produced significant [P<0.01] writhing inhibition in Swiss albino mice at oral dose of 500 mg/kg body weight comparable to the standard drug diclofenac sodium

Rupture of rudimentary horn of uterus at 16 weeks of gestation

Rupture of gravid uterus is a rare but serious obstetric complication. Rupture in primigravida in first or second trimester generally occurs in mullerian anomalies. A 24-year-old, primigravida, at 16 weeks gestation presented with dull, lower abdominal pain, and tachycardia. She underwent D and C for the presumptive diagnosis of missed abortion few days' back/ Chronic ectopic pregnancy was diagnosed on the basis of history and examination, and her laparotomy was planned. Upon laparotomy, right-sided ruptured ectopic pregnancy in rudimentary horn of unicornuate uterus was found and ruptured horn was excised. The patient had uneventful recovery

Routine blood transfusion should not be [routine] in cardiac surgery

To determine if open-heart surgery can be performed in a public hospital in Pakistan without the use of routine blood transfusions. Considering the high prevalence of Hepatitis B and C in the donor population, decreased use of donated blood is the best protection against these and other transfusion transmitted infections. Cross sectional observational study. This study was conducted at cardiac surgery department, Mayo Hospital Lahore. It included patients operated from January 2006 to September 2006. Duration of study was 9 months. Total of 106 patients undergoing open-heart surgery were included in the study. These were all adult patients operated during the first nine months of 2006 by a single group of surgeons. Patients who were re explored for bleeding or had complicated postoperative course or who did not survive the operation were excluded. All the pump blood after cessation of cardiopulmonary bypass was transfused to the patient. Intra and post-operative allogeneic blood transfusions were given based upon strict transfusion criterion. Any patient who received 1 unit of blood[1] or 2 units of blood with post operative haemoglobin of 11 gram per 100 ml or more than 11 gram per 100 ml or more than 2 units of blood with post operative haemoglobin of 12 gram per 100 ml or more than 12 gram per 100 ml was considered to have received unnecessary transfusion[2]. 67 patients [63.21%] did not receive any blood transfusion. 32 patients, [30.19%] were transfused 2 units of blood. 7 [6.60%] patients received more than two units of blood. 8 [7.55%] patients received unnecessary transfusion. Blood transfusions can be eliminated in most routine cardiac operations. As appropriate drugs and technology like cell savers and in pump haemo-cocentration devices become available to us, the number of patients receiving blood transfusions can most likely be decreased further

Peripheral nerve affection in patients with hyperlipidemia: a clinical and electrophysiological study

Familial hypercholesterolemia is a common genetic disorder, in its heterozygous form occur in 1:500 of the general population. Peripheral neuropathy has been reported with this disorder, some related it to the use of lipid-lowering agents [statins], others related it to the disease itself. This study was conducted on 3 groups of patients: 1[st] group; 15 patients with familial hypercholesterolemia receiving statins for variable durations, 2[nd] group: 15 newly diagnosed patients with familial hypercholesterolemia not receiving statins, and a 3[rd] group: 15 healthy matching controls. None of the subjects in the 3 groups had any disease causing peripheral neuropathy e.g. diabetes mellitus, renal failure, alcohol abuse... etc. All patients and controls were subjected to nerve conduction studies in both lower limbs; sensory and motor. None of the patients or controls had symptoms or signs of peripheral neuropathy. Electrophysiohgical studies didn't show any abnormalities in 2[nd] group and controls. In patients taking statins, 3 patients had neurophysiological evidence of sensory axonal neuropathy. The results of the present study support the previous reports that statins could be a cause of sensory polyneuropathy. Further investigations are recommended to determine which patient should discontinue statin treatment and identify other treatment options

Utilidad del ultrasonido en el cáncer del cuello uterino / Use of the ultrasonic in the cervix neoplasms

Evaluamos por ultrasonido el cuello uterino de 19 pacientes con cáncer invasivo y 2 con NIC III constatando cambios del patrón ecográfico descrito por otros autores en las primeras y ningún cambio que haga sospechar malignidad en las segundas. También se evaluo la axtensión de la enfermedad a la pelvis y otros órganos vecinos, encontrándose 2 pacientes con hidronefrosis renal derecha y 2 con matástasis a higado y una de ellas también a páncreas. Se concluye en que todo examen de ecografía pélvica debe evaluar el cuello uterino para detectar cualquier alteración del patrón normal y tomar biopsia para realizar el diagnóstico

Study of anti-diabetic effect of a compound medicinal plant prescription in normal and diabetic rabbits

Alleged antidiabetic property of a folkloric prescription containing Bergenia ligulata [Pakhan bed], Asteracantha longifolia [Tal Makhana], Cinnamomum cassia [Taj] and Argyria cuneater [Samundar Sokh] has been evaluated in rabbits after its oral administration. The indigenous drug prescription exerted a significant hypoglycaemic effect in both normal and diabetic rabbits. In normal rabbits, oral administration of 1 and 2 g/kg body weight doses of the compound powder caused maximum decrease in blood glucose level at 10 and 24 hour intervals after its administration. In addition the 2 g/kg dose also produced a fall in blood sugar at 4 hours. In the alloxan treated diabetic rabbits, the 2 g/kg dose only could produce a significant decrease in blood glucose levels at 10 and 24 hours. The maximum decrease in blood glucose was observed at 24 hours at all dosage levels in normal as well as diabetic rabbits. It is conceivable that this folk medicine contains some hypoglycaemic principles which can reduce the blood glucose levels of diabetics. The treated rabbits did not show any signs of acute toxicity which encourages the possible use of this compound medicinal plant prescription by diabetic patients

Role of microorganisms in diaper dermatitis

The microorganisms isolated from diaper area of fifty infants with diaper dermatitis attending the Mosul Teaching Hospital and fifty normal infants [Controls] from AI-Jameha and AI-Rabea Nurseries were studied. Candida albicans [C. albicans] was isolated from 74% of the cases affected with diaper dermatitis and from 8% of the normal controls. Escherichia coli [E. coli] was isolated from 36% of the patients affected with diaper dermatitis and from 16% of the normal controls. The differences in both C. albicans and E. coli were statistically significant [p> 0.0001 and < 0.05 respectively]. Coagulase negative Staphylococci, Staphylococcus aureus, Klebsiella, Proteus and Pseudomonas species were also isolated from the lesion of diaper dermatitis in pure as well as in mixed culture with C. albicans. The results of our work support the view that both C. albicans and E. coli play a significant role in the pathogenesis of diaper dermatitis. We compared our results with a similar study from Alabama Medical Center, significant differences were encountered and were discussed