Barlow’s Repair: Light in the Dark Tunnel: A Case Report Could Omit’ Light in A Dark Tunnel’t

Barlow’s disease has a complex pathology requiring reconstructive surgery. Despite the complicated surgery it holds a positive outcome. We report a successful case of Barlow’s disease who underwent mitral valve reconstructive surgery at our centre. Post-operative echocardiography shows a well-functioning repaired mitral valve without significant mitral regurgitation.

Comparison between the Use of LMA™ and SLIPA™ in Patients Undergoing Minor Surgeries

Supraglottic airway devices have been used as safe alternatives to endotracheal intubation in appropriate types of surgery. This was a prospective, randomised, single blind study comparing the use of LMA™ and SLIPA™ in terms of ease of insertion, haemodynamic changes and occurrence of adverse effects (e.g. blood stains on the device upon removal and sore throat). A total of 62 ASA I or II patients, aged between 18 to 70 years were recruited for this study. Patients were randomised into two groups; LMA™ and SLIPA™ group. Following induction of anaesthesia, an appropriate sized LMA™ or SLIPA™ was inserted after ensuring adequate depth of anaesthesia. Anaesthesia was maintained with oxygen, nitrous oxide and sevoflurane. The ease of insertion was graded and haemodynamic changes were recorded at 2 minute intervals up to 10 minutes after insertion of the airway devices. The presence of blood stains upon airway device removal at the end of surgery and incidence of sore throat was also recorded. No difficult insertion was experienced in either of these devices. Insertion was either easy [LMA™ 87.1% versus SLIPA™ 80.6% (p = 0.49)] or moderate [LMA™ 12.9% versus SLIPA™ 19.4% (p = 0.16)]. Throughout the study period, the haemodynamic changes that occurred in both groups were not statistically different. Traces of blood were noted on the surface of the device in 9.7% of patients in the SLIPA™ group versus 6.5% of patients in the LMA™ group. The incidence of sore throat was recorded in 12.9% versus 19.4% of patients in the SLIPA™ and the LMA™ groups respectively. These findings were not statistically significant. In conclusion, this study showed no significant differences between the use of LMA™ and SLIPA™ in terms of ease of insertion, haemodynamic changes and adverse effects in patients undergoing minor surgical procedures.

Exposure of gasoline station workers to leaded gasoline in the Gaza strip: awareness and self reported symptoms

Awareness and self reported symptoms among 105 gasoline station workers in the Gaza Strip were assessed. A cross section of workers was asked to fill in a questionnaire. Workers reported high level of knowledge on health effects of leaded gasoline 88 [83.8%] and lead as an environmental pollutant 89 [84.8%]. Protective measures were poorly used. Knowledge seems not to have much influence on practice. The most common self reported symptoms were neurological symptoms including headache 78 [74.3%], fatigue 74 [70.5%], irritability 66 [62.9%], concentration difficulties 65 [61.9%], and sleep disturbance 55 [52.4%]. The prevalence of symptoms increased with increasing years of work [chi corrected=7.713, P=0.021]. Use of respiratory mask in particular can potentially limit such symptoms [chi corrected=8.325, P=0.004]

Effects of sublethal doses of selected botanical molluscicides on oxygen consumption of the brown garden snail, Eobania vermiculata

Laboratory bioassays were carried out for evaluating the efficacy of certain plant materials including Nicotine, Thymol, Menthol, Caffeine and Camphor as molluscicides against the brown garden snail, Eobania vermiculata using the topical application method. The obtained results proved that Nicotine and Thymol were the most promising from the molluscicidal point of view with LD [50]204.02 and 551.20 micro g/snail for the two materials, respectively. The effects of sublethal doses [LD[25] and LD[50]] of the most potent materials, Thymol and Nicotine, on the oxygen consumption of E. vermiculata snails after 1, 7 and 15 days post treatment were evaluated. Results indicated that only snails treated with LD [50] Thymol showed significant decrease in their oxygen uptake; while all the other treatments stimulated significant increase in the oxygen consumption along the three periods of estimation. This stimulation was most pronounced with the low sublethal doses of the both examined botanical molluscicides. The succession of time post exposure did not enable the treated snails to eliminate the adverse effects of the applied materials. Depending on the results of the current investigation, we can conclude that the both examined botanical materials, Thymol and Nicotine, are effective in killing the agricultural pest E. vermiculata but further studies are needed to evaluate the efficacy of these materials as safe and economic molluscicides in the field

outcome of surgical interference in patients with chronic obstructive renal failure

To evaluate some of the morphological, functional and clinical impacts of surgical management of chronic obstructive renal failure. We will try to assess some of the factors that may predict favorable outcomes. Sixty four clinically diagnosed patients as having chronic obstructive renal failure [41 men 64.1% and 23 women 35.9% ranging in age between 25 and 69 years, mean 47 years] in the period from October 2005 to October 2008. The patients on this study were divided according to past history of renal impairment and/or regular dialysis into two groups as follow: Group [A]: Patients with chronic renal failure with no regular dialysis [36 patients] Males: 26 [72.22%] Females: 10[27.78%]. Group [B]: Patients with chronic renal failure with regular dialysis [28 patients] Males: 18 [64.29%] Females: 10 [35.71%]. All patients have been evaluated according to the protocol of obstructive uropathy. Clinically most patients presented by anuria 17 [26.6%] patients [9 group A and 8 group B], oliguria 24 [37.5%] patients [14 group A and 10 group B], loin pain 42 [65.6%], patients [27 group A and 15 group B], nausea and vomiting 27 [42.2%] patients [8 group A and 19 group B]. 50 Patients underwent direct intervention and 14 patients were managed by temporary drainage until improvement of the general condition then definitive surgical procedure. In our series patients with chronic obstructive renal failure [group A], showed improvement in 31 patients [86.1%] and did not improve in 5 patients [13.9]. Out of the 5 patients who did not improve after management 1 patient [2.8%] remained unchanged and 4 patients [11.1%] continued to have progressive renal failure up to regular dialysis. In patients with chronic obstructive renal failure [group B], renal functions showed different degrees of improvement as follow: In 15 patients [53.6%] good improvement and subsequent complete weaning from dialysis occurred, while in 5 patients [17.8%] there was a decrease in weekly dialysis sessions from 3 to 2 sessions/week. In the remaining 8 patients [28.6%] there was no improvement and patients continued to have regular dialysis as preintervention. The overall complications in this series were [15.6%]. The incidence was much more in the chronic cases group B. The mortality rate in our series is [3.1%] which is not high if compared with other series dealing with corrective surgery in obstructive renal failure. The degree of improvement of renal function found to be correlated to preoperative residual parenchyma thickness, parenchymal echogenicity, corticomedullary differentiation, presenting hemoglobin value and radioisotope GFR. Finally there is evidence of reversibility of renal function after long standing obstruction which provides justification for efforts to identify and treat urinary tract obstruction even if a patient with an obstruction requires dialysis to avoid the dialysis or kidney transplantation or helping patients under dialysis for complete weaning form dialysis or decrease their number of weekly sessions

Toxicological study of plant extracts on termite and laboratory animals.

Toxic activity of leaf extracts of Polygonum hydropiper L. and Pogostemon parviflorus Benth. were tested in the laboratory against tea termite, Odontotermes assamensis Holm. Both the tested extracts caused mortality of the termite. The highest toxic activity (100%) was found in the 2.0% chloroform extracts of P. hydropiper. The chloroform extract of P. hydropiper was explored for possible mammalian toxicological effects. The LD50 was 758.58 mg/kg in male albino mice. Subcutaneous injection of sub-lethal dose of extract into male mice once a week for 6 weeks failed to express any significant influence on WBC, RBC count and blood cholesterol.

Nodular lymphocyte predominant Hodgkin's lymphoma

To describe the clinicopathological features, treatment, treatment outcome and sequelae of patients with nodular lymphocyte predominant Hodgkin's lymphoma [NLPHL] in a Saudi population. This is a retrospective review of 29 patients with lymphocyte predominant Hodgkin's lymphoma treated at 2 major hospitals [King Khalid University Hospital and Security Forces Hospital] in Riyadh, Kingdom of Saudi Arabia from 1985 to 2000. Histological subtypes were confirmed by review of hematoxylin and eosin paraffin sections and immunochemistry. Details of clinical presentation, stage, treatment and results of treatment were analyzed. On pathological reappraisal of the 29 cases, 3 patients had nodular sclerosis Hodgkin's lymphoma and 4 patients were reclassified as lymphocyte rich classical Hodgkin's lymphoma. Twenty-two patients were identified to have nodular lymphocyte predominant Hodgkin's lymphoma [NLPHL]. These patients comprised of 18 male and 4 female patients with a median age at presentation of 25 years. Nineteen [86%] patients had an early stage [Ann Arbor stage I and II] disease, 2 had stage III and one patient had a stage IV. The majority of the patients presented with peripheral lymphadenopathy and long duration of symptoms. For 16 patients, details of treatment and follow-up were available. All of these achieved a complete response to initial treatment. Four patients relapsed following the primary therapy. Our results are consistent with the previous series reported from Western countries and confirm that patients with NLPHL have a characteristic clinical and pathological profile that distinguish it from other types of Hodgkin's lymphoma. The disease tends to run an unusual course and although most patients achieve an excellent response to therapy there is a tendency to relapse. Treatment remains controversial; however, recent understanding of the molecular pathogenesis of NLPHL could lead to modification of current therapeutic approach to this disease

Experience of King Abdul Aziz city science and technology in funding medical research in Saudi Arabia

Funding scientific research is important for accelerating the progress of science and technology, to fulfill the development objectives of the country. King Abdul-Aziz City for Science and Technology [KACST] was established in 1977 to support and promote applied scientific research and coordinate the activities of the scientific research institutions and centers in line with requirements of development plans of the Kingdom. King Abdul-Aziz City for Science and Technology also cooperates with other concerned institutions in formulating strategies and national policies for the development of science and technology. King Abdul-Aziz City for Science and Technology has started several research grants programs, which include; Annual General Grants Program, National Grants Program, Limited Grants Program, Humanities Grants Program, Graduate Students Grants Program and Production Sectors Grants Program for the promotion of science and technology in the Kingdom. The process of funding follows a systematic scientific mechanism based on predetermined research priorities. Selection of the research proposals is accomplished on the basis of strict scientific criteria. The funding of medical research projects is considered most important among all scientific fields, as these are related to human health. The medical field is classified into specific sub fields constituting the major branches of medicine. Since 1979, KACST has funded 430 medical research projects at an estimated cost of 185.9 million Saudi Riyals representing approximately 31.2% of the grants total funding. King Abdul-Aziz City for Science and Technology puts much emphasis on publishing results obtained from the research projects through different channels. Seven hundred and thirty-eight scientific papers have been published in all fields whereas 243 research papers out of them are in the medical field. This paper highlights the establishment, aims and tasks associated with KACST. Also, the paper reviews research funding by KACST grants programs with a focus on funded medical research projects and publications of research papers originating from different funded projects

study of plasma endotholin and nitric oxide in diabetic patients

The endothelin and nitric oxide considered a new system useful to understand and study the molecular mechanisms involved in aging process and in many vascular alteration pathologies. The study of this work was conducted on 65 subjects which divided into three groups. Group I It included 25 NIDDM, 14 male and 11 female. Group II. It included 25 IDDM, 14 male and 11 female. Group III: It included 15 healthy subjects, 8 males and 7 females as control. The following investigation were done to all subjects: fasting and 2 hours PP plasma glucose level-Glycated hemoglobin urine analysis for microalbumin lipid profile plasma levels of endothelin and nitric oxide. The results of this study showed that significant increase in FB and PP blood sugar, cholesterol, triglycerides, LDL, microalbumin and endothelin with significant decreases in nitric oxide levels in both diabetic groups compared to controls. The result of previous parameters did, not differ significantly between both studied diabetic groups. Also these results showed that significant elevation endothelin and significant reduction of nitric oxide in poor controlled diabetic subjects as compared to controlled diabetic subjects. Conclusion plasma endothelin and nitric oxide levels could be added as chemical markers of diabetic control

Effects of obesity smoking and hypertension on plasma endothelin

Endothelins belong to a family of vasoactive peptides implicated in several disorders of the microvasculature. Endothelin-1 is a potent vasoconstrictive peptide with divers physiologic actions and has been considered to be involved in pathogenesis of hypertension. Several investigators had reported multiple vascular complications related to the high circulatory level of endothelin-[1]. The study comprised 80 male subjects allocated in 4 study groups: Group 1 contained 20 normal men. Group 11 contained 20 obese men. Group 111: contained 20 hypertensive men. Group IV contained 20 smokers. All of study participants were assigned for estimation of plasma levels of endothelin-1 .insulin and blood lipid profile. The obtained results showed a significantly higher fasting plasma ET-[1] levels in all study groups compared to the control. furthermore, there was a significant increase of fasting plasma insulin levels in all study groups, except the smokers, hypertensive as compared to the control levels. The mean value of serum cholesterol and LDL was significantly increased in obese group as compared to controls, but did not differ significantly in hypertensive and smokers compared to controls. The mean value of serum TGS was significantly increased in all study group compared to controls, On the other hand, serum HDL was significantly decreased in all study groups compared with controls. Analysis of the obtained results showed the presence of a positive significant correation between fasting plasma ET-[1] and the mean BMI of obese subjects. Furthermore, fasting plasma ET-[1] showed a positive significant correlation with fasting plasma of insulin in all study groups except the smokers, such correlation suggested a synergistic or additive effect of both peptides in the pathogenesis of obesity, hypertension. Moreover, there was a positive significant correlation between fasting plasma level of ET-[1] with cholesterol, TGs and LDL and a negative significant correlation with serum levels of HDL in all study group. These results signify the presence of a relationship between dyslipidemia occuring in obese, hypertensive and smokers and these peptides. This relation may be causal or concomitant Conclusion, Increased fasting plasma levels of ET-[1] increases the risk of occurrence of cardiovascular complications in either obese, hypertensive, or smoker subjects. The concomitant increase of fasting plasma insulin levels leads to a more pronounced damaging effect and despite being a causal or result, the concomitant dyslipidemia will sign a danger signal for these high risk subjects of being at an increased risk of cardiovascular complications

study of plasma leptin as a risk factor for ischemic heart disease

Leptin which is peptide hormone secreted by adipose tissue was known to regulate body weight and adipose tissue mass through a feedback mechanism. Circulating leptin levels refect the net amount of adipose tissue for a given individual, being elevated in obese subjects and reduced in under weight subjects. This study was conducted on 87 subjects. Allocated in 5 study groups: Group l: 19 patients [l2male and 7 female] .IHD with D.M. Group Il: 19 patients [11 male and 8 female] IHD with hypertension Group Ill: 14 patients [all are male] IHD with smoking. Group IV: 15 patients [9 male and 6 female] IHD without risk factor. Group V contained 20 healthy subjects [I 2male and 8 female] as controls. Lipid profile, serum insulin, serum leptin and BMI was estimated to all subjects. The present study showed that serum insulin level was significantly increased in diabetic patient with IHD as compared to controls, but did not changed significantly with other IHD groups as compared to controls. Serum leptin was significantly increased in all IHD] except diabetic patients as compared to controls. However serum leptin not significantly differ in IHD patients without risk factors as compared with IHD patients with risk factors. No statistically significant difference existed between male and female IHD patients regarding of serum leptin and BMI. Also, the present study showed that significant positive correlation between serum leptin and serum insulin levels in IHD patients with D.M. and non significant correlation in IHD patients with hypertension, smoking and lHD without risk factor, Also, our results showd that non significant correlation between serum leptin and BMI in IHD diabetic patients, but significant positive correlation in IHD with hypertension. There is significant negative correlation between serum leptin and HDLc in lHD patients without risk factors. Leptin which is peptide hormone secreted by adipose tissue was considered as a risk factor for IHD. The mechanism by which leptin can cause IHD are still not definitely established

Intrapericardial chemotherapy for the management of neoplastic cardiac tamponade

A young patient with disseminated osteogenic sarcoma presented with cardiac tamponade. She was successfully managed with pericardiocentesis and intrapericardial instillation of cisplatin. There was no reaccumulation of pericardial fluid or recurrence of tamponade until the patient's death 12 months later. Intrapericardial chemotherapy may be effective in the management of cardiac tamponade secondary to malignancy

changing trends of adult Hodgkin's disease in Saudi Arabia

Hodgkin's disease is one of the most common malignant lymphomas affecting the younger population. This disease has diversified pathologies and clinical stages that necessitate a well optimized clinical management. Regular updating of epidemiological behavior of Hodgkin's disease is obvious from various parts of the world; however, studies from the Kingdom of Saudi Arabia [KSA] in this field are scanty and more than a decade old. The aim of this study was to investigate the current trends in presentation and distribution of Hodgkin's disease with special reference to gender, age, histopathological subtypes, and clinical stages of this disease in Saudi patients. A total of 142 Hodgkin's disease patients attending 2 referral hospitals [King Khalid University Hospital and Security Forces Hospital] in Riyadh, KSA, were included in this study. The records from the questionnaires were analyzed retrospectively for determining the trends of Hodgkin's disease in Saudi adults, over a period of 15 years [1985-2000]. There were 86 males and 56 females, with a male to female ratio of 1.53:1. The mean age of the patients was 28.63 years, while most of the patients were <40 years [80.3%]. Nodular sclerosis was the most frequent pathology. Presence of B symptoms had a significant correlation with histology type as well as clinical stage of Hodgkin's disease. Time course analysis showed the increasing trend of Hodgkin's disease frequency, especially in younger adults. The rate of nodular sclerosis continued to increase during the entire course of study whereas the frequency of other histology types showed a decreasing trend during 1992-2000. To the author's knowledge, this is the largest case series of adult Hodgkin's disease from KSA. The results of this study revealed a different pattern of Hodgkin's disease as compared to earlier studies reported from this region. These findings provide valuable insights in the understanding of current epidemiological features of Hodgkin's disease in KSA