The impact of omeprazole on mycophenolate pharmacokinetics in kidney transplant recipients

Background@#The absorption rates of mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS) may be influenced by the concomitant use of omeprazole. @*Methods@#One hundred kidney transplant patients were recruited during their outpatient visits, including 50 on MMF and 50 on EC-MPS. At the clinic, a predose mycophenolic acid (MPA) sample (C0) was collected; subsequently, the participants received the proton-pump inhibitor omeprazole along with either MMF or EC-MPS. Two more blood samples were collected at 1.5 and 3.5 hours and used to estimate an area under the curve (AUC) from zero to 12 hours [AUC (0-12)]. @*Results@#The mean number of months after transplant was 92 months. The median AUC (0-12) and C0 results were 62.2 mg·h/L and 2.0 mg/L for the MMF group and 71.9 mg·h/L and 1.8 mg/L for the EC-MPS group (P = 0.160 and 0.225, respectively). Interestingly, 54% of the MMF group and 62% of the EC-MPS group showed AUCs above the target values. The correlation between MPA C0 and the predicted AUC was poor in both groups. @*Conclusion@#Omeprazole can be safely co-administered with either MMF or EC-MPS, as it did not compromise the MPA exposure. Unexpectedly, however, a high percentage of patients presented MPA AUCs exceeding the target value, highlighting the importance of periodically assessing MPA level.

The impact of omeprazole on mycophenolate pharmacokinetics in kidney transplant recipients

Background@#The absorption rates of mycophenolate mofetil (MMF) and enteric-coated mycophenolate sodium (EC-MPS) may be influenced by the concomitant use of omeprazole. @*Methods@#One hundred kidney transplant patients were recruited during their outpatient visits, including 50 on MMF and 50 on EC-MPS. At the clinic, a predose mycophenolic acid (MPA) sample (C0) was collected; subsequently, the participants received the proton-pump inhibitor omeprazole along with either MMF or EC-MPS. Two more blood samples were collected at 1.5 and 3.5 hours and used to estimate an area under the curve (AUC) from zero to 12 hours [AUC (0-12)]. @*Results@#The mean number of months after transplant was 92 months. The median AUC (0-12) and C0 results were 62.2 mg·h/L and 2.0 mg/L for the MMF group and 71.9 mg·h/L and 1.8 mg/L for the EC-MPS group (P = 0.160 and 0.225, respectively). Interestingly, 54% of the MMF group and 62% of the EC-MPS group showed AUCs above the target values. The correlation between MPA C0 and the predicted AUC was poor in both groups. @*Conclusion@#Omeprazole can be safely co-administered with either MMF or EC-MPS, as it did not compromise the MPA exposure. Unexpectedly, however, a high percentage of patients presented MPA AUCs exceeding the target value, highlighting the importance of periodically assessing MPA level.

Comparison of Laser In Situ Keratomileusis Flap Morphology and Predictability by WaveLight FS200 Femtosecond Laser and Moria Microkeratome: An Anterior Segment Optical Coherence Tomography Study

PURPOSE: To evaluate laser in situ keratomileusis (LASIK) flap thickness predictability and morphology by femtosecond (FS) laser and microkeratome (MK) using anterior segment optical coherence tomography. METHODS: Fifty-two candidates for the LASIK procedure were stratified into two groups: FS laser-assisted (Allegretto FS-200) and MK flap creation (Moria 2). Flap thickness was determined at five points. The side-cut angle was measured in three directions at the margin interface. LASIK flap assessment was performed one month postoperatively by Spectralis anterior segment optical coherence tomography. RESULTS: Fifty-two patients (93 eyes) were recruited; 49 eyes were stratified to the FS group and 44 eyes to the MK group. The FS group had relatively even flap configurations, and the MK group had meniscus-shaped flaps. Mean differences between planned and actual flap thickness were 12.93 ± 8.89 and 19.91 ± 5.77 µm in the FS and MK groups, respectively. In thin flaps (100 to 110 µm), there was a significant disparity between the two groups (7.80 ± 4.71 and 19.44 ± 4.46 µm in the FS and MK groups, respectively). However, in thicker flaps (130 µm), comparable flap thickness disparity was achieved (18.54 ± 9.52 and 20.83 ± 5.99 µm in the FS and MK groups, respectively). Mean side-cut angle was 74.29 ± 5.79 degrees and 32.34 ± 4.94 degrees in the FS and MK groups, respectively. CONCLUSIONS: Comparable flap thickness predictability was achieved in thicker flaps (130 µm), while the FS laser technique yielded a more predictable result in thinner flaps (100 to 110 µm). Different flap morphology was observed in meniscus flaps in MK-LASIK and flap morphology in FS-LASIK.

Eyelid angiokeratoma

Angiokeratoma is a rare, usually acquired muco-cutaneous wart-like vascular lesion that is frequently reported in the scrotum. Bleeding may occur if angiokeratoma is excoriated or traumatized. We report an exceedingly rare solitary eyelid angiokeratoma in an otherwise normal middle aged male. Our case represents the second case in the English peer reviewed literature since 1966, when the first case of eyelid angiokeratoma was reported

Tobacco control efforts in the Gulf Cooperation Council countries: achievements and challenges

This paper reports a review into the current state of tobacco use, governance and national commitment for control, and current intervention frameworks in place to reduce the use of tobacco among the populations of the Gulf Cooperation Council [GCC] member states and Yemen. It further reviews structured policy-oriented interventions [in line with the MPOWER package of 6 evidence-based tobacco control measures] that represent government actions to strengthen, implement and manage tobacco control programmes and to address the growing epidemic of tobacco use. Our findings show that tobacco control in the GCC countries has witnessed real progress over the past decades. These are still early days but they indicate steps in the right direction. Future investment in implementation and enforcement of the Framework Convention on Tobacco Control, production of robust tobacco control legislation and the establishment of universally available tobacco cessation services are essential to sustain and strengthen tobacco control in the GCC region.

time of first passage of meconium in inborn neonates in Baghdad teaching hospital-medical city

The first passage of stool after birth [meconium], is delayed in preterm neonates compared to term neonates. Ninety-nine percent of term infants and 76% of premature infants pass a stool in the first 24 hours of life. Ninety-nine percent of premature infants pass a stool by 48 hours. To explain the effect of some factors on the time of first passage of meconium[POM] in neonates. Between January and March 2009, all neonates born in Baghdad teaching Hospital-medical city-Baghdad, with gestational age [GA] of 28-42 weeks and without metabolic, congenital or gastrointestinal diseases, were included. Neonates were divided into four groups: A. GA /= 37 weeks[term]. Neonates were followed for first POM. A total of 222 neonates [115 males]; 12, 22, 29 and 159 neonates in group A, B, C and D respectively were included. With decreasing gestation, a trend was found for delayed first POM [P<0.0001].Compared to term neonates 157/159 [98.7%], less preterm neonates passed their first stool within 24 hours after birth group A; 2/12 [16.6%]; group B; 9/22 [40.9%]; and group C; 26/29 [89.6%]. First POM was associated with birth weight < 2.5 kg [P= 0.0001], 42/69 [60.8%] of neonates passed their first stool within 24 hours after birth, compared to 152/153 [99.3%] of neonates > 2.5 kg. The time of first POM was associated with type of feeding [P=0.0001] and with the need for respiratory support, [P=0.0001]. First POM was not associated with gender, and birth weight in relation to GA. More than [98.7%] of term neonates passed their first stool within 24 hours after birth. The first POM was delayed in preterm neonates compared to term neonates. The first POM was significantly associated with gestational age. It was also delayed with decreasing birth weight, and in neonates who need respiratory support compared to those who did not. The first POM was earlier in breast fed neonates compared to formula fed or combined type of feeding

protective effect of some polyphenolic compounds on lipopolysaccharide-induced hepatitis in D-galactosamine sensitized rats

To study the hepatoprotective effect of teas and cocoa extracts against liver injury and to know the potent effect of each in protecting the liver from Lipopolysaccharide-induced hepatitis in D-galactosamine sensitized rats. Rats were divided into eight groups; group I received saline, groups II, III and IV received black tea, green tea and cocoa extracts respectively orally for one month; group V received saline, groups VI, VII and VIII received black tea, green tea and cocoa extracts respectively orally for one month before induction of hepatitis. Indicated that the prophylactic study significantly improved serum hepatic enzymes; liver oxidants/antioxidants profile and serum tumor necrosis factor-a levels compared to DGa1N / LPS group. Green tea extract showed the maximum improvement in liver enzymes and oxidants/antioxidants profile in prophylactic groups. Also cocoa extract showed the maximum improvement in tumor necrosis factor-a levels compared to green and black tea prophylactic groups. The antihepatotoxic effect of teas and cocoa was attributed to their free radical scavenging antioxidants [catechins, epicatechins and procyanidins] which protected the liver from oxidative damage

Cu: Zn ratio in differential diagnosis between hepatocellular carcinoma and cirrhotic patients

The aim of this study is to investigate the role of Cu: Zn ratio in the differential diagnosis between patients with hepatocellular carcinoma [HCC] and cirrhotic patients. This study was carried out on 50 patients classified into four groups; Group I: 10 healthy people, Group II: 15 cirrhotic patients, Group III: 15 cirrhotic patients with hepatocellular carcinoma and Group IV: 10 patients with metastasis. Liver functions, kidney functions, Na, K, Cu, Zn, fibrinogen, alpha fetoprotein and complet blood picture were estimated. Cu: Zn ratio was increased significantly in HCC group compared to other groups. The increase in Cu: Zn ratio may be useful in differential diagnosis between HCC and cirrhotic patients, it also useful for follow up because it is a simple and inexpensive method

Pathological and ultrastructural studies on Anisakis simplex rudolphi-1809 infecting Carangoides Bajad with special reference to intestinal maturation in puppies

Thirty five [70%] of 51 Carangoides bajad were naturally infected with Anisakis simplex during the period from September 2007 to January 2008. The fish were collected from eastern south coast of the Red Sea at Hurgada. The morphological and ultrastructures of Anisakis larvae and adults, and the induced lesions in the fish [intermediate host], five puppies [final host] were orally given infected fish. The body of the larvae is gradually tapering towards the anterior part. It is covered by striated ornamentation longitudinally and horizontally, except the anterior region which is smooth. The morphological and ultrastrutural examinations of the anterior body end of larvae showed a prominent boring tooth, 3 pairs of lips inconspicuous and an excretory ventral pore between the rudimentary subventral lips. The anal end showed a distinct mucron and a slit-shaped anus. The pathological studies revealed encapsulated larvae with concentrical fibrous connective tissue infiltrated, with macrophages and lymphocytes on the surface of liver, spleen and peritoneum of the infected fish. The macrophages aggregated together to form the denser part of the capsule, and invaded the adjacent parenchymal tissue. The hepatocytes, under the affected capsule were necrotic and invaded by melanomacrophages

Effect of drying methods on the chemical and technological properties of the instant talbina powders

Talbina, cooked barley syrup, is made by cooking barley flour in water. It was subjected to different drying methods, freeze-drying, spray drying and under vacuum drying to produce instant Talbina powders [A], [B] and [C], respectively. Chemical composition, scanning electron microscope [SEM]; X-ray diffraction, differential scanning colorimeter [DSC] and color attributes of the barley flour and the produced instant Talbina powders were studied to see the effect of the drying methods. Reconstitution capacity of the instant Talbina powders was studied. Adding milk improved the organoleptic properties of the reconstituted instant Talbina powders, while adding vanilla deteriorated these organoleptic properties. Reconstitution capacity of the instant Talbina powder [B] recorded the highest score in aroma, taste and overall acceptability compared with reconstituted instant Talbina powder [A] and [C], respectively. Instant Talbina powder can be produced by spray drying of cooked solution of Talbina with big quantity, economic costs, high reconstitution capacity and good quality in color, aroma, taste and overall acceptability

Influence of isotretinoin treatment on monoamines in different brain areas of male rats

Despite widespread use of isotretinoin for its anti-acne effects and its current evaluation in clinical trials as a cancer treatment, little is known about its effect on brain function and neuronal pathways in adult animals, particularly after oral administration which mimics the human route. Here, adult male rats were gavaged daily with olive oil and 1.5mg/kg/day isotretinoin for 4 weeks during which body weight was measured and changes in food intake and locomotor activity were observed. After decapitation, the concentrations of dopamine [DA], norepinephrine [NE], serotonin [5-HT] and 5-hydroxyindoleacetic acid [5-HIAA] were measured in different brain areas of rats after 2 and 4 weeks of repeated injection. The results show that, following isotretinoin administration body weight, food intake and locomotor activity were generally decreased. Treatment with isotretinoin produced marked increases in the concentrations of DA and 5-HIAA after 2 and 4 weeks and of NE after 4 weeks in the various brain regions examined. However, level of 5-HT was significantly decreased in most of the brain areas studied after 2 and 4 weeks following isotretinoin treatment. The results also show that all of these effects induced by isotretinoin treatment were tended to resolve within one week of drug cessation. It is possible to conclude that such alteration in monoamine systems could contribute to the isotretinoin induced increase in depression related behavior

Preoperative vascular evaluation of living renal donors Gadolinium-enhanced magnetic resonance angiography [MRA] versus conventional renal angiography

The aim is to assess the accuracy and sensitivity of Magnetic Resonance Angiography [MRA] in preoperative vascular evaluation of living renal donors. Twenty five individuals [donors] coming up for renal donation, eleven related and fourteen unrelated donors with ages between 20-45 years. Each donor had 3D MRA as an outpatient procedure and intra-arterial DSA [Digital Subtraction Angiography] as an inpatient procedure. The operative findings were considered as a standard for comparison between MRA and DSA results. No difference was found between MRA and DSA. The accuracy of MRA when compared with operative finding was 96%. MRA is a non-invasive, accurate and pretty safe procedure for the evaluation of healthy renal donors

Observations on besnoitiosis in virginia opossum [didelphis virginiana] from Michigan, USA

Besnoitia tissue cysts were found in five naturally-infected adult opossums [Didelphis virginiana] from Michigan. Details of the microscopy, histopathology, ultra-structure, and genetic features of the cysts were studied to identify their species-specific traits. The materials were differentiated phenotypically from cysts of other Besnoitia spp. by difference in size, pattern of tissue distribution, morphology of pellicle and nucleus, number of micronemes and rhoptries, amount of lipids and amylopectin, and presence of enigmatic bodies. Morphometric variations identified the tissue cysts and the pathologic changes in opossums host to be due to B. darlingi. The data were proved by phylogenetic analysis based on DNA sequences of the first internal transcribed spacer of nuclear rDNA. Cluster analysis showed that B. darlingi was distinct from all other Besnoitia spp. as two distinct phylogenetic clades: I- included Besnoitia spp. described from opossum [B. darlingi], sheep [B. jellisonf], rodent [B. akadoni] and rabbit [B. oryctofelisi] and clade II- encompassed parasites described from cattle [B. besnoiti], equids [B. bennetti] and reindeer [B. tarandi]. The genetic attributed particular to the genus Besnoitia complemented the morphological features and lead to accurate delimitation of Besnoitia species

Accidental drug poisoning

To study the accidental drug poisoning. A retrospective study. Prince Rashid Ben Al- Hassan Hospital- Northern Jordan. Children with accidental drug poisoning, who were admitted to Prince Rashid Hospital from January 2001 to January 2005. Fifty-nine children have been enrolled in the study; thirty-six [61%] were male. Thirty-two [54%] of children belong to the age group of 1- 4 years. Twenty-nine [49%] children had ingested miscellaneous drugs, 15 [26%] anticonvulsant drugs, 5 [8%] antipsychotic drugs, and 6 [10%] children had ingested drugs for local use and 4 [7%] unknown. In 5 [8%] children the drug had been ingested due to unidentified identity. In 2 [3%] the drug was given by mistake to the child. Eighty-eight percent of drug ingestion took place at homes. Lack of supervision at the time of ingestion was noted in 52 [89%] of cases. Drowsiness was the most common presenting features [24%]. Gastric lavage was done in 27 [46%] children. Drug poisoning is still a major health problem in our community. Family should be aware of the problem and health professionals should participate in preventive measures. This study emphasizes the need for establishment of poison control centers all over the country

Preparation and evaluation of instant noodles made from wheat, rice, sorghum flours and their blends

The suitability of using wheat, sorghum flour and their blends in the manufacture of instant noodles is evaluated from the chemical, physical and rheological point of views. Viscoelastic and thermal properties were elucidated using viscoamylograph and differential scanning colorimeter [DSC]. Other technological parameters like, cooking quality, colour attributes and sensory evaluation techniques were used to characterize the physicochemical properties of these noodles. Comparing between steam and microwave as a method of starch gelatinization. The microwave treatment of the [wheat + rice] and [wheat + rice + sorghum] blends gave the lowest values in cooking loss. Also this treatment lowered the colour attribute values towards more whitness [L], less redness [a] and less yellowness [b]. The panelists preference are directed towards wheat noodles and their blends [wheat + sorghum], [wheat + rice] and [sorghum + rice + wheat] which gave the best scores in colour, flavour, mouthfeel, elasticity and overall acceptability

Synthesis and biochemical evaluation of novel aminoheterocyclic steroids as potent inhibitors of iron-induced oxidative stress

The objective of this study was to elucidate the potential role of novel synthesized aminosteroidal heterocyclic compounds 2, 5, 9b or 10c against iron-induced oxidative stress with particular insight on erythrocyte ghosts in male rats. Chronic iron supplementation [3000 mg/kg diet] for six weeks significantly increased plasma iron and ferritin levels. It also produced significant increase in plasma TN F-alpha and NO levels. Lipid metabolism was also affected by excess iron, so that plasma and erythrocyte membrane total cholesterol, triglycerides, phospholipids and total lipids levels were significantly elevated. In consequence, a significant increase in plasma leptin level was detected. Iron overload clearly induces oxidative stress as indicated by the significant increase in both plasma and erythrocyte membrane lipid peroxidation levels. Noteworthy, excess iron not only decreased the mean value of erythrocyte membrane protein but also caused marked alterations in the membrane protein fractions with concomitant inhibition in:erythrocyte membrane ATPases activity. On the other hand, treatment with the aminosteriodal heterocyclic compounds especially compounds 5, 2, or 10c in an oral dose of 5mg/kg B.W/day could ameliorate almost all of the changes in plasma and erythrocyte ghosts components induced by iron overload. The efficacious role of these novel synthesized aminosteriods in preventing iron-induced oxidative stress may be mediated through their iron chelating properties, anti-lipid peroxidation activities and membrane stabilizing actions. The encouraging results obtained in the present study lend credence to substantial investigation to assess the use of these compounds as a potent line of therapy to retard the pathogenesis of iron-overload diseases

Construction of an arabic reading test for assessment of dyslexic children

Dyslexia is a specific language-based disorder of constitutional origin, characterized by difficulties in phonological processing. The Arabic language differs in many aspects from foreign languages and the few previously designed Arabic tests for assessment of dyslexia did not pay attention to phonological awareness problems. This necessitates the design of an Arabic test which could properly assign specific difficulties among Arabic reading dyslexic children, including phonological awareness as a major contributing factor for dyslexia. The study was carried out in Assiut City, Egypt, during the period from September 1999 to the end of January 2001. The newly designed Arabic Reading Test [ART] in this work passed through many stages. Firstly, test construction by 11 Arabic teachers [specific judges]. Secondly it was applied, in a pilot study, to 50 normal students [9-10 years old] to ascertain clarity of the test. Then test standardization was proven through application on a second sample [n=252 students], and third sample [n=58 dyslexics]. The reliability of the ART was proven by the test-retest method [r=0.913, p<0.01]. Validity was proven by judgment validity, internal consistency validity [ranged from 0.238 for auditory perception to 0.940 for phonological awareness and spelling], contrasted group validity, and criterion related validity [in relation to Schonell r=0.859, Awaad reading r=0.817, Awaad comprehension r=671, mid-term Arabic scores r=0.686]. The ART was thus proven to be highly reliable, and valid for assessment of dyslexia among Arabic reading children. It has great value in predicting dyslexia even among preschool age Arabic speaking children, through assessment of their phonological awareness skills, and thus, remediation programs can be properly and early directed

Preparation and evaluation of newcastle disease virus inactivated vaccines adjuvanated with crude or fractionized Nigella sative oil

Different types of inactivated oil emulsion Newcastle disease vaccines were prepared using different extractions of the Nigella Sativa oil. The physical properties of emulsions were earned out and included emulsion type, emulsion stability and emulsion viscosity. The vaccinated chicks were bled at one-week intervals post-vaccination over six weeks and the collected sera were tested by the HI test. After that, they were challenged 21-days and 42-days post-vaccination by the intramascular inoculation with VVNDV. From this study we can conclude that the non-specific immunostimulant effect of Nigella Saliva oil is acquired when it is used as a crude oil and this improved its ability as a good adjuvant for viral vaccines

Isolated agenesis of the gallbladder

We report a rare case of agenesis of the gallbladder, which was misdiagnosed as cholecystitis. This is the first reported case from the Middle East. Despite advances in biliary imaging, the diagnosis is usually made at surgery. Like most patients, our patient became asymptomatic after the surgery. Extensive dissection to exclude the presence of gallbladder in an ectopic site is discouraged