Comparative study of serum ferritin levels and hepatic transaminases between uncomplicated paediatric dengue inpatients and other febrile illnesses in Kanchipuram, India

Background: Fever is the most common complaint with bringing children for hospital consultation. Dengue is a cause of public health concern with case fatality rate of 1%. Ferritin is an acute-phase reactant which is produced in response to infection and inflammation. Liver enzymes are also considered as markers of febrile illness. Aim of this study was to assess serum ferritin levels, aspartate-aminotransferase (AST) and alanine-aminotransferase (ALT) levels in pediatric inpatients with febrile illness, to correlate it with patient’s Dengue profile and to analyse these parameters with sub-group analysis of dengue and OFI.Methods: Among 120 children admitted for fever of more than 3 days duration were included in the study. 58 were Dengue-NS1 positive and the remaining 62 were considered to be OFI. Serum ferritin levels, AST and ALT were the investigative parameters measured at the time of admission for the study and treated as per WHO Dengue Guidelines. Data was coded and entered in Microsoft Excel 2013. Data was analysed using SPSS v16. p value of <0.05 was considered statistically significant.Results: Ferritin levels were higher in Dengue-IgM positive subgroup than in OFI subgroup (U= 173, Z score -6.09, p<0.00001). AST levels are higher in Dengue-NS1 positive subgroup than in OFI subgroup (U= 103, Z score -8.08, p<0.00001). AST levels were also higher in Dengue-IgM positive subgroup than in OFI subgroup (U= 377.5, Z score -4.86, p<0.00001). ALT levels are higher in Dengue-NS1 positive subgroup than in OFI subgroup (U=76, Z score -8.95, p<0.00001) as well as in Dengue-IgM positive subgroup than in OFI subgroup (U= 417, Z score -4.4, p<0.00001).Conclusions: Hyperferritinemia and elevation of hepatic-transaminases is seen in dengue. Although elevated in other febrile illnesses, it is elevated more so in dengue. This can be a predictor of severity of dengue fever, but needs to be confirmed in larger studies.

Multiple myeloma with primary systemic amyloidosis affecting cutaneous, gastro intestinal and cardio-vascular system

Amyloidosis refers to a group of disorders characterized by extracellular deposition of protein fibrils. Primary systemic amyloidosis is commonly due to an underlying plasma cell dyscrasia. Infiltrative amyloid cardiomyopathy is a rare cause of predominantly diastolic myocardial disease. Restrictive cardiomyopathy is the main finding in cardiac amyloidosis and results from the replacement of normal myocardial contractile elements by infiltration and interstitial deposits of amyloid, leading to alterations in cellular metabolism, calcium transport, receptor regulation, and cellular edema. Injury can also occur from circulating light chains in the absence of amyloid fibril formation. Cardiac amyloidosis should be considered in any patient presenting with congestive heart failure, preserved systolic function, and a discrepancy between a low QRS voltage on electrocardiography and an apparent left ventricular hypertrophy on sonogram. The pattern of left ventricular diastolic dysfunction changes during the course of amyloidosis and the classically described restrictive physiology occurs only in advanced stages of the disease. This is a case report where an unusual extensive cutaneous and cardiac involvement provided the sign of widespread systemic deposition of amyloid protein which eventually led to the diagnosis of multiple myeloma.

Psychosocial impact and quality of life among adult Egyptian patients with psoriatic arthritis

Background: psoriatic arthritis [PsA] is a chronic, inflammatory, progressive joint disease. It has much psychosocial impact and affects quality of life [QOL] of the patients

Aim of the study: to determine the psychosocial impact of PsA on the patients and to define QOL of them

Patients and Methods: the study was conducted on 50 PsA patients, 68 psoriasis [Ps] patients, and 100 controls. A case-control, clinic-based study design was used in this research. An interviewing form and Middle Sex Hospital Questionnaire were used to survey the characteristics of the patients and controls. Severity of PsA was determined clinically. Also, the medical outcomes study 36-item short form [SF-36] was used to assess impact of the disease on the patient's QOL

Results: most [92.0%] of PsA patients had psychiatric symptoms. The disease had interfered with most of patients' personal feelings and relationships, daily activities, school/work, and leisure/sport. Majority [88.0%] of the patients had stigma feeling. Also, 40.0% and 60.0% of PsA patients had severe and mild forms, respectively. The differences between two forms of PsA regarding interference with school/work and presence of suicidal ideation were significant. The difference regarding presence of familial psychological stress was significant. The highly affected SF-36 domain scores were general health and physical limitation. The eight mean domain scores were significantly lower among PsA patients than controls. The mean domain scores of physical functioning, physical limitation, social functioning, emotional limitation, and mental health were significantly lower among patients with severe PsA than those with mild PsA. The eight mean domain scores were significantly lower among PsA patients than those with only Ps

Conclusions: the physical and psychosocial aspects of PsA may interact and influence one another. So, PsA has a great effect on the patients' QOL; disrupting physical and psychosocial aspects, and interfering with daily activities, school/work, and leisure/sport. QOL scores were significantly lower among PsA than only Ps patients

Carbon Dioxide versus Air Insufflation in Gastric Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) with air insufflation is commonly used for the staging and treatment of early gastric carcinoma. However, carbon dioxide (CO2) use has been shown to cause less post-procedural pain and fewer adverse events. The objective of this study was to compare the post-procedural pain and adverse events associated with CO₂ and air insufflation in ESD. METHODS: A systematic search was conducted for randomized control trials (RCTs) comparing the two approaches in ESD. The Mantel-Haenszel method was used to analyze the data. The mean difference (MD) and odds ratio (OR) were used for continuous and categorical variables, respectively. RESULTS: Four RCTs with a total of 391 patients who underwent ESD were included in our meta-analysis. The difference in maximal post-procedural pain between the two groups was statistically significant (MD, -7.41; 95% confidence interval [CI], -13.6 – -1.21; p=0.020). However, no significant differences were found in the length of procedure, end-tidal CO2, rate of perforation, and postprocedural hemorrhage between the two groups. The incidence of overall adverse events was significantly lower in the CO2 group (OR, 0.51; CI, 0.32–0.84; p=0.007). CONCLUSIONS:: CO2 insufflation in gastric ESD is associated with less post-operative pain and discomfort, and a lower risk of overall adverse events compared with air insufflation.

Outcomes of prediabetes and undiscovered diabetes among patients with acute coronary syndrome

Objectives: this study assessed outcomes of prediabetes and undiagnosed diabetes mellitus among patients with acute coronary syndrome

Methods: a total of 99 consecutive patients admitted to the coronary care unit of King Khalid Hospital, Tabuk from June 2014 to April 2015 were recruited for this study. A structured questionnaire was administered to obtain the respondents' socio-demographic characteristics and coronary risk factors. Blood samples were taken for Glycosylated haemoglobin [HbA1c] for the diagnosis of diabetes mellitus and prediabetes. The ethical committees of both the University of Tabuk and King Khalid Hospital approved this research

Results: the mean age of participants was 51.8 years +/- 11.3, with male predominance [84.8%]. Twentythree [29.8%] patients were found to be prediabetes, 11 [14.3%] newly discovered diabetes mellitus, while 37 [48.1%] were known diabetics. Interestingly those with undiscovered diabetes had higher rates of complications: 45.4% had ventricular arrhythmias and 63.6% had low ejection fraction. A strong statistical correlation was found between HbA1c and the number of cigarettes smoked per day [p < 0.001] and between HbA1c and hypokalaemia. No correlation was found between HbA1c and acute coronary syndrome complications [p > 0.05]

Conclusion: prediabetes and undiagnosed diabetes mellitus were common among patients with acute coronary syndrome in Tabuk and were associated with more cardiovascular complications than known diabetics. More multicentre studies are needed to assess the prognosis of acute coronary syndrome among patients with undiagnosed diabetes mellitus and prediabetes

Studies on Aedes AegyptI resistance to some insecticides in the Jazan district, Saudi Arabia

The present study provided information on the susceptibility status of the adult and larvae of Aedes aegypti mosquitoes in Jazan region of Saudi Arabia. Bioassay tests were performed on adults and larvae by using WHO recommended concentrations and test kits. Adults of Ae. aegypti mosquitoes were exposed to test papers impregnated with Lambda-cyhalothrin [0.05%], Cyfluthrin [0.15%], Deltamethrin [0.05%], Permethrin [0.75%], Fenitrothion [1%], Bendiocarb [0.1%] and DDT [4%] insecticides. Ae. aegypti mosquitoes were found to be susceptible only to Cyfluthrin; [mortality rate was 100%], whereas variable resistances were observed from the rest of the other insecticides tested [mortality rates ranged between 93.6 and 17%]. Larvae were subjected to different concentrations of Diflubenzuron, Methoprene [IGRs] and Temephos [Organophosphate]. Adult emergence inhibition [IE50 and IE95] values for the IGRs and the [LC[50] and LC[95]] for Temephos were determined by log-probit regression analysis. Ae. aegypti larvae were resistant to Temephos [LC[50] 61.8 - LC[95] 35600.1 mg/l] and showed high susceptibility to Methoprene than Diflubenzuron [IE[50] 0.49 - IE[95] 10.9 mg/l] and [IE[50] 0.86 and IE[95] 93.8 mg/l], respectively. Larvae were more susceptible to Methoprene than Diflubenzuron by 1.8 folds

Risk factors and effects of infestation with Pediculosis Capitis and Scabies among primary school students in Cairo, Egypt

Background: Pediculosis capitis [PC] and scabies are an important public health problem in childhood. They have a worldwide distribution. Also, they have many effects on the infested students

Objectives: To define the prevalence of PC and scabies, to find out the socio-demographic, environment, and health care behavior risk factors, and to determine the effects on the studied students in Cairo, Egypt

Subjects and Methods: A cross-section, analytical study design was chosen to conduct this work. Three primary schools were the field of this study. Total number of the students was 1987. The students were clinically examined; for each infested case with PC and/ or scabies a control student was chosen

Results: Prevalence of PC and scabies was 10.2% and 3.4%, respectively. These infestations were more common significantly among students in the public school. Significant social risk factors of infested students were the low level of head of the family education, occupation, and social status. Also, significant personal hygiene risk factors were poor hair, body, and environment hygiene. While significant health care behavior risk factors were student never received skin examination, no early consultation for skin diseases, and no compliance with therapy. Also; female gender, the last birth order child, had previous infestation with PC, had sibling[s] with PC, and had parents with history of infestation with PC were significant risk factors. On the other hand; male gender, the last birth order child, had previous infestation with scabies, had sibling[s] with scabies, and had parents with history of infestation with scabies were significant risk factors. Further, the PC cases with crowding index >1, had no sun access, had shared water supply and bathing facilities, co-sleeping, had no short cut hair, and sharing hair brushes were significant risk factors. On the other hand, the scabitcs with crowding index >1, had no sun access, had shared water supply and bathing facilities, and co-sleeping were significant risk factors. Lastly, presences of psychiatric, sleep, and peers' relations disturbances were significantly more common among the infested students

Conclusions: Many risk factors of PC and scabies can be manipulated, so these infestations can be prevented, so many health hazards on the students could be prevented

Recommendations: Improving students' hygiene, health education, and regular dermatological screening and treatment of students are important essentiality. Also, dermatological health component should be integrated in school health program. Lastly, further studies in different rural and urban areas in Egypt are recommended

Investigating the anticonvulsant effects of repetitive transcranial magnetic stimulation on perforant path kindling model in rats

Almost 20% of epileptics are drug resistant. Studies have shown that low frequency repetitive transcranial magnetic stimulation [rTMS] is with therapeutic effects on epilepsy-affected laboratory models. Anticonvulsant effects of rTMS depend on several parameters among which radiation frequency is the most important one. In this study, the therapeutic impacts of 1 and 2 Hz rTMS on convulsing parameters in epileptic model of electrical kindling stimulation of the perforant path were investigated. In this experimental study 21 rats were randomly divided into three groups, namely '1 Hz treatment group' and '2 Hz treatment group' and 'kindling group'. The kindling group only received kindling stimulations for seven days. One Hz and 2 Hz frequency treatment groups received maximally 5 min rTMS after termination of kindling stimulation per day for a week. Stimulation and stability electrodes had been placed, in turn, on perforant path and dentate gyrus. For quantifying the duration of the subsequent discharge waves, two-way ANOVA test and Bonferroni post-test were employed. In addition, for quantifying the convulsive behaviors, Kruskal-Wallis and the Mann-Whitney U tests were used. The results showed that 1 Hz and 2 Hz frequency rTMS have considerable inhibitory impact on the development of convulsive phases. Anticonvulsive effect was observed from the first day after rTMS was undertaken. In addition, the animals did not show fourth and fifth convulsive stages, and a significant reduction was evident in their recorded peak discharge waves compared with kindle group. Low frequency rTMS possesses significant anticonvulsive effects which depend upon sTMS stimulation frequency

Factors influencing parental consent for participation in clinical research involving their children in Egypt

Factors affecting parents' decision to involve their children in clinical research have not been studied in all cultural backgrounds. We aimed to explore the attitudes and beliefs influencing parents' decision to involve their children in clinical research in Mansoura, Egypt. Of 523 families approached, 357 filled the questionnaire. Only 98 [27.5%] parents consented to involve their child in clinical research. The children of consenters were significantly older than refusers: 8.6 [SD 7.2] versus 2.6 [SD 1.2] years. Factors favouring consent were: research of benefit to child [84.7%], enough explanation about the benefits [40.8%] and to learn more about child's condition [29.6%]. Factors favouring refusal were: use of new drugs or vaccines [89.6%] and invasive procedures [84.2%]. Parents' rate of consent was positively correlated with the research being non-invasive and the belief that research was of benefit to their child and negatively correlated with belief that refusal may negatively affect the care provided to their child

Histological study on the possible protective role of parsley oil on prednisolone-induced liver and lung injury in adult male albino rats

Corticosteroids have been used extensively since cortisone was first synthesized in the 1950s, but it leads to the development of numerous side effects. Parsley is one of the most effective medicinal herbs. It has antioxidant and free radical scavenging activities. The present study was designed to evaluate the toxic effect of the chronic use of prednisolone on the histological structure of the liver and lung and the protective effect of parsley oil against the changes induced by prednisolone. Twenty-five adult male albino rats were used. They were divided into three groups: group I was the control group; group II received 2 mg/kg/day prednisolone once daily for 1 month; and group III received parsley oil 0.6 ml/kg/day once daily followed by prednisolone after 2 h for 1 month. The liver and the lung were dissected out and processed for light and electron microscopic examination. In addition, a statistical study was carried out for determining the thickness of the interalveolar septum. In group II, some hepatocytes showed vacuolations and fatty changes and other hepatocytes revealed apoptotic changes. Lung tissue revealed sloughing of the bronchiolar epithelium. Hemorrhage and cellular infiltration were seen in airway spaces. Moreover, there was highly significant thickening of the interalveolar septa. Apparent increase in atypical type II pneumocytes with hyperchromatic nuclei was seen. Electron microscopy revealed vacuolated hyperchromatic type II pneumocytes. In group III, liver cells were normal except for some vacuolations in the cytoplasm. The lung continued to reveal significant increase in thickness of the interalveolar septa. Some type II pneumocytes showed hyperchromatic features. Electron microscopy revealed type II pneumocytes with a few lamellar bodies. Compared with the liver, the dose of parsley and its duration of treatment with respect to the lung should be markedly higher to have a significant effect, as the destructive effect of prednisolone on the lung is greater than that on the liver

Non-thermal continuous and modulated electromagnetic radiation fields effects on sleep EEG of rats

In the present study, the alteration in the sleep EEG in rats due to chronic exposure to low-level non-thermal electromagnetic radiation was investigated. Two types of radiation fields were used; 900 MHz unmodulated wave and 900 MHz modulated at 8 and 16 Hz waves. Animals has exposed to radiation fields for 1 month [1 h/day]. EEG power spectral analyses of exposed and control animals during slow wave sleep [SWS] and rapid eye movement sleep [REM sleep] revealed that the REM sleep is more susceptible to modulated radiofrequency radiation fields [RFR] than the SWS. The latency of REM sleep increased due to radiation exposure indicating a change in the ultradian rhythm of normal sleep cycles. The cumulative and irreversible effect of radiation exposure was proposed and the interaction of the extremely low frequency radiation with the similar EEG frequencies was suggested

reproductive toxicity of ribavirin in the adult rabbit testis [light and electron microscope study]

Ribavirin is one of the approved antiviral drugs indicated for various viral infections. So it is used as a current chemotherapy with interferon alpha for treatment of viral hepatitis C. The aim of the present study was to assess Ribavirin toxicity on the structure of testicular tissue of adult male rabbits after exposure to the drug as well as to evaluate the extent of improvement of testicular tissue structure after stoppage of drug administration. Eighteen adult male rabbits were used in this study. The rabbits were divided into three groups: control group [C] 6 male rabbits received distilled water by the same method and duration as the corresponding experimental groups, a treated group [T] was formed of 6 adult rabbits receiving Ribavirn in a dose of 15mg/kg/day at two divided doses for 10 weeks and a recovery group [R] receiving Ribavirin in a dose of 15mg/kg/day for 10 weeks followed by 10 weeks without treatment to assess the effect of drug withdrawal. The testes of each rabbit were immediately dissected out and specimens were fixed and stained with H and E. Minute specimens were stained with Toluidine blue for LM examination, and ultrathin sections were stained with Uranyl acetate and Lead citrate for TEM examination. Marked histological changes of the testis at the level of the light and electron microscope including disorganization of the semineferous tubules, reduction in the thickness of the germinal epithelium vaccuolation and degeneration of the spermatogenic cells. Sertoli cells and leydig cells were also affected. Partial recovery of the testis was observed in the recovery group, but some of the changes were still obvious. These testicular changes persisted after stoppage of Ribavirin administration indicates the cumulative toxic effects of Ribavirin that lead to hypospermatogenesis, oligospermia and then azospermia

Chronic idiopathic thrombocytopenic purpura effects of certain variables on the response to treatment

Idiopathic thrombocytopenic purpura is an acquired chronic autoimmune disease.Treatment when indicated is usually by corticosteroids,then splenectomy if no acceptable response,with variable response rate to both types of treatment. To look for the effects of certain variables on the type of response to steroid therapy in patients with adult idiopathic thrombocytopenic purpura, and to study the outcome of splenectomy in relation to previous steroid therapy. A prospective study on 80 patients, presented with bleeding and a platelet count of

Effect of ofloxacin on the cartilage of the knee joint of juvenile rats

Ofloxacin is one of fluoroquinolones derivatives, which has a broad spectrum bacterial activity. It is contraindicated in children and adolescents because of its potential chondotoxicity in juveniles. However, fluoroquinolones continue to be prescribed as a drug of choice for treatment of some life threatening diseases in pediatrics. This study was conducted to examine the effect of ofloxacin on cartilage of juvenile rats by light and electron microscopes. Twenty newborn albino rats were treated with an oral dose of 900 mg/kg/day of ofloxacin for 28 days. The animals were sacrificed after the completion of the administration and the knee joints were prepared for light and electron microscopic examination. Morphometric study and statistical analysis of the results were also performed. The lesions were demonstrated in the articular cartilage of all the animals. Fissures, chondrtocyte clusters and wide area of matrix devoid of cells in the intermediate zone were observed. The surface of the premature articular cartilage of the femur was irregular. The matrix of the articular cartilage showed less staining with toluidine blue and masson trichrome. Electron microscopic results showed separation between chondrocyte cell membrane and the matrix. The chondrocytes were necrotic with pyknotic nuclei and vacuolation of their cytoplasm. There were electron dense aggregates on the cell membrane and inside the cells. The thickness of the premature articular cartilage and epiphyseal plate cartilage were significantly decreased. The numbers of chondrocytes of the premature articular cartilage and epiphyseal plate cartilage were significantly decreased. The numbers of chondrocytes of the premature articular cartilage and epiphyseal plate cartilage were significantly decreased

Prosthetic Rehabilitation of Patient With Subtotal Maxillectomy And Orbital Exenteration.

Orbital exenteration presents a unique challenge to the maxillofacial prosthodontist. Prosthetic rehabilitation of the orbit is often complicated by the extent of resection, tissue response and the method of retention. Loss of an eye due to trauma or disease resulting in facial defect has a crippling effect on patients psychology. The placement of good prosthesis serves as a great psychological, social and cosmetic benefit in rehabilitation of the patient. The article discusses the prosthetic rehabilitation in an elderly male patient with orbital defect.

Formulation and evaluation of olanzapine matrix pellets for controlled release

Olanzapine is an antipsychotic used in treatment of schizophrenia. This research was carried out to design oral controlled release matrix pellets of water insoluble drug Olanzapine [OZ], using blend of Sodium Alginate [SA] and Glyceryl Palmito-Stearate [GPS] as matrix polymers, micro crystalline cellulose [MCC] as spheronizer enhancer and Sodium Lauryl Sulphate [SLS] as pore forming agent. OZ formulations were developed by the pelletization technique by drug loaded pellets and characterized with regard to the drug content, size distribution, Scanning Electron Microscopy [SEM], Differential Scanning Calorimetry [DSC], Fourier Transform Infrared Spectroscopy [FTIR] and X-ray Diffraction study [XRD]. Stability studies were carried out on the optimized formulation for a period of 90 days at 40 +/- 2°C and 75 +/- 5% relative humidity. The drug content was in the range of 93.34-98.12%. The mean particle size of the drug loaded pellets was in the range 1024 to 1087 micro m. SEM photographs and calculated sphericity factor confirmed that the prepared formulations were spherical in nature. The compatibility between drug and polymers in the drug loaded pellets was confirmed by DSC and FTIR studies. Stability studies indicated that pellets are stable. XRD patterns revealed the crystalline nature of the pure OZ. Loose surface crystal study indicated that crystalline OZ is present in all formulations and more clear in formulation F5. Drug release was controlled for more than 24 hrs and mechanism of the drug release followed by Fickian diffusion. It may be concluded that F5 is an ideal formulation for once a day administration

Effect of titanium dioxide [TiO2] as a color additive on the testes, sperms and chromosomes of male albino rats

Titanium dioxide [TiO2] is one of the top 50 produced substances for use around the world. 70% of all [TiO2] produced is used as pigment in consumer products such as plastics, health, beauty aids and other personal care product that we use. Toothpaste products use [TiO2] to get that desirable bright white color as do many other products such as lotions, creams, shave foam, cosmetics, sunscreen lotions and more. Food products such as sour cream, cottage cheese [via the cheese dressing] ice cream and other dairy products use a small quantity of the pigment to attain that familiar brightwhite coloration. The aim of this study was to evaluate the histopathological effect of 1/20 of LD50 of [Ti02] on the testes, sperms and chromosomes of albino rats and its relation to the duration of its adminstration. Forty male albino rats had been divided into four groups, ten rats for each. The first was served as a control group, the second was gavaged by [TiO2] 600mg/kg daily for 4weeks. The third was gavaged with same dose of [TiO2] for 8 weeks and the forth group was gavaged by same dose of [Ti02] for 12 weeks. Each rat's group were sacrificed after each duration, testes specimens were taken and stained with Haematoxylin and Eosin. The sperms were examined for number, viability, motility and shape abnormalities. For chromosomal study, rats from each group were anaesthetized and the bone marrow cells were obtained by Rabello-Gay and Ahmed method. Microscopic examination of the testicular specimens, revealed disorganized germinal epithelium with abnormal mitotic figures and apoptotic cells. Sperm analysis showed that sperm count, viability and motility were decreased and the sperm anomalies were increased. Chromosomal analysis of bone marrow cells showed many aberrations as, chromatid deletions, ring chromosomes, chromosomal gaps, dicentric chromosomes, clumping of the chromosomes and polyploidy. All the former revealed that the histopathological changes and abnormalities caused by [TiO2] had been aggravated by prolonged duration of administration

Respiratory gated simultaneous integrated boost-intensity modulated radiotherapy [SIB-IMRT] after breast conservative surgery for carcinoma of the breast: the Salmaniya medical complex experience

To present our clinical experience using SIB-IMRT Technique for Intact Breast cancer. A retrospective review of 45 cases of Stage I-IV breast cancer patients treated with SIB-IMRT with respiratory gating after conservative treatments from 35th November 2008 to 16th February 2010. The most common fractionation was 1.8 Gy to Ipsilateral Breast tissue and 2.2 Gy to the lumpectomy cavity giving whole breast dose as 50.4 Gy and Lumpectomy cavity dose as 50.4 Gy and Lumpectomy cavity dose as 61.6 Gy over 28 fractions concomitantly. Respiaratory gating was done and CT-images were taken in inspiration breath hold position. A total of 45 patients with breast cancer- stage [17.7%], II [71%], II [8.9%], IV [2.2%] were treated with SIB-IMRT with respiratory gated radiotherapy. Out of 45 patients, 24 are of left sided breast cancer and 21 are of right sided breast cancer patients. The median, Dose maximum [D-max] in SIB-IMRT is 106.2% of prescribed lumpectomy site dose. The median isodose line prescribed to PTV-2 is 100%. The Conformity index [CI] is 0.9688 [median value] and Homogeneity index [HII] 1.06 [median]. The median ipsilateral lung, mean dose is 21.66 Gy and V-20 is 37.4%. For left sided cases the median value of mean heart dose, V-30 and V-40 are 22.98 Gy, 23.45% and 9.45% respectively. Acute skin toxicity was of Grade-I in 2.2%, Grade-II in 64.4%, Grade-III in 31.1%, and Grade-IV in 2.2%. The global Breast cosmoses were seen excellent in majority [93%] of case at median follow up of 8 months duration. Breast SIB-IMRT Technique is feasible and comparable with other treatment techniques with reduced treatment duration by six fractions. At median follow up of 8 months the skin toxicity and cosmoses are excellent in high percentage of cases

Acute respiratory distress syndrome in poor prognostic germ cell tumor with multiple lung metastases: a case report

We report a case which is unique as this patient was diagnosed pathologically as adenocarcinoma of the endometrium but clinically progressed as germ cell tumor. This was evident by progressive and rapid raised tumor markers [BHCG and LDH] with the development of multiple bilateral lung metastases. She was treated by administrating low doses of systemic combination chemotherapy as per the literature. Unfortunately, she developed acute respiratory distress syndrome as the complication of treatment and died due to it

Clinically-defined maturity onset diabetes of the young in Omanis: absence of the Common caucasian gene mutations

We are seeing a progressive increase in the number of young patients with clinically defined maturity onset diabetes of the young [MODY] having a family history suggestive of a monogenic cause of their disease and no evidence of autoimmune type 1 diabetes mellitus [T1DM]. The aim of this study was to determine whether or not mutations in the 3 commonest forms of MODY, hepatic nuclear factor 4alpha [HNF4 alpha], HNF1alpha and glucokinase [GK], are a cause of diabetes in young Omanis. The study was performed at Sultan Qaboos University Hospital [SQUH], Oman. Twenty young diabetics with a family history suggestive of monogenic inheritance were identified in less than 18 months; the median age of onset of diabetes was 25 years and the median body mass index [BMI] 29 at presentation. Screening for the presence of autoimmune antibodies against pancreatic beta cells islet cell antibody [ICA] and glutamic acid decarboxylase [GAD] was negative. Fourteen of them consented to genetic screening and their blood was sent to Prof. A. Hattersley's Unit at the Peninsular Medical School, Exeter, UK. There, their DNA was screened for known mutations by sequencing exon 1-10 of the GCK and exon 2-10 of the HNF1alpha and HNF4alpha genes, the three commonest forms of MODY in Europe. Surprisingly, none of the patients had any of the tested MODY mutations. In this small sample of patients with clinically defined MODY, mutations of the three most commonly affected genes occurring in Caucasians were not observed. Either these patients have novel MODY mutations or have inherited a high proportion of the type 2 diabetes mellitus [T2DM] susceptibility genes compounded by excessive insulin resistance due to obesity