Prophylactic effect of ondansetron for intrathecal fentanyl-induced pruritus

Using opioids along with local analgesic increase anesthesia duration and provide appropriate postoperative analgesia. However, intrathecal injection of opioids is associated with upsetting side effects including pruritus. Ondansetron [5-HT3 receptor agonist] has anti-pruritus effects. Therefore, we conducted a double blind randomized case-control study to evaluate prophylactic effects of ondansetron for preventing intrathecal fentanyl-induced pruritus. Two hundred seven patients with ASA status I, II or III, who were candidate for pelvic or lower extremity surgery with spinal anesthesia [SA] using bupivacaine hyperbaric [10-15 mg] and fentanyl [25 micro g] were included in the study. Patients were randomly assigned to two groups of case [ondansetron 8mg IV] and control [4 ml normal saline IV]. Patients' hemodynamic indexes and side effects were evaluated at 5, 10, 30, 60 minutes and then hourly up to 6 hours after SA. Pruritus presence, degree, and site were evaluated after two and six hours. Data were analyzed using Kolmogorov-Smirnov test, student t-test, Mann-Whitney U, chi[2], Fisher exact test, and Spearman linear correlation coefficient. The pruritus incidence was 60% in control and 34% in case group. Severe pruritus was observed in 18% of control group and 6% of case group. Ninety four percent of patients with pruritus in control group expressed it in above T[6] dermatomes and 74% of patients with pruritus in case group had pruritus in T[6]-L[1] dermatomes. The incidence of pruritus in L[1]-lower dermatomes was similar in two groups. Headache and nausea after anesthesia were more common in control group [p=0.035]. Ondansetron decrease incidence and degree of intrathecal fentanyl-induced pruritus. This reduction was more significant around injection area T[6]-L[1] dermatomes. Ondansetron injection does not influence systolic blood pressure, duration of anesthesia and analgesia, and does not induced urinary retention and back pain

Overexpression of Her-2/neu oncogene in 51 cases of endometrial carcinoma

Endometrial cancer is a common malignancy of the female genital tract. Her-2 overexpression is strongly correlated with tumor grade, type, and stage and this association complicate the issue of response of Her-2 positive endometrial carcinoma to chemotherapy. The aims of the current study are; to estimate the overexpression of Her-2 in endometrial carcinoma in our patients, to correlate the results with other known clinicopathologic markers and to compare our results with others. This is a cross-sectional retrospective study of 51 cases of endometrial carcinoma collected with their clinical data from Al-Batool Teaching Hospital and Al-Khansa'a Maternity Teaching Hospital in Mosul-Iraq from January 2007 to January 2010. All cases were revised histologically. Forty-three cases were total abdominal hysterectomy and 8 were curetting material. Tumors were classified into two main types, endometroid and non-endometroid carcinomas. Immunoperoxidase stains for Her-2/neu were performed on representative formalin-fixed paraffin embedded blocks. Majority of the endometrial carcinoma were in the 6th decade [50.9%] with a mean of 56.5 year. Her-2/ neu overexpression was observed in 58.8% of cases. The most frequent association was with non-endometroid carcinoma [100%]. Expression of Her-2/neu increased with increasing grade reaching 89.47% in grade III tumors. The highest expression was detected in tumors invading deep into the myometrium [77.77%]. HER-2/neu appears to play an important role in the biologic behavior of endometrial cancers. It was overexpressed in non-endometroid carcinoma, especially papillary-serous type, high grade tumors, and among the higher stages. Therefore, targeted therapies directed against HER-2, could be effective in some patients with endometrial cancer

Patterns of meningococcal infection in Sudan with emergence of Neisseria meningitidis serogroup W135

This study was conducted during the 2004-2006 epidemic of meningitis in Sudan to follow-up the frequency of disease outbreak or endemic waves and to evaluate the new quadrivalent vaccine for actual application. Samples were collected from Darfur, El Gedaref, Kassala and Khartoum States and transported to the National Health Central Laboratory in Khartoum. Of 196 patients with clinical symptoms and signs of meningitis, conventional culture identified Neisseria meningitidis in 37 [18.9%], confirmed by polymerase chain reaction. N. meningitidis type A was identified in 29 [78.4%] patients, type C in 3 [8.1%] and N. meningitidis W135 in 5 [15.5%]. The serotyping and molecular diagnosis patterns of N. meningitidis showed the emergence of the new strain,W 135, in patients from the borders of Sudan, 3 from the West Darfur, and 1 each from El Gedaref and Kassala. These could be related to the movement of pilgrims through the borders to Saudi Arabia in the Hajj season. Serious consideration may be needed for quadrivalent vaccination to prevent seasonal and Hajj season outbreaks

Hepatitis B virus infection among staff in three hospitals in Khartoum, Sudan, 2006-07

This study was conducted to determine the seropositivity of hepatitis B infection, associated risk factors and history of vaccination among staff in 3 teaching hospitals in Khartoum. The study was carried out from March 2006 to March 2007. Participants comprised 245 randomly selected hospital staff; 12 [4.9%] reacted positively for HBsAg, 6 of whom were nurses, 4 domestic staff and 2 laboratory staff. Only 37 participants [15.1%] said that they had attended training courses in biosafety. Just over 50% indicated that they had had needle-stick or sharp injuries during work; 61 [24.9%] indicated that they always followed the bio-safety precautions, 52 [21.4%] said that they always wore gloves during their work while 43 [17.6%] said they never wore them. Only 11 [4.5%] of the participants had received the full vaccination dose for hepatitis B

Undifferentiated [embryonal] sarcoma of the liver. case report and review of literature

Undifferentiated [embryonal] sarcoma of the liver was first defined as a separate clinicopathological entity in 1978. It is uncommon hepatic tumor of mesenchymal origin, usually observed in children and teenage, but also infrequently encounter in adult. It represent about 9-15% of all hepatic tumor in children. We report a case of undifferentiated embryonal sarcoma of the liver in a 6 year old girl who presented with non specific right hypochondrial pain and mass with fever. Laboratory studies of the liver function were normal and the other tests were non specific. Ultrasonography and CT scan showed a large heterogeneous mass ranging from cystic tissue with multiple septa to more predominant solid component in the right lobe of the liver. Exploratory laparotomy was performed and revealed a large mass in the right lobe and part of the left lobe of the liver. Tumor resection was performed and about 70% of the total liver was resected. Macroscopically, tumor was large solitary globular firm predominant solid mass weighing 1100gm and measuring 18 x 12 x 8 cm, with variegated cut surface of solid, cystic, necrotic and hemorrhagic areas. Microscopically, the tumor has a variable but distinctive sarcomatous appearance, composed of spindle, oval and stellate-shaped sarcomatous cells, with marked nuclear pleomorphism, closely packed in whorls or scattered loosely in a myxoid ground substance. Numerous bizarre multinucleated giant cells, containing large intracytoplasmic hyaline globules with ample mitosis many of which are atypical. Tumor cells entrapped hyperplastic bile ducts. Accordingly the diagnosis of undifferentiated embryonal sarcoma of the liver was performed. Conclusion: Prompt detection of this aggressive tumor with complete surgical resection is the key to a successful outcome. Prognosis recently improved following postoperative chemotherapy

occurrence of nocardia species among patients with pulmonary infection

The aim is to determine the frequency of Nocardia spp. among tuberculous patients in Khartoum state. Prospective study. Abu-Anga Teaching Hospital, El-Shaab Teaching Hospital and the Tuberculosis Reference Laboratory at the National Health Laboratory, Khartoum, Sudan. Three hundred and twenty-nine patients were included in this study during the period from October 2004 to January 2006. The patients were examined for the presence of acid-fast bacilli. Thin bacterial smears were prepared and stained by Ziehl Neelsen [ZN] stain. Two tubes of the Lowenstein-Jensen [LJ] medium were inoculated with 20 ul of the neutralized sputum sample that was obtained from the digestion and decontamination. One of the two tubes contained glycerol while the other tube contained pyruvic acid to isolate M. bovis species if encountered. All cultures were incubated at 37°C for 8 weeks. The growth was monitored up to the 8[th] week. Phenotypic characterization was performed by using different biochemical tests. Ten isolates showed rapid growth pattern within 2-3 days after inoculation. Further conventional methods suggested that all these isolates were belonging to the family Nocardiaceae. Nocardia spp revealed considerable occurrence among patients with pulmonary infections [3.3%]. This finding suggested that pulmonary nocardiosis might occur in patients who suffer from chronic lung disease in Sudan

[Production of dietary fiber-rich biscuits from wheat flour, sorghum and mango peel flour]

The present study was carried out in the Food Research and. Post-harvest Technology Center. August 2007, for the production of fiber rich biscuits from wheat, sorghum and mango flour, so as to increase nutritional value of the biscuits. Mango peel was the main waste of mango juice processing. Mango waste is potentially considered as a good source of human nutrients and dietary fibers. Mango peel powder was prepared from the peel after being washed dried, and milled. The powder was added to replace wheat flour in quantities of 5, 7 and 9 gm. The preparation of biscuits physical, chemical and orgnoleptic quality tests were evaluated. Results indicated that consumers prefer biscuit powder that contained up to 7 grams dried mango peel product

Impact of anthropmetric measures on sural nerve conduction in healthy subjects

Nerve conduction studies are an invaluable aid to investigate and quantify the physiological activity of peripheral nerves. These include measurement of sensory and motor conduction velocities and latencies of peripheral nerves. These nerve conduction parameters may be affected by anthropometric factors like age, sex, height, weight and BMI. In this observational study the impact of these anthropometric parameters was measured on sensory nerve conduction velocity [SNCV] and sensory latency [SNSL] of sural nerve. Sural nerve conduction studies were conducted in EMG room of Neurology section of Medical Unit 1 at Sir Ganga Ram Hospital, Lahore on Electromyograph by Nihon Kohden MEB-5304K. After following strict exclusion criteria by careful history and physical examination 25 normal healthy subjects recruited from local population by random sampling technique. The age range was 40-70 years with mean age 47.2 +/- 9.23 years. Gender distribution was 60% females and 40% males. The mean SNCV was found to be 53.16 +/- 5.68 meter per second [m/sec] and mean SNSL was 2.81 +/- 0.45 milliseconds [msec]. It was found that the mean sural nerve conduction velocity was higher and the mean sensory latency was shorter in healthy subjects than that of the Western races. Moreover, the SNCV decreases and SNSL increases significantly with age

role of microorganisms in restenosis after coronary stent implantation

Coronary intervention [PCI] with stent implantation. Seropositivity to certain infectious agents may play a role in the development of ISR through induction of chronic immunologic response. To assess the association between chronic infection with Cytomegalovirus [CMV], Chlamydia pneumoniae [Cp], and Helicobacter pylori [Hp], whether single or combined infection, and restenosis in patients undergoing coronary stenting. Forty patients with ISR [diagnosed by coronary angiography] were compared to 30 control patients who have had coronary stenting with no evidence [by angiography] of ISR. The third group composed of 20 healthy controls. Using Indirect ELISA method; detection of IgG specific antibodies in the sera of the 3 study groups for CMV, Chlamydia pneumoniae, and Helicobacter pylori were done. Patients with ISR were mainly above the age of 50 years [62.5%] with male predominance [70%]. Chronic infection with Cytomegalovirus [82.5% in ISR patients], based on serological findings, was a Significant risk factor for ISR [OR = 3.1, P = 0.03].Neither chronic infection with Cp [72 .5% in ISR patients] nor with Hp [67.5% in ISR patients] were proved as significant risk factors for ISR [OR = 1.7, P = 0.27 and OR = 1.2, P = 0.71 respectively]. Pathogen burden i.e. combined chronic infection with 2 or 3 microorganisms had no role in the development of ISR. Evaluation of patients who have higher titers of IgG antibodies specific for CMV may help to identify patients at greater risk for ISR. The IgG titer of significant risk should always be assessed by comparing to control group since it highly correlates to epidemiological attributes and technical applications

Evaluation of a PCR-amplified IS6110 insertion element in the rapid diagnosis of pulmonary tuberculosis in comparison to microscopic methods in Sudan

The aim of this study was to evaluate the sensitivity and specificity of a polymerase chain reaction [PCR]-based method [IS6110 insertion site] in the diagnosis of pulmonary tuberculosis in sputum samples in comparison to smears by using culture on Loewenstein-Jensen medium as a standard. The study was conducted during the period 1999 through to 2000, at Khartoum Teaching Hospital, Sudan, on 200 sputum samples. The samples were collected from patients suspected of having pulmonary tuberculosis, were examined using a PCR amplified IS6110 insertion element in comparison to Ziehl-Neelsen stained smears in terms of sensitivity and specificity. Culture on Loewenstein-Jensen medium was used as the standard to control the 2 tests. Microscope sensitivity was found to be 65.4% and the specificity was 90.5%, whereas sensitivity of the IS6110 was 88.5% and specificity was 98.6%. The study concluded that though IS6110 sensitivity was 13.1% higher than smear method, it provided a significant improvement in specificity for the diagnosis of pulmonary tuberculosis. Improvement is still needed to increase the sensitivity of the IS6110 methods by decreasing the number of the false negative samples before its use can be at routine levels

Preparation of subtilisin complexes with alpha-2- macroglobulin and their characterization

The subtilisin complexes with dexamethasone and Alpha-2 macroglobulin were synthesized and were found to be immunoreactive to the specific antidexamethasone antibodies. These complexes also retain proteolytic activity when low molecular weight substrate was used by Homogeneous colorimetric method. The doubly labelled substrate was also used to study the enzyme activity in complex form. The Dex-subtilisin showed the proteolytic activity whereas Dex-subtilisin A2M did not show the proteolytic activity due to no access of small molecular weight substrate towards the large molecular weight protein in a co-complex form

Sub-acute toxicity studies of Catha edulis [Khat]

The aim of this study is to investigate the effect of [Catha edulis on some biochemical parameters on short and long-term basis. Fresh Khat in a dose of 20 grams/kilogram, was given to three groups of rabbits [nine each], for one, two, and three weeks, and a fourth group was left as a control, and in another trial fresh Khat was given in three doses 20, 30 and 40 gram/kilogram to three groups of rabbits [six each], for six months, and a fourth group was left as a control. The results were as follows: fasting blood sugar [FBS], triglyceride [TG], GOT, and GPT were increased in both trials. The CBC which was measured only in the second trial showed that Khat lowered hemoglobin, WBCs, and lymphocytes while it increased neutrophils. The Khat treated groups showed lowered body weights in the second [six months] trial. The heart weight relative to the body weight was increased in the first trial, while this result was not seen in the second trial

relationship of allergic rhinitis/asthma with skin test reactivity and serum IGE levels

The relationship between intradermal skin tests reactivity and serum level of total IgE was evaluated in 200 atopic subjects selected from a general population sample randomly [having strong family history of allergy] attending ENT OPD of Sir Ganga Ram Hospital, Lahore. Intradermal test results were related to the history of allergy status of the patients and total serum IgE levels. Intradermal test reactivity to dust and pollen correlated with the presence of allergy symptoms. Similarly mean total serum IgE levels [Behring method] were significantly higher [P<0.001] in allergic [333.3 I.U./ml] than in non-allergic subjects [75.34 I.U./ml]. Positive association was found between the degree of intracutaneous test results and serum IgE levels

Retropharyngeal abscess in adults

Ten patients with retropharyngeal abscess treated over a period of 6 years between 1988 to 1993 were studied. Five of these patients had tuberculous disease of cervical vertebrae, 3 cases were traumatic in origin, 2 caused by perforating foreign bodies and one during intubation. The remaining 2 cases were result of sepsis in the upper aerodigestive tract. High doses of intravenous antibiotics directed towards the causative micro-organisms and coverage was given to the anaerobes as well. In addition to this, antitubercular regimen was started in tuberculous disease of cervical spines. Adequate airway control and early surgical intervention was the main stay of treatment. All the patients underwent surgical drainage of the retropharyngeal abscess within 24 hours of admission. Morbidity period was very short due to adequate medical and surgical treatment, 8 patients had wonderful recovery and were discharged 4-33 days [mean 15.3 days] from the date of their admission. Two of them developed potentially fatal complications. One of them developed pyopneumothorax and the other who was diabetic as well developed mediastinitis. Early surgical drainage and adequate medical treatment remain the most appropriate methods of treating retropharyngeal space abscess it avoids life threatening complications with rapid recovery

Six years spectrum of primary tuberculosis in aerodigestive tract, head and neck

Primary tuberculosis of aerodigestive tract, head and neck is one of the rare forms of extra pulmonary tuberculosis. A retrospective analysis of twenty-two patients seen in the last six years in ENT Department of Sir Ganga Ram Hospital, Lahore was conducted to illustrate the various modes of clinical presentation. Of the twenty-two patients, 15 were male and 7 female. The average age of presentation was 35 years with an age range of 8 years to 70 years. It was evaluated that out of 22 patients, tuberculous cervical lymph node [31.83%] was the commonest affected site. Most patients [22.73%] who had lesions involving the cervical vertebrae, presented as retropharyngeal abscess. Tuberculous cervical sinus [13.64%], tuberculous lesions of the larynx [9.00%] and middle ear [9.00%] were less frequent. Nasopharyngeal [4.5%], nasal [4.5%] and parotid gland [4.5%] tuberculosis were infrequent. All the patients had a physical examination of upper aerodigestive tract, head and neck, and baseline investigations including the ESR, Mantoux test, X-Ray chest and X-Ray cervical spine [only in case of T.B. Cervical vertebrae]. Biopsy of the affected sites except lesions involving the vertebrae were performed and all the patients had histologically confirmed tuberculous lesion. In 19 out of 22 patients the primary pulmonary focus of tuberculous infection could not be found. Only 3 had radiographic evidence of healed pulmonary tuberculosis. The clinical appearance in most of the cases often simulated malignancy. The frequency of occurrence of primary tuberculous lesion different sites in upper aerodigestive tract; head and neck and its management has been discussed

Study of the analytical methods for the determination of chloroquine phosphate

The different assay methods for the determination of chloroquine phosphate have been reviewed. The quantitative determination of Chloroquine phosphate from commercial pharmaceutical preparations have been analysed by acid-base, non-aqueous and spectrophotometric methods and their results have been compared. The spectrophotometric method has been found to be a better method for the determination of percentage purity of Chloroquine phosphate in pharmaceutical preparations

Antibiotic susceptibility and biotypes of clinical isolates of haemophilus influenzae

The susceptibility of 200 strains of Haemophilus influenzae isolated from patients seen in the Riyadh University Hospitals to various antibiotics was determined using the agar dilution method. The antibiotics tested included ampicillin, chloramphenicol, tetracycline, cotrimoxazole, cephamandole, cefotaxime, ceftazidime, moxalactam and ceftriaxone. Ampicillin resistance was seen in 15% of the strains, 80% of which were found to be beta lactamase producers. Resistance to other antibiotics was as follows: chloramphenicol 5.5%, tetracycline 10.5% and cotrimoxazole 1.5%. All the strains were susceptible to the second and third generation cephalosporins. Biotyping of the strains showed biotype II H. influenzae to be the most common biotype isolated and biotype III to be the most resistant to antibiotics