Synthesis, biological evaluation and molecular modeling investigation of some new benzimidazole analogs as antiviral agents

A set of heterocyclic benzimidazole derivatives bearing 1,3,5-triazine group with different substituents at C-2 and C-5 of the benzimidazole ring have been synthesized and evaluated for their antiviral activities against HSV-1. The structures of these compounds have been established by analytical data, IR spectra, [1]H NMR, and mass spectra. Compounds 8a and 8b proved to be the most active antiherpetic agents in this study, at EC[50]% concentrations of 2.9, 3.4 mg/ml, respectively. Computational evaluation of the quantum chemical descriptors such as hydrophobicity [log P], HOMO and LUMO, and the gap energy, were calculated and correlated with the antiviral activity. The tested compounds showed proper degree of hydrophobicity [<0.5 - >5]. The HOMO-LUMO gap energy values of the tested compounds are comparable with the observed values for the antiviral drug, Acyclovir

Evaluation of endothelial dysfunction in postmenopausal women

Postmenopause was correlated with atherosclerosis. The aim of the study was to evaluate endothelial cell dysfunction by carotid intimal- medial thickness [IMT] and correlate it, using recently available plasma markers nitric oxide [NO], E-selectin, Nuclear factor kappa B [NF-kB]. Case control study. Mansoura university and private clinic. The work was conducted on 15 postmenopausal women with age mean 62.55 +/- 6.68 and 10 premenopausal women with age mean 43.2 +/- 2.53 as a control group. All cases were subjected to complete clinical examination, carotid artery intimal-medial thickness [IMT] measurement by ultrasonography scanning and study of selected plasma markers of endothelial dysfunction nitric oxide [colorimetric method], E selectin [ELISA] and [NF-kB] [immunocytochemistry]. In addition to plasma lipid [colorimetric method]. There was significant [p=0.003] increase in the IMT in post-menopausal women in comparison to the control group. The lipid profile showed significant increase in triglycerides [TG] [p=0.001] and total cholesterol [p=0.013] and significant decrease in HDL-C [p=0.02] in postmenopausal women in comparison to the control group. The nitric oxide [NO] level was significantly lower in post menopausal women compared with control group [p=0.015]. The plasma E-selectin level was elevated in postmenopausal versus with the control group [p=0.03]. NF-kB was significantly increased in post-menopausal women in comparison to control group [P<0.01]. IMT was positively correlated significantly with total cholesterol [p=0.009], LDL-C [p=0.02] and NF-kB [p=0.000] and negatively correlated with HDL-C [p=0.001]. NF-kB was correlated positively with age [p=0.016], total cholesterol [p=0.005], LDL-C [p=0.012] and negatively correlated with HDL-C [p=0.026] and NO [p=0.004]. The present data are in Keeping with the evidence for significant endothelial cell dysfunction, increased IMT, decreased NO in postmenopausal women

Assessment of the normal range of the angular and linear movement at lumbo scral region in Egyptian people

The range of linear and angular movements at the lumbo-sacral region in normal Egyptian people was assessed and compared with figures with other similar works overseas. The study was conducted on 90 cases who had no previous serious lumbar problem. The assessment included history taking, clinical examination and radiological examination including antero-posterior and lateral oblique views to the lumbo- sacral region and motion films [flexion and extension] for the same region. The results denoted that the mean of lumbar movements ranged from 45 to 72 degrees and the mean of horizontal displacement at the lumbar spine ranged from 0 to 4 mm or from 0 to 10% of the antero- posterior diameter of the vertebra

Assessment of the correlation between open lumbar discectomy and stability of the lumbar Spine

We assessed the stability of lumbar spine in cases subjected to open lumbar discectomy. Operative interference was mainly at the level of L4-5 in 76 cases [84.4 percent]. All cases had subjected to clinical and radiological examination pre- and post-operative for a period of follow-up at least one year to detect post-operative sequel and instability. The results of this study proved that instability of lumbar spine post-operative was detected in 36 cases [40 percent]. It was found that there was a significant relation between sex and lumbar instability [more in males 52.1 percent] and a significant relationship between occupation and lumbar stability where instability was higher in manual workers [50 percent]. Also, there was a significant relation between the period of follow-up and instability. We concluded from this study that here is a significant relation between lumbar discectomy and instability, more in males and manual workers and with the length of the period of follow-up

Surgical workshop avoiding operative wound sepsis by a new subcutaneous suturing technique

Postoperative wound infection adds considerably to the morbidity and mortality of patients and increases the length of hospitalization and medical costs [Green and Wenzel, 1977]. Bacterial contamination of the operative wound may be exogenous or endogenous and usually is confined to the subcutaneous tissues. Despite every effort to maintain asepsis, we can not guarantee against microscopical contamination [Pollock, 1985]. It is crucial, therefore that the presence of sutures in the subcutaneous layer particularly when there has been contamination following open viscus surgery will predispose to wound complications such as suture abscesses, granulomas and sinuses [Carlos, 1983]. Moreover bacterial migration along braided sutures, reactivity of some absorbable sutures and strangulating effect of tight sutures add to the risk of wound sepsis [Staffer et al., 1986]. Together with subcuticular suture for skin closure, the author has for a number of years adopted a new technique for subcutaneous tissue approximation that allows sound wound healing with minimal scarring and almost avoiding wound sepsis

Computed tomography versus magnetic reasonance imaging in diagnosis of congenital cystic intracranial lesions

Twenty one cases of congenital cystic intracranial lesions [having a range of age 24 days to 15 years] were subjected to CT and MRI examinations. The imaging findings were compared with the final diagnosis obtained by clinical data, operation and follow up. The lesions appeared mostly as hypodense nonenhancing masses of CSF density by CT, exerting mass effect according to the size and no surrounding edema. By MRI, they appeared hypointense in T1WI and hyperintense in T2WI. The pathological varieties encountered were; 2 cases of holoprosencephaly, 2 hydranencephaly, one porencephaly, 8 Dandy walker [DW] complex, 7 arachnoid cysts, and one epidermoid tumour. Both CT and MRI can give similar informations concerning the size, shape, rim thickness and other morphologic characteristics of cystic intracranial lesions. Additional data given by MRI are; superior visualization of cerebellar vermis in cases of Dandy Walker complex hence it could be classified into [type A] with absent vermis and [type B] with present vermis in the axial MRI cuts for the fourth ventricular level. MRI is better for detection of infection in an arachnoid cyst by the presence of high signal intensity inside the cyst, It is also able to predict the nature of the contents of the epidermoid cyst whether protein or triglycerides according to its signal intensity in both T[1] and T[2] WI. MRI can detect abnormal signal intensity in the cyst wall of a porencephalic cyst that helps differentiation from arachnoid cysts. Also MRI has a better performance specially in posterior fossa lesions as it is not affected by beam hardening artifact as CT. Other advantages of MRI include lack of ionizing radiation and direct visualization of blood flow, Muliplanar capability and high soft tissue resolution. CT is superior to MRI in the detection of calcification in certain lesions as epidermoid cyst

Cervical lymphadenopathy: Fine needle aspiration biopsy versus surgical lymph node biopsy

Sixty-three patients with cervical Iymphadenopathy were investigated to compare the results of fine needle aspiration biopsy [FNAB] versus surgical lymph node biopsy [SLNB]. FNABs were sent for cytopathology and in 15 patients for microbiology. Adequate specimens with accurate diagnosis were obtained in 58 patients [92 percent]. Five cases [8 percent] could not be evaluated Seventeen patients [27 percent] were diagnosed as malignant cases whereas rest 41 patients [65 percent] had benign conditions. Accurately, reports for malignant tumors included metastatic epidermoid carcinoma, lymphoma and metastatic thyroid carcinoma. Among benign conditions accurate diagnosis was established in patients with tuberculosis chronic lymphadenitis and hyperplastic lymph nodes. The findings of FNAB were helpful in directing subsequent workup. Diagnostic accuracy of SLNB was 100 percent. It specifically established the definitive dianosis in lymphoma and inflammatory cases. Complications were not found in either procedures. It was concluded that FNAB can be relied on to diagnose malignant tumors as it is safe, minimally invasive and extremely cost-effective. SLNB may be necessary for lymphoma and inflammatory conditions

Antibiotics in acute biliary pancreatitis

The value of antibiotic therapy in acute biliary pancreatitis was assessed in a prospective study including 40 patients with 43 attacks over a three-year period at Ain Shams University Hospital, Cairo, Egypt and Namas General Hospital, Assir, K.S.A. The criteria for inclusion in this study were a consistent clinical picture, hyperamylasemia and an ultrasound evidence of biliary stones or sludge. On the basis of laboratory findings, 77.5% of cases were graded as "mild" pancreatitis, whereas 22.5% were graded as "severe" pancreatitis. Twenty patients [20 attacks] were managed conservatively with intravenous fluids, nasogastric aspiration and analgesics, while in the remaining 20 patients [23 attacks], antibiotics were added. Patients managed without antibiotics developed mortality and complication rates of 10% for each. However, no deaths nor significant complications were recorded in the group treated with antibiotics. The time interval to resume normal laboratory criteria and start oral intake and hospitalization were significantly shorter in the group treated with antibiotics. In conclusion, antibiotic therapy is of great invaluability in the management of acute biliary pancreatitis and should be used routinely to achieve good prognosis

Management of blunt abdominal trauma due to road traffic accidents

This retrospective study present an analysis of 89 road traffic accident [RTA] patients on whom laparotomy was indicated. They account for 5% of total RTA patients admitted at Ain Shams University Specialized Hospital, Cairo, Egypt and Namas General Hospital, Asir, K.S.A. during a 3 years period. Eighty four underwent surgery; the remaining 5 died in the admissioin area before surgery. Males outnumbered females by a ratio of 9 : 1. Diagnostic peritoneal lavage [DPL] yielded a diagnostic accuracy of 97.5% with no recorded complications. Spleen [42 patients] and liver [36 patients] were the most common injured organs. Commonst procedures were splenectomy [37], liver suture [35] and hollow viscus repair [12]. Overall mortality was 20%. In conclusion, improving outcome for RTA victims requires an organized trauma system providing optimal management. DPL should be used whenever indicated. Mortality injuries. Teaching traffic rules, liberal use of preventive measures like seat belts and enforcement of traffic penalties are warranted

Appraisal of the surgical management of acute gallstone pancreatitis

The usefulness of corrective biliary surgery in gallstone pancreatitis is well established. Three questions are still controversial: What is the ideal timing of surgery? what is the optimal plan of treatment in severe cases? what is the role of endoscopic sphincterotomy [ES]? In this prospective study, surgical intervention in various stages of gallstone pancreatitis was evaluated with special reference about the value of ES. Fifty-two patients were included in this study on the basis of consistent clinical picture, hyperamylasemia and an ultrasound evidence of biliary stones. Forty patients [77%] had mild pancreatitis. while 12 patients [23%] had severe pancreatitis. Patients were operated upon within 48 hours of admission [Group I; 17 patients], within 6-8 days after the attack subsided [gropu II; 15 patients], or after 1-3 monts latter to preliminary conservative treatment [Group III; 20 patients]. In group I, II, operation was relatively easy and could be accomplished with minimal morbidity. All patients with oedematous pancreatitis had a prompt recovery with no recorded complications. In cases of haemorrhagic pancreatitis, although the opration and postoperative course were more difficult, 5 out of 7 patients recovered from their illness denoting that early surgery coud be beneficial. two patients with necrotizing pancreatitis died due to fulminent sepsis and multisystem failure, while another patient died with myocardial infarction 2 weeks postoperatively irrespective of recovery from original illness. Group III patients were treated conservatively, discharged and then readmitted for elective surgery with no recorded deaths nor significant complications. In all patients, cholecystectomy and operative cholangiography were performed with common bile duct [CBD] exploraiton when indicated. ES was used in 4 cases; retained stone [one patient], prior to laparoscopic cholecystectomy [one patient] and cholangitis [2 patients]. Drainage procedures were carried out in 3 cases; tranduodenal sphincterotomy [one patient] and choledochoduodenostomy [2 patients]. Mortality rates were 0% and 25% in mild and severe cases respectively with an overall mortality rate of 5.8%. Hospitalization was significantly shorter in the groups operated on during the primary admission. In conclusion, we recommend early surgery in all mild cases whereas in severe cases, the tinting of sugery should be relient on clinical findings. A more conservative approach in haemorrhagic- necrotizing pancreatitis is required. ES could be used safely to clear CBD in cases of retained stones, cholangitis or prior to laparoscopic cholecystectomy

Routine or selective antibiotic prophylaxis in biliary surgery

The microbial flora of the bile were studied in 141 patients admitted for biliary surgery. Positive bile cultures were found in 30 [21.3 percent] patients. Gram negative organisms were isolated in 28 [93 percent] patients. The incidence of wound infection was higher in the positive bile culture group. To rationalize the use of prophylactic antibiotics in biliary surgery and to identify the groups of patients at risk, we correlated the positive bile cultures with certain factors such as presence of acute cholecystitis, choledocholithiasis, diabetes and old age. The study concluded that prophylactic antibiotics should be administered to the patients with one or more of the risk factors studied. This policy protects 41.7 percent of the patients at risk, and spares 89.2 percent of the patients with sterile bile from receiving antibiotics unnecessarily

Experience with cholecystectomy; a study of 148 consecutive operations

Experience with 138 [116 females and 22 males] patients who had done cholecystectomy operation showed that the mean age of the patients was 39 years [range 14-70 years]. The age incidence in the female patients was significantly lower than in Western studies. Twenty-four [17.4 percent] patients were diabetic. Elective admissions account for 88.4 percent of cases and 11.6 percent were emergency admissions. Ultrasonography confirmed the diagnosis in the 95 percent of cases. Elective cholecystectomy was performed in 108 [78.4 percent] patients, with common bile duct [CBD] intervention in 14 [10 percent] patients, while emergency cholecystectomy was done in the remaining 16 [11.6 percent] patients. Cholangiograhy was performed in 11 cases when any risk factor of bile duct stones or history of pancreatitis was associated. Fifty - five [40 percent] patients had an additional unrelated surgical procedures. Elective operations were safely performed in elderly patients with no significant increase of hospital stay. The mean hospital stay was 10.2 [range 7-30] days. There were no deaths. The general overall morbidity rate was 13.8 percent and the procedure related morbidity was 2.2 percent. Hospital stay was significantly prolonged with CBD exploration, diabetes, cases of peritoneal drainage and wound infection

Is mechanical bowel preparation still necessary for colonic resection and anastomosis?

In a series of 26 patients with elective and emergency colectomies with primary anastomosis, all pre- and preoperative mechanical preparation of the bowel was omitted. The patients were covered by preoperative intravenous dose of cephalexin and metronidazole. Antibiotics were continued for 5 days postoperatively. No anastomotic dehiscence was clinically apparent, and wound infection was noted in only 11.5 percent of patients

Surgical versus endoscopic management of retained recurrent bile duct stones

Twenty patients with retained or recurrent bile duct stones were reviewed to compare the results of operative versus endoscopic therapy. Ten patients [two with T tube] underwent common bile duct exploration [CBDE] with T tube replacement or drainage procedure, while the remaining ten [five with T tube] underwent endoscopic sphincterotomy [ES] and stone extraction. There was no mortality. Success rates were similar for CBDE and ES. No complications occurred in groups managed endoscopically, while in the group treated operatively, duodenal fistula occurred in one case and superficial wound infection occurred in another case. Both complications were cured concervatively. Hospitalization was significantly shorter in groups managed by ES than those underwent CBDE. The conclusion is that the results of ES and CBDE are comparable and the use of ES should remain the procedure of choice for bile duct stones after cholecystectomy

Management of postcholecystectomy complications: role of interventional radiology

This study summarized diagnostic and therapeutic procedures in 26 patients who suffered postcholecystectomy complications. Complications were divided into bile stricture or ligation, retained stones and pathologic fluid collections. Specific lesions were bile duct stricture [n = 11], accidental bile duct ligation [n = 3], retained stones [n = 7], abscess [n = 4] and biloma [n = 1]. Presenting problems were right upper abdominal pain, sepsis, jaundice and intermittent cholangitis. The patients underwent 37 interventional radiologic procedures including 14 percutaneous transhepatic cholangiograms [PTC], 4 percutaneous biliary drainage [PBD], 4 T-tube cholangiography, 3 endoscopic retrograde cholangiopancreatography [ERCP], 7 endoscopic sphincterotomy [ES] and stone extraction, and drainage of 4 abscesses and one biloma. Ten [38%] patients did not need further surgical intervention, while in the remaining 16 patients who underwent reoperation, the procedures helped to establish the diagnosis, improve the patient's preoperative status, or to serve as a landmark for the surgeon to locate and repair the ligated or strictured duct. Interventional radiologic procedures were found helpful to cure the complication and obviate reoperation, improve the general conditions of the patient and provide an adequate guide for bile duct reconstruction

Non palpable: breast lesions: wire localization and excisional biopsy

Twenty four female patients with 25 nonpalpable breast lesions and having abnormal mammographic findings 12 patients had breast tenderness and/or nodularity, 8 patients for routine screening mammography and 4 patients with positive family history of breast carcinoma, were studied in this series. Needle localisation with guide wire mammography was performed to all patients immediately before excisional biopsy operation. The needle localization biopsy was done under general anaesthesia, non major complications occurred but two minor complications occurred and responded well to treatment. In this series the fibroaytic disease was the commonest benign pathological lesion detected in 18 specimens [72%] followed, fibroadenoma in 3 specimens [12%] and breast fibrosis in one specimen [4%]. Three specimens in this series had in situ duct carcinoma, modified radical mastectomy was done to them and axillary nodes were negative for malignancy