Knowledge and Practice Of Peripheral Intravenous Catheter Among Nurses in a Teaching Hospital in Malaysia: Universiti Kebangsaan Malaysia Medical Centre

@#Introduction: Insertion of Peripheral intravenous catheter (PIVC) is a common invasive procedure performed on patients that may contribute to several complications. Nurses are required to have adequate knowledge and practice to ensure the successful of the procedure. The objective of this study was to determine the knowledge and practice of nurses towards PIVC insertion procedures. Methods: A descriptive cross-sectional study design was conducted at Universiti Kebangsaan Malaysia Medical Centre. A total of seventy- seven nurses working in the emergency department, obstetrics & gynecology patient admission centre, daycare oncology were participated in this study. The data was gathered using a modified questionnaire and standard PIVC insertion guidelines. Results: 21 (27.3%) nurses had high knowledge and 56 (72.7%) had low knowledge of PIVC insertion (M=7.77, SD=1.87). All 77 (100%) nurses performed insertion of PIVC according to the standard of practice (M=23.16, SD=1.51). A positive correlation between age and knowledge (rho=0.123) but a negative correlation towards practice (rho=-0.413). A positive correlation between working experience and knowledge (rho=0.094) but a negative correlation towards practice (rho=-0.047). There was a positive correlation between nurses’ knowledge and practice (rho=0.038). Conclusion: Nurses with good knowledge of PIVC insertion performed better as they were aware of the negative consequences of the procedure if conducted incorrectly. Knowledgeable and competent nurses are essential to ensure the quality of nursing care and safe practice towards patients. Future studies with larger samples of nurses involved in more hospitals in Malaysia are recommended.

Response surface methodology-based optimization of ultrasound-assisted extraction of β-sitosterol and lupeol from Astragalus atropilosus (roots) and validation by HPTLC method

Objective: To optimize the ultrasonication method for efficient extraction of β-sitosterol and lupeol from the roots of Astragalus atropilosus using Box-Behnken design of response surface methodology (RSM), and its validation by high performance thin layer chromatography (HPTLC) method.Methods: Ultrasonication method was used to extract β-sitosterol and lupeol from Astragalus atropilosus (roots). RSM was used to optimize the different extraction parameters viz. liquid to solid ratio (10–14 mL/g), temperature (60-80 ℃) and time (40–60 min) to maximize the yield of β-sitosterol and lupeol. The quantitative estimation of β-sitosterol and lupeol was done in chloroform extract of Astragalus atropilosus by validated HPTLC method on 10 cm × 20 cm glass-backed silica gel 60F254 plate using hexane and ethyl acetate (8:2, v/v) as mobile phase. Results: A quadratic polynomial model was found to be most appropriate with regard to R1 (yield of total extraction; R2/％ CV = 0.9948/0.28), R2 (β-sitosterol yield; R2/％ CV = 0.9923/0.39) and R3 (lupeol yield; R2/％ CV = 0.9942/0.97). The values of adjusted R2/predicted R2/signal to noise ratio for R1, R2, and R3 were 0.9782/0.9551/48.77, 0.9904/0.9110/31.33, and 0.9927/0.9401/36.08, respectively, indicating a high degree of correlation and adequate signal. The linear correlation plot between the predicted and experimental values for R1, R2, and R3 showed high values of R2 ranging from 0.9905-0.9973. β-sitosterol and lupeol in chloroform extract of Astragalus atropilosus were detected at Rf values of 0.22 and 0.34, respectively, at λ max = 518 nm. The optimized ultrasonic extraction produced 8.462％ w/w of R1, 0.451％ w/w of R2 and 0.172％ w/w of R3 at 13.5 mL/g liquid to solid ratio,78 ℃ of temperature and 60 min of time.Conclusions: The experimental findings of RSM optimized extraction and HPTLC analysis can be further applied for the efficient extraction of β-sitosterol and lupeol in other species of Astragalus.

Assessment of knowledge, attitude and practice toward acne vulgaris among community in Jeddah City, 2016

Background: acne vulgaris is the most common skin condition seen by the dermatologists. It is a chronic inflammatory disease of pilosebaceous unit characterized by seborrhea, comedones, papules, pustules, nodules, cysts and in some cases scars and keloids, which persist for rest of the life

Objectives: the present work aimed at evaluating the level of awareness, Attitude and Practice toward acne vulgaris in Jeddah city

Methods: a cross sectional analytical questionnaire based study was carried out among the general population in Jeddah city. This study started in the year [2016] and composed of 461 subjects. The mean age of citizens was 28, 82. To assess citizens' demographic factors and beliefs about acne vulgaris, consenting citizens completed an anonymous online questionnaire. The data was entered and analyzed using SPSS version 20

Results: The sample is consisted of 65, 8% women and 34, 2% men. Among the respondents 7, 7% reported suffering from acne vulgaris and 13, 6% confirmed having a history of acne vulgaris illness in their family. The results of the study showed that 153 [34, 8%] subjects had weak knowledge related to the disease, 260 [59, 1%] subjects had average level of knowledge while only 27 [6, 1%] subjects had good knowledge regarding acne vulgaris. There was a statistical significant association between gender, educational level and the level of awareness about acne vulgaris

Conclusion: acne vulgaris is a disease that is potentially controllable but that cannot be cured. Education still be important overall the treatment of the patients

Study of the relationship between calcium ion and thyroid hormones, liver enzymes in some patients of hypocalcaemia and hypercalcaemia

Objective: This study focuses on the relationship between calcium ion concentration in human body and thyroid hormones with liver enzymes to determine the effect of some physiological and biochemical parameter of liver [glutamic oxaloacetic transaminase [GOT], glutamic pyruvic transaminase [GPT], Bilirubin] and thyroid stimulating hormone [TSH; T3, T4], on the levels of calcium ion in the blood

Methods: The current study included 40 patients from two different hospitals in Karbala city. This study has been investigated to find the effect of thyroid hormones [T3, T4, TSH] and liver enzymes [GOT, GPT, Bilirubin] on calcium ion concentration

Results: The results revealed there is no significant difference [P > 0.01] between calcium ion concentration and thyroid hormones [T4, T3, TSH] in each groups of different ages, respectively. Therefore, weak correlation between calcium and hormones pointed to an increase or decrease of calcium ion concentration effect by these hormones

Conclusion: There is no significant difference [P > 0.01] between liver enzymes [GOT, GPT, Bilirubin] and calcium ion concentration in each groups of different ages respectively, although weak correlation between calcium and hormones that pointed to an increase or decrease of calcium ion concentration is also affected by these enzymes

Infectious complications after allogeneic bone marrow transplantation: Sheikha Badryia Center, Kuwait

To present our experience of post-transplant infections in allogeneic stem cell transplants at Sheikha Badryia Stem Cell Transplant Centre, Kuwait. Retrospective analysis of 21 consecutive patients with malignant and non-malignant hematological disorders who received a transplant of an unmanipulated bone marrow graft from an HLA-I identical sibling donor from November 2011 to December 2013. Pre-transplant infection surveillance was carried out, and strict prophylaxis against infection was observed. Bone marrow stem | cells were used as the stem cell source. Cyclosporin and methotrexate with or without mycophenolate mofetil / methylprednisolone were used as graft-versus-host disease [GVHD] prophylaxis. The engraftment was monitored with molecular analysis. Survival was calculated from the date of transplant to death or last follow-up. Twenty-one patients received allogeneic stem cell transplants from HLA- matched siblings for various hematological disorders. Twelve patients were female. The median age of the patient cohort was 34 years [range 3-41 years]. All patients and donors were cytomegalovirus [CMV] IgG-positive. Seventeen patients [80.95%] developed febrile episodes in different phases of post-transplant recovery. Post-transplant infections were confirmed in 20 patients [90.2%] on the basis of clinical assessment and microbiological, virological, and histopathological examination. Mortality related to infections and chronic graft versus host disease was one patient [4.8%]. 90% of our patients developed febrile episodes with relatively low culture yield. The majority of infections were treated effectively

Antioxidant and cardio protective effect of palm oil leaves extract [standardized ethanolic fraction] in rats' model of saturated fats induced metabolic disorders

Recently, it is suggested to use POLE [palm oil leaf extract] as a nutraceutical health product in food industry due to its newly discovered content of polyphenols and antioxidant vitamins. In the experiment, the antioxidant and anti-lipid-peroxidation activities of the extract were confirmed using; DPPH [1-diphenyl-2-picryl-hydrazil] radical scavenging activity, ferric ion induced lipid peroxidation inhibition, reducing power and hydrogen peroxide scavenging activity assays. The cardio-protective activity was studied in vivo using a model of metabolic syndrome induced by high fat diet. Lipid profile, obesity indices, renal tubular handling of water and electrolytes, blood pressure and arterial stiffness were measured at the end of the treatment period. Sprague Dawley rats weighing 150-200 g were divided into six groups, viz; group C; was treated as a negative control and fed with standard rodents chow, group H; was treated as a positive control and fed with an experimental diet enriched with saturated free fatty acids for 8 weeks, groups HP0.5, HP1 and HP2 which were fed with 0.5,1 and 2 g/kg [body weight] /day of POLE orally during the last 24 days of the high fat diet feeding period and group P; fed with highest dose of POLE. Results revealed that POLE possesses a cardio-protective effect which is ascribed to its content of polyphenols.

Percutaneous nephrolithotomy in children: a preliminary report

The recurrence of pediatric nephrolithiasis, the morbidity of repeated open surgical treatment as well as our experience in percutaneous nephrolithotomy [PNL] in adult patients, all derived us to shift to PNL for managing renal stones >1.5 cm in pediatric patients. Our aim of this study is to evaluate the safety and efficacy of PNL in pediatric patients. During the period of the month between May 2011 and April 2013, 38 children [47 renal units] underwent PNL for renal stones 1.5-5 cm in length. Patient demographics, stone characteristics, and clinical outcome were prospectively studied. Data of those who underwent conventional and tubeless PNL were compared. Median follow-up period was 12 months [range: 6-24]. The median age at presentation was 8-year [range: 3-12]. The operative time ranged from 30 to 120 min [median [0]. Overall stone clearance rate was [1.5% after single PNL. The median hospital stay was 3 days. Auxiliary procedures were successful for the remaining 4 patients [nephroscopic clearance in one and shockwave lithotripsy in 3]. Tubeless PNL was performed in 17 renal units with a comparable outcome to conventional ones. The perioperative complications were noted in 5/47 [10.6%] of all procedures [Clavien Grade II in 4 and Clavien Grade IIIa in 1] and were managed conservatively. Percutaneous nephrolithotomy for renal stones in pediatric patients is safe and feasible if performed by a well-experienced endourologist. Tubeless PNL is a better choice for children

Patterns and etiology of maxillofacial fractures in Riyadh City, Saudi Arabia

The aim of the present study was to study the etiologies and patterns of Maxillofacial fractures in patients treated in Riyadh City, Saudi Arabia, between 2007 and 2011. Data were obtained through a retrospective review of 237 patients admitted to the King Saud Medical City Dental Department with a diagnosis of maxillofacial trauma. After excluding patient files with incomplete or unclear records, and cases in which computed tomography showed no evidence of fracture, the files of 200 patients with a diagnosis of maxillofacial fracture were included in the study. For each case, patient's sex and age, pattern of facial fractures, and cause of injury were recorded on a data sheet. The data were transferred to an SPSS [ver. 16.0; SPSS Inc., Chicago, IL, USA] spreadsheet for statistical analysis. The chi-square test was used to test the association between two categorical variables or factors [age group, cause] with p value set at p < 0.05, and t-test value at < 0.05 and independent. Motor vehicle accidents were the most common cause of maxillofacial fractures in most age groups, especially in males. Within the study sample, mandibular fractures were significantly more common than middle-third facial fractures [56.4% vs. 43.6%; p= 0.006]. Among mandibular fractures, parasymphyseal fractures were most common [47%], followed by condylar fractures [35.3%]. Most [77.2%] middle-third facial fractures involved the zygomatic complex, and the incidence of such fractures differed significantly between male and female patients. p=0.72, not significant. Males were more prone to maxillofacial fractures, perhaps as a result of the conservative nature of Saudi society, as the rules of Saudi Arabia do not allow the females to drive. Motor vehicle accidents were the most common cause of maxillofacial fractures in patients aged

Hepatitis C genotype and associated risks factors of patients at university Kebangsaan Malaysia medical centre

Objectives: Hepatitis C virus [HCV] genotyping is important for treatment and epidemiological purposes. The objective was to determine HCV genotype and their associations with certain risk factors at University Kebangsaan Malaysia Medical Centre [UKMMC]

Methods: A total of 89 samples were collected from December 2009 to January 2011. Demographic data of patients were collected from medical record. Reverse Transcriptase Polymerase chain reaction [RT PCR] was performed and sixty-four samples yielded positive for HCV. Sequencing was performed and analyzed based on sequence information in GenBank. Statistical analysis were done using SPSS version 15

Results: HCV genotype 3 [73%] was the most frequent genotype, followed by genotype 1[27%]. The distribution of HCV genotype/ subtype was as follows: 3a [64.8%], 1a [13.5%], 1 [10.8%], 3 [8.1%] and 1b [2.7%]

Conclusions: HCV subtypes 3a, 1a, and 1b were identified in patients at UKMMC, Malaysia with subtype 3a being the most prevalent. No significant association was found between HCV genotypes and patients' demographic data

Level of empathy among medical students in Kuwait university, Kuwait

To evaluate the level of empathy among medical students in Kuwait University Medical School and its association with sociodemographic factors, stress levels and personality. A cross-sectional survey of 264 medical students was conducted in the Faculty of Medicine, Kuwait University. Empathy levels were measured using the Jefferson Scale, personality was assessed using the Zuckerman-Kuhlman Personality Scale and the Perceived Stress Scale was used to measure stress levels. Factors associated with empathy were evaluated using t test/ANOVA for categorical variables and correlation for continuous predictors. Mean empathy score was 104.6 +/- 16.3. Empathy scores were significantly associated with gender, year of study, mother's level of education, household income, satisfactory relationship with the mother and stress levels. Male medical students in their clinical years also had significantly lower empathy levels. However, factors such as grade point average, desired specialty, marital status of parents, father's educational level and relationship with father were not significantly [p > 0.05] associated with levels of empathy. Stress scores were significantly and positively associated with empathy [r = 0.13; p = 0.041]. Medical students in Kuwait University had low empathy level and this may be a cause for concern; as such we suggest a possible inclusion of emphasis on empathy in the curriculum

role of cytokines among women with spontaneous miscarriage

To evaluate cytokine production in women with unexplained pregnancy loss. The study enrolled 84 women age 15-41 years with a mean age of 25.07 +/- 6.6, during the period from September 2011 till March 2012 from Basrah Hospitals, Iraq. The patients group comprised 46 women with first trimester miscarriage. The control group included 38 women with first trimester successful pregnancy with no history of miscarriage. Cytokines were measured by ELISA. There were significantly higher levels of IFN-gamma, TNF-alpha, IL-2 and IL-10 in the aborted women as compared to the controls. In relation to IL-4 and IL-6 non-significant difference was detected between women with miscarriage and control groups. Significant effect of age on serum IL-2 and IL-10 in women with first trimester miscarriage was recorded while no effect observed in the levels of IFN-gamma, TNF-alpha, IL-4 and IL-6. Furthermore, significant higher level of all Th-1 cytokines for miscarriage group than control group for women aged 25-34 years was noticed. In contrast, non-significant differences were found between estimated level for miscarriage and control groups of all Th-1 cytokines for age group >34 years. This study supports the hypothesis of role of Th-1 produced cytokines in the pathogenesis of miscarriage

Lymphadenopathic Kaposi's sarcoma in an immunocompetent adult

Kaposi's sarcomas [KS] are vascular lesions which usually originate from multiple sites in the mid-dermis extending to the dermis. The aetiology is unknown, but infection from human herpes virus type 8 has been suggested. Several reports of KS had come from Africa initially and from worldwide later due to the close association with HIV/AIDS. Prior to this however, KS was very frequent in Eastern Europe, Italy and the United States where it existed in an indolent form in the elderly men of Jewish ancestry. KS may also be due to iatrogenic immune suppression from chronic use of steroids, elevated degree of expression of numerous cytokines and angiogenic growth factors including TNF alpha, IL-6, bFGF, HIVtat protein and oncostatin M. Lymphadenopathic KS involves the lymph-nodes, viscera and the gastrointestinal tract and may run a disseminated and aggressive course. We are reporting one such case in an immunocompetent male

Koro-Like Symptoms With Associated Erectile Dysfunction In A Rohingya Refugee

This case report highlights Koro-like symptoms with erectile dysfunction. Methods: We report a case of a Rohingya refugee who presented with Koro-like symptoms associated with erectile dysfunction and severe religious guilt. Results: Sexual dysfunction, i.e. erectile dysfunction may be a predisposing factor for a Koro incidence. Religious issues complicated by superstitious beliefs pose a treatment challenge. Conclusion: Treating patient with sexual dysfunction should involve exploring and addressing patient’s conflicts to avoid worsening of symptoms. As this case illustrates, severe anxiety can present with Koro-like symptoms.

Association between apolipoprotein E-polymorphism and ischemic heart disease patients with or without type 2 diabetes mellitus: a preliminary study in Kuwait

We investigated the association between apolipoprotein E polymorphism and ischemic heart disease with or without type 2 diabetes in Kuwait and examined the impact of apolipoprotein E polymorphism in diabetic patients. The present study was conducted from January 2005 to June 2006 in the Diabetic Clinic of AI-Amiri and Al-Sabah Hospitals in Kuwait City. Apolipoprotein E polymorphism was assessed in 250 subjects of which 83 were ischemic heart disease patients [41 diabetic and 42 non-diabetic] and 105 were diabetic patients without ischemic heart disease. Results were compared with 62 healthy controls. Apolipoprotein E polymorphisms were detected by polymerase chain reaction-restriction fragment length polymorphism. Apolipoprotein E3 allele was the most commonly occurring form. The frequency of apolipoprotein E4 was higher in ischemic heart disease patients with type 2 diabetes [39%] and the non-diabetic [31%] group, but lower in the diabetic [20%] and control groups [16%]. Apolipoprotein E4 allele may be related to the development of ischemic heart disease in patients with or without type 2 diabetes in Kuwait. However, future studies with larger population sizes are needed to establish such relationship

Allergic reaction to abciximab with atypical manifestations

Abciximab [ReoPro, Eli Lilly and Company, Indianapolis, Indiana] is an intravenous agent that had been approved for treatment of acute coronary syndrome undergoing coronary interventions. It is a chimeric monoclonal antibody fragment that binds to the glycoprotein IIb/IIIa receptor with a potential for the development of an immune response to variable portions within the antigen binding site following its administration. We describe a 58-year-old man who developed sudden headache, short of breath, choking and restlessness after receiving Abciximab for coronary intervention. Discontinuation of abciximab and administration of intravenous fluids, steroid and antihistamines led to improvement of his symptoms gradually

Parasitic fauna of spiny eel mastacembelus mastacembelus from greater zab river in Iraq

A total of 128 spiny eels Mastacembelus mastacembelus [Mastacembelidae] were collected from the Greater Zab river at Iski Kalak town, west of Erbil city, Kurdistan region, Iraq, from July 2007 to the end of June 2008. The fish were examined for ecto and endo parasites. The study revealed the existence of 16 species of parasites [with a total prevalence of 89.06%] including: two species of protozoans [Trypanosoma sp. and Trichodina pediculus], one species of monogenetic trematodes [Mastacembelocleidus heteranchorus], six species of digenetic trematodes [Allocreadium transversale, Asymphylodora macracetabulum, Pseudochetosoma salmonicola, Clinostomum complanatum, Diplostomum flexicaudum and D. spathaceum], two species of cestodes [Polyonchobothrium magnum and Ligula intestinalis], two species arachnoide [Cystobranchus mammillatus, Argulus foliaceus and Arrenurus sp. respectively]. Five species of these parasites [T. pediculus, A. transversale, D. flexicaudum, C. mammillatus and Arrenurus sp.] were recorded for the first time in Iraq. In addition, M. mastacembelus was regarded as a new host for A. macracetabulum, C. complanatum and A. foliaceus

Influence of primary hypothyroidism on serum leptin level

Leptin is the protein product of the ob gene, secreted by adipocytes. It has been suggested that it may plays an important role in regulating appetite and energy expenditure, but beside that, little is known about the physiological actions of leptin in humans. To evaluate a possible influence of primary hypothyroidism on serum leptin levels. Fifty-six newly diagnosed patients with primary hypothyroidism [40 females and 16 males] and 32 normal controls matched for age, ethnic status and body mass index [BMI] were studied. Body mass index [BMI; kg/m2], thyroid function [using enzyme-linked immunoflourescent assay] and serum levels of leptin, thyroid autoantibodies [measured by enzyme-linked immunosorbant assay] and lipid profile [measured by enzymatic colourimeteric assays] were assessed in all studied subjects. No significant difference in serum leptin levels was recorded between hypothyroid patients and controls [16.3 +/- 14.9; 14.8 +/- 12.9, P> 0.05], but women in each group had significant higher leptin concentrations than men [patients: 19.6 +/- 16.3 vs. 8.3 +/- 5.0; controls: 19.0 +/- 14.4 vs. 7.7 +/- 4.1; P<0.05]. Serum levels of cholesterol [p<0.002], LDL-cholesterol [p<0.004] and atherogenic ratio [p<0.03] were generally higher in patients than controls. The serum leptin concentration correlated positively with BMI within both patients [r=0.32; p<0.016] and controls [r=0.28; p<0.024]. However, no association was demonstrated between values of serum T3, T4, TSH, triglyceride, HDL-cholesterol and thyroid auto antibodies. Circulating thyroid hormones do not appear to play any significant effect on leptin levels in patients with primary hypothyroidism

Effect of different intrathecal morphine doses in low dilute dose bupivacaine for postoperative analgesia in anal surgery

Postoperative pain for anal surgery is a concern. Intrathecal morphine is effective and simple method for postoperative analgesia. The aim of this study is to compare the efficacy of 50 ug intrathecal morphine in low dilute bupivacaine 0.125% to 100 ug morphine in low dilute bupivacaine 0.125% and to compare the advantage and disadvantage in each group. Sixty patients of ASA grade I and II scheduled for anal surgery were randomly allocated to receive saddle block in setting position either lml of 0.25% hyperbaric bupivacaine with 1ml saline 0.9% [total volume 2ml to give concentration of 0.125%] [Group I n=20] or 1ml of hyperbaric bupivacaine 0.25% with 1ml of morphine 50 micro g [group II n=20] or 1ml hyperbaric bupivacaine 0.25% with 1ml of morphine 100 ug [group III n=20]. The duration of analgesia in the groups I, H, III were 2.8 +/- 0.55 hr, 6.4 +/- 0.8 hr and 11.2 +/- 1.2 hr respectively which was highly significant. Postoperative nausea and vomiting occurred at overall highly significant incidence during the first 24 hours, in group II, III, while there was no nausea and vomiting in group I. Urinary retention was also significant between group I, II and III with mean 3.95, 6.82 and 9.12 hours, in group II eight patients need catheter while in group Ill fourteen patients need catheter. As regard pruntus no patients in group I, while in group II one patients complaining of sever pruritus, in group Ill five patients complaining of sever pruritus and need treatment. A transient respirator depression with respiratory rate<8 pen minute and SPO2<90% occurred in one patients only in group III. No homodynamic changes

Effect of N-butyl-2-cyanoacrylate [histoacryl blue] on bone healing [a histologic study on guinea pigs]

The aim of this study was to evaluate the effect of n butyl-2-cyanoacryl ate on bone healing. Thirty adult male guinea pigs with an average weight of 400-500 grams were used in this study Animals were divided into two groups [A and B] Group [A] included 21 animals, and Group [B] was a control group which included 9 animals. Each animal of both groups was subjected to a unilateral [left side] mandibular body surgically created [1] mm width bony defect, the inferior border of the mandible was left intact, the surgically created defects of Group [A] were filled with Bulyl-2-cyanoacrylate. While, the surgically created defects of Group [B] were left to heal spontaneously without any materials added. Clinical results and observations showed no infection or foreign body reaction in any of the animals either the control or the study group Histological results by the end of the second week the histoacryl group showed less granulation tissue and mild inflammation compared to the control sites At the end of the third week, the control showed more pronounced granulation tissue regression and decreased inflammation compared to the study sites, and by the end of the fourth week, both the control and study sites exhibited similar histology with absence of inflammation and granulation tissue. The application of cyanoacrylate tissue adhesive to bone defects shows absence of foreign body reactions, infection, and no disturbance of bone heating, with an anti-inflammatory effect, yet it should be used with caution to decrease the amount of the glue introduced inside the gap as a residue of the glue was seen histologically in the first two weeks after the application

Anti-inflammatory activity of silymarin in patients with knee osteoarthritis. A comparative study with piromcam and meloxicam

To evaluate the anti-inflammatory effect of Silymarin in patients with knee osteoarthritis OA in comparison with piroxicam and meloxicam. A double-blind clinical trial was performed at the Department of Rheumatology, Baghdad Teaching Hospital, Baghdad, Iraq during the period from October 2004 to September 2005, in which 220 patients 79 males and 141 females with painful knee osteoarthritis were randomized into 5 groups, treated with either silymarin 300mg/day, piroxicam 20mg/day, meloxicam 15mg, or a combination of silymarin with piroxicam or meloxicam. Serum levels of interleukin-1 alpha, interleukin-8, and the complement proteins C3 and C4 were assessed at zero time, and after 8 weeks. Silymarin reduces significantly serum levels of IL-1 alpha and IL-8, C3 and C4 after 8 weeks compared to the pre-treatment levels. Piroxicam showed no significant reduction in IL-1 alpha levels, while IL-8 decreased significantly, compared to pre-treatment value. Meloxicam elevates serum levels of IL-1 alpha significantly, while IL-8 did not significantly change compared to the pre-treatment value. Piroxicam or meloxicam produced slight, non-significant increase in serum levels of complement proteins after the 8-week treatment period. Adjunct use of silymarin with piroxicam results in significant reduction in both cytokines IL-1 alpha and IL-8, and serum levels of C3 and C4. However, its adjunct use with, meloxicam did not reveal any significant changes in this respect. Silymarin reduces the elevated levels of interleukins and complement proteins, when used alone, or in combination with NSAIDs for the treatment of knee OA