Role of mdct in diagnosis of lower limb peripheral arteries diseases

Background: Lower limb peripheral arterial disease [PAD] is a common disease that affects about two hundred million peoples per year. It is the third leading cause of cardiovascular morbidity. We plan to evaluate the diagnostic performance of 64-section computed tomographic [CT] angiography in the assessment of steno-occlusive disease in patients with PAD, with conventional digital subtraction angiography [DSA] as the reference standard

Aim of study: is to compare the diagnostic accuracy of multidetector computed tomographic [MDCT] angiography in diagnosis of PAD compared to the DSA as pre-operative evaluation of lower limb peripheral arterial diseases

Patients and methods: The study included 20 patients clinically presented with symptomatic PAD from February 2018 to July 2018. The study protocol was approved, and written informed consent was obtained from all patients. The patients underwent CT angiography and subsequent DSA. For stenosis analysis [>/=70% stenosis], the arterial bed was divided into 35 segments and evaluated by three readers. Inter observer agreement was determined with generalized Kappa statistics. Accuracy, sensitivity, specificity, was calculated. Mc Nemar test was used to prove significant differences between CT angiographic and DSA findings

Results: A total of 700 arterial segments were evaluated, with excellent agreement between readers [Kappa >/= . 0.928]. On a segmental basis, both sensitivity and specificity for stenosis of 70% or more were at least 96% [386 of 400 segments and 290 of 300 segments, respectively], with an accuracy of 98% [686 of 7oo segments].There was no significant difference between CT angiographic and DSA findings [P = .62-.87]

Conclusion: The diagnostic performance of 64-section CT angiography is excellent in patients with clinical symptoms of PAD

effects of team-based learning on learning outcomes in a course of rheumatology

Introduction: we evaluated the effects of implementing Team-Based Learning [TBL] on student engagement, accountability, satisfaction, and preference for lecture or team-based learning. Moreover, we assessed the effect of TBL on knowledge retention and application over time through short answer questions based on clinical scenarios addressing history taking and diagnosis skills in medical students

Methods: the study was conducted in a quasi-experimental design. The study population were all of the third-year medical students [n=84] participating in a course of rheumatology in Shariati Hospital, which is a teaching hospital affiliated to Tehran University of Medical Sciences. We compared TBL with the conventional lecture-based method. The assessments were performed after implementation of TBL by the Classroom Engagement Survey [CES] and Team-Based Learning Student Assessment Instrument [TBL-SAI]. The assessment for application of knowledge was conducted in 3 time-points through short answer questions on rheumatic diseases. The comparison of results was made by Student's t-test and repeated-measures analysis of variance [RMANOVA] using SPSS software, version 16

Results: the CES scores indicated a high level of engagement in TBL [Mean +/- SD=26.7 +/- 3.70, p=0.0001] but not in the lecture-based sessions [Mean +/- SD=23.80 +/- 4.35, p=0.09]. The total mean score [SD] for TBL-SAI was 159.68 [14.14] for TBL sessions indicating a favorable outcome [p=0.0001]. The student scores obtained from the short answer questions showed that over time the students' scores had declined significantly less for the TBL sessions in comparison to the lecture-based sessions, F [2, 166]=4.624, p=0.011

Conclusion: the results indicated higher student engagement, satisfaction and long term learning by TBL

Comparison of serum lipid profile in Type-2 Diabetics with and without retinopathy in Pakistani population

Objective: To compare serum cholesterol, TG, HDL-C and LDL-C concentrations between type-2 Diabetes mellitus [DM] patients with retinopathy and without retinopathy and to study association between various modifiable risk factors of Diabetic retinopathy [DR]

Methods: The study included 300 patients with type 2 DM; 140 of them were without DR [Group-I] and 160 were with DR [Group-II]. Serum total cholesterol, LDL-C, HDL-C, and TG levels were determined. SPSS 17.0 for windows was used for statistical analysis

Results: Overall, mean age of study population was 48.86 +/- 5.62 years. Subjects with DR were older [P < 0.018], had higher fasting plasma glucose [P < 0.01] and higher HbA1c [P <0.01] concentrations compared with those without DR. Analysis of serum cholesterol, LDL-C, HDL-C and TG among subgroups of patients with no DR, with NPDR and PDR showed statistically significant difference [p <0.01]. There was strong positive correlation of severity of DR with BSF, HbA1c, serum LDL-C, total cholesterol and TG

Conclusion: The serum cholesterol, TG, HDL-C and LDL-C concentrations were found to be significantly deranged in patients with DR as compared to those without DR

Evaluation of immune response of bacterial toxin utilized as immune-potential adjuvant

The present work aimed to evaluate the adjuvanticity of r-CTB compared with currently used alum; laboratory animals were subcutaneously immunized using r-CTB and alum adjuvenated diphtheria vaccine candidates. Maximum antibody level was detected on the 5[th]-6[th] week post immunization with r-CTB used as 1,5,and 20 micro gm, and the Ab level post r-CTB was significantly elevated than alum adjuvanted vaccine [P<0.05]. Antibody and IFN-gamma level were r-CTB dose dependent, while IL-10 level was not. IFN-gamma level was significantly higher and long durative in case of immunization with r-CTB adjuvanted diphtheria vaccine than that detected post immunization with alum adjuvanted diphtheria one and post challenge as well. While, IL-10 level in case of adjuvation with r-CTB and Alum was almost the same concentration and need the same duration to reach the base line 0 level post immunization

Identification of new genetic risk factors for prostate cancer / 亚洲男科学杂志(英文版)

There is evidence that a substantial part of genetic predisposition to prostate cancer (PCa) may be due to lower penetrance genes which are found by genome-wide association studies. We have recently conducted such a study and seven new regions of the genome linked to PCa risk have been identified. Three of these loci contain candidate susceptibility genes: MSMB, LMTK2 and KLK2/3. The MSMB and KLK2/3 genes may be useful for PCa screening, and the LMTK2 gene might provide a potential therapeutic target. Together with results from other groups, there are now 23 germline genetic variants which have been reported. These results have the potential to be developed into a genetic test. However, we consider that marketing of tests to the public is premature, as PCa risk can not be evaluated fully at this stage and the appropriate screening protocols need to be developed. Follow-up validation studies, as well as studies to explore the psychological implications of genetic profile testing, will be vital prior to roll out into healthcare.

Non-traumatic surgical abdominal emergency in the elderly

The most frequent surgical problem in the elderly patients is the abdominal surgical emergency, which is potentially serious, considerable challenge and a life threatening condition in this populations. The higher incidence of serious pathology in this age group, increasing demand for surgical emergency care to save life and increase its expectancy. The aim of this study was to evaluate the causes and the outcome of non-traumatic surgical abdominal emergencies in elderly patients. A total of 150 patients aged 60 years and above, with a mean age of 68.3 [range 60-84] years who had undergone emergency surgical interventions studied, as regards, the demographic features the indications for emergency surgery the post-operative clinical course and the outcome of surgery. Sixty percent [90/l 50] of patients were males. Causes of surgical emergency were acute cholecystitis 39/150 [26%], strangulated hernia 30/l50 [20%], hollow viscus perforation 27/150 [18%], bowel obstruction 18/150 [12%], acute mesenteric ischaemia l4/150 [9.3%], acute appendicitis 12/150 [8%] and upper gastrointestinal bleeding 10/l50 [6.6%]. Gallstones had been previously detected by ultrasound in 16 [4 1%] of 39 patients with acute calculous cholecystitis. Twenty eight [93.3%] of 30 patients were aware of their external hernias prior to incarceration. Twenty one patients 21/150 [14%] died in the early postoperative period. A higher mortality rate was noted in acute mesenteric ischaemia 11/14 [78.5%], gastrointestinal bleeding 3/10 [30%] and in perforation 4/27 [14.8%] cases, being 35.3% [18/51] in patients with these three severe conditions, and 3.03% [3/99] in the remaining patients. So, we conclude that the acute calcular cholecystitis and external strangulated hernias, which are generally preventable, were the most common surgical emergencies. Surgical treatment of acute mesenteric ischaemia, gastrointestinal bleeding and peritonitis secondary to free perforation had a worse prognosis in older patients

Effect of the hypothyroidism on the skeletal muscle [Soleus] of the adult male albino rat

The thyroid gland is one of the most important endocrine organs that almost all cells of the body are target sites for its hormones, the thyroid state influences markedly both cardiac and skeletal muscles as has been previously reported by many authors. Concerning the skeletal muscles, the hypothyroidism causes atrophy of the muscle fiber and abnormal accumulation of the glycogen. These findings allow a new field for researchers to study the histological picture of the skeletal muscle and the correlation between muscle/body weight ratios in the hypothyroidism. The present study is planned to throw more light on the structure of the skeletal muscle [soleus] and body weight evaluation in the experimentally induced hypothyroid of adult male albino rats. Twenty healthy adult male albino rats, average weight [170 gms each] were used in this study, the body weight evaluated monthly and the skeletal muscle structure was examined histological by light and electron-microscopes after three months of experimentally hypothyroidism. The body weight of the animals were reduced with statistical significant and the skeletal muscle structure affected by experimentally hypothyroidism, where disorganization of the muscle fibers with clear atrophic changes, reduction of the mitochondria and areas of degeneration with abnormal accumulation of glycogen in the skeletal muscle fibers

Management of laparoscopic cholecystectomy complications

This article aimed at throwing a light on management of bile duct injuries inflicted during laparoscopic cholecystectomy. The present research included 60 patients, presented with biliary complications after laparoscopic cholecystectomy. They were selected from Al-Azhar university hospitals and Domiate general Hospitals, in the period from March 2003 to March 2006. The results of this work proved that complications of laparoscopic cholecystectomy were well tolerated and the majority of them successfully managed conservatively and those needed surgical interference showed very good results. Although it has some complications, laparoscopic cholecystectomy is advocated to be the procedure of choice in the management of gall bladder diseases [stones] as its complications are tolerated and managed with conservative or surgical treatment with a success rate over 90%

Determination of factors precipitating encephalopathy in patients with liver cirrhosis

Hepatic encephalopathy is one of the potentially fatal complications seen in patients with advanced hepatic cirrhosis heralding a poor prognosis. Various clinical conditions have been implicated to precipitate encephalopathy with decompensated cirrhosis. To determine the frequency of various factors precipitating hepatic encephalopathy in our setup. It is a single centre, descriptive study. In Combined Military Okara from January to December 2005. Forty three patients admitted in the calendar year 2005 with the diagnosis of chronic liver disease / cirrhosis that were found to be in different grades of encephalopathy were included in the study. A careful clinical and laboratory assessment of all the cases was made and the search for the presence of various already identified precipitating factors was carried out. Fifty six percent of the patients included in the study were males and 41.9% were females. Mean age of patients was 56.46 years. Evidence of HCV infection was found in 83% and that of HBV in 17%. Upper gastrointestinal bleed was present in 37.2%, constipation in 20.9% and hypokalemia in 14% of the total patients. No cause was identifiable in 9.3% of the patients. Upper gastrointestinal bleed is the most common factor followed by constipation and electrolyte imbalance

new antidiabetic drug restoring normal insulin secretion from beta-cells and normal histology

A benzimidazole derivative was prepared and evaluated as antidiabetic drug. It was found to be nontoxic to albino mice up to dose of 3200 mg/kg body weight. It had no hypoglycemic activity but it was found to cause beta-cell regeneration in alloxanoised rats. Measuring blood glucose levels and insulin levels in treated alloxanoised rats were found to reach normal levels after treatment. In addition histological examination of the pancreas from treated alloxanoised rats showed normal islets of langerhans with normal morphology of beta-cells

Low molecular weight heparin for the management of venous thromboembolism in pregnancy

This study is aiming to evaluate the effect and dose of Anoxaparin given to pregnant women with acute venous thromboembolism. This Observational 'prospective' study was carried out at Bab-El Shaareyia university hospital-Cairo-Egypt and Maternity Hospital, Sabbah- Kuwait on 20 pregnant women aged 22-41 years, with acute venous thromboembolism verified by objective means. Patients were treated with Enoxaparin from diagnosis until delivery. Treatment was monitored with anti-activated factor xa [anti-xa] activity, and the dose was adjusted to achieve 0.5-l.0U/ml 2-3 hours post-injection. Non of the patients suffered recurrent venous thromboembolisn or major bleeding complications. In 9 of 13 women starting with conventional dose of Enoxaparin, dose escalation was necessary to reach target anti- xa activity. None of the 6 women who started with Enoxaparin required dose escalation. One women who started with 133iu/kg bd required dose reduction. Bioaccumulaton was not observed. This study suggests that Enoxaparin may be used for the treatment acute venous thromboembolism in pregnancy approximately 10-20% higher doses of Enoxaparin may he needed as compared with non-pregnant individuals

Evaluation of cardiovascular changes in adolescents with mild essential hypertension by echocardiography and duplex ultrasonography

The aim of this research was to assess the cardiac as well as the vascular changes in adolescents with mild essential hypertension by echocardiography and duplex ultrasonographic technique of both carotid arteries. Forty-seven male patients with mild essential hypertension were chosen for the study. Sixteen male normotensive subjects in the same age group were taken as controls. The echocardiographic data showed that isovolumic relaxation time, posterior wall thickness at diastole, muscle mass and muscle mass index were significantly increased in hypertensive group; while, Ef%, Fs%, MVCF, stroke volume, stroke volume index, cardiac output, cardiac output index, E- F-slope, interventricular septal thickness at diastole, aortic root and left atrium dimensions insignificantly changed. Duplex data of both carotid arteries showed that intimal-medical thickness significantly increased, while pulsatility index insignificantly increased in hypertensive group

Endoscopic Trans-thoracic sympathectomy in the treatment of primary palmar hyperhidrosis: results and complications

This study aimed to evaluate the results of primary palmer hyperhidrosis by using endoscope transthoracic sympathectomy with particular reference to the complication, the immediate and long term effectiveness of treatment and patient satisfaction with the endoscope results. Twenty patients with bilateral primary hyperhidrosis were treated by endoscopic transthoracic sympathectomy on both sides. When the stellate ganglion is uniquely identified by a pad of fat covering it above the head of the first rib, a diathermy hook used to confirm identification by palpating the sympathetic chain and rolling the nerves over the ribs. The 2nd, 3rd and 4th ganglia were cut and preserved for histopathological examination. All patients were relieved of their symptoms except the left side of a female patient [aged 26 years and treated by open surgical method]. Compensatory hyperhidrosis was the only significant side effect and reported in sixty five%. There was no mortality or major complications. Endoscopic transthoracic sympathectomy is safe-easy, reliable and effective way in the treatment of patients with primary palmer hyperhidrosis