Multiple Osteomas of Mandible in a Patient with Gardner’s Syndrome - Report of a Case

Introduction: Osteomas are benign tumors of the bone usually seen in craniofacial bones which arise from either the cortex or medulla. They are usually asymptomatic with slow painless growth. Multiple osteomas are often associated with Gardners syndrome. Solitary osteomas are typically non syndromic. Case Presentation: The patient presented with remarkable facial asymmetry following the growth in the mandible. Multiple os- teomas were noted which invoked suspicion of a syndrome. On endoscopic evaluation the patient was found to have multiple intestinal polyps, pathgnomonic for Gardners syndrome. Management and prognosis: The lesion was surgically removed under local anaesthesia. as an excisional biopsy and the asymmetry was rectified. Histopathologic examination revealed it to be ivory osteoma with dense compact bone and less mar- row spaces. The jaw lesions would precede the development of colonic polyps and therefore may contribute to early diagnosis of Gardner’s syndrome. There is also a chance of malignant evolution associated with the polyps Conclusion: People with the condition have a higher risk of developing other family adenomatous polyp (FAP)related cancers including pancreatic cancer and liver cancer. The patient should be in close follow up

The pattern of adverse effects related to antimicrobial therapy in a tertiary care hospital

Background: Antimicrobial drugs are life-saving drugs but they come with their own share of adverse drug reactions (ADRs). Institutional drug policy helps in the rational use of the antimicrobial for the given clinical condition. This helps in controlling the development of resistance as well as minimizing adverse events. Aims and Objectives: This study aims to share the pattern of adverse reactions seen to the commonly prescribed antimicrobials. Materials and Methods: This is a retrospective, observational study. The data of patients, admitted to a tertiary care center in North Kerala who reported adverse effects related to antimicrobial treatment, were obtained from the case files from the medical record library. ADRs with antimicrobials reported during the period from November 2018 to November 2019 were obtained and the data were expressed as percentages in Microsoft excel. Causality assessment was done using the world health organization casualty scale. Results: 92 case reports were analyzed. Among the different antimicrobials used, Ciprofloxacin was the most commonly prescribed antimicrobial (18.5%) followed by ceftriaxone (12%). 13 different patterns of ADRs were obtained following the use of these drugs, among which allergic reactions to drugs were the most common (71.7%) with a causality assessment showing it to be the probable cause. Conclusion: The monitoring of ADRs to antimicrobials is the need of the hour. This study helped in determining the different patterns of ADRs with antimicrobials. Active surveillance and complete reporting help in identifying these and reporting and managing them to prevent such occurrences in the future.

Additive antiproteinuric effect of pentoxifylline in patients with diabetic nephropathy under angiotensin receptor blockade: A short-term, randomized, and controlled trial

Background: The ever-increasing prevalence of diabetes has led to a higher incidence of progression into complications including nephropathy. Diabetic kidney disease (DKD) is a chronic condition that is managed with renin-angiotensin-aldosterone system blockers which retard its progression. Pentoxifylline as an add-on therapy has been tried for reducing DKD. Aims and Objectives: The aims of this study were to study the safety and efficacy of pentoxifylline added on to an angiotensin II receptor blocker (ARB) to reduce the progression of the disease condition in diabetic nephropathy (DN) patients over 1 year. Materials and Methods: It is a randomized open-label study conducted in the Department of Nephrology, of a tertiary care center for 1 year. Type 2 diabetes patients with DN who satisfied the eligibility criteria were randomized into pentoxifylline added on to ARB or ARB alone and followed up for urine albumin-creatinine ratio (ACR) and serum tumor necrosis factor (TNF)-alpha. Results: Twenty-six patients were recruited and completed the study. Urine ACR was significantly low in the pentoxifylline group compared to the ARB alone group (P = 0.021). Serum TNF-? was decreased in the pentoxifylline group in comparison to the ARB alone group (P = 0.06). Conclusion: Pentoxifylline caused significant lowering of urinary ACR and urine TNF-? for 4 months.

The application of sigma metrics in the laboratory to assess quality control processes in South Africa

Objective: This study aimed to determine the sigma metrics of analytes when using different total allowable error guidelines.Methods: A retrospective analysis was performed on 19 general chemistry analytes at Charlotte Maxeke Johannesburg Academic Hospital in South Africa between January 2017 and December 2017. Sigma metrics were calculated on two identical analysers, using internal quality control data and total allowable error guidelines from the Ricos biological variation database and three alternative sources (the Royal College of Pathologists of Australasia, the Clinical Laboratory Improvements Amendment, and the European Federation of Clinical Chemistry and Laboratory Medicine). Results: The sigma performance was similar on both analysers but varied based on the guideline used, with the Clinical Laboratory Improvements Amendment guidelines resulting in the best sigma metrics (53% of analytes on one analyser and 46% on the other had acceptable sigma metrics) and the Royal College of Pathologists of Australia guidelines being the most stringent (21% and 23%). Sodium and chloride performed poorly across all guidelines (sigma < 3). There were also month-to-month variations that may result in acceptable sigma despite poor performance during certain months.Conclusion: The sigma varies greatly depending on the total allowable error, but could be a valuable tool to save time and decrease costs in high-volume laboratories. Sigma metrics calculations need to be standardised

Glucose Uptake and Insulin Response in Tissue-engineered Human Skeletal Muscle

BACKGROUND@#Tissue-engineered muscles (‘‘myobundles’’) offer a promising platform for developing a human in vitro model of healthy and diseased muscle for drug development and testing. Compared to traditional monolayer cultures, myobundles better model the three-dimensional structure of native skeletal muscle and are amenable to diverse functional measures to monitor the muscle health and drug response. Characterizing the metabolic function of human myobundles is of particular interest to enable their utilization in mechanistic studies of human metabolic diseases, identification of related drug targets, and systematic studies of drug safety and efficacy. @*METHODS@#To this end, we studied glucose uptake and insulin responsiveness in human tissue-engineered skeletal muscle myobundles in the basal state and in response to drug treatments. @*RESULTS@#In the human skeletal muscle myobundle system, insulin stimulates a 50% increase in 2-deoxyglucose (2-DG) uptake with a compiled EC50 of 0.27 ± 0.03 nM. Treatment of myobundles with 400㎛ㄹ metformin increased basal 2-DG uptake 1.7-fold and caused a significant drop in twitch and tetanus contractile force along with decreased fatigue resistance.Treatment with the histone deacetylase inhibitor 4-phenylbutyrate (4-PBA) increased the magnitude of insulin response from a 1.2-fold increase in glucose uptake in the untreated state to a 1.4-fold increase after 4-PBA treatment. 4-PBA treated myobundles also exhibited increased fatigue resistance and increased twitch half-relaxation time. @*CONCLUSION@#Although tissue-engineered human myobundles exhibit a modest increase in glucose uptake in response to insulin, they recapitulate key features of in vivo insulin sensitivity and exhibit relevant drug-mediated perturbations in contractile function and glucose metabolism.

Glucose Uptake and Insulin Response in Tissue-engineered Human Skeletal Muscle

BACKGROUND@#Tissue-engineered muscles (‘‘myobundles’’) offer a promising platform for developing a human in vitro model of healthy and diseased muscle for drug development and testing. Compared to traditional monolayer cultures, myobundles better model the three-dimensional structure of native skeletal muscle and are amenable to diverse functional measures to monitor the muscle health and drug response. Characterizing the metabolic function of human myobundles is of particular interest to enable their utilization in mechanistic studies of human metabolic diseases, identification of related drug targets, and systematic studies of drug safety and efficacy. @*METHODS@#To this end, we studied glucose uptake and insulin responsiveness in human tissue-engineered skeletal muscle myobundles in the basal state and in response to drug treatments. @*RESULTS@#In the human skeletal muscle myobundle system, insulin stimulates a 50% increase in 2-deoxyglucose (2-DG) uptake with a compiled EC50 of 0.27 ± 0.03 nM. Treatment of myobundles with 400㎛ㄹ metformin increased basal 2-DG uptake 1.7-fold and caused a significant drop in twitch and tetanus contractile force along with decreased fatigue resistance.Treatment with the histone deacetylase inhibitor 4-phenylbutyrate (4-PBA) increased the magnitude of insulin response from a 1.2-fold increase in glucose uptake in the untreated state to a 1.4-fold increase after 4-PBA treatment. 4-PBA treated myobundles also exhibited increased fatigue resistance and increased twitch half-relaxation time. @*CONCLUSION@#Although tissue-engineered human myobundles exhibit a modest increase in glucose uptake in response to insulin, they recapitulate key features of in vivo insulin sensitivity and exhibit relevant drug-mediated perturbations in contractile function and glucose metabolism.

Antiviral activity of a standardized root water extract of Eurycoma longifolia (Physta®) against dengue virus

@#The aim of this study was to investigate the antiviral property of Eurycoma longifolia Jack (EL) against dengue virus. A propriety standardized extract of Eurycoma longifolia Jack (Physta®) was tested for anti-viral activity after viral adsorption in Vero cell line. Viral yield was measured by qRT-PCR in four serotypes of dengue virus. The antiviral activity was further investigated in an in vivo AG129 mouse model for dengue inhibitory candidates. 100 mg/kg EL extract was fed twice daily and challenged with a lethal dose of (~1x105 PFU per mouse) of DENV-2 over a period of six days. Antiviral activity with IC50 of 33.84, 33.55, 58.35 and 119 μg/ml for DENV-1, DENV-2, DENV-3 and DENV-4 serotypes respectively was observed. The selectivity index (SI) values determined as the ratio of cytotoxic concentration (CC50) to inhibitory concentration (IC50) was the lowest for DENV-2 at 28.9. The dengue virus (DENV) replication measured by qRT-PCR showed a reduction of 100% for DENV-1, DENV-2, DENV-3 and 80% for DENV-4 at day 2 of exposure. In the in vivo AG129 mouse model, a lower weight reduction, 30% lower viral load and 12% higher platelet in the extract group compared to the control was observed at day 6. The extract of E. longifolia has potential anti-dengue properties with improving trends in platelet counts. E. longifolia supplementation is potentially a two-pronged approach in treating dengue fever.

Low serum testosterone is a predictor of high-grade disease in patients with prostate cancer / Baixa testosterona sérica é prognóstica de doença de alto grau em pacientes com câncer de próstata

Summary Objective: To evaluate the relation between serum total testosterone (TT) and prostate cancer (PCa) grade and the effect of race and demographic characteristics on such association. Method: We analyzed 695 patients undergoing radical prostatectomy (RP), of whom 423 had serum TT collected. Patients were classified as having hypogonadism or eugonadism based on two thresholds of testosterone: threshold 1 (300 ng/dL) and threshold 2 (250 ng/dL). We evaluated the relation between TT levels and a Gleason score (GS) ≥ 7 in RP specimens. Outcomes were evaluated using univariate and multivariate analyses, accounting for race and other demographic predictors. Results: Out of 423 patients, 37.8% had hypogonadism based on the threshold 1 and 23.9% based on the threshold 2. Patients with hypogonadism, in both thresholds, had a higher chance of GS ≥ 7 (OR 1.79, p=0.02 and OR 2.08, p=0.012, respectively). In the multivariate analysis, adjusted for age, TT, body mass index (BMI) and race, low TT (p=0.023) and age (p=0.002) were found to be independent risk factors for GS ≥ 7. Among Black individuals, low serum TT was a stronger predictor of high-grade disease compared to White men (p=0.02). Conclusion: Hypogonadism is independently associated to higher GS in localized PCa. The effect of this association is significantly more pronounced among Black men and could partly explain aggressive characteristics of PCa found in this race.

Resumo Objetivo: Avaliar a relação entre testosterona sérica total (TT) e grau do câncer de próstata (CP) e o efeito da raça e de características demográficas sobre essa associação. Método: Foram analisados 695 pacientes submetidos a prostatectomia radical (PR), dos quais 423 tinham medidas dos níveis séricos de TT. Os pacientes foram classificados como portadores de hipogonadismo ou eugonadismo com base em dois limites de testosterona: limite 1 (300 ng/dL) e limite 2 (250 ng/dL). Avaliou-se a relação entre nível de TT e escore Gleason (GS) ≥ 7 em amostras de PR. Os resultados foram avaliados por análises univariada e multivariada, com ajuste para raça e outros fatores prognósticos demográficos. Resultados: Do total de 423 pacientes, 37,8% apresentavam hipogonadismo com base no limite 1, e 23,9% com base no limite 2. Os pacientes com hipogonadismo, independentemente do limite de referência, tiveram uma chance maior de GS ≥ 7 (OR 1,79, p=0,02 e OR 2,08, p=0,012, respectivamente). Na análise multivariada, após ajuste para idade, TT, índice de massa corporal (IMC) e raça, baixo TT (p=0,023) e idade (p=0,002) foram considerados fatores de risco independentes para GS ≥ 7. Entre os indivíduos negros, baixo TT sérico foi mais preditivo de doença de alto grau em comparação com os brancos (p=0,02). Conclusão: O hipogonadismo é independentemente associado a escores mais altos de GS no CP localizado. O efeito dessa associação é significativamente mais pronunciado entre homens negros, o que poderia explicar, em parte, as características agressivas do CP observadas nessa população.

Occupational Carbon Monoxide Poisoning Associated with Diesel Motor Operation in an Air-raid Shelter in June 2015, Jinan City, China-An Epidemiological Investigation / 生物医学与环境科学（英文）

Occupational carbon monoxide (CO) poisoning related to diesel motor fumes in an air-raid shelter (ARS) was first identified in Jinan City, China, in June 2015. A total of 17 cases were identified, including 14 possible cases of firemen and 3 confirmed cases of water channel clean-up workers. The overall attack rate (AR) of firemen was 42% (14/33). The firemen had a significantly higher AR with a longer exposure and more protracted time of rescue in the ARS (P < 0.05). All the cases stated that they did not realize the potentially high level of exposure to CO in the ARS. CO poisoning posed a risk to both patients and service providers. Occupational safety and health education should be promoted and enforced in all workplaces where CO sources exist.

Gastric heterotopia in the rectum. a rare cause of ectopic gastric tissue

Gastric heterotopia refers to the discovery of normal gastric tissue at foreign, unexpected sites. It has been described anywhere in the alimentary tract, even in the mediastinum, scrotum, and spinal cord. It is not uncommonly seen in the oesophagus or small intestine. However, large bowel lesions are rare, with the most common location of colonic lesions is the rectum. Although it is a rare entity, it may be the source for significant problems such as rectal bleeding, abdominal pain, deep rectal pain, and malignancy. Here, we report an additional case of gastric heterotopia in the rectum of a 56 year old gentleman, and review the literature

Atención a la función docente educativa en la formación del médico general / Work with the Teaching-Learning Function in the Formation of the General Practitioner

Introducción: la función docente educativa integra el perfil profesional del médico general, e incluye la responsabilidad con la educación en salud y la participación en la formación de estudiantes. Objetivos: evaluar el tratamiento a la función docente educativa en el plan de estudio y la preparación para asumirla según la percepción de los egresados y elaborar acciones para su atención desde el pregrado. Método: se utilizaron métodos teóricos y empíricos, se revisó el plan de estudio y se aplicó cuestionario a 132 recién graduados en la Facultad de Ciencias Médicas Mariana Grajales Coello, en el período de marzo 2014 a enero 2015. Resultados: el plan de estudio tiene posibilidades desde su diseño para la atención a esta función. Solo 34 (25,75%) dominaban sus seis componentes, participar en actividades docentes con estudiantes (67,6%), desarrollar promoción y educación para la salud (65,8%) y la autoeducación (61,8%); 100% reconocen a la disciplina principal integradora y 66,6% al sexto año como las que más aportaron; 83,95% señalaron a la ayudantía y menos de 50% a la investigación y extensión universitaria; el 43,18% se autoevaluaron de regular y solo el 13,63% se consideraron excelentemente preparados. Se diseñaron acciones en los diferentes colectivos pedagógicos y en otras áreas implicadas. Conclusiones: existen insuficiencias en el tratamiento a la función docente educativa en el pregrado y los egresados reconocen carencias en su preparación para asumirla desde su vida laboral. Se hace una propuesta de acciones a partir de las posibilidades que brinda el currículo, y el trabajo metodológico a sus diferentes niveles.

Introduction: educational teaching function integrates the professional profile of the general practitioner, highlighting the responsibility for health education and participation in training students. Objectives: to evaluate the graduates’ perception on the treatment during their career and their preparation as professionals. Methods: theoretical and empiricist methods were used with a questionare to 132 recently graduated in Faculty of Medical Sciences Holguin. Results: the curriculum is likely from design to care for this function but only 34 (25.75%) dominated the six components, participate in educational activities with students (67.6%), develop promotion and education health (65.8%) and self-education (61.8%); 100% recognize the integrative core discipline and 66.6% in the sixth year as the largest contributors; the 83.95% drew assistantship and less than 50% to research and extension; 43.18% evaluated themselves regularly and only 13.63% were considered excellently prepared. Several actions were designed in the different pedagogical teams as well as in other implied areas. Conclusions: there are inadequacies in treatment educational role in teaching undergraduate and graduates recognize gaps in their preparation to assume from their working lives. A proposal for action from the possibilities offered by the curriculum and methodological work at different levels.

Prevalencia de la insuficiencia renal crónica en Camagüey / Prevalence of chronic kidney failure in Camagüey

Fundamento: el envejecimiento demográfico en el mundo, trae aparejado un incremento de las enfermedades crónicas no transmisibles. Dentro de ellas, la insuficiencia renal crónica es catalogada en el mundo como una epidemia, y considerada también una enfermedad catastrófica. Objetivo: determinar la prevalencia de la insuficiencia renal crónica en la provincia. Métodos: se realizó un estudio transversal descriptivo en 175 pacientes con diagnóstico de insuficiencia renal crónica en el servicio de Nefrología del Hospital Universitario Manuel Ascunce Domenech de Camagüey, desde de enero de 2012 hasta diciembre de 2014 mediante muestreo probabilístico Los datos relacionados con las variables de interés fueron extraídos de las historias clínicas. La clasificación de la insuficiencia renal crónica se realizó a partir de filtrado glomerular más reciente, según la fórmula de Cockcroft-Gault. Resultados: se encontró mayor número de pacientes con edad entre 61-70 años del sexo masculino, nefropatías vascular, diabética y obstructiva, insuficiencia renal crónica en estadios IV y V, para una prevalencia global de 25 por 100 mil habitantes en la provincia. Conclusiones: existió predominio de los adultos mayores y del sexo masculino, así como mayor prevalencia de las formas avanzadas de la insuficiencia renal crónica, donde las causas fueron por nefropatías vascular y diabética.

Background: the aging of the population worldwide brings about an increase in the chronic diseases that are not communicable. Among them, chronic kidney disease is classified as an epidemic. Objective: to determine the prevalence of chronic kidney disease in Camagüey province. Methods: through a probabilistic sample, a cross-sectional, descriptive study was conducted in 175 patients diagnosed with chronic kidney disease, at Nephrology service in Manuel Ascunce Domenech hospital in Camagüey, from January 2012 to December 2014. Data related to the variables of interest were taken from medical records. Classification of chronic kidney disease was carried out through latest glomerular filtration rate, according to Cockcroft-Gault. Results: a higher number of patients between 61 and 70 years of age was found. Most of them were males with vascular, diabetic, and obstructive nephropathies, chronic kidney disease in IV and V stages. The global prevalence is 25 per 100 000 inhabitants in the province. Conclusions: male elderly patients prevailed, as well as last stages of chronic kidney disease, where the causes came from diabetic and vascular nephropathies.

Patronage and perceived efficacy of herbal antityphoid preparations, and anti-salmonella activity of a herbal preparation used in Ghana.

Objectives: To assess the patronage, and the perceived efficacy of herbal preparations in the treatment of typhoid fever, and to ascertain the anti-salmonella activity of a herbal preparation used as an antityphoid in Ghana. Materials and Methods: Purposively and conveniently from 700, 65 individuals who had had typhoid fever (clinically confirmed) were sampled. Well-structured questionnaires on the subject were administered to sampled individuals. Experimentally, the Minimum Inhibitory Concentration (MIC) of a herbal antityphoid preparation on Salmonella typhi was determined using the broth dilution method. Results: 46/65 (70.8%) used herbal preparations (19 used pre-packaged products; 27 used extemporaneous preparations) while 19/65 (29.2%) used orthodox drugs to treat their infection. Some of the herbs commonly used were Nauclea latifolia, Morinda lucida, Paullinia pinnata, Vernonia amygdalina, Cassia alata, Phyllantus fraternus, Azadirachta indica, Mangifera indica, and Carica papaya. Majority, 42/45 (91.3%), recovered after the use of the herbal anti-typhoid products (laboratory confirmation), 7/42 (15.2%) had relapse within three months, 9/45 (19.6%) experienced mild side effects. Experimentally, both the prepared herbal mixture and ciprofloxacin had MICs of 4 and 2 μg/μl respectively. Conclusion: Herbal anti-typhoid preparations are highly patronized and have been found to be efficacious. Experimentally the herbal mixture prepared showed interesting anti-salmonella activity.

Pulmonary aspergilloma: an evasive disease

Aspergillomas are often misdiagnosed as tuberculosis [TB] in developing countries where the prevalence of TB is high, hemoptysis is often equated with TB, and most patients are diagnosed clinically. This report describes the case of a patient being treated for smearnegative TB who presented with hemoptysis and was found to have an aspergilloma

case of acute oesophageal necrosis [AEN] in a hypothermic patient. The grave prognosis of the black oesophagus

Acute oesophageal necrosis, also known as black oesophagus, is a rare, and potentially lethal syndrome which is often diagnosed incidentally during upper endoscopy for evaluation of upper gastrointestinal bleed. It is characterised by diffuse circumferential black mucosal discolouration in the distal oesophagus secondary to necrosis that may extend proximally to involve variable length of the oesophagus. One theory of pathogenesis is that the relatively low perfusion state in the distal areas of the oesophagus makes it susceptible to mucosal injury. We present a case of acute oesophageal necrosis in a 62 year-old lady with history of alcoholic cirrhosis who presented with haematemesis and severe hypothermia, and was eventually found to have acute oesophageal necrosis

The Implementation of an Effective Aerobic Walking Program Based on Ottawa Panel Guidelines for Older Individuals with Mild to Moderate Osteoarthritis: A Participant Exercise Preference Pilot Randomized Clinical Trial Protocol Design.

Aims: Osteoarthritis is the most common disabling disorder affecting particularly knees. A recent systematic review demonstrated the efficacy of walking programs for improving pain, functional status, endurance, and quality of life, in the management of knee osteoarthritis. Even though evidence suggests that walking provides numerous clinical benefits, older people diagnosed with osteoarthritis avoid physical activity. General objective is to evaluate the effect of participants’ exercise preference. We expect to encourage osteoarthritis participants to adhere successfully to a proven effective walking program. Study Design: This is a 9-month supervised walking program with a 3-month follow-up period using a preference trial design which consists of three single blind randomized clinical trials, based on a participant exercise preference model, to elicit preferences independently of randomization. Place and Duration: Indoor Walking Club in the City of Ottawa, Billings Bridge Shopping Centre, next door to The Arthritis Society Ottawa office. Methodology: A total of 69 participants with a confirmed diagnosis of osteoarthritis of the knee will be recruited from the general public from the Ottawa area. We are implementing a knowledge translation strategy, in order to improve adherence and consequently ensure the maintenance of pain relief, functional status and quality of life, among older individuals diagnosed with mild to moderate osteoarthritis. This article summarizes the study protocol of the walking study, by explaining the methods and interventions selected and discussing on the need for this trial. Conclusion: This proposed pilot randomized controlled trial will address a new knowledge gap by concentring on questions of clinical and scientific importance to improve the understanding related to the efficacy of strategies to promote the adoption and long-term adherence of community-based walking programs.

Anti-tussive, muco-suppressant and expectorant properties, and the safety profile of a hydro-ethanolic extract of Scoparia dulcis.

Background: Scoparia dulcis is used in Ghanaian folkloric medicine for the management of asthma and its related complications. This study was therefore aimed at evaluating the anti-tussive, muco-suppressant and expectorant properties of hydroethanolic extract of S. dulcis (SDE), and to ascertain its safety for use in asthma and obstructive pulmonary disease management. Methods: The number of coughs induced in guinea pigs using citric acid and the concentration of phenol red secreted in tracheae of mice were measured. Preliminary phytochemical analysis was conducted on the extract using standard procedures. Safety for use of the extract was assessed by conducting an acute and delayed toxicity test. Results: The extract showed a dose-independent inhibition (p ≤ 0.001) of cough elicited by 7.5% citric acid, and a dose-dependent increase (p ≤ 0.05) in the amount of phenol red output in mice tracheae similar to that of ammonium chloride. For the muco-suppressant activity, SDE dose-dependently reduced (p ≤ 0.001) the concentration of ammonium chloride-induced phenol red secretions from mice tracheae. Phytochemical screening showed the presence of tannins, alkaloids, glycosides, saponins, steroids, and phenolic compounds. No acute and/or delayed toxic symptoms were observed after an oral administration of up to 5 g/kg of S. dulcis extract. Conclusion: The results showed that S. dulcis extract has anti-tussive, muco-suppressant and, expectorant and/or mucolytic properties; making it a possible remedy for asthma, and obstructive pulmonary disease.

Hernia de disco lumbar en un niño con fibrosis quística: caso clínico / Lumbar disc herniation in a child with cystic fibrosis: case report

Presentamos el caso de un niño con fibrosis quística y hernia de disco lumbar. Un niño de 8 años de edad consultó por dolor lumbar que aumentaba con la tos, al sentarse, caminar o inclinarse, y disminuía al acostarse. La prueba de levantamiento de la pierna en extensión fue positiva cuando el miembro inferior derecho llegó a 60 grados. La prueba contralateral fue negativa. La resonancia magnética nuclear mostró una protrusión central del disco intervertebral entre L5-S1. El tratamiento conservador no fue efectivo, por lo cual se efectuó tratamiento quirúrgico, que hizo desaparecer el dolor. Según nuestro conocimiento, este es el primer caso comunicado de hernia de disco lumbar en un niño con fibrosis quística. Aunque este caso podría ser una coincidencia, se debe realizar una investigación detallada ante el dolor de espalda, síntoma frecuente en pacientes con fibrosis quística.

We report a case of child with cystic fibrosis and lumbar disc herniation. An 8-year-old boy presented with low back pain that exacerbated on coughing, sitting, walking, or bending and diminished when lying down. The straight leg raising test was positive when the right leg was lifted at 60 degrees. Crossed leg raising test was negative. Lumbar MRI revealed a L5-S1central disc protrusion. Conservative treatment was not effective and the patient underwent surgery. Postoperatively the patient experienced regression of the pain. To the best of our knowledge this is the first reported case of lumbar disc herniation in a child with cystic fibrosis. Although this case might be coincidental, thorough investigation of back pain, which is frequent in patients with cystic fibrosis, should be performed.

Retrovesical hydatid cyst presenting with urinary retention and left kidney atrophy

Hydatid disease of the urinary tract is uncommon, accounting for only 2-3% of cases. There are very few reported cases in the literature of pelvic hydatid cysts causing obstructive uropathy and renal failure. We report a case of pelvic hydatid cyst in a patient presenting with urinary retention and secondary complete atrophy of one kidney. The patient was treated with surgical excision of this large retrovesical cyst, along with a simple left nephroureterectomy, with rapid improvement of symptoms. Hydatid disease should be taken into consideration in the differential diagnosis of a cystic mass in any anatomic localization, especially in patients from endemic areas

Age, body mass index, and number of previous trials: are they prognosticators of intra-uterine-insemination for infertility treatment?

To examine whether pregnancy rate [PR] of intrauterine insemination [IUI] is related to certain demographic factors, such as age and body mass index [BMI], along with number of IUI cycles performed, a set of infertile Saudi women. During this prospective study [a 24-month period], 301 Saudi women with infertility underwent IUI in our infertility clinic. We investigated whether PR is correlated with patient age and BMI, and the number of IUI trials, in order to determine if they could be used as prognosticators of pregnancy success. The highest PR was 14.89% for ages 19-25 and the lowest PR was 4.16% for ages 41-45, indicating no statistically significant difference among PR in all age groups [p value of 0.225]. Also, in terms of BMI, the highest PR was 13.04% for BMI >/= 35 and the lowest was 7.84% for BMI of <25 to 18.5, indicating no significant difference among different BMI groups [p value of 0.788]. One-cycle treatment, as expected, was more successful [PR=12.84%] than 2-cycle treatment [PR=5.75%], however, 3-5-cycles treatment still showed encouraging results [PR=17.24%]; but the difference did not reach statistical significance [p value=0.167]. PR after IUI treatment remained approximately 10% from 19 to 40 years of age and declined after 40. Although no significant difference was observed among different age groups, earlier treatment is still recommended. There was a positive but not statistically significant correlation between PR and patient's BMI indicating that BMI is not a determining factor. There was also no correlation between PR and number of IUI trials. Patients can thus try as many times as they want before moving on to in vitro fertilization [IVF] treatment