Genetic diversity of secreted protein with an altered thrombospondin repeat (SPATR) of Plasmodium knowlesi clinical isolates from Malaysia

@#The Plasmodium knowlesi secreted protein with an altered thrombospondin repeat (PkSPATR) is an important protein that helps in the parasite’s invasion into the host cell. This protein has been regarded as one of the potential vaccine candidates against P. knowlesi infection. This study investigates the genetic diversity and natural selection of PkSPATR gene of P. knowlesi clinical isolates from Malaysia. PCR amplification of the full length PkSPATR gene was performed on 60 blood samples of infected P. knowlesi patients from Peninsular Malaysia and Malaysian Borneo. The amplified PCR products were cloned and sequenced. Sequence analysis of PkSPATR from Malaysia showed higher nucleotide diversity (CDS p: 0.01462) than previously reported Plasmodium vivax PvSPATR (p = 0.0003). PkSPATR from Peninsular Malaysia was observed to have slightly higher diversity (CDS p: 0.01307) than those from Malaysian Borneo (CDS p: 0.01212). Natural selection analysis on PkSPATR indicated significant purifying selection. Multiple amino acid sequence alignment revealed 69 polymorphic sites. The phylogenetic tree and haplotype network did not show any distinct clustering of PkSPATR. The low genetic diversity level, natural selection and absence of clustering implied functional constrains of the PkSPATR protein.

Role of higher levels of post-challenge antibodies in protective vaccination against Leishmania tropica infection of BALB/c mice

Objective: To study the role of antibodies in protection against Leishmania tropica (L. tropica) infection in the experimental model of BALB/c mice. Methods: BALB/c mice were vaccinated against L. tropica by soluble Leishmania antigen or recombinant L. tropica stress-inducible protein-1 (LtSTI1) of L. tropica, and against Leishmania major (L. major) by soluble Leishmania antigen. Monophosphoryl lipid A was used as an adjuvant. The L. tropica- or L. major-vaccinated mice were challenged by L. tropica or L. major, respectively. The levels of anti-Leishmania antibodies (IgG1 and IgG2a) were determined after vaccination and after challenge. Results: All vaccinated groups caused a higher antibody response in comparison with the control group. The L. major-vaccinated group showed lower IgG1 response than the control group after the challenge. Conversely, in L. tropica-vaccinated mice, the levels of antibodies were higher than the control group. Moreover, the group receiving rLtSTI1 and monophosphoryl lipid A showed higher levels of antibodies than those of the rLtSTI1 group. In vaccinated mice, antibody responses against L. tropica remained high until 16 weeks after the challenge. Conclusions: The higher levels of post-challenge antibodies are associated with protective vaccination against L. tropica infection of BALB/c mice. Our findings provide new insight into the association of antibody with vaccine-induced protective immunity against L. tropica infection. More studies are needed to clarify the role of antibody in protection against L. tropica.

The Cytotoxic Effect of Small and Large Molecules of PMF Fraction Extracted from Camel Urine on Cancer Cells.

Aim of the work: Animal urine, including that of camels, has long been used for the therapeutic management of human ailments. In this study, we sought to characterize the cytotoxic properties of newly derived purified fractions from previously described camel urine extract (PMF) on various cancer cell lines. Methodology: Two new size dissimilar fractions of PMF (large and small) were obtained by fractionalizing PMF using 3kD and 50kD membrane filters. A SRB cytotoxicity assay of the PMF fractions was performed on cancer cell lines (A549, HCT116, HepG2, MCF-7, U251 and Hela) as well as normal cell lines (human fibroblast cell line and Vero). Results: This study showed that the newly derived and more purified fraction of PMF (new PMF) possesses effective and selective anti-cancer properties against several types of cancer cell lines. Conclusion: This study, as well as previous ones, suggests that camel urine extracts (old and new PMF) may provide newer therapeutic alternatives to clinically manage cancer patients. However, further studies are needed to verify these positive preliminary results.

Prevalence of Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) Infection and their Co-infection among Blood Donors in Minia Governorate, Egypt.

Aim: Infections with Hepatitis B virus (HBV) and Hepatitis C virus (HCV) cause serious morbidity and mortality. This study was designed to determine the prevalence of Hepatitis B and C infections and their co-infections among blood donors in Minia governorate, Egypt. Study Design: A cross-sectional study. Place and Duration of Study: The study was conducted over a period of 6 months starting from May 2011 till December 2011 and it included 5410 samples from blood donors at the Regional Blood Transfusion Center in Minia governorate. Methodology: Both HBsAg and antibodies to HCV were detected by EIA in 5410 blood samples from potentially healthy asymptomatic blood donors. Detection of HBV DNA and HCV RNA was carried out by real-time PCR (RT-PCR). Results: Most individuals were males (4305; 79.6%) and were from rural areas (3695; 68.3%). The sero-prevalence of infections was 0.9% (48 cases) for HBV and 6% (322 cases) for HCV, and 0.1% (7 cases) for co-infection. Out of 7 samples with co-infection, only one (14.3%) was positive for HBV DNA and HCV RNA. The mean age of HCV-antibody positive donors (33.2 ±9.41 years) was significantly higher than that of the HBV-positive donors (27.3± 6.06 years) and co-infection (29.9± 10.21 years) (P<0.05). Prevalence of HBV and HCV was higher in males (1% and 6.6% respectively) while HCV was higher in rural areas (6.8%) unlike HBV which did not show any difference in residential distribution (0.9% for both rural and urban areas). Conclusion: The prevalence of both viruses is low and that of the dual infection is lower than any of the two viruses alone.

Osteoarthritis prescribing habits in the western region of Saudi Arabia

Objective: Osteoarthritis prescribing habits in Western Region of KSA and whether they match the guidelines or not

Methods: Qualitative using structured questionnaire via face to face interviews, the study included 100 doctors interfering with OA management. Interviews were conducted in Jeddah and Mecca Hospitals between July and December 2012

Results: 71% of doctors mentioned that they depend on their personal experience and don't follow International Guidelines [p value < 0.05]. All doctors use both Non-pharmacological and Pharmacological measures in the treatment of OA. Non-pharmacological measures are weight reduction [96%], patient's education [74%], exercise [73%], heat / ice application [39%] and rest [31%]. 81% of doctors mentioned that they start treatment with mono-therapy in the form of NSAIDs [36 - 44.44%] which is not matching the guidelines, followed by Paracetamol [32- 39.51%] and Celecoxib [10- 12.35%]. 14% mentioned that they start treatment with combined therapy. The most common combination is Glucosamine + Diclophenac/ Celecoxib [4-28.57%] followed by Paracetamol + NSAIDs [3 - 21.43%], Ibuprofen/ Diclophenac + Celecoxib [3-21.43%] and Paracetamol + Celecoxib [2 - 14.29%]

Conclusions:Non-pharmacological measures recommended by doctors are weight Reduction, patient education, physiotherapy, exercise, heat application, and ice therapy, which match the international guidelines. Pharmacological measures in form of NSAIDs whether selective or non-selective are the 1st line choice for doctors unlike the international guidelines that recommend Paracetamol as 1st line

Performance status and deaths among children registered in Kuwait National Primary Immuno-deficiency Disorders Registry.

Children with primary immunodeficiency disorders (PIDD) have an increased risk of suffering from physical, social, and psychological problems. The aim of this study was to evaluate the performance status and mortality of children with PIDD in Kuwait and to determine the variables and co-morbidities that may affect their performance and risk of death. The data for the children were obtained from Kuwait National Primary Immunodeficiency Disorders Registry describes the patients' characteristics, co-morbidities and their treatment regimens. Each patient was scored using the Lansky Play Performance Scale (LPPS), and we evaluated the number of deaths among the children and the effects of different variables on their LPPS scores and mortality. We examined 98 pediatric patients with a mean delay in diagnosis of 21.2 months. Antimicrobial prophylaxis was administered to 57.2% of the patients, whereas intravenous immunoglobulin (IVIG) therapy was used in 44%. Eight patients underwent bone marrow transplants. The mean LPPS score for all the patients was 65.5, and there was a significant disparity in the mean LPPS scores across PIDD categories.Twenty-one patients died. The variables that were found to have a significant effect on both the LPPS score and the risk of death were an age of onset of less than 6 months, a history of CMV infection, parental consanguinity, the use of antimicrobial prophylaxis and IVIG therapy. In conclusion, patients with PIDD have a poor performance status and a high rate of mortality. Early diagnosis and aggressive therapeutic interventions directed at patients with early onset of symptoms and CMV infections can help improve the quality of life of patients with PIDD.

Improvement of steatosis after interferon therapy in HCV genotype 4 is related to weight loss.

Introduction Hepatic steatosis is common in patients with chronic hepatitis C virus (HCV) infection, and its occurrence may be related to both host and viral factors. Relationship between improvement in steatosis and response to anti-viral treatment remains unclear. This study assessed the factors associated with steatosis in patients infected with genotype 4 HCV, and to correlate degree of changes in steatosis with host factors and response to treatment. Methods Records of 175 patients with chronic genotype 4 HCV infection, who had received interferon and ribavirin combination therapy, were reviewed retrospectively to extract data on body mass index (BMI), presence of diabetes mellitus, and liver histology findings. Paired BMI data and liver biopsies (pre- and 24-weeks post-treatment) were available in 86 patients. Baseline steatosis and its changes (before and after treatment) were the dependent variables in a univariate and multivariate analyses. Results Steatosis was found in 88/175 (50.3%) of baseline biopsies. Its presence was related to baseline BMI (r=0.33, P<0.01), but not with viral load, or grade of liver inflammation or fibrosis. On follow up, improvement in steatosis was significantly associated with degree of weight loss but not with response to anti-viral treatment. Conclusion Steatosis is common in genotype 4 HCV infection, and its presence appears to be related to high BMI, but not to viral load or degree of liver injury.

Isolation and characterization of an acrylamide-degrading Bacillus cereus.

Several local acrylamide-degrading bacteria have been isolated. One of the isolate that exhibited the highest growth on acrylamide as a nitrogen source was then further characterized. The isolate was tentatively identified as Bacillus cereus strain DRY135 based on carbon utilization profiles using Biolog GP plates and partial 16S rDNA molecular phylogeny. The isolate grew optimally in between the temperatures of 25 and 30oC and within the pH range of 6.8 to 7.0. Glucose, fructose, lactose, maltose, mannitol, citric acid and sucrose supported growth with glucose being the best carbon source. Different concentrations of acrylamide ranging from 100 to 4000 mg l-1 incorporated into the growth media shows that the highest growth was obtained at acrylamide concentrations of between 500 to 1500 mg l-1. At 1000 mg l-1 of acrylamide, degradation was 90% completed after ten days of incubation with concomitant cell growth. The metabolite acrylic acid was detected in the media during degradation. Other amides such as methacrylamide, nicotinamide, acetamide, propionamide and urea supported growth with the highest growth supported by acetamide, propionamide and urea. Strain DRY135, however, was not able to assimilate 2-chloroacetamide. The characteristics of this isolate suggest that it would be useful in the bioremediation of acrylamide.

Posterior septectomy in transnasal endoscopic choanoplasty

Congenital choanal atresia [CA] is a challenging surgical problem. Choosing between the transnasal and transpalatal routes is still a controversial feature in the surgical management of CA. The purpose of this study was to evaluate the results of transnasal endoscopic choanoplasty with versus without posterior septectomy. Thirteen patients were included in this study [8 females and 5 males] aged 3 days to 17 years [mean age 4.06 years], 7 cases with bilateral CA and 6 cases with unilateral CA who underwent surgical repair at Al-Azhar university hospitals between 2004 and 2008. All patients underwent transnasal endoscopic repair using powered instrument. The first 5 cases had repair without posterior septectomy, while the last 8 cases had repair with posterior septectomy. All cases were stented for 4 to 6 weeks and followed for at least 10 months. Postoperatively, 11 patients [84.6%] had successful repair, while 2 cases [15.4%] had restenosis which needed revision surgery. Restenosis occurred in 2 of the 5 cases who underwent repair without posterior septectomy. No restenosis in patients who underwent repair with posterior septectomy. One patient developed pressure necrosis of the palate few days after surgery, which healed after replacement of the stent by a smaller one

Endoscopic appearance of the nasal opening of human nasopalatine duct

The nasopalatine duct [NPD] in human adults is rarely patent and likely exists as a vestigial remnant. NPD is a common site for infection, tumors and cysts. This study was done to describe the location and gross anatomy of the nasal opening of the human NPD. A total of 100 volunteers, at Al-Azhar university hospitals, were examined by 30° telescope for the site and appearance of the nasal opening of NPD and photographs were taken and examined. Our results showed that the NPD was located 3 mm +/- 0.2 mm [mean +/- SD] above the nasal floor on the nasal septum, in both nostrils [90% bilateral], 2 cm +/- 0.03 cm dorsal to the columella. NPD was detected in 95% of the examined nostrils. The shape of the NPD fossa was oval [70%], and round [30%]. In the center of the fossa, a small, round aperture was visualized in 33% of fossae. In conclusion, the nasal opening of the NPD is an easily detectable bilateral and symmetrical structure, located at the junction of the nasal septum and floor of the nasal cavity. It can be potentially useful as an anatomical landmark

Clinical features and risk factors for HIV encephalopathy in children.

A prospective cohort study was conducted to determine the incidence of progressive encephalopathy (PE) and its associated clinical manifestations amongst a cohort of HIV infected children attending the HIV/AIDS clinic of the Pediatric Institute, Kuala Lumpur Hospital, Malaysia. Neurological and neurobehavioral assessments were performed in 55 children with HIV over a 24-month study period. Parameters assessed were physical and neurological assessments, CD4 counts, CD4 percentages, RNA viral loads and an IQ assessment at four monthly intervals. PE was diagnosed when patient developed at least one of the definitive criteria for PE based on the Consensus of Pediatric Neurology/Psychology Working Group, AIDS Clinical Trial 1996. The incidence of encephalopathy was 18.2% (n = 10) in 2002. All the patients had hepatosplenomegaly, lymphadenopathy, abnormal deep tendon reflexes and five had impairment in brain growth. The CD4 counts and CD4 percentages were more likely to be associated with PE compared to the non-PE group.

Bulbar substitution urethroplasty by use of tubularized ventral and dorsal onlay buccal mucosal grafts

We report our experience and evaluation of the outcome in men undergoing bulbar urethral reconstruction with tubulanzed neourethra from ventrally and dorsally situated buccal mucosal onlay grafts. Twelve patients with urethral stricture underwent substitution bulbar urethroplasty with buccal mucosal grafts. Preoperative evaluation was performed with complete urine analysis with culture and sensitivity tests, uroflow, retrograde and voiding cystourethrogram and urethral sonography. Complete excision of the stricture area was performed with preservation of the healthy corpus spongiosum intact as a separate vascular layer. Harvesting of 2 buccal mucosal grafts was done from cheek. The 1[st] graft was fixed dorsally onto the corporeal bodies. The 2[nd] graft was fixed ventrally to the undersurface of corpus spongiosum. Fashioning of the grafts was performed as a tube over a 14 Fr catheter. Three months after catheter removal; urinary flow rate, AUA symptom scores and retrograde urethrogram were performed. The average age of our patients was 33.5 years. Average follow up was 12 months. Of strictures, 2 patients [16.7%] were idiopathic in origin, 4 [33.3%] were traumatic, 4 [33.3%] were infectious and 2 [16.7%] were iatrogemc. The average stricture length was 3 cms. The average operative time was 165 mm. The average estimated blood loss was 214 ml. Hospital stay averaged 3.2 days. Peak unnary flow rates improved from an average of 7.9ml/second to 30.4 ml/second [p < 0.001]. AUA symptom scores decreased from an average of 20.5 preoperatively to 43 postoperatively [p < 0.001]. There were 2 early postoperative complications, 1 had a postoperative febrile UTIs and another patient had prolonged penurethral leakage which heal spontaneously. The overall success rate was 91.7%. Three to 6 months after surgery, RGUG demonstrated small non symptomatic ventral sacculation in one patient and narrowing in another patient which required endoscopic incision. The creation of neourethra from modulation of ventrally and dorsally situated onlay buccal mucosal grafts after complete excision of strictured urethra is a new added reasonable and reconstructive option for management of long bulbar urethral strictures [>2cm.]. However, more efforts, researches and extended follow up are necessary to establish and explain the hidden secretes of improving the outcome of substitution urethroplasty with buccal mucosal grafts

Serum homocysteine concentration in patients with acute MI and chronic IHD.

This was an observational study carried out in the Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka; with the active co-operation of Coronary Care Unit (CCU) of BSMMU & National Institute of Cardiovascular Disease (NICVD), Dhaka. This study was carried out from March 2002 to January 2003. Total seventy (70) subjects were studied. Out of them 20 were of Acute MI, 20 were Chronic ischemic heart disease (CHD) and 30 were age and sex matched healthy controls. Hospitalized diagnosed patients were selected by taking history, clinical examination and several investigations like ECG. Echocardiogram, Angiogram and several enzymes assay. Several studies in many countries showed that serum homocysteine (Hcy) was elevated in IHD Patient. Cardiovascular disease is alarmingly increasing in Bangladesh. So our aim and objective of the study was to find out the association of serum Hcy with Acute MI and chronic ischemic heart disease (CHD) patients in our population. Mean Hcy level of Acute MI were 21.16 +/- 4.56 (micromol/l), 27.55 +/- 10.40 (micromol/l) and that of control was 13.03 +/- 10.51(micromol/l). Serum Hcy was significantly higher in both cases than control. But insignificant difference was found between AMI vs CHD (P> 0.05). Quantitative measurement of serum Hcy was measured by fluorescence polarization Immunoassay (FPIA) in IMX analyzer (Abbott-USA).

Inhibition of COXI and not COX2 enzyme potentiates the opioid induced analgesia in rats

Opioids are widely used in the treatment of various types of pain and hyperalgesic states. However, opioid related side effects are well known and are representing a great challenge in using these drugs for the management of pain. A combined use of opioids with nonsteroidal anti-inflammatory drugs [NSAIDs] has been advocated in clinical practice to potentiate each other analgesic effect and to reduce the dose and related side effects of both drugs. Several studies on animal and human models have shown that such combination provides greater efficacy in pain relief. Reducing the doses of opioids used, due to the presence of N'SAIDs, ultimately reduces potential for side effects. It is unclear whether NSAIDs induces its opioid analgesic potentiating effect through inhibition of COX1 or COX2 enzymes. Both isoforms contribute to the inflammatory process, but COX2 is of considerable therapeutic interest as its induction, results in an enhanced formation of prostaglandins, during acute as well as chronic inflammation. It is generally assumed t hat NSAIDs anti-inflammatory and analgesic activity is mediated via COX2 inhibition. In contrast, it has been reported that the potencies of various NSAIDs to potentiate opioid induced presynaptic inhibitory effect nearly matched their inhibitory potencies at COX1. The present study was designed to study the effect of co-administration of the non selective COX inhibitor, indomethacin or diclofenac with pentazocine on pain relief and to compare it with the effect of its coadministration with the selective COX2 inhibitors, rofecoxib and meloxicam. Tail flick and hot plate assays were used asmodels o f central nociception. Non selective COX inhibitors, indomethacin and diclofenac potentiated the antinoceceptive effect of the opioid agonist pentazocine, an effect that was abolished by naloxone. The selective COX2 inhibitors, rofecoxib and meloxicam failed to modify the analgesic effect of pentazocine. These results suggest that analgesia potentiating effect of NSAIDs is mediated through inhibition of COX1 rather COX2 enzyme. The finding support a novel therapeutic intervention by which reduced doses of opioids can be used in the presence of NSAIDs that act preferentially on COX1 to produce effective pain relief with reduced side effects

DNA damage evaluation of hydroxyapatite on fibroblast cell L929 using the single cell gel electrophoresis assay

Hydroxyapatite is the main component of the bone which is a potential biomaterial substance that can be applied in orthopaedics. In this study, the biocompatibility of this biomaterial was assessed using an in vitro technique. The cytotoxicity and genotoxicity effect of HA2 and HA3 against L929 fibroblast cell was evaluated using the MTT Assay and Alkaline Comet Assay respectively. Both HA2 and HA3 compound showed low cytotoxicity effect as determined using MTT Assay. Cells viability following 72 hours incubation at maximum concentration of both HA2 and HA3 (200 mg/ml) were 75.3 +/- 8.8% and 86.7 +/- 13.1% respectively. However, the cytotoxicity effect of ZnSO4.7H2O as a positive control showed an IC50 values of 46 mg/ml (160 microM). On the other hand, both HA2 and HA3 compound showed a slight genotoxicity effect as determined using the Alkaline Comet Assay following incubation at the concentration 200 mg/ml for 72 hours. This assay has been widely used in genetic toxicology to detect DNA strand breaks and alkali-labile site. The percentage of the cells with DNA damage for both substance was 27.7 +/- 1.3% and 15.6 +/- 1.0% for HA2 and HA3 respectively. Incubation of the cells for 24 hours with 38 microg/ml (IC25) of positive control showed an increase in percentage of cells with DNA damage (67.5 +/- 0.7%). In conclusion, our study indicated that both hydroxyapatite compounds showed a good biocompatibility in fibroblast cells.

value of recurrent laryngeal nerve identification and stimulation by usig intraoperative disposable nerve stimulator during thyoid operation

Recurrent laryngeal nerve [RLN] iatrogenic injury is one of the most serious complications in thyroid surgery. Paralysis of vocal cords can repesents a srious complication inducing, when bilateral, serious functional sequelae such as phonatory, respiratory and psychological problems that limit working capacities and social relationships of patients. This work is to study the importance of searching, identification and exposure of the RLN surgically and confirming this by using a disposable nerve stimulator to avoid its injury.Design: prospective study. Patients and Records of forty patients who underwent thyroidectomy by the authers at several Hospitals were reviewed for RLN paralysis between January2001 and December 2003. Intraoperative determination of RLN function was evaluated with a disposable nerve stimulator [Xomed, Jacksonville, Florida] set at 0.5 milliamper [mA]. Without the use of neuromuscular blockade during anesthesia, RLN function was assessed by palpating of the cricoarytenoid joint and posterior cricoaryteniod muscle while the stimulus was applied directly to nerve after identificantion. Postoperative, assessment of RLN integrity was determined by using flexible nasolaryngoscopy 7 days after the procedure to visualize the vocal cord mobility. RLNs were identified and stimulated intraoperatively in all patients. Concerning the postoperative results, flexible nasolaryngoscopy was utilized in all patients one week after the procedure. All patients had bilateral mobile vocal cords after the first week postoperatively. Conclusions: The authors concluded that iatrogenic injury to the RLN or to its branches could be avoided by searching, identifying, and exposing the nerve itself and by following its course with care. In addition, using intraoperative disposable nerve stimulator is very helpful in confirming the location and function of the RLN

Surgery of the inferior nasal turbinates: a comparative study of the operative outcomes of three techniques

In the present study, three of the widely practiced surgical procedures for the reduction of the size of the inferior turbinates, i.e. Partial inferior turbinectomy [PIT], submucous diathermy [SMD] and submucous turbinectomy or turbinoplasty [ST or TP] were assessed for subjective efficacy and morbidity. In all cases, turbinectomy was performed as an isolated procedure. The study was conducted on three groups of 90 adult patients [assigned into three groups of 30 patients each] with symptoms and signs of nasal obstruction due to enlargement of inferior turbinates. All patients were followed up for two weeks after surgery and after two months with subjective assessments of nasal breathing. The data obtained showed that the three procedures are relatively safe, effective, well-tolerated and do not require an expensive instrumentation. Nevertheless, when turbinectomy deemed necessary, the most conservative techniques are preferred

Diagnosis of endometriosis: a second look at the role of biochemical markers

To evaluate the accuracy of 3 markers CA-125, CA 19-9 and CRP in the diagnosis of endometriosis especially in virgins or unmarried women with dysmenorrheal and/or oleic pain. 50 no pregnant female patients in the reproductive age undergoing laparoscopy for infertility and/or chronic pelvic were included. Serum CA-125, CA 19-9 and VRP, were assayed twice; during the 1st 3 days of the menstrual cycle, and 7-10 days later. According to laparoscopic results, the study population was divided into: cases with early endometriosis group [I, 17 cases]; cases with advanced endometriosis included [group II, 19 cases]; cases with non-endometriotic pelvic inflammations/adhesions, [group III, 13 cases]; and cases with normal laparoscopic findings [group IV, II cases]. Serum levels of all markers were higher in endometriosis group compared to non-endometriotic inflammatory lesions and to controls. CA-125 was the most accurate when measured using during menstruation, CA 19-9 was the least accurate, while CRP menstrual/ preovulatory samples ratio was 100% accurate. Measurement of CRP during menstruation and it the revelatory period could provide an accurate marker for the diagnosis of endometriosis especially in airing or unmarried women with early disease

Laparoscopic nephropexy for symptomatic nephroptosis: initial experience

To evaluate the efficacy of laparoscopic nephropexy as a minimally invasive procedure for treatment of cases with symptomatic nephroptosis. We have performed laparoscopic right nephropexy in 6 patients presenting with symptomatic nephroptosis documented by radiographic studies [IVU] and/or renal scans. Exposure of the kidney was achieved via a transperitoneal laparoscopic approach. For kidney fixation, the upper most part of the lateral border of the kidney was sutured to the overlying fascia of the quadratus lumborum muscle using ah intracorporeal suturing technique. In addition, the mid-portion of the renal capsule was sutured to the back muscle and its covering fascia using two or three running sutures thereby, creating a vertical and horizontal means of fixation. Laparoscopic right nephropexy was successfully accomplished in all 6 patients. The average operative time was 4 hours. All patients resumed oral intake during the first postoperative day; the average amount of parenteral analgesia required postoperatively was 42.7 mg of morphine sulphate or its equivelant. Hospital stay averaged 2.5 days; return to usual activities occurred on average at 2.5 weeks postoperatively. Postoperative imaging studies confirmed reduction or elimination of nephroptosis in all patients; all patients have remained asymptomatic during an average follow-up of 19 months [range: 3 to 33 months]. Laparoscopic nephropexy appears to be a feasible minimally invasive treatment option for patients with symptomatic, documented nephroptosis. It can be safely and effectively accomplished with satisfactory anatomical and clinical results

Effect of the selective cox 2 inhibitor, rofecoxib versus the non selective cox inhibitor, indomethacin on renal hemodynamics and tubular excretion

Nonsteroidal anti-inflammatory drugs [NSAIDs] are among the most widely prescribed medications worldwide. The mechanism through which NSAIDs provide analgesia and suppress inflammation is the inhibition of the enzyme cyclooxygenase [COX] with subsequent suppression of the prostanoids synthesis. The suppression of prostanoids synthesis can also produce gastric and renal toxicity, as we!l as impair normal platelet function. Two distinct but related enzymes, cyclo-oxygenase-1 [COX-1] and cyclooxygenase-2 [COX-2] mediate prostanoids synthesis and contribute to the inflammatory process. However, it is generally assumed that NSAIDs anti-inflammatory and analgesic activity is mediated via COX-2 inhibition while Inhibition of COX-1 is thought to be responsible for the gastric toxicity and bleeding complications. It is unclear whether NSAID-induced renal toxicity is attributable to inhibition of COX-1 or COX-2. The present study was designed to compare the effect of chronic administration of selective COX-2 inhibitor, rofecoxib with that of the non selective COX inhibitor, in-domethacin on renal hemodynamics and tubular excretion. Thus, changes in mean arterial pressure [MAP], renal blood flow [RBF], glomerular filtration rate [GFR], urine volume and urinary Na 4 and K excretion ratio, hematocrite value, serum Na +.K +,urea and crearinine concentrations were all detected after IM injection of rofecoxib [1 umol/kg], indomethacin [3 umol/kg] or the vehicle for three weeks. Results from the present study showed that three weeks treatment with both indomethacin and rofecoxib induced a decrease in urine volume and Na + and K + excretion. Indomethacin but not rofecoxib reduced RBF and GFR. No significant change was observed in MAP, hematocrite value or serum Na + serum. Serum K + urea and creatinine levels were all elevated suggesting impairment in the renal functions. It seems likely that COX-2 inhibition causes acute salt and water retention, whereas the decline in RBF and GFR is caused by the blockade of COX-1. COX-2 inhibitors should be used with caution since they are, like traditional NSAIDs, can induce renal function impairment