Role of the IL8 rs4073 polymorphism in central nervous system toxicity in patients receiving multidrug-resistant tuberculosis treatment / Papel do polimorfismo rs4073 do gene IL8 na toxicidade do sistema nervoso central em pacientes em tratamento para tuberculose multirresistente

ABSTRACT Objective: To determine the role of the IL8 rs4073 polymorphism in predicting the risk of central nervous system (CNS) toxicity in patients receiving standard pharmacological treatment for multidrug-resistant tuberculosis (MDR-TB). Methods: A cohort of 85 consenting MDR-TB patients receiving treatment with second-line antituberculosis drugs had their blood samples amplified for the IL8 (rs4073) gene and genotyped. All patients were clinically screened for evidence of treatment toxicity and categorized accordingly. Crude and adjusted associations were assessed. Results: The chief complaints fell into the following categories: CNS toxicity; gastrointestinal toxicity; skin toxicity; and eye and ear toxicities. Symptoms of gastrointestinal toxicity were reported by 59% of the patients, and symptoms of CNS toxicity were reported by 42.7%. With regard to the genotypes of IL8 (rs4073), the following were identified: AA, in 64 of the study participants; AT, in 7; and TT, in 11. A significant association was found between the dominant model of inheritance and CNS toxicity for the crude model (p = 0.024; OR = 3.57; 95% CI, 1.18-10.76) and the adjusted model (p = 0.031; OR = 3.92; 95% CI, 1.13-13.58). The AT+TT genotype of IL8 (rs4073) showed a 3.92 times increased risk of CNS toxicity when compared with the AA genotype. Conclusions: The AT+TT genotype has a tendency to be associated with an increased risk of adverse clinical features during MDR-TB treatment.

RESUMO Objetivo: Determinar o papel do polimorfismo rs4073 do gene IL8 na previsão do risco de toxicidade do sistema nervoso central (SNC) em pacientes em tratamento farmacológico padrão para tuberculose multirresistente (TBMR). Métodos: Amostras de sangue de uma coorte de 85 pacientes com TBMR que assinaram um termo de consentimento livre e esclarecido e que estavam recebendo tratamento com medicamentos antituberculosos de segunda linha foram amplificadas para o gene IL8 (rs4073) e genotipadas. Todos os pacientes foram avaliados clinicamente quanto a evidências de toxicidade do tratamento e categorizados de acordo com os achados. Foram avaliadas as associações brutas e ajustadas. Resultados: As principais queixas enquadraram-se nas seguintes categorias: toxicidade do SNC; toxicidade gastrointestinal; toxicidade cutânea; e toxicidade ocular e ototoxicidade. Sintomas de toxicidade gastrointestinal foram relatados por 59% dos pacientes, e sintomas de toxicidade do SNC foram relatados por 42,7%. Foram identificados os seguintes genótipos de IL8 (rs4073): AA, em 64 dos participantes; AT, em 7; TT, em 11. Houve associação significativa entre o modelo dominante de herança e toxicidade do SNC no modelo bruto (p = 0,024; OR = 3,57; IC95%: 1,18-10,76) e no ajustado (p = 0,031; OR = 3,92; IC95%: 1,13-13,58). O genótipo AT+TT do gene IL8 (rs4073) apresentou risco 3,92 vezes maior de toxicidade do SNC que o genótipo AA. Conclusões: O genótipo AT+TT tende a se associar a um maior risco de características clínicas adversas durante o tratamento da TBMR.

The use of integrin binding domain loaded hydrogel (RGD) with minimally invasive surgical technique in treatment of periodontal intrabony defect: a randomized clinical and biochemical study

Abstract Periodontal regeneration faces multiple challenges, the most important being cellular insufficiency. In an attempt to improve defect cellularity, we aimed to demonstrate enhancing cellular attraction using arginine-glycine-aspartic acid (RGD) adhesion molecule legend blended hydrogel within the intrabony defects. Methodology Forty-five intrabony defects were selected from patients with stage III or IV - grade A or B periodontitis and divided randomly into three equal groups of 15 each: group1 (G1): received minimally invasive surgical technique (MIST) alone, group2 (G2): received MIST and placebo hydrogel injection, and group3 (G3): were treated with MIST and RGD hydrogel injection. Primary outcomes 6 months following therapy were; defect base fill (DBF) and defect width measurement (DW); secondary outcomes were clinical attachment level (CAL), pocket depth (PD), plaque index (PI), gingival index (GI), and biochemical analysis of bone morphogenetic protein (BMP-2) evaluated at 1,7,14 and 21 days following therapy. Results Significant improvements in DBF, CAL, and PD were observed in the three studied groups 6 months following therapy compared to baseline (p<0.05). A significant improvement in DBF was reported in G3 compared to G1 and 2 (p=0.005). Additionally, a significantly higher CAL gain was reported in G3 compared to that of G1 (p=0.02). Group 3 was associated with a significantly higher level of BMP-2 compared to G1 and G2 in all reported periods. Conclusion RGD peptide carried on a hydrogel delivery agent and contained with a minimally invasive flap could be a reliable option in improving the outcomes of periodontal therapy.

Hidrodisección guiada por ultrasonido para el tratamiento de pacientes con sindrome del tunel carpiano / Ultrasound-Guided hydrodissection for treatment of Patients with Carpal Tunnel Syndrome

El estudio tuvo como objetivo comparar el grupo de hidrodisección de solución salina normal guiada por ultrasonido más esteroides y el grupo de hidrodisección de solución salina normal guiada por ultrasonido sola en pacientes con síndrome del túnel carpiano (STC), y determinar su relevancia clínica en relación con los resultados del tratamiento. Realizamos 60 hidrodisecciones guiadas por ecografía con solución salina normal con y sin inyecciones de corticosteroides en 51 pacientes con STC y evaluamos los resultados de la ecografía antes y después de la inyección. Clasificamos estas inyecciones en dos grupos según la solución salina normal más corticosteroide (grupo de esteroides). solución salina normal (grupo de control) y también registramos datos clínicos que incluían el sexo, la edad, el lado de la inyección, el peso corporal y la duración de las molestias relacionadas con el STC antes de la inyección. Los resultados se midieron mediante la escala analógica visual que se asignó para evaluar el resultado primario. Los resultados secundarios se evaluaron mediante el cuestionario del síndrome del túnel carpiano de Boston, el área transversal del nervio mediano y estudios electrofisiológicos. La evaluación se realizó antes de la inyección y 1, 3 y 6 meses después de la inyección, y se comparó el alivio de los síntomas para los pacientes que recibieron la inyección de solución salina normal y de esteroides. Comparamos las hidrodisecciones con la solución salina normal y las inyecciones de corticosteroides. Los datos clínicos, las puntuaciones de CSA-MN antes de la inyección en la entrada del túnel carpiano y las puntuaciones de BCTQ antes de la inyección no mostraron diferencias significativas entre los grupos (p> 0,05). Todos los pacientes (datos de 30 muñecas en cada grupo) completaron el estudio. En comparación con el grupo de control, en todos los momentos posteriores a la inyección, ambos grupos tuvieron una reducción significativa del dolor y la discapacidad, una mejora en las medidas de respuesta electrofisiológica y una disminución del área transversal del nervio mediano. Nuestro estudio revela que la solución salina normal guiada por ecografía con y sin hidrodisección de corticosteroides tiene un efecto terapéutico en los pacientes con STC. Se demostró que la hidrodisección nerviosa es potencialmente beneficiosa para los pacientes con STC antes de la cirugía. La hidrodisección es un procedimiento simple y mínimamente invasivo que se puede realizar utilizando únicamente NS. Además, en comparación con la inyección a ciegas, la hidrodisección bajo guía ecográfica puede reducir las posibilidades de lesión nerviosa

The study aimed to compare Ultrasound-Guided Normal saline plus steroid hydrodissection group and Ultrasound-Guided normal saline alone hydrodissection group in patients with carpal tunnel syndrome (CTS), and to determine their clinical relevance in relation to treatment outcomes. We performed 60 US-guided hydrodissections Normal saline with and without corticosteroid injections in 51 patients with CTS and evaluated their pre- and post-injection US findings. We categorized these injections into two groups based on the normal saline plus corticosteroid (steroid group). normal saline (control group) and we also recorded clinical data including gender, age, side of injection, BW, and the duration of preinjection CTS related discomfort. The outcomes were measured using the visual analog scale was assigned to assess the primary outcome. The secondary outcomes were assessed using the Boston Carpal Tunnel Syndrome Questionnaire, cross-sectional area of the median nerve, and electrophysiological studies. The assessment was performed prior to injection, and 1-, 3-, and 6-months' post-injection, and the symptom relief for the patients receiving normal saline and steroid injection were compared. We compared hydrodissections with normal saline and corticosteroid injections The clinical data, pre injection CSA-MN at the inlet of the carpal tunnel, and pre-injection BCTQ scores showed no significant intergroup differences (p > 0.05). All patients (data from 30 wrists in each group) completed the study. Compared both the control group, at all post-injection time points, both groups had a significant reduction in pain and disability, improvement on electrophysiological response measures, and decreased cross-sectional area of the median nerve. Our study reveals that ultrasound-guided Normal saline with and without corticosteroid hydrodissection has therapeutic effect in patients CTS. Nerve hydrodissection was shown to be potentially beneficial for CTS patients' pre-surgery. Hydrodissection is a simple, minimally invasive procedure that can be performed using only NS. In addition, compared to blind injection, hydrodissection under ultrasound guidance can lower the chances of nerve injury

Hidrodisección guiada por ultrasonido para el tratamiento de pacientes con sindrome del tunel carpiano / Ultrasound-Guided hydrodissection for treatment of Patients with Carpal Tunnel Syndrome

El estudio tuvo como objetivo comparar el grupo de hidrodisección de solución salina normal guiada por ultrasonido más esteroides y el grupo de hidrodisección de solución salina normal guiada por ultrasonido sola en pacientes con síndrome del túnel carpiano (STC), y determinar su relevancia clínica en relación con los resultados del tratamiento. Realizamos 60 hidrodisecciones guiadas por ecografía con solución salina normal con y sin inyecciones de corticosteroides en 51 pacientes con STC y evaluamos los resultados de la ecografía antes y después 21. Evers S, Thoreson AR, Smith J, Zhao C, Geske JR, Amadio PC. Ultrasound-guided hydrodissection decreases gliding resistance of the median nerve within the carpal tunnel. Muscle Nerve 2017 June 16. doi: 10.1002/mus.25723. 22. Smith J, Wisniewski S, J, Finnoff JT, Payne JM. Sonographically Guided Carpal Tunnel Injections. J Ultrasound Med 2008;27:1485-1490. 23. Trescott AME. Peripheral Nerve Entrapments: Clinical Diagnosis and Management. Switzerland: Springer International Publishing; 2016 24. Marshall S, Tardif G, Ashworth N. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev 2002(4). 25. Atroshi I, Flondell M, Hofer M, Ranstam J. Methyprednisolone Injections for the Carpal Tunnel Syndrome: A randomized Placebo-Controlled Trial. Ann Int Med 2013;159:309-317. 26. Peters-Veluthamaningal C, Winters JC, Groenier KH, Meyboom-de Jong B. Randomised controlled trial of local corticosteroid injections for carpal tunnel syndrome in general practice. BMC family practice 2010;11:54. 27. Wu YT, Ho TY, Chou YC, Ke MJ, Li TY, Tsai CK, et al. Six-month efficacy of perineural dextrose for carpal tunnel syndrome: A prospective, randomized, double-blind, controlledtrial. Mayo Clinic proceedings 2017;92:1179-1189. 28. Kirwan J. Is there a place for intra-articular hyaluronate in osteoarthritis of the knee? The Knee 2001;8:93-101. 29. Saltzman BM, Leroux T, Meyer MA, Basques BA, Chahal J, Bach BR, Jr., et al. The therapeutic effect of intra-articular normal saline injections for knee osteoarthritis: Ameta-analysis of evidence level 1 studies. The American journal of sports medicine 2017;45:2647-2653. 30. Padua L, Padua R, Aprile I, Pasqualetti P, Tonali P. Multiperspective follow-up of untreated carpal tunnel syndrome: a multicenter study. Neurology. 2001;56(11):1459­ 66 31. Ortiz-Corredor F, Enriquez F, Diaz-Ruiz J, Calambas N. Natural evolution of carpal tunnel syndrome in untreated patients. Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 2008;119:1373-1378 32. Gordon T, Brushart TM, Chan KM. Augmenting nerve regeneration with electrical stimulation. Neurol Res 2008; 30:1012- 1022. 33. Aulisa L, Tamburrelli F, Padua R, Romanini E, Lo Monaco M, Padua L. Carpal tunnel syndrome: Indication for surgical treatment based on electrophysiologic study. J Hand Surg Am 1998; 23:687-691. 34. Peters-Veluthamaningal C, Winters JC, Groenier KH, Meyboom- de Jong B. Randomised controlled trial of local corticosteroid injections for carpal tunnel syndrome in general practice. BMC Fam Pract. 2010;11:54. 35. Girlanda P, Dattola R, Venuto C, Mangiapane R, Nicolosi C, Messina C. Local steroid treatment in idiopathic carpal tunnel syndrome: short- and longterm efficacy. J Neurol. 1993; 240(3):187- 190. 36. Karadas¸ Ö, Tok F, Ulas¸ UH, Odabas¸i Z. The effectiveness of triamcinolone acetonide vs. procaine hydrochloride injection in the management of carpal tunnel syndrome: a double blind randomized clinical trial. Am J Phys Med Rehabil. 2011; 90(4):287-292. 128 LA PRENSA MÉDICA ARGENTINA Ultrasound-Guided hydrodissection for treatment of Patients with Carpal Tunnel Syndrome V.107/Nº 2 de la inyección. Clasificamos estas inyecciones en dos grupos según la solución salina normal más corticosteroide (grupo de esteroides). solución salina normal (grupo de control) y también registramos datos clínicos que incluyen el sexo, la edad, el lado de la inyección, el peso corporal y la duración de las molestias relacionadas con el STC antes de la inyección. Los resultados se midieron mediante la escala analógica visual que se asignó para evaluar el resultado primario. Los resultados secundarios se evaluaron mediante el cuestionario del síndrome del túnel carpiano de Boston, el área transversal del nervio mediano y estudios electrofisiológicos. La evaluación se realizó antes de la inyección y 1, 3 y 6 meses después de la inyección, y se comparó el alivio de los síntomas de los pacientes que recibieron la inyección de solución salina normal y de esteroides. Comparamos las hidrodisecciones con la solución salina normal y las inyecciones de corticosteroides; los datos clínicos, la preinyección de CSA-MN en la entrada del túnel carpiano y las puntuaciones de BCTQ antes de la inyección no mostraron diferencias significativas entre los grupos (p> 0,05). Todos los pacientes (datos de 30 muñecas en cada grupo) completaron el estudio. En comparación con el grupo de control, en todos los momentos posteriores a la inyección, ambos grupos tuvieron una reducción significativa del dolor y la discapacidad, una mejoría en las medidas de respuesta electrofisiológica y una disminución del área transversal del nervio mediano. Nuestro estudio revela que la solución salina normal guiada por ecografía con y sin hidrodisección de corticosteroides tiene un efecto terapéutico en los pacientes con STC. Se demostró que la hidrodisección nerviosa es potencialmente beneficiosa para los pacientes con STC antes de la cirugía. La hidrodisección es un procedimiento simple y mínimamente invasivo que se puede realizar utilizando únicamente NS. Además, en comparación con la inyección a ciegas, la hidrodisección bajo guía ecográfica puede reducir las posibilidades de lesión nerviosa.

The study aimed to compare Ultrasound-Guided Normal saline plus steroid hydrodissection group and Ultrasound-Guided normal saline alone hydrodissection group in patients with carpal tunnel syndrome (CTS), and to determine their clinical relevance in relation to treatment outcomes. We performed 60 US-guided hydrodissections Normal saline with and without corticosteroid injections in 51 patients with CTS and evaluated their pre- and post-injection US findings. We categorized these injections into two groups based on the normal saline plus corticosteroid (steroid group). normal saline (control group) and we also recorded clinical data including gender, age, side of injection, BW, and the duration of pre-injection CTS related discomfort. The outcomes were measured using the visual analog scale was assigned to assess the primary outcome. The secondary outcomes were assessed using the Boston Carpal Tunnel Syndrome Questionnaire, cross-sectional area of the median nerve, and electrophysiological studies. The assessment was performed prior to injection, and 1, 3, and 6 months' post-injection, and the symptom relief for the patients receiving normal saline and steroid injection were compared. We compared hydrodissections with normal saline and corticosteroid injections the clinical data, pre injection CSA-MN at the inlet of the carpal tunnel, and pre-injection BCTQ scores showed no significant intergroup differences (p > 0.05). All patients (data from 30 wrists in each group) completed the study. Compared both the control group, at all post-injection time points, both groups had a significant reduction in pain and disability, improvement on electrophysiological response measures, and decreased cross-sectional area of the median nerve. Our study reveals that ultrasound-guided Normal saline with and without corticosteroid hydrodissection has therapeutic effect in patients CTS. Nerve hydrodissection was shown to be potentially beneficial for CTS patients' pre-surgery. Hydrodissection is a simple, minimally invasive procedure that can be performed using only NS. In addition, compared to blind injection, hydrodissection under ultrasound guidance can lower the chances of nerve injury.

Upregulation of sulfatase-1 decreases metastatic potential of SKOV3 human ovarian cancer cells in vitro and in vivo

Aim: Sulfatase-1 (SULF-1) is one of the genes associated with the inhibition of several signaling pathways by desulfating HSPG in cancer cells. The aim of this study is to investigate the effect of SULF-1 upregulation on SKOV3 ovarian cancer cell line and its influence on cell proliferation, migration, invasion in vitro, and lymph node metastasis in 615 inbred mice in vivo. Materials and Methods: In in vitro study, we upregulated SULF-1 in SKOV3 cells using SULF-1 expression plasmid. Quantitative real-time reverse transcription-polymerase chain reaction (qRT-PCR) and western blotting were used to measure SULF-1 expression levels after stable upregulation. CCK-8, flow cytometry, Boyden Transwell-chamber, and scratch-wound healing assay were performed to explore the effect of SULF-1 on the proliferation, migration, and invasion. In in vivo study, immunohistochemistry and eosin stain (H and E) were used to evaluate the expression level of SULF-1 gene and to measure the lymph node metastatic rate of mice inoculated with SULF-1-SKOV3-expressed plasmid, SKOV3, and Nc-SKOV3 cells. Results: qRT-PCR and western blot assay confirmed that SULF-1 was upregulated both in mRNA and protein levels. Following SULF-1 stable upregulation, the cell proliferation, migration, and invasion were significantly reduced in the SULF-1 upregulated cells (SULF-1-SKOV3) compared with the nontransfected (SKOV3) and the nonspecific sequence transfected cells (Nc-SKOV3). IHC results showed that SULF-1 was highly expressed after stably upregulation in SKOV3 cells, and H and E stain confirmed that the mice inoculated with SULF-1-SKOV3 cells decreased lymph node metastatic rate compared to the two control groups. Conclusions: Our findings showed that overexpression of SULF-1 in SKOV3 results in a decrease in ovarian cancer cell proliferation, migration, and invasion in vitro and decreased lymph node metastasis in vivo. This finding could have a potential therapeutic window in the management of ovarian cancer

Asymptomatic urinary tract infection by proteus mirabilis in rheumatoid arthritis patients

Background: Proteus mirabilis is thought to contribute inrheumatoid arthritis (RA) development in susceptible individuals through molecular mimicry mechanism. This study was detecting the prevalence of asymptomatic bacteriuria (ABU) caused by Proteus mirabilis in RA patients to shed light on its rule in RA pathogenesis.Methods: This work has been conducted in medical Microbiology and Immunology Department and Rheumatology and Rehabitilation Department, Faculty of Medicine, Zagazig University, during the period from May 2017 to May 2018 over a period of 12 months. This study is a case control included 70 RA patients (66 females and 4 males), with age ranged from 25 to 65 years, and 70 healthy controls (67 females and 3 males), with age ranged from 24 to 65 years. Two consecutive urine samples one week interval were collected from each participant for urine count and culture. Blood samples were collected from each participant for detection the level of IgG antibodies against both Proteus mirabilis and E. coli (the most frequent isolated organism from the RA urine) by homely prepared ELISA. Results: The ABU was detected in (40%) of RA patients and in (4.3%) of healthy controls. The most common isolated organisms were E. coli (50%) followed by Proteus mirabilis (25%). A significant difference between both studied groups regarding IgG antibodies levels against Proteus mirabilis was detected (P< 0.001). No significant difference was observed between both studied groups regarding IgG antibodies levels against E. coli (P= 0.902). Significant positive correlation was found between Proteus mirabilis IgG antibodies levels and the levels of ESR and CRP in RA patients. In conclusion: Proteus mirabilis seems to have a role in RA development

Pattern of hearing loss in a tertiary hospital in the north western Nigeria

Background: Hearing impairment is a major public health problem in developing countries. According to the World Health Organization,approximately 15% of the world's adult population has some degree of hearing loss. About one­third of those who are affected have disabling hearing loss and two­third of them live in developing countries. Aim: This study aims to determine the causes and pattern of hearing loss in Zaria, North Western Nigeria. Materials and Methods: This was a retrospective study conducted at ear, nose,and throat unit of Ahmadu Bello University Teaching Hospital Zaria, Kaduna Nigeria. The hospital is a tertiary health­care facility in North Western Nigeria and is a referral center to many primary, secondary, tertiary and private health facilities in Nigeria. The records of all patients who were managed for hearing loss in our unit over a period of 5 years between January 2011 and December 2015 were reviewed. Information obtained from the case files included demographic characteristics, main presenting symptoms, and causes of hearing loss. Findings of pure tone audiograms, tympanograms, and otoacoustic emission were also recorded. The data obtained were analyzed using statistical package for Social Science Version 21. Results: Of the 277 patients who presented with hearing loss,only 144 met the inclusion criteria. There were 86 (59.7%) males and 58 (40.3%) females with sex ratio (M:F) of 1.4:1. The mean age was 29.9 years with standard deviation of ±2.18. The most common cause of hearing loss was presbyacusis 24 (16.7%) followed by ototoxicity 14 (9.7%), most of the patients 91 (63.2%) had bilateral hearing loss while 53 (36.8%) had unilateral hearing loss. Majority 112 (77.8%) had sensorineural hearing loss, followed by 24 (16.7%) conductive and mixed 8 (5.5%). Majority of the patients 94 (64.3%) had mild to moderately severe with the remaining 50 (34.7%) having severe to profound hearing losses, respectively. Tympanometric findings showed that 118 (90.8%) and 11 (8.5%) had Types A and B tympanograms, respectively. Conclusion: Majority of the patients were adult with bilateral mild to moderately severe sensorineural hearing loss. Age­related hearing loss was the most common cause of hearing loss followed by ototoxicity

Laparoscopic sleeve gastrectomy. Is there a need to reinforce the staple-line?

Objectives: To assess the effect of staple-line reinforcement on the rate of staple-line leak and bleeding post laparoscopic sleeve gastrectomy

Methods: In this retrospective study we analyzed 326 patients who underwent laparoscopic sleeve gastrectomy at King Hussein Medical Center between January 2010 and April 2016. Staple-line reinforcement using continuous lambert suture method was used in 229 patients [reinforcement group] while it was not used in 97 patients [non-reinforcement group]. Patient characteristics, comorbidities, duration of surgery, hospital stay, as well as complications including staple-line leak and bleeding after surgery were obtained, analyzed and compared between the reinforcement and non-reinforcement groups

Patients: Patients of the reinforcement group had baseline characteristics and comorbidities similar to those in the non-reinforcement group but had two cases of leak [0.87%] and two cases of bleeding [0.87%]. While patients of the non-reinforcement group had one case of leak [1.03%] and five cases of bleeding [5.15%]. Although there was no significant difference regarding leak rate between the two groups [P= 1.000], bleeding rate was significantly decreased in the reinforcement group [P=0.026]. One of the patients with leak died in the reinforcement group while there were no deaths in the non-reinforcement group

Conclusion: According to our results; reinforcement of the staple-line by lembert suture in laparoscopic sleeve gastrectomy reduced the incidence of staple-line bleeding but was associated with prolongation in operation time compared with no staple-line reinforcement. While the difference in leak rate between the two groups was not significant

Preliminary Phytochemical Screenings and Antipyretic, Analgesic and Anti-inflammatory Activities of Methanol Extract of Vernonia cinerea Less. (Fam: Asteraceae).

Aims: The aim of the current study was to undertake phytochemical screenings and evaluate antipyretic, analgesic and anti-inflammatory activities of the methanol extract of whole plant of Vernonia cinerea Less. (VCME). Place and Duration of Study: The study was carried out for one year in 2012 in the Department of Pharmacy, Southern University Bangladesh, Chittagong, Bangladesh. Methodology: For preliminary phytochemical screenings, the crude methanol extract of V. cinerea was subjected to various tests to determine the chemical nature of the extract. Antipyretic activity was assessed by the yeast-induced hyperthermia in mice. The analgesic property was evaluated by formalin-induced writhing test. Acetyl salicylic acid (ASA) was used as standard in in-vitro anti-inflammatory activity test. Results: Results of the preliminary phytochemical screening revealed the presence of alkaloids, flavonoids and triterpenoids in the extract. In yeast-induced pyrexia, the crude extract demonstrated a significant (p=0.05) reduction of mices’ body temperature after elevation by the administration of yeast. These effects were pronounced at the 2nd and 3rd h post-treatment with the extract. VCME exhibited a dose dependent activity in analgesic activity test with 32.61% and 52.17% protection at the dose of 200 and 400mg/kg, respectively as compared to that 76.09% exhibited by standard diclofenac sodium. In the anti-inflammatory test, the crude extract at the dose of 400μg/ml showed 65.12% inhibition of protein denaturation whereas standard acetyl salicylic acid (ASA) revealed 76.74% inhibition. Conclusion: These results revealed that V. cinerea may be used in pharmaceutical applications because of its effective pharmacological properties.

Pharmacological Activities of Blumea lacera (Burm. f) DC: A Medicinal Plant of Bangladesh.

Aims: The crude methanol extract of whole plant of Blumea lacera (Burn.f.) DC. has been investigated for anti-diarrheal, antimicrobial, anxiolytic, anti-atherothrombosis, membrane stabilizing and alpha-amylase inhibitory activities. Place and Duration of Study: The study was carried out in 2013 in the Department of Pharmacy, Southern University Bangladesh, Chittagong, Bangladesh. Methodology: Test for anti-diarrheal activity was carried out by castor oil-induced diarrhea in mice. The preliminary antimicrobial activity was determined by the agar disc diffusion method. The anxiolytic activity was examined in mice by using the hole board test and open field test (OFT). The anti-atherothrombosis activity was evaluated using standard streptokinase. The membrane stabilizing activity was assessed by using hypotonic solution induced hemolysis of human erythrocyte. The plant extract was also assessed for anti-diabetic ability using In vitro α-amylase inhibitory potential. The α- amylase inhibitory activity of B. lacera was measured using the starch-iodine method. Results: The crude extract of B. lacera showed anti-diarrheal activity in dose-dependent manner. In antimicrobial assay, this extract showed better activity against the tested fungi compared to the bacteria used in the screening. Significant anxiolytic activity was found for this plant extract. In the In vitro anti-atherothrombosis test, the extract exhibited 46.17% clot lysis as compared to the standard, streptokinase (81.53%). In membrane stabilizing activity test, the plant extract at 1.0mg/ml inhibited the heat-induced hemolysis of RBCs by 52.27% whereas the standard acetyl salicylic acid (ASA) demonstrated 81.72% inhibition of hemolysis. Our results revealed that the extract had dose dependent prevention of digestion of carbohydrates by inhibiting α-amylase. The ability of B. lacera to inhibit thermal-and hypotonic-enzyme activity was found to be statistically significant (p=0.05). Conclusion: These results demonstrated that B. lacera may be used in pharmaceutical applications because of its effective pharmacological properties.

Pattern of human epidermal growth factor receptor 2 [HER2] expression in invasive breast carcinoma, immunohistochemical - study on patients in Upper Egypt

Breast cancer is a major public health problem throughout the world. It accounts for 38% of all new cancer cases among women living in Egypt. One of the most important prognostic and determinant factor of the line of its treatment is the human epidermal growth factor receptor 2 [HER2], it is associated with the more aggressive phenotype. Attention has been focused on the expression of HER2 receptor proteins in breast cancer cells especially its membranous domain, it resulted in variable results concerning its percentage of expression as well as its geographic distribution. So there is a need to study HER2 types of expression in breast cancer patients in our location as well as its correlation with the clinicopathological parameters. HER2 expression in 336 retrospective breast cancer specimens was examined immunohistochemically using tissue microarray. Expression was scored into 0, 1, 2 and 3 degrees and was correlated with clinicopathological criteria. HER2 expression in our specimens showed both membranous and cytoplasmic staining patterns. 18.6% of specimens showed membranous immunoreactivity and 74.1% specimens showed cytoplasmic staining pattern. Significant statistical association was found between cytoplasmic staining of HER2 and tumors of low grade, ER positivity [p<0.001, 0.001, 0.008] respectively. There was statistical significance difference between high membranous expression of HER2 and ER negativity [p=0.038], but our results didn't find significant difference with tumor size, lymphvascular invasion or lymph node metastasis. The frequency of high membranous expression of HER2 in our specimens is 18.6% and inversely correlated with ER positive tumors. This group of patients should be subjected to specific treatment with Trastuzumab, to improve their survival. Surprisingly cutoplasmic expression detected in most of our patients with frequency of 74.1% with positive relationship to low tumor grade and hormone receptor positive tumors. Since this group of patients may be resistant to trastuzumab and need specific treatment with tyrosine kinase drug inhibitors, this observation is going to be discussed and need to be followed up in the future

Closing the Prevention of Mother-to-Child Transmission Gap in Nigeria: an Evaluation of Service Improvement Intervention in Nigeria

Objectives: The objective was to assess improvement; or lack thereof; in the uptake of prevention of mother-to-child transmission (MTCT) services at selected sites supported sites by the Global HIV/AIDS Initiative Nigeria (GHAIN).Design: The study used aggregated monthly service statistics to evaluate service improvement efforts that were conducted before and after these were undertaken between July 2007-June 2008. Settings and subjects: The service improvement efforts took place in 60 public healthcare facilities. Outcome measures: The study measured changes in the number of pregnant women who attended antenatal clinics for the first time; the number of pregnant women tested for human immunodeficiency virus (HIV); the number of HIV-positive women receiving antiretroviral (ARV) prophylaxis; and the service ratio; an indicator of the relative uptake of ARV prophylaxis. An estimate of MTCT events that were averted through ARV prophylaxis taken by the pregnant women was also calculated. Results: One hundred and twenty thousand; five hundred and thirty-seven women attended an antenatal clinic (ANC) for the first time. There was an average of 167.4 monthly attendances per facility. ANC attendance increased per facility by 11.1 women monthly post-intervention (p-value 0.01). The uptake of HIV testing was 87; with a monthly average increase of 17.8 women tested per facility (p-value 0.01). ARV prophylaxis uptake rose from 3.3-5.4 women per facility per month (p-value 0.01). The service ratio per facility improved from 5.3 women receiving ARVs to 6.5 for every 10 women who tested positive for HIV (p-value 0.01). Applying risk reduction estimates of different ARV regimens; it was estimated that between 88-169 MTCT events were averted pre-intervention; and 143-276 events; post-intervention. Conclusion: Service improvement intervention improved the utilisation of PMTCT services. It should be a key intervention that is used to close the PMTCT gap in Nigeria

Hepatoprotective activity of Melia azedarach leaf extract against simvastatin induced Hepatotoxicity in rats.

The aim of the study is to investigate the hepatoprotective activity of Melia azedarach L leaves extracts against simvastatin induced hepatotoxicity. The phytochemical screening was carried on the leaves extracts of Melia azedarach revealed the presence of some active ingredients such as Alkaloids, Tannins, Sponginess, Phenols, glycosides, steroids, terpenoids and flavonoids. Leaves of Melia azedarach was successively extracted with ethanol against simvastatin (20mg/kg.p.o) induced hepatotoxicity using Standard drug Silymarin (25 mg/kg). There was a significant changes in biochemical parameters (increases in serum glutamate pyruvate transaminase (SGPT), Serum glutamate oxaloacetate transaminase (SGOT), alanine phosphatase (ALP),serum bilirubin and decrease the total proteins content.) in simvastatin treated rats, which were restored towards normalization in Melia azedarach (300 mg/kg and 500 mg/kg) treated animals. Thus the present study ascertains that the leaf extract of Melia azedarach possesses significant hepatoprotective activity.

Acute abdomen at El Obeid Hospital, Western Sudan

Acute abdominal pain is the presenting complaint in emergency departments of all hospitals worldwide, resulting in a huge drain of human and non-human resources. To study the pattern, causes and management outcomes of patients presenting with acute abdomen to El Obeid Hospital, Western Sudan. This was a prospective study. All patients who presented with acute abdomen to the University Surgical Unit at El Obeid Hospital between January 1999 and December 2000 were included. The patient characteristics, clinical features, investigations, management and postoperative care were recorded in a pre-designed sheet. There were 421 patients. 242 were males [57.5%]. Acute appendicitis was the commonest cause accounting for 63% of the patients, followed by acute intestinal obstruction 20.4% and abdominal trauma 11.6%. One third of the patients with acute appendicitis reported with complications. The majority of acute intestinal obstruction cases were due to obstructed and/or strangulated hernia. Acute cholecystitis and perforated duodenal ulcers were not common. Perforated typhoid ulcers and tuberculous peritonitis were less frequent but had high mortality. The overall mortality was 8.5% and those deaths occurred mostly in patients presenting late with generalized peritonitis. Acute abdomen was a common surgical emergency at El Obeid Hospital, Western Sudan. The leading causes were acute appendicitis, acute intestinal obstruction and abdominal trauma. Awareness of the seriousness of the condition and better hospital facilities and care may reduce an unacceptable high mortality

Assessment of tolerability of beta- blockade therapy in patient with left ventricular systolic dysfunction heart failure

Little data exist to demonstrate the tolerability of beta-blocker therapy in an unselected community heart failure population already treated with the clinical trial or higher dose ACEI or ARB. 141 patients who had left ventricular systolic failure on standard therapy were recruited in our study. Patients were assigned to receive either Carvedilol or Bisoprolol. This prospective observational study showed that beta-blocker therapy is well tolerated and can be safely titrated in an out-patient setting

The effect of aqueous extracts of Hibiscus sabdariffa (Sorrel) calyces on heamatological profile and organ pathological changes in Trypanasoma congolense ­ infected rat

Abstract: The effects of aqueous extract of Hibiscus sabdariffa calyces on haematology and pathological changes in some selected organs during experimental Trypanosoma congolense infection of rats were investigated. Three groups of rats were intraperitoneally infected with T. congolense (Karu stock). One group was administered with the aqueous extract and another given a solution of vitamin C in drinking water; the remaining infected group was left untreated. Data from these groups were compared with those of two groups of healthy rats, one of which was similarly treated with the aqueous extract. The experiment was terminated three weeks, post-infection (pi). The uninfected and infected rats administered the extract consumed the equivalent of 9.94 mg ­ and 9.61 mg ascorbic acid / 100g / day during the experiment. Consumption of the extract significantly (p<0.01) retarded the rate of weight gain in both healthy and infected rats; even though the feed-intake was not significantly affected. After two weeks of infection the extract and vitamin C kept the parasitaemia significantly (p<0.01) lower than the untreated infected group. The anaemia in the untreated infected group was significantly (p<0.01) more severe than that of the corresponding extract- or vitamin-treated groups. Trypanosoma congolense infection caused significant (p<0.01) decreases in serum total proteins and albumin; serum and organ ascorbic acid as well as significant (p<0.01) elevation of serum alanine amino transferase levels in untreated rats. Consumption of the extract or vitamin C, however, prevented these disease­induced anomalies in the treated infected rats. Serum creatinine and urea levels were not affected by infection but the extract elevated these parameters significantly (p<0.01) above infection levels. It was concluded that consumption of the extract ameliorated the pathological changes in blood and organs of T. congolense-infected rats

Clinical and haematological findings in Sudanese patients with sickle cell disease attending the hospitals in Elobeid, Kordofan

This study aimed at assessing the clinical features and haematological parameters in sickle Sudanese patients attending El Obeid Hospitals in North Kordofan, Sudan. Eighty five patients with homozygous sickle cell [SS] disease, [both sexes] were included in this study. Their age ranged between 6 months to 42 years. Forty persons were used as control. Clinical manifestations were recorded at examination. Freshly obtained blood samples from patients and control were used to estimate haematological parameters which included: haemoglobin concentration [Hb], packed cell volume [PCV], red blood cell count [RBC], white blood cell count [WBC], mean corpuscular haemoglobin [MCH], mean corpuscular volume [MCV], and erythrocyte sedimentation rate [E.S.R]. The clinical investigations revealed that all patients presented with painful crisis, 96.5% had chronic anemia, 84.7% had recurrent malaria and 81.2% had different infections [76% was chest infection], 32.9% of the sickle cell disease [SCD] patients had no blood transfusion, while the rest had blood transfused once to five times. Haematological measurement indicate that all SCD patients in this study were reported anaemic, and their Hb, PCV and RBC count were significantly lower [P<0.001] compared with the control group, while WBC count of and MCV were significantly higher [P<0.001, P<0.01]. In this study the prevalence of SCD in Misseria tribe [24.7%] was highest compared to other tribes. This study affirmed the problem of sickle cell disease in Kordofan state, which should draw attention toward the need of further studies

comparison of patient-controlled analgesia fentanyl and combined spinal-epidural fentanyl-ropivacaine for labor analgesia

To compare the analgesic efficacy of fentanyl and ropivacaine given by combined spinal-epidural route and fentanyl given by patient-controlled analgesia for labor pain. Forty full-terms parturient were in active labor and requested analgesia divided into two groups: Group 1: CSE [20 patients]: after placement of epidural needle 25 microg fentanyl was injected intrathecal and 5m1 of 0.2% ropivacaine was injected in epidural space, followed by top-up doses of fentanyl 25 microg and ropivacaine 5ml of 0.2% in epidural catheter every 60 min or on patient request. Group 2: PCA [20 patients]: PCA was commenced with 50 microg fentanyl IV. Subsequent doses were given by PCA as 20 microg fentanyl increments [2ml] with lockout interval of 5 mm and a basal rate of 2 ml per hour. The maximal rate per hour is 20ml Maternal measurements were obtained hourly and neonates were assessed by 1, 5 and 10 min Apgar scores. Maternal satisfaction was significantly more in CSE group p=0.033. Duration to vaginal delivery was significantly less in CSE group p<0.05. Maternal VASS was significantly higher in PCA group p=0.0001. Neuraxial injection of drugs provided better analgesia and resulted in a shorter duration of labor than systemic analgesia. PCA fentanyl is a good technique to laboring women who do not want epidural analgesia