Preventive role of gum Arabic administration on STZ induced diabetic kidney disease in rats; renal antioxidant and histopathological evidence / Función preventiva de la administración de goma arábiga en la enfermedad renal diabética inducida por STZ en ratas; antioxidante renal y evidencia histopatológica

This study was set to investigate the effect of gum Arabic (G.A.) on diabetic kidney disease. We divided sixty male Sprague rats randomly into six groups. Normal control, normal rats treated with G.A., untreated diabetic rats, diabetic rats treated with insulin, diabetic rats treated with G.A., and diabetic rats treated with both insulin and G.A. Diabetes was induced by a single intraperitoneal injection of STZ. Forty eight hr post injections. Insulin was injected subcutaneously (1.6/IU/100g/day). We provided G.A. in drinking water (10 %w/ v).). At the end of the twelve weeks, blood was drawn for measurement of blood glucose, glycosylated hemoglobin (HbA1C), serum lipids, serum creatinine, and blood urea. Renal tissue oxidative stress (O.S.) was assessed by measuring the activities of superoxide dismutase (SOD) and catalase (CAT), and the concentrations of reduced glutathione (GSH) and malondialdehyde (MDA). For histological assessments, sections from segments of kidneys were processed and stained with hematoxylin and eosin (H&E) for assessment under the light microscope. STZinduced diabetes caused an elevation of blood glucose, HbA1c, urea and creatinine, triglycerides LDL and cholesterol, MDA with reduction of HDL, GSH level, and CAT and SOD activities. Histologically, kidneys from diabetic rats showed marked glomerular and tubular changes. Administration of G.A. alone to diabetic rats had a significant hypoglycemic, hypolipidemic, and antioxidant effect, although the levels achieved remained significantly abnormal compared with the untreated group with no effect on urea and creatinine levels. Co-administration of G.A. with insulin reversed the impact of D.M. on all parameters evaluated including the histological changes and led to normal urea and creatinine levels. We concluded that G.A., in combination with insulin, improves chemically-induced diabetes and its renal complications, possibly by modulation of oxidative stress.

En este estudio se evaluó el efecto de la goma arábiga (GA) en la enfermedad renal diabética. Dividimos sesenta ratas macho Sprague Dawley al azar en seis grupos. Control normal, ratas normales tratadas con GA, ratas diabéticas no tratadas, ratas diabéticas tratadas con insulina, ratas diabéticas tratadas con GA y ratas diabéticas tratadas con insulina y GA. La diabetes fue inducida por una sola inyección intraperitoneal de STZ. Cuarenta y ocho horas después se inyectó insulina por vía subcutánea (1,6 / UI / 100 g / día). A los animales se les dió GA en agua potable (10 % p / v)). Al final de las doce semanas, se extrajo sangre para medir la glucosa, la hemoglobina glicosilada (HbA1C), los lípidos en suero, la creatinina en suero y la urea en sangre. El estrés oxidativo del tejido renal (SO) se evaluó midiendo las actividades de la enzima superóxido dismutasa (SOD) y la catalasa (CAT), y las concentraciones de glutatión reducido (GSH) y malondialdehído (MDA). Para las evaluaciones histológicas, se procesaron secciones de segmentos de riñones y se tiñeron con hematoxilina y eosina (H & E) para análisis bajo microscopio óptico. La diabetes inducida por STZ causó una elevación de la glucosa en sangre, HbA1c, urea y creatinina, triglicéridos LDL y colesterol, MDA con reducción de las actividades de HDL, GSH y CAT y SOD. Histológicamente, los riñones de ratas diabéticas mostraron marcados cambios glomerulares y tubulares. La administración de GA solo en las ratas diabéticas tuvo un efecto hipoglucémico, hipolipidémico y antioxidante significativo, aunque los niveles alcanzados permanecieron significativamente anormales en comparación con el grupo no tratado, sin ningún efecto sobre los niveles de urea y creatinina. La dministración conjunta de GA con insulina revirtió el impacto de DM en todos los parámetros evaluados, incluidos los cambios histológicos y condujeron a niveles normales de urea y creatinina. Concluimos que GA en combinación con insulina, mejora la diabetes inducida químicamente y sus complicaciones renales, posiblemente mediante la modulación del estrés oxidativo.

Prognostic value of p53 expression intensity in urothelial cancers

Objective: To determine association of immunohistochemical expression intensity of p53 with grade and stage of urothelial cancers

Study Design: Descriptive cross-sectional analytical study

Place and Duration of Study: Pathology Department, King Edward Medical University, Lahore, from January to December 2016

Methodology: Data of transurethral resection/radical cystesctomy urinary bladder biopsies was collected. Clinical, radiological and cystoscopic findings of patients were noted from patients' charts in the Urology Ward. Biopsies were graded histologically according to WHO 2004 grading system. TNM system was used for pathological staging. On selected slides, immunoshistochemistry for p53 was applied. Nuclear immunoreactivity was considered positive if present in >10% of tumor cells and negative if <10% of tumor cells. Intensity was considered weak [less than 15% cells] and strong [more than 15% cells]. Data was analyzed by SPSS version 21. Linear-by-linear association was calculated between p53 expression and stage of urothelial tumors, Chi-Square test was used to see association between grade and intensity of p53. Qualitative variables, like grade and stage of carcinoma along with p53 expression, were calculated in terms of frequencies and percentages. P

Results: Out of the 70 patients, 61 [87%] were males and 9 [13%] females. Out of 25 low grade lesions, 4 [16%] cases were p53 positive; and out of 45 high grade lesions, 41 [91%] cases were p53 positive. There was 33% [2/6 cases] positivity in Tis, 55% [16/29 cases] in T1, 72% in T2 [21/29], and 100% in T3a [5/5 cases] and T3b [1/1 case]. Strong intensity of p53 staining was noted to be 5.4% [n=25] of low grade and 94.6% [n=45] of high grade tumors

Conclusion: p53 expression was greater and more frequently strong in higher grade and stage of urothelial carcinoma. It can be used as a prognostic marker in predicting higher grade and stage of bladder cancer

Varicocele Surgery Improves Sperm Count in Infertile Oligospermic Patients and so Improves Fertility; A Study in a Tertiary Care Hospital

The objective of this study was to find out the role of varicocele surgery in oligospermic infertile patients. It was a prospective and descriptive study carried out in Surgical Unit-I, Abbasi Shaheed Hospital and Karachi Medical and Dental College (KMDC), Karachi from April 2004 to March 2014. In this study, all patients of infertility due to low sperm count having bilateral varicocele were included while those patients having azoospermia or patients with unilateral varicocele were excluded. All patients were clinically assessed for bilateral varicocele and confirmed by ultrasonography of scrotum and relevant investigations were done. Patients were prepared for varicocele surgery and ligation of pampiniform plexus done. Semenanalysis were done during follow up and results were analyzed on SPSS version 14. Total fifty seven patients (n=57) were included in which age range was 20 to 30 years in 33.3%, 31 to 40 years in 42.1%, 41 to 50 years in 19.3% and 51 years to onwards in 05.3% patients only. Chronic smoking was found in 68.4% patients while 31.6% were nonsmokers. Normal testes was found in 77.19% while 22.81% had smaller (atrophied) testes. Very low sperm count was in 15.79%, 50.88% had low sperm count and 33.33% had near normal sperm count. All patients were operated for bilateral varicocele and discharged. Follow-up semen analysis showed improvement and semen analysis became normal in 19.3% after six months, 21.05% after nine months and 36.84% after one year of surgery while 22.81% had no improvement even after one year of surgery. Thus, patients with bilateral varicocele having low sperm count showed improvement in sperm count after varicocele surgery and so infertile patients may become fertile after varicocele surgery.

What are the most discriminating two-dimensional and doppler sonographic features in differentiation of benign and malignant adnexal masses?

To determine the two-dimensional and doppler sonographic features that best allow differentiation between malignant and benign adnexal masses, besides develop a new scoring system enable more accurate diagnosis with these features. A cross sectional prospective study was conducted on patients scheduled for surgery due to presence of adnexal masses at Women's Health Hospital, Assiut, Egypt between October 2012 and October 2013. All patients were evaluated by 2D ultrasound for morphological features of the masses aided by doppler examination of their vessels. The final diagnosis was based on histopathological reports used as gold standard. One hundred forty-six patients were recruited, 104 with benign masses, 42 with malignant masses. Features that allowed statistically significant discrimination of benignity from malignancy were; volume of mass, type of mass, presence and thickness of septae, presence and length of papillary projections, location of vessels at colour Doppler and colour score. A scoring formula was supposed combined those features together to develop a new scoring system; Assiut Scoring System [ASS]. The cut-off score with the highest accuracy in detection of malignancy had a sensitivity of 93.5% and specificity of '92.2%. Assiut Scoring System; a multiparameter scoring that use four 2D ultrasound and two doppler features, has a high sensitivity and specificity for prediction of malignancy in adnexal masses

Unplanned versus planned extubation in respiratory intensive care unit, predictors of outcome

The incidence of post-intensive care unit admission complications is high; some of these complications are inevitable and often leads to medical emergencies. Among these complications is the extubation failure whether resulted from planned extubation which is prepared and performed by the medical team or unplanned extubation [UE]. Unplanned extubation [UE] is a real event in all ICUS worldwide and is considered as one of the major complications in mechanically ventilated patients. However, its impact on mortality, duration of mechanical ventilation [MV] as well as predictors of UE and need for reintubation had not been adequately defined. To define the profile of the patients at risk of unplanned extubation and establish predictive criteria for extubation outcome. This study was carried out in the Respiratory Intensive Care Unit of Chest Department, Zagazig University Hospitals during the period from March 2010 to January 2011. Sixty-seven invasively mechanically ventilated patients who were admitted to the RICU were enrolled in the study. They were [47] males and [20] females with mean age [51.56 +/- 6.28] years. Patients were admitted to the RICU because of one of the following diagnostic categories; acute exacerbation of chronic obstructive pulmonary disease [AECOPD] [41 patients], Pneumonia [6 patients], Bronchial asthma [2 patients], Pulmonary edema [5 patients], Bronchiectasis [6 patients], Systemic lupus erythematosus [1 patient], interstitial lung disease [ILD] [1 patient], Infected cystic lung [1 patient], Overlap syndrome [4 patients]. Patients were classified into two groups according to the way of extubation: Group I: Unplanned extubation group [they were 27 patients who underwent UE either self inflicted [13 patients] or accidental extubation [14 patients] and Group II: Planned extubation group [they were 40 patients who fulfilled weaning criteria and tolerated 2-hspontaneous breathing trial through T-tube without signs of distress and followed by extubatu after 24 h]. On admission to ICU the following were carried out and recorded for all patients: Full medical history from the patient [if possible] or his relatives, history of previous intubation and/or ventilatory support and Presence of co morbidities, Full clinical examination, Plain chest and heart X-ray, Arterial blood gases, Routine laboratory investigations, Mechanical ventilation, Assessment of APACHE III score [acute physiology and chronic health evaluation score] Assessment of Glasgow Coma Score [GCS] and Assessment of sequential Organ failure score [SOFA]. During ICU stay, assessment of the following parameters was done daily including: GCS, Evidence of agitation. Use of sedatives, Degree of sedation using Ramsay Sedation Scoring System, Presence of any physical restrains [Wrist restraints], Amount of endotracheal secretion, Assessment of the strength of the cough reflex by cough strength scale, Nine equivalents of nursing manpower use score [NEMS] to assess nursing workload and Arterial blood gases. If unplanned extubation occurred during anytime before weaning, the following were reported: Time of UE, Ventilation parameters at the time of UE [ventilatory mode, FIO2tidal volume, rate, amount of pressure support and PEEP], Presence of agitation, use of physical restraints, Use of sedation, Last Ramsay score, Last cough strength scale, Last endotracheal secretion scale, GCS at time of extubation, SOFA score at time of extubation, Last NEMS score, Last ABG. If patient passed to weaning and tolerated SBT for 2 h the following tests were performed before extubation in addition to assessment of the same parameters reported among patients in the UE group including Assessment of swallowing by swallowing score, Minute ventilation recovery time, Dead space addition test [DSA], Cuff leak test. The Outcome of the studied patients as regards extubation was categorized into either extubation success or failure. Also the Outcome of the studied cases as regards mortality was classified into either survival or death. The results of this study revealed that the frequency of planned extubation represents 59.7% while unplanned extubation represents 40.3% of the studied subjects. There is no significant difference between planned and unplanned extubation as regards the cause of admission to ICU, [P > 0.05] with predominance of COPD exacerbation which represents 61.19% of the studied population. On starting MV there is an increased risk of unplanned extubation in a significant way with the presence of agitation [74.07%] and decreased the percentage of use of sedation [37.04%], use of physical restraints [77.78%] and lower Ramsay score value [1.33 +/- .48], [P value <0.05]. There is no significant difference as regards history of previous MV, NEMS score and type of respiratory failure between planned and unplanned extubation, [P value > 0.05]. Successful extubation is significantly higher in the planned extubation group [75%] in comparison to the unplanned extubation group [18.52%] while extubation failure is significantly higher among the unplanned extubation group [81.48%] in comparison to [25%] in the planned extubation group, [P value < 0.05]. Survival represents 92.5% in the planned extubation group and 59.26% in the unplanned extubation group with statistical significance. There is a significant increase in the risk of failed extubation among the unplanned extubation group with moderate and large amounts of E/T secretions [86.36%] and with extubation at the night shift [63.64%], [P value < 0.05]. But there is no significant difference among failures or succeeders as regards use of physical restraints, presence of agitation and sedation. There is a significant increase in the risk of failed extubation in the unplanned extubation group with a longer duration of MV [7.32 +/- 2.22] days, with increased PaCO2 [54 +/- 7.7] mmHg, with Pa02/ FIO[2] <200, with decreased GCS [11.36 +/- 1.9] and lower cough strength scale [1.7 +/- .7], [P value < 0.05]. On the other hand there is no significant difference between successful and failed extubation as regards PH value, Ramsay score, NEMS score and SOFA score, [P value > 0 .05]. The frequency of both ways of unplanned extubation in the studied subjects revealed that self inflicted extubation represents 48.15% while accidental extubation represents 51.85%. There is a significant increase in the duration of MV in self inflicted than in accidental extubation [6.07 +/- 2.76 VS 3.35 +/- 1.13 days], [P value <0.05]. There is an increased risk of self inflicted extubation with the use of physical restraints [92.31%] and presence of agitation [84.62%], [P value <0.05]. But there is no significant difference among them as regards time of extubation, Ramsay score, NEMS, GCS and use of sedation. Successful extubation is significantly higher in the self inflicted group [30.77%] in comparison to the accidental extubation group [7.14%], [P value < 0.05]. Survival represents [61.54%] in the self inflicted group and [57.14]% in the accidental extubation group but without any significant difference, [P value > 0.05]. Most of successful extubations among the planned extubation group have a mild amount of E/T secretions [86.67%] and without use of sedation [100%] with a significant difference where extubation failure is significantly higher in moderate and large amounts of E/T secretions, [60%], [P value < 0.05]. All patients with planned extubation whether successful or failures have been extubated at the morning shift. On the other hand, there is no significant difference between succeeders and failures as regards use of physical restraints and presence of agitation. There is an increased risk of failed extubation among planned extubation with a longer duration of MV [7.6 +/- 1.07 days] higher values of PaCO[2] [53 +/- 1.76] mmHg and lowerPaO[2]/FIO[2] [202 +/- 8.23] and cough strength scale [2] in comparison to succeeders, [P value < 0.05]. There is not any significant difference between succeeders and failures as regards, NEMS, SOFA, GCS and Ramsay scores, [P > 0.05]. Increased minute ventilation recovery time [12.6 +/- 4.7] minutes, and a lower value of swallowing score [13.8 +/- 2.62] carry the risk of failed extubation in a significant way, [P value < 0.05]. An increase in severity of illness on ICU admission, agitation, less use of sedation with lower Ramsay score during MV intensify the risk of unplanned extubation, which usually occurs during the night shift, even with the use of physical restraints. Unplanned extubation is associated with an increased incidence of failed extubation [especially with accidental extubation] and mortality. Factors affecting airway competence; magnitude of cough on command and abundant amount of E/T secretions are significant predictors of extubation failure in planned and unplanned extubation. Prolonged minute ventilation recovery time, failed DSA test and lower swallowing score are associated with an increased risk of failed planned extubation

Colon cancer metastasis to the thyroid gland

Thyroid metastasis originating from colon cancer is an uncommon clinical entity. We present a case of a 40-year-old Saudi male patient that was known to have metastatic adenocarcinoma of the colon, and who presented initially with hoarseness of voice. A left thyroid lesion was found and fine-needle aspiration biopsy showed that it was a colon cancer metastasis. His condition later deteriorated with development of stridor. Tracheostomy was performed and the diagnosis was confirmed by biopsy. A high index of suspicion is required to consider colorectal carcinoma metastatic to the thyroid

Assessment of health-related quality of life among adolescents with type 1 diabetes mellitus in Saudi Arabia

To evaluate the health-related quality of life [HRQoL] for adolescents with type 1 diabetes mellitus [T1DM]. A cross-sectional study was conducted among 214 adolescents [13-18 years] with T1DM at the Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia from June to September 2013. Respondents were selected by their availability during routine visits to outpatient clinics, and interviewed using the Arabic translated version of the Pediatric Quality of Life Inventory 3.0 Diabetes Module [PedsQL 3.0 DM] independently. Female gender, multiple daily injection [MDI], longer duration of T1DM [>7 years], diabetic ketoacidosis [DKA] and adolescents with >7 HbA1c level had at least one poor HRQoL outcome. Multivariate linear regression analysis showed that age, treatment type [MDI], DKA, and >7 HbA1c were independent influencing factors for subscale diabetes symptoms, whereas >7 HbA1c was the independent influencing factor for treatment barriers and overall HRQoL. The DKA was the independent influencing factor for the subscale of worry, and female gender was the independent influencing factor for the subscale of communication. Female gender, age, treatment type, >7 HbA1c, and DKA are the strongest determinants for lower HRQoL for at least one subscale of the PedsQL 3.0 DM

Smokeless tobacco consumption in a multi-ethnic community in Pakistan: a cross-sectional study

Smokeless tobacco is commonly used in south Asia. In addition to causing oral and pharyngeal cancers, its harmful effects are comparable to smoking tobacco. A cross-sectional survey with systematic sampling was conducted in 2010-2011 to investigate smokeless tobacco use in a multi-ethnic, semi-urban population in Islamabad, Pakistan [n = 2030]. The prevalence of smokeless tobacco use was 16.0% [21.6% among males and 8.8% among females]; 51.7% of smokeless tobacco users were also cigarette smokers. The rate of smokeless tobacco use was comparatively high among Pakhtun males [38.2%] and Sindhi females [22.4%]. The associations between smokeless tobacco use and ethnicity, age group, income level and cigarette smoking were statistically significant among male smokeless tobacco users. Of the sample 41.4% [840/2030] had inadequate knowledge about the health problems associated with smokeless tobacco. Appropriate interventions are needed to raise awareness of the health risks and to prevent smokeless tobacco use

Burn wound infection; significance of rule of nine in microbial surveillance

Burn injuries are common and major health problem throughout the world. The burn wound represents as a favorable area for opportunistic colonization of microorganisms with exogenous and endogenous origin. In burns patients infections arise from multiple sources. Burn wounds become initially colonized and infected with Gram positive bacteria, mainly Staphylococci, that are superseded during the second week by Gram Negative bacteria. it is a microbial surveillance retrospective study; that aimed to evaluate the significance of Rule of nine in diagnosis of aerobic bacterial burn wound infection and carried out in between June 2007 to September 2011 in the Department of Pharmaceutics, University of Karachi.Descriptive retrospective study. A total of 118 patient irrespective of age, sex, date and time of burn, date and time of hospital admission, interval between time of burn and hospital admission, degree and percentage [%] of burn and duration of hospital stay [when specimen collected] were registered for this study. All patients were divided into two groups [A and B]. Out of 58 patients of group A isolation rate per patient was 1.1 while in group B it becomes 3.0. According to TBSA the isolation rate in group B rises with rise in TBSA. Most prevalent organism in these patients was found S. aureus[23%] P.aeruginosa[21%]. Burn patients are incubator for variety of aerobic bacteria and rate of isolation of these organisms increase with rise in TBSA. The wounds of these patient must required continuous microbial surveillance that may reduce the rate of mortality

Immunohistochemical expression of vascular endothelial growth factor receptors FIt1 and KDR in the endometrium during the estrus cycle in albino rats

Angiogenesis is an important process in endometrial development and embryonic implantation and is regulated through vascular endothelial growth factor [VEGF]; its receptors Flt1 and KDR. This work aimed to study the immunoexpression of VEGF receptors [VEGF-Rs] in the endometrium at different ages and reproductive phases and correlate them with the histological profiles in these phases. Seventy female albino rats were included in this study. They were divided into seven groups of 10 rats each: one group consisted of rats in the prepubertal period at age 4-6 weeks; five groups consisted of rats in the reproductive period at age 6-10 months, which were divided according to estrus cycle phases into proestrus, estrus, metestrus, diestrus, and pregnant groups; and the sixth group consisted of rats in the postmenopausal period at age 15-18 months. The uteri of all rats were removed and processed for staining with H and E and were subjected to immunohistochemical staining for Flt1 and KDR. For morphometric measurements, uterine wall thickness and Flt1 and KDR optical density in the endometrial surface epithelium, glandular epithelium, stromal cells, and endometrial endothelial cells were measured using image analysis. Results were statistically compared. The expression of VEGF-Rs was highest in the pubertal age group with marked expression of these receptors in the proestrus phase followed by the estrus phase. This supports the role of sex hormones, especially the estrogen hormone, in regulating VEGF-R expression. The Flt1 receptor was predominantly expressed in endometrial and stromal cells as well as in blastocysts, whereas the KDR receptor was predominantly expressed in endometrial endothelial cells. Comparison among all groups and then between each two groups revealed statistically significant differences in the measured morphometric parameters. The upregulation of Flt1 and KDR could be involved in the regulation of endometrial endothelial cell proliferation and in increase in endometrial vascular permeability, especially at implantation sites

Ileocaecal TB with multiple hepatic granuloma mimicking malignancy with metastasis to liver

Abdominal tuberculosis is a rare manifestation of tuberculosis[1]. It can involve any part of the gastrointestinal tract but the most likely sites of infection are the peritoneum and the ileo-caecal region. We present unusual a case of Ileocaecal TB with multiple hepatic granuloma mimicking malignancy with metastasis to liver. A 38 years old male, Sudanese, had two months history of painful tender mass in the right iliac fossa that was associated with low grade fever, constipation and loss of appetite. He had no symptoms or signs related to other systems and he denied any contact with chronic cough patient. ESR 100mm/hr, normal CXR, ultrasound revealed multiple hypoechoic liver focal lesions, multiple para-aortic Lymph node and a thick wall terminal ilium. CT abdomen showed bowel segment with wall thickening and irregular lumen in the right iliac fossa, enlarge para-aortic lymph nodes and multiple hepatic focal lesions which gave the impression of caecal carcinoma with liver metastasis. OGD was reported as normal. Colonoscopy revealed an abnormal mucosa at the caecum, suspicious of carcinoma caecum. Multiple biopsies were taken. Histopathology revealed epithelioid granulomas with Langhans giant cells as well as areas of mild cryptitis, could be either tuberculosis or Crohns disease, Ultrasound guided liver biopsy from the focal lesions revealed epithelioid cells and poorly formed granulomas with areas of caseation and fibrosis suggestive of tuberculosis. PCR for aspirate from liver focal lesion biopsy was positive for tuberculosis. The patient was treated with antituberculous chemotherapy. Complete cure was obtained during follow up

Limb-salvage angioplasty in poor surgical chronic liver disease and diabetic patients

Critical limb ischemia [CLI] in high surgical risk patients with chronic liver diseases has a grave prognosis with a one-year mortality rate of 20% and a one- year amputation rate of 25% after the initial diagnosis. According to Trans-Atlantic Inter-Society Consensus [TASC]-II Guidelines, revascularization [surgical and endovascular] is the treatment of choice for patients with critical limb ischemia [CLI]. The primary goal of revascularization is to relieve ischemic rest pain, heal ulcers, prevent amputation, improve patient's quality of life [limb salvage] and secondary goal was the periprocedural complications. Endovascular techniques include balloon angioplasty, stents, stent-grafts, and plaque debulking procedures. Surgical options, identification of patients at risk of postoperative complications could have an impact on the indications for a procedure as well as permitting modifications of treatment to reduce the surgical risk. This study evaluated the treatment out comes after limb salvage angioplasty for patients who otherwise would be candidates for primary amputation due to poor co-morbid conditions as chronic liver disease and diabetes. The clinical evaluation, laboratory investigations and abdominal ultrasonography were performed to all patients to evaluate their liver status. Patients were classified according to Child-pugh classification into child A, B and C. All patients were subjected to either detailed arterial duplex or C.T. angiography to assess their arterial lesions from January 2008- January 2010. 95 patients with critical limb ischemia [Rutherford categories 4, 5, 6] were treated by primary percutaneous transluminal angioplasty [PTA]. No patient was excluded on the basis of the extent of arterial occlusive disease. The primary end points were immediate technical success, clinical improvement and limb salvages rates. Secondary end points were periprocedural complications and mortality. Most of the patients were male [54.7%] with mean age 62 [48-70 years]. Underlying cirrhosis due to HCV was [82.2%], HBV [5.4%], while mixed viral infections was [12.4%]. 54% were categorized as Child B, 32% as child A and 14% as child C. Associated diabetes mellitus was present in 96% of the cases, hypertension in 64.2%, ischemic heart disease in 74% and hyperlipedemia in 32%. Rest pain, tissue loss, or both, were the presenting symptoms in 83% while infection and ulcer were present in the other 17% of patients. The total numbers of interventions were 154; the treated lesions were 89 in the tibial arteries, 12 in the popliteal artery, 44 in the superficial femoral artery, 3 in the common femoral artery and 6 in the iliac arteries with initial technical success rate of 93.6% and periprocedural complications of 12.6%. All patients were in Rutherford clinical category 4, 5, 6 none of these patients had a previous bypass operation. Mean follow-up was 15 months. The limb-salvage rate was 87.4%. Eighty patients [84.2%] of toe amputation sites healed primarily, three patients with rest pain had resolution of their symptoms after angioplasty. All technical failures were due to inability to cross the lesions. Of the 6 technical failures, 4 required amputation, and 2 refused any further therapy

Paraspinal tuberculosis mimicking malignancy

Tuberculosis [TB] of the paraspinal muscles is a rare clinical entity. We present a case of an 18-year-old, Saudi male patient presenting with the clinical picture of a paraspinal mass that turned out to be paraspinal TB. It originated from the paraspinal tissues and muscles, and invaded the C6 and C7 vertebrae. Initially, it was highly suspicious for malignancy. A biopsy confirmed the diagnosis of TB, and the patient was treated successfully with anti-TB therapy. It is important to be aware that paraspinal TB can mimic malignancy

Serum interleukin-18 levels in patients with systemic lupus erythematosus: relation with disease activity and lupus nephritis

To further investigate the possible role of IL-18 in the pathogenesis of systemic lupus erythematosus [SLE] and development of lupus nephritis [LN], and to explore its relationship with pathological classes of LN, degree of acute renal activity and chronic damage. Forty-one SLE patients with LN, thirty-one lupus non-nephritis patients and fifteen age and sex matched healthy controls were enrolled in this study. SLE patients were subjected to disease activity assessment by SLEDAI, renal disease activity assessment by the Systemic Lupus International Collaborating Clinics [SLICC] Renal Activity Score, laboratory investigations including measurement of serum interleukin-18 using Enzyme Linked Immunosorbent Assay. Renal biopsy was obtained from LN patients and pathological classification was made according to World Health Organization [WHO] criteria. Analysis of activity and chronicity indices was done on these biopsy specimens. Serum levels of IL-18 were significantly higher in patients with LN than lupus non-nephritis patients and healthy controls [p < 0.001]. There were significant correlations between IL-18 and SLEDAI [p = 0.002], proteinuria [p = 0.027], renal activity score [p = 0.003] and activity index [p = 0.039] in patients with LN. There was no significant difference in the serum levels of IL-18 between WHO classes of LN IL-18 appears to have a pathogenic role in the development of SLE and plays a crucial role in triggering inflammation in LN. Serum IL-18 levels could be a useful biomarker to assess the activity of renal disease in SLE

Pattern of morbidity and mortality in Karbala hospitals during Ashura mass gathering at Karbala, Iraq, 2010

Religious mass gatherings are increasingly common in Iraq and can harbour considerable public health risks. This study was aimed at determining morbidity and mortality patterns in hospitals in Karbala city, Iraq during the mass gathering for Ashura in 2010. We conducted a cross-sectional study on attendees at the 3 public hospitals in the city. The study period was divided into pre-event, event, and post-event phases. Morbidity and mortality data were obtained from hospital registry books and the coroner's office. About 80% of the 18 415 consultations were at emergency rooms. Average daily emergency room attendance was higher during the event compared with pre- and post-event phases, while average daily admissions decreased. Compared with the pre-event phase, a 7-fold increase in febrile disorders and a 2-fold increase in chronic diseases and injuries were noted during the event phase. There was no difference between the 3 phases for average daily death rate,nor for cause of death

Primary health care: what is it and what is it not? Views of teaching faculty at an undergraduate medical college in Pakistan

Over 30 years after the Alma-Ata declaration on primary health care in 1978 there are still misconceptions about the basic concept of primary health care. This study aimed to investigate the knowledge and opinions about various aspects of primary health care and its appropriate implementation among the teaching faculty at Shifa College of Medicine in Islamabad, Pakistan. A structured questionnaire was answered by 70 physicians present at the end of the month seminar. Two-thirds of the doctors [67.1%] believed that primary health care involved only basic health care for common illnesses. Few respondents suggested that community-oriented programmes [4.3%], maternal and child health [2.9%], screening [1.0%] or treatment of noncommunicable diseases [2.9%] should be components of primary care. The concepts to primary health care as defined at Alma-Ata in 1978 were not well understood by teaching faculty from the basic and clinical health sciences in this medical college

Reasons for cancellation of elective cardiac surgery at Prince Sultan cardiac centre, Saudi Arabia

The cancellation of surgery is a significant drain on health resources. However, a persistent problem in most hospitals is short notice cancellation of scheduled operations, even upto the day of surgery. In some cases, patients have been prepared for surgery, and the staff is assembled and expecting to operate. In UK 8% of scheduled elective operations are cancelled within 24 hours of surgery. The reasons include cancellation by the patient, cancellation for poorly optimized medical conditions, or cancellations due to poor organization. Many of these are difficult to quantify. However, one relatively easily measured factor is the possibility that some operating lists were predictably overbooked. An operating list may over-run because of delayed starts, slow turnover, unanticipated surgical/anaesthetic problems or staff shortages. Many of these are difficult to quantify. Prince Sultan Cardiac center is one of the largest referral center in the Middle East and there is no published data on the reasons for cancellation of specifically cardiac procedures. However, an audit was performed to assess the reasons for the cancellation of the cases on the day of surgery in cardiac theatres. According to one of the studies published in an Australian journal the percentage of cancelled cardiothoracic cases was determined to be 15.8%.Total number of cardiac surgical patients including pediatric and adult during a period from June 2008 to May 2009 were 2191. Out of those, 1681 cases were done during the study period, 510 [23.27%] cases were cancelled during the study period. The operation theatre was functional for 331 days during the study period. Cancellations done by the surgeons were 34% while the patient's related cancellations were 32%. The administrative issues contributed to 34% in overall cancellation and anaesthetist-related cancellation were 0%.We estimated 22% of the elective operations which were cancelled on the day of surgery were potentially avoidable. There is still a need to do further research to look for the identifiable reasons and strategic measures to eliminate the reasons for cancellation on the day of surgery

Risk factors for surgical site infection in clean surgeries in Abbasi Shaheed Hospital

To assess the risk of surgical site infection in clean surgeries associated with age, sex and duration of surgery in Abbasi Shaheed Hospital. This study is a Case control study and was conducted in surgical Unit-1, Abbasi Shaheed Hospital, Karachi from January 2006 to December 2008. Its sample size is Non-probability, convenience and 150 patients were taken for this study in which 100 patients with healthy surgical site were taken as control while 50 patients with infected surgical site were taken as the cases. All male and female patients of age between 18 to 55 years were included in this study. For ail diabetic and non-diabetic patients who were admitted in ward for elective clean surgery, same method of skin preparation was under taken with povidone iodine and spirit. Control were patients without surgical site infection while cases were patients with surgical site infection. All patients received three doses of prophylactic antibiotic first generation cephalosporin 500 mg i/v Shourly preoperatively. SPSS version 10 was used to analyze the data. The ages of the patients were between 18-55 years with increased risk of surgical site infection with increasing age. Out of 50 patients with surgical site infection, 28 [56%] were diabetic and 22 [44%] were non-diabetic. It was seen that 24 patients [16%] had surgery of duration 46-60 minutes and 12 of them [50%] had surgical site infection as compared to 36% in surgery of less than 30 min. Odd ratio of infection for diabetes, duration of surgery, age and gender were 10.3, 6.5, 3.1 and 1.3 respectively. Significant association was found between type, duration of surgery and ASA score. Adjusted analysis revealed a significant relation between age, ASA class, diabetes mellitus, uncontrolled postoperative blood glucose level, duration of surgery and surgical site infection. Mastectomy was significantly associated with surgical site infections along with longer duration and ASA class III

Knowledge, practice and attitude toward epilepsy among primary and secondary school teachers in South Gezira locality, Gezira State, Sudan

The attitudes toward school pupils with epilepsy are influenced by the degree of school teachers' knowledge of the disorder. Teachers usually do not receive any formal instructions on epilepsy during their training. This study aims to assess school teachers' knowledge, attitude and practice when dealing with epilepsy in school children. This study was part of a series mandated by the Gezira Epilepsy Care Programme [GECP], to obtain baseline data for a community-adapted epilepsy education program. A pretested, semi-structured, 35-items questionnaire was the investigational tool. It was used to evaluate the knowledge of the basic facts about epilepsy among school teachers in this cross-sectional study. The questionnaire allowed teachers to express their opinions by means of free answers. The schools were chosen at random but not in a systematic equiprobability design. Two hundred teachers from public primary [100] and secondary [100] schools in the rural area of south Gezira Locality, Gezira State, Central Sudan, were recruited. In this study, the majority of respondents had never been informed about epilepsy and therefore gave evasive answers to many questions. Few of the respondents considered epilepsy as contagious. None of participants objected to having epileptic children in their classes. Only 47 teachers [47%] in the primary schools had any knowledge of the initial procedures to help a child in seizure, presenting reasonable answers, compared to 64 [64%] teachers in the secondary schools. All school teachers should be given some kind of training in health services. The GECP should involve teachers in its current training programs for caregivers and lay association to help epileptic patients

Desmoid tumour of lower abdomen

A desmoid tumour is slow growing fibromatosis with aggressive infiltration of adjacent tissue and extremely unusual systemic metastases. We report a case of a female patient aged 25 years who had a mass in lower abdomen for 2 years. There was no previous history of any surgical intervention. Preoperative evaluation included ultrasound and computed tomography. Patient underwent primary resection with wide margins. Histology revealed a desmoid tumour