Prevalence of pulmonary hypertension in patients with chronic kidney disease on and without dialysis

Background: Pulmonary arterial hypertension is a newly recognized disease in patients with renal disease. In a recent review, the prevalence of PHT in ESRD patients was reported to be around 40-50%

Aim of the work: To evaluate the prevalence of primary pulmonary hypertension among CKD patients on and without dialysis and to compare clinical, hemodynamic, and metabolic variables among patients with and without PH to search for possible etiologic factors

Patients and methods: Our study included 99 CKD patients; 65 patients on hemodialysis, 12 on peritoneal dialysis and 22 on conservative management. Detailed medical history, examination, and complete laboratory investigations were obtained. Systolic PAP, EF% and cardiac output were evaluated by Doppler echocardiography and AVF flow by Doppler ultrasound

Results: A high prevalence of pulmonary hypertension was demonstrated among 27 patients [41.53%] receiving long-term hemodialysis with a mean systolic PAP of 49.33 +/- 9.18 mmHg; as well as in two patients [16.66%] receiving peritoneal dialysis 43 +/- 1.41 mmHg, and in five patients [[22.72%] receiving conservative management 44.8 +/- 5.89 mmHg

Conclusion: This study demonstrated a high prevalence of pulmonary hypertension among patients with CKD on and without dialysis. The prevalence was highest among patients with ESRD receiving long-term hemodialysis [41.53%] especially in patients with older age, longer duration of dialysis treatment, higher AV fistula flow, cardiac output

Immunohistochemical expression of cell-cycle proteins in renal cell carcinoma and their prognostic significance

Molecular markers that predict prognosis more than stage and grade remain the elusive holy grail of renal cell carcinoma [RCC researchers]. Many molecules have been identified, as a consequence of the elucidation of the molecular biology of RCC progression and metastasis, but few have remained significant above clinical and pathologic factors in multivariate analysis. The goal of the study was to evaluate Immunohistochemical expression of the cell-cycle regulatory proteins p27 [Kipl] and cyclin E in normal human kidneys and renal cell carcinoma [RCC] tissues. Association was analyzed with cancer clinical parameters. We have examined the protein contents of cyclin E and p27 in 57 cases of RCCs, using immunohistochemistry. We found significantly increased expression of p27 in normal tissue relative to tumor [p=0.015]. Low protein content of p27 was associated with high TNM stage, lymph node status and poor prognosis for patients with renal cell carcinoma. No significant association with grade, gender or age we further observed substantial differences in the pattern of G1/S regulatory defects between the different RCC subtypes. The majority of both conventional and papillary cases expressed p2'7, however, chromophobe tumours generally showed low p27 staining. Conversely, high expression of cyclin E was demonstrated in renal cell carcinoma tissue relative to normal kidney [p=0.027] and was associated with high nuclear grade and stage. No significant association with lymph node metastases, gender, age, tumor recurrence, death or survival. We further observed that papillary RCCs exhibited high cyclin E than other two subtypes. In conclusion, this study shown that cyclin E as well as p27 were deregulated in renal cell carcinoma and that loss of p27[Kipl] expression is a risk factor for the disease recurrence and cancer-related patient death

Analysis of paracetaiiviol and ascorbic acid in pharmaceutical binary mixture

Two simple and sensitive spectrophotometric methods were developed for the determinagion of paracetamol [I] and ascorbic acid [II] in pharmaceutical binary mixture. The first method depends on the use of the first-derivative spectrophotometric technique for the slinultaneons determination of components of the mixture. The second method depends on the reaction of the studied drugs with 5-diazo-1, 2, 4-triazol-3-carboxylic acid [DTCA] reagent to give colored products measured at 480 nm and 580 nm for [I] and [II] respectively. All variables affecting reaction conditions were optimized The proposed methods were successfully applied for the analysis of the studied drugs in their pare and commercial dosage forms and are in good agreement with those obtained from the reported methods. No significant difference in the acuracy and precision as revealed by the accepted values of t- and F-tests, respectively. Molar ratios of the drugs with the colorimetric reagent [DTCA] were determined and the reaction mechanisms were suggested

Utility of certain spectrofluorimetric methods for analysis of two pharmaceutical binary mixtures

Simple and very sensitive spectrofluorimetric methods were developed for determination of adrenaline [I] -procaine hydrochloride [II] mixture and salbutamol sulfate [III] - guaifenesin [IV] mixture. adrenaline [I] in the first mixture was determined by coupling with 5-diazo-l,2,4-triazolo-3-carboxylic acid [DTCA] reagent in alkaline medium forming fluorigenic product which can be measured at 340 nm [lambda ex. 245 nm], while procaine hydrochloride [II] gave no fluorescence. salbutamol sulfate [III] was analyzed by reaction with ethyl acetoacetate [eaa] forming coumarin derivative, which can be measured at 320 nm lambda ex. 280 nm]. guaifenesin [iv], the second drug in mixture has a considerable native fluorescence in methanol was measured at 310 nm [lambda ex. 230 nm]. all variables affecting reaction conditions were optimized. linear correlations were obtained over the range of 19-100, 37-400 and 22-150 ng/ml for [I], [III] and [IV], respectively. the proposed methods were successfully applied for the analysis of the studied drugs in their pure and commercial dosage forms and the obtained results were in good agreement with those obtained from the reported methods; no significant difference in the accuracy and precision as revealed by the accepted values of t-and f-tests, respectively

Spectrophotometric determination of certain drugs using ammonium cerium [IV] sulfate and p-dimethylaminobenzaldehyde

A spectrophotometric method for the determination of acetylcysteine, captopril carbimazole propylthiouracel and thiopental sodium is described. The method was based on the oxidation of the studied drugs with excess ammonium cerium [IV] sulfate. Followed by measuring the excess unreacted ammonium cerium [IV] sulfate, through reaction with p-DMAB into the corresponding p-dimethylaminobenzoquinone, which has a red colour can be measured at 464 nm. The decrease in the absorption intensity at 464 nm caused by the presence of the investigated drugs is directly proportional to their concentration. Investigations were carried out to study all variables and a validation study for the proposed procedure according to USP 2002 was also performed. Beer's law was obeyed in the range of 1-40 micro.g/ml. The detection limit ranged from 0.22-1.22 micro g/ml, while the quantitation limit ranged from 0.73-4.06 micro g/ml. The proposed method was successfully applied for the analysis of the studied drugs in pharmaceutical preparations with good recoveries in the range of 98.12-100.02%. Results were compared with those obtained from the pharmacopoeial or reported methods

Low-dose combined spinal epidural versus general anaesthesia for elective caesarean delivery: a comparative study

Combined spinal epidural [CSE] technique has allowed intrathecal doses of local anesthetic to be greatly reduced. Although regional anaesthesia is the preferred anaesthetic technique for caesarean section, general anaesthesia is still required in certain situations. The present study was designed to compare intraoperative haemodynamics, total ephedrine consumption, blood loss and postoperative analgesia of low-dose combined spinal epidural anesthesia with general anesthesia for uncomplicated elective caesarean delivery. Sixty ASAI parturients, with gestational age>36weeks with intrauterine single fetus scheduled for elective caesarean delivery. Patients were classified into 2 equal groups. Group 1: Low-dose Combined SpinAl Epidural Anaesthesia group [CSE]. Patients received subarachnoid 0.5% hyperbaric bupivacaine 6 mg mixed with fentanyl 20 micro g, and epidural 0.25% bupivacaine 10 mL. Group 2: General Anaesthesia group [GA]. Patients were induced by propofol, succinyl choline and atracurium with 50% nitrous oxide in oxygen and isoflurane 0.75%. After fetal delivery fentanyl was injected 1A micro g/kg, with with 60% nitrous oxide in oxygen and isoflurane 0.5%. There were nonsignificant differences regarding demographic data. Haemodynamic measurements showed nonsignificant changes in group1, while showed a significant increase in MABP and HR after induction and during extubation. There was a significant increase in total ephedrine consumption in group 1, while there was significant increases in blood loss, total amount of morphine consumption and VAS score in group 2. We conclude that low-dose combined spinal epidural anaesthesia is preferred to general anaesthesia for elective uncomplicated caesarean delivery with regard to haemodynamics, intraoperative blood loss and postoperative analgesia

Comparative evaluation of intrathecal minidose bupivacaine / fentanyl vs. conventional dose of bupivacaine for surgical repair of inguinal hernia in elderly patients

Spinal anesthesia is often used for surgical repair of inguinal hernia in the geriatric population. Intrathecal opioids enhance analgesia from subtherapeutic doses of local anesthetic and make it possible to achieve successful spinal anesthesia using otherwise inadequate doses of local anesthetic. This study was designed to investigate and compare whether a modification of the spinal anesthesia technique with addition of opioid to the injectate, combined with a reduction in the amount of bupivacaine versus conventional dose, could be effective procedure, with stable haemodynamics, maintain postoperative pain relief and reduce the recovery time, thus making spinal anesthesia more suitable for ambulatory inguinal herniorrhaphy. Forty patients ASA physical status I-III were classified into 2 equal groups. Group 1 received intrathecal bupivacaine 5 mg plus fentanyl 20microg. Group2 received intrathecal bupivacaine 15 mg only. Comparison of the 2 groups was in accordance to time of onset, level of sensory blockade, duration of analgesia, mean arterial blood pressure, heart rate, degree of pain sensation using visual analogue scale, intraoperative and postoperative nausea and vomiting, total amount of vasopressor used and time to recovery and home discharge. Our results showed that the time of onset of maximal blockade was slightly faster in the minidose group patients than the other group. The peak sensory level was higher in the conventional dose group patients. The conventional dose group patients were more likely to require treatment of hypotension than patients in the minidose bupivacaine-fentanyl group. Total amount of ephedrine requirements were in conventional dose group than the minidose bupivacaine-fentanyl group. Recovery and home discharge time was nonsignificantly prolonged in conventional dose group. Minidose of 5 mg bupivacaine in combination with 20 microg fentanyl provided spinal anesthesia for surgical repair of inguinal hernia in the elderly. The minidose combination caused dramatically less hypotension than 15 mg bupivacaine and nearly eliminated the need for vasopressor support of blood pressure

Accuracy of low dose dobutamine echocardiography in detection of myocardial viability experience of menofia university

The identification of severely dysfunctional but viable myocardium is of particular importance for the selection of patients with depressed left ventricular function who will benefit from coronary revascularization. Assessment of inotropic reserve with dobutamine has recently been used for this purpose. Aim of the Study: Detecting the accuracy of low-dose dobutamine echocardiography [DSE] for the identification of viable myocardium in patients with previous myocardial infarction. Resting and low-dose dobutamine [7.5ag/kg/min] echocardiography [R and DSE] and resting post-revascularization echocardiography [PRecho] [3 months later] were prospectively studied in 33 patients with previous myocardial infarction and severely depressed regional function. Revascularization had been done either by CABG or PTCA for all patients. Wall motion assessment was done using 4 point score with 1 normal and 4 dyskinetic and viable tissue was diagnosed by presence of contractile response [CR] during LDD infusion in echocardiography using 17 segment model. Out of the 561 myocardial segments resting echo [IR] revealed 367 segments with normal wall motion [NWM], 109 hypokinetic with [CR] in 83, 52 akinetic with [CR] in 24,33 dyskinetic with CR in 3. Post-revascularization echo. revealed 476 segments with NWM, 26 hypo, 28 ak., and 30 dyskinetic. Compared to PR DSE., degree of matching was S5.6%. Sensitivity and specificity for detection of viability was 79.6% and 100% respectively. DSE can be used accurately for detection of clinical viability and predicting early functional recovery post-revascularization.

Relation between left ventricular mass index [LVMI] and coronary artery disease in hypertensive patients with left ventricular hypertrophy [LVH]

It has been reported that coronary flow reserve decreased in nearly all patients when left ventricular mass index [LVMI] become 50% its normal values. Aim of Study: Correlation between LVMI, exercise ECG and coronary angiography findings to determine timing of catheterization in ischemic hypertensive patients. Three hundred and eight seven patients had been divided into group I with no hypertension including 195 cases, and group II with hypertension and included 192. The latter group had been subdivided into hypertensive with no left ventricular hypertrophy [LVH] 83/192 group IIa, and hypertensive with LVH 109/192 group IIb. This group IIb has been subdivided again into group IIbl with LVMI <20% 23 cases, group IIb2 with LVMI 20-<50% 13 cases and group IIb3 with LVMI 50% and including 73 cases. All cases had been subjected to clinical assessment, non-invasive assessment [resting ECG, exercise ECG, and Echocardiogram] and invasive test [coronary angiography]. Group I revealed 135 cases [69.3%] while group II showed 126 [65.6%] with CAD. The highest prevalence of CAD was observed in group IIb3. Stress ECG could detect CAD in group I with sensitivity of 53.3% versus 69.8% in group II [p=0.05] and speeificity of 90% versus 78.8% respectively with p<0.05

Plasmid-mediated high-level ceftriaxone resistance in a Salmonella enterica serotype typhimurium isolate

We evaluated ion exchange chromatography [IEC] on the Jeol Aminotac 500 analyzer for total homocysteine [tHcy] determination and compared it with an immunoassay method using fluorescence polarization on an Abbott IMx analyzer. IEC method validation [linearity, limit of detection, precision, interference] was made according to the French Biology Society guidelines [Societe Fran‡aise de Biologie Clinique]. Moreover, during a 2-month period, 55 plasma samples from patients scheduled for routine tHCy measurement were assayed by both methods for determining correlation. The IEC method was found linear up to at least 190 micro mol/l, and the limit of detection was 1.6 micro mol/l. Precision was studied with 3 controls at 6, 15 and 30 micro mol/l. Intra-assay coefficients of variation [n = 14] were 8.3, 3.1 and 2.3%, respectively, and inter-assay coefficients of variation [n = 15] were 9.6, 5.1 and 4.9%, respectively. No interference was found with other sulfur-containing amino acids [methionine, cysteine]. An excellent agreement was found between IEC and fluorescence polarization [Deming regression; y = 0.99x - 1.23; r = 0.97; p < 0.001]. The IEC method for tHcy measurement shows adequate precision and correlates highly with the IMx assay. The IEC method is more time-consuming but less expensive in reagent cost and allows simultaneous determination of plasma methionine concentration which may help to explain the underlying mechanism responsible for hyperhomocysteinemia

Photocatalytic degradation of mono-and di-sulfonic acid dyes on iron and copper modified MCM-41 and Y Zeolites

The photocatalytic degradation of mono- and di-sulfonic acid dyes [Acid yellow 99] and [Acid Red 44] were investigated in an aqueous medium using iron and copper modified MCM-41 and Y zeolites. The substrate for each was chosen as a simple model for the study of reactions involving some complex commercial products used for the dyeing of textile fibers. The decrease in concentration of both acid dyes was followed spectrophotometrically. The results obtained revealed that the different investigated catalytic systems, in presence of H[2]O[2], as oxygen carrier material enhanced the photocatalytic degradation process. However, the catalytic activity of Cu-modified MCM-41 system was bigger than those measured for the other catalytic systems. It has been found that the degradation process depends mainly on the generated OH radicals from irradiated H[2]O[2], because the catalyst alone has no effect

Incidence of bloodstream infections in a speciality hospital in Kuwait: 8-year experience

To determine the frequency of isolation and antibiotic-susceptibility patterns of clinically significant bacterial pathogens isolated from blood. The study was conducted over a period of 8 years [1995-2002] at Infectious Diseases Hospital [DH], Kuwait. Demographic and clinical data were obtained from medical records. 18,535 blood cultures were analyzed. Disk diffusion method was used to perform antibiotic-susceptibility testing. Minimum inhibitory concentrations of 9 antimicrobials were determined using E-test. Double disk [potentiation] test and E-test ESBL strips were used to detect the production of extended-spectrum beta-lactamases [ESBLs]. Salmonella spp. and Brucella spp. were predominant blood isolates, and represented 60.6 and 30.0% of all clinically significant episodes of bloodstream infections, respectively. Among the Salmonella, Salmonella enterica serotypes typhi and paratyphi A were most frequently isolated. The percentage of multidrug resistance [MDR] among them varied from 22 to 51%. A high percentage [40%] of MDR S. enterica serotypes typhi and paratyphi A also showed reduced susceptibility to ceftriaxone and ciprofloxacin. During the study period, Salmonella spp. and Brucella spp. were predominant blood isolates. MDR S. enter/ca serotypes typhi and paratyphiA, with reduced susceptibility to ceftriaxone and ciprofloxacin, are among the most frequent causes of bloodstream infections in IDH, suggesting the need to monitor their susceptibility

Oxidized diphenylamine as a spectrophotometrec reagent for the determination of some pharmaceutical thiols and thioamides

Oxidized diphenylamine is newly utilized as a redox spectrophotometric reagent for the determination of six pharmaceutically important thiol and thioamide drugs named: acetylcystiene, captopril, carbimazole, propylthiouracil, thiopental sodium, and tiopronin. The method is based on measurement of the decrease in absorption intensity of the oxidized diphenylamine [diphenylbenzidine violet, lambda max = 580 nm] reagent as a result of the reduction effect of the analysed drugs This reagent was instantaneously prepared by the oxidation of diphenylamine using ferric sulphate in sulphuric acid medium. The molar ratio of the chromogen reagent was determined to be 2:1; diphenylamine: iron [III]. The decrease in colour intensity was found to be quantitatively dependent on drug concentration. Experimental variables including reagent concentration, acid type and concentration, dilution solvent, reaction time, temperature and stability were studied and optimized. Validation parameters including linearity range, detection and quantitation limits, precision, selectivity and robustness were evaluated. The proposed method was found to be simple, sensitive and accurate one indicated by the studied validation parameters. Good recoveries [98.0 +/- 0.14 - 100%, +/- 0.98] were obtained by the suggested method and it was applied for the determination of the studied drugs in many pharmaceutical dosage forms available in the local market. Good agreement, indicated by acceptable t- and F- tests, was found between results obtained by the suggested method and those obtained by the reported or pharmacopoeial methods

Seroepidemiological and microbiological study of brucellosis in Kuwait

The primary objective of the study was to determine the prevalence of brucellosis and the antimicrobial susceptibility pattern of local Brucellae isolates in the Infectious Diseases Hospital, Kuwait. Subjects and A single serum sample was collected from each of 1,836 patients of different nationalities from January 2000 to December 2001. Any patient with a provisional diagnosis of fever or brucellosis had a standard tube agglutination [STA] test for the quantitation of Brucella antibodies. Blood cultures were done in 166 of 455 patients with significant STA titers, using the Bactec system. Antimicrobial susceptibility testing of 123 isolates of Brucella spp. was done against 8 antimicrobial agents. A total of 455 serum samples [24.8%] having an STA titer of >/= 1:160 were presumptively diagnosed as cases of brucellosis. The peak isolation was in April and May. Brucella spp. were isolated from 123 blood cultures [74.1%]. The blood culture isolation rate was significantly higher in patients with an STA titer of >/= 1:1,280 than in those with an STA titer of

indicence of sacroiliac joint pain in failed back surgery

Sacroiliac joint can be a source of pain in cases of failed back surgery after spinal fusion. This can be due to a missed sacroiliac joint problem from before spinal surgery or it can be a new event secondary to violation of the sacroiliac joint during the graft technique or due to increased stress on the joint after spinal fusion. This study reviewed 30 patients with lumbosacral fusion, all presenting with persistent back pain and had surgery by the same technique using single midline incision for the spinal fusion and harvesting the graft. Fixation was done by pedicular screws and fusion using posterolateral autogenous bone graft. Seventeen patients had sacroiliac joint pain with positive therapeutic test using local injection of the sacroiliac joint. Ten patients had radiological changes on computerized tomography

Spectrophotometric determination of piroxicam using 2,2-diphenyl-1-picrylhydrazyl1]

An indirect spectrophotometric method has been developed for the determination of piroxicam by interaction with 2,2-diphenyl-1-picrylhydrazyl [DPPH]. The DPPH reagent is an intense violet-colored stable free radical which is discolored on reaction with the drug. The decrease in violet color is used as measure of the quantity of the drug present. Beer's Law is obeyed in the concentration range of 2-20 mug of piroxicam per ml [sigma max = 1.66 x 10 4 mol -1 cm -1]. No interference occurred by the degradation product of the drug [2-aminopyridine] or the common excipients in pharmaceutical preparations. A reaction pathway was suggested and verified by the synthesized piroxicam cyclodehydration product. The structure of the latter compound was confirmed by TLC, IR and PMR spectroscopy

HPLC and spectrophotometric determination of nifuroxazide and its pharmaceutical formulations

Two methods for the quantitative determination of nifuroxazide are described. The first method is based on the HPLC separation of the compound with an ODS reversed phase column using acetonitrile-water [40:60] as mobile phase and spectrophotometric detection at 380 nm. Accelerated stability tests in direct sun light and at elevated temperature were carried out. The second one is a spectrophotometric procedure based on the interaction of the drug with tetraethylammonium hydroxide [TEAH] in dimethylsulphoxide [DMSO] medium at 20 +/- 5C to produce a blue product. The quantitation of the product was carried out at 610 nm [molar absorptivity 2.99 x 104 1 mol-1 cm-1]. A linear correlation was found between absorbance at lambda max and concentration of nifuroxazide in the range 0.5-9.0 mugml1. The two proposed methods were used for the determination of nifuroxazide powder and its dosage form. Both methods are rapid, accurate, precise and their results were comparable with the X-th French pharmacopoeial procedure

Effect of nigella sativa crude oil skin penetration and viability of schistosoma mansoni cercariae

Nigella sativa crude oil directly tested in different concentrations on viable cercarial suspension is found to have direct lethal effect, even in high dilutions on cercariae. Histological studies revealed that Nigella sativa oil locally painted on the skin completely prevents cercarial penetration while food oil slightly decreases and delays it compared with the non painted control group. Whereas, unexpectedly skin painting with vaseline markedly increases cercarial motility and skin penetration. Local painting of the skin with Nigella sativa oil initiates a massive local immune response presented by increased number of mast cells

Quantitation of floctafenine by high pressure liquid chromatography [HPLC] and spectrophotometric methods

Two methods for the quantitative determination of floctafenine are described. The first, a spectrophotometric procedure, is based on the formation of a red Schiff-base between floctafenine and p- dimethylaminocinnamaldehyde [p-DAC] after reduction with zinc powder and hydrochloric acid in ethanol acidic medium at room temperature. At the maximum absorption of 541 nm, Beer-Lambert's Law was adhered to over the 1-9 mug/ml range [epsilon max 3.99 x 10 4 l/mol/cm]. The second method involved the application of HPLC, C-18 column, with a mobile phase consisting of 82.5: 17.5 methanol: water at a flow rate of 1 ml/min. Samples dissolved in methanol were estimated by the measurement of peak height using UV detection at 254 nm. The results obtained with the two proposed methods revealed their successful application for the quantitative estimation of floctafenine in bulk drug and as tablets with good accuracy and precision