Histological study on the effect of metformin on high-fat-diet-induced liver injury in adult male albino rats

Changes in lifestyle and food habits increase the prevalence of nonalcoholic fatty liver disease [NAFLD]. It is a chronic condition that has no or few symptoms. It may be accompanied by inflammation and insulin resistance. Moreover, it is closely linked to diabetes. Metformin is an antidiabetic agent that can improve insulin resistance. The study was conducted to investigate the effect of metformin on liver injury induced by a high-fat diet. The study lasted for 12 weeks. Thirty-six adult male albino rats were used and divided into four groups. Group I was the control group. Group II rats received metformin. Group III rats were fed a high-fat diet for induction of NAFLD. Group IV rats were fed a high-fat diet for induction of NAFLD and then administered metformin orally in the last 4 weeks of the study. Liver specimens were processed for light and electron microscopic examination. Moreover, liver weight index was determined, and biochemical, morphometric, and statistical studies were performed. Induction of NAFLD [group III] resulted in severe insulin resistance. Hepatocytes showed macrovesicular and microvesicular steatosis, ballooning, and lobular inflammation. The number of positive cells and the reaction for tumor necrosis factor-alpha in group III apparently increased as compared with group IV. Lipid droplets, loss of mitochondrial cristae, and dispersion of rER were detected in group III. Metformin improved insulin resistance, and liver histological changes were fewer than those in group III. Metformin can greatly improve liver histological changes associated with a model of NAFLD

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

optimal succinylcholine dose for intubating emergency patients: retrospective comparative study

Succinylcholine remains the drug of choice for satisfactory rapid-sequence tracheal intubation. It is not clear from the literature why the 1 mg/kg dose of succinylcholine has been traditionally used. The effective dose [ED95] of succinylcholine is less than 0.3 mg/kg. The dose of 1 mg/kg represents 3.5 to 4 times the ED95. To compare the effect of the traditionally used 1 mg/kg of succinylcholine with lower doses of 0.6 mg/kg and 0.45 mg/kg on intubation condition regarding the onset time, duration of action, duration of abdominal fasciculation, and the intubation grading. This retrospective comparative study was carried into three groups of ASA III and IV [American Society of Anesthesiologist's Physical Status III and IV] non-prepared emergency patients who were intubated at emergency department of Hamad General Hospital, Doha, Qatar during January 1st 2007 to August 31, 2010. The Institutional Research Board [IRB] approval was obtained. This study was limited to 88 patients who received fentanyl 1 micro g/kg followed by etomidate 0.3 mg/kg intravenously as induction agents and succinylcholine as a muscle relaxant agent in doses of 0.45 mg/kg, 0.6 mg/kg, or 1 mg/kg. Increasing the succinylcholine dosage shortened the onset time, prolonged the duration of action, and prolonged the duration of abdominal fasciculation significantly [P<.001]. Tracheal intubation was 100% successful in the three groups of patients. Succinylcholine dose of 0.45 mg/kg provides an optimal intubation condition in ASA III and IV emergency non-prepared patients. Duration of action of succinylcholine is dose dependent; reducing the dose allows a more rapid return of spontaneous respiration and airway reflexes

Evaluation of serum soluble FAS and soluble FAS ligand in maternal and cord blood of preeclamptic mothers

Preeclampsia is a potentially life-threatening disease for both mother and fetus. It remains one of the most important causes of maternal and fetal mortality and morbidity in developing countries. Fas-FasL pathway of apoptosis is abnormally activated in diseases associated with impaired immune tolerance or chronic inflammation. We hypothesize that preeclampsia might be associated with abnormal activation of the Fas-FasL pathway. We reported the results of an ELISA-based quantitation of soluble Fas and soluble Fas ligand in the maternal and cord blood sera of 20 gestations complicated by preeclampsia and of 20 normal control gestations. Our results establish the presence of higher soluble FasL levels in maternal [254.4 +/- 146.7 pg/mL] and cord blood sera [217.7 +/- 53.6 pg/mL] of preeclamptic mothers in comparison to their levels in normal control mothers [199.0 +/- 88.5pg/mL and 130.6 +/- 51.5 pg/mL] In contrast, soluble Fas levels were similar in both groups. We found a statistically significant difference for soluble FasL serum levels in maternal and cord blood of preeclamptic mothers when compared with normal controls [p = 0.016 and 0.024]. For soluble Fas the differences were not significant

Conclusion: the concentration of soluble Fas and soluble FasL is altered in preeclampsia and they might influence pathogenesis or sequelae of preeclampsia

Laser in situ keratomileusis for children with myopic anisometropia

The purpose of the study was to evaluate the safety, efficacy, predictability and stability of laser in situ keratormileusis to correct high myopia or myopic astigmatism in patients with an isometropia, in whom convential therapies have failed Eleven] patients aged 7.5 to 12.5 years with myopic anisometropia and amblyopia had LASIK in the more myopic eye. Preoperative spherical equivalent ranged from -4.75 to - 12 D and spectacle corrected visual acuity ranged from 0.1 to 0.5 Minimum follow up was 12 months. One year after LASIK, the spherical equivalent refraction ranged from 0 to- 2.25D [mean-l.00]. The main regression of the refractive error occurred in the first 3 months after surgery, preoperative BCVA of 0.5 or better was present in 2 eyes [18%], and BCVA of 0.33 or better was present in 5 eyes [45%], one year after LASIK BCVA of 0.5 or better was present in 4 eyes [36%], and BCVA of 0.33 or better was present in 10 eyes [91%]. There were no significant complications LASIK was effective for correction of myopic anisometropia in this study, was safe and relatively predictable, and provided good visual results

Factors influencing the prognosis of pneumatic retinopexy

To evaluate the factors affecting the prognosis of pneumatic retinopexy in the management of primary rhegmatogenous retinal detachment, as age, sex, localization of R.D, extension of R.D, size, number and localization of breaks. Thirty five eyes with primary rhegmatogenous retinal detachment were treated with pneumatic retinopexy, injecting Sulphur hexafloride gas [SF6], sealing the breaks with cryo or laser photocoagulation and postoperative positioning. Retinal reattachment was achieved in 30 eyes [85.71%] after single operation. Factors affecting the results and complications were reported. Pneumatic retinopexy is an effective procedure in management of R.D when cases are well selected. Localization, size, number of breaks are important factors affecting the results. Time of evolution and extension of R.D are factors which significantly affecting the prognosis of pneumatic retinopexy

Role of colour flow doppler echocardiography in the identification of acute rheumatic carditis in children without clinical evidence of carditis

This study was carried out on 70 patients: 15 patients with presumptive diagnosis of acute rheumatic fever [group one], 25 patients with no clinical evidence of carditis [group two] and 30 patients with a clinical evidence of carditis [group three] in addition to 20 healthy children as control group A and another 20 normal children [control group B] formed a comparison group for 14 patients of group two. The results revealed that mitral valve thickening was detected in group three [100%], but only in 28% of group two and 20% of group one. All patients had normal left ventricular systolic function. Congestive heart failure was invariably associated with the presence of hemodynamically significant valve lesions. The specificity of Doppler for detecting pathologic mitral regurgitation was 100% with a positive predictive value of 100%. A pathologic mitral regurgitation was identified in 100% of group three versus 48% in group two and 33.5% in group one and it was evident in seven patients with echocardiographically normal appearance of valve morphology

study of autonomic functions in patients with mitral valve prolapse

This work was performed to evaluate autonomic functions by cardiovascular reflexes among patients with mitral valve prolapse [MVP]. It comprised 45 patients [16 males and 29 females] with MVP diagnosed on clinical and echocardiographic basis. Twenty-three normal individuals [7 males and 16 females] with matched sex, age, weight, height and body mass index were taken as a control group. Abnormal autonomic functions had been observed in the MVP patients in the form of parasympathetic dysfunction and inappropriate [imbalance] sympathetic response to different stress in the form of hyperactive early response and hypoactive response on sustained stress and this autonomic imbalance was not related to age or sex but could be related to the severity of MVP. The degree of autonomic affection [quantitative defect] was related to the presence of symptoms among the studied MVP patients. The symptomatology of MVP was not related to sex, severity of MVP, but it was related to the younger age group

Autograft nail as a material for tympanoplasty [Experimental study]

Various materials from the human body have been used as autografts in tympanoplasty. Nails have not been used for substitution. This experiment was designed to study the reaction of the middle ear and the body to implanted nails. Autograft nails were implanted in the middle ear and subcutaneous tissues of the rabbit. After one month the sites of implantation were microscopically examined and showed a severe cellular inflammatory reaction with fragmentation of the implant which was engulfed by giant cells. A severe degenerative reaction was also found in the temporal bone. In conclusion, autogenous nail is unsuitable for middle ear implantation as it leads to a severe inflammatory reaction

clinical comparative study between extradural morphine versus buprenorphine after transurethral prostatectomy

The frist successful trial of extradural opioids injection was in Jerusalem[1]. Chronic pain was magaged extradurally at first by 2 mg morphine. Up to 10 mg morphine was used extradurally with very good analgesia but on the expense of severe respiratory depression[2]. Morphine can be detected in the cerebrospinal fluid it is injected in such a high dose[3]. Many trials was performed to use morphine in the extradural space for postoperative pain relief, with gradually decreasing dose in order to obtain pain relief with prevention of respiratory depression[4]. Extradural morphine 2 mg did not produce sufficient pain relief following caeserian section[5]. Morphine 3 mg injection in the extradural space can be effective in postoperative pain relief as previously reported[6]. Many factors may contribute to the effect of extraduraI opioids as the direct dural effect, fat deposition and systemic absorbtion. To reduce the incidence of respiratory depression it was suggested to use lipid. Isoluble drug, as buprenorphine, as this agent enter the neural tissue rather than it remains in the cerebrospinal fluid. When buprenorphine is injected in the extradural space a higher dose is required to compensate for deposition in fat and systemic absorbtion[7]. A dose of 0.1 mg buprenorphine was suggested as the optimum extradural dose for the relife of postoperative pain[8]. Because of the high lipid solubility of buprenorphine it has been suggested that its extradural dose is similar to the intravenous one[8]. Because of the high lipid solubility of buprenorphine it has been suggested that its extradural dose is similar to the intravenous one[9]. On intramuscular administration a dose of 0.09 mg of buprenorphine is equipotent to 3 mg morphine[9]. In the present study we compared 3 mg morphine with buprenorphine 0.09 mg extradurally for post operative pain relieve after transurethral prostatectomy [TUR]. A larger dose of buprenorphine [0.18 mg] was also studied

Comparison of the effects of nalbuphine, fentanyl and pethidine in rabbits pretreated wilth a monoamine oxidase inhibitor tranylcypromine [parnate]

The existence of a severe toxic interaction from the clinical use of pethidine and monoamine oxidase [MAO] inhibitors is well known. The present study evaluates the possibility of such an interaction for the opioid partial agonist Nalbuphine and the pure agonist fentanyl. Conscious rabbits [n = 6] in each group pretreated 24 hours previously with physiological saline or the MAO inhibitor tranylcypromine [Parnate] 1.5 mg/kg S.C. were subsequently given physiological saline, pethidine 5 mg/kg, fentanyl 0.02 mg/kg and effect and parnate produced only a small increase in the rabbits temperature, the combination of parnate and pethidine produced a marked hyperpyrexia [+ 4.4 +/- 0.19°C, P < 0.001], hypertension 33.9 +/- 3.1 mmHg; P < 0.01] and agitation. Two rabbits died at 40 and 50 minutes after the pethidine- parnate combination. Nalbuphine and fentanyl were without significant effects on the parameters when given after the MAO-inhibitor parnate

incidence of arterial hypoxemia in the immediate postoperative period during the transfer of surgical patients to the recovery room

The incidence rate of hypoxemia in the immediate post-operative Period Was determined using pulse oximeter for continuous minitorring of arterial oxygen satusation [sao2] in 148 ASA class I or II adult patients breathing room air during their transfer from the operating room [O.R.] to the recovery room [R.R.]. These patients were categorized according to the type of operartion into two groups, as the following 72 patients undergone abdominal procedures and 76 patients undergone pelvic and peripheral operations. Hypoxemia was defined as 90% sao2 [arterial oxygen partial pressure -pao2=58 mmhg]. Severe hypoxemia was defined as 85% sao2 [Poao2=50 mmhg]. Hypoxemia occurred in 48 [66.7%] patients of group A, and in 24 [31.58%] patients of group B. The incidence of hypoxemia was significantly higher in group A [patients undergoing abdominal procedures] than in group B [those under-going non-abdominal procedures], Also group A of Patients experienced a significantly higher incidence of severe hypoxemia [25%], than group B of patients [1 3.16%]. Thus the type of operation was a significant predictor of the immediate postoperative hypoxemia. Postoperative hypoxemia also correlates significantly with the patient age and obesity

Immediate venous sequelae of intravenous administration of midazolam versus propofol. A light and electron microscopic study

Eighteen guinea-pigs were categorized into three groups I, II, and III [6 each]. Animals of group I were injected intravenously via the external jugular veins with midazolam, group II were injected with propofol, while group Ill were received normal saline as a control model. Light microscopy revealed mild oedema in venous wall in group I and II. While electron microscopy revealed the relative innocuousness of propofol compared with midazolam in equipotent doses, probably due to the effect of the fat emmulsion solvent of propofol. In addition to the isotonicity and pH neutrality of the later