Adoption of Euvax-B vaccine in Nineveh

Hepatitis B infection is one of the most important health problems around the world. The high mortality rate of the hepatitis B encouraged research that led to the finding of an effective vaccine against it. The aim of the present study was to find out the use of the Euvax-B vaccine in sectors of Nineveh province. According to the results obtained in this study, in the next five years, the vaccination coverage for the second and third doses needs to improve(AU)

La infección por hepatitis B es uno de los más importantes problemas de salud del mundo. La alta tasa de mortalidad de la hepatitis B impulsó las investigaciones que llevaron a encontrar una vacuna eficaz contra la misma. El objetivo del presente estudio fue conocer el uso de la vacuna Euvax-B en sectores de la provincia de Nínive. De acuerdo con los resultados obtenidos, en los próximos cinco años, se debe incrementar la cobertura de inmunización de la segunda y tercera dosis de la vacuna(AU)

Identification of Fungal Pathogens in Otomycosis and Their Drug Sensitivity: Our Experience

Abstract Introduction Otomycosis is a common problem in otolaryngology practice. However, we usually encounter some difficulties in its treatment because many patients show resistance to antifungal agents, and present high recurrence rate. Objectives To determine the fungal pathogens that cause otomycosis as well as their susceptibility to the commonly used antifungal agents. Additionally, to discover the main reasons for antifungal resistance. Methods We conducted an experimental descriptive study on 122 patients clinically diagnosed with otomycosis from April 2016 to April 2017. Aural discharge specimens were collected for direct microscopic examination and fungal culture. In vitro antifungal susceptibility testing was performed against the commonly used antifungal drugs. We tested the isolated fungi for their enzymatic activity. Results Positive fungal infection was found in 102 samples. The most common fungal pathogens were Aspergillus and Candida species, with Aspergillus niger being the predominant isolate (51%). The antifungal susceptibility testing showed that mold isolates had the highest sensitivity to voriconazole (93.48%), while the highest resistance was to fluconazole (100%). For yeast, the highest sensitivity was to nystatin (88.24%), followed by amphotericin B (82.35%), and the highest resistance was to terbinafine (100%), followed by Itraconazole (94.12%). Filamentous fungi expressed a high enzymatic ability, making them more virulent. Conclusion The Aspergillus and Candida species are the most common fungal isolates in otomycosis. Voriconazole and Nystatin are the medications of choice for the treatment of otomycosis in our community. The high virulence of fungal pathogens is owed to their high enzymatic activity. Empirical use of antifungals should be discouraged.

Complete pathological response in rectal cancer after neoadjuvant therapy - case report

A fifty-four year old woman underwent colonoscopy due to symptoms of altered bowel habit and weight loss. There was a malignant looking lesion at her rectosigmoid junction [Fig. 1a] which was confirmed histologically to be a moderately differentiated adenocarcinoma. Although the blood results were normal, her CT scan and MRI [Fig 2a] showed an apple core lesion at rectosigmoid junction which was deemed to be Stage IIIC (T4aN2aM0)

Cytokeratin 13, Cytokeratin 17, and Ki-67 Expression in Human Acquired Cholesteatoma and Their Correlation With Its Destructive Capacity

OBJECTIVES: Cholesteatoma is a nonneoplastic destructive lesion of the temporal bone with debated pathogenesis and bone resorptive mechanism. Both molecular and cellular events chiefly master its activity. Continued research is necessary to clarify factors related to its aggressiveness. We aimed to investigate the expression of Ki-67, cytokeratin 13 (CK13) and cytokeratin 17 (CK17) in acquired nonrecurrent human cholesteatoma and correlate them with its bone destructive capacity. METHODS: A prospective quantitative immunohistochemical study was carried out using fresh acquired cholesteatoma tissues (n=19), collected during cholesteatoma surgery. Deep meatal skin tissues from the same patients were used as control (n=8). Cholesteatoma patients were divided into 2 groups and compared (invasive and noninvasive) according to a grading score for bone resorption based upon clinical, radiologic and intraoperative findings. To our knowledge, the role of CK17 in cholesteatoma aggressiveness was first investigated in this paper. RESULTS: Both Ki-67 and CK17 were significantly overexpressed in cholesteatoma than control tissues (P < 0.001 for both Ki-67 and CK17). In addition, Ki-67 and CK17 were significantly higher in the invasive group than noninvasive group of cholesteatoma (P=0.029, P=0.033, respectively). Furthermore, Ki-67 and CK17 showed a moderate positive correlation with bone erosion scores (r=0.547, P=0.015 and r=0.588, P=0.008, respectively). In terms of CK13, no significant difference was found between cholesteatoma and skin (P=0.766). CONCLUSION: Both Ki-67 and CK17 were overexpressed in cholesteatoma tissue and positively correlated with bone resorption activity. The concept that Ki-67 can be a predictor for aggressiveness of cholesteatoma was supported. In addition, this is the first study demonstrating CK17 as a favoring marker in the aggressiveness of acquired cholesteatoma.

Impact of oral vitamin D supplementation on first tooth eruption of Jordanian premature infants

Objective: to elucidate the impact of oral vitamin D supplementation on the time [early versus late chronological age] of first tooth eruption in premature infants

Method: a total number of 110 Jordanian preterm infants [gestational age < 37 weeks, and birth weight < 2500 g] who were born and attended the neonatal follow up clinics at Prince Hashim Ben AI-Hussein and Queen Alia Military Hospital / Jordan from April 2012 till March 2014, were included and randomized into three main groups:- A-preterm infants who were fed exclusively breast milk without extra Vitamin D supplementation, B-preterm infants who were fed exclusively special preterm formula containing 400 IU vitamin D/100mg, but not supplemented with extra oral vitamin D. C-preterm infants who were fed exclusively special preterm formula containing 400 IU vitamin D/100mg and additionally supplemented with 400 IU of oral vitamin D. A first tooth eruption record was completed by the principal neonatologist and the parents of the enrolled infants during the annual clinic visits

Results: a total of 110 premature infants [50 males, 60 females,] were included in this study. 44 preterm infants were of gestational age < 32 weeks at birth, and 66 were> 32 weeks gestation at birth. 61 premature babies had a birth weight < 1.5 kg, and 49 had a birth weight> 1.5 kg. Early tooth eruption occurred in 83 of the total 110 studied preterm infants [32, 24, and 27 infants from groups A, B, and C respectively], and 27 [8, 11, and 8 infants from groups A, B, and C respectively] have had late first tooth eruption. The mean number of breast fed infants with early tooth eruption [ who had the least content of vitamin D in milk ] is significantly more than the means of the other two groups [P - value = 0.036 ]. The mean number of infants in the three groups with late tooth eruption is not significantly different [P- value = 0.269]. Comparing the breast fed infants with different gestational ages, and different birth weights with the infants in the other two groups in respect to early versus late first tooth eruption, no statistically significant effect of increased vitamin D content more than the breast milk content could be found

Conclusion: there is clear evidence that extra supplementation with oral vitamin D has no effect on the time of first tooth eruption of premature infants

Pathogenesis and Bone Resorption in Acquired Cholesteatoma: Current Knowledge and Future Prospectives

Cholesteatoma is a cystic non tumorous lesion of the temporal bone that has the ability to destroy nearby structures by its power to cause bone resorption and as a result, fatal complications prevail. We aimed to conduct a comprehensive review for pathogenesis of acquired cholesteatoma, bone resorption mechanisms, and offer a future vision of this serious disease. We have reviewed different theories for pathogenesis of acquired cholesteatoma including the most relevant and updated ones with special emphasis on the mechanisms of bone resorption through Medline/PubMed research using the keywords ‘aetiopathogenesis, bone resorption, acquired cholesteatoma, temporal bone, and cytokines.’ In order to strengthen our study, we searched the reference lists of identified reviews. Cholesteatoma is a subject of debate among otolaryngologists since it was prescribed firstly. Over many decades, several theories were postulated for aetiopathogenesis of cholesteatoma with a tendency to follow more than one theory to explain the proper nature of that disease. Until now, the mechanism of bone resorption has yet to be more clarified. In the last century, a leap has occurred in the field of biomolecular cholesteatoma research which improved our knowledge about its pathophysiology and bone destructive mechanism. However, surgery is still the only available treatment. We conclude that discovery of new therapeutic choices for cholesteatoma other than surgery by the use of anti-growth, anti-proliferative, apoptotic agents as well as medications that antagonize osteoclastogenesis should be the main concern in the future clinical and experimental research work. Also, searching for predictors of the aggressiveness of cholesteatoma can affect the timing of intervention and prevent occurrence of complications.

Fabrication and Optimization of Novel Lornoxicam Matrix Tablets Using 3-Factor 3-Level Box-Behnken Statistical Design: Invitro and Invivo Evaluation.

In the present study efforts have been made to prepare sustained release matrix tablets of Lornoxicam. Matrix tablets were prepared by direct compression method by using Hydroxypropyl methyl cellulose K15 (HPMC- K15), Ethyl cellulose (EC) and Sodium carboxy methyl cellulose (Na-CMC) as polymers in different concentrations. A 3-factor 3- level Box-Behnken statistical design was used as an optimization tool having total of 17 experimental runs with 5 central points. All three polymers were selected as independent variables while %age drug release at various time intervals and hardness were used as dependant variables. In vivo studies were conducted on human plasma using Tenoxicam as internal standered. All the detections were made on SYKNM HPLC. Foriour Transform Infrared Spectroscopy (FTIR) and Differential Scanning Calorimetery (DSC) studies were conducted and no chemical interaction was found between drug and polymers. The drug release mechanism was mainly governed by non-fickian (anomalous) diffusion and zero-order (case II) transport diffusion. Regression analysis was performed on dissolution data obtained with the selected response variables and polynomial models were constructed. Polynomial models were further validated using one way ANOVA and results indicated that all the polymers used have significant effect on selected response (p>0.05). Contour plots and three dimensional response surface curves were drawn. In- vivo studies were conducted on two tablet formulation indicating slow and sustained release of the drug from matrix. From Behnken design it is possible to successfully formulate and optimize Lornoxicam sustained release matrix tablets with three polymers (HPMC- K15, EC and Na-CMC) in combination.

Dyslipidemia in Insulin Resistance: Cause or Effect.

Lipids are of one of the four basic types of molecules of life and its derivatives serve diverse functions in the body. Generally acclaimed functions of lipids include shock absorption and insulation, and energy storage of the body. Phospholipids and cholesterol form the integral part of cell membrane. In addition cholesterol serves as the precursor for bile salts, male and female sex hormones, vitamin D and adrenocortical hormones. Complex lipids consist of neutral lipid core of cholesterol esters and or triacylglycerol and proteins are the chylomicrons, VLDL, LDL and HDL which serve as the carriers of fats, fatty acids and other lipids in the body. Complex lipids are tightly controlled in the body. Its dysregulation has been mainly linked to obesity, diabetes and insulin resistance though the issue is yet to be clearly understood. The present review evaluates recent reports in this regards and try to explain the relationship between dyspidemia and insulin resistance.

case of submacular cysticercosis treated by pars plana vitrectomy in Kuwait

We report a case of submacular cysticercosis in the left eye of an Indian patient living in Kuwait. Though he was systemically asymptomatic, his magnetic resonance imaging showed multiple cysts in the brain. The patient underwent pars plana vitrectomy [PPV], and the cyst was removed in total through a retinotomy over the cyst. He had another small cyst in the periphery that was also removed. He was treated with oral albendazole and systemic steroids after the surgery to treat his neurocysticercosis. He developed rhegmatogenous retinal detachment after the surgery, and the retina was successfully reattached with sclera buckling and PPV procedure. His final best corrected visual acuity improved from counting fingers at 1/2 m at presentation to 20/400. This case report shows that the ocular cysticercosis may be seen among expatriates working in the Middle East. It is important to rule out the presence of neurocysticercosis in such patients as well as multiple cysts in the affected eye. However, the functional outcome of surgical treatment of submacular cysticercosis can be disappointing

Efficacy and safety of tap water iontophoresis for palmoplantar hyperhidrosis

To evaluate the efficacy and safety of tap water iontophoresis [TWI] for the treatment of palmoplantar hyperhidrosis in our local setting. Thirteen patients of idiopathic palmoplantar hyperhidrosis were enrolled in the study from the Department of Dermatology, Lahore Medical and Dental College/Ghurki Hospital and Skin Clinic, Gulberg, Lahore from May 2009 to August 2012. Two patients dropped out, and the study was completed by eleven patients. The patients were treated with TWI three times a week for six weeks and followed up at twelve weeks. Each session lasted for 20 minutes, with the polarity being reversed after 10 minutes. The results were assessed by the hyperhidrosis disease severity index, improvement of sweating on a scale of one to four and the starch-iodine test. Any adverse events were noted. All the patients responded well to the treatment with minimal discomfort. Tap water iontophoresis is a safe, effective, inexpensive and affordable treatment modality for palmoplantar hyperhidrosis. It improves quality of life significantly during treatment.

Cytoplasmic expression of P63 in neoplastic and non neoplastic prostatic tissue

P63 gene, is one of tumor suppressor genes. In normal and benign prostatic glands, it is found only in basal cells, so p63 helps to differentiate prostate cancer from benign mimicker, as it is expressed mainly in the nuclei of cells of normal and benign lesions. We studied the cytoplasmic mislocalization of p63 in different prostatic lesions as it may have a role in prostatic oncogenesis. Groups of 34 malignant, 26 suspicious and 12 benign prostatic tissue cases were retrieved from pathology department in Assiut university hospital and from other private laboratories. All specimens were immunostained for p63 and p504s. P504s was used to confirm diagnosis of malignancy. Prostatic acinar adenocarcinoma cases compared with normal prostatic tissues and benign prostatic lesions, showed statistically highly significant cytoplasmic staining for p63 [p=0.00002]. The intensity of cytoplasmic expression has high significant correlation with Gleason's score [p=0.000]. Additionally cytoplasmic expression was present in 8/10 high grade prostatic intraepithelial neoplasia [HGPIN] foci within the malignant specimen, with faint intensity. Cytoplasmic staining for p63 was also detected in benign glands within or near malignant foci in 42/44 of malignant cases. The aberrant cytoplasmic p63 expression in malignant foci, PIN and normal benign looking glands within malignant cases and its absence in normal and benign prostatic lesions emphasized the oncogenic role of aberrant genetic expression. Also its expression in benign glands surrounding malignancy may be used as an indicator for nearby malignant lesions or premalignant changes

Antioxidant and gastroprotective activities of Andrographis paniculata (Hempedu Bumi) in Sprague Dawley rats.

Antioxidant and gastroprotective activities of aqueous and ethanolic extract of Andrographis paniculata leaves in rats have been reported. Sprague Dawley rats, 6 per group were used and rats in groups 1 to 6 were pretreated with (0.25% w/v) carboxymethyl cellulose (negative control, 5 ml/kg), 20 mg/kg omeprazole (positive control), (250 mg/kg and 500 mg/kg) of aqueous leaf extracts (APLAE) and (250 and 500 mg/kg) of ethanol leaf extracts (APLEE) respectively. Animals were orally administered with 95% ethanol (5 ml/kg) 60 min after their pretreatments. Rats were sacrificed 1 h after treatment and gastric contents were collected to measure pH and mucous weight. Stomach was analyzed for gross and histological changes. Ulcer control group showed extensive lesions of gastric mucosal layer, whereas rats pretreated with omeprazole, 250 and 500 mg/kg of APLAE showed significant and dose dependent reduction in gastric lesions with increased pH and mucus content of stomach. Rats pretreated with 250 or 500 mg/kg of APLEE showed significantly better inhibition of gastric mucosal lesions. Further, the in vitro antioxidant studies using 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay showed that ethanol extracts have superior free radical scavenging activity with IC50 value = 10.9 than aqueous extracts with IC50 value = 24.65. Results of this study showed that pretreatment with ethonolic extract of A. paniculata ethanolic provided significant protection against gastric ulcer by regulating of pH, mucous production and antioxidant property.

Prognostic role of C-reactive protein in acute stroke.

Background & objective: Stroke is a dreadful health hazard all over the world as well as in our country and one of the leading causes of mortality & morbidity. The relationship between serum C-reactive protein (CRP) level and post stroke outcome is not well studied especially in Bangladesh. We were interested to study this relationship in our country. Materials & methods: A cross sectional prospective study was performed on 50-stroke patients. Serum CRP & Lipid profile was determined. Post stroke outcome was measured by modified ranking scale (good outcome, score within 0 – 2 & bad outcome, score within 3 – 6). The subjects were divided in two groups, CRP level above or below 10 mg/L. Statistical analysis was performed by using SPSS software. Chi-square test & Spearman’s rho correlation test was done to see the level of significance. Results: Mean serum CRP level was 9.69 mg/L that was higher than normal subjects. Correlation analysis between serums CRP level of stroke patients with post stroke outcome was found to be positively correlated (r = 0.598/p<0.01). Conclusion: Serum CRP level may be used as a prognostic marker in stroke patients and it helps to make necessary management plan to physician.

Metabolic Syndrome and Insulin resistance: Etiopathegenesis and influencing factors.

Metabolic syndrome and insulin resistance has been the subject of much debate over the last two decades. Its pathophysiologycal basis, however, still remains to be clearly understood. Both genetic and environmental factors have been implicated in its pathogenesis. Mutation of genes encoding signal transduction molecules of insulin and acquired factors like aging, diets, physical activity, obesity and related molecular changes, dyslipidemia, hypertension and smoking were proposed by many groups. This review examined both acquired and genetic factors and discussed model of hormone-receptor-postreceptor interactions to explore the molecular basis of insulin resistance.

Clinical-pathological feature of primary endometrial cancer patients treated with hysterectomy at King Hussein medical center

To describe the clinical and histopathological features of patients with primary endometrial cancer operated at King Hussein Medical Center the last six years. This retrospective study included cases operated in at King Hussein Medical Center in the period between October 2001 and December 2007. Histopathological data were available for 78 females: however, only 52 patients with primary endometrial cancer were included in this study. Patients with endometrial cancer who were diagnosed after hysteroscopy and endometrial biopsy, and those who had secondary endometrial cancer were excluded from this study. Clinical and histopathological details were collected and analyzed. The sample consisted of 52 females. Age ranged from 14 - 78 years [mean 59.00 +/- 13.35]. The most common presenting symptom was postmenopausal bleeding which occurred in 37 patients [71.2%]. Endometrioid Adenocarcinoma was the predominant histological sub-type, being reported in 34 patients [65.4%], while other types including mixed Mullerian tumors, endometrial stromal sarcoma, clear cell carcinoma, adenosquamous carcinoma, adenocanthoma and papillary serous adenocarcinoma were found among 18 patients [34.6%]. The tumor was confined to the body of the uterus [Stage one] in 30 specimens [57.7%] at the time of surgery. Endometrioid adenocarcinoma of the endometrium is the most common primary endometrial carcinoma operated upon at King Hussein Medical Center. Postmenopausal bleeding was the predominant presenting symptom. Most of the patients were diagnosed early

Lentinula edodes (Shiitake) mushroom extract protects against hydrogen peroxide induced cytotoxicty in peripheral blood mononuclear cells.

Lentinula edodes (Berk) Pegler, commonly known as Shiitake mushroom has been used as medicinal food in Asian countries, especially in China and Japan and is believed to possess strong immunomodulatory property. In the present study, the methanolic extract of the fruit bodies of L. edodes was investigated for cytoprotective effect against H2O2-induced cytotoxicity in human peripheral blood mononuclear cells (PBMCs) by measuring the activities of xanthine oxidase (XO) and glutathione peroxidase (GPx) . H2O2 at a concentration of 5 μM caused 50% inhibition of PBMCs viability. The extract improved the PBMC viability and exerted a dose-dependent protection against H2O2-induced cytotoxicity. At 100 μg/ml of extract concentration, the cell viability increased by 60% compared with the PBMCs incubated with H2O2 alone. The extract also inhibited XO activity in PBMC, while showing moderate stimulatory effect on GPx. However, in the presence of H2O2 alone, both the enzyme activities were increased significantly. The GPx activity increased, possibly in response to the increased availability of H2O2 in the cell. When the cells were pretreated with the extract and washed (to remove the extract) prior to the addition of H2O2, the GPx and XO activities as well as the cell viability were comparable to those when incubated with the extract alone. Thus, it is suggested that one of the possible mechanisms via which L. edodes methanolic extract confers protection against H2O2-induced oxidative stress in PBMC is by inhibiting the superoxide-producing XO and increasing GPx activity which could rapidly inactivate H2O2.

Isolation and antimicrobial susceptibility pattern of methicillin resistant and methicillin sensitive staphylococcus aureus

To find out frequency and antibiotic sensitivity pattern of methicillin resistant and methicillin sensitive staphylococcus aurues. Descriptive study. Microbiology section of Department of Pathology in National Institute Of Child Health Karachi, from March 2008 to April 2009. All the clinical samples received in laboratory were processed. All staphylococcus aureus isolates were then identified by conventional method. The isolates were tested by the modified Kirby Baur disc diffusion method and results were interpreted as outlined by National Committee for Clinical Laboratory Standard criteria. Eighty seven isolates of staphylococcus aureus were recovered from various clinical samples. Sixty six [75.86%] were isolated from various swabs and 21[24.13%] from blood. Twenty isolates [22.9%] were methicillin resistant. In this group high resistant was found to cloxacillin [100%], cephradine [100%], co-trimoxazole [95%], erythromycin [70%], chloromycetin [65%], gentamicin [55%] and low resistance was observed to ciprofloxacin [30%]. In MSSA 0% resistance was seen to meropenem, ciprofloxacin and chloromycetin and high resistance found to co-trimoxazole [98.5%] and pencillin [73.13%]. Low resistance was also observed with amoxiclav [20.89%]. Both MRSA and MSSA were 100% sensitive to vancomycin. In this study high resistance pattern to non b-lactam antibiotic was found in MRSA leaving restricted choice for the treatment. Good hygiene practices, infection control and emphasis on hand washing etc may slow down the process of resistance