The Assessment of Gastric Antral Wall Thickness in Helicobacter pylori Gastritis by Abdominal Ultrasonography, Case-Control Study (2016-2018)

Abdominal ultrasonography is effective in the visualization of gastric wall layers and measuring its thickness. The study aimed to assess gastric antral wall thickness in patients with H. pylori gastritis by abdominal ultrasonography and to study its predictive value in detecting H. pylori gastritis.

Investigation of the morphology of longus colli among patients with neck pain using ultrasonography – a preliminary study

Objective: Longus colli provides stability to cervical spine during movements. In clinical practice, the clinicians teach exercises to longus colli to manage neck pain. The aim of this study was to investigate differences in thickness or anterior-posterior dimension (APD), shape ratio and contraction ratio of longus colli between subjects with neck pain and healthy controls. Materials and methods: A total of 12 subjects (6 with neck pain and 6 healthy controls) were recruited by predefined selection criteria. Ultrasound imaging of bilateral longus colli was conducted at the level C5-C6. Anterior-posterior dimension (APD) and lateral dimension (LD) were measured using Ultrasonography. Shape ratio (LD/APD) and contraction ratio (APD during contraction/APD during rest) were calculated. Mann-Whitney U test was used to compare the thickness of longus colli between healthy and neck pain subjects. Results and discussion: The results showed that the subjects with neck pain had smaller APD (Mean Rank=4.83, n=6) than healthy subjects (Mean Rank=8.17, n=6), U=16.00, z=-1.601 (corrected for ties), p=0.109, two tailed. Also, shape ratio showed higher values in neck pain subjects (Mean Rank=7.17, n=6) than normal subjects (Mean Rank=5.83, n=6), U=14.00, z=-0.641(corrected for ties) p=0.522, two tailed. In addition, contraction ratio was smaller in neck pain subjects (Mean Rank=4.83, n=6) than those healthy subjects (Mean Rank=8.17, n=6), U=8.00, z=- 1.601(corrected for ties) p=0.109, two tailed. Conclusion: There is a trend of reduced size of longus colli with the median of APD and smaller contraction ratio among patients with neck pain when compared to healthy controls.

[Design and performance evaluation of dry cupping tools described in the book Al-Tasreef]

Dry cupping is one of the main procedures in many traditional medicine systems all around the world with its root in antiquity. Traditional method of dry cupping is depended on practitioner proficiency and can lead to skin burn if the practitioner is a beginner. On the other hand, Zahrawi [11th century AD], the Muslim physician from Andulus [current Spain] presented two novel forms of cup for cupping to improve and correct cupping problems. In this regards, based on the model described in Al-Tasreef, we tried to redesign and manufacture the tools. These tools were made from galvanized iron owing to its nonconductivity of heat. Zahrawi models were compared with traditional model [with the same material and size] by negative pressure of mercury as well as qualitative test performed by a traditional practitioner. The results showed the superiority of Zahrawi's models [9792Pa and 10200Pa] over the traditional model, displaying a better and more stable vacuum pressure [mean: 8704 Pa with variation in repeat the test]. Furthermore, the introduced models are user friendly; i.e., every practitioner, even the beginner without specialized skill, may work with them easily. Therefore, the new model is suggested for dry cupping

Bilateral combined Monteggia and Galeazzi fractures: a case report

We present an exceedingly rare case of left Monteggia-Galeazzi fracture-dislocation and right Monteggiadistal radius fracture occurring simultaneously in a 20-year old male patient who had fallen 13 meters from a building. The combination of Monteggia and Galeazzi fracture-dislocation in the same forearm is very rare and, to the best of our knowledge, simultaneous bilateral Monteggia and Galeazzi or distal radius fracture in the same patient, have never been reported

Axillary artery injury with proximal humerus epiphyseal separation: a rare case report

Fracture of the proximal humerus associated with vascular injury has rarely been reported in children, and only two cases have been reported in the literature. In adults this combination has been reported more frequently. We present the case of a 14 year old boy with proximal humeral epiphyseal separation and axillary artery injury

direct medical costs of colorectal cancer in Iran; analyzing the patient's level data from a cancer specific hospital in Isfahan

The Immense cost of cancer treatment is one of the main challenges of health care systems all over the world including Iran. The aim of this study was to analyze the direct treatment costs of colorectal cancer patients in Isfahan, Iran. In this cross sectional study, the medical records of colorectal cancer [CRC] patients admitted to the Seyyed-al-Shohada Hospital "SSH" from 2005-2010 were reviewed. The profiles of 452 patients were examined. However based on inclusion, exclusion criteria a total number of 432 profiles were analyzed. All records including age, sex, treatment processes and treatment costs were extracted from the patients' profiles and analyzed using Kruskal-Wallis test. The results showed that 56.1% of CRC patients were male. The mean age of patients suffering from CRC was 56 +/- 13.4. More than Thirty-six percent of the patients were in stages 1-3 of CRC and more than half of them [64.4%] were in the 4[th] stage. The higher the stage of the cancer the higher the percentage of treatments used. 5-Fluorouracil and Leucovorin [5FU/LV] was the most common used chemical treatment protocol. The mean treatment cost for stage one was 10715 [ +/- 4927], for stage two 15920 [ +/- 3440], stage three 16452 [ +/- 2828] and for stage four was 16723 [ +/- 2555] US Dollars. The cost of drug treatment was the first cost driven between the medical services. CRC in Iranian population starts in younger age than people in western countries. This imposed considerable direct and indirect economic cost to the society. The direct medical cost of colorectal cancer in Iran is very higher than 38 million [dollar sign]. Screening programs could reduce the economic cost of CRC significantly

Relaesable scleral flap suture in trabeculectomy: preliminary results of a new technique

To demonstrate a technique for a releasable scleral flap suture placed to reduce post-trabeculectomy complications. Under a fornix based conjunctival flap, a rectangular partial thickness scieral flap is fashioned. A scierostomy is made followed by a peripheral iridectomy and the scieral flap is secured. A trapezoid suture is then placed from the sciera across the scleral flap to exit on the corneal surface and then tightend under the conjunctival flap which is then secured. During the follow-up, this suture can be safely removed on the slit lamp if the lOP is high. If the lOP is ideal, the suture can be left in place. Immediate postoperative complications as flat anterior chamber and choroidal detachment didn't occur. The suture was removed only if the filtration was not sufficient and the lOP was high. The releasable scieral flap suture was effective in preventing post trabeculectomy complications. In addition, it can be easily removed on the slit lamp without the need to fish under the conjunctiva, or to search for equipments as lasers

Blood levels of iron, copper, zinc, nitric oxide, and APOE [epsilon]4 allele frequency in patients with Alzheimer's disease

Alzheimer's disease [AD] is the most common form of dementia, characterized by slow, progressive memory loss. As the disease progresses other symptoms such as visuospatial disorientation, language impairment, and executive dysfunction or frontal lobe signs develop. The current study was performed to investigate the role of iron, copper, zinc, nitric oxide [NO] in relation to ApoE epsilon 4 allele frequencies in patients with AD. This study was carried out on sixty elderly subjects aged >/= 60 years. The subjects were classified into two groups matched for age and gender: Group I: included 30 elderly patients [74.3 +/- 7.2 years] diagnosed as probable Alzheimer's disease according to the DSM-IV-TR and the NINCDS-ADRDA. Group II: included 30 cognitively normal elderly subjects [71.7 +/- 3.6 years] with no evidence of any neurological or psychiatric diseases, or any medical illness that affects cognition. Laboratory investigations were done for patients. The following plasma parameters were measured: iron, copper, zinc and nitric oxide together with ApoE genotyping by PCR - RFLP. The current study revealed that plasma copper, zinc and nitric oxide levels were higher in AD group than control group. But, no statistically significant difference could be found between the two groups in plasma iron level. The frequency of ApoE 4 allele was higher among AD patients than control subjects. In comparison between ApoE4 +ve and ApoE4 -ve patients, no statistical significant difference in the neuropsychological assessment and biochemical assays was observed. Plasma copper level had statistically significant negative correlation with constructional praxis, ward list recognition, recall of constructional praxis, and stage of AD. While, iron, zinc, and NO plasma levels were not significantly correlated with any of the tested neuropsychological tests. We have demonstrated that, NO level had the highest sensitivity and specificity for predicting AD, followed by copper level. It can be concluded that, the ApoE4 gene is a strong risk factor for the AD but it is neither necessary, nor enough for the disease occurrence. Trace metals and NO abnormalities would influence ApoE, leading to development AD. Also, Copper blood levels are related to the abnormal cognition in AD patients

Ventilator-associated pneumonia Part 1: epidemiology, pathogenesis and prevention

Ventilator-associated pneumonia [VAP] is the leading cause of morbidity and mortality in intensive care units [ICUs]. Intubation and mechanical ventilation [MV] is associated with a 7-fold to 21 -fold increase in the incidence of pneumonia and approximately one third of patients receiving mechanical ventilation will develop this complication. Prevention of VAP must be regarded as one of the most important issues in critical care. It is possible through the use of several evidence-based strategies intended to minimize intubation, the duration of mechanical ventilation, and the risk of aspiration of oropharyngeal pathogens. Important components of effective preventive strategies focus on basic infection control principles like hand washing, adequate ICU staff education, and optimal resource utilization. Measures to prevent VAP extend into all aspects of daily intensive care practice, including antibiotic selection and duration of use, preferred routes of intubation, limitation of sedation, protocolized weaning, optimal use of noninvasive mask ventilation, patient positioning, ventilator circuit management, transfusion practices, stress ulcer prophylaxis, and glycemic control. However, strategies to prevent VAP are likely to be successful only if based upon a sound understanding of pathogenesis and epidemiology. In the first part of this article we review the evidence on prevalence, pathogenesis, microbiology, and prevention of VAP. Evidence-based recommendations for prevention of VAP are provided. Diagnosis and treatment of this condition are discussed in part two

study of residents' satisfactioin toward their family medicine program

To explore the resident's satisfaction toward their Family Medicine clinical attachment. This study included all fourth year [R4] residents of the Saudi Family Medicine Program. A total of 44 Saudi Family Medicine R4 residents were interviewed [26 males and 18 females]. They, the R4 residents were briefed as regard the study objectives. They were assured that the collected data will always remain confidential, and the results of this study are for their benefit and no harm is ever expected. All the necessary official approvals were secured prior to start of data collection. The verbal consent of all residents was obtained before their participation in this study. The 2007 version for the National Student Survey Questionnaire was adopted by the researcher for data collection. The survey comprises 22 statements divided into 7 areas, i.e., teaching, assessment and feedback, academic support, organization and management, learning resources, personal development and a final statement about the overall satisfaction with the quality of the course. Satisfaction mean scores of the Saudi Board Family Medicine residents do not reflect a high degree of satisfaction. The overall satisfaction with quality of the family medicine course reached only 70%. The mean percentage of the total score for satisfaction was 66.4%. The least satisfaction was expressed toward 'assessment and feedback' [57.2%], 'teaching' [60.5%] and academic support [69.3%], while the highest satisfaction was expressed toward 'organization and management' [73.3%] and 'learning resources' [74%].The educational Program for Saudi Board in Family Medicine does not yield optimal satisfaction among its residents. The main areas of least satisfaction among residents are mostly related to the trainers. Further studies are needed to evaluate the whole family medicine program. Trainers should be well-trained prior to their participation in the program and undergo continued education, with proper motivation to achieve the program's educational goals. The residents' assessment methods should be evaluated and revised

Effect of placental insufficiency on the hematological profile of neonates

Placental insufficiency is the major cause of intrauterine growth retardation. Umbilical artery [UA] Doppler allows the non-invasive assessment of the severity of impaired placental vascular abnormality. UA end diastolic velocities are positive [PEDV] in mild placental insufficiency but are absent or reversed [AEDV] in 60-70% of the tertiary villous vessels are damaged. The degree of placental dysfunction determines the severity of fetal disease. In addition to disturbances in placental respiratory function, hematologic abnormalities during fetal life and at birth can occur. To evaluate the relationship between umbilical artery end diastolic velocity in growth restricted fetuses and hematologic parameters in the neonate. All cases of suspected placental insufficiency born over one years period at Al-Galaa Teaching Maternity Hospital were included in the study. They were distributed among three groups: Group [I]: 56 cases both term and preterm with mild placental insufficiency and PEDV and Group [II]: 44 cases both term and preterm with severe placental vascular compromise and absent [AEDV] or reversed [REDV] Group [III]: 50 cases both term and preterm acting as controls. Placental insufficiency and growth restricted fetuses were studied with ultrasound and Doppler evaluations of end-diastolic velocity. A complete blood count to assess the hematological parameters was collected from venous cord blood from all neonates born to compromised mothers at birth and a second sample of peripheral venous blood was collected at 48 hrs of life. A total of 103 cases met the inclusion criteria of the study. Our results showed significant anemia, leucopenia, thrombocytopenia, with marked increase in nRBCs in group [II] cases with severe placental insufficiency and absent or reversed end-diastolic volume compared to cases in Group [I] with mild placental insufficiency and positive end-diastolic volume. Again all hematological indices were significantly lower, with a marked increase in the nRBCs in Groups [I] and [II] compared to the control group [III]. The severity of hematological alternations at birth and during the first 48 hours of life growth restricted neonates was proportionate to and predicted by the antenatal umbilical artery end diastolic velocity Doppler status

Water status of breastfed infants during weaning in Yazd, Iran

To investigate the state of hydration in infants during the weaning period in dry and hot climates in the center of Iran. Using a refractometer, 162 urine specific gravity [USG] was measured from 400 infants, between 4 to 6 months old. They were chosen among infants who visited the primary clinics in the city of Yazd, Iran for routine vaccination during the summer and winter of 2005. A questionnaire was filled out on air conditioning system and diet from mothers. A USG > 1.020 was accepted as dehydrated, and a USG < 1.010 as well hydrated. Thirty-one percent of the infants were dehydrated, and 34% were well hydrated, infants were more dehydrated in summer [p < 0.05]. Twenty-seven percent of them started solid food without water supplementation, and dehydration was significant in most of them [p < 0.05]. We could not determine which type of air conditioning devices now used at home affect water status, but there was a trend toward dehydration in those using both fan and cooler [p=0.096]. In the desert area in the center of Iran, during weaning, approximately one third of the infants are exposed to the danger of dehydration. Our primary health care provider should consider the priority of water during weaning when water supplementation is safe

Laser hyperthermia for treatment of implanted malignant tumour in mice

Different modalities could be used for treatment of recurrent and non-resectable malignant tumours. Laser hyperthermia [HPT] is a loco-regional ablative technique that could be applied by surface or interstitial approach. The present study evaluates both approaches of laser HPT using Neodymium: Yttrium Aluminum Garnet [Nd:YAG] laser [1064nm] for treatment of subcutaneously implanted malignant tumour in mice. Seventy-five Swiss albino female mice were included in the present study. Each animal was injected subcutaneously at its dorsum with Ehrlich ascites carcinoma cells. Tumours developed 6-8 days after injection. All mice were randomly divided into three equal groups. Tumours at group [A], had received no treatment and served as a control group. Tumours at group [B], were treated by surface approach of laser HPT, whereas, tumours at group [C], were treated by interstitial approach of laser HPT. The results were grossly and histo-pathologically evaluated. Both approaches of laser HPT, at the same temperature, had proven favorable responses as denoted by the statistical significant changes at tumours' volumes in both groups [B and C] in relation to the control group [A] at the 7[th] and 14[th] days after treatment. Grossly, false deep ulcers after interstitial approach of laser HPT, while large ulcers after surface approach of laser HPT were elicited. The enlightenment of active tumour re-growth was supported by the histopathological findings. Within the limitation of the present study, laser HPT has proven to be an effective, palliative, minimally invasive, loco-regional modality for treatment of subcutaneous malignant tumours. The favorable results at the present study encourage for refinement of laser HPT technique preliminary to its proposed application in humans, especially for those patients with skin metastases when multiplicity of the lesions and/or the debilitating general condition of the patients may interfere with tumours' excisions

Effects of dietary zinc supplement during lactation on longitudinal changes in plasma and milk zinc concentrations

Effects of dietary zinc supplement during lactation on maternal plasma zinc and milk zinc concentrations through 5 months of lactation were examined. One hundred and thirty eight healthy lactating mothers received a weekly 100 mg elemental zinc supplement [ZG, n = 67] or placebo [PG, n = 71] starting one week postpartum in a double blind, randomized design. Milk and plasma zinc concentrations were determined by atomic absorption spectrophotoineter. During the course of study, there was not a significant difference between ZG and PG groups in dietary zinc and energy intake. The mean plasma zinc concentration during the 1st week and 5th month were 134 +/- 49.1 and lI5.6 +/- 23ug/dl [p=0.005] for PG group, respectively: that of the ZG group these figures were 124.9 +/- 52.8 and I21 +/- 27.1ug/dl [p=0.38,], respectively. The mean serum alkaline phosphatase concentration of the 1st week and 5th month were 94.8 +/- 3 7 and 92.6 +/- 29.9 iu/l for PG group, respectively: that of the ZG group these figures were 90.5 +/- 36 and 90 +/- 29 iu/l [p=0.21], respectively. Milk zinc concentration declined significantly over the course of study for two groups, with the sharpest decline occurring during the first 2 months. The mean monthly zinc concentration of ZG group declined from 310 +/- 138 during the 1st week to l18 +/- 64pg/dl at 5th month [declined by 52%]. Corresponding means for PG group were 322 +/- 1 61 and l09 +/- 70ug/dl [declined by 60%], respectively. Milk zinc concentration was significantly different between two groups for 3 and 4 months. A similar study, however, with different zinc dose and administration manner, in zinc marginal deficient lactating mothers is needed to assess the impact of zinc supplementation on milk zinc concentrations

Study of cryoglobulinemia in patients with chronic hepatitis C viral infection

Hepatitis C virus [HCV] is involved in an increasing number of non hepatic diseases. Mixed cryoglobulinemia [MC] is considered a lymphoproliferative disorder. It is characterized by arthralgia, generalized weakness, purpura and organ involvement such as membranoproliferative glomerulonephritis, peripheral neuropathy, vasculitis and chronic liver diseases. Cryoglobulinemia is quite frequent in chronic HCV infection and especially when appropriate techniques of cryoglobulin detection are applied. Its frequency is usually higher in older male cirrhotic patients and who have a longer duration of HCV infection. The term essential mixed cryoglobulinemia [EMC] has been used to describe the syndrome with no evidence of underlying disease. Chronic HCV infection is the main cause [90%] of EMC type II and III with or without clinical or biochemical evidence of liver damage. In addition, HCV was described as a lymphotropic virus and may play a direct role in the development of low grade non-Hodgkin's lymphoma which is usually associated with EMC. Aiming to estimate cryoglobulins in patients with CHC viral infection to identify the possible correlation between cryoglobulinemia and CHC viral infection, we conducted this study on 40 patients with CHC viral infection. Another group of 10 normal persons was considered a control group. Among our patients, there were 32.5% positive patients for cryoglobulinemia, those patients had increased incidence of cirrhosis and low C4. We suggested that EMC associated with HCV infection should no longer be referred to as essential but rather as hepatitis C associated with MC. In addition, every patient with chronic HCV infection may have MC, so that serum cryoglobulins and complement components must be evaluated repeatedly during the course of chronic HCV infection for avoiding their complications

Biochemical study on gastrin, secretin and somatostatin homeostasis in end stage renal failure

Chronic renal failure is a complex disease that is associated with enormous biochemical alterations which induce marked multiorgan dysfunctions. Gastrointestinal disorders are diagnosed occasionally while renal failure is not yet recognized. The specific mechanisms underlying these complaints are not yet completely known. Aim: The present study aimed to assess the circulating state of three major biologically active gut hormones i.e. gastrin, secretin and somatostalin. Their responses to standard test meal and to hemodialysis were also determined The present study was conducted on 20 patients with CRFdue to variable kidney diseases. Of them 10 patients receiving conservative treatment only [Conservative group] and the remaining 10 patients undergoing maintenance hemo-dialysis [hemodialysis group] beside the conservative therapy. Also 12 healthy volunteers were similarly investigated. Plasma total gastrin, secretin and somatostatin [S.S] concentrations beside the routine investigations were determined. In conservative uremic group, fasting and one hour postprandial plasma total gastrin, secretin and somatostatin levels were significantly higher than their corresponding normal control levels: Moreover, test meal induced significant increase in these hormones in both CRF and control groups in comparison to their fasting levels. In hemodialysis uremic patients, plasma total gastrin, secretin and somatostatin concentrations before dialysis were significantly higher than their corresponding levels in the normal control and in conservative uremic groups. Hemodialysis caused significant reduction of the circulating gastrin, secretin and somatostatin concentrations when compared with their plasma concentrations before dialysis. However, in hemodialyzed uremics, unlike plasma gastrin and secretin concentrations, plasma SS concentration before dialysis was not significantly different from the fasting level in CRF patients on conservative therapy. Hypersecretinemia and hypersomatostatinemia were concomitant finding with hypergastrinemia in CRF. Disproprotionate synthesis and release of gastrin, secretin and somatostatin can be explained by impairment of the feedback loops and cross regulations in between these hormones. However, being excreted mainly by kidney, impaired excretion of these hormones is also a possible cause of their high circulating concentrations.

Impact of type 2 diabetes mellitus on cardiac structure and function: the association with microalbuminuria and hyperinsulinemia

Early determination of myocardial manifestations of diabetes mellitus [DM] is of a major importance, since myocardial involvement considerably influence the prognosis of diabetic patients. Microalbuminuria [MA] and hyperinsulinemia [HI] have been shown to predict cardiovascular [CV] disease in patients with DM. However the relationship between these risk factors and both cardiac structure and function is still unclear. To assess the Echocardiographic evidence of cardiomyopathy in asymptomatic patients with type 2 DM; to relate these findings to MA and fasting plasma insulin level [FI]; and to investigate whether these observations are independent of glycemic control and other clinical CV risk factors. 63 type 2 diabetic patients without known cardiac diseases, duration of DM [mean 52.4 +/- 51.4 month], age [47.4 +/- 807 year], body mass index [BMI] [26.6 +/- 3.2], men [41/63], in addition to 20 healthy subjects matched for age, sex and BMI served as control were enrolled in the present study. Based on MA and FI, patients were subgrouped into [microalbuminuric and normoalbuminuric] and [hyperinsulinemic and normoinsulinemic] respectively. We compared Echo- derived indices of left ventricular [LV] structure and LV systolic and diastolic functions in patients versus control subjects and between the different patient subgroups. Diabetic patients had greater LV posterior wall thickness [PWT], interventricular septal thickness [IVST], and LV mass index [LVMI] [p<0.0001 for each]. LV diastolic dysfunction, manifested as reduction in E velocity and E/A ratio and prolongation in isovolumic relaxation time [IVRT] [p<0.001 for each], was documented in diabetic patients as compared with control subjects. MA was diagnosed in 15/63 [24%] patients. As compared with normoalbuminuric patients, MA was associated with higher fasting blood glucose [FBG] and FI [p<0.05 for each], greater LVPWT [p<0.05], and LVMI [p=0.02], and lower fractional shortening [FS], ejection fraction [EF], and E/A ratio [p<0.001, p=0.006 and p<0.05 respectively]. Patients with HI had lower FS [p=0.02] and lower E velocity [p=0.04] than in patients with normal FI. In multi-variate analysis, the associated findings either with MA or FI has been unchanged after adjusting for the duration of DM, glycemic control, age, gender, BMI, and BP. Type 2 diabetic patients without overt heart disease have increased LV wall thickness and LVMI and LV diastolic dysfunction suggesting subclinical diabetic cardiomyopathy [DCM]. MA and HI are independently associated with these changes, which may contribute to the relation of albuminuria and HI with increased rate of CV event among diabetics. Thus, screening of either MA or HI may identify patients at CV high risk

Comparative study of the analgesic profiles of a new intravenous paracetamol preparation, ketorolac, and their combination in day case otorhinolaryngologic surgeries

This study was done on 60 adult patients who had day case otorhinolarngologic surgeries. Patients were allocated into three groups, according to perioperative analgesic used: Group 1 [n =20] was given 30 mg ketorolac IV, Group 2 [n=20] was given a new solubilised paracetamol formulation [Perfalgan 10mg/mi] 1gm IV infusion, and Group 3 [n=20] was given 30mg ketorolac IV plus Perfalgan 1gm IV infusion. Analgesic profiles were evaluated using the sum of pain intensity difference after 6 and 12 hours of drug intake [SPID[6and12]], the total pain relief score after 6 and 12 hours of drug intake [TOTPAR[6and12]], global patient satisfactionwith pain control, and use of rescue analgesics. Surgeons' satisfaction with intraoperative bleeding and surgical field, in addition to bleeding time were also studied as indications of tolerability to the drugs. This study demonstrated no significant differences in pain scores between ketorolac and Perfalgan, while SPID[6and12] and TOTPAR[6and12] were significantly higher in the combination group [11.6 +/- 2.1 and 20.2 +/- 4.5, p=0.01 and 0.022 respectively for SPID[6and12] and 19.6 +/- 6.2 and 39.3 +/- 8.6, p=0.001 and 0.003 respectively for TOTPAR[6and12] indicating much less pain intensity and better pain relief with the combination. In addition, fewer patients in the combination group required rescue pethidine, while no significant difference was detected in the use of rescue pethidine between the other two groups. Fourteen patients in the combination group rated their satisfaction for the analgesic regimen as very good to excellent, while only one patient in the ketorolac group had a very good response, and none of the Perfalgan group had a very good to excellent response. Surgeons' satisfaction with intraoperative surgical bleeding and surgical field was satisfactory to excellent in all groups. In addition, postoperative bleeding times in all groups did not show any significant prolongation 12 hours after discharge from recovery room. This study has demonstrated that the use of a combination of paracetamol IV infusion in the new formulation known as 'Perfalgan' Ig and IV ketorolac 30mg for control of postoperative pain in day case otorhinologic surgeries was efficient and enough to avoid the use of additional narcotics, and had a better analgesic efficacy than either drug alone, without any significant side effects on intraoperative or postoperative surgical bleeding

Egyptian sugar cane wax: Therapeutic significance of a new lipid-lowering agent in rat

Data from the epidemiological studies indicate that increases in serum cholesterol levels are associated with increased risk of death from coronary heart disease. Policosanol is a mixture of high-molecular-mass aliphatic alchohols isolated and purified from sugar cane [Saccharum Officinarum L.]. Policosanol is a drug currently in use to reduce elevated LDL-C and total cholesterol levels in combination with dietary therapy in patients with hypercholesterolemia. In the present study, Egyptian sugar cane wax was extracted, its polycosanols were determined qualitatively and quantitatively with GC-MS and GC and evaluated for its potency to reduce hypercholesterolemia in rat. The results showed that polycosanol constitutes 3.25% of wax. Octacosanol [C280H] is the major component, amounting to 85% of Policosanols in wax. An intervention study was adopted to evaluate the effect and of polycosanols on the cholesterol levels. 30 male albino rats were divided into five groups of equal mean body weights. The first group of rats was fed on basal diet [control]. The second group was fed on basal diet containing 1% cholesterol. Groups 3, 4 and 5 were fed on basal diet containing 1% cholesterol and sugar cane wax extract [15, 45 and 100 mg per kg diet, respectively]. Total cholesterol and low density lipoprotein cholesterol showed significant increase [p<0.05] in hypercholesterolemic group compared to control. Supplementation of sugar cane wax extract in diets of both groups 4 and 5 significantly [p<0.05] decreased total cholesterol level compared to second group. Significant increase was observed in HDL-C in group 5 compared to second group. The data obtained revealed that triacylglycerol was significantly decreased due to supplementation with sugar cane wax extract of groups 4 and 5 compared to hypercholesterolemia in rats of second group. Non significant differences were noticed in the mean value of body weight, organ weight and relative organ weights between different experimental groups. Sugar cane wax seems to be a very promising photo-chemical alternative to classic lipid-lowering agents

Transforming growth factor beta 1 in essential hypertension and glomerulonephritis: the effects of inhibition of the renin angiotensin system on its serum level in glomerulonephritis

This study was carried out on 12 patients with essential hypertension without micro or macroalbuminuria [group I] and 15 patients with chronic glomerulonephritis with mean 24-hour urinary protein = 4.3 + 3.l g/24 hours, [group II], 7 patients had hypertension [group IIa] and 8 patients had normal blood pressure [group IIb]. Ten healthy subjects were taken as controls. Blood urea, serum creatinine, fasting and 2-hour postprandial plasma glucose, urine analysis, 24-hour urinary protein and serum TGF-beta 1 were measured in diseased groups and controls. TGF-beta 1 was significantly higher in group I with essential hypertension [mean +/- SD 80.4 +/- 18.2 ng/dl] and group II with glomerulonephritis. [387.2 +/- 89.0 ng/dl], compared to control group [36.3 +/- 12.9 ng/dl]. In group II, patients with glomerulonephritis mean serum TGF-beta 1 was significantly higher than group I patients with essential hypertension [p <0.001]. In group II, TGF-beta 1 was not significantly different in hypertensive [group IIa] or normotensive patients [group IIb] [mean serum TGF-beta l = 393.3 +/- 92.0 and 379.0 +/- 84.l ng/dl, respectively]. Patients with glomerulonephritis received the angiotensin converting enzyme inhibitor ACE-I [captopril 25-75 mg/day] for four weeks then blood urea, serum creatinine, 24-hour urinary protein and serum TGF-beta 1 were re-estimated. There was significant reduction in both 24-hour urinary protein and TGF-beta 1 after captopril with no significant changes in urea and creatinine. It might be concluded that serum TGF-beta 1is elevated in patients with essential hypertension and glomerulonephritis. In patients with glomerulonephritis the use of ACE-I may reduce proteinuria and serum TGF-beta 1. Reduction of TGF-beta 1 might be a possible mechanism in the reduction of proteinuria in patients with glomerulonephritis, however, other mechanisms cannot be ruled out