Medicinal and biological values of Callistemon viminalis extracts: History, current situation and prospects

Callistemon viminalis (C. viminalis) is a plant that has been reported to have various medicinal values such as antibacterial, antifungal, antioxidant activities and other pharmaceutical and insecticidal properties. This review covers the potentials, applications and properties of different extracts from different parts (branches, flowers, fruits, bark, leaves) of C. viminalis. Furthermore, the chemical structures of the bioactive compounds were reported for biological activities. All the results supported the traditional uses of C. viminalis in folk medicine. In addition, some researches supported the use of C. viminalis extracts for the preparation of metal oxide nanoparticles.

Medicinal and biological values of Callistemon viminalis extracts: History, current situation and prospects

Callistemon viminalis (C. viminalis) is a plant that has been reported to have various medicinal values such as antibacterial, antifungal, antioxidant activities and other pharmaceutical and insecticidal properties. This review covers the potentials, applications and properties of different extracts from different parts (branches, flowers, fruits, bark, leaves) of C. viminalis. Furthermore, the chemical structures of the bioactive compounds were reported for biological activities. All the results supported the traditional uses of C. viminalis in folk medicine. In addition, some researches supported the use of C. viminalis extracts for the preparation of metal oxide nanoparticles.

Comparison of drug release from liquid crystalline monoolein dispersions and solid lipid nanoparticles using a flow cytometric technique

Colloidal lipid particles such as solid lipid nanoparticles and liquid crystalline nanoparticles have great opportunities as drug carriers especially for lipophilic drugs intended for intravenous administration. In order to evaluate drug release from these nanoparticles and determine their behavior after administration, emulsion droplets were used as a lipophilic compartment to which the transfer of a model drug was measured. The detection of the model drug transferred from monoolein cubic particles and trimyristin solid lipid nanoparticles into emulsion droplets was performed using a flow cytometric technique. A higher rate and amount of porphyrin transfer from the solid lipid nanoparticles compared to the monoolein cubic particles was observed. This difference might be attributed to the formation of a highly ordered particle which leads to the expulsion of drug to the surface of the crystalline particle. Furthermore, the sponge-like structure of the monoolein cubic particles decreases the rate and amount of drug transferred. In conclusion, the flow cytometric technique is a suitable technique to study drug transfer from these carriers to large lipophilic acceptors. Monoolein cubic particles with their unique structure can be used successfully as a drug carrier with slow drug release compared with trimyristin nanoparticles.

Seroprevalence of Toxoplasma gondii infection among patients in Hospital Universiti Sains Malaysia

Toxoplasmosis is a worldwide endemic zoonotic infection caused by the obligate coccidian parasite Toxoplasma gondii. To assess the seroprevalence of T. gondii infection among hospital population of Hospital Universiti Sains Malaysia (HUSM), a cross-sectional study was conducted using serum samples of 102 participants. Samples were screened for the presence of anti-Toxoplasma IgG and IgM antibodies by enzyme-linked immunosorbent assay (ELISA). Only one sample recorded as IgM positive (0.98%) (1/102; 95% CI = 0.02– 5.34%), whereas 44.12% (45/102; 95% CI = 34.29–54.29%) were IgG positive. The study showed that seroprevalence of toxoplasmosis significantly differs between age groups (p < 0.001), with high prevalence of T. gondii infection (37.8%) among patients aged less than one month. Moreover, the study indicated a significant difference in the prevalence of toxoplasmosis between males and females. Additionally, a significant dependent relationships were observed (p = 0.003), when the reasons of toxoplasma serology request was considered, and the highest prevalence (59.6%) observed in congenital toxoplasmosis. In conclusion, the seroprevalence of toxoplasmosis in our study group was high. The study provides preliminary information about the seroprevalence and epidemiology of T. gondii infection among the hospital population in HUSM.

Masimo® Plethysmograph Variability Index as a Tool for Assessment of Fluid Responsiveness in Elective Major Abdominal Surgeries.

Background: Maximizing the stroke volume (SV) as measured by Trans-oesophageal Doppler (TED) optimizes preload, & is a goal-directed fluid therapy technique that has been used in a variety of clinical settings. Masimo® Plethysmograph variability Index (PVI) is a reliable, safe & noninvasive tool to guide fluid management. PVI is an automated measure of the dynamic change in the perfusion index (PI) that occurs during a respiratory cycle. This study was designed to determine whether PVI, measured using finger co-oximetry is an efficient predictor of fluid responsiveness in low-risk patients undergoing elective major abdominal surgery. Subjects and Methods: 60 ASA I-II patients of either sex, 25-60 years old, undergoing major abdominal surgery were enrolled in this study. A Masimo® Radical-7 Pulse Co-Oximeter probe & a Cardio Q TED probe were applied to each patient. In all patients, a fluid bolus of 500 ml of 130/0.4 tetrastarch colloid solution was administered rapidly via pressurized IV infusion. Maintenance & deficits were calculated routinely. If the SV decreased by 10%, a 250-mL bolus of colloid was given via fast infusion. Patients’ demography, TED-derived measurements: (SV & Flow Time corrected (FTc)), Masimo®-derived measurements: (PVI & PI), HR and MAP were all collected and statistically analyzed. Measurements were done at five minutes post-induction T1, Ten minutes after volume expansion (500 ml colloid) T2, If the SV decreased by 10%, (guided by TED) T3, Then 250 ml colloid is given. Ten minutes after a 250-ml colloid bolus T4. Results: A significant difference was found in FTc, SV, PI & PVI in T1 vs. T2 & T3 vs. T4 (P=0.001). There was a significant difference in PI & PVI between responders & non-responders for the 1st bolus (P<0.05) and in SV & PVI in subsequent boluses (P<0.01). There was no significant difference between percent changes of SV and PVI at T3 & T4. Conclusions: Plethysmograph Variability Index (PVI) measured by Masimo® Co-Oximeter is an efficient predictor of fluid responsiveness as SV measured by TED in low risk patients undergoing elective major surgery.

Pulse-induced Continuous Cardiac Output Monitor versus Trans-esophageal Doppler Monitor for Optimization of Fluid Management in Patients Undergoing Major Abdominal Surgery. A Comparative Study.

Background: Perioperative fluid management is essential to the practice of anaesthesia. Outcomes may be improved if fluid therapy is individualized according to the patient's fluid responsiveness. Pulse-induced continuous cardiac output (PiCCO) monitor is an invasive device that quantifies several parameters, including cardiac output (CO), stroke volume variation (SVV) and extravascular lung water (EVLW). Trans-oesophageal Doppler monitoring (TED) is another minimally invasive form and has the benefit of providing beat to beat analysis. Aim of Work: We designed this prospective, randomized comparative study to evaluate the use of PiCCO monitor from the fluid and haemodynamic point of view in comparison to TED monitor in order to maintain an adequate circulatory volume ensuring end-organ perfusion and oxygen delivery. Patients and Methods: This study was performed on 72 patients of either sex (ASA I-II), undergoing major abdominal surgery. Patients were randomly allocated into two groups; PiCCO group (n=36); where fluid management was guided by SVV & colloid boluses were given to maintain SVV below 10% and TED group (n=36); where fluid management was guided by (systolic flow time corrected for heart rate) (FTc) & colloid was infused when the (FTc) ˂ 0.35 second, the fluid challenge would be repeated until FTc raised ˃ 0.40 second with no change in SV. Laboratory parameters of organ hypoperfusion in perioperative period were recorded as well as the number of postoperative complications, mortality and length of ICU stay. Results: PiCCO group received more intraoperative colloids (P=0.001) and had lower incidence of hypotensive events (P=0.001). Postoperative lactate levels were lower in PiCCO group (P=0.04). PiCCO group showed fewer numbers of patients developed complications & overall number of postoperative complications (P=0.01). It also showed shorter duration of ICU length of stay (P=0.01). No mortality was recorded in both groups. Conclusions: During major abdominal surgery; intraoperative fluid optimization using PiCCO monitor showed more haemodynamic stability and was associated with a lower incidence of postoperative complications, organ dysfunction and infectious complications with a tendency to decrease the ICU length of stay in comparison to TED monitor.

Perfusion index derived from pulse oximetry versus lactate monitoring for outcome prediction in polytraumatized patients

Perfusion Index is a non-invasive numerical value of peripheral perfusion [PI] obtained from pulse oximetery. Prognostic value of perfusion index and its relation to serum lactate and brain natriuretic peptide [BNP] changes has not been investigated in poly-traumatized patients. Fifty poly-traumatized adult patients with hemorrhagic shock without head injury were studied in a prospective observational study, perfusion index changes in relation to serum lactate, lactate clearance and Brain Natriuretic Peptide in survivors and non survivors and their predictability of mortality was evaluated. Full resuscitation according to the advanced trauma life support guidelines [ATLS] was carried out and the morbidity and mortality were followed up for 48 hours. Perfusion index was included as a target for peripheral perfusion and we compared its sensitivity and specificity with serum lactate and BNP for prediction of mortality. Statistical analysis was done using pearson's correlation and receiver operating curve [ROC]. Perfusion index showed a significant difference between survivors and non survivors after the first 6 hours post resuscitation [p < 0.001], ROC analysis showed that perfusion index /= 2.25 mmol/L provided the optimal cutoff point for predicting mortality with AUC was 0.57, sensitivity 79% and specificity 69%. Lactate clearance showed a significant difference between survivors and non survivors [p < 0.001], ROC curve analysis showed that lactate clearance < 3.0 mmol/L/24 hours provided the optimal cutoff point for predicting mortality with AUC was 0.97, sensitivity 97% and specificity 86%. Brain natriuretic peptide level at 48 hours [BNP-48] was significantly higher in non survivors than in survivors [p < 0.001]. ROC analysis showed that BNP-48 >/= 95.0 pg/ml provided the optimal cutoff point for predicting mortality with AUC was less than 0.5, sensitivity 61% and specificity 32%. Perfusion index is a good prognostic factor of mortality and lactate clearance seems the most accurate predictor of mortality as well. Serum lactate is the least accurate predictor of mortality followed by brain natriuretic peptide

Correlation of Glu298Asp eNOS Polymorphism with Serum NO Levels in Egyptian Patients with Coronary Artery Disease.

Background: Nitric oxide (NO) is a potent vasodilator synthesized by the vascular endothelium. It has been reported that endothelial nitric oxide synthase (eNOS) Glu298Asp gene polymorphism is associated with coronary artery disease (CAD). Methodology: In this study, we investigated Glu298Asp eNOS polymorphism and serum NO in a group of 146 age-matched male subjects; 77 patients with coronary artery disease (CAD) classified according to the severity of coronary insufficiency and 69 normal male controls. Results: The obtained frequencies of the eNOS Glu298Asp genotypes for the CAD subjects were GG (54.5%), GT (31.20%), and TT (14.3%). The allele distributions of G and T were 70.1 and 29.9%, respectively. In the control group, the genotype frequencies were 53.6% for GG, 36.2% for GT, and 10.2% for TT, and the frequencies of the G and T alleles were 71.7% and 28.3%, respectively. There were no significant differences in genotype and allele frequencies between the CAD patients and the control group. The mean serum NO levels in CAD patients was significantly higher than that of healthy subjects (p=0.0139). Conclusion: No significant association was detected when CAD severity, genotypes and NO serum levels were correlated.

Preliminary study on the occurrence of pten and PIK3CA gene mutations in endometrial cancer among Malaysian women

Genetic mutations in endometrial cancer (EC) have been extensively studied in the Western population but not much in Asian cohorts. This study has demonstrated that PTEN and PIK3CA mutations are commonly found in EC among Malaysian women. Following RNA extraction from 20 cancerous and 18 non-cancerous tissues, the presence of mutations in 9 exons of PTEN and 3 exons of PIK3CA genes were detected using realtime PCR, accompanied by High Resolution Melt (HRM) analysis. Sequencing confirmed specificity of each PCR product. The mutations for both genes were detected in the samples with varying frequencies. Notably, all samples expressed mutation of PTEN at exon 7 but none in exon 4. Further analysis demonstrated that strong concurrent mutations occurred between exons 7 of PTEN with exon 20 region 1 of PIK3CA gene (90%). Our data showed mutations are present in EC and not the non-cancerous tissues. Larger samples are being collected to validate this observation.

Evaluation of extracts and essential oil from Callistemon viminalis leaves: antibacterial and antioxidant activities, total phenolic and flavonoid contents

OBJECTIVE@#To investigate antioxidant and antibacterial activities of Callistemon viminalis (C. viminalis) leaves.@*METHODS@#The essential oil of C. viminalis leaves obtained by hydro-distillation was analyzed by GC/MS. Different extracts were tested for total phenolic and flavonoid contents and in vitro antioxidant (DPPH assay) and antibacterial (agar disc diffusion and 96-well micro-plates methods) actives.@*RESULTS@#Fourteen components were identified in the essential oil, representing 98.94% of the total oil. The major components were 1,8-cineole (64.53%) and α-pinene (9.69%). Leaf essential oil exhibited the highest antioxidant activity of (88.60±1.51)% comparable to gallic acid, a standard compound [(80.00±2.12)%]. Additionally, the biggest zone of inhibitions against the studied bacterial strains was observed by the essential oil when compared to the standard antibiotic (tetracycline). The crude methanol extract and ethyl acetate fraction had a significant antibacterial activity against the tested bacterial strains.@*CONCLUSIONS@#It can be suggested that C. viminalis is a great potential source of antibacterial and antioxidant compounds useful for new antimicrobial drugs from the natural basis. The present study revealed that the essential oil as well as the methanol extracts and ethyl acetate fraction of C. viminalis leaves exhibited highly significant antibacterial activity against the tested bacterial strains.

Real-time PCR versus phenotypic diagnostic methods in detection of methicillin and vancomycin resistant staphylococci

Staphylococci are the most frequently isolated bacteria from blood. The prevalence of antibiotic resistance has dramatically increased. Real-time PCR offers rapid, accurate, and sensitive method to detect the presence of antimicrobial resistance. This study is mainly aimed to detect uethicillin [oxacillin] and vancomycin resistant staphylococci isolated from blood of patients with significant bacteremia in Assiut University Hospital using both real-time PCR and phenotypic agnostic methods. Sixty Staphylococcal isolates were included. These isolates were collected from positive blood culture bottles [BACTEC 9050 System] of patients with significant bacteremia in Assiut University Hospital. Identification of staphylococcal species was performed by subculture on Mannitol Salt Agar [MSA] and by Microscan system, while antibiotic sensitivity testing was performed by Microscan system, Epsilometer test [E- test], Disc diffusion [DD] method, Oxacillin Resistance Screening Agar Base [ORSAB] and by real-time PCR for mec A and van A genes. Seven S. aureus isolates and fifty three Coagulase-negative staphylococci [CoNS] were detected by both MSA and Microscan system. The most effective antibiotics for staphylococcal isolates were in order. Vancomycin, Linezolid, Synercid, Rifampicin, Chloramphenicol, Gentamycin, Tetracycline, Trimethoprim/Sulphamethoxazole, Clindamycin, Ofloxacin, Ciprofloxacin, Azithromycin and Erythromycin. Concerning methicillin resistance, Real-time PCR which is the gold standard method detected mecA gene in 57 isolates. Accordingly, sensitivity and specificity of E-test were 964% and 100% respectively, DD method showed 87.7% sensitivity and 100% specificity, ORSAB media showed 92.9% sensitivity and 100% specificity while Microscan showed 100.0% sensitivity and 100.0% specificity. Concerning vancomycin resistance, E-test which is the gold standard method detected vancomycin resistance in 6 staphylococcal isolates. Therefore, the DD method showed 66.7% sensitivity and 100.0% specificity while Microscan showed 83.3% sensitivity and 100.0% specificity. Real-time PCR detected van A gene in only one staphylococcal isolate. CoNS organisms are more implicating than S. aureus in bloodstream infections [BSIs]. About 95% of staphylococcal isolates were resistant to methicillin and 10% were resistant to vancomycin. Real-time PCR was more accurate and rapid method for detection of methicillin resistance than phenotypic methods and it could be considered a confirmatory method for detection of vancomycin resistance in staphylococcal isolates suspected to have the van A gene

Diagnostic value of B-natriuretic peptide, ankle brachial index and carotid doppler in detection of sub-clinical cardiovascular disease in type 2 diabetic patients

Diabetes is important as a cause of cardiovascular disease [CVD], ranging from asymptomatic ischemia to clinically evident heart failure. Therefore, early identification of sub-clinical CVD in diabetic patients may be particularly important in leading to early initiation of treatment. The aim of the present study was to identify role of BNP [Brain natriuretic Peptide]. Ankle Brachial Index [ABI] and carotid Doppler in detection of sub-clinical CVD in type 2 diabetic patients. BNP was measured in 60 consecutive diabetic patients [patients group] whom were attended internal medicine outpatient clinics or admitted at endocrinology unit of Assiut university hospital. Another 40 patients; were chosen as [control group] their age and sex matched with patients. Echocardiography examinations were performed to all participants. ABI measurements were eonducted on all study participants. Carotid intima Media Thickness [CIMT] and carotid Plaque were evaluated by Carotid Doppler Ultrasonography, along with the determination of anthropometric parameters, HbAlc, lipid profile, assessment of diabetic retinopathy, nephropathy, and neuropathy, in patients with type 2 diabetes mellitus [T2DM]. Our study revealed 11 patients had Left ventricular hypertrophy [LVH], 20 patients had Left Ventricular Diastolic Dysfunction [LVDD], and no systolic dysfunction were detected. BNP were independent determinants of mild to moderate LVDD. Prevalence of a low ABI [<0.9] was 18.3%. Patients with low ABI had significant increased mean ages [P=0.038] duration of DM [P=0.004], concentration of HbAlc [P=0.044], BNP [P=0.013] and microalbuminurea [P-0.007].Patients with low ABI significantly associated with nephropathy [P=0.001], retinopathy [P=0:007], LVH [P=0.010] LVDD [P=0.018] and carotid artery atherosclerosis [P=0.018]. 20 patients [33.3%] were found to have evidence of carotid artery disease of them 5 patients [8.3%] had increased CIMT and 15 patients [25%] had carotid artery plaques, patients with carotid plaque were significantly smoker [P=0.008], male gender [P=0.013], had low HDL [P-0.008] and higher concentration of HbAlc [P=0.001]. Also patients with carotid artery atherosclerosis were significantly associated with nephropathy [P=0.000], neuropathy [P=0.050], Peripheral Arterial Disease [PAD] [P=0.018], LVDD [0.002].Conclusion: Our study showed that BNP discriminated patients at high risk for mild to moderate LVDD. A low ABI were prevalent in our study and associated with age, duration of diabetes, high HbAlc, microalbuminurea and chronic complication of DM, also carotid atherosclerosis high prevalent in our study especially carotid plaques which significantly associated with male gender, smoking, high HbAlc, low HDL, LVDD, PAD, and diabetic microangiopathy

Genetic association of SNPs in the FTO gene and predisposition to obesity in Malaysian Malays

The common variants in the fat mass- and obesity-associated (FTO) gene have been previously found to be associated with obesity in various adult populations. The objective of the present study was to investigate whether the single nucleotide polymorphisms (SNPs) and linkage disequilibrium (LD) blocks in various regions of the FTO gene are associated with predisposition to obesity in Malaysian Malays. Thirty-one FTO SNPs were genotyped in 587 (158 obese and 429 non-obese) Malaysian Malay subjects. Obesity traits and lipid profiles were measured and single-marker association testing, LD testing, and haplotype association analysis were performed. LD analysis of the FTO SNPs revealed the presence of 57 regions with complete LD (D’ = 1.0). In addition, we detected the association of rs17817288 with low-density lipoprotein cholesterol. The FTO gene may therefore be involved in lipid metabolism in Malaysian Malays. Two haplotype blocks were present in this region of the FTO gene, but no particular haplotype was found to be significantly associated with an increased risk of obesity in Malaysian Malays.

Perioperative effects of various anesthetic adjuvants with TIVA guided by bispectral index / 대한마취과학회지

BACKGROUND: This prospective, randomized, double blinded, controlled study was designed to compare effects of intravenous co-administration of clonidine, magnesium, or ketamine on anesthetic consumption, intraoperative hemodynamics, postoperative analgesia and recovery indices during Bispectral Index (BIS) guided total intravenous anesthesia (TIVA). METHODS: After ethical committee approval and written informed consent, 120 adult patients ASA I and II scheduled for open cholecystectomy were randomly assigned to one of 4 equal groups. Group CL received clonidine 3 microg/kg and maintained by 2 microg/kg/h. Group MG received magnesium sulphate 50 mg/kg and maintained by 8 mg/kg/h. Group KET received racemic ketamine 0.4 mg/kg and maintained by 0.2 mg/kg/h. Control group (CT) received the same volume of isotonic saline. Anesthesia was induced and maintained by fentanyl, propofol and rocuronium. Propofol infusion was adjusted to keep the BIS value between 45-55. Intraoperative hemodynamics, induction time, anesthetic consumption, recovery indices, and PACU discharge were recorded. RESULTS: Induction time, propofol requirements for induction and maintenance of anesthesia, intraoperative fentanyl and hemodynamic values were significantly lower with Groups CL and MG compared to Groups KET and CT (P < 0.05). Patients in Group MG showed significantly lower muscle relaxant consumption, delayed recovery and PACU discharge than other groups (P < 0.05). First, analgesic requirement was significantly longer and total postoperative analgesic consumption was significantly lower in the adjuvant groups versus Group CT (P < 0.05). CONCLUSIONS: Clonidine, magnesium, and ketamine can be useful adjuvant agents to BIS-guided TIVA. Pharmacokinetic studies of such drug combinations were recommended to investigate their interaction.

Controlled mechanical ventilation with lmasureme[TM] Versus I-Gel[TM] in anesthetized adult patients

The efficacy, safety and ease of insertion of LMA[TM] Supreme and the i-gel™ in adult cases undergoing elective surgical procedures requiring general anesthesia with controlled mechanical ventilation. This study included 60 ASA physical status I-II adult patients of both sexes scheduled for elective surgical procedures under general anesthesia. Patients were randomly allocated into one of two groups; LMA-S[TM] GI [n=30] and i-gel[TM] Gil [n=30]. A size 4 LMA Supreme[TM] and a size 4 i-gel[TM] were used with standard monitoring. Number of insertion attempts, ease of insertion, presence of gastric insufflation, laryn-geal leak, leak pressure, ease of gastric tube insertion, ventilatory parameters, complications as well as hemodynamic variables was recorded. The results showed no clinically significant changes of heart rate, MAP, Sp0[2] or P[ET] CO[2] in GI and GIL The i-gel[TM] showed higher frequency of ease of insertion[p=0.048] and gastric tube [p< 0.001]. First attempt of insertion was successful in 60% of LMA-S[TM] GI and 73.3% of the i-gel[TM]Gil [p=0.460] without failures in both groups. Leak pressure was significantly higher in the i-gel[TM] [25.5 +/- 4.8 cm H[2]O] compared to the LMA-S[TM] [21.1 +/- 7.6 cm H[2]O] [p=0.010] while both peak and plateau pressures were significantly lower in i-gel[TM] GI [19.35 +/- 2.25 cm H[2]O and 17.75 +/- 2.07 cm H[2]O] compared to LMA-S[TM] Gil [30.05 +/- 3.82 cm H[2]O and 28.80 +/- 3.99cm H[2]O][p<0.001] respectively. There was no significant difference between both groups in the frequency of complications encountered during insertion or recovery

Preoperative subconjunctival injection of mitomycin C versus intraoperative topical application as an adjunctive treatment for surgical removal of primary pterygium

To compare the efficacy of preoperative local injection of mitomycin C [MMC] to intraoperative application of MMC in the prevention of pterygium recurrence after surgical removal. Seventy eyes of 70 patients with primary pterygia were randomly allocated to two groups. The first group [Group A, 35 eyes] received 0.1 ml of 0.15 mg/ml of subconjunctival MMC injected into the head of the pterygium 24 h before surgical excision with the bare sclera technique. The second group [Group B 35 eyes] underwent surgical removal with the bare sclera technique with intraoperative application of MMC [0.15 mg/ml] over bare sclera for 3 min. The study was performed between March 2007 and December 2008, and follow up was performed for 1 year postoperatively. Differences between frequencies in both groups were compared by the Chi-square test or Fisher exact test. Differences between means in both groups were compared by Student's t-test. P < 0.05 was considered significant. The rate of pterygium recurrence was 5.70% in Group A and 8.57% in Group B at 1 year postoperatively [P>0.05]. Postoperatively, scleral thinning occurred in one eye in each group that resolved by 5 months postoperatively. No serious postoperative complications occurred in either group. Preoperative local injection of 0.15 mg/ml MMC is as effective as intraoperative topical application of 0.15 mg/ml MMC for preventing pterygium recurrence after surgical removal

Difficult intubation management in a child with I-cell disease

I-cell disease [mucolipidosis II] is a rare metabolic disorder resulting from the deficiency of a specific lysosomal enzyme, N-acetylglucosamine-1-phosphotransferease. Developmental delay and growth failure are common presentations of I-cell disease. Psychomotor deterioration is rapid and progressive. Some physical signs such as hip dislocations, inguinal hernia, hepatomegaly, joint limitation, and skin changes may be present at birth. Coarse facial features and skeletal abnormalities become more conspicuous with time. The life expectancy of children with this condition is poor, with death usually occurring around the fifth year. A case report of the anesthetic management of gingivectomy with multiple dental extractions in a 5-year-old Omani female with I-cell disease is presented. The problems faced and their management during anesthesia are described

Sub-antibiotic doses of erythromycin as a prokinetic in abdominal surgeries: reviving the old

All patients undergoing major abdominal procedures have some degree of gastric atony in the immediate postoperative period, presenting mainly with vomiting. Many prokinetic agents have been used in the past, but none is a universal remedy. Studies showed that subantibiotic doses of erythromycin, a macrolide. antibiotic and motilin agonist, accelerates gastric emptying. This study investigated whether preoperative subantibiotic dose oral erythromycin [250 mg], altered residual gastric volume and postoperative adverse effects in patients scheduled for abdominal surgeries. Erythromycin was compared with the commonly used prokinetic metoclopramide and antiemetic ondansetron, in terms of prokinetic efficacy, cost and adverse effects. In a double-blind study, eighty patients [20 each] were allocated randomly to receive orally, either erythromycin 250 mg [E250] or erythromycin 500 mg [E500], or 10 mg metoclopramide [M], or 4mg ondansetron [Z], an hour pre-induction of anesthesia. Preoperative oral erythromycin in subantibiotic dose 250mg elicited a significantly lower residual gastric volume [P<0.001] and a lower VAS for vomiting, compared with ondansetron. As for metoclopramide and erythromycin 500, residual gastric volume was comparable, but E 250 had a lower VAS for vomiting than both groups. Rescue remedy for vomiting was required for groups E500, M and Z [100, 10 and 10 %] compared to 0% in group E250. Ultimately, subantibiotic oral dose of erythromycin [250 mg], given1 hr preoperatively, is an inexpensive prokinetic alternative with a promising post-operative profile which may be superior to the inexpensive prokinetic metoclopramide with known adverse effects, and the expensive antiemetic ondansetron

Pioglitazone versus metformin in two rat models of glucose intolerance and diabetes

Insulin resistance has been implicated in the pathogenesis of type 2 diabetes. High fat diets cause insulin resistance. Both metformin and pioglitazone are considered "insulin sensitizers" and used as antihyperglycemic agents for type 2 diabetes treatment. The aim of this study is to Compare pioglitazone and metformin effects on carbohydrate metabolism and insulin sensitivity in diabetic and glucose intolerant rats on high fat diet. Male albino rats were randomized to seven groups. The 1 st group received high carbohydrate diet [control]. The 2 nd, 3 rd and 4 th groups received high sunflower oil diets for 6 weeks and either left untreated, or given pioglitazone or metformin during the last 3 weeks. The 5 th, 6 th, and 7 th groups were made diabetic by STZ injection on day 15 of the 6 weeks-high fat diet regimen. They were either left untreated, or given pioglitazone or metformin during the last 3 weeks. High-fat diet induced glucose intolerance; represented by increase of serum glucose associated with increase in liver glucose-6-phosphatase and decreases in liver glucose-6-phosphate dehydrogenase and glucokinase activities. No significant differences were observed between pioglitazone and metformin. In diabetic rats, both pioglitazone and metformin decreased elevated serum glucose by-30%. Only metformin increased hepatic glycogen, and normalized glucose-6-phosphatase activity. On the other hand, pioglitazone normalized elevated renal glycogen content and increased glucose-6-phosphate dehydrogenase activity. High sunflower oil diet impaired glucose tolerance. Pioglitazone and metformin had comparable effects on estimates of carbohydrate metabolism and insulin sensitivity in high-fat fed rats, but different effects in diabetic rats

Clinical and radiological aspects of closed reduction in developmental dysplasia of the hip treated in the first six months

To evaluate the success rate and subsequent restoration of normal acetabular angle [AC], and associated growth changes secondary to avascular necrosis of the proximal femur in cases of developmental dysplasia of the hip [DDH] treated during the first six months of life. Retrospective study from 1998 to 2006. Department of Pediatric Orthopedics, Altona Children Hospital, Hamburg, Germany. Twenty six patients with twenty nine dysplastic hips were evaluated regarding grade of hip dysplasia. The success rate of closed reduction, postoperative restoration of normal acetabular coverage [AC angle] and associated complication were noted. Closed reduction of DDH with intraoperative arthrogram followed by spica cast. Success rate of closed reduction and restoration of normal acetabular index. Closed reduction could be achieved in twenty two hips [76%]. Out of those twenty two hips fifteen [68%] developed normal acetabular index, six [27%] showed persistent acetabular dysplasia and one [5%] had border -line measurement. Closed reduction was not successful in seven hips. Those seven hips were treated by open reduction and capsulorrhaphy. Closed reduction of DDH in the first six months of life was achieved in [76%] of dislocated hips, and did not show any significant growth changes in the proximal femur. The early changes in the ossific nucleus of capital femoral epiphysis [CFE] alone were found to be of very little value in predicting the nature of development of the hip