Salmonella enteritidis abdominal aorta mycotic aneurysm presented with acute cholestatic jaundice: A case report and literature review

@#Mycotic aneurysm is one of the extra-intestinal manifestations of Salmonella Enteritidis infection. The diagnosis of this condition is challenging owed to its variation in clinical presentations. We presented a case of a 54-year-old man with underlying diabetes mellitus and chronic smokers presented with acute right flank pain and fever associated with mild jaundice. The initial laboratory investigations suggested features of obstructive jaundice and urinary tract infection. The contrast enhancing computed tomography of the abdomen revealed the presence of saccular mycotic aneurysm located at the infrarenal abdominal aorta. The blood culture grew Salmonella Enteritidis which was susceptible to ceftriaxone, trimethoprim-sulfamethoxazole, ciprofloxacin, ampicillin, and amoxicillin-clavulanic acid. Intravenous ceftriaxone was initiated, and he underwent open surgery and artery repair at day 8 of admission. He responded well to the treatment given and subsequently discharged home after completed three weeks of intravenous ceftriaxone.

Effect of Finish Line Design and Cement Space Thickness on the Marginal Accuracy of Monolithic Zirconia Crowns / Efeito do desenho da linha de término e da espessura do espaço de cimento na precisão marginal de coroas monolíticas de zircônia

Objective: The purpose of this study was to evaluate the effect of finish line design and cement space thickness on the marginal accuracy of monolithic zirconia crowns. Materials and methods: Thirty crowns were fabricated from translucent zirconia (inCoris TZI) using Cerec in-Lab system and divided into three main groups (10 each) according to the finish line type of the die (knife-edge, chamfer, and shoulder). Every group was divided into two subgroups (5 each) according to cement space thickness (20 and50µm). Optical impressions were taken for the dies using the Cerec scanner and cement space was set twice for every finish line design; 20 and 50 µm. The completed crowns were cemented to the dies and the marginal gap was evaluated. The collected data was statistically analyzed using Mann-Whitney U test and Kruskal-Wallis test and the significance level was set at P ≤ 0.05. Results: Regarding the marginal gap; there was no statistically significant difference between different finish line designs or between different cement space thicknesses. Conclusion: Neither finish line design nor cement space thickness has an effect on the marginal gap of inCoris TZI crowns. (AU)

Declaração do problema: A necessidade de um método minimamente invasivo de preparação de coroa única é inevitável, principalmente com dentes enfraquecidos e com alta probabilidade de irritação pulpar. Portanto, é necessária uma restauração durável e adaptada, com preparação menos invasiva da linha de término. Objetivo: O objetivo deste estudo foi avaliar o efeito do design da linha de término e da espessura do espaço de cimento na precisão marginal das coroas monolíticas de zircônia. Material e Métodos: Trinta coroas foram fabricadas a partir de zircônia translúcida (inCoris TZI) usando o sistema Cerec em laboratório, e divididas em três grupos principais (n = 10), de acordo com o tipo de linha de término da matriz (lâmina, chanfro e ombro). Cada grupo foi dividido em dois subgrupos (5 cada), de acordo com a espessura do espaço do cimento (20 e 50 µm). Impressões ópticas foram obtidas para as matrizes usando o scanner Cerec e o espaço de cimento foi definido duas vezes para cada projeto de linha de chegada: 20 e 50 µm. As coroas confeccionadas foram cimentadas nos moldes e a diferença marginal foi avaliada. Os dados coletados foram analisados estatisticamente pelo teste U de Mann-Whitney e Kruskal-Wallis e o nível de significância foi estabelecido em P ≤ 0,05. Resultados: Em relação ao gap marginal não houve diferença estatisticamente significante entre diferentes projetos de linha de acabamento ou entre diferentes espessuras de espaço de cimento. Conclusão: nem o design da linha de término, nem a espessura do espaço de cimento afetam a folga marginal das coroas inCoris TZI. (AU)

Assessment of Thrombin Generations in Patients with Chronic Liver Diseases

Background/objectives: The area of hypercoagulability in cirrhosis and its potential contribution to certain clinical aspects have received a lot of attention. The clinical manifestations of the hemostatic disorders of cirrhosis have been traditionally related to bleeding due to multiple procoagulant factor defects, excessive fibrinolysis, and thrombocytopenia. Aim: Assess the function of blood coagulation in patients with chronic liver diseases and improve the knowledge of the pathophysiology of haemostasis. Patients and methods: This is a prospective case-control study which was conducted at outpatient clinic of internal medicine dept., Minia University Hospital, Minia Governorate, during the period from March 2017 to August 2018. Results: Protein C and S concentrations decreased significantly in Group (II A, II B, and IIC) compared to control and also, Group (II C) decreased significantly than Group (II A, II B). Regarding Thrombin fragments (F 1+2), Child score A patients had significantly higher concentration compared to the other three groups. However, as regards, Thrombin-antithrombin (TAT), Child score C group had a significantly higher level compared to other groups. Conclusion: Thrombin fragments and thrombin antithrombin complex are considered as the main specific markers for thrombin generations which were elevated strongly depending upon the pathogenesis and the severity of the liver diseases.

A Survey to Assess Quality of Life of Gastro‐Oesophageal Reflux Disease (GERD) Patients in Saudi Arabia

Gastrointestinal Esophagus Ailment is a chronic disease that usually results in complications. GERD symptomsinclude chest pain, acid regurgitation, heartburn, nausea, chronic cough, asthma, and hoarseness. A considerablenumber of research studies have shown that old age, obesity, drug and substance abuse are significant factorsthat exacerbate the present condition. The findings from the present research study illustrate that the conditionhas a major impact on psychological problems. Precisely, the consequences of the condition appeared to vary indifferent age groups. In particular, this difference was determined with chi-square while taking into considerationthe existing variables. Furthermore, the results ascertained that some variations were registered in terms ofseveral factors that differ significantly across gender. Eating pattern between males and females also emerged asa major factor in the research study. The difference is also evident in the age group category as the age group18-25 shares different sentiments in various aspects.

Role of Serum Osteoprotegerin as a Diagnostic Indicator of Primary Osteoporosis in Perimenopausal and Postmenopausal Women: An Indian Perspective

@#Introduction:Osteoporosis (OP) is a major health problem in the older population. The aim of the study was to assess the role of serum osteoprotegerin (OPG) as a diagnostic indicator of primary osteoporosis in peri- and postmenopausal women in an Indian population. Materials and Methods: After ethical approval, 90 cases (45 cases and 45 controls) of peri- and post-menopausal females above 40 years of age presenting to our outpatient department were included in the study. It was a case controlled study conducted between July 2014 to July 2015. Based on the clinical features, t-score and radiological evidence from the DEXA scan, they were equally divided into two groups (cases and controls). Serum osteoprotegerin (OPG) levels were measured amongst cases and controls. Results:The total calcium (mg/dl) level was lower among the cases and the difference was significant (p-Value= <0.001). Similarly, alkaline phosphatase (u/l), osteoprotegerin (u/ml) levels were higher in the cases as compared to controls and the difference was significant (p-Value= <0.001). The mean osteoprotegerin level showed a slight increase with increase in severity of the grading of BMD of spine. The results suggested a cut-off value of ≥10.5 u/ml (86.7% sensitive and 80% specific with accuracy of 84.5%) between normal and osteoporosis. Conclusion: From the present study, we conclude that osteoprotegerin is a valid biomarker to diagnose postmenopausal women with low bone mineral density.

Inhibition of Cancer Cells Line by Biosurfactant Produced from Leuconostocmesenteroidesssp Cremoris.

Objective: This brief research was initiated to search for cytotoxic effect of bio surfactant produced by Leuconostocmesenteroidesssp. cremorisisolated from raw cow’s milk. Methods: Extraction of extracellular bio sufactant was completed and partially purified by cold acetone precipitation, bio surfactant were tested against two cell lines, AMN3 (cancer cell line of mice mammary gland) and REF (noon cancerous normal cell line transformed) specifically regarding cell viability and proliferation. Results: Bio surfactant was found to decrease viability of AMN3 cancer cell line studied at concentrations 1:3,2:2 and 1:3 V/V (biosurfactant: free serum media), the inhibition percentage were 56.4%, 56.8% and 51.8% respectively, without affecting normal fibroblasts growth. Conclusion: The results gathered in this work are very promising regarding the bio surfactant potential for cancer treatment and encourage further work with other cell lines.

Parasitological studies on some intestinal parasites in primary school children in Aswan Governorate, Egypt

This cross sectional study in Aswan Governorate determined the prevalence of intestinal parasites and to identify the risk factors for infection in primary school children in this geographical area. The results would facilitate evaluation of the endemic level of different intestinal parasites and the determination of whether widespread or focal measures of parasite control are required. After obtaining official permission from the school administration, information and consent forms were given to the parents of all the schoolchildren. They were three-hundreds children aged between 6-12 year were enrolled; a detailed questionnaire, complete clinical assessment complete as well as stool analysis was done The study showed that the over-all infection was 31%, single parasitic infection was 26% and mixed one was 5%.The commonest helminthic infection was E. vermicularis 6.6% followed by H. nana 3% Ascaris lumbricoides 1%, The commonest protozoa infection was E. histolytica 8.3% followed by Giardia lamblia 3.7% and Cryptosporidium parvum 1.7%. Mixed infection was E. vermicularis plus E. histolytica [23.4%], E vermicularis plus G. lamblia [17.6%], E. vermicularis plus C. parvum [11.8%], E. histolytica plus H. nana [11.85%], A. lumbricoides plus E. histolytica [17.6%] and G. lamblia plus E. histolytica. in [11.8%]. Parasitic infection was more prevalent in boys [53.8%] than girls [46.2%] and more prevalent in rural children [39.73%] than urban ones [20.13%] among age ranged from to 12 years [8.97+/-1.72]

Robotic transmesocolonic Pyelolithotomy of horseshoe kidney

Introduction The purpose of this video is to demonstrate the use of the robot to perform a transmesocolonic pyelolithotomy of a horseshoe kidney. Materials and Methods A 35-year old female presented with vague abdominal pain. CT scan imaging revealed the presence of a left horseshoe kidney with multiple pelvicalyceal stones. The patient was positioned in the supine position. A total of 4 ports were introduced. A 3-arm da Vinci robotic surgical system was docked, and the arms were connected. First, the dilated renal pelvis was identified behind the thin mesocolon. The mesocolon was entered and renal pelvis was dissected completely from the surrounding fat. Then, the renal pelvis was opened after adequate dissection and stones were visualized inside the calyces. By Prograsp forceps, stones were removed from all the calyces under vision and were extracted from the assistant trocar. Finally, the pylotomy incision was closed using 4 0 Maxon in a continuous fashion and the mesocolon was closed using 3 0 PDS interrupted sutures. A JP drain was placed. Result Operative time was forty-five minutes, blood loss was 100 ml. The patient was discharged after 48 hours with no immediate complications. Conclusion The utilization of minimal invasive surgery using the robot to extract multiple pelvicalyceal stones from a horseshoe kidney without reflecting the mesocolon proved to be a feasible and novel way in the management of complex stone disease improving the outcome with minimal morbidity. .

comparative study of open, laparoscopic and robotic partial nephrectomy in obese patients

Partial nephrectomy is a standard intervention for the treatment of small renal tumors. Our study compares the outcomes of three different partial nephrectomy methods [open, laparoscopic and robotic assisted] in obese [>/=30 Kg/m[2]] patients with renal tumors. Between 2005-2011, 66 obese patients had partial nephrectomy. Patients were divided into three groups according to intervention received: Open [n = 21], laparoscopic [n = 31] and robotic [n = 14]. The outcome variables of blood loss, length of hospital stay, and complications were assessed. Mean blood loss in the laparoscopic group [100 mls] was significantly less than open group [300 mls] and no difference between laparoscopic and robotic groups [150 mls]. We observed a shorter median hospital stay in the laparoscopic group [two days] than open group [four days] and no difference between laparoscopic and robotic groups [three days]. Three patients in the laparoscopic group had complications: Two grade II and one with grade III [based on Clavien-Dindo classification]. Tumor location, pathology, grade, stage, patient gender, age, preoperative creatinine and postoperative creatinine were not different among the groups [P > 0.05]. The mean tumor size in the laparoscopic group [2.70 cms] was significantly smaller than that of the open group [4.22 cm] [P; < 0.05], but not statistically different from that of the robotic group [2.99 cm]. Our study demonstrates that in obese patients, both laparoscopic and robotic partial nephrectomy are associated with less blood loss than open partial nephrectomy. Second, the length of the hospital stay was not related to the type of utilized intervention

Unplanned versus planned extubation in respiratory intensive care unit, predictors of outcome

The incidence of post-intensive care unit admission complications is high; some of these complications are inevitable and often leads to medical emergencies. Among these complications is the extubation failure whether resulted from planned extubation which is prepared and performed by the medical team or unplanned extubation [UE]. Unplanned extubation [UE] is a real event in all ICUS worldwide and is considered as one of the major complications in mechanically ventilated patients. However, its impact on mortality, duration of mechanical ventilation [MV] as well as predictors of UE and need for reintubation had not been adequately defined. To define the profile of the patients at risk of unplanned extubation and establish predictive criteria for extubation outcome. This study was carried out in the Respiratory Intensive Care Unit of Chest Department, Zagazig University Hospitals during the period from March 2010 to January 2011. Sixty-seven invasively mechanically ventilated patients who were admitted to the RICU were enrolled in the study. They were [47] males and [20] females with mean age [51.56 +/- 6.28] years. Patients were admitted to the RICU because of one of the following diagnostic categories; acute exacerbation of chronic obstructive pulmonary disease [AECOPD] [41 patients], Pneumonia [6 patients], Bronchial asthma [2 patients], Pulmonary edema [5 patients], Bronchiectasis [6 patients], Systemic lupus erythematosus [1 patient], interstitial lung disease [ILD] [1 patient], Infected cystic lung [1 patient], Overlap syndrome [4 patients]. Patients were classified into two groups according to the way of extubation: Group I: Unplanned extubation group [they were 27 patients who underwent UE either self inflicted [13 patients] or accidental extubation [14 patients] and Group II: Planned extubation group [they were 40 patients who fulfilled weaning criteria and tolerated 2-hspontaneous breathing trial through T-tube without signs of distress and followed by extubatu after 24 h]. On admission to ICU the following were carried out and recorded for all patients: Full medical history from the patient [if possible] or his relatives, history of previous intubation and/or ventilatory support and Presence of co morbidities, Full clinical examination, Plain chest and heart X-ray, Arterial blood gases, Routine laboratory investigations, Mechanical ventilation, Assessment of APACHE III score [acute physiology and chronic health evaluation score] Assessment of Glasgow Coma Score [GCS] and Assessment of sequential Organ failure score [SOFA]. During ICU stay, assessment of the following parameters was done daily including: GCS, Evidence of agitation. Use of sedatives, Degree of sedation using Ramsay Sedation Scoring System, Presence of any physical restrains [Wrist restraints], Amount of endotracheal secretion, Assessment of the strength of the cough reflex by cough strength scale, Nine equivalents of nursing manpower use score [NEMS] to assess nursing workload and Arterial blood gases. If unplanned extubation occurred during anytime before weaning, the following were reported: Time of UE, Ventilation parameters at the time of UE [ventilatory mode, FIO2tidal volume, rate, amount of pressure support and PEEP], Presence of agitation, use of physical restraints, Use of sedation, Last Ramsay score, Last cough strength scale, Last endotracheal secretion scale, GCS at time of extubation, SOFA score at time of extubation, Last NEMS score, Last ABG. If patient passed to weaning and tolerated SBT for 2 h the following tests were performed before extubation in addition to assessment of the same parameters reported among patients in the UE group including Assessment of swallowing by swallowing score, Minute ventilation recovery time, Dead space addition test [DSA], Cuff leak test. The Outcome of the studied patients as regards extubation was categorized into either extubation success or failure. Also the Outcome of the studied cases as regards mortality was classified into either survival or death. The results of this study revealed that the frequency of planned extubation represents 59.7% while unplanned extubation represents 40.3% of the studied subjects. There is no significant difference between planned and unplanned extubation as regards the cause of admission to ICU, [P > 0.05] with predominance of COPD exacerbation which represents 61.19% of the studied population. On starting MV there is an increased risk of unplanned extubation in a significant way with the presence of agitation [74.07%] and decreased the percentage of use of sedation [37.04%], use of physical restraints [77.78%] and lower Ramsay score value [1.33 +/- .48], [P value <0.05]. There is no significant difference as regards history of previous MV, NEMS score and type of respiratory failure between planned and unplanned extubation, [P value > 0.05]. Successful extubation is significantly higher in the planned extubation group [75%] in comparison to the unplanned extubation group [18.52%] while extubation failure is significantly higher among the unplanned extubation group [81.48%] in comparison to [25%] in the planned extubation group, [P value < 0.05]. Survival represents 92.5% in the planned extubation group and 59.26% in the unplanned extubation group with statistical significance. There is a significant increase in the risk of failed extubation among the unplanned extubation group with moderate and large amounts of E/T secretions [86.36%] and with extubation at the night shift [63.64%], [P value < 0.05]. But there is no significant difference among failures or succeeders as regards use of physical restraints, presence of agitation and sedation. There is a significant increase in the risk of failed extubation in the unplanned extubation group with a longer duration of MV [7.32 +/- 2.22] days, with increased PaCO2 [54 +/- 7.7] mmHg, with Pa02/ FIO[2] <200, with decreased GCS [11.36 +/- 1.9] and lower cough strength scale [1.7 +/- .7], [P value < 0.05]. On the other hand there is no significant difference between successful and failed extubation as regards PH value, Ramsay score, NEMS score and SOFA score, [P value > 0 .05]. The frequency of both ways of unplanned extubation in the studied subjects revealed that self inflicted extubation represents 48.15% while accidental extubation represents 51.85%. There is a significant increase in the duration of MV in self inflicted than in accidental extubation [6.07 +/- 2.76 VS 3.35 +/- 1.13 days], [P value <0.05]. There is an increased risk of self inflicted extubation with the use of physical restraints [92.31%] and presence of agitation [84.62%], [P value <0.05]. But there is no significant difference among them as regards time of extubation, Ramsay score, NEMS, GCS and use of sedation. Successful extubation is significantly higher in the self inflicted group [30.77%] in comparison to the accidental extubation group [7.14%], [P value < 0.05]. Survival represents [61.54%] in the self inflicted group and [57.14]% in the accidental extubation group but without any significant difference, [P value > 0.05]. Most of successful extubations among the planned extubation group have a mild amount of E/T secretions [86.67%] and without use of sedation [100%] with a significant difference where extubation failure is significantly higher in moderate and large amounts of E/T secretions, [60%], [P value < 0.05]. All patients with planned extubation whether successful or failures have been extubated at the morning shift. On the other hand, there is no significant difference between succeeders and failures as regards use of physical restraints and presence of agitation. There is an increased risk of failed extubation among planned extubation with a longer duration of MV [7.6 +/- 1.07 days] higher values of PaCO[2] [53 +/- 1.76] mmHg and lowerPaO[2]/FIO[2] [202 +/- 8.23] and cough strength scale [2] in comparison to succeeders, [P value < 0.05]. There is not any significant difference between succeeders and failures as regards, NEMS, SOFA, GCS and Ramsay scores, [P > 0.05]. Increased minute ventilation recovery time [12.6 +/- 4.7] minutes, and a lower value of swallowing score [13.8 +/- 2.62] carry the risk of failed extubation in a significant way, [P value < 0.05]. An increase in severity of illness on ICU admission, agitation, less use of sedation with lower Ramsay score during MV intensify the risk of unplanned extubation, which usually occurs during the night shift, even with the use of physical restraints. Unplanned extubation is associated with an increased incidence of failed extubation [especially with accidental extubation] and mortality. Factors affecting airway competence; magnitude of cough on command and abundant amount of E/T secretions are significant predictors of extubation failure in planned and unplanned extubation. Prolonged minute ventilation recovery time, failed DSA test and lower swallowing score are associated with an increased risk of failed planned extubation

Antimicrobial resistance patterns among acinetobacter baumannii isolated from king abdulaziz hospital, Jeddah,Saudi Arabia, four-year surveillance study [2010-2013]

To carry out a retrospective study on Acinetobacter baumannii [A.baumannii] isolates and analyze its epidemiology, antimicrobial resistance patterns, and nosocomial status from various clinical isolates of patients samples admitted in a tertiary care Hospital, King Abdulaziz hospital, Jeddah, Saudi Arabia. The clinical specimens over a period of 4 years from January 2010 to December 2013 were identified and analyzed, by the conventional microbiology methods and/or an automated identification systems [Pheonix and MicroScan] and there covered A. baumannii isolates were segregated for further study to detect the prevalence and tested for antibiotic susceptibility patterns used the automated susceptibility systems, and/or the disk diffusion and E test methods A total 1176 A. baumannii strains out of 13440 isolates were collected from various specimens during study period. The overall proportion of A. baumannii isolates among all clinical isolates has increased throughout the study from 4.2% [N.134] in 2010 to 12.3%[N.443] in 2013. Most of the source of infections was obtained from the intensive care unit [27.3%], followed by male surgical ward [11.4%], female surgical ward [9.7%] male medical ward [7.7%], female medical ward [7.5%], renal unit [6.7%], neonatal intensive care [5.7%], pediatric Intensive care [4.9%] and lastly out patient, private ward, Ob-Gyne ward and cardiac unit were 4.3%, 2.7%, 2.5% and 2.3% respectively.cefoxitin was the most resistant agents with [100%], then ceftriaxone [92.3%], gentamicin [90.3%], cefepime [88.7%], levofloxacin [88.5%], piperacellin/ tazobactam [88.4%], ciprofloxacin [88.4%], meropenem [88.2%], ceftazidime [88.2%], imipenem [86.5%], amikacin [84.6%], trimethoprim/sulphamethoxazole [69.3%], while colistin and tigecycline were with no resistance. The prevalence of MDR and PDR A. baumannii was increased throughout this study from 55% and 20%, respectively in 2010 to 67% and 33% in 2013. Trend of A. baumannii infection incidence is on the increase with increase of MDR and PDR suggests that prevention of healthcare-associated transmission of A. baumannii infection is essential

Possible protective effect of Moringa oleifera leaf extract on dexamethasone induced histological changes in adlt rat testes

Dexamethasone [Dex] is a widely used therapeutic agent for its immunosuppressive and anti-inflammatory action. It has adverse effects on many body organs and systems. Moringa oleifera is an antioxidant-rich natural plant. It contains vitamins C and A, and various phenolic compounds. The present study was designed to evaluate the ability of M. oleifera leaf extract to protect rat testis against Dex-induced spermatogenic defects. Thirty adult male rats were divided equally into three groups [10 animals each]: the control group [group I] and two experimental groups [groups II and III]. Rats of group II were subjected to intraperitoneal injection of 7mg/kg/day of Dex for 10 days. In group III the rats were treated with M. oleifera leaf extract at 400mg/kg/day, and then after 2h they were administered an intraperitoneal injection of Dex with the same dose as for group II for 10 days. The testes were dissected out and processed for light and electron microscope examination. Microscopic examination revealed that most of the seminiferous tubules of group II were lined with germ cells with dark pyknotic nuclei and vacuolated cytoplasm. The lumen of some tubules was obliterated with exfoliated and sometimes multinucleated giant cells. There was statistically highly significant increase in the percentage of sperm abnormality. Degenerated interstitial Leydig cells were also observed. However, in the moringa-treated group, the histological changes were reduced and the percentage of sperm abnormality was more or less similar to that of the control group. These results demonstrated that M. oleifera leaf extract has a potent protective effect against the testicular toxicity induced by Dex and hence might be clinically useful

GeneXpert MTB/RIF Testing in the Management of Patients with Active Tuberculosis; A Real Life Experience from Saudi Arabia

BACKGROUND: GeneXpert MTB/RIF is a real-time PCR assay with established diagnostic performance in pulmonary and extra-pulmonary forms of tuberculosis. The aim of this study was to assess the contribution of GeneXpert MTB/RIF assay to the management of patients with any form of active tuberculosis in a single large tertiary center in Saudi Arabia, with a special focus on the impact on time to start of antituberculous therapy compared with Ziehl-Neelsen (ZN) smears and mycobacterial cultures. MATERIALS AND METHODS: Clinical, radiological and laboratory records for all patients who were commenced on antituberculous therapy between March 2011 and February 2013 were retrospectively reviewed. RESULTS: A total of 140 patients were included, 38.6% of which had pulmonary tuberculosis. GeneXpert MTB/RIF was requested for only 39.2% of patients and was the only reason for starting antituberculous therapy for only 12.1%. The median time to a positive GeneXpert MTB/RIF result was 0 days (IQR 3) compared with 0 day (IQR 1) for smear microscopy (P > 0.999) and 22 days (IQR 21) for mycobacterial cultures (P < 0.001). No patients discontinued antituberculous therapy because of a negative GeneXpert MTB/RIF result. CONCLUSIONS: In a setting wherein physicians are highly experienced in the diagnosis and treatment of tuberculosis, GeneXpert MTB/RIF was remarkably under-utilized and had only a limited impact on decisions related to starting or stopping antituberculous therapy. Cost-effectiveness and clinical utility of routine testing of all smear-negative clinical samples submitted for tuberculosis investigations by GeneXpert MTB/RIF warrant further study.

Theoretical and experimental study on lipophilicity and wound healing activity of ginger compounds

<p><b>OBJECTIVE</b>To correlate the chromatographic and computational method to calculate lipophilicity of selected ginger compounds and to observe the effects of log P on wound healing.</p><p><b>METHODS</b>Mixtures of acetonitrile and water with acetonitrile content between 95% and 50% v/v in 5% increments were kept separately in 10 different chromatographic chambers, saturated with solvent for 2 h. Spots were observed under UV light at λ=254 nm p-anisaldehyde used as a spraying reagent. Theoretical calculation was done using the Alogps 2.1 online program at www.vcclab.org/lab/alogps. For percentage wound contraction, five groups of animal (mice) (25-30 g) of either sex were selected. Wound were created on dorsal surface of animals using toothed forceps, scalpel and pointed scissors. The wound areas were calculated using vernier caliper. After making wound mice were orally administered 35 mg/kg 6-shogoal, 6-gingerol, 8-gingerol and 10-gingerol respectively. Group E as the control group received tap water.</p><p><b>RESULTS</b>The lipophilicity values determined in thin layer chromatography were correlated with the theoretically calculated various log P by linear regression analysis. Significant correlations were found between log P values calculated by software program and the experimental reversed-phase thin-layer chromatography data. Order of wound healing property of ginger compounds is directly dependent on lipophilicity i.e. more lipophilic compound has highest activity.</p><p><b>CONCLUSIONS</b>Experimentally determined lipophilicity (R MO) values were correlated with log P determined by software's and found satisfactory. Lipophilicity (R MO) is a useful parameter for the determination and prediction of biological activity of ginger compounds.</p>

Surgical management of exertional anterior compartment syndrome of the leg / Tratamiento quirúrgico del síndrome compartimental anterior de la pierna por esfuerzo excesivo

OBJECTIVE: To describe the characteristic presentation of exertional leg pain in athletes and to discuss the diagnostic options and surgical management of exertional anterior compartment syndrome of the leg in this group of patients. METHODS: Data from a series of athletes presenting with exertional leg pain were analysed and categorized according to aetiology. RESULTS: Sixty-six athletes presenting with exertional leg pain in 102 limbs were analysed. Sixteen patients in a first group of 20 patients with a provisional diagnosis of exertional anterior compartment syndrome of the leg underwent a closed fasciotomy with complete resolution of symptoms. A second group of 42 patients were diagnosed as medial tibial stress syndrome and a third group of four patients had confirmed stress fracture of the tibia. CONCLUSION: Exertional leg pain is a common presenting complaint of athletes to sports physicians and physiotherapists. Careful analysis can lead to an accurate diagnosis and commencement of effective treatment. Exertional anterior compartment syndrome can be successfully treated utilizing a closed fasciotomy with a rapid return to sport.

OBJETIVO: Describir las manifestaciones características del dolor en la pierna que presentan los atletas, y discutir las opciones de diagnósticos y tratamiento quirúrgico del síndrome compartimental de la pierna en este grupo de pacientes. MÉTODOS: Los datos de una serie de atletas con dolor en la pierna debido al esfuerzo excesivo en los ejercicios, fueron analizados y categorizados según la etiología. RESULTADOS: Sesenta y seis atletas con dolor de piernas debido al esfuerzo excesivo en 102 miembros fueron analizados. Dieciséis pacientes en un primer grupo de 20 pacientes con un diagnóstico provisional de síndrome compartimental anterior de la pierna por esfuerzo experimentaron fasciotomía cerrada con resolución completa de los síntomas. Un segundo grupo de 42 pacientes fueron diagnosticados con síndrome de estrés medial de la tibia, y a un tercer grupo de cuatro pacientes se le confirmó fractura por estrés o sobrecarga de la tibia. CONCLUSIÓN: El dolor de la pierna por esfuerzo en los ejercicios es una queja común con las que los acuden a los médicos y fisioterapeutas de la medicina deportiva. Un análisis cuidadoso puede conducir a un diagnóstico preciso y al comienzo de un tratamiento eficaz. El síndrome compartimental anterior por esfuerzo puede tratarse con éxito utilizando una fasciotomía cerrada que permita un rápido retorno a la actividad deportiva.

Academic satisfaction among traditional and problem based learning medical students. A comparative study

To evaluate the academic satisfaction and importance among traditional learning [TL] and problem based learning [PBL] medical students, and to further evaluate the areas of concern in the academic education from the student's point of view. A cross sectional study was conducted at the College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia from May to June 2012. The survey questionnaires were self-administered and consisted of mainly 6 sections: teaching, learning, supervision, course organization, information technology [IT] facilities, and development of skills. A total of 92 TL [males: 66 [71.7%]; females: 26 [28.3%]], and 108 PBL [males: 84 [77.8%]; females: 24 [22.1%]], with a mean age of 21.3 +/- 1.3 [TL], and 20.7 +/- 1.0 [PBL] were included in the study. The overall satisfaction rate was higher in the PBL students when compared with TL students in: teaching [84.7%/60.3%]; learning [81.4%/64.5%]; supervision [80%/51.5%]; course organization [69.3%/46.9%]; IT facilities [74.0%/58.9%]; and development of skills [79.1%/53.9%]. There was statistical significance difference in academic satisfaction comparing both groups of students [p

Medical angioplasty - Hope and expectations: an optimistic overview

Primary and secondary prevention of cardiovascular diseases [CVD] are markedly overlooked worldwide. The use of these kinds of preventive methods will greatly improve outcome of or even reverse major CVD, especially coronary atherosclerosis. Comprehensive lifestyle changes combined with aggressive medical therapy [lipid lowering agents "statins", antiplatelet agents, beta-blockers and angiotensin-converting enzyme inhibitors] for patients suffering from coronary heart disease significantly reduce all major adverse cardiovascular events [MACE], especially in those with stable coronary artery disease [CAD], even if their coronary lesions are significant. The main mechanistic pathways for the significant reduction of MACE are: Stabilization of atheromatous plaques through endothelial function reparation, strengthening of the fibrous cap of the atheromatous plaque and reduction of atheroma burden, i.e., reversal of the process of coronary artery stenosis, the great dream of "medical angioplasty". Despite the compelling data indicating the great beneficial effects of both primary and secondary prevention of coronary atherosclerosis, the US national survey data reveals that only a minority of patients eligible by guidelines for these therapies in fact receive them. Hence, we strongly believe that our main duties as cardiologists is to improve the up-to-date knowledge of the practicing physicians about utility of aggressive medical therapy for both prevention and reversal of CVD, and also to promote useful primary and secondary prevention programs among physicians and patients. Meanwhile, further improvement and refinement of the current therapeutic modalities and introduction of new modalities for the management of lipid parameters other than LDL-C, such as HDL-C, triglyceride, lipoprotein [a], LDL particle size and susceptibility to oxidation may add further favourable effects in prevention and reversal of atherosclerotic process. Cardiologists should be just as aggressive with prevention as many have been with intervention. This optimistic overview is a valley cry to all practicing physicians; please depart from usual methods of intervention to preventive strategies which are largely overlooked

New Zealand green-lipped mussel Verna canaliculus possesses an anti-inflammatory activity in the rat adjuvant arthritis with no ulcerogenic effect: the role of cytokines and antioxidant mechanisms

This study investigated the possible prophylactic and therapeutic anti-inflammatory effect of New Zealand green-lipped mussel [NZGLM] in adjuvant arthritis [AA] as well as its probable ulcerogenic activity in comparison with other NSAIDs used in arthritic disorders and the likely mechanisms underlying these potential effects. Arthritis was induced by s.c. injection of Freund's complete adjuvant into the right hind paw of Wistar rats of all groups except the normal one. The adjuvant was injected in one of the footpads to allow study of the acute inflammatory reaction in that local area of the injected paw as well as the immunological reaction that develops approximately 9 days later in the contralateral paw. Treatments with diclofenac [2 mg/kg/po] and NZGLM [250, 1000 mg/kg/po] were initiated on day 0, which is the day of adjuvant injection [prophylactic model dosing] or day 9 [therapeutic model] and continued once daily till day 21. The normal group and a control arthritic group were given oral 1% Tween 80. Both the injected and the contralateral paws' volumes were measured before adjuvant inoculation and then every 2-3 days by volume displacement. After the last measurement, blood samples were collected and were used for serum determination of tumor necrosis factor-a [TNF-alpha], interleukin-1 p [IL-1[3], malondialdehyde and nitrite. In the ulcerogenicity study, rats were injected with the adjuvant in the hind paw and at day 16 post-induction, the A A rats were then divided into 3 groups, 2 groups were treated daily for 5 days with indomethacin [3 mg/kg/po] or NZGLM [1000 mg/kg/po], while the 3rd group served as control. The animals were fasted for 20 hrs on day 4 prior to the final dose and then sacrificed 4 hrs after the, final dose of drug and their stomachs were removed, and examined for the total lesion score. Gastric mucosal homogenates were used for the estimation of lipid peroxides and myeloperoxidase activity. NZGLM exerted a significant dose-dependent anti-inflammatory effect in the AA model, its higher dose being comparable to that of diclofenac and that this effect is likely to be mediated by inhibiting the proinflammatory cytokines; TNF-alpha and IL-lp and through its antioxidant properties. In contrast to indomethacin, NZGLM did not produce any significant ulcerogenic effect

Taurine: a promising agent of therapeutic potential in experimentally-induced arthritis

Taurine is an amino acid whose protective effects were shown in certain inflammatory conditions. The present work aimed to explore the possible anti-arthritic effects of taurine in comparison with diclofenac. Rats were allocated into five groups [n = 10]. The normal and control groups received normal saline. The remaining three groups were treated with diclofenac [2 mg/kg], taurine [5 mg/kg], or taurine [50 mg/kg], respectively. Drugs were i.p. injected for 26 successive days starting from the onset of adjuvant induction. Arthritis was induced by s.c. injection of 0.4 ml of Freund's complete adjuvant [FCA] into the subplantar region of the right hind paws of rats in all groups except the normal one. Paw volume was measured before and at different time intervals after adjuvant inoculation. After the last measurement, blood samples were collected and were used for estimation of serum levels of lipid peroxides, nitrite, total antioxidants, tumor necrosis factor-alpha, and interleukin-1beta as well as lactate dehydrogenase activity. Histopathological examination of knee tissues of all rats was also performed. Injection of FCA induced marked arthritis manifested by paw edema during the 26-day experiment period. Treatment with diclofenac or taurine [50 mg/kg] markedly inhibited adjuvant arthritis as well as its associated biochemical and histological changes. Taurine [5 mg/kg] did not affect FCA-induced paw edema but it attenuated some of the induced biochemical changes. Taurine effects could be explained by inhibition of pro-inflammatory cytokines production as well as its antioxidant effects