Antibacterial activity of Ricinus communis plant extract against antibiotic resistant Helicobacter pylori and Gluconobacter oxydans isolated from fresh apple juices samples

Abstract Bacteria were isolated from samples of Fresh Apple juices from shops of three different localities of Lahore. Analysis of samples from Liberty, Anarkali and Yateem khana Markets show different levels of contamination. There were pathogenic and non-pathogenic bacteria in all samples and were identified by the morphological and biochemical tests. Most of the plasmids of pathogenic bacteria were 4kb in their molecular size. Ribotyping of 16S ribosomal RNA gene sequencing was done to confirm Helicobacter pylori strain and Gluconobacter oxydans. The highest sensitivity of 210mm was shown by Enterobacter sp. against Aztheromysine disk (15µg) while Micrococcus sp. was highly resistant against all of the Antibiotics applied. The antibiotic resistance of pathogenic bacteria was also checked against Ricinus communis plant's extracts, all isolated bacterial pathogens were resistant but only, E.coli was inhibited at 300µl of the extracts. Presence of pathogenic bacteria in Apple juice samples was due to contamination of sewage water in drinking water while some of these pathogenic bacteria came from Apple's tree and other from store houses of fruits.

Resumo As bactérias foram isoladas de amostras de suco de maçã fresco de lojas de três diferentes localidades de Lahore. A análise de amostras dos mercados Liberty, Anarkali e Yateem khana mostram diferentes níveis de contaminação. Havia bactérias patogênicas e não patogênicas em todas as amostras e foram identificadas pelos testes morfológicos e bioquímicos. A maioria dos plasmídeos de bactérias patogênicas tinha 4 kb em seu tamanho molecular. A ribotipagem do sequenciamento do gene do RNA ribossômico 16S foi realizada para confirmar a cepa de Helicobacter pylori e Gluconobacter oxydans. A maior sensibilidade de 210 mm foi mostrada por Enterobacter sp. contra disco de azteromisina (15µg) enquanto Micrococcus sp. foi altamente resistente a todos os antibióticos aplicados. A resistência a antibióticos de bactérias patogênicas também foi verificada contra extratos de plantas de Ricinus communis, todos os patógenos bacterianos isolados foram resistentes, mas apenas E. coli foi inibida em 300µl dos extratos. A presença de bactérias patogênicas nas amostras de suco de maçã deveu-se à contaminação da água de esgoto na água potável, enquanto algumas dessas bactérias patogênicas vieram da árvore da maçã e outras de armazéns de frutas.

Bioinformatics Analysis of LDLR Gene Mutation that Shed a New Light on Red Yeast Rice Monacolin K Treatment � Systematic Review

Background: Hypercholesteremia is the major cause of cardiovascular diseases. It results from elevated cholesterol levels in the blood. LDL cholesterol is removed from the circulation by using the LDL receptor. Red mold rice or red yeast rice is produced by fermentation of the Monascus Purpureus yeast on rice. Many researchers suggest that the active component in Red Yeast Rice (monacolin k) serves as a treatment for hypercholesteremic patients. Methods: By using NCBI databases, specifically GenBank to analyze DNA sequence and mRNA sequence of LDLR gene. GenBank file format was helpful to extract an accession number of the gene, number of amino acids, exons, and length of nucleotides. FASTA format was also useful to retrieve the nucleotide sequence and get the function of the protein. BLAST was used to compare the protein product of the LDLR gene between humans and pan paniscus (pygmy chimpanzee). Results: In accession number NC_000019, the number of amino acids in protein product is 44389 bp, and the number of exons found is 18. On the other hand, the gene is located in chromosome 19. The function of LDLR gene is to control the production of LDL receptor where the low-density lipoprotein particles attach to it and are taken into the cell ending up in the lysosome where the protein is degraded and cholesterol is made which will inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase that controls the production of cholesterol. Finally, many organisms have the same gene like dogs, cows, mice, rats, zebrafish, and frogs. Conclusion: Mutation in the LDLR gene causing high level of cholesterol in the blood especially LDL (Low-density Lipoprotein). Monacolin k that found in red yeast rice (RYR) is safe and natural alternative treatment for hypercholesteremic patients by lowering the cholesterol level in the blood.

HerboDontics A Descriptive Review

Background:Herbal ingredients have been a part of human life since ancient times when they relied upon only the plants and their products for curing ailments. There is vast research on the efficacy of Ayurveda in curing diseases. However need is felt regarding extensive studies on the usage of such historic natural products in oral health care and especially in endodontics. One of the important factors for successful root canal treatment is complete eradication of microbes, which require efficient bio-mechanical preparation of root canal system. There are variety of chemical based solutions available for the purpose of endodontic irrigation. Due to various safety concerns including oral and peri-radicular toxicity, there is the need for such solutions which can be usedas their alternative. In recent years, there has been a profound increase in the literature and research regarding the use of herbal solutions as endodontic irrigants. This article aims at providing a comprehensive overview about various herbal solutions that can be used in endodontic treatment.

Utilization of Treated Seed Kernel Flours of Some Fruits in Biscuit Manufacture

During the processing of fruits, large quantities of wastes are generated, these by-products contain large amounts of oil, starch and protein that can be exploited due to their good nutritional, technological, and functional properties. However, due to the presence of several antinutritional factors, such as polyphenolic compounds, phytic acid, cyanogenic glycoside and oxalates, the use of fruit wastes in human food is limited. The present investigation was aimed to study the effect of soaking and heating on antinutritional factors. It also examines the effect of substituting defatted apricot, peach, and mango seed kernel flours for wheat flour in various ratios (5, 10, and 15%) on the chemical composition, physical features, and sensory properties evaluation of biscuits. The results revealed a significant effect of soaking and heating on the antinutrients, detoxification led to a significant (p≤0.05) decrease in antinutritional factors with ratios 43.63-52.73% total phenols, 78.17-86.16% tannins, 45.92-54.34% phytic acid and 40.42-44.70% oxalates, along with the complete removal (100%) of hydrocyanic acid (HCN). Wheat biscuit contained 3.20% moisture, 6.31% protein, 15.46% fat, 0.64% crude fiber, 1.25% ash and 76.33% carbohydrate. Highly acceptable biscuits could be obtained by incorporating 5% of defatted apricot, peach and mango kernel flours in the wheat biscuits formulation. As a by-product, apricot, peach and mango kernels offer an exciting potential as a food ingredient permitting to enrich biscuits and enlarge the food base for consumers.

Remarkable Clinical Improvement Following Microsurgical Resection of Left Lingual Gyrus Cerebral Cavernous Malformation: A Case Report

Moyamoya disease is a chronic and unusual cerebrovascular disorder characterized by progressive stenosis and occlusion of the distal portions of internal carotid arteries and its main branches within the circle of Willis. Posterior circulation (vertebral and basilar arteries) may also be affected; however, this presentation is uncommon. As well as stenosis of the terminal portion of intracranial arteries, it is seen the development of a network of collateral vessels abnormally dilated at the base of the brain with an aspect of a "puff of smoke," whose term in Japanese is described as "moyamoya." The present study aims to report two consecutive cases of patients who presented to our service with different clinical manifestations. Further investigation with digital subtraction angiography showed a moyamoya pattern.

Fatal dengue encephalitis in a recruit: lessons learnt

Dengue infections may present within a widely variable spectrum of clinical manifestations. However, neurologic complications in general are rare and unusual. A 19 yrs old healthy male army recruit was brought to a service hospital in South India in a state of unresponsiveness, following 12 km route march. Despite aggressive and prompt management, his condition progressively deteriorated and he finally passed away about 10 hrs after reporting to the hospital. The final cause of death was acute dengue encephalitis with raised intracranial pressure. Epidemio-clinico-pathological correlation in this case led to the conclusion that vigorous exertion with a hyper-metabolic state of fever in a setting of encephalitis led to metabolic injury, multi-organ failure, cerebral edema and intracranial hemorrhage. Encephalitis following dengue virus (DENV) infection is a rare phenomenon with the incidence ranging from 0.5% to 6.2%. Neurological features associated with DENV were first reported by Sanguansermsri et al in 1976. The rare neurologic presentations reported with DENV infection are transverse myelitis, acute encephalomyelitis, myositis, and gullain barre syndrome. As encephalitis caused by DENV mimics that caused by other pathogens it should always be kept in mind while managing encephalitis of unknown origin. Medical officers should maintain a high index of suspicion of DENV encephalitis. Training of medical officers; therefore, needs to be undertaken with regular refresher cadres, besides equipping of all peripheral facilities with rapid diagnostic kits for dengue. The same will ensure prompt detection of cases and timely referral to higher medical centres in chain. The instant case reflects an important, potentially fatal, complication of dengue. Pathophysiology of DENV encephalitis needs to be elucidated on priority through research involving all stakeholders.

Review on Some Plants’ Therapeutic Effects against Gastrointestinal Microbes

Plants play vital roles in many health care systems, be it rural or an urban community. Plants became familiar as medicine due to the primordial ideologies and believed. Several plant parts served as medicines to so many ailments including gastrointestinal ailments, due to the fact that their active ingredients are powerful against the microbes as well as healing so many physiological abnormalities. The principal antimicrobial components were used to inhibit the growth of microbes (S. aureus, E. coli, Salmonella spp, B. cereus, and B. subtili,), as well as most of the recognized compounds in most plants were aromatic or saturated organic compounds which enabled the plants to be active against the gastrointestinal microbes. The commonly used diluents were; water, methanol and Di methyl sulphate oxides to ascertain the level of activity of the plants. As such, plant materials in one way or the other are very active when dealing with microbes due to their active ingredients or the phytoconstituents. Most of the microbes identified in many reviewed researches were enteric bacterial species, by which divided into both gram negative and gram positive bacterial isolates, they differ in their cell components, which are the main targets of bioactive constituents to deal with any bacteria. However, certain parasites contributed towards the production of ailments for their survival and causing havoc to the hosts and sometimes be mutualistic.

Date Supplement and Iron Salts Plus Physical Activity on Efficiency of Iron Absorption

The aim of this study was to investigate the effect of date supplement and iron plus physical activity on anemic femalestudents. This study includes 40 anemic female students, from the new valley university; they were divided into four equalgroups ten in each group; 1st group ingested “date” plus exercise, 2nd group ingested date without exercise, 3rd groupsupplemented with iron salts with exercise, 4th group supplemented with iron salts without exercise, pre/post-test VO2max,pulse rate, Hb, iron, ferritin and O2 were determined. 5 ml venous blood was drawn from all participants for the pre/postvariables. Dose of date sheet was (10 gm) twice daily, and dose of iron salts was one capsule (5mg) daily. Results: Resultsindicated that date supplement, and iron together with exercise affect positively the anemic female students. Conclusion:black dates and iron with or without hulls, are effective, safe and cheap supplements for improving hemoglobin andrestoring iron stores to correct iron deficiency.

Effect of tranexamic acid in prevention of postpartum hemorrhage in elective caesarean delivery: a randomized controlled study

Background: Postpartum hemorrhage is the ugly ghost that most obstetricians believe because many cases unpredicted and may be associated with rapid patient deterioration that may lead mortality or developing serious long-term morbidities. The objective of this study is to assess the efficacy of slowly intravenous administration of tranexamic acid in prevention and decline the severity of postpartum hemorrhage immediately prior to elective caesarean section.Methods: A double blinded, randomized, case control trial carried out at Obstetrics and Gynecology Department, Faculty of Medicine, South Valley University, Egypt from May 2017 to April 2018. This study was conducted on 500 full term pregnant women underwent elective caesarean section. The patients were divided randomly into: Group A (study group) included 250 patients received tranexamic acid 1gm slowly iv over 2 minutes at least 10 minutes before operation started and Group B (control group) included 250 patients that received placebo (normal saline NaCl 0.9%).Results: Incidence of PPH in group A and group B were (4.4% and 6.8) respectively, 1.2% in group A and 2.8% in group B had severe degree of PPH. Amount of blood loss immediately after placental delivery up to first 6 hours postoperative was statistically significant increase in placebo group than tranexamic acid group with p value <0.001.Conclusions: Tranexamic acid administration few minutes prior to elective cesarean section was effective in reducing the incidence and severity of PPH and decreased the use of additional uterotonic drugs and additional surgical interventions.

Does oregano protect against testicular toxicity produced by ethylene glycol in adult male albino rat? / ¿El orégano protege contra la toxicidad testicular producida por etilenglicol en ratas macho albinas adultas?

SUMMARY: Origanum vulgare Linn has traditionally been used as a diuretic and antispasmodic. Therefore, we investigated the active extract of Origanum vulgare for possible andrological effect and preventive effects against testicular damage using ethylene glycol rat model of testicular damage, to rationalize its medicinal use. Male Wistar rats received lithogenic treatment comprising of 0.75 % ethylene glycol injection twice with one day interval, then in drinking water, active extract of Origanum vulgare treatment (20 mg/kg) was given for 3 weeks to prevent toxic damage including loss of body weight gain and appetite, Following oral administration of EGME, a rapid decrease in testis weight associated with testicular cell damage was observed. Origanum vulgare treatment (20 mg/kg) prevented as well as reversed toxic changes including loss of body weight gain.

RESUMEN: Origanum vulgare Linn se ha usado tradicionalmente como diurético y antiespasmódico. Por lo tanto, investigamos el extracto activo de Origanum vulgare por su posible efecto andrológico y efectos preventivos contra el daño testicular utilizando el modelo de rata de etilenglicol de daño testicular. El objetivo del estudio fue racionalizar su uso medicinal. Su utilizaron ratas Wistar macho que recibieron un tratamiento litogénico de una inyección de etilenglicol al 0,75 %, dos veces con un intervalo de un día, y luego se administró en agua potable. Se administró el extracto activo del tratamiento con Origanum vulgare (20 mg / kg) durante 3 semanas con el objetivo de prevenir el daño tóxico, la pérdida de peso corporal y el apetito. Tras la administración oral de EGME, se observó una rápida disminución del peso de los testículos asociada al daño de las células testiculares. El tratamiento con Origanum vulgare (20 mg / kg) logró prevenir y revertir las alteraciones tóxicas, incluyendo la pérdida de peso corporal.

Antibiotics Consumption in the Eastern Region of Libya 2012-2013

Background: Drug utilization studies conducted in Libya during the period 1991-2013, have pointed out that there is an irrational use of antibiotics as a common practice that costs the health system more than 7.7 million Libyan Dinars / year. The aim of this study is to assess the trend of antimicrobial consumption in the Eastern region of Libya during 2012 ­ 2013.Methods: Antimicrobial consumption data from the years 2012 and 2013 were obtained mainly from Benghazi office, Medical Supply Organization (MSO; the only official drug-importing body in Libya). This study is concerned with antibiotics imported only to the Eastern region of Libya, population of which representing approximately 35% of total Libyan population. The WHO, Anatomical-Therapeutic-Chemical (ATC) classification and the Defined Daily Dose (DDD) methodology were used to calculate antibiotic consumption. The total antimicrobial consumption data were calculated as DDD/1000 inhabitants/day.Results: Total utilization of antibiotics decreased dramatically from 15.47 DDD/1000 inhabitants/day in 2012 to 4.30 DDD/1000 inhabitants/day in 2013 which in turn shows a significant decline compared to 41.72 DDD/1000 inhabitants/day during the period 1991-1993. Consumption of penicillins decreased from 19.902 DDD/1000 inhabitants/day during 1991-1993 to 1.896 DDD/1000 inhabitants/day during 2012-2013 with pattern of amoxicillin/clavulanic acid consumption which equals 3 times ampicillin consumption and is the highest compared to all penicillins. This was accompanied by a prominent increase in consumption of amphenicols and fusidic acid during 2012-2013, noting that fusidic acid consumption was the highest among all antibiotics. Conclusion: MSO since 2011 (post 17th February, 2011 revolution) lost its control over importing medicine due to receiving many drugs, as donations from different international sources without acceptable levels of coordination. This has been reflected on drug purchasing policy of MSO during 2013, which failed to regain the previously accepted level of DDD/1000 inhabitants/day for antibiotics consumption. The decreased consumption of penicillins together with increased consumption of amphenicols and fusidic acid complies with the pattern of antibiotic resistance reported previously in Libya. Similar studies should be conducted to evaluate national drug consumption under normal conditions, to be compared with regional and international data

Association of organochlorine pesticides with the mRNA expression of tumour necrosis factor-alpha (TNF-α) & cyclooxygenase-2 (COX-2) genes in idiopathic preterm birth.

Background & objectives: Preterm birth (PTB) is an important cause of prenatal death, neonatal morbidity and mortality and adult illness. Increased inflammation occurs in normal parturition, and inflammatory cytokines and oxidative stress are found to be higher in PTB cases. The present study was planned to investigate the association of organochlorine pesticides (OCPs) with mRNA expression of inflammatory pathway genes such as tumour necrosis factor-alpha (TNF-α) and cyclooxygenase-2 (COX-2) in preterm delivery (PTD) cases. Methods: Maternal blood samples of PTD (n=30) cases and equal number of term delivery (n=30) were collected at the time of labour. Women occupationally exposed to OCPs and other high risk factors such as anaemia, hypertension, bacterial vaginosis, renal and heart disease, diabetes, etc. were excluded. The OCP levels were estimated by gas chromatography, and mRNA expressions of TNF-α and COX-2 genes were analysed using real-time PCR (qPCR). Results: Significantly higher levels of β-HCH (beta-hexachlorocyclohexane, 95% CI=2.08-4.633, P=0.001), p’p’-DDE (para, para-dichlorodiphenyldichloroethylene, 95% CI=0.546-2.551, P=0.003), and o’p’-DDD (ortho, para-dichlorodiphenyldichloroethane, 95% CI=0.004-0.690, P=0.047) were observed in maternal blood of PTB cases as compared to term delivery. The mRNA expressions of COX-2 and TNF-α genes were 3.13 and 2.31 folds higher in PTB cases in comparison to term delivery. Linear positive correlations were observed between period of gestation (POG) and ΔCt of COX-2 and TNF-α genes. Interpretation & conclusions: Environmental factors such as OCPs may be associated with inflammatory events showing gene-environment interaction in PTB cases. Evaluating the molecular control of inflammation along with gene environment interaction may be used as a model to explore the aetiology of idiopathic PTB cases and may be considered for the prognosis of adverse reproductive outcomes.

Piel marmórea telangiectasica congenita y sindactilia en un recién nacido prematuro: A proposito de un caso / Congenital cutis marmorata telangiectatica and syndactyly in a preterm: Case report

La piel marmórea telangiectásica congenita (cutis marmorata telangiectatica congenita, CMTC) es una anomalía vascular congenita rara, a menudo benigna, localizada o generalizada, de etiología desconocida. Se caracteriza por piel marmórea persistente, telangiectasia y flebectasia. Podrían presentarse manifestaciones extracutáneas asociadas con la CMTC en el 18,8-70% de los casos. El diagnóstico de este trastorno se basa en los hallazgos clínicos. El pronóstico es bueno y suele mejorar dentro de los dos años de vida. En este artículo presentamos el caso de un varón recien nacido con CMTC en la piel de todas las extremidades, el tronco y el rostro, y una anomalía asociada, que incluía sindactilia. Presentamos este caso debido a su rareza.

Cutis marmorata telangiectatica congenita (CMTC) is a rare, commonly benign, congenital, localized or generalized vascular anomaly of unknown aetiology. It is characterized by persistent cutis marmorata, telangiectasia and phlebectasia. Extracutaneous findings may be associated with CMTC in 18.8-70% of the cases. Diagnosis of the disorder is based on the clinical findings. The prognosis is good and improvement is observed within 2 years after birth. Herein, we report a case of a male neonate with CMTC presented on the skin of all his limbs, trunk and face, and an associated anomaly including syndactyly. We present this case because of its rarity.

Síndrome de artrogriposis, disfunción tubular renal y colestasis: causa de colestasis neonatal. A propósito de un caso / Arthrogryposis-renal tubular dysfunction-cholestasis syndrome: a cause of neonatal cholestasis. Case report

El síndrome de artrogriposis, disfunción tubular renal y colestasis es un trastorno fatal infrecuente que compromete múltiples aparatos y sistemas de órganos. Es un trastorno autosómico recesivo hereditario, causado por defectos en los genes VPS33B y VIPAR. Los tres signos primordiales de este síndrome son la artrogriposis, la disfunción tubular renal y la colestasis. Otros compromisos orgánicos a veces asociados con este síndrome son ictiosis, malformación del sistema nervioso central, anomalías trombocíticas, defectos cardíacos congénitos y grave retraso del crecimiento. Las manifestaciones clínicas, la biopsia de un órgano y los análisis de mutaciones pueden ayudar con el diagnóstico, pero no existe un tratamiento curativo; solamente puede instaurarse un tratamiento sintomático. Varios síntomas de esta afección usualmente se manifiestan en el período neonatal: artrogriposis, colestasis neonatal, lesiones cutáneas, entre otros. En general, la supervivencia se prolonga hasta el primer año de vida. Presentamos el caso de una recién nacida con una rápida evolución y desenlace fatal.

Arthrogryposis-renal dysfunction-cholestasis syndrome is a rare lethal disorder that involves multipl organ system. It is inherited autosomal recessive and caused by defects in the VPS33B and VIPAR genes. Three cardinal findings of this syndrome are arthrogryposis, renal tubular dysfunction and cholestasis.The other organ involvements including ichthyosis, central nervous system malformation, platelet anomalies, congenital heart defects and severe failure to thrive are sometimes associated with this syndrome. Clinical findings, organ biopsy and mutational analysis can help for diagnosing but there is no curative treatment except supportive care. Several symptoms of this condition are already usually present in the neonatal period: arthrogryposis, neonatal cholestasis, skin lesions, among others. Usually survival is until the first year of life. We present a newborn whose evolution was rapidly fatal.

Capsule endoscopy: single center experience

Objective: capsule endoscopy [CE] has revolutionized the evaluation of small bowel disorders, particularly obscure gastrointestinal bleeding [OGIB]. The aim of this study was to determine the findings and the diagnostic yield of CE in a large series of patients with suspected small bowel disease mainly OGIB; as well as to compare our results to that of other reported centers

Methods: data on 230 patients who underwent capsule endoscopy for suspected small bowel related symptoms and/ or signs mainly overt [81 patients] or occult [66 patients] OGIB were obtained by retrospective chart review and review of an internal computer database of capsule endoscopy patients. Data presented as percentages, p value used to show differences whenever relevant

Results: out of 230 patients investigated for small bowel related symptoms and /or signs, 7 patients excluded mainly due to improper preparation, of the remaining 223, 128 [57.3%] had some lesion detected by CE,80 [35.8%] had definite lesions detected that could unequivocally explain patients' complaints. Patients with overt GI bleeding had the highest diagnostic yield [64.1%], this was significantly greater [P < 0.001] compared to that in patients with occult bleeding [43.9%] as well as those with abdominal pain and/or diarrhea [33.3%]. Angiodysplasia is the most common cause of OGIB [26.5%]

Conclusions: the yield of clinically important findings on CE in patients with OGIB is 55% and is greater in patients with obscure-overt than obscure-occult GI bleeding. Angiodysplasia account for the majority of significant lesions in both groups

Desplazamiento esofágico de un tubo endotraqueal durante la oxigenación nasofaríngea en un neonato con secuencia de Pierre Robin: caso clínico / Esophageal dislodgement of an endotracheal tube during nasopharyngeal oxygenation in a neonate with Pierre-Robin sequence: a case report

La intubación convencional para la asistencia respiratoria en niños con vía aérea dificultosa puede ser un desafío incluso en manos expertas. Los rápidos avances en la atención respiratoria han reducido la incidencia de intubación traqueal dificultosa y por ende las complicaciones. Sin embargo, en algunos pacientes, todavía ocurren complicaciones graves inesperadas. Describimos el caso de un neonato con secuencia de Pierre Robin con vía aérea dificultosa, que presentó una migración del tubo endotraqueal hacia el esófago luego de haberse desprendido del conector del tubo. Deseamos compartir esta experiencia ya que, de acuerdo con nuestro conocimiento, esta complicación no ha sido comunicada anteriormente en neonatos.

Conventional intubation for pulmonary management in children with a difficult airway may be very challenging even in skilled hands. Rapid advancements in respiratory care have reduced the incidence of difficult tracheal intubation and the incidence of complications have decreased accordingly. However, serious unexpected complications still occur in some patients today. Herein, we describe a syndromic newborn infant with a difficult airway who experienced migration of the endotracheal tube into the esophagus after displacement of the tube connector. We would like to share our experience and contribute to the literature with the presentation of this undesired event. To the best of our knowledge, no such complication has been reported in the neonatal literature before.

[A] massive tuberculosis abscess at the erector spinae muscles and subcutaneous tissues in a young man

Tuberculosis [TB] is a chronic granulomatous infection which can present in an atypical form. Isolated muscle involvement is very rare. We report a 25-year-old man who presented with a massive cystic swelling on the right side of his back, extending from the lower thoracic to the gluteal region. He had a history of contact with a friend who was suspected of having TB. Magnetic resonance imaging [MRI] showed that the origin of the cyst was from the erector spinae muscles. The result of a fluid aspirate showed acid fast bacilli. The swelling disappeared after treatment with anti-tuberculous medications. Muscular involvement in TB is very rare. In our patient, the reports of an ultrasound and MRI confirmed isolated muscle and subcutaneous involvement without bony lesions. This case is reported to increase physician awareness regarding soft tissue TB. Although it is rare, similar cases may be seen in the future

Evaluation of off-service rotations at National Guard Health Affairs: results from a perception survey of off-service residents

"Off-service" clinical rotations are part of the necessary requirements for many residency training programs. Because these rotations are off-service, little attention is given to their structure and quality of training. This often leads to suboptimal educational experience for the residents on these rotations. The aim of this study was to assess medical residents' perceptions, opinions, and levels of satisfaction with their "off-service" rotations at a major residency training site in Saudi Arabia. It was also to evaluate the reliability and validity of a questionnaire used for quality assurance in these rotations. Improved reliability and validity of this questionnaire may help to improve the educational experience of residents in their "off-service" rotations. A close-ended questionnaire was developed, Pilot tested and distributed to 110 off-service residents in training programs of different specializations at King Fahad Naitonal Guard Hospital and King Abdulziz Medical City, Riyadh, Saudi Arabia, between September 2011 and December 2011. A total of 80 out of 110 residents completed and returned the questionnaire. Only 33% of these residents had a clear set of goals and educational learning objectives before the beginning of their off-service rotations to direct their training. Surgical specializations had low satisfaction mean scores of 57.2 [11.9] compared to emergency medicine, which had 70.7 [16.2], P value [0.03]. The reliability of the questionnaire was Cronbach's alpha 0.57. The factor analysis yielded a 4-factor solution [educational environment, educational balance, educational goals and objectives, and learning ability]; thus, accounting for 51% variance in the data. Our data suggest that there were significant weaknesses in the curriculum for off-service clinical rotations in KAMC and that residents were not completely satisfied with their training

In vitro anti-inflammatory, cytotoxic and antioxidant activities of boesenbergin A, a chalcone isolated from Boesenbergia rotunda (L.) (fingerroot)

The current in vitro study was designed to investigate the anti-inflammatory, cytotoxic and antioxidant activities of boesenbergin A (BA), a chalcone derivative of known structure isolated from Boesenbergia rotunda. Human hepatocellular carcinoma (HepG2), colon adenocarcinoma (HT-29), non-small cell lung cancer (A549), prostate adenocarcinoma (PC3), and normal hepatic cells (WRL-68) were used to evaluate the cytotoxicity of BA using the MTT assay. The antioxidant activity of BA was assessed by the ORAC assay and compared to quercetin as a standard reference antioxidant. ORAC results are reported as the equivalent concentration of Trolox that produces the same level of antioxidant activity as the sample tested at 20 µg/mL. The toxic effect of BA on different cell types, reported as IC50, yielded 20.22 ± 3.15, 10.69 ± 2.64, 20.31 ± 1.34, 94.10 ± 1.19, and 9.324 ± 0.24 µg/mL for A549, PC3, HepG2, HT-29, and WRL-68, respectively. BA displayed considerable antioxidant activity, when the results of ORAC assay were reported as Trolox equivalents. BA (20 µg/mL) and quercetin (5 µg/mL) were equivalent to a Trolox concentration of 11.91 ± 0.23 and 160.32 ± 2.75 µM, respectively. Moreover, the anti-inflammatory activity of BA was significant at 12.5 to 50 µM and without any significant cytotoxicity for the murine macrophage cell line RAW 264.7 at 50 µM. The significant biological activities observed in this study indicated that BA may be one of the agents responsible for the reported biological activities of B. rotunda crude extract.

Mixed-genotypes Infections with Hepatitis C Virus in Hemodialysis Subjects

Mixed-genotypes hepatitis C virus (HCV) infections are normally ignored in chronic hemodialysis patients. The aim of this study is to investigate the prevalence of mixedgenotypes infections among hemodialysis patients in Pahang province, Malaysia. Reverse-transcription and polymerase chain reaction methods were performed using two different sets of primers, targeting the 5’ untranslated region and nonstructural 5B region. Target region base sequences were obtained by direct sequencing. Discrepancy in outcomes from phylogenetic analysis of both regions suggests double infections. Of 40 subjects in eight hemodialysis centres, evidence of mixed-genotypes infections was found in 5 subjects (12.5%) from three different centres. Four patients were infected with mixed genotypes 3 and 1 and one with genotypes 3 and 4. Cases of mixed HCV genotypes infection were considered high among hemodialysis patients in Pahang. However, further investigation is needed to confirm whether they are true mixed infections or perhaps infection with recombinant virus and also to assess the clinicopathologic characteristics of the infection.