Association of hemolysismarkers and cortisol level with different severity of sickle cell disease among Sudanese patients

Background:Sickle cell anemia (SCA) is an inherited disorder of hemoglobin. Several biomarkers have been identified, which is essential in the different clinical presentations of the disease. This study aimed to determine the association between hemolysis markers andcortisol level with varying severity groups of Sudanese patients with SCA.Methods:This descriptive cross-sectional study included 100 patients with sickle cell disease between February 2016 and April 2017. According to Hedo et al scoring, medical history was obtained to conduct disease severity. A total of 3ml of venous blood was collected from each patient. A complete hemogram was performed using an automated hematology analyzer (Sysmix®-KX-21N). Bilirubin and lactate dehydrogenase (LDH) were estimated using a spectrophotometer, while cortisol was measured using the Elecsys® system 2010 E170. The reticulocyte count was performed manually. Data were analyzed using statistical package for the social sciences (SPSS)version 21 computer software program.Results:Disease severity was variable and was categorized into; eighteen (18%) patients had mild symptoms, while 70 (70%) patients had moderate disease, and 12 (12%) patients had severe disease. The analysis of variance (ANOVA)test showed that hemoglobin, reticulocyte count, LDH, and direct bilirubin were positively correlated with disease severity,p value: 0.001, 0.04, 0.00, and 0.02, respectively. While indirect bilirubin, total bilirubin, and cortisol did not correlate withdisease severity, the pvalue was (0.248, 0.083, and 0.868, respectively).Conclusions:This study confirmed that the hemolysis markers (Hb, reticulocyte count, direct bilirubin and LDH) were positively associated with disease severity. In contrast, indirect bilirubin, total bilirubin, and cortisol levels were not associated with the disease severity.

The Effects of Three and Six Sessions of Low Energy Extracorporeal Shockwave Therapy on Graft Incorporation and Knee Functions Post Anterior Cruciate Ligament Reconstruction

@#Introduction: One session of high energy extracorporeal shockwave therapy (ESWT) was found to improve the healing of anterior cruciate ligament (ACL) after reconstruction in animal and human studies. This study investigated the effects of three and six sessions of low energy ESWT on graft incorporation and knee functions post ACL reconstruction in humans. Materials and methods: Thirty participants with ACL injuries were recruited and assigned equally into three groups with 10 participants per group (n=10). Participants in the control group received physiotherapy alone without low energy ESWT. Participants in the 3ESWT group underwent three sessions of low energy ESWT (one session per week) combined with physiotherapy, and participants in the 6ESWT group received six sessions of low energy ESWT (one session per week) combined with physiotherapy. However, five participants were lost to follow-up. Evaluations of graft incorporation of the tibial tunnel using magnetic resonance (MRI) and Lysholm score were carried out before ACL reconstruction and after six months post ACL reconstruction. Results: The number of grafts with partial incorporation in the tibia tunnel in 6ESWT was significantly higher compared with the number of grafts with non-incorporation at six months post-operatively, X2 (1, N=9) =5.44, p =0.02. However, there was no significant difference between frequencies of graft incorporation in tibia tunnel in the control and 3ESWT groups, X2 (1, N=7) =3.57, p =0.06 and X2 (1, N=9) =2.78, p =0.10, respectively at 6 months postoperatively. Lysholm scores were significantly higher at 6 months post ACL reconstruction compared to the baseline value for each group (p<0.002, respectively). However, there was no significant difference in the Lysholm score between each group (F = 2.798, p = 0.083). Conclusions: Six sessions of low energy ESWT improved graft incorporation in the tibial tunnel. Both three and six sessions of low energy of ESWT does not affect the knee function score at six months post ACL reconstruction.

Current prevalence of Opisthorchis viverrini infection and associated risk factors in Nakhon Phanom Province, Northeastern Thailand

@# Opisthorchiasis caused by Opisthorchis viverrini infection is a major public health concern in Thailand. Despite many decades of national campaigns in place to reduce and control opisthorchiasis in Thailand, the infections remain to exist particularly in the northern and northeastern parts of the country. This study aimed to evaluate the current prevalence of O. viverrini infection in rural communities in northeast Thailand. A cross-sectional survey was conducted between February and October 2018 in three districts (Na Kae, That Phanom and Wang Yang) in Nakhon Phanom Province, Thailand. Demographic data were collected using a standardised questionnaire. Stool samples were collected and processed using the Kato-Katz technique to determine the presence of O. viverrini and other intestinal parasites. In total, 564 individuals were enrolled. The overall intestinal helminth infections were 15.2% (95% CI: 12.4–18.5). Species distribution included a majority of O. viverrini mono-infections (12.9%), followed by Strongyloides stercoralis (1.4%) and Taenia spp. (0.4%). The prevalence of O. viverrini was significantly higher in Wang Yang district (P = 0.022), in males (P = 0.004) and those previously positive with helminth infections (P<0.001) and received treatment of anti-helminths (P<0.001), than in their counterparts. Multivariate regression analysis revealed that being male (adjusted odds ratio [aOR] 1.77, P = 0.035) and those who previously tested positive for helminth infections (aOR 8.69, P<0.001) were significantly associated with a higher odd of O. viverrini infections, but lower in those who had previous stool examination (aOR 0.22, P = 0.001). This study demonstrated that the updated prevalence of O. viverrini infection is still high in rural communities in northeast Thailand. The data of this study will be useful to guide and improve strategies for future O. viverrini and other helminths prevention and control in this region.

Effect of sildenafil citrate on the outcome of in vitro fertilization after multiple IVF failures attributed to poor endometrial development: a randomized controlled trial

Aim of the work: this study aimed to evaluate the effect of sildenafil citrate on endometrial development in women with history of recurrent implantation failure after IVF

Setting: this study was conducted in obstetrics and gynecology department of Ain Shams University

Patients and methods: this is a randomized controlled trial on 80 women with previous two or more failed IVF. Women in group A [N=40] took oral sildenafil citrate at dose 25mg tab /6h daily from day six of induction of ovulation until day of HCG administration; while those in group B [N=40] took placebo tablets

Outcome measuers: the primary outcome was change in endometrial thickness before and after intervention

Results: endometrial thickness in both groups was statistically insignificant between the two groups when measured in day 6 with p-value 0.070.Endometrial thickness on day of HMG injection measured and found that it was higher in group A[Sildenafil Group] than group B[Placebo Group] with significantly increased statistically difference between the two groups with p-value <0.001

Conclusion: sildenafil citrate leads to smooth muscle relaxation and vasodilation. This may enhance endometrial development and increased pregnancy rate in females undergoing IVF which may be attributed to the increase in the endometrial thickness

In vitro Antitheilerial Activity of Paluther (Artemether 80) Against Theileria lestoquardi.

Aim: The aim of this study was to screen Artemether 80 for activity against Theileria lestoquardi (Apicomplexa: Theileridae) using buparvaquone as a standard drug. Study Design: In vitro study under laboratories conditions. Place and Duration of Study: Veterinary Research Institute, between 2006 and 2008. Methodology: Artemether 80 was screened for the first time to investigate activity against T. lestoquardi at different concentrations. Blood was collected separately from normal sheep and sheep infected naturally with Theileria. Normal lymphocyte cells and lymphocyte cells infected with Theileria were isolated from heparinized blood with Ficoll-paque. Isolated cells were grown in Minimum Essential Medium (MEM), supplemented with 20% calf serum and sub cultured. The parasite was identified with indirect fluorescent antibody test (IFA). A volume of 2.7 ml of lymphoblast cell suspension at concentration of 5x104 cell/ ml was distributed in tissue culture plates, and then 0.3 ml of drug at concentrations of 0.1, 1.0, 10 and 100 mg/L was added separately. A volume of 0.3 ml MEM was added to infected untreated control. Results: The in vitro antitheilerial activity of Artemether 80 against T. lestoquardi 48 h after exposure was 0%, 14%, 30% and 45% at concentrations of 0.01, 0.1, 1.0 and 10 mg/L, respectively as compared with activity of buparvaquone at the same concentrations being 74%, 83%, 92% and 100%, respectively. Both Artemether 80 and buparvaquone caused in vitro partial cytotoxic effect at the highest concentrations. Activity and/ or partial cytotoxic effect of both drugs caused changes in the morphology of macroscizonts and host lymphoblast cells, decreased the number of macroschizonts/cell, mean number of dividing cells, increased the number of cells with extra cellular macroschizonts. Conclusion: It was concluded that Artemether 80 is slightly effective in vitro against T. lestoquardi.

Antitheilerial Herbal Medicine: A Review.

The aim of this study is to overview some of the medicinal plants tested for the treatment of theileriosis. Treatment of theileriosis with standard drugs such as parvaquone and buparvaquone is very expensive, and these drugs are not always available in the third world developing countries. Thus, it is desirable to seek for discovery of medicinal plants for treatment of theileriosis.

Relationship between Psychosocial Risk Factors and Work-Related Musculoskeletal Disorders among Public Hospital Nurses in Malaysia

OBJECTIVE: This study examined the relationships between psychosocial work factors and risk of WRMSDs among public hospital nurses in the Klang Valley, Malaysia. METHODS: We conducted a cross-sectional study among 660 public hospital nurses. A self-administered questionnaire was used to collect data on the occurrence of WRMSDs according to body regions, socio-demographic profiles, occupational information and psychosocial risk factors. 468 questionnaires were returned (response rate of 71%), and 376 questionnaires qualified for subsequent analysis. Univariate analyses were applied to test for mean and categorical differences across the WRMSDs; multiple logistic regression was applied to predict WRMSDs based on the Job Strain Model's psychosocial risk factors. RESULTS: Over two thirds of the sample of nurses experienced discomfort or pain in at least one site of the musculoskeletal system within the last year. The neck was the most prevalent site (48.94%), followed by the feet (47.20%), the upper back (40.69%) and the lower back (35.28%). More than 50% of the nurses complained of having discomfort in region one (neck, shoulders and upperback) and region four (hips, knees, ankles, and feet). The results also revealed that psychological job demands, job strain and iso-strain ratio demonstrated statistically significant mean differences (p < 0.05) between nurses with and without WRMSDs. According to univariate logistic regression, all psychosocial risk factors illustrated significant association with the occurrence of WRMSDs in various regions of the body (OR: 1.52-2.14). Multiple logistic regression showed all psychosocial risk factors were significantly associated with WRMSDs across body regions (OR: 1.03-1.19) except for region 1 (neck, shoulders and upper back) and region 4 (hips, knees, ankles, and feet). All demographic variables except for years of employment were statistically and significantly associated with WRMSDs (p < 0.05). CONCLUSIONS: The findings indicated the high prevalence of WRMSDs in many body regions, and the risks of developing WRMSDs according to the various body regions were associated with important psychosocial risk factors based on the job strain model. These findings have implications for the management of WRMSDs among public hospital nurses in the Klang Valley, Malaysia.

Vitamin D status in health care professionals in Qatar

To investigate the prevalence of vitamin D deficiency among health care professionals working at Hamad Medical Corporation in Doha, Qatar. Between 15th January 2007 and 15th January 2008,340 healthy volunteers were included in this study. Each subject completed a diary to determine the duration of sunlight exposure, and vitamin D supplements. Serum levels of 25-hydroxyvitamin D [25OHD], parathyroid hormone [PTH], calcium, phosphorus, alkaline phosphatase, total protein, and albumin were obtained. Those with abnormal results were called for counselling. The mean overall vitamin D level was 11.7 ng/ml. It was lower in females [10.3 ng/ml] than in males [13.7 ng/ml]. Ninety-seven percent of all participants had a mean level <30 ng/ml. Eighty-seven percent had a mean level of <20 ng/ml. We concluded that the prevalence of vitamin D deficiency among health care professionals in Qatar is very high

Clinicopathologic manifestations and outcome of dengue fever and dengue haemorrhagic fever.

During the peak period of outbreak from July through October, during the year 2000 through 2002, a total of 390 cases of either dengue fever (DF) or dengue haemorrhagic fever (DHF) were collected from medicine outpatient department (MOPD) of Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka to study their clinicopathologic manifestations and management outcome. Data were collected using a structured questionnaire. Almost all of the patients presented with fever (100%), headache (98.2%), bodyache (97.7%), anorexia (100%) and nausea (100%) and the vast majority had skin rash (78.5%), backache (78.2%) and retro-orbital pain (79.7%). Mean +/-SD of duration of total illness was 7.57 +/- 1.11 days and that of fever and skin rash were 5.40 +/- 0.86 and 3.02 +/- 0.78 days respectively. Mean +/-SD of platelet count was 69643.59 +/- 32043.97/mm3 of blood and that of haematocrit was 41.18 +/- 2.65%. Almost all of the patients (97.7%) developed thrombocytopenia but only 4.1% developed leucopenia at sometime during the course of the disease and anaemia was found in 49.4% of the patients. Both anti-dengue IgG and anti-dengue IgM were positive in 55.1% of patients and either anti-dengue IgG or anti-dengue IgM was positive in 23.6% and 21.3% of patients respectively. Management outcome of the patients was quite satisfactory without any case fatality.

Association of the tumor necrosis factor alpha gene polymorphism with susceptibility and clinical-immunological findings of systemic lupus erythematosus.

The etiology of systemic lupus erythematosus (SLE) is unknown but genetic factors seem to play a role in the disease pathogenesis. The tumor necrosis factor alpha (TNFa) gene, encoded at the TNF locus in the MHC class III region, is now known to be an important candidate gene in SLE, due to the proinflammatory activities of the TNFa. The objectives of this study were to examine the role of the TNFa polymorphism for the susceptibility of Malaysian Chinese lupus patients to SLE and to determine its association with organ involvement. The allelic frequencies of the TNFa polymorphic variant (TNF2) of seventy lupus patients were determined during follow-up at the Medical Clinic of the National University Hospital Malaysia by PCR-RFLP technique. Sixty-four females and 6 males with a mean age of 33+/-12 years were included. Clinical data were obtained from case records. Autoantibody levels were measured by ELISA. Fifty-nine ethnically-matched blood donors were used as controls. The allelic frequency of the TNF2 variant was found to be significantly increased in the patients compared to the controls (52.8% vs 33.8%). SLE patients with the polymorphic TNF2 variant were found to be at increased risk of central nervous system involvement (p = 0.004, RR = 2.59) and to have an increased frequency of anti-La antibodies (p = 0.03). In view of these findings we suggest that TNF2 variant is playing a role in conferring susceptibility to SLE and in the disease pathogenesis.

Prevalence of type 2 diabetes in urban slums of Dhaka, Bangladesh.

This cross-sectional study was conducted to estimate the prevalence of type 2 diabetes along with its risk factors in urban slum population of Dhaka, Bangladesh. A random sample of 1555 slum dwellers of Dhaka city (age > or = 20 years) were included in the study. Capillary blood glucose levels, fasting and 2-h after 75g oral glucose load (for a selected subjects, n = 476), were measured. Height, weight, waist and hip circumferences, blood pressure and some other important socio-demographic information on age, sex, education, income, and occupation status were collected. The overall prevalence of type 2 diabetes was found to be 8.1 percent, and the prevalence for men and women were 7.7 percent and 8.5 percent respectively. Prevalence of diabetes was found to be lower following 2-h glucose values in the selected population compared to the FBG procedure. Age, sex, literacy and waist to hip ratio for men were found as significant risk factors following both fasting blood glucose and 2-h post glucose values adjusted for a number of confounding variables. Poor to moderate agreement was observed between fasting blood glucose and 2-h glucose (kappa 0.41, p < 0.001). The agreement was even poorer between impaired fasting glucose and impaired glucose tolerance. Poor agreement between FBG and 2-h BG may raise concern for the dependability of diagnostic procedures. Higher prevalence of type 2 diabetes in the urban slum may indicate an epidemiological transition due to fast urban migration and possibly urbanization. However, this issue needs further exploration.

The association of the HLA class II antigens with clinical and autoantibody expression in Malaysian Chinese patients with systemic lupus erythematosus.

The frequency of the HLA class II antigens/alleles (HLA-DR, DQ and DP) were studied in 70 Malaysian Chinese patients with systemic lupus erythematosus (SLE) to examine the contribution of these genes to disease susceptibility, their clinical expression and Immunological responses. This was done using modified PCR-RFLP technique. These samples were then compared with 66 ethnically matched controls. We found a strong association of the DQA1*0102 (p corr = 0.032, rr = 3.39), DQB1*0501 (p corr = 0.003, rr = 4.55), *0601 (p corr = 0.006, rr = 4.22) and DPB1* 0901(p corr = 0.02, rr = 4.58) with SLE. Clinically, we found a strong association of DR2 and DQA1*0301 with renal involvement and DQA1*0102 with alopecia. Immunologically, statistical analysis (Chi-square test ) showed a strong association of DQA1*0102 with anti-Ro/La antibodies while DQA1*0301 was observed to be strongly associated with antibodies to ds DNA. DQA1*0102 was found more frequently in those with a later disease onset (30 years of age or above). From these data we suggest that the HLA class II genes play a role in conferring disease susceptibility and clinical and immunological expression.

Effect of core modification on the release of chlorpheniramine maleate from ethylcelulose and cellulose acetate propionate microcapsules

Chlorpheniramine maleate [CPM] was microencapsulated using ethylcellulose [EC] and cellulose acetate propionate [CAP] as polymeric drug carriers. Phase separation technique induced by non-solvent addition was used in preparing the microcapsules. Conditions for microencapsulating the drug were determined by constructing phase diagrams for both EC-toluene-cyclohexane and CAP-toluene-cyclohexane systems. At 3% EC in toluene 50% cyclohexane was found to be suitable to prepare hard wall microcapsules while, this concentration was 40% in case of 6% CAP in toluene. Modification of the crystalline shape of the drug was applied to facilitate polymer deposition. The physical properties, drug incorporation efficiencies of the prepared microcapsules were also greatly improved when modified spherical crystals of CPM rather than fine powder were encapsulated. The release profile of the drug from microcapsules was dependent on shape of core, type of polymer, pH of dissolution media. Generally dissolution was characterized by an initial rapid release followed by a slow one. At dissolution media of pH 1.2 drug release was slow compared with release at pH 7.2 and the release from CAP microcapsules was slower than that from EC microcapsules. This could be attributed to the low acid solubility of CPM and enteric coating property of CAP. On the other hand, at pH 7.2 initial release was higher than in pH 1.2 and the release was fast in case of CAP compared with that for EC. In all cases microcapsules containing spherical cores showed slow and uniform drug release compared with that containing unmodified cores. Further coating of the prepared microcapsules with chitosan caused more release retardation with a change in release kinetics from non-linear diffusion model into nearly constant release as shown with EC microcapsules

Comparison between the effect of cimetidine and ranitidine on serum prolactin and testosterone levels and testicular structure in male albino rats

The effect of cimetidine and ranitidine [as H[2] receptor antagonists] on serum prolactin and testosterone levels and testicular structure in albino rats were investigated. Thirty healthy male adult Albino rats were used, they were divided into three groups, ten animals each, a control group, and 2 experimental groups [cimetidine and ranitidine groups]. Long term administration of doses equivalent to human therapeutic dose range of both cimetidine and ranitidine were used. In cimetidine group, a dose of 8 mg/Rat was administered intraperitoneally daily for one month. It produced highly significant increase in serum prolactin level [P < 0.001] and also highly significant decrease in serum testosterone level [P < 0.001]. Microscopically the testis showed a decrease in size of the seminiferous tubules and reduction in germinal layers with arrest of spermatogenesis in level of spermatid. Neither Sertoli cells nor Leydig cells showed any significant changes as compared with the control group. In ranitidine group a dose of 3 mg/Rat was administered intraperitoneally daily for one month. This group showed normal serum prolactin and testosterone level, and normal microscopic structure of the testis as compared with the control group

A new combination chemotherapy for recurrent Hodgkin's lymphoma.

Thirty seven Hodgkin's lymphoma patients with recurrence after first remission induced by radiation therapy and/or chemotherapy with mustine, oncovin, procarbazine and prednisolone (MOPP) were randomised to treat with a new combination chemotherapy comprising of doxorubicin, oncovin, procarbazine and prednisolone (DOPP). While the other group received further cycles of MOPP. Twenty two patients received DOPP and out of them 14 (63.6%) showed complete remission (CR). Other group of 15 patients were treated with further cycles of MOPP and among them two (13.3%) showed CR. However, the overall response rate including CR and partial remission (PR) in both the groups were almost same, 90.9% with DOPP and 86.6% with MOPP. It is concluded that DOPP combination is satisfactory and most likely superior to MOPP for producing CR in patients treated with radiotherapy and/or MOPP.

Cancer morbidity.

In the present study, 1736 cases of cancer has been analysed by major sites, sub-sites and mortality trend. The most common cancerous lesion in the male was in the lungs and in the female in the uterine cervix. The second common lesion in male and female were larynx and breast respectively. In children, retinoblastoma was the commonest type of cancer.