Detection of hepatitis c virus 5' noncoding RNA in serum samples

To evaluate the level of 5' noncoding region [copies/ml] of Hepatitis C Virus and correlate that with the clinical and laboratory parameters. Experimental controlled trial. National Hospital, Riyadh, Saudi Arabia. Sixty-four patients were included in this study, 47 patients were sero-positive for anti-HCV antibodies by third generation enzyme immunometric assay [EIA]. Quantitative and qualitative HCV 5' noncoding RNA from serum samples was detected by nested PCR. Another four serum patients' samples were investigated for hepatitis C virus genotyping. In addition to 13 normal control subjects were included in this study. Alanine transaminase [ALT] levels were raised during the acute infection [mean 83.51]. The clinical features were varied from 23 [45%] asymptomatic patients to 17 [33%] who had jaundice, 46 [90%] complained from fatigue and 34 [66.6%] had nausea and vomiting. Among the 51 HCV-RNA positive samples obtained from patients, 12 samples had below 2,000 copies of HCV-RNA/ml, 4 had between 2,001 and 15,000 copies, 3 had between 15,001 and 50,000 copies, 4 had between 50,001 and 100,000 copies, 9 had between 100,001 and 300,000 copies, and 19 had over 300,000 copies of HCV-RNA/mL. 5' noncoding region of HCV could completely distinguish between genotype and subtype of HCV and these could be important for the initiation of treatment

Effect of cardiopulmonary bypass on the pharmacokinetics of intravenous paracetamol

Recently, intravenous paracetamol [propacetamol] is commonly in use as analgesic and antipyretic after surgery. The pharmacokinetics of intravenous paracetamol in patients undergoing cardiac surgery with cardiopulmonary bypass [CPB] were not previously described. This study was designed to investigate the effect of CPB on the pharmacokinetics of single intravenous dose of paracetamol in adult patients. Experimentally, nine patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass using mild hypothermia were selected. Intravenous propacetamol [2 g] was infused over 10 min and arterial samples were taken starting from 20 min after infusion and afterwards over 8 hours from infusion. Plasma paracetamol concentrations were measured by high-pressure liquid chromatography. ANOVA was used to compare between the pharmacokinetic parameters before and after CPB. The results revealed a C of 10.19 +/- 0.9545 mg. litre[-1] which was appeared after 20 min of infusion [experimentally]. Mean clearance [CL] was significantly reduced by about 40% in post CPB [prebypass 0.589 +/- 0.1069 L.h[-1]. Kg[-1] vs. 0.357 +/- 0.0394 L.h[-1]. Kg[-1] after CPB, P < 0.05]. The elimination rate constant [Ke] was significantly reduced by about 55% after CPB compared to prebypass values. However, the elimination half-life [t1/2] was significantly increased from 1.380 h before bypass to 2.431 h in post bypass period. It appears from this study that hypothermic cardiopulmonary bypass can affect the kinetic profile of IV paracetamol in patients undergoing coronary artery bypass graft surgery by altering its elimination. However, the change in the pharmacokinetic parameters and blood level of paracetamol is not serious and its use in such situations as analgesic and antipyretic is safe

Effect of cardiopulmonary bypass on the pharmacokinetics of intravenous paracetamol [Propacetmol hydrochloride]

Recently, intravenous paracetamol [propacetamol] is commonly in use as analgesic and antipyretic after surgery. To our knowledge, the pharmacokinetic of intravenous paracetamol in patients undergoing cardiac surgery with cardiopulmonary bypass were not previously described. This study was designed to investigate the effect of cardiopulmonary bypass on the pharmacokinetics of single intravenous dose of paracetamol in adult patients undergoing coronary artery bypass surgery with hypothermic cardiopulmonary bypass. Nine patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass using mild hypothermia 30°C were selected. Intravenous paracetamol [2g single dose of Propacetamol hydrochloride [Pro-Daflgan UPSA, Fr]] was infused over 10 min and arterial samples were taken starting from 20 min after infusion and afterwards over 8 hours from infusion. Plasma paracetamol concentrations were measured by high-pressure liquid chromatography. The pharmacokinetics of paracetamol was calculated assuming a linear one compartment model with instantaneous input and first order output. The pharmacokinetic data were reported as mean [SD]. ANOVA was used to compare between the pharmacokinetic parameters before and after CPB. C[max] 10.19 [0.9545] mg.litre[-1] appeared 20 min after the end of infusion [experimentally]. Mean clearance [CL] was significantly reduced by about 40% in post CPB [prebypass 0.589 [0.1069] L.h[-1].kg[-1] vs. 0.357 [0.0394] L.h[-1].kg[-1] after CPB, P < 0.05]. The elimination rate constant [Ke] was significantly reduced by about 43% after CPB compared to pre-bypass values. However, the elimination half-life [t[1/2]] was significantly increased from 1.380 h before bypass to 2.431h in post bypass period. It appears from this study that hypotuermic cardiopulmonary bypass can affect the kinetic profile of IV paracetamol in patients undergoing coronary artery bypass graft surgery, and these changes should be considered while using this drug in such situations

Vitamin D deficiency among pre-menopausal women in Riyadh, Saudi Arabia

Riyadh is a region of year-round sunny weather where milk is fortified with vitamin D and where women wear dress styles that cover the whole body or most of it and their outdoor activity is limited. This may produce variable effects on vitamin D synthesis and parathyroid hormone levels which in turn affect bone mineralization, increasing the fracture risk. To determine prevalence and degree of vitamin D deficiency in premenopausal females [19-49 years] presenting to a dermatology clinic. Cross-sectional clinic-based Quota sample. The Dermatology Clinic in Riyadh National Hospital, Riyadh, Saudi Arabia. Three hundred eighty six married adult females [19-49 yrs old] attending the Dermatology Clinic during April and May 2005, and who agreed to be screened. Serum levels of 25-hydroxyvitamin D [25-OHD], parathyroid hormone, calcium, and phosphorus. This study included 386 premenopausal women, most of them [293/75.9%] were veiled [using dress style that is black and covers the whole body], while 93 [24.1%] were not veiled [wearing black dress exposing hands and face], of whom 46 [49%] reported using sunscreen on exposure to sun. Vitamin D deficiency was found in 38.4% of veiled women, with a low serum 25-OHD: 35.2+15.7 nmol/L, compared with 60.8+20.4 amongst the non-veiled women/no sunscreen. Serum 25-OHD amongst the non-veiled women/sunscreen was also low [37.9+17.6] but higher than that in the veiled group. Vitamin D deficiency and insufficiency are prevalent amongst sunlight-deprived female adults [veiled and sunscreen users] in Riyadh. Greater awareness of physicians and population about vitamin D and its importance for optimal health is needed. Increased dietary and supplemental vitamin D intakes are reasonable approaches to guarantee vitamin D sufficiency

discriminative ability of percent free psa in patients with PSA > 10 ng/ml

Objective: To study the discriminative role of % free PSA in patients with a total PSA > 10 ng/ml

Patients and Methods: Our patient cohort con-sisted of 90 males aged between 45 and 81 years [mean age: 67 +/- 9 years]. All patients had a biopsy-proven prostate pathology. Fifty-six patients had BPH [Group I] while 34 had prostate cancer [Group II]. Blood samples were collected from all patients, and total PSA, free PSA and % free PSA were calculated in all specimens. Total PSA was measured using the Imx assay [Abbott, USA]. The significance of the differences between the groups was assessed by the Mann-Whitney Wilcoxon rank sum test and Spearman's correlation coefficient for the correlation between % free PSA and the pathological diagnosis

Results: The difference in total PSA between the two groups was insignificant. The mean value in BPH patients was 11.7 +/- 11.4 ng/ml, while in patients with prostate cancer its was 15.8 +/- 19.2 [p = 0.8]. The mean % free PSA was 18 +/- 1% in patients with BPH and 16 +/- 0.6% in patients with prostate cancer [p = 0.3]. A strong correlation was evident between % free PSA 15% and the pathological diagnosis [p = 0.87]. This was also true for the cutoff values of 20% and 25% [p=0.79 and 0.62, respectively]

Conclusion: As a diagnostic test, % free PSA alone cannot be used for the discrimination of BPH from prostate cancer. In patients with a total PSA > 10 ng/ml, % free PSA has no value in the discrimination between benign and malignant pathology

Laboratory markers versus clinical variablesfor early and accurate prediction of infection and sepsis in febrile medical patients

Fever is the most frequent symptom of severe microbial infection.Together with abnormal temperature, tachycardia, Tachypnea and abnormal white blood cell count define the systemic inflammatory response syndrome [SIRS]. In 150 hospitalized medical patients with fever; clinical variables and laboratory markers as procalcitonin [PCT], elastase al-antitrypsin and lactoferrin levels in plasma were determined and evaluated for their diagnostic efficiency. Of the 150 patients, 95%had SIRS;of whom only 71% had clinical evidence of infection. On the otherhand only 45% of the patients enrolled in this study had microbial infection proved by microbiological testing . It was also found that clinical variables apart from Total WBC count and respiratory rate were non significant markers for microbial infection, because they lack sufficient specificity.Procalcitonin supranormal level was the most sensitive [70% initially and 75% after 24 hours] early laboratory marker followed by elastase al-antitrypsin [58% initially and 67% after 24 hours] for predicting microbial infection and bacteremia . Procalcitonin was also a predictor for mortality at 24 hours level [80%]followed by elastase al-antitrypsin [78%]. The thirdmarker , Lactoferrin can not be used as screening test because it showed the worst sensitivity both initially [32%]and at 24 hours[45%] for prediction of microbial infection as well as bacteremia [36%] initially and [45%]at 24 hours .It can be used as bad prognostic sign

Conclusion: In febrile medical patients plasma procalcitonin followed by elastase al-antitrypsin supranormal levels can predict early microbial infection and bacteremia as well as mortality better than do clinical symptoms. Thus allow early therapeutic treatment without the need of repeated blood culture as well as better outcome and survival