Enhancement of Annexin V in response to combination of epigallocatechin gallate and quercetin as a potent arrest the cell cycle of colorectal cancer

Abstract Colorectal cancer (CRC) is one of the most common cancers leading to comorbidities and mortalities globally. The rational of current study was to evaluate the combined epigallocatechin gallate and quercetin as a potent antitumor agent as commentary agent for therapeutic protocol. The present study investigated the effect of epigallocatechin Gallate (EGCG) (150mg) and quercetin (200mg) at different proportions on proliferation and induction of apoptosis in human colon cancer cells (HCT-116). Cell growth, colonogenic, Annexin V in addition cell cycle were detected in response to phytomolecules. Data obtained showed that, the colony formation was inhibited significantly in CRC starting from the lowest concentration tested of 10 µg/mL resulting in no colonies as visualized by a phase-contrast microscope. Data showed a significant elevation in the annexin V at 100 µg/mL EGCG(25.85%) and 150 µg/mL quercetin (48.35%). Moreover, cell cycle analysis showed that this combination caused cell cycle arrest at the G1 phase at concentration of 100 µg/mL (72.7%) and 150 µg/mL (75.25%). The combined effect of epigallocatechin Gallate and quercetin exert antiproliferative activity against CRC, it is promising in alternative conventional chemotherapeutic agent.

Resumo O câncer colorretal (CCR) é um dos cânceres mais comuns, levando a comorbidades e mortalidade em todo o mundo. O racional do presente estudo foi avaliar a combinação de galato de epigalocatequina e quercetina como um agente antitumoral potente como agente de comentário para protocolo terapêutico. O presente estudo investigou o efeito de galato de epigalocatequina (EGCG) (150 mg) e quercetina (200 mg) em diferentes proporções na proliferação e indução de apoptose em células de câncer de cólon humano (HCT-116). O crescimento celular, colonogênico, anexina V, além do ciclo celular foram detectados em resposta a fitomoléculas. Os dados obtidos mostraram que a formação de colônias foi inibida significativamente no CRC a partir da concentração mais baixa testada de 10 µg/mL, resultando em nenhuma colônia conforme visualizado por um microscópio de contraste de fase. Os dados mostraram uma elevação significativa na anexina V a 100 µg/mL de EGCG (25,85%) e 150 µg/mL de quercetina (48,35%). Além disso, a análise do ciclo celular mostrou que essa combinação causou parada do ciclo celular na fase G1 na concentração de 100 µg/mL (72,7%) e 150 µg/mL (75,25%). O efeito combinado da epigalocatequina galato e quercetina exerce atividade antiproliferativa contra o CCR, é promissor como agente quimioterápico alternativo convencional.

Enhancement of Annexin V in response to combination of epigallocatechin gallate and quercetin as a potent arrest the cell cycle of colorectal cancer / Aumento da anexina V em resposta à combinação de galato de epigalocatequina e quercetina como uma potente parada do ciclo celular do câncer colorretal

Abstract Colorectal cancer (CRC) is one of the most common cancers leading to comorbidities and mortalities globally. The rational of current study was to evaluate the combined epigallocatechin gallate and quercetin as a potent antitumor agent as commentary agent for therapeutic protocol. The present study investigated the effect of epigallocatechin Gallate (EGCG) (150mg) and quercetin (200mg) at different proportions on proliferation and induction of apoptosis in human colon cancer cells (HCT-116). Cell growth, colonogenic, Annexin V in addition cell cycle were detected in response to phytomolecules. Data obtained showed that, the colony formation was inhibited significantly in CRC starting from the lowest concentration tested of 10 µg/mL resulting in no colonies as visualized by a phase-contrast microscope. Data showed a significant elevation in the annexin V at 100 µg/mL EGCG(25.85%) and 150 µg/mL quercetin (48.35%). Moreover, cell cycle analysis showed that this combination caused cell cycle arrest at the G1 phase at concentration of 100 µg/mL (72.7%) and 150 µg/mL (75.25%). The combined effect of epigallocatechin Gallate and quercetin exert antiproliferative activity against CRC, it is promising in alternative conventional chemotherapeutic agent.

Resumo O câncer colorretal (CCR) é um dos cânceres mais comuns, levando a comorbidades e mortalidade em todo o mundo. O racional do presente estudo foi avaliar a combinação de galato de epigalocatequina e quercetina como um agente antitumoral potente como agente de comentário para protocolo terapêutico. O presente estudo investigou o efeito de galato de epigalocatequina (EGCG) (150 mg) e quercetina (200 mg) em diferentes proporções na proliferação e indução de apoptose em células de câncer de cólon humano (HCT-116). O crescimento celular, colonogênico, anexina V, além do ciclo celular foram detectados em resposta a fitomoléculas. Os dados obtidos mostraram que a formação de colônias foi inibida significativamente no CRC a partir da concentração mais baixa testada de 10 µg/mL, resultando em nenhuma colônia conforme visualizado por um microscópio de contraste de fase. Os dados mostraram uma elevação significativa na anexina V a 100 µg/mL de EGCG (25,85%) e 150 µg/mL de quercetina (48,35%). Além disso, a análise do ciclo celular mostrou que essa combinação causou parada do ciclo celular na fase G1 na concentração de 100 µg/mL (72,7%) e 150 µg/mL (75,25%). O efeito combinado da epigalocatequina galato e quercetina exerce atividade antiproliferativa contra o CCR, é promissor como agente quimioterápico alternativo convencional.

Olive Leaves Extract Alleviate Diabetic Nephropathy in Diabetic Male Rats: Impact on Oxidative Stress and Protein Glycation

Diabetes (DM) is one of the top five causes of death worldwide. Controlling glucose level is vital for protectingthe complications and improving the diabetics’ health. Olive (Olea europaea L.) leave extract (OLE) containsbiologically active antioxidant phenolic compounds. This research was carried out to evaluate the effect of OLEon oxidative status and advanced glycation end products (AGEs) in DM rats. Male Wister rats (n=40, 200 ± 20g) were divided into Group (1); Control rats and Groups (2-5); DM rats were intraperitoneal(i.p.) injected withSTZ (65 mg/kg), only DM rats (fasting blood glucose >250 mg/dl) were randomly classified into DM , DM+metformin (MT) (600 mg/kg) as reference drug, DM+OLE (200 mg/kg), and DM+OLE (400 mg/kg) groups. Atthe end of the experiment (6 weeks), blood and kidney samples were collected for biochemical andhistopathological studies. Serum glucose, renal functions (creatinine (Cr), and blood urea nitrogen (BUN)),electrolyte ions (sodium (Na+) and potassium (K+)), as well as renal oxidative statusbiomarkers (nitric oxide(NO), malondialdehyde (MDA), superoxide dismutase (SOD), and AGEs) were determined. The results revealedthat there were significant increases in glucose, Cr, BUN, and K+ with a significant decrease in Na+ levels, aswell as significant decrease in renal oxidative stress and elevated AGEs levels compared to the control rats.Although MT treatment was more effective than OLE (400 mg/kg) in reducing glucose level, while OLEtreatment was more effective than MT in reducing oxidative stress and AGEs levels. Oral administration of OLE(400 mg/kg) showed significant hypoglycemic and antioxidant effects as well as improved renal functions andinhibited AGEs levels compared to the DM rats. Also overcome most of the renal histopathological changesinduced by DM. Therefore, co-administration of MT and OLE is recommended in preventing DM complications

Foix-chavany-marie syndrome [anterior opercular syndrome] case report

Foix-Chavany-Marie syndrome is a rare cortico-subcortical suprabulbar or pseudobulbar palsy of the lower cranial nerves 5, 7, 9, 10 and 12. This syndrome consists of anarthria, bilateralvolitional paresis of the facial, lingual, pharyngeal, and masticatory muscles bilaterally with preservation of the reflexive, emotional and autonomic innervations of the same muscles. We present the first case report in the Middle East of Foix-Chavany-Marie syndrome

Cerebral cavernoamas: radiological prevalence and clinical features in a 10 year retrospective study in a teaching hospital

Cerebral cavernous angiomas remain one of the most negotiable and controversial topics in neurological and neurosurgical practice. It can present with symptoms or can be found incidentally. The aim of this study is to evaluate the prevalence, clinical presentation, treatment options and outcome of patients with cerebral cavernoma.: Brain MRI for [14372] patients done in our university teaching hospital during 10 -year period from 2001 to 2011 were reviewed, 33 cases of cerebral cavernoma were found. The medical charts of these patients were reviewed and analyzed for their clinical presentation, treatment options and outcome. We identified 33 cases of cavernoma with a mean age of 33 +/- 16.8% years. There were 18 females and 15 males. Four cases were excluded from analysis [but included in prevalence calculation] due to unavailability of clinical data. In the 29 other cases there were 35 cavernomas. The radiologic prevalence of cavernomas in this population was 0.23%. Most cavernomas were found in the supratentorial regions mostly found in the frontal lobes. The most common presenting symptoms were seizures in males and headache in females. The radiologic prevalence of cerebral cavernomas was less than previous series, while clinical presentation was the same. Performing MRI at higher resolution and field strength with more sensitive sequences may lead to the detection of subtle or small brain abnormalities that would not have been detected previously

Keystone design sliding skin flap for the management of small full thickness burns

Deep dermal burns and full thickness burns are generally managed by excision and split thickness skin grafting. The skin graft may lead to unacceptable colour changes and be aesthetically unacceptable. Also, there may be a contour defect and, furthermore, it is followed by varying degrees of contracture. The keystone design sliding flap, first described in 2003, avoids the need for grafting and is not associated with any skin graft problems. We report two cases of the use of this flap as the primary surgery in reconstruction of small full thickness burn defects

Factors affecting the clinical picture and prognosis of puffer fish poisoning in Suez city [Egypt] during year of 2008

Puffer fish is a common form of poisoning throughout Egyptian coastal cities such as Suez city. Puffer fish contains one of the most powerful marine toxins which is called tetrodotoxin. We attract attention of health professional to toxicity of puffer fish and factors affecting the clinical picture and outcome of poisoning which will help for early diagnosis and proper management. The study was carried out nine patients with history of puffer fish ingestion transferred to General Suez Hospital. Diagnosis was made on the basis of recent dietary history and clinical presentation. All cases were clinically examined, investigated and observed from admission to discharge. All patients were treated with gastric lavage, activated charcoal and symptomatic. Accordingly to clinical grading system for tetrodotoxin toxicity, three patients had grade 1 and another three had grade 2 but, three fatal cases had grade 3 and their condition worsened and became grade 4. The onset of appearance of toxic symptoms of puffer fish poisoning was rapid. All investigations for all patients were within normal limits. Clinical manifestations of poisoning were mainly neurological, but the cardiovascular effects were not common in the majority of patients. Toxic manifestations were wide range from mild to severe according to state of preparation and clean of puffer fish. Fatal cases ate gonads and head of fish and the cause of death was respiratory failure. The factors affecting the severity and the prognosis of puffer fish toxicity are the mode or preparation, the clean and the eaten part of fish

Mini-Mental state examination [MMSE] scores in healthy educated adult Jordanian population

The Mini-Mental Status Examination [MMSE] is a simple informative and validated screening test of cognitive functions. No data from MMSE scores in healthy populations has been published about educated Jordanians. To study the MMSE scores in the healthy educated Jordanian population. 150 healthy educated adult Jordanians were interviewed and tested for their MMSE score. Their scores were analyzed and the effect of age, sex and education on the score was studied. 150 adult subjects aged 35 +/- 12.5 years [range 18-71 years] with a mean level of education 14.2 +/- 2.6 years [range 7-20 years] scored 27.8 +/- 2.2 / 30 [range 21-30]. No correlation was found between age and MMSE score [Pearson correlation =-0.08, p=0.32], while there was direct correlation with education level [Pearson 0.53, p=0.000]. There were 77 [51.3%] males and 73 [48.7%] females who scored 27.7 +/- 2.4 and 27.8 +/- 2.1 respectively [p=0.942 ANOVA]. There was also no correlation with age at a cutoff of 45 years [p=0.203] while people with higher education [> 12 years, n=105] scored better than those with basic education [7-12 years, n=45], 28.4 +/- 1.8 and 26.3 +/- 2.5, respectively [p=0.000]. Local MMSE scores for healthy educated adult Jordanians are presented here that can be of help to the practicing physician assessing patients' cognitive functions. The local data confirmed previous associations with education but not with age as this series consists mostly of those from the young adult population. We suggest a lower normal score of 21 for those with basic education and a score of 24 for those with higher education

Analysis of membrane protein genes in a Brazilian isolate of Anaplasma marginale

The sequencing of the complete genome of Anaplasma marginale has enabled the identification of several genes that encode membrane proteins, thereby increasing the chances of identifying candidate immunogens. Little is known regarding the genetic variability of genes that encode membrane proteins in A. marginale isolates. The aim of the present study was to determine the degree of conservation of the predicted amino acid sequences of OMP1, OMP4, OMP5, OMP7, OMP8, OMP10, OMP14, OMP15, SODb, OPAG1, OPAG3, VirB3, VirB9-1, PepA, EF-Tu and AM854 proteins in a Brazilian isolate of A. marginale compared to other isolates. Hence, primers were used to amplify these genes: omp1, omp4, omp5, omp7, omp8, omp10, omp14, omp15, sodb, opag1, opag3, virb3, VirB9-1, pepA, ef-tu and am854. After polimerase chain reaction amplification, the products were cloned and sequenced using the Sanger method and the predicted amino acid sequence were multi-aligned using the CLUSTALW and MEGA 4 programs, comparing the predicted sequences between the Brazilian, Saint Maries, Florida and A. marginale centrale isolates. With the exception of outer membrane protein (OMP) 7, all proteins exhibited 92-100 percent homology to the other A. marginale isolates. However, only OMP1, OMP5, EF-Tu, VirB3, SODb and VirB9-1 were selected as potential immunogens capable of promoting cross-protection between isolates due to the high degree of homology (over 72 percent) also found with A. (centrale) marginale.

Mortalidad tras un año de protocolización en el manejo del paciente quemado / Effects of standarization of burn patient treatment on mortality

Background: In 2006, the burn unit of an emergency public hospital in Chile standardized its medical and surgical treatment protocols. Aim: To analyze the evolution of mortality among patients admitted to the unit after the standardization process. Material and Methods: Patients admitted to the unit between March 2005 and March 2006, were analyzed. An early surgical debridement was performed, according to the guide-lines, after a standardized reanimation with Lactate Ringer using Parkland formula (4 ml/kg/ percent burn surface area). All patients were monitored. An algorithm was used to decide the indication of vasoactive drugs or invasive monitorization. Results: Eighty eight patients aged 43 +/- 19 years (65 percent males) were admitted. The estimated percentage body burned was 30 +/- 21 percent, deep in 12.5 +/- 17 percent. A mean of 9.122 +/- 6.930 mi of fluid were administered in the first 24 hours. The first surgical debridement was performed at 48 hours (range 1 to 15 days). The first escharotomy was performed at 4.2 days (range 3 hours -15 days), the first covering at 3.8 days (range 3 hours-19 days) the first auto graft at 18 days (range 4-26 days). Operative times in the first three surgical procedures were less than 87 min. Global mortality was 37 percent. Conclusions: The standardized treatment of burns resulted in an absolute reduction of mortality.

Introducción: En el 2005 el Servicio de Quemados del HUAP inició un proceso de modernización. Durante el primer año se intervino en el protocolo terapéutico médico y quirúrgico. Se analizarán la mortalidad observada en este período. Materiales y Métodos: Se analizaron los pacientes admitidos en Cuidados Intermedios e Intensivos de nuestra unidad desde el Iº de marzo de 2005 a Iº de marzo de 2006. Se realizó aseo quirúrgico precoz, según protocolo, previa reanimación estandarizada con Ringer Lactato usando la fórmula de Parkland, 4 cc/kg/ por ciento SCT (superficie corporal total). Todos los casos fueron monitorizados, guiados por diuresis y con algoritmo para decidir inicio de drogas vasoactivas o monitorización invasiva. Resultados: Ingresan 88 pacientes, 58 por ciento trasladados de otros centros. Edad promedio 43 +/- 18,9 años; hombres 65 por ciento, mujeres 35 por ciento; superficie corporal quemada 30 +/- 21 por ciento, profunda 12,5 +/- 17 por ciento. Se administró en promedio 9.122 +/- 6.930 ce durante las primeras 24 hrs. Primer aseo se realizó a las 48 hrs (1 hr -15 días), Ia escarectomía a los 4,2 días (3 hrs - 15 días), Ia cobertura a los 3,8 días (3 hrs - 19 días), 1er autoinjerto a los 18 días (4 - 26 días). Tiempos operatorios promedio en las 3 primeras cirugías inferiores a 87 min. Mortalidad absoluta disminuyó a 19 por ciento. Mortalidad global 37 por ciento. Conclusiones: Luego del primer año del proceso de modernización, con reanimación estandarizada, equipos quirúrgicos proporcionales a la SCT quemada con disminución de los tiempos quirúrgicos, asociado a un manejo multidisciplinario, se logró una disminución de la mortalidad global.

Alterations in growth and branching of Neurospora crassa caused by sub-inhibitory concentrations of antifungal agents / Alteraciones de crecimiento y ramificación en Neurospora crassa provocadas por concentraciones subinhibitorias de agentes antimicóticos

Six antifungal agents at subinhibitory concentrations were used for investigating their ability to affect the growth and branching in Neurospora crassa. Among the antifungals herein used, the azole agent ketoconazole at 0.5 μg/ml inhibited radial growth more than fluconazole at 5.0 μg/ml while amphotericin B at 0.05 μg/ml was more effective than nystatin at 0.05 μg/ml. Morphological alterations in hyphae were observed in the presence of griseofulvin, ketoconazole and terbinafine at the established concentrations. The antifungal agents were more effective on vegetative growth than on conidial germination. Terbinafine markedly reduced growth unit length (GU) by 54.89%, and caused mycelia to become hyperbranched. In all cases, there was a high correlation between hyphal length and number of tips (r > 0.9). All our results showed highly significant differences by ANOVA, (p < 0.001, α = 0.05). Considering that the hyphal tip is the main interface between the fungus and its environment /through which enzymes and toxins are secreted and nutrients absorbed, it would not be desirable to obtain a hyperbranched mycelia with inefficient doses of antifungal drugs.

Se investigó el efecto de seis agentes antimicóticos en concentraciones subinhibitorias sobre el crecimiento y la ramificación en Neurospora crassa. El agente azólico ketoconazol a la concentración de 0,5 μg/ml inhibió el crecimiento radial más que el fluconazol a 5,0 μg/ml, y la anfotericina B a 0,05 μg/ ml fue más eficiente que 0,05 μg/ml de nistatina, entre los agentes poliénicos usados. En presencia de griseofulvina, ketoconazol y terbinafina a las concentraciones establecidas se observaron alteraciones morfológicas en las hifas. Los agentes antimicóticos fueron más eficientes sobre el crecimiento vegetativo que sobre la germinación conidial. La terbinafina redujo marcadamente (54,89%) la longitud de la unidad de crecimiento y provocó la hiperramificación del micelio. En todos los casos, existió gran correlación entre la longitud y el número de ápices de las hifas (r > 0,9). Todos los resultados mostraron diferencias altamente significativas de acuerdo con ANOVA (p < 0,001, α = 0,05). Considerando que el ápice de la hifa es la principal interfase entre el hongo y su ambiente, a través de la cual las enzimas y las toxinas son secretadas y los nutrientes son absorbidos, un micelio hiperramificado resultante de dosis ineficientes de agentes antimicóticos sería perjudicial.

Clinical experience with Gullain Barre Syndrome over a 6-year period in one hospital in the Middle East

Gulain Barre Syndrome [GBS] is the most common cause of sporadic acute flaccid paralysis but is still relatively rare. No series describing the full clinical course of patients with GBS were reported form the Arab world. Here we report on our experience with GBS over a 6-years-old period in one large medical facility form January 1999 till December 2004. We encountered 12 patients with GBS. The median age was 47 years and all had generalized weakness and areflexi. One patient started as Miller Fisher Syndrome [MFS] and ended up with GBS. More than 80% of patients were admitted to Intensive Care Unit [ICU], and 75% were intubated. All patients received supportive care. Specific treatment included intravenous immunoglubin IVIG in all patients [100%], plasma exchange [PE] in 2 patients [17%], and intravenous methyl prednisolone [IVMP] in 1 patient [9%]. The median time to walk independently was 62 days. Transient complications occurred in the majority of patent but the overall outcome was good in the majority of patients; with one single [8%] and probably unrelated mortality. Compared to other series, no significant difference in clinical presentation or outcome was noted

Hepatoprotective effect of Cinnamon extracts against carbon tetrachloride induced oxidative stress and liver injury in rats

Cinnamon is used to flavor most foods in Arabian countries. The aim of this study was to evaluate the medicinal importance, reflecting an important trend in research. The hepatoprotective activity of aqueous and ethanolic extracts of cinnamon was investigated against carbon tetrachloride (CC1(4)) induced lipid peroxidation and hepatic injury in rats. The elevated serum AST and ALT enzymatic activities induced by CC1(4) were significantly restored to near normal by oral administration of 200 mg/kg of either extracts once daily for 7 days, as compared to untreated rats. There was a significant elevation in the level of liver malondialdhyde (MDA), while the activities of antioxidant enzymes superoxide dismutase and catalase (SOD and CAT) were significantly decreased in CC1(4) intoxicated rats. The results obtained indicated that ethanolic extract has more potent hepatoprotective action than water extract against CC1(4) by lowering the MDA level and elevating antioxidants enzymes activities (SOD and CAT). The possible mechanism of this activity may be free radical-scavenging polyphenol compounds. The hepatoprotective properties were documented by the histopathological data obtained. Consequently, this extract can be used as a therapeutic regime in treatment of some hepatic disorders without any side effects. Further study will be done for separation and identification of active components and for testing antitumor activity.

Lipid profile in Jordanian patients with first ever ischemic stroke

To study the relationship between lipid profile, total cholesterol [TC], low density lipoprotein [LDL], high density lipoprotein [HDL], and triglycerides [TG] in Jordanian patients admitted with first ever ischemic stroke [IS] to a teaching hospital over a 3-year-period, and compared them to a control group. A retrospective case control study of all patients with diagnosis of IS who were admitted to the Jordan University Hospital, Amman, Jordan from January 2004 to December 2006 and had a documented fasting lipid profile within 48 hours of their admission. They were compared to controls without IS. Ninety-eight patients with IS were studied and compared to 98 control subjects. Both patients and control groups were similar regarding age, gender distribution, prevalence of hypertension, diabetes mellitus, ischemic heart disease [IHD], and smoking. The lipid profile showed a significantly lower HDL level in IS patients compared to the control group. There were no significant differences between the patients and control regarding TC, LDL, or TG levels. Control group used statins more frequently than patients [28% versus 10%, p=0.002]. Both groups had high prevalence of risk factors. Though this study is limited by its retrospective design, it suggests that IS patients have significantly lower levels of HDL

Level of aflatoxin residues in mugil cephalus and tilapia nilotica fishes from streams and aquaculture in Alexandria

Sixty random samples of Bori [Mugil cephalus] and boulti [Tilapia nilotica] were collected from four aquacultures and streams around Alexandria governorate for detection of aflatoxins residues in their edible parts. Cultured M. cephnlus showed high level of total aflatoxins [27.61, 13.49micro g/kg] than cultured T. nilotica [7.12 micro g/kg] or naturally live T nilotica in water stream [1.81 micro g/kg]. Aflatoxin B[1] was the predominant toxin among others [B2, G 1, and G2] in both species. Generally, aflatoxins residues were higher in cultured M. cephalus and its concentration in one farm reach to above the maximum allowable limits. Efforts should be directed towards decreasing the level of aflatoxins in fish feeds to avoid the hazard effect of aflatoxins on human health

Comparative study between superiorly based pharyngeal flap and sphincteroplasty in treatment of velopharyngeal insufficiency after cleft palate repair

Despite technical advances in cleft palate repairs, the post-surgical development of palatal fistulas and velopharyngeal insufficiency [VPI] is not uncommon. Approximately 20-38% of children who undergo cleft palate repair develop VPI. Surgical alteration of the VP sphincter is directed at decreasing the horizontal cross-sectional surface area of the sphincter's tissue boundaries. This can be achieved by the interposition of pedicled pharyngeal flaps [splitting one large port into two smaller one] or repositioning the posterior and lateral borders of the sphincter by the introduction of musculomucosal tissue flaps [Sphincteroplasty]. is to compare results of pharyngoplasty and superiorly based pharyngeal flap in the treatment of velopharyngeal insufficiency after cleft palate repair. A random group of twenty - two patients with VPI after cleft palate repair was studied. Patients were prone to three diagnostic procedures at phoniatric clinic, preoperatively: 1- Flexible fiber optic nasopharyngoscopy. 2-Nasometric evaluation 3-Tape recording. Patients were classified into two random groups; For 11 patients pharyngoplasty was done. Superiorly based pharyngeal flap was done for the rest of the patients. Nasometric evaluation and tape recording were repeated after phonotherapy [3-4 months postoperatively] and percentage drop in nasometer for nasal and oral sentences were calculated.Flexible fiber optic nasopharyngoscopy was repeated after 3 - 6 months postoperatively. In group I, three patients had persistence of nasal tone postoperatively [two patients had marked improvement and one patient had minimal improvement], giving incidence of complications 27.3%. According to results of postoperative tape recording of this group, 8 patients were categorized as good results, two as moderate and one as poor result. In group II, one patient had partial dehiscence and persistence of nasal tone postoperatively. Two patients had hypo nasality, one of them developed sleep apnea. Incidence of complications in this group was 27.3%. According to results of postoperative tape recording in this group, 9 patients were categorized as good results, one as moderate and one as poor result. Percentage drop in nasometer in nasal sentence in group I and II was 35.55% and 42.61% respectively. Percentage drop in nasometer in oral sentence in group I and II was 51.95% and 49.11% respectively. Both sphincter pharyngoplasty and superiorly based pharyngeal flap proved to be effective in treatment of velopharyngeal insufficiency with accepted incidence of complications. Sphincter pharyngoplasty had better results in patients with good palatal and lateral pharyngeal wall movements on preoperative videoendoscopy. Superiorly based pharyngeal flap had better results in patients with poor palatal and lateral pharyngeal wall movements on preoperative videoendoscopy

Neurologic involvement in wolfram syndrome

To study 10 patients with Wolfram syndrome sometimes referrd to as DIDMOAD [diabetes insipidus, mellitus, optic atrophy and deafness] from three Jordanian families to assess for neurologic involvement, all of them had diabetes mellitus, nine [90%] patients had optic atrophy [OA], and eight [80%] patients had sensorineural deafness. All patients had standard full clinical neurologic examination. Eight patients were seen by staff psychiatrist for one time interview. Standard non-contrast brain and pituitary magnetic resonance imaging was carried out for all the patients. five patients had full field pattern shift visual evoked response. Eight patients had nerve conduction study of one upper and one lower limb. Six patients had 18 channel electroencephalogram. Five patients had brainstem evoked response study. Apart from defining features of the syndrome [diabetes mellitus, optic atrophy, sensorineural deafness] 3 patients [30%] had abnormal neurologic examination [depressed deep tendon reflexes, stuttering and mild ataxia], two [20%] had mildly abnormal psychiatric findings [temper outburst and depression] three patients [30%] had abnormal brain magnetic resonance imaging, three patients [30%] had abnormal visual evoked response with demylinating pattern in early optic involvement and axonal pattern in late disease. Two patients [20%] had abnormal nerve conduction study [mild sensory motor polyneuropathy with axonal and demyelinating features]. One patient [10%] had abnormal electroencephalogram and all patients tested for brainstem evoked response [100%] had normal brainstem evoked response study. This study shows part of the spectrum of neurologic involvement in Wolfram syndrome. It is consistent with the degenerative nature of this clinical entity. Early demyelination followed by degeneration may be inferred from this study, and this is important to prove or disprove in the light of lacking enough neuropathologic data and understanding of its pathogenesis. Further pathologic and neurophysiologic studies are required

Pattern of admissions of children with sickle cell disease in Qateef central hospital, Saudi Arabia

Sickle Cell Disease [SCD] in the Eastern Province of Saudi Arabia is thought to be a benign form of disease. This is not true for all patients and it contradicts our clinical observation. Therefore, we conducted this study to look at the patterns of different presentations of SCD patients who required admission to Qateef Central Hospital [QCH]. The study was conducted prospectively between March 1990 and July 1991. All SCD patients less than 13 years were included. The total number of patients admitted to the paediatric medical ward during the study period was 2886, out of which 561 were SCD patients [19.4%]. Out of these, painful crises were responsible for 298 admissions [53%], anaemic episodes for 204 admissions [36.4%], infection for 83 admissions [15%], acute chest syndrome for 28 admissions [5%] and others for 20 admissions [3.6%]. The SCD patients form a large proportion of paediatric admissions. They present with various complications of the disease