High Plasma Sphingosine 1-phosphate Levels Predict Osteoporotic Fractures in Postmenopausal Women: The Center of Excellence for Osteoporosis Research Study

BACKGROUND: Higher sphingosine 1-phosphate (S1P) plasma levels are associated with decreased bone mineral density (BMD), and increased risk of prevalent vertebral fracture. So, we hypothesized that postmenopausal women with increased baseline plasma S1P levels have a greater risk for future incident fracture (osteoporosis-related fractures [ORFs]). METHODS: This study was conducted in a prospective longitudinal cohort of 707 women recruited in 2004 and followed up annually for a mean period of 5.2±1.3 years. They were postmenopausal (aged ≥50 years). The primary outcome measure was the time to the first confirmed ORF event using radiographs and/or a surgical report. RESULTS: The plasma S1P levels (µmol/L) were significantly higher in the women with incident fracture (7.23±0.79) than in those without ORFs (5.02±0.51; P < 0.001). High S1P levels were strongly associated with increased fracture risk. After adjustment for age and other confounders, the hazard ratio (HR) was 6.12 (95% confidence interval [CI], 4.92−7.66) for each 1-standard deviation increase in plasma S1P levels. The women in the highest quartile of S1P levels had a significant increase in fracture risk (HR, 9.89; 95% CI, 2.83−34.44). Results were similar when we compared plasma S1P levels at the 1-year visit. CONCLUSIONS: The associations between plasma S1P levels and fracture risk were independent of BMD and other confounders. These findings demonstrate that high plasma S1P level at baseline and at years 1 to 5 is a strong and independent risk factor for future [ORFs] among postmenopausal women and could be a useful biomarker for fracture risk assessment in this population.

Incidence, types, geographical distribution, and risk factors of congenital anomalies in Al-Ramadi Maternity and Children's Teaching Hospital, Western Iraq

To study the incidence, types, geographical distribution, and risk factors of congenital anomalies [CAs] in a teaching hospital. A total of 5864 neonates were examined for CAs between October 2010 and October 2011 in Al-Ramadi Maternity and Children's Teaching Hospital, Al-Ramadi, Western Iraq. Data include: neonate's name, gender, weight, and type of CAs, mother's age, residence, education, parity, consanguinity, smoking, illness, drugs, and ultrasound [U/S] results, father's age and smoking, and family recurrence of CAs. For every case, 2 controls were selected. Types and incidence of CAs was calculated. Odds ratio and confidence interval was utilized for risk factors evaluation. Overall CA incidences were 40.5/1000 for total births, 40.8/1000 live births, and 270.0/1000 for stillbirths. Twenty percent of CAs was found as multiple, 80% single, 63.8% major, and 36.2% minor. The cardiovascular system was found most affected, followed by genito-urinary system. Low birth weight, male gender, maternal smoking, consanguinity, parity, and CAs family recurrence were found to be significant risk factors, and oligohydramnios, polyhydramnios, and positive CAs by U/S, found as significant co-factors associated with CAs, while parental age, and maternal education were not considered risk factors. Although the incidence of CAs was lower than the Al-Fallujah rate, it is still higher than many developed and developing countries. Amniotic fluid volume changes in U/S may hide an ominous CA, and maternal smoking exposure during pregnancy and consanguinity may expose the family to a congenitally anomalous delivery

Doppler ultrasonogragshic evaluation of portal circulation in patients of portal hypertension treated by splenectomy, devascularization and oesophageal transection

The portal hypertension with bleeding oesophageal varicose is a major medical problem in Egypt, the risk of death from 10% to 40% in these patients due to massive secondary heamorrhage. Splenectomy, Devascularization and Oesophageal Transection is one of the most important lines was used to treatment of bleeding oesophageal varices in patients suffering from portal hypertension particularly after failure of upper gastrointestinal tract endoscopy. The doppler Ultrasonography is simple,non invasive investigation to determine the blood vessels diameter, direction of blood flow, blood volume and degree of vascular congestion. The portal circulation evaluated pre and post operative by doppler Ultrasonography in 50 patients [41 males and 9 females] suffering from portal hypertension and oesophageal varices [Child A or Child B] and treated by Splenectomy, Devascularization and Oesophageal Transection to determine the degree of correction of the hemodynamic state. The portal vein diameter decreased after the operation by 1.5 mm, cross sectional area by 0.42 cm while its flow velocity increased after the operation by 3.22 ' cm/sec Its flow volume increased after the operation by 49.2ml/min and its congestive index decreased after the operation by 0.07cm/sec.So the operation is effective in the treatment of portal hypertension and oesophageal varices as it improves liver blood flow and liver perfusion. It also eradicated oesophageal varices

Cerebro-spinal fluid enzymatic changes in patients of acute cerebral infarctions

C.S.F. enzymes [CK, LDH and AST] were determined in 30 patients suffering from acute cereebral infarction [22 patients thrombotic and 8 patients embolic], 18 males and 12 females with age ranged from 19 to 70 years on the 1st, 3rd and 10 the days of occurance of the stroke, as well as in 10 healthy control persons of matched age and sex. There was significant elevation of C.S.F. CK on the 1st and 3 rd days while non significant mc-crease was observed on the tenth day as compared to control group. Meanwhile CSF LDH showed a non significant elevation in the three occations. As regards C.S.F. AST, it was increased insignificantly on the 1st and 10th days and significantly on the 3 rd day as compared to the control group. Also non significant difference was observed between the thrombotic and Embolic groups

Changes in the intraocular pressure in chronic liver diseases with ascites

The aim of the present work is to study changes in the intraocular pressure in cases having chronic liver diseases with ascites. Fifty patients suffering from chronic liver diseases with ascites and 12 non ascitic patients as a control were studied. Careful history, thorough clinical examination, laboratory, ultrasono-graphic and endoscopic investigations were performed for every patient and contro1. The intrao-cular pressure was measured by Schiotz indentation tonometer and confirmed by hand held applanation tonometer in 3 different sittings. There was no significant difference in the mean intraocular pressure between ascitic patients and non-ascitic controls. There was positive statistical correlation between the degree of portal hypertension as manifested by congestive splenomegaly and the intraocular pressure in 38patients. The lowest intraocular pressure measurements were found in 14 patients with blood urea ranging from 68 - 152 mg. This may be explained by the osmotic effect of urea on aqueous outflow present in patients with chronic liver diseases and ascites who are prone to develop functional renal failure. There was a significant decrease in the intraocular pressure in ascitic patients after diuretic therapy when compared to values before therapy

Effect of bromhexine on dry eye

A great immunological resemblance exists between the external eye and respiratory tract. Dryness lowers ocular resistance. Bromhexine gave excellent results in combating chest infection through augmentation of amount of bronchial secretion, being a bronchial mucolytic drug. We used bromhexine in treating dryness caused by Sjogren's syndrome and trachomatous cicatrisation in 100 eyes. Bromhexine proved to be effective in the majority of cases, but of very short duration. Cases were diagnosed and followed by quantitative rose bengal, and affirmed by Shirmer's test and B.U.T.

Effects of open heart surgery on intra ocular pressure [IOP]

The intra ocular pressure in both eyes of 23 patients undergoing open heart surgery, was measured by Schiotz indentation tonometer before, during and after the surgery until it returned to the pre operative levels. It was observed that a marked and rapid drop of the IOP occurs during the operation time, reaching its minimum during the cardio-pulmonary by-pass [[PB] period, then it gradually rises to its normal pre operative levels in 69.5% of cases [16 out of 23] at the end of the first post operative day, in 91% of cases [21 out of 23] at the end of the second post operative day and in all cases [100% of cases] at the end of the third post operative day. The possible explanations for such changes were discussed in view of the anaesthetic agents, techniques and associated hemodynamic parameters

Yag laser anterior capsulotomy

Planned extracapslar cataract extraction was done for different types of senile cataract, to study the role of Nd-YAG laser in anterior capsulotomy. As a result of this work is proved that YAG laser is a safe and satisfactory method for anterior capsulotomy

Evaluation of adhesive N-butyl-2-cyanoacrylate for recurrent pterygium

The study was carried on 40 surgeries which were done for recurrent pterygium. The following different techniques of N-butyle-2-cyanoacrylate application were used a. Limbo-scleral for 15 eyes b. scleral application for 15 eyes. C. No adhesive substance was used in the last 10 eyes as a control. The recurrence rate was high in the cases in which we did not use the adhesive substance. With the adhesive substance the incidence of recurrence was less with the cases of multiple application technique and for 14 days duration

adhesive substance in pterygium surgery

Different techniques of n-butyl-2-cyanoacrylate monomer application were done for 50 pterygium surgery. It was corneo-limbal in 10 eyes, Limbal in 10, Limbo-scleral in 10 and scleral in 10 eyes. No adhesive substance was used in the last 10 eyes, as a control. We have obtained favourable results with the adhesive substance, it is proved that it is quite safe and satisfactory as regards the low incidence of recurrence

Corneal astigmatism after glaucoma surgery

Different techniques of subscleral trabeculectomies were done, using different shapes of scleral flaps, in comparison with peripheral iridectomy, and iridenecliesis to study the incidence of postoperative astigmatism, in glaucoma surgery. The incidence of corneal astigmatism was lower in peripheral iridectomy and subscleral trabecuIectomies, specially triangular flaps, in comparison with iridencleisis

Superficial scleral flaps in subscleral trabeculectomy

Different shapes of the scleral flaps were used for 60 trabeculictomies; It was triangular in 20, rectangular in 20 and semicircular in 20 eyes. We have obtained favourable results with triangular and rectangular flaps, however the triangular design of the flaps may assist more the good alignment, formation of a posterior diffuse bleb, which is less liable to complications as delayed anterior chamber formation, infection, and perforation

Comparison between trephine, punch and no 15 bard parker knife subscleral trabeculectomies

Under a traingular scleral flap, 66 trabeculectomies were done using; Trephine, punch and No 15 Bard-Parker knife. Each technique was used for 22 eyes. Trepanotrabeculectomy proved to be quite safe and satisfactory, all that was needed was a sharp trephine, and some experience as regards its use. The success rate was high and the complications were few