Bacillus licheniformis strain UKCH17 from northwestern Indian Himalayas: Characterization of chitinolytic enzyme and determination of its antifungal potential

Bacterial biocontrol agents are viable alternatives to chemical pesticides with target specificity and ecological safety. Here, we have identified a pesticidal microbial agent, an extra cellular chitinase producing Bacillus strain (designated as UKCH17) from Uttarakhand soils, a biologically rich Northwestern Indian Himalayas ecosystem. The 16S rRNA gene sequence of UKCH17 showed 99% similarity with sequences of B. licheniformis available in the public domain. The culture supernatants have a maximum chitinase activity of 99 U/mL after 4 days of culturing. The isolate showed strong antifungal activity manifested in the form of progressive mycelia degradation of Rhizoctonia solani, Fusarium solani and Sclerotium rolfsi in dual culture plates. Mycelial deformities like constrictions and protoplast leakage were observed in microscopic studies. However, it showed little growth reduction in Helicoverpa armigera when fed on surface contaminated diet. The electrophoretic analysis showed a monomeric 70 kDa active enzyme having an optimum pH and temperature of 5 and 50ºC, respectively. The enzyme also obeyed Michaelis-Menten kinetics, the Km and kcat values being 0.387 mg colloidal chitin/mL and 6335 s-1, respectively. Partial characterization of chitinase gene also confirms the family 18 status of glycosyl hydrolase from UKCH17. Above all, seed bacterization improved germination percentage and other plant growth characteristics of Pisum sativum in sick pots of R. solani and S. rolfsi suggesting its utilization as potent antifungal biocontrol agent.

Antiedematogenic activity of the indole derivative N-salicyloyltryptamine in animal models

ABSTRACT The N-salicyloyltryptamine (NST) is an indole derivative compound analogue to the alkaloid N-benzoyltryptamine. In the present study, the antiedematogenic activity of NST was investigated in animal models. Firstly, the acute toxicity for NST was assessed according to the OECD Guideline no. 423. The potential NST-induced antiedematogenic activity was evaluated by carrageenan-induced paw edema in rats, as well as by dextran-, compound 48/80-, histamine-, serotonin-, capsaicine-, and prostaglandin E2-induced paw edema in mice. The effect of NST on compound 48/80-induced ex vivo mast cell degranulation on mice mesenteric bed was investigated. No death or alteration of behavioral parameters was observed after administration of NST (2000 mg/kg, i.p.) during the observation time of 14 days. The NST (100 and 200 mg/kg, i.p.) inhibited the carrageenan-induced edema from the 1st to the 5th hour (**p<0.01; ***p<0.001). The edematogenic activity induced by dextran, compound 48/80, histamine, serotonin, capsaicin, and prostaglandin E2 was inhibited by NST (100 mg/kg, i.p.) throughout the observation period (**p<0.01; ***p<0.001). The pretreatment with NST (50, 100 or 200 mg/kg, i.p) attenuates the compound 48/80-induced mast cell degranulation (**p<0.01; ***p<0.001). Thus, the inhibition of both mast cell degranulation and release of endogenous mediators are probably involved in the NST-induced antiedematogenic effect.

Frecuencia de dislipidemia y estado nutricional de escolares de áreas rurales paraguayas / Frequency of dislipidemia and nutritional state in schoolchildren of P a raguayan rural areas

Mundialmente la prevalencia de dislipidemias ha crecido en la última década en niños y adultos. En nuestro país las enfermedades circulatorias son la primera causa de muerte. Se determinó la frecuencia de dislipidemia, estado nutricional y factores asociados a dislipidemia en escolares de cuatro escuelas rurales públicas. Estudio observacional descriptivo de corte transverso en una población de escolares de 5 a 13 años de edad, de ambos sexos, con muestreo de casos consecutivos, realizado entre abril de 2008 a setiembre de 2009. Se determinó el estado nutricional por IMC según CDC 2000 y los niveles de colesterol y triglicéridos en sangre por métodos enzimáticos. A través de una encuesta, se consultaron los antecedentes familiares de dislipidemia, actividad física y hábitos alimentarios. El 59% de los 182 escolares incluidos en el estudio presentaron dislipidemia, 33% niveles de colesterol de riesgo moderado o alto, 41% niveles de triglicérido de riesgo moderado o alto. El 8% de los escolares mostró sobrepeso u obesidad. En cuanto a factores de riesgo asociados a dislipidemia, el 60% consumía carnes no magras al menos dos o tres veces por semana y el 56% de los niños que poseían padres con antecedentes de dislipidemia presentaban hipercolesterolemia de riesgo. La prevalencia de dislipidemia en esta población es preocupante y por ello, es necesario introducir estrategias dirigidas a mejorar los hábitos alimenticios en las instituciones educativas.

The worldwide prevalence of dislypidemiain children and adults has increased in the lastdecade.In our country, circulatory diseases are the first cause of death. The frequency ofdislypidemia, nutritional state and factors associated to dislypidemias in schoolchildren offour public rural schoolswas determined. This was a cross-sectional descriptiveobservational studywith consecutive samplingcarried out in a population of schoolboysand girlsaged5to13years oldfrom April 2008 to September 2009.The nutritional statewas determined by BMI according toCDC 2000and colesterol and triglycerides bloodlevels by enymatic methods. A survey collected family backgrounds about dislypidemia,physical activity and food habits.Fifty nine percent of the 182schoolchildren included inthe study presented dislypidemia, 33%had moderated or high risk for colesterol levelsand41%moderated or high risk for triglycerids levels while8%had overweight orobesity. In relation to risk factors associated to dislypidemia,60%ate lean meatat leasttwo to three times a week and56%of the children, who had parents with dislypidemiabackgrounds,showed risk hipercholesterolemia.The prevalence of dislypidemiafoundin this population is worrisomeshowing that it is necessary to introduce educationalstrategies aimed at improving food habits in the educational institutions.

Grado de Satisfacción de los médicos, que son usuarios del Dpto. de Análisis Clínicos del Instituto de Investigaciones en Ciencias de la Salud (UNA) durante el año 2010 / Degree of satisfaction of physicians using the services of the Department of Clinical Analysis of the Health Sciences Research Institute (UNA) during 2010

El Instituto de Investigaciones en Ciencias de la Salud depende de la Universidad Nacional de Asunción, es un establecimiento público con laboratorios que brinda a la comunidad servicios de rutina y especializados que satisfacen requisitos de calidad; los cuales son accesibles, seguros, confiables y confidenciales. La satisfacción del usuario médico es un indicador reconocido de calidad asistencial, es por ello que el Instituto ha elaborado un estudio de opinión con el objetivo de conocer el grado de satisfacción de los profesionales médicos con respecto al Departamento de Análisis Clínicos (AC) mediante una encuesta dirigida a los mismos y mejorar si fuese necesario el servicio brindado por el laboratorio. Se realizó un estudio observacional descriptivo de corte transverso, la selección de los médicos fue a partir de los pedidos de análisis que llegaron al Dpto. de AC durante el año 2010. Se utilizó como instrumento de medición una encuesta con 11 ítems y sugerencias, relacionadas con la satisfacción de los usuarios médicos. Los pedidos médicos solicitados fueron 68.9 % del Hospital de Clínicas y el 31.1% correspondieron a Centros de Salud del Ministerio de Salud Pública, Hospital de Policía, Hospital de las Fuerzas Armadas, entre otros. Del estudio de opinión se concluye que el grado de satisfacción de los médicos con respecto al Departamento de AC es bueno pero que es necesario insistir en aspectos de comunicación y colaboración entre los servicios clínicos y los laboratorios para que la mejora en el trabajo participativo de estos estamentos sea más fructífera.

Localization of sulphonylurea receptor proteins SUR2A and SUR2B and/or SUR1 in rat kidney

To further explore precise expression and localization of sulphonylurea receptor isoforms SUR2A and SUR2B [SUR1] in rat kidney, total RNA was isolated from the kidney tissue using the TRIzol kit. Three different primer sets designed against SUR isoforms were used in reverse transcriptase reactions. Western blotting was done on membrane fractions obtained from kidney tissues using the primary antisera for SUR2A and SUR2B [SUR1]. Paraformaldehyde fixed kidney sections were immunostained with SUR2A and SUR2B [SUR1] primary antisera. Sections were developed with DAB as a chromogen. RT-PCR results demonstrated mRNA consistent with SUR1 isoform to be the only identifiable transcript. Western blotting could not identify any protein consistent with SUR2A or SUR2B [SUR1] but recognized instead a smaller 55kD protein of unknown identity. Immunohistochemistry demonstrated a differential staining pattern whereby SUR2A was localized to the mesangial cells, intra- and extrarenal blood vessels and smooth muscles. In contrast, SUR2B [SUR1] was localized only to distal nephron epithelia. Intense immunoreactivity was localized to the thick ascending limb and as well as in the outer and inner medullary collecting ducts, both. Our results demonstrate differential and highly localized expression pattern of sulphonylurea receptor proteins SUR2A and 2B [SUR1] in rat kidney with implications for drug design

Correlación entre el aclaramiento de creatinina y la fórmula MDRD-4 en la estimación del filtrado glomerular / Correlation between creatinine clearance and MDRD-4 formula in the estimation of the glomerular filtrate

La creatinina sérica y el aclaramiento de creatinina (ClCr) son los métodos mayoritariamente empleados como medida del Filtrado Glomerular (FG), procedimientos no exentos de problemas tanto preanalíticos como analíticos. En los últimos años se viene proponiendo la utilización de fórmulas predictivas del FG. Buscamos comprobar la correlación entre el método analítico y el estimado por la ecuación de MDRD-4. Se estudiaron retrospectivamente 89 pacientes, con un promedio de 51 ± 14 años; 31 varones y 58 mujeres. Aunque la media del FG estimada por la fórmula MDRD-4 fue de 66 ± 28.83 ml/min y la obtenida con la depuración de creatinina fue de 62±30.22ml/min. (p<0.05); se encontró una correlación positiva entre ambos métodos (r=0,796; p=0,001). En nuestra población la ecuación MDRD-4 presenta una buena equivalencia con el ClCr y podría utilizarse para evaluar la función renal en pacientes con riesgo de desarrollar enfermedad renal crónica (ERC).

Serum creatinine and creatinine clearance (CrCl) methods are mostly used as measures of glomerular filtration (GF) and are procedures that are not exempt from both pre-analytical and analytical problems. In recent years, it has been proposed the use of predictive formulas of GF. In this study, we sought to verify the correlation between the analytical method and the estimated by the MDRD-4 formula. Eighty nine patients were studied retrospectively, they had a mean age of 51±14 years and there were 31 males and 58 females. Though the mean GF estimated by the MRDR-4 formula was 66 ± 28.83 ml/min and the obtained by creatinine depuration was 62 ± 30.22ml/min. (p<0.05), a positive correlation between both methods was found (r=0.796; p=0.001). In our population, the MRDR-4 formula has a good equivalence with the CrCl and could be used to assess the renal function of patients at risk of developing chronic kidney disease (CKD).

Evaluación de parámetros litogénicos en pacientes con urolitiasis que concurrieron al Instituto de Investigaciones en Ciencias de la Salud en el año 2009 / Evaluation of lithogenic parameters in urolithiasis patients attending the Instituto de Investigaciones en Ciencias de la Salud in 2009

Los cálculos renales se forman cuando la concentración de los componentes de la orina alcanzan un nivel en el cual es posible la cristalización. Aunque las manifestaciones clínicas de todos los cálculos son similares, los mismos difieren en su composición, patogénesis y tratamiento. El trasfondo metabólico está asociado a la urolitiasis y la evaluación metabólica es fundamental para establecer un tratamiento específico y evitar las recidivas. En este estudio, observacional descriptivo, de corte trasverso sedeterminaron los valores de analitos con potencial litogénico o inhibidor de cristalización, en muestras de sangre y orina de 40 pacientes de ambos sexos con diagnóstico de urolitiasis que concurrieron al Laboratorio de Análisis Clínicos del IICS de junio a octubredel 2009, así como describir las manifestaciones clínicas más frecuentes. El protocolo del estudio fue aprobado por los comités científico y ético del IICS y durante su ejecución serespetaron principios éticos y científicos. Del total de pacientes, 52,5% fueron niños (n=21, edad media 9±4 años) y 47,5% adultos (n=19, edad media 35±17 años). Sedetectaron alteraciones en los valores de parámetros con potencial litogénico en el 48% de los niños y 87% de los adultos litiásicos. La hipocitraturia y la hipercalciuria fueron los desarreglos metabólicos más frecuentes en ambos grupos. Los síntomas más frecuentesreferidos por los pacientes fueron: cólicos, hematuria y fiebre. La mitad de los pacientes presentaron antecedentes familiares de litiasis renal. El 58% de los pacientes adultos estaba excedido de peso. La ingesta de agua fue inferior a 2 litros en 90% y el 47% de niños y adultos respectivamente. Estos hallazgos señalan la importancia de la evaluación metabólica como herramienta para orientar el diagnóstico y tratamiento adecuado.

Kidney stones are formed when concentration of urinary components reach such a level in which crystallization is possible. Although clinical manifestations of all kidney stones are similar, they differ in composition, pathogenesis and treatment. Metabolic background is associated to urolithiasis and metabolic evaluation is essential to establish specific treatment and avoid recurrences. In this cross-sectional observational descriptive study,we determined the levels of analytes with lithogenic or crystallization inhibitor potential in blood and urine samples of 40 patients, male and female, with diagnosis of urolithiasisthat attended the Department of Clinical Analysis of the IICS from June to October, 2009. Additionally, we describe the most frequent clinical manifestations present in these patients. The study protocol was submitted and approved by the IICS scientific and ethic committees. Of the total number of patients, 52.5% were children (n=21, 9±4 years old) and 47.5% adults (n=19, 35±17 years old). Alterations in the values of the potentially lithogenic parameters were detected in 48% of the children and 87% of the adults. The most frequent metabolic abnormalities were hypocitraturia and hypercalciuria in both groups. The most frequent symptoms were colics, hematuria and fever. Half of the patients referred a family history of urolithiasis. Overweight was detected in 58% of the adult patients. Water intake lower than 2 litres per day was referred by 90% of children and 47% of adults respectively. These findings point out the importance of the metabolic evaluation as a tool to orient adequate diagnosis and treatment.

Anticonvulsant property of N-salicyloyltryptamine: evidence of enhance of central GABAergic neurotransmission / Propriedade anticonvulsivante de N-saliciloiltriptamina: proteção significativa com o sistema GABAérgico

AIM: In the present study we verified the anticonvulsant properties of the new tryptamine analogue, N-salicyloyltryptamine (NST), in rodents. METHODS AND RESULTS: In the evaluation of the anticonvulsant activity, NST protected the animals from the incidence of seizures induced by pentylenetetrazole (PTZ) and picrotoxin (PIC), in doses of 100 and 200 mg/kg. NST (100 and 200 mg/kg, i.p.) significantly eliminated the extensor reflex of maximal electric-induced seizure tests in 40 percent of the experimental animals. However, in the PTZ model FLU (10 mg/kg, i.p.), an antagonist of the benzodiazepine (BZD) site in the GABA A-BZD receptor complex, inhibited the prolongation of seizure latency induced by NST. CONCLUSION: Our results demonstrated an anticonvulsant activity of the new analogue that could be, at least in part, associated to the involvement of the GABAergic mechanism.

OBJETIVO: O presente estudo buscou avaliar o possível efeito anticonvulsivante do novo análogo da triptamina, N-saliciloiltriptamina (NST), em roedores. MÉTODOS E RESULTADOS: Na avaliação do efeito anticonvulsivante, os animais tratados com NST (100 e 200 mg/kg, i.p.) foram protegidos de maneira estatisticamente significativa (p<0,05) quanto a latência e incidência do aparecimento das convulsões induzidas pela administração do pentilenotetrazol (PTZ) e da picrotoxina (PIC). O efeito protetor do NST nas convulsões induzidas pelo PTZ foi revertido pela administração do flumazenil (10 mg/kg, i.p.), um antagonista dos receptores GABA-benzodiazepínicos (GABA A-BZD). A administração de NST (100 e 200 mg/kg, i.p.) protegeu de forma estatisticamente significativa (p < 0,05) os animais no teste das convulsões induzidas pelo eletrochoque-auricular em camundongos. CONCLUSÃO: Os resultados do presente estudo sugerem que o efeito anticonvulsivante de NST está associado, pelo menos em parte, ao sistema GABAérgico.

Úlcera de córnea bacteriana: agentes etiológicos, sensibilidad antimicrobiana y tratamiento instituido / Bacterial corneal ulcer: ethiological agents, antimicrobial susceptibility and treatment

La úlcera de córnea bacteriana o queratitis es una condición seria que puede llevar a la pérdida de la visión. La selección del tratamiento se basa en estudios microbiológicos y en el patrón de sensibilidad en un área geográfica determinada. El objetivo de este estudio fue conocer la sensibilidad y la mejor terapia empírica para el tratamiento de pacientes con queratitis bacteriana; de la Cátedra de Oftalmología del Hospital de Clínicas, y cuyas muestras fueron tomadas en el laboratorio de Microbiología del Instituto de Investigaciones en Ciencias de la Salud. Se revisaron las fichas de todos los pacientes con queratitis en cuyos cultivos se aislaron bacterias, desde julio de 2003 a diciembre de 2006. De 175 pacientes con queratitis, se encontró que 73 eran de origen bacteriano, encontrándose más de una bacteria en algunas muestras. De las 87 bacterias,; estafilococos coagulasa negativo (Scn: 27,6%) fueron predominantes, seguido de Staphylococcus aureus (Sau: 11,2%), Streptococcus pneumoniae (Spn: 10,3%), Pseudomonas aeruginosa (Pae: 12,6%) y Acinetobacter sp Ac - 8%). El 100% de los aislados de Scn y Sau, fue sensible a ciprofloxacina y a oxacilina, 89% y 100% a gentamicina, 80% y 88% a tobramicina, respectivamente. Todos los aislados de Spn fueron sensibles a eritromicina, de igual manera todos los aislados de Pae y Ac- a ciprofloxacina y tobramicina; 73% y 100% a gentamicina, respectivamente. El 93% de los pacientes recibió tratamiento empírico de colirio antibiótico reforzado (CAR) de cefazolina 50 mg/ml y gentamicina 16mg/ml; y 7% ciprofloxacina al 0,3%. En esta serie, para las úlceras de córnea debidas a estafilococos y a bacilos gramnegativos no fermentadores, la droga de elección es la ciprofloxacina, y debida a S. pneumoniae, eritromicina. En base a los datos obtenidos se concluye que la combinación de cefazolina y ciprofloxacina es un esquema terapéutico empírico que puede ser recomendado para las queratitis bacterianas.

Bacterial corneal ulcer or keratitis is a serious condition that can lead to visual loss. Treatment selection is based on microbiologic studies and in susceptibility pattern of the especific geographical area. The objective of this study was to determine the susceptibility and best empirical treatment of patients with bacterial keratitis of the Chair of Ophthalmology of the Hospital de Clinicas whose samples were collected in the Microbiology Laboratory of the Instituto de Investigaciones en Ciencias de la Salud. A retrospective review of the medical records of all culture-positive bacterial keratitis seen from July 2003 to December 2006 was performed. Out of 175 patients with keratitis 73 were found to be of bacterial ethiology. Of the 87 bacteria, coagulase-negative staphylococci (Scn: 27.6%) was predominant followed by Staphylococcus aureus (Sau: 11.2%), Streptococcus pneumoniae (Spn: 10.3%), Pseudomonas aeruginosa (Pae: 12.6%) and Acinetobacter sp (Ac- 8%). All Scn and Sau isolates showed susceptibility to ciprofloxacin and oxacillin, 89% and 100% to gentamicin and 80% and 88% to tobramycin, respectively. All Spn isolates were susceptible to eritromicin; all Pae and Ac- isolates were susceptible to ciprofloxacin and tobramycin, 73% and 100% to gentamicin, respectively. Ninety three percent of the patients received an empirical treatment with a reinforced antibiotic eyedrops of cefazolin 50 mg/ml and gentamicine 16mg/ml; and 7% with ciprofloxacine 0.3%. In this series, for the corneal ulcer due to Staphylococcus species and non-fermenting Gram-negative rods, the drug of choice is ciprofloxacin and for S. pneumoniae is eritromicin. Based in the results of this study, it can said that cefazolin and ciprofloxacin combination is an empirical therapeutic scheme that could be recommended for bacterial keratitis.

Queratitis infecciosas: características clínicas y microbiológicas: período 2003-2006 / Infectious keratitis: clinical and microbiological characteristics: 2003-2006 period

Las queratitis infecciosas poseen una elevada morbilidad, poniendo en riesgo la visión sino son tratadas rápida y apropiadamente. El objetivo del presente estudio es evaluar lascaracterísticas clínicas y microbiológicas, el tratamiento implementado y la evoluciónclínic120.A los dos meses del post-tratamiento en pacientes con queratitis infecciosas queconsultaron en el Departamento de Oftalmología del Hospital de Clínicas entre julio de2003 a diciembre de 2006. De 167 pacientes, 74,3% eran varones; la edad media ± DEfue de 40 ± 19 años. Los cultivos fueron positivos en el 71,9% de los casos; aislándosebacterias como único agente etiológico en el 43,7%; exclusivamente hongos 17,4%;hongos y bacterias 10,8%. Entre las bacterias aisladas se encontraron, estafilocococoagulasa-negativa (29%), Pseudomonas aeruginosa (16%), Streptococcus pneumoniae(10,5%) y Staphylococcus aureus (8,1%) y entre los hongos Fusarium sp (57,4%). De154 pacientes, que tenían datos sobre el tratamiento empleado, el 77,8% recibió colirioreforzado de cefazolina 50 mg/ml y gentamicina 16mg/ml; 33,5% fluconazol y 12%ciprofloxacina. Se tuvo información sobre la evolución a los dos meses en 133 pacientes,de los cuales el 82% presentó leucoma, 13,5% recubrimiento conjuntival y 4,5%evisceración. Una mala evolución estuvo asociada al origen micótico y al tamaño grandede la úlcera. La frecuencia de las queratitis infecciosas de origen micótico es alta en estaserie, y relacionada con una peor evolución. El fluconazol es el único antimicóticodisponible en nuestro medio, pero su efecto es principalmente sobre hongos nofilamentosos, por lo tanto se deberían incorporar nuevos esquemas de tratamientoantimicótico, como la natamicina, que podría evitar la pérdida de la visión de numerosos pacientes

Intestinal ischamemia in a child due to polyarteritis nodosa: a case report.

Polyarteritis nodosa (PAN) is a rare type of childhood vasculitis. We report the case of a 10-year-old boy who was referred to our hospital following an appendicectomy with fever, abdominal pain, vomiting, diarrhoea, weight loss, joint pains and skin rash. Shortly after admission, he developed peritonitis, and an emergency laparotomy revealed ischaemia of the jejunum which required partial resection. Histologic examination of the resected bowel showed features consistent with PAN. He was treated with steroids and cyclophosphamide. Nineteen months later, he is asymptomatic and thriving. PAN should be included in the differential diagnosis if a child with constitutional symptoms also has gastrointestinal complaints or develops an acute abdomen.

Animal study of intravascular gene therapy based on polyurethane implantable devices / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the feasibility of utilizing two implantable devices made from modified polyurethane films with antibody tethered replication-defective adenoviruses encoding for green fluorescent protein (AdGFP) as gene delivery platforms.</p><p><b>METHODS</b>Intra-aortic button implants of collagen-coated polyurethane films with antibody tethered AdGFP were sutured into the infrarenal aorta of adult pigs and pulmonary valve leaflet in juvenile sheep was replaced by polyurethane pulmonary valve cusp replacement with antibody-tethered AdGFP. After seven days, the buttons, prosthetic leaflets, and their surrounding tissues were explanted and evaluated for biocompatibility and AdGFP-mediated gene transfer by fluorescent microscopy and PCR analysis.</p><p><b>RESULTS</b>In vivo analysis of gene transfer from collagen-coated polyurethane films in pig infrarenal aorta implants, one week explants of the collagen-coated polyurethane films demonstrated (14.2 +/- 2.5)% of neointimal cells on the surface of the implant. In sheep pulmonary valve leaflet replacement studies, polyurethane films with antibody tethered AdGFP vector demonstrated (25.1 +/- 5.7)% of cells attached to polyurethane valve leaflets were transduced in one week. PCR analyses showed that GFP DNA was not detectable in blood or distal tissues.</p><p><b>CONCLUSION</b>Site-specific intravascular delivery of adenoviral vectors for gene therapy can be achieved with these two kinds of polyurethane implants utilizing the antivector antibody tethering mechanism.</p>

Idiopathic intussusception in infancy and childhood

Idiopathic intussusception is an important cause of abdominal pain, bleeding per rectum and intestinal obstruction in infancy and childhood. This aim of this study was to undertake a retrospective review of all children who presented with idiopathic intussusception over a 17-year period. The medical records of children who presented with idiopathic intussusception from January 1984 through December 2000 at King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia were reviewed. The data obtained included age, sex, clinical presentation, diagnostic investigations, mode of treatment, length of hospital stay and results. Thirty-three children [21 male, 12 female] presented with 37 episodes of intussusception. Their mean age was 8.4 months [range 5 hours to 36 months]. The clinical features included rectal bleeding [81%], vomiting [78%], abdominal colic/pain [65%] and abdominal mass [62%]. All cases were ileocolic intussusception with no leading point. Barium enema was attempted in 36 cases with success in 20 [56%]. Laparotomy was required in 16 cases, manual reduction being successful in 11 [30%] and 6 [16%] had bowel resection. At surgery, after attempted barium reduction, 9 [56%] cases had the intussusception already reduced to the cecum. Seventy% of the cases presented within 24 hours of onset of symptoms. The 4 recurrences in 3 children had successful enema reduction. There was no mortality but 3 operative cases required late surgery for adhesive intestinal obstruction including one requiring bowel resection. Idiopathic intussusception commonly presents as an ileo-colic type but is uncommon in our institution. The clinical features are classical, rectal bleeding being the most common. The majority presented within 24 hours of onset of symptoms and barium enema reduction was successful in 20 out of 36 cases in which it was attempted. Since most intussusceptions were already in the cecum at surgery after failed enema reduction, a repeat or delayed enema reduction could be considered in stable cases. Recurrent intussusception occurred in 3 non-operated cases and adhesive intestinal obstruction in 3 laparotomy cases

Pediatric thoracic trauma

A retrospective analysis of the medical records of children up to 12 years of age inclusive, who sustained thoracic injuries during a 6-year period. Ninety-one children were treated at King Fahad National Guard Hospital, Riyadh from January 1993 through December 1998. The clinical data included age, sex, mechanism of injury, associated injuries, pediatric trauma score, treatment and mortality. Eighty-seven children [96%] had injuries from blunt trauma and 4 from penetrating injuries. Of the blunt trauma cases, 82 children sustained motor vehicle accident related injuries, 62 as pedestrians and 20 as passengers. Penetrating thoracic injuries occurred in 4 children: 1 stab wound and 3 gunshots. The most frequent thoracic injuries were pulmonary contusion [70], pneumothorax [32], fractured rib [20] and fractured clavicle [18]. Extrathoracic injuries included head [45], abdominal [41] and skeletal [26]. Thoracotomy was required in only 1 child, laparotomy being necessary in 9 children for intraabdominal injuries. Tube thoracostomy was required in 33 children. Nine children died from motor vehicle accident related fatal head and neck injuries, 8 as pedestrians all with a pediatric trauma score <= 6. Thoracic injuries in children below 12 years of age are usually from motor vehicle accident related blunt trauma. Pulmonary contusion and pneumothorax are the most common thoracic injuries. Most thoracic injuries can be managed either conservatively or by tube thoracostomy. Thoracic trauma in children is an indicator of multisystem injury with head injury being the most common cause of mortality

The elderly in society: a universal concern

O idoso e suas múltiplas necessidades säo preocupaçöes universais, que sempre estiveram presentes na história da humanidade, ainda que manifestadas de diferentes formas. É apresentada uma avaliaçäo crítica da matéria

experience of modified soave procedure in King Khalid University Hospital

A modification of the original Soave procedure is described in this paper. Eight patients within the age range 6 months to 14 years at the time of presentation were operated upon. Three of those were referred after trial of conservative treatment for constipation to exclude or confirm Hirschsprung's disease; in five, transverse colostomy had already been performed. There was no operative mortality but three patients had postoperative complications; namely anal stenosis and subacute intestinal obstruction