Efficacy of pentamidine-loaded chitosan nanoparticles as a novel drug delivery system for Leishmania tropica

@#The present study compares the in vitro effects of nanoparticles loaded pentamidine drug and conventional pentamidine on Leishmania tropica. Herein, pentamidine-loaded chitosan nanoparticles (PTN-CNPs) have been synthesized through an ionic gelation method with sodium tripolyphosphate (TPP). Next, the physical characteristics of PTN-CNPs were determined through the surface texture, zeta potential, in vitro drug release, drug loading content (DLC), and encapsulation efficacy (EE) and compared its efficacy with free pentamidine (PTN) drug against promastigotes and axenic amastigotes forms of L. tropica in vitro. The PTN-CNPs displayed a spherical shape having a size of 88 nm, an almost negative surface charge (-3.09 mV), EE for PTN entrapment of 86%, and in vitro drug release of 92% after 36 h. In vitro antileishmanial activity of PTN-CNPs and free PTN was performed against Leishmania tropica KWH23 promastigote and axenic amastigote using 3-(4, 5- dimethylthiazol-2-yl)-2, 5-diphenyletetrazolium bromide (MTT) assay. It was observed that the effect of PTN-CNPs and free PTN on both forms of the parasite was dose and time dependent. Free PTN presented low efficacy even at higher dose (40 µg/ml) with 25.6 ± 1.3 and 26.5 ±1.4 mean viability rate of the promastigotes and axenic amastigotes, respectively after 72 hrs incubation. While PTN-CNPs showed strong antileishmanial effects on both forms of parasite with 16 ± 0.4 and 19 ± 0.7 mean viability rate at the same higher concentration (40 µg/ml) after 72 hrs incubation. Half maximal inhibitory concentration (IC50) values of PTN-CNPs toward promastigotes and amastigotes were obtained as 0.1375 µg/ml and 0.1910 µg/ml, respectively. In conclusion, PTN-CNPs effectively inhibited both forms of the L. tropica; however, its effect was more salient on promastigotes. This data indicates that the PTN-CNPs act as a target drug delivery system. However, further research is needed to support its efficacy in animal and human CL.

Is Nitrite Negativity in Urine Analysis an Indicator of Antibiotic Resistance?

Introduction: Studies have reported a correlation between anegative nitrite on urine analysis and resistance tocephalosporin in urine cultured isolate in cases of UTI. Nitritenegativity has therefore been suggested as an aid forphysicians in choosing initial empiric specific antimicrobialtherapy in patients with UTI. Other studies however haveshown contrary results.Study Question: Does whether urinary nitrite test negativityidentify pediatric patients with a higher likelihood of antibioticresistance in bacterial isolates from urines sample cultures.Method: Retrospective chart review of all pediatric patientsfrom birth to 14 years old who received a diagnosis of UTIbased on urine analysis and cultures. We analyzed urineanalysis result, nitrite test result, urine culture and antibioticsensitivity pattern and statistically looked for any correlation ofnitrite negativity on urine analysis with antibiotic resistancepattern of bacterial isolates from urine cultures.Results: No significant statistical difference found betweenantibiotic sensitivity rates of isolates grown from cultures ofnitrite-positive & from nitrite-negative urinary specimens.Conclusions: Physicians should choose initial antimicrobialagent based on knowledge of locally prevalent patterns ofantibiotic resistance, and not on urinary nitrite test results.

Determination of subcarinal angle of trachea using computed tomography

Background: Change in tracheal bifurcation angle (subcarinal angle) is an indirect marker of various cardiac, pulmonary and mediastinal pathologies. Helical computed tomography (CT) allows acquisition of volumetric set of data of the chest and can be used for accurate measurements of subcarinal angle using reconstructed images on a workstation using minimum intensity projection (MinIP).The objective of this study was to estimate normal subcarinal angle (SCA) of trachea by computed tomography and to assess its relationship with gender.Methods: This was an observational study comprising a study cohort of 552 patients comprising of 312 males and 240 females who were subjected to CT chest for various indications in our department. Patients with no underlying cardiac, mediastinal or pulmonary disease were included in the study. Spiral CT scan of chest was performed on 64-slice seimens CT SOMATOM and images were reconstructed with thickness of 1.5mm and the images were viewed in coronal reformatted minimum intensity projection (MinIP) for determination of subcarinal angle using the angle measuring tool provided in the workstationResults: The mean subcarinal angle (SCA) in males was (67.60±14.55). The mean subcarinal angle (SCA) in females was (78.90±11.04). Females had a higher mean SCA compared to males with a statistically significant difference (p-value <0.05).Conclusions: The mean SCA in females was higher compared to males with a statistically significant difference between the two. This study holds practical relevance with regard to the performance of invasive trachea-bronchial procedures like bronchoscopy and tracheal/bronchial intubation.

Spectrum of Magnetic Resonance Imaging Findings in Vertebral Artery Dissection

Introduction: Vertebral artery dissection (VAD) is animportant cause of posterior circulation stroke in youngpatients and presents with a host of clinically varied symptomsdepending upon the type and site of dissection. Currentresearch aimed to study the spectrum of magnetic resonanceimaging findings in vertebral artery dissection.Material and methods: This was an observational studywhere a cohort of 193 patients of posterior circulation strokewere evaluated with magnetic resonance imaging and amongthem 17 patients having vertebral artery dissection wereselected and magnetic resonance imaging findings werestudied using spin echo, diffusion weighted imaging and 3Dtime of flight MR angiography sequences.Results: Of the total 17 patients imaged with age range of23-59 years (mean age 38 years), 11 were males and 6 werefemales. V3 was the commonest site of dissection (n=10)followed by V4 (n=4) and V2 (n=3). The most commonpattern of dissection was steno-occlusive (n=15), whereas2 patients had aneurysmal type of dissection. T1W imagesrevealed intra-arterial thrombus in all the 17 patients. T2Wrevealed absent flow in vertebral artery in 5 patients. 3D TOFMRA revealed narrowed lumen in 10 patients and completeocclusion in 5 patients. One patient revealed intimal flap on3D TOF MRA.Conclusion: MRI is an excellent non-invasive modality forevaluation of posterior circulation stroke. MRI in conjunctionwith MR angiography helps clinch the diagnosis of VAD andthus helps in planning management and subsequent follow upof these patients.

Characteristics of neonatal pneumothorax in Saudi Arabia: three years' experience

Objectives: To identify the incidence, clinical characteristics, predisposing factors, morbidity, and mortality among hospitalized neonates with pneumothorax

Methods: The records of 2 204 infants admitted to the neonatal intensive care unit at King Fahad Medical City, Saudi Arabia, between 2011 and 2014 were reviewed. All newborns hospitalized in the neonatal intensive care unit with pneumothorax were included in the study. Participants were evaluated for baseline characteristics, predisposing factors of neonatal pneumothorax [NP], accompanying disorders, and mortality

Results: Pneumothorax was diagnosed in 86 patients, with an incidence of 3.9%. The most common predisposing factors of NP were bag mask ventilation, followed by hypoplastic lung disease, and mechanical ventilation. Twenty-five [29.1%] newborns with pneumothorax died. The most common accompanying disorder was premature rupture of membrane. On multivariate analysis, pulmonary hemorrhage, a birth weight < 2 500 g, and low Apgar score [< 7] at one minute were independently associated with mortality

Conclusions: This study highlights the extent of NP problems among hospitalized neonates and the most common predisposing factors of NP

Seroprevalence of Anti-Human Metapneumovirus Antibodies in Hospitalized Children in Suleimani City/Iraq.

Background: Human Metapneumovirus (hMPV) is an important respiratory viral pathogen among children, and it is one of the causes of pediatric hospital admissions due to acute respiratory tract infections. Objective: This study was done to predict the seroprevalence of anti-hMPV antibodies among hospitalized children presenting with acute respiratory tract infections in Suleimani Governorate, Kurdistan Region/Iraq. Place and Duration: This study was done at the department of microbiology, school of medicine, suleimani University, between April 2011 and March 2012. Methods: Indirect immunofluorescent assay (IIFA) was performed to detect serum antihMPV antibodies (IgM and IgG antibodies) from three hundred hospitalized children less than 5 years old with acute respiratory tract infections. Results: IgM anti-hMPV antibodies were positive in thirty six (12%) out of three hundred children. The highest seroprevalence was found in the age group <1 year old, while the lowest in the age group 4 to <5 years old. No significant gender difference was found among seropositive children. The IgM anti – hMPV seropositive children were suffering from pneumonia, bronchiolitis, or other less severe acute respiratory tract infections like acute bronchitis and croup in frequencies of sixteen (44%), 10 (28%), and 10 (28%). The IgG anti-hMPV antibodies were positive in two hundred and twenty five (75%) out of the three hundred children, and there was a gradual increase in percentage of seropositivity with increasing age. Conclusion: hMPV is an important viral respiratory pathogen among hospitalized children in Suleimani Governorate/Kurdistan/Iraq, and most of the children had experienced hMPV infection by the age of five years.

Isolation of a rare nocardia wallacei from an HIV-positive patient with pulmonary infection in southern Saudi Arabia

This study aimed to clarify the taxonomic position of an actinomycete isolated from an HIV-positive male patient with pulmonary complications in Asir, southern region of Saudi Arabia. The strain was found to have phenotypic properties typical of nocardiae and 16S rRNA gene analysis clustered the isolate with Nocardia wallacei [accession KC677696] in the phylogenetic branch of the amikacin resistance Nocardia transvalensis complex. We consider that nocardiosis is usually missed or misdiagnosed clinically and recognition of these bacteria based on phenotypic tests is strenuous, but definitive identification is attainable by molecular methods

Multiple myeloma presenting as dysphagia

Plasmacytoma is a discrete solitary mass of neoplastic monoclonal plasma cells in either bone marrow or soft tissue sites. Extramedullary plasmacytoma or multiple myeloma of the larynx is extremely a rare condition. We report a 77-year-old male patient diagnosed with multiple myeloma and presented with dysphagia. The rarity of the disease incidence and difficulty of the diagnosis of this disease is discussed. We present this case to increase the awareness of the Otolaryngologists of this rare disease to expedite its diagnosis and management

Association between neurological and rheumatological manifestations in vitamin D deficiency and vitamin D levels

We aimed to investigate the associations between the neurological manifestations of vitamin D deficiency and bone profile as well as the levels of 25-hydroxyvitamin D. We conducted a case series on patients with vitamin D deficiency who were followed up at King Abdulaziz Medical City, Jeddah between January 2010 and December 2011. We collected patients' demographic data and gathered information on etiological factors for vitamin D deficiency as well as clinical presentations [typical, neurological and rheumatological] and radiological findings. The t-test was used to determine whether there was an association between the neurological manifestations of vitamin D deficiency and vitamin D levels and bone profile. We enrolled 60 patients with vitamin D deficiency. Of these, 44 [73.3%] had neurological presentations, namely progressive muscle weakness and proximal weakness, which was observed more often than distal weakness. In addition, gait disturbances were observed in 61.7% of all patients with neurological and rheumatological presentations. There was no significant association between neurological and rheumatological manifestations and bone profile or vitamin D levels. We found a significant association between difficulty in walking and the levels of serum calcium and phosphate [P = 0.043 and 0.037, respectively]. Neurological and rheumatologic manifestations of vitamin D deficiency are not associated with 25-hydroxyvitamin D levels or bone profile

Normative spirometric values in adult kashmiri population.

Background. Normative values of pulmonary functions of healthy population are affected by different geographic, ethnic, climatic and demographic factors. Objective. Present study was designed to derive normative spirometric values, prediction equations for future reference in adult Kashmiri population. Methods. Pulmonary function testing was carried out on 3080 normal healthy non-smoking individuals (1974 males; age 18-65 years) of Kashmir valley. Multiple regression analysis was used to develop prediction equations for use in this population. Results. Forced vital capacity (FVC, L/s) (4.3±0.8 versus 3.0±0.5; p<0.05), forced expiratory volume in the first second (FEV1, L/s) (3.9±0.7 versus 2.6±0.5; p<0.05) and peak expiratory flow rate (PEFR, L/s) (7.9±1.8 versus 5.3±1.2; p<0.05) were significantly higher in males in comparison with females. All the other parameters except FEV1/PEFR ratio were significantly higher among males (p<0.05). Irrespective of gender, all the parameters declined with increasing age. Females had higher FEV1/PEFR ratio (p<0.05) in age group of 15-30 years. Overall the inter-group difference across the districts studied was not significant. Spirometric parameters manifested an overall negative correlation with increasing body mass index (BMI), although FVC and FEV1 in males with low BMI were high (p<0.05). Conclusion. These prediction equations can be utilised as reference values for future use in adult Kashmiri population.

Inhibition of angiogenic attributes by decursin in endothelial cells and ex vivo rat aortic ring angiogenesis model.

The present study was undertaken to observe the inhibition of angiogenesis by decursin. It was the first time to show that decursin offered strong anti-angiogenic activities under the biologically relevant growth (with serum) conditions. Decursin significantly inhibited human umbilical vein endothelial cell (HUVEC) proliferation concomitant with G1 phase cell cycle arrest. Decursin also inhibited HUVEC-capillary tube formation and invasion/migration in a dose-dependant manner which was associated with the suppression of matrix metalloproteinase (MMP) -2 and -9 activities. Decursin suppressed angiogenesis in ex vivo rat aortic ring angiogenesis model where it significantly inhibited blood capillary-network sprouting from rat aortic sections. Taken together, these findings suggested anti-angiogenic activity of decursin in biologically relevant condition, and warrants further pre-clinical studies for its potential clinical usefulness.

Profile of bacterial pneumonia during Hajj.

Background & objectives The congregation of a large number of people during Hajj seasons from different parts of the world in overcrowded conditions within a confined area for a long period of time presents many public health challenges and health risks. One of the main health problems of the crowding is ease transmission of pneumonia by air droplets. This study was aimed to determine the most common causes of bacterial pneumonia during the 2005 Hajj season and to relate the findings with clinical conditions. Methods A total of 141 patients with suspected pneumonia from the three main tertiary care hospitals in Makkah, Saudi Arabia, were investigated during Hajj season, 2005. Sputum and serum samples were collected and investigated for the possible presence of typical or atypical causative agents. Results Of the 141 clinically suspected pneumonia cases, 76 (53.9%) were confirmed positive by microbiological tests. More than 94 per cent of the confirmed cases were in the age group >50 yr, and 56.6 per cent of the cases were men. The most frequent isolates were Candida albicans (28.7%) and Pseudomonas aeruginosa (21.8%), followed by Legionella pneumophila (14.9%) and Klabsiella pneumoniae (9.2%). More than one causative pathogens were isolated in 15 patients (16.3%), and 55 per cent of patients were diabetic. Interpretation & conclusions Clinicians should be aware that typical pneumonia treatment regimens may not work well during the Hajj season due to the wide variety of isolated organisms. This necessitates taking a sputum sample before starting treatment for identification and sensitivity testing. Special precautions need to be taken for >50 yr old patients.

Hemobilia in a child due to right hepatic artery pseudoaneurysm: multidetector-row computed tomography demonstration

We present a case of a 12-year-old boy who developed upper gastrointestinal bleeding in the form of hematemesis and melena 1 month after blunt trauma to liver. Computed tomography [CT] angiography with multidetector-row CT demonstrated pseudoaneurysm of right hepatic artery related to old liver laceration to be the cause of the bleeding. Pseudoaneurysm was resected using the roadmap provided by CT angiography findings

Pseudotumor cerebri and prolactin secreting pituitary adenoma. Association or coincidence?

The occurrence of pseudotumor cerebri [PTC] and hyperprolactinemia related to a prolactinoma are extremely rare, and the link between these pathologies has not been examined adequately in the post-MRI era. We report a patient with a small intrasellar prolactinoma who also developed PTC. Magnetic resonance venography did not show any evidence of compression of the cavernous or any other sinuses. She initially responded to treatment with acetazolamide and cabergoline. However 9 months later, her PTC symptoms recurred despite a normal serum prolactin level and a mild reduction of the pituitary tumor size on MRI. She improved after a lumboperitoneal shunt. We conclude that the findings in our patient do not support an association between PTC and hyperprolactinemia or prolactinoma. However, the case supports the need for clinicians to consider the diagnosis of PTC when patients with small pituitary lesions exhibit raised intracranial pressure features

Comparison of attitude of primary health care physicians and nurses towards domestic violence against women

Domestic violence [DV] against women has increased during the past few years and became an important public health problem. Personal values and beliefs of primary health care workers can affect both diagnostic and management procedures adopted to deal with battered women. The current study was formulated to compare attitude of physicians and nurses towards DV against women. All physicians and nurses currently working in the primary health care centers in Kuwait [2516] were asked to answer a self-administered questionnaire. Out of them, 1553 completed the questionnaire with an overall response rate of 61.7%. Physicians tended to have a higher positive overall attitude score towards violence against women than nurses [60.75 +13.16% compared with 58.3 +13.82%, P<0.001], with a mean percent score of 75.73 +21.80% compared with 69.7 +21.3% for good reasons to hit women domain. No significant differences were revealed between the two groups for either the relationship between partners domain [42.36 +15.37% compared with 42.9 +15.99%, P=0.679] or the management domain [58.39 +17.11% compared with 58.7 +20.59%, P=0.104]. Relatively low positive attitude scores were recorded by primary care physicians and nurses Yet, physicians tended to have higher scores than nurses. There is a great need to improve attitude of health care workers, especially nurses, about DV against women through properly planned training programs

Computed tomography findings in bilateral perinephric lymphangiomatosis

Perinephric lymphangioma is rare disorder that may be confused with various forms of renal cystic diseases and urinomas. In this disorder a developmental malformation results in failure of developing lymphatic tissue to establish normal communication with the rest of lymphatic system. Once there is restricted drainage of lymphatic fluid the lymphatic channels dilate to form cystic masses that may be unilocular or multilocular and may be seen unilaterally or bilaterally. This condition presents with various signs and symptoms or can be just an incidental finding which in presence of misleading clinical history may be confused with other diseases. CT scan with delayed cuts and USG guided aspiration with biochemical analysis of fluid will help us in arriving to final diagnosis

Genotype and antiretroviral drug resistance of human immunodeficiency virus-1 in Saudi Arabia

To analyze antiretroviral drug resistance and determine the genotype of human immunodeficiency virus [HIV]-l in Saudi patients by sequencing an amplified region of the viral pol gene. This retrospective study analyzed data from plasma samples submitted for genotypic drug sensitivity monitoring. Samples were analyzed at the Special Infectious Agent Unit, King Fahd Medical Research Center of King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia from August 2004 to June 2009. The Viroseq2.5 kit [Celera/Abbott] was used with ABI Prism 3100 sequencer. All patients were Saudi nationals and were on antiretroviral therapy, some experiencing treatment failure. Based on protease region [PR], genotypes of 63 samples were as follows: C:22, G:21, B:9, CRF02_AG:5, D:3, A:l, F:l, and J:l. Based on reverse transcriptase region [RT], genotypes were as follows: C:23, G:24, B:9, CRF02 AG: 2, D:2, A:l, and F:l. Antiretroviral susceptibility testing results were as follows: 52% of the isolates were susceptible to all 3 major classes of antiretroviral drugs used, 41% had mutations known to confer high level resistance to one or more of the nucleoside analogue reverse transcriptase inhibitors, 16% had mutations known to confer high level resistance to non-nucleoside analogues reverse transcriptase inhibitors, 13% had mutations known to confer high level resistance to one or more of the protease inhibitors [PI]. Most isolates were susceptible to 2 or at least one class of antiretroviral, and only 3% of the isolates had resistance to several members of all 3 classes. Antiretroviral resistance is not uncommon in Saudi patients on antiretroviral therapy

Legionella infection; an environmental and clinical study during hajj season

Respiratory system is most commonly affected during Hajj season. [1] to determine the prevalence of Legionella in drinking water, cooling sprinklers and other sources of water consumed in pilgrimage area of the holy city, Makkah; [2] to study the prevalence of pneumonia caused by Legionella species from clinically suspected cases; and [3] to determine whether there is any relationship disease incidence and water supply system. The clinical samples were received from in-patients of the following five Ministry of Health [MOH] Hospitals; Hera General Hospital, Al-Noor Specialist Hospital, King Faisal Hospital, King Abdul-Aziz Hospital, and Ajyad Hospital during Hajj 2003. The patients included in the study were those who fulfilled the following criteria; clinically diagnosed as pneumonia, negative on routine cultures and found negative for acid fast bacilli [AFB] from sputum/bronchial aspirate [BAL]. Serological tests was done by Enzyme linked Immunosorbent assay [ELISA] for Legionella antibodies total lgG and IgM. Out of total 133 patients suspected for Legionella, 83 [62.4%] were male and 50 [37.6%] female. The male versus female ratio was 1:0.6. The major age group affected was between 50-70 years [63.2%]. There were 4 [3.0%] cases of Legionella species isolated from microbiological cultures. The overall seropositive rate among clinically suspected cases was 4.51%. A total of 560 water samples were collected from Arafat, Muzdalifa, Mena, and areas around the Holy Mosque and found negative for Legionella species. Pneumonia was one of the most common illnesses among pilgrims. The water supplied to all areas of the pilgrimage was free from the Legionella and no link has been established among the patients with water supply systems. Both clinicians' awareness and availability of specialized laboratory tests for atypical pneumonia such as Legionella is necessary. Although, all water samples found negative for Legionella but it is recommended to screen all water reservoirs for Legionella annually before Hajj season

Trend of childhood cancers in Iraq after the two gulf wars

This study was conducted to find out the rates of childhood malignancies in Baghdad hospitals, and to study the changes in the trend of these diseases in three periods of time after the first and the second Gulf war. This hospitAl based record study was conducted during the period from February through June 2007 in the two main centers of childhood oncology in Baghdad; Children Welfare Teaching Hospital, and Child's Central Teaching Hospital. All the records of patients [age between 0-15 years and diagnosed as having malignant diseases during the following three periods] were included. The first period includes the years [1990, 1991], the second period [1997, 1998], and the third period includes the years [2004, 2005]. The total sample was 2013 patients; 1172 males and 841 females; 462 patients were diagnosed in the first period, 688 in the second and 863 patients in the third period. The study showed a slight increase in the rate of childhood malignancies over the three periods [3.46, 3.52, and 4.04] /100000/ year respectively. There was an increase in the number of cases in all age groups especially patient's age less than 5 years. The male: female ratio was 1.4:1 with no significant change through the 3 periods. Leukemia was the most common childhood malignancy followed by lymphoma and solid tumors [1202, 421, and 332] patients respectively. The majority of patients live in the middle region of Iraq with the highest frequency from Baghdad. There is an increase in the survival percentage [9.9%, 25.5%, and 32.4%] and decrease in fatality percentage over the three periods [41.3%, 32.4%, and 27.9%] respectively. There is an increase in the rate of childhood cancer in Iraq during the studied period, with no detectable changes in the trend regarding the type, and geographical distribution