Tissue Clock Beyond Time Clock: Endovascular Thrombectomy for Patients With Large Vessel Occlusion Stroke Beyond 24 Hours / 대한뇌졸중학회지

Background@#and Purpose Randomized trials proved the benefits of mechanical thrombectomy (MT) for select patients with large vessel occlusion (LVO) within 24 hours of last-known-well (LKW). Recent data suggest that LVO patients may benefit from MT beyond 24 hours. This study reports the safety and outcomes of MT beyond 24 hours of LKW compared to standard medical therapy (SMT). @*Methods@#This is a retrospective analysis of LVO patients presented to 11 comprehensive stroke centers in the United States beyond 24 hours from LKW between January 2015 and December 2021. We assessed 90-day outcomes using the modified Rankin Scale (mRS). @*Results@#Of 334 patients presented with LVO beyond 24 hours, 64% received MT and 36% received SMT only. Patients who received MT were older (67±15 vs. 64±15 years, P=0.047) and had a higher baseline National Institutes of Health Stroke Scale (NIHSS; 16±7 vs.10±9, P<0.001). Successful recanalization (modified thrombolysis in cerebral infarction score 2b-3) was achieved in 83%, and 5.6% had symptomatic intracranial hemorrhage compared to 2.5% in the SMT group (P=0.19). MT was associated with mRS 0–2 at 90 days (adjusted odds ratio [aOR] 5.73, P=0.026), less mortality (34% vs. 63%, P<0.001), and better discharge NIHSS (P<0.001) compared to SMT in patients with baseline NIHSS ≥6. This treatment benefit remained after matching both groups. Age (aOR 0.94, P<0.001), baseline NIHSS (aOR 0.91, P=0.017), Alberta Stroke Program Early Computed Tomography (ASPECTS) score ≥8 (aOR 3.06, P=0.041), and collaterals scores (aOR 1.41, P=0.027) were associated with 90-day functional independence. @*Conclusion@#In patients with salvageable brain tissue, MT for LVO beyond 24 hours appears to improve outcomes compared to SMT, especially in patients with severe strokes. Patients’ age, ASPECTS, collaterals, and baseline NIHSS score should be considered before discounting MT merely based on LKW.

Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality / 대한뇌졸중학회지

Background@#and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. @*Methods@#We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). @*Results@#There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. @*Conclusions@#During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

Tuberculous meningitis masquerading as acute ischemic stroke in young adult

Tubercular meningitis (TBM) constitute 5% of all cases of extra pulmonary tuberculosis but a presentation leading to an ischemic stroke in a young adult is a rare clinical entity. In a case of TB vasculopathy, vasculitis, venous thrombosis and aneurysm may be the underlying events leading to a stroke. Stroke in TBM is seen in the tubercular zone which encompasses internal capsule, thalamus and caudate nucleus. Inflammatory mediators like TNF alpha, Interferon gamma and vascular endothelial growth factor have been implicated in the pathogenesis of arteritis. Imaging modalities like MRI show lesions which are usually bilateral in the territory of the perforating vessels. We report a case of 24 year old Asian male who presented with complaints of headache, projectile vomiting and altered sensorium. On examination his Glasgow Coma Scale (GCS) was 10/15, with left oculomotor and left facial nerve palsy, and hypotonia of all 4 limbs with bilateral plantar reflexes being mute. Contrast MRI of brain showed acute infarct, meningeal enhancement and basal exudates. He was started on Anti-tubercular therapy and steroids, but had a poor clinical outcome, due to his late presentation.

Investigation of the potential anti-influenza activity of five plants grown in Sudan and used folklorically for respiratory infections

Respiratory tract infections caused by influenza viruses have challenged clinicians due to shortages of ideal antiviraltherapy or rapid development of resistance to available drugs. The development of new medications, especially fromnatural sources, is particularly important to combat the highly mutagenic influenza virus. This study was conducted totest the activity of some medicinal plants used traditionally in Sudan for the treatment of respiratory tract infectionsand other various diseases. Balanites aegyptiaca, Cordia africana, Aristolochia bracteolata, Boscia senegalensis, andLeptadenia arborea were extracted by water and methanol and tested against influenza virus strain A/WSN/33(H1N1)using zanamivir as a standard. The effective concentrations for methanol and water extracts were found in the rangesof 0.25–20 mg/ml and 10–35 mg/ml, respectively. The toxicities of all extracts were evaluated against Madin–Darbycanine kidney cells, and the cytotoxic concentration for all extracts was 80 mg/ml. Plants’ extracts at a concentrationof 2.5–20 mg/ml prevented hemagglutinin-assisted viral adsorption to RBCs using hemagglutination inhibitionassay. The proven anti-influenza activity of the tested plants could explain their folkloric use. It would be valuableto standardize the plants’ extracts and conduct in vivo studies so as to develop a safe and effective herbal formula forinfluenza.

Green Combustion Synthesis of CeO2 and TiO2 Nanoparticles Doped with Same Oxide Materials of ZrO2: Investigation of in vitro Assay with Antibiotic Resistant Bacterium (ARB) and Anticancer Effect

This article reports the synthesis, characteristics and biomedical applications of CeO2-ZrO2 and TiO2-ZrO2 nanoparticles. The nanoparticles are synthesized by Green combustion method. Aloe Vera, dates and pomegranate extracts are used as mediators to avoid toxicity instead of chemical reagents. Hence it is biocompatible, non-toxic and avoiding adverse effect in biomedical applications. The nanoparticles are characterized by XRD to confirm the physical structure. The FTIR, Raman and SEM with EDAX analyses the chemical composition and their morphology. The antibacterial activity of these nanoparticles is assayed by well diffusion method against the bacterial pathogens of Stephylococcusaureus, Shigillaflexneri and Bacillus sp. The anticancer effect of the nanoparticles is investigated on A549 cell line by In Vitro assay. The conceivable purpose is the hydroxyl radicals which are easily produced by oxidizing more hydroxide ions in alkaline solution. Thus the competence of the development is rationally improved at pH is 9.

Evaluation of Loop Mediated Isothermal Amplification (LAMP) for Diagnosis of Plasmodium falciparum in Wad Medani City, Gezira State, Sudan

Plasmodium falciparumconsidered as the most serious form of species causes malaria compared with other species. Diagnosis of falciparummalaria in Sudan remain a major problem, the laboratory diagnosis depends solely on microscopy and RDTs. Loop mediated isothermal Original Research Article amplification (LAMP) assay is a molecular technique done in isothermal temperature using simple, inexpensive instruments for detection of falciparummalaria. The aim of the study is to evaluate the diagnostic performance of loop mediated isothermal amplification (LAMP) assay for detection ofP. falciparumand compare with microscopic detection. A cross sectional hospital based study conducted on 220 blood samples collected from participants suspected to have falciparum malaria attending Wad Medani Teaching Hospitalsand 26 healthy participants during the period November 2018 to January 2019. Thick blood films were done and used for P. falciparum detection. The extracted DNA by TE buffer was amplified by LAMP assay targeting 18S rRNA gene. Data were analyzed using Medical calculator (MedCalc) programs (V. 16). The results showed that the sensitivity, specificity, positive predictive value, negative predictive values were 99.1%, 84.6%, 53.2%, 99.8% respectively. Validation of LAMP diagnostic performance revealed that area under the curve is 0.919, while Weighted Kappa is 0.866. The study concluded that the LAMP assay had the identical diagnostic performance compared with microscopy in diagnosis of Plasmodium falciparum malaria. This gives a relative effortlessness application of LAMP assay in Sudan after availing the required logistics

Efficacy of thrombolytic therapy with IV streptokinase in acute ST elevation myocardial infarction patients

Background: Acute Myocardial Infarction is one of the leading causes of mortality and morbidity. Now there are a number of drugs for Thrombolysis but still Streptokinase is used in many of the centers because of the ease of availability and less cost. ST segment elevation resolution following thrombolysis is simple, non-invasive, accessible tool for the assessment of coronary reperfusion. Objective of the present study was to assess the efficacy of thrombolysis in Acute STEMI patients, with respect to resolution of ST-elevation on treatment with streptokinase and also to predict short term outcome during hospital stay in terms of adverse events and mortality.Methods: 60 Acute STEMI patients who had received thrombolytic therapy with streptokinase were studied in three groups namely Category A, Category B and Category C based on ST segment resolution after administration of thrombolytic therapy.Results: Of 60 patients, 9 patients (15%) had <30% ST resolution (no STR), 26 patients (43.3%) had 30-70% ST resolution (partial STR), 25 patients (41.7%) had >70% ST resolution (complete STR).Conclusions: In the present study we conclude that the efficacy of IV streptokinase for thrombolysis in acute STEMI is 41.7%. Patients with no resolution of ST segment 90 minutes following thrombolysis associated with more frequent adverse events and increased mortality compare to partial and complete resolution group.

Height is a risk factor for development of peripheral insensate neuropathy

Background: Peripheral insensate neuropathy is one of the most common and forms of peripheral neuropathy. It is a preeminent cause for disability, foot ulcers, deformity and amputations in individuals who are at risk.Methods: A study was conducted in Mahatma Gandhi Medical College & Research Institute, Pondicherry, India in the year 2017-18, which included examination of 760 people of more than 30 years of age by random sampling method who was attending the outpatient clinic. The Semmes Weinstein monofilament was adopted to ascertain the presence of peripheral insensate neuropathy.Results: In present study, the prevalence of peripheral insensate neuropathy was 3.2%. As the height increased, the prevalence of peripheral insensate neuropathy increased, regardless of other independent risk factors like diabetes, hypertension, etc. The risk of the peripheral insensate neuropathy increases at a height of >171.5cm in males and at a height of >164.5cm in females.Conclusions: The authors confirm that body height is a significant and independent risk factor for peripheral insensate neuropathy, regardless of co-morbidities. Height as a guide, helps the health care professionals in identifying the people who are at risk for peripheral insensate neuropathy.

Trastorno delirante y conducta suicida: estudio descriptivo de 26 casos / Delusional disorder and suicidal behavior: descriptive study of 26 cases

Resumen Introducción/antecedentes: La conducta suicida en el trastorno delirante (TD) ha sido escasamente estudiada. Objetivo: Profundizar en el conocimiento de las características demográficas, ambientales, psicosociales y clínicas del suicido en un grupo de pacientes con TD con la finalidad de contribuir a generar y sugerir estrategias que contribuyan a realizar nuevos estudios de mayor nivel explicativo. Método: Estudio epidemiológico descriptivo retrospectivo de Registro de Casos en el Dispensario de Psiquiatría e Higiene Mental de Córdoba sobre pacientes con TD según criterios DSM-IV-TR. Aquellos pacientes que cumplieron con los criterios de inclusión definidos constituyeron nuestra muestra final de 261 casos, de ellos 26 casos presentaron evidencias de intento de suicidio. Las variables sobre las que se recogió información en base a protocolos, fueron agrupadas con el orden siguiente: I. Sociodemográficos y generales. II. Factores de riesgo del TD (familiares y personales). III. Cuadro Clínico y el Diagnóstico del TD (Presentación, Sintomatología, Funcionalidad y Discapacidad, utilización de los recursos sanitarios, tratamiento, problemas psicosociales, evolución y curso) y medios letales utilizados. Resultados: La edad media de los pacientes fue de 47 años y el 60% fueron hombres. Los datos sociodemográficos muestran que los pacientes con intento de suicidio residían en núcleos rurales (46,2%), no tenían estudios en un 15,4%, un 57,7% no trabajaba y un 26,9% recibía una pensión por enfermedad o jubilación laboral. El subtipo persecutorio con 8 casos, fue el más frecuente, seguido de los subtipos de grandiosidad (6 casos) y celotípico (6 casos), mixto (3 casos), erotomaniaco (2 casos) y somático (1 casos). Discusión y Conclusión: Son necesarios futuros estudios prospectivos para investigar los factores de protección, de riesgo y/o asociados al suicidio en el TD.

Introduction/Background: Suicidal behavior in delusional disorder (DD) patients has been poorly studied. Objective: Investigate the demographic, environmental, psychosocial and clinical characteristics of the suicidal behavior in a group of patients with DD. Method: Retrospective descriptive study of DD cases registered at Psychiatry and Mental Hygiene Clinic of Cordoba according to DSM-IV criteria was conducted. We obtained a sample of 261 DD patients who met the inclusion criteria, of them 26 cases presented evidence of suicidal behavior. Data and variables collected were divided into 4 groups: I. Socio-demographic and general data. II. DD risk factors (personal and family). III. DD clinical picture and diagnosis (presentation, symptoms, disability, use of health care resources, treatment, and evolution) and lethal methods used. Results: The mean age of the patients was 47 years old and 60% were males. Socio-demographic data show that 46.2% of patients with suicidal behavior lived in rural areas, only 15,4% were analphabet, 57,7% were unemployed, and 26.9% were receiving a pension because of illness or retirement. The persecutory subtype with 8 cases was the most frequent presentation, followed by grandiose (6 cases) and jealous (6 cases), mixed (3 cases), erotomanic (2 cases) and somatic (1 case) subtypes. Discussion and conclusion: It is necessary to conduct future prospective studies to investigate the protective and risks factors associated with the suicidal behavior in DD patients.

Effect of Double Straight Leg Raise Exercise Training on Abdominal Fat of Adolescent Population – An Interventional Study from Madurai, India

Background:Central/abdominal obesity is associated with metabolic and vascular complications than whole body obesity. High intensity exercises were generally proven to reduce total body fat as well as regional fat. Conflicting results were observed with the effects of specific abdominal exercises on abdominal fat. Hence the present study was done to find out the sole effect of double straight leg raise exercise on abdominal fat before and after 6 weeks of training and to compare with that of the control group. Methods: A total of 40 obese students of a private medical college were recruited for the study and divided into control (n=20) and leg raising group (n=20).The study was conducted for 5 days a week for 6 weeks during September to October 2017. Body Mass Index (BMI), Waist Hip Ratio (WHR) and Abdominal Subcutaneous fat using ultrasound was measured. Results: Paired and unpaired t test was used for statistical analysis. A significant decrease in BMI and Abdominal subcutaneous fat( p value < 0.001, < 0.017)was observed in the leg raising group with no significant change in WHR( p value<0.968). Control group showed no significant change in BMI& WHP ( p value < 0.199, < 0.072) except for increase(( p value < 0.035) in abdominal subcutaneous fat. Conclusion: Leg raising exercises help to reduce abdominal subcutaneous fat &Body weight but not the abdominal girth and if practiced along with other types of abdominal exercises may yield better results.

Anatomical Features Of Bones And Bony Cavities Of The Ostrich Skull (struthio Camelus)

Background: The morphology of ostrich skeleton was meager rather than fowl for which already a lot of literatureis available. This work attempts to present different views of skull bones of ostrich.Materials and Methods: The present research was carried out on ten heads of adult ostriches. The obtainedheads were collected from different ostrich slaughtered houses at Alexandria. The preparations of bones wereperformed by maceration technique. Two head was radiographed at Surgery Department, Faculty of VeterinaryMedicine, Zagazig University.Results: Ostrich skull consists of two parts; neurocranium and splanchnocranium which are separated by twolarge orbital cavities. Neurocranium is composed of single bones (occipital, sphenoid, ethmoidal) and paired(temporal, parietal and frontal) bones. The splanchnocranium consists of single bones (mandible, vomer andhyoid bones) and paired (quadrate, lacrimal, nasal bone, premaxilla, maxilla, Zygomatic (jugal), palatine boneand pterygoid) bones.Conclusion: A significant result was obtained in this work that, there are variations in shape and components ofostrich skull bones in comparison with other birds. The similarity to small domestic birds was almost near toduck and geese rather than fowl and pigeon skulls. Also, there are some variations with large birds like an emu.

Antidiabetic and antioxidant activity of ethyl acetate extract fraction of Moringa oleifera leaves in streptozotocin-induced diabetes rats via inhibition of inflammatory mediators

Objective: To evaluate the antioxidant and antidiabetic mechanism(s) of ethyl acetate extract fraction of Moringa oleifera (M. oleifera) leaves on streptozotocin-induced diabetes in male Sprague-Dawley rats. Methods: A total of 24 adult male rats were segregated randomly into four groups (6 rats each group). Streptozotocin-induced diabetes rats were given (oral gavage) ethyl acetate extract fraction of M. oleifera (200 mg/kg b.w.) for 30 d. The rats of control and experimental groups were sacrificed after 24 hours of final dose of treatment, to extract blood and pancreatic tissue for biochemical and histopathological analysis. Results: The ethyl acetate extract fraction of M. oleifera significantly reversed (P<0.05) the manifestation of streptozotocin on the levels of serum glucose & insulin, lipid profile, hepatic damage markers (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and lactate dehydrogenase),malondialdehyde formation, antioxidants (glutathione, Vitamin C & Vitamin E), antioxidant enzymes (superoxide dismutase, glutathione S-transferase, glutathione peroxidase and catalase) and pro-inflammatory cytokines (IL-1β, TNF-α& IL-6). Histopathological analysis of pancreatic tissues was in concurrence with the biochemical results. Conclusions: These findings support that M. oleifera leaves have potent therapeutic effect on diabetes mellitus via increasing antioxidant levels and inhibition of pro-inflammatory mediators.

Obesity may be erythropoietin dose-saving in hemodialysis patients

BACKGROUND: In dialysis patients, the obesity-survival paradox still requires an explanation. Anemia and high doses of erythropoiesis-stimulating agents (ESAs) are associated with worse outcomes in the hemodialysis (HD) population. In the present study, we explored the relation between obesity and anemia control in a sample of maintenance HD patients in Egypt. METHODS: This multicenter observational study included 733 patients on maintenance HD from 9 hemodialysis centers in Egypt. Clinical and laboratory data as well as average doses of ESAs and parenteral iron were recorded. The erythropoietin resistance index (ERI) was calculated. RESULTS: Obesity, defined as a body mass index (BMI) ≥ 30 kg/m2, was present in 22.6% of the studied population. The target hemoglobin level (10.0–11.5 g/dL) was achieved in 27.3% of non-obese and 25.3% of obese patients, with no significant difference. The median serum ferritin and the values of transferrin saturation index did not differ significantly between these two groups. The weekly ESA dose was significantly lower in obese than in non-obese patients (P = 0.0001). A trend toward higher ESA doses and ERI values was observed in patients with lower BMIs (P < 0.0001). Multiple linear regression revealed that the BMI and urea reduction ratio were the strongest predictors of the ERI. CONCLUSION: Our study adds more evidence to obesity-associated advantages in HD patients. BMI may determine ESA response, with better responses observed in patients with higher BMIs.

Impact of kangaroo position on serum nitric oxide in preterm infants

Background: Kangaroo mother care is a standardized protocol-based care for preterm and low birth weight infants. The core feature is early positioning of the infant, prone and upright on the mother or father's chest to maximize skin to skin proximity. Kangaroo mother care [KMC] is a safe and effective method of caring for low birth weight infants and is promoted for its potential to improve newborn survival

The aim of this study was to investigate serum nitric oxide [NO] in stable preterm infants before and after 60 min kangaroo position and to find out a relation between serum NO and neonatal temperature during that position

Results: showed a statistically significant increase in body temperature, peripheral oxygen saturation and mean arterial blood pressure immediately after 60 min of KMC compared to the results before this maneuver. There was significant increase in NO immediately after 60 minutes KMC

Conclusion: Kangaroo position could increase body temperature through NO dependent mechanisms. KMC is effective in improving all vital signs especially Temperature in preterm infants avoiding the harmful consequences of hypothermia in those infants

Relationship between diabetic retinopathy and methylenetetrahydrofolate reductase gene polymorphism

Purpose: To assess MTHFR rs 1801133 [C677T] gene polymorphism in diabetic patients as a risk factor for diabetic retinopathy and to establish the changes in Platelet indices and count in diabetic patient as compared to the healthy control group

Patients and Methods: The study included 40 patients with Type 2 Diabetes Mellitus. They were divided into 2 equal groups, 20 patients with Diabetic Retinopathy, 20 patients without Diabetic Retinopathy. Patients were selected from those attending the outpatient Ophthalmology Unit and Diabetes Clinic of Al-Zahraa University Hospital in the period from June 2014 to June 2015. Their ages ranged between 34 to 66 years old

They were 14 males and 26 females. Twenty cases apparently healthy individuals were selected as a control group. All cases were subjected to full history taking and complete ophthalmological examination. Also laboratory investigations were done including complete blood picture, kidney and liver function tests, coagulation profile, urine analysis, lipid profile, fasting and postprandial blood sugar and Genetic study for detection of MTHFR gene C677T mutation [rs 1801133] by real time PCR

Results: In all diabetic patients the mutant homozygous TT showed a highly statistically significant increase in FBS [p=0.000], PPBS [p=0.000], HbAlC [p=0.000] and cholesterol [p=0.001] as compared to wild type. Also in all diabetic patients the mutant homozygous TT showed a highly statistically significant increase in FBS [p=0.002], PPBS [p=0.001], HbAlC [p=0.019] and cholesterol [p=0.012] as compared to heterozygous mutant type

Conclusion: The homozygous mutant type [TT] of rs!801133 was detected in 10% of DR patients group while absent in DWR group and the control group. The heterozygous mutant type [CT] was increased in DR group [50%] as compared to DWR group [35%] and the control group [25%]

Synthesis, biological evaluation and docking analysis of some novel quinazolin derivatives as antitumor agents

Different acid chlorides [2a-d] reacted with anthranilic acid to produce 2-substituted-3, 1-benzoxazin-4-one [3a-d] which was used as starting material to synthesize some condensed and non-condensed heterocyclic compounds by reaction with nitrogen nucleophiles e.g., hydrazine hydrate, and formamide. Some of the newly synthesized analogues were chosen to evaluate their cytotoxic activity against human liver carcinoma cell lines [HePG2- MCF7- A549]. The docking and the cytotoxic activity results revealed that nearly all of the compounds containing N-phenyl aniline showed signifcant inhibition for the three cell lines

Epidemiological evaluation and outcome of pure abdominal trauma victims who underwent surgical exploratory laparotomy

Objective: The aim of this study was to evaluate the epidemiological profile, surgical treatment, andoutcome of patients suffering from pure abdominal injuries who underwent exploratory laparotomy in the emergency department of Aswan University Hospital, Egypt

Patients and methods: This was an evaluation and assessment of observational and descriptive study with prospective approach through interviews of 80 patients with pure abdominal trauma who were subjected to surgical treatment in the form of exploratory laparotomy and evaluation of their medical records

Results: The most affected individuals were male patients younger than 49 years, most of them withlow educational level and single. There was a predominance of trauma in the rural areasthat mostly occurred at night time and evening. Blunt trauma was the most common type of abdominal trauma, and road traffic accidents were the most frequent mechanism of trauma.The upper abdomen was the most affected region. Pain was the most common presenting symptom, and the spleen was the most affected organ. The hospital stay ranged from 1 to11 days. Most patients were discharged with permanent sequelae; there were six deaths

Conclusion: Blunt trauma was the most common type of abdominal injury. Road traffic accidents were themost common mechanism of blunt trauma, and stab wounds were the most common type of penetrating injuries. A number of risk factors were identified in this study, which include the type of abdominal trauma, presence of chronic diseases, delay in early transport from the siteof trauma to the emergency department, and age of patient. Despite the magnitude of traumas,the outcome was satisfactory

Evaluation of primary repair of common bile duct in common bile duct stones

Background: Despite advancements in gallbladder surgery with the introduction of endoscopic and laparoscopic techniques, many surgeons, especially in the developing world, still perform open cholecystectomy with common bile duct [CBD] exploration for choledocholithiasis

Aim of the study: The purpose of the study was to report the outcomes of open CBD exploration without theuse of Tetubes

Materials and methods: A prospective study of open CBD exploration and primary closure was performed without Tetube drainage. Preoperative investigations, the surgical techniques, and perioperative outcomes were recorded

Results: Fifty patients had CBD exploration. In 45 patients this was performed by means of asupraduodenal choledochotomy, and in five of these patients free passage into the duodenum could not be achieved using catheters, irrigation, and dilators. These were completed with acholedochoduodenostomy

Conclusion: In a limited resource setting, there is still a role for open CBD exploration and primary closure without the necessity of Tetubes and stents as evidenced by a good perioperative patient outcome

Association between albuminuria and abnormal cardiac findings in patients with type 2 diabetic nephropathy: role of urine albumin excretion

Background: diabetic patients have higher morbidity and mortality rates from cardiovascular diseases compared with non-diabetic background population and this is distinct particularly in the patients with high Urinary Albumin Excretion [UAE]. The main aims of our study were to detect abnormal cardiac Jindings in patients with type 2 diabetic nephropathy and its relatioe to increased levels of UAE

Methods: our descriptive; cross sectional study consisted of 105 diabetic patients with documented diabetic nephropathy who attended diabetic out-patient clinic of internal medicine department, Assiut University Hospital, where routine investigation, glycated hemoglobin[HbA1c], 24-hour UAE and Trans-Thoracic Echocardiography [TTE] was done for all patients

Results: We evaluated 105 patients with type 2 diabetic nephropathy [56 males and 49 females] where patients were divided into two groups; group I included those with microalbuminuria [39%] [Age: 54.3 +/- 14.4y[mean +/- standard deviation]] years and group I1 included those with macroalbuminuria [61%] [Age: 59.7 +/- 7.9 y]. In comparison between two groups we found that there were significant relationship between the degree of albuminuria, occurrence of left Ventricular Hypertrophy [LVH] and Segmental Fall Motion Abnormality [SWMA] with [P < 0.001 and P=0.032] respectively

Conclusion: our data indicate a possible link between abnormal cardiac findings and progression of diabetic nephropathy. Data also suggest that assessment of cardiac morbidity by echocardiography in patients with diabetic nephropathy may be mandatory for early preventive strategies

Amelioration of insulin resistance in rats treated with rice bran oil

Background: insulin resistance [IR] is a pathological condition characterized by inadequate peripheral tissue metabolic response to circulating insulin. It plays pathophysiological role in type 2 diabetes mellitus [T2DM]. High dosage of fructose in the diet [60 g/100 g diet] may induce insulin resistance accompanied by deleterious metabolic consequences including hyperglycemia and hyperinsulinemia. Rice bran oil [RBO], is a rich source of antioxidants especially gamma-oryzanol, alpha-tocopherols and tocotrienols which contribute to high oxidative stability, longer shelf life than other edible oils and high antioxidant property against free radicals. The present work was undertaken to study if the addition of rice bran oil in rat's diets ameliorate the insulin resistance

Materials and methods: to achieve this target, plasma fasting glucose, serum insulin and calculated HOMA-IR, which assesse the presence of insulin resistance, was evaluated. Serum lipid profile [cholesterol, triglycerides, high-density lipoprotein- cholesterol [HDL] and low-density lipoprotein- cholesterol [LDL] was also evaluated. In addition, the oxidative stress was assessed through hepatic malondialdehyd [MDA] as an oxidative biomarker and the antioxidant enzyme superoxide dismutase [SOD] was also estimated

Results: RBO ameliorated HOMA-IR, oxidative biomarker [MDA] and increased SOD activity

Conclusion: high fructose diet induced oxidative stress which lead to insulin resistance, this was ameliorated by addition of RBO