Changes in blood and urine parameters among pregnant women during third trimester

Background: During pregnancy, the pregnant lady undergoes significant anatomical and physiological changes in order to nurture and accommodate the developing fetus. These changes begin after conception and affect every organ system in the body.Methods: The study was carried out in the United Arab Emirates - Ajman (Thumbay Hospital) during the period of (March - Jun) in the year of 2018 to estimate HbA1c% levels, hematological blood parameters and urine culture in healthy pregnant women during 3rd trimester. The study was conducted on (108) healthy pregnant women during3rd trimester. Urine culture was performed to detect the growth of bacteria after the culture, gram stain was done to differentiate the bacteria followed by biochemical test to detect the type of bacteria.Results: A total 26 (79%) of patients had normal HbA1c% result while 7(21%) had elevated HbA1c% result. The results of HbA1c% in last trimester mean±SD (range) HbA1c% (n=33) were 5.5±0.52% (111.5±14.8 mg/dL). Also, our results showed strong positive correlation between HbA1% with estimated Average blood glucose (r=0.78, P value=0.00), and weak positive correlation between HbA1 with age (years) (r=0.2, P value=0.02). Bacterial culture showed that two positive results of stenotrophomonas maltophilia was isolated, three cases of Staphylococcus aureus was isolated and three cases of staphylococcus saprophyticus. Hematological profile showed a clinically significant (≤ 0.05) in Hb mean 11.47, P value 0.001, HCT mean, 33.9 P value 0.001 and MCV mean 73.7 value 0.001. No clinically significant (≥ 0.05) in RBCs mean 3.93, P value 0.010, MCH mean 27.3 P value 0.061 and MCHC mean 30.9 P value 0.134.Conclusions: Our study conclude that estimation of HbA1c%, hematological blood parameters and urine culture level in last trimester will be helpful in diagnosis, monitoring and predicting fetal distress.

Psycho-social factors affecting antenatal care services utilization at the Ministry of Health’s primary health care centers in Jeddah, Kingdom of Saudi Arabia, 2017-2018: an analytical cross-sectional study

Background: This study aimed to explore the psychosocial factors affecting the utilization of antenatal care (ANC) services.Methods: This was an analytical cross-sectional study carried-out in the 4 main MOH maternity hospitals in Jeddah. The study sample included 2 groups: 80 women with inadequate ANC attendance and 159 with adequate ANC attendance. We applied probability proportional to size sampling technique. The outcome of this study was ANC attendance (adequate or inadequate). Independent variables included: age, nationality, educational level, occupation, monthly income, the dependent variables included: the number of ANC visits.Results: The utilization findings of this study revealed that 88 women out of 239 women had not fully used the health services provided to them (underutilization) and the utilization rate was 66.5%. Approximately one-half of the women with inadequate ANC had birth intervals of less than 2 years. Three-quarters of them reported that they did not plan their current pregnancies, and nearly two-thirds of them had high levels of stress. Logistic regression analysis indicated that inadequate ANC attendance was predicted by past negative experiences related to ANC attendance (p=0.001) (OR=0.183 CI=0.065-0.513).Conclusions: The most significant identified barriers to utilization of ANC services were high stress, previous negative ANC experience, unplanned pregnancy, and short birth intervals. Furthermore, women who had adequate ANC visits were more likely to have planned pregnancies and be aware of available ANC services.

Evaluation of Antidiabetic Potentiality of Truffles and Balanites Aegyptiaca among Streptozotocin Induced Diabetic Rats

The potential application of Truffle (Terfeziaceae) and Desert Date tree (Balanites aegyptiaca) for modulating the diabetesmellitus related symptoms has gained much interest. However, less firm evidence has come from data to increase theunderstanding of the mechanism by which Truffle and Balanites protect pancreatic β-cells. The present study aimed toevaluate the effect of methanolic extract of Truffle and Balanites aegyptiaca on the fasting blood glucose (FBG) level; thechanges in pancreatic histology as well as the changes in iNOS and IL-1β genes expression level among STZ induceddiabetic rats which might help in better clarification of possible mechanisms beside the beneficial effects of the studiedplants on diabetes. The elevation of the FBG level, pathological pancreatic changes and the level of both IL-1β and iNOSgene expressions in diabetic rats were observed in comparison with negative control rats. This increase was declinedsignificantly due to the administration of Truffle and Balanites extracts. All of the studied parameters did not completelyreverse to the normal levels as compared with negative control rats. The obtained results concluded that the beneficial effectof Truffle and Balanites aegyptiaca on STZ-induced diabetes was at least partly due to the reduction of IL-1β and iNOS geneover the expression which can have a protective effect on β cell.

Microscopic characterization and HPTLC of the leaves, stems and roots of Fadogia agrestis - an African folk medicinal plant

ABSTRACT Fadogia agrestis Schweinf. ex Hiern (Vangueria agrestis (Schweinf. ex Hiern) Lantz), Rubiaceae, is an African traditional medicinal plant also used as a dietary supplement in the US. The present paper is the first report of the pharmacognostic study of the leaf, stem and root of F. agrestis by microscopy, HPTLC and total phenolic/flavonoid content analyses. Noteworthy microscopic features that can help in identification and quality control are septate and lignified non-glandular trichomes on leaf and stem epidermises, paracytic stomata on leaf abaxial epidermis, numerous cells containing yellow substances of presumably phenolic compounds in leaf and stem, calcium oxalate druses and prismatic crystals in leaf and styloids in stem, primary phloem fibers in stem, brachysclereids in stem and root, spherical starch grains in root, and vessels with vestured pits and simple perforated end walls. In addition to microscopy, a total phenolic/flavonoid content determination and an HPTLC method were also developed for rapid chemical fingerprint analyses of Fadogia samples and dietary supplements.

Ketamine as an adjunct to bupivacaine in infra-orbital nerve block analgesia after cleft lip repair / Cetamina como adjuvante de bupivacaína em bloqueio do nervo infraorbitário para analgesia após correção de lábio leporino

Abstract Objectives: We conducted this study to investigate the safety and analgesic efficacy of the addition of Ketamine to Bupivacaine in bilateral extra-oral infra-orbital nerve block in children undergoing cleft lip surgeries. Methods: Sixty patients were randomly allocated into two groups (n = 30), Group B received infra-orbital nerve block with 2 mL of 0.25% Bupivacaine and Group BK received 0.5 mg.kg-1 Ketamine for each side added to 1 mL of 0.5% Bupivacaine solution diluted up to 2 mL solution to 0.25% Bupivacaine concentration. Assessment parameters included; hemodynamics, recovery time, time to first oral intake, postoperative Faces Legs Activity Cry Consolability (FLACC) scores, Four-point Agitation scores, analgesic consumption and adverse effects. Results: Patients in Group BK showed lower postoperative FLACC scores during all recorded time points (p < 0.0001). Two patients in Group BK versus 12 in Group B requested for postoperative rescue analgesia (p < 0.001). There were no differences between groups in time, minutes (min), to first request for rescue analgesia. Patients in Group BK reported lower analgesic consumption (366.67 ± 45.67 vs. 240.0 ± 0.0 mg, p < 0.04). The time to first oral intake was significantly reduced in Group BK (87.67 ± 15.41 vs. 27.33 ± 8.68 min, p < 0.001). Lower postoperative Agitation scores were recorded in Group BK patients that reached a statistical significance at 45 min (0.86 ± 0.11 vs. 0.46 ± 0.16, p < 0.04) and in the first hour (h) postoperatively (1.40 ± 0.17 vs. 0.67 ± 0.14, p < 0.003). Higher parent satisfaction scores were recorded in Group BK (p < 0.04) without significant adverse effects. Conclusions: The addition of Ketamine to Bupivacaine has accentuated the analgesic efficacy of infra-orbital nerve block in children undergoing cleft lip repair surgeries.

Resumo Objetivos: Realizamos este estudo para avaliar a segurança e eficácia da analgesia com a adição de cetamina à bupivacaína em bloqueio do nervo infraorbitário, bilateral e extraoral, em crianças submetidas à cirurgia de lábio leporino. Métodos: Foram randomicamente alocados 60 pacientes em dois grupos (n = 30): o Grupo B recebeu bloqueio do nervo infraorbitário com bupivacaína a 0,25% (2 mL) e o Grupo BC recebeu bloqueio com cetamina (0,5 mg.kg-1) em cada lado, mais a adição de 1 mL de solução de bupivacaína a 0,5% diluída até 2 mL da concentração a 0,25%. Os parâmetros de avaliação incluíram: hemodinâmica, tempo de recuperação, tempo até a primeira ingestão oral, escores da escala FLACC (que avalia a expressão facial [Face], os movimentos das pernas [Legs], a atividade [Activity], o choro [Cry] e a consolabilidade [Consolability]), escores de agitação em escala de quatro pontos, consumo de analgésicos e efeitos adversos no pós-operatório. Resultados: Os pacientes do Grupo BC apresentaram escores FLACC mais baixos em todos os momentos mensurados no pós-operatório (p < 0,0001). Dois pacientes do Grupo BC versus 12 do Grupo B solicitaram analgesia de resgate no pós-operatório (p < 0,001). Não houve diferenças entre os grupos em relação ao tempo até a primeira solicitação de analgesia de resgate. Os pacientes do Grupo BC relataram consumo menor de analgésicos (366,67 ± 45,67 vs. 240,0 ± 0,0 mg, p < 0,04). O tempo em minutos (min) até a primeira ingestão oral foi significativamente reduzido no Grupo BC (87,67 ± 15,41 vs. 27,33 ± 8,68 min, p < 0,001). Escores mais baixos de agitação no pós-operatório foram registrados para os pacientes do Grupo BC, com significância estatística no tempo de 45 min (0,86 ± 0,11 vs. 0,46 ± 0,16; p < 0,04) e na primeira hora de pós-operatório (1,40 ± 0,17 vs. 0,67 ± 0,14; p < 0,003). Índices mais altos de satisfação dos pais foram registrados no Grupo BC (p < 0,04), sem efeitos adversos significativos. Conclusões: A adição de cetamina à bupivacaína acentuou a eficácia analgésica do bloqueio do nervo infraorbitário em crianças submetidas à cirurgia de correção de lábio leporino.

Preoperative biliary drainage for pancreatic cancer

Pancreatic cancer is a leading cause of cancer-related morbidity and mortality, but any meaningful improvement in its prognosis remains elusive. The lack of early diagnostic methods means that many patients only present when symptoms develop, such as obstructive jaundice. Once a diagnosis of pancreatic cancer has been made in a patient with obstructive jaundice, then a decision should be made if the patient is a candidate for surgical resection. Patients who are candidates for surgical resection generally do not need preoperative biliary drainage, unless they present with cholangitis, or if they require neo-adjuvant chemotherapy. If preoperative biliary drainage is to be done, then patient factors and local expertise should guide appropriate interventions. The evidence for endoscopic retrograde cholangiopancreatography as a first-line therapy for biliary decompression is strong; However, the use of percutaneous transhepatic biliary drainage as well as endoscopic ultrasound-guided biliary drainage has generally not been found to be inferior. Finally, to ensure ongoing patency and minimize complications, an appropriate self-expanding metal stent should ideally be placed.

Perceptions Of Physicians About Clinical Pharmacist’s Role In Al Qassim’s Hospitals In Saudi Arabia

@#The objective of this study is to explore physician’s perception toward clinical pharmacy services and role of clinical pharmacists in governmental hospitals at Al-Qassim region. An observational cross-sectional survey was conducted. Results: 150 males and 39 females participated giving 75.5% (189 of 250) response rate. Physicians perceptions were found to be high (equal or more than 90% of frequency) in some clinical pharmacy services such as patients’ education and counselling, monitoring of patients’ responses to drug therapy including toxicity/side effects and provision of drug information to healthcare professionals. The physicians showed low perception (less than 76%) in the taking of patients’ medication history on admission, by clinical pharmacists. Conclusion: Physicians’ perception toward clinical pharmacy services and the role of clinical pharmacists was not found to be completely favourable. The reason of this mixed responses and to the accommodating feelings of clinical pharmacy services in clinical setting appear to relate to the state of infrastructure and environments of hospitals. The infrastructure and environments of hospitals need to be updated for an improved accommodation clinical pharmacy services.

Protective effect of Cordia boissieri A. DC. (Boraginaceae) on metabolic syndrome.

Increased fructose ingestion has been linked to obesity, hyperglycemia, dyslipidemia, and hypertension associated with metabolic syndrome. Cordia boissieri A. DC. (Boraginaceae) is a slow growing beautiful plant, used traditionally as herbal remedy by diabetic Hispanic women in the Southwestern USA. The present study aimed to elucidate the toxicity and the possible protective effect of ethyl acetate extract of C. boissieri leaves on metabolic syndrome. Three groups of rats were fed on fructose-enriched diet for 14 weeks. One group served as fructose-enriched diet control, while the remaining groups were treated with metformin (10 mg/kg/day) and ethyl acetate extract (200 mg/kg/day) during the last 4 weeks. A fourth group was fed on normal laboratory diet. At the end of the experiment, blood samples were withdrawn for the estimation of metabolic syndrome-related markers and liver samples were subjected to histopathological and immunohistochemical examination. Induction of metabolic syndrome using fructose enriched diet was associated with increased weight gain coupled with elevated levels of blood glucose, insulin, uric acid, urea, creatinine, total cholesterol, triglycerides, malondialdehyde (MDA), nitric oxide and tumor necrosis factor in addition to, decreased level of glutathione (GSH). Four-weeks oral administration of ethyl acetate extract attenuated most of the changes associated with metabolic syndrome as marked by improved insulin sensitivity, glucose tolerance, kidney function, lipid profiles and reduced oxidative stress and inflammation. The present study provides evidence of the potential protective effect of C. boissieri against metabolic syndrome.

Cancer management in Sudan: current status and future perspectives

Sudan is one of the developing countries that face a great challenge with cancer management. About 5700 cases had been seen during year 2007 in Radiation and Isotope Center- Khartoum [RICK] and Institute of Nuclear medicine, Molecular biology, and Oncology [INMO] Wadmedani which are the only cancer centers in Sudan. Aim of this work is to highlight the difficulties of cancer management in Sudan and to propose possible solutions. This paper evaluates the current situation of cancer management in Sudan through reviewing of data available in cancer centers and reports from the Sudan national bureau of statistic. Suggestions are also made for cancer control plan in Sudan having the current situation in mind and guided by the published international data on cancer control. The preliminary analysis of the available data reveals that Sudan has very limited resources available to deal with cancer and the service provided is not evenly distributed. Establishment of new centers is extremely needed with special attention to good distribution of services. To achieve such a goal training of more staff and upgrading of the existing centers is mandatory to manage all types of cancer. Cancer registry is the right way to plan for cancer control in Sudan

Maternal acute lymphocytic leukemia with rearrangement of the mixed lineage leukemia gene occurring during pregnancy

Acute lymphoblastic leukemia [ALL] is a relatively rare disease during pregnancy, accounting for about 15% of all cases of pregnancy-associated leukemia. Although mixed lineage leukemia gene [MLL] rearrangement is the dominant genetic aberration in infantile acute leukemia, the occurrence of MLL gene rearrangement in maternal ALL occurring during pregnancy has not been reported. Out of 31 cases of maternal leukemia diagnosed during pregnancy at our institution, 5 were ALL cases. Three of the 5 patients had MLL gene rearrangement. The data for these 5 patients are presented in this report. We believe that the association of MLL gene rearrangement with maternal leukemia is biologically plausible and this observation needs to be validated in a larger cohort of pregnancy-associated maternal leukemia cases