Characteristic Changes in Decidual Gene Expression Signature in Spontaneous Term Parturition

BACKGROUND: The decidua has been implicated in the “terminal pathway” of human term parturition, which is characterized by the activation of pro-inflammatory pathways in gestational tissues. However, the transcriptomic changes in the decidua leading to terminal pathway activation have not been systematically explored. This study aimed to compare the decidual expression of developmental signaling and inflammation-related genes before and after spontaneous term labor in order to reveal their involvement in this process. METHODS: Chorioamniotic membranes were obtained from normal pregnant women who delivered at term with spontaneous labor (TIL, n = 14) or without labor (TNL, n = 15). Decidual cells were isolated from snap-frozen chorioamniotic membranes with laser microdissection. The expression of 46 genes involved in decidual development, sex steroid and prostaglandin signaling, as well as pro- and anti-inflammatory pathways, was analyzed using high-throughput quantitative real-time polymerase chain reaction (qRT-PCR). Chorioamniotic membrane sections were immunostained and then semi-quantified for five proteins, and immunoassays for three chemokines were performed on maternal plasma samples. RESULTS: The genes with the highest expression in the decidua at term gestation included insulin-like growth factor-binding protein 1 (IGFBP1), galectin-1 (LGALS1), and progestogen-associated endometrial protein (PAEP); the expression of estrogen receptor 1 (ESR1), homeobox A11 (HOXA11), interleukin 1β (IL1B), IL8, progesterone receptor membrane component 2 (PGRMC2), and prostaglandin E synthase (PTGES) was higher in TIL than in TNL cases; the expression of chemokine C-C motif ligand 2 (CCL2), CCL5, LGALS1, LGALS3, and PAEP was lower in TIL than in TNL cases; immunostaining confirmed qRT-PCR data for IL-8, CCL2, galectin-1, galectin-3, and PAEP; and no correlations between the decidual gene expression and the maternal plasma protein concentrations of CCL2, CCL5, and IL-8 were found. CONCLUSIONS: Our data suggests that with the initiation of parturition, the decidual expression of anti-inflammatory mediators decreases, while the expression of pro-inflammatory mediators and steroid receptors increases. This shift may affect downstream signaling pathways that can lead to parturition.

demographic and clinical characteristics of leprosy in Saudi Arabia

Leprosy is a chronic disease caused by Mycobacterium leprae. Although the occurrence of leprosy has declined in Saudi Arabia, it has not yet been eradicated. To our knowledge, this descriptive retrospective study is the first to assess the clinical presentation of leprosy at the time of diagnosis in Saudi Arabia. All study subjects were leprosy patients admitted to Ibn Sina hospital, the only referral hospital for leprosy in Saudi Arabia, between January 2000 and May 2012. A total of 164 subjects, the majority of whom [65%] were between 21 and 50 years of age, were included, and the male-to-female ratio was 2.8:1. Of these 164 patients, 63% were Saudis, and 77% of all admitted patients were from the western region. Lepromatous leprosy was observed most frequently [33%], and 31% of cases had a positive history of close contact with leprosy. At the time of diagnosis, 84% of all subjects presented with skin manifestation. The prevalence of neurological deficit at the time of diagnosis was 87%. Erythema nodosum leprosum [E.N.L.] developed in only 10% of all subjects. Further studies are needed to determine the clinical characteristics pertaining to each type of leprosy in the region, and training courses in caring for and diagnosing patients with leprosy should be organized for health workers

comparative study of bovine bone used alone and in combination with transforming growth factor-beta for the treatment of periodontal osseous defects in humans

Objectives: Transforming growth factor-betas [TGF[beta]s] are multifunctional growth factors with a broad range of biological activities in various cell types in many different tissues. The purpose of this study was to evaluate the treatment of intrabony defects with anorganic bovine bone mineral matrix combined with TGF[beta]-1 with the use of anorganic bovine bone alone

Materials and Methods: Thirty-two sites from sixteen patients were selected using a split-mouth study design for each patient, determined randomly through a biased coin randomization. One site received a mucoperiosteal flap, and the osseous defect was fi lled with the combined therapy [Group 1]. The other site treated was with anorganic bovine bone alone and served as a control [Group 2]. All the treated sites were covered with a bioabsorbable collagen membrane. The clinical parameters and radiographic follow-up examinations were recorded after 3, 6, 9, and 12 months

Results: Clinically, there was a statistically signifi cant gain in the clinical attachment level [+5.03 +/- 0.14 mm] and a statistically signifi cant reduction of pocket probing depth [?5.16 mm +/- 0.13] for Group 1 sites compared to sites in Group 2 [P

Conclusions: The use of anorganic bovine bone mineral matrix combined with TGF[beta]-1 seemed to be effective in the treatment of intrabony defects. This showed an improvement in the clinical outcome of periodontal therapy superior to the use of anorganic bovine bone on its own

Mucoadhesive polymers as efficient drug delivery systems

The drug action can be reinforced as a result of the development of new drug delivery systems. Over the past few decades, mucosa/ drug delivery has received a great deal of attention to improve both the local and systemic drug effects. Drug delivery across the mucosa bypasses the first-pass hepatic metabolism and avoids the degradation caused by the gastrointestinal enzymes. Mucoadhesive dosage forms are designed to enable prolonged retention at the desirable site of action, provide sustained release of drug and thus, lead to an improved bioavailability, as well as therapeutic outcomes. Compared with other mucosa/ rissues, vaginal mucosa/ cavity is more appropriate and attractive for drug delivery. In addition, a prolonged contact of mucoadhesive dosage forms with the vaginal mucosa may be achieved more easily than at other absorption sites like rectum or intestinal mucosa. This review aims to highlight the recent advances in the study of mucoadhesion and mucoadhesive polymers. It provides an overview of the structure of mucosa/ membranes, the mechanism and theories involved in mucoadhesion, and finally it describes briefly the main characteristics and the advantages of vaginal mucoadhesive drug delivery systems compared with other delivery systems

Methemoglobinemia in an elderly patient with glucose-6-phosphate dehydrogenase deficiency: a case report

Glucose-6-phosphate dehydrogenase [G6PD] deficiency is an X-linked genetic disorder characterized by low levels of the G6PD enzyme. It is present worldwide but with more prevalence in the Middle East and the Mediterranean areas. We report a case of severe hemolysis due to G6PD deficiency manifesting as methemoglobinemia in a 70 year old Omani male never known to have any previous hemolytic episodes or previously diagnosed of G6PD deficiency.

Are We Aware of Dengue Fever? A Community Based KAP Survey on Dengue Fever in Rawalpindi

To assess the knowledge, attitude and practices regarding dengue fever and its prevention in Rawalpindi. A Cross Sectional Survey. Community of Rawalpindi, from July to Sept. 2012. A total of 215 participants were selected through consecutive sampling echnique. A structured questionnaire was self administered after informed consent was obtained from all the participants. Knowledge of dengue was measured by asking questions related to disease symptoms and preventive measures. Association between knowledge and awareness at p<0.05 was accepted as significant. It was found that the knowledge of the community regarding Dengue fever was adequate [91%]. The respondents' awareness about preventive measures for dengue was also satisfactory [88%]. A significant association found between knowledge and awareness of dengue fever and preventive measures [P= 0.01]. Mass media was identified as an effective tool in raising awareness. However; adequate knowledge about prevention did not reflect in community practices [P=0.031]; factors identified responsible for it, were like water storage for domestic use due to water shortage and excessive load shedding. Local community is well aware about dengue fever and its prevention; however it was found that good knowledge doesn't necessarily lead to good practice. Health educational campaigns should be designed to improve behavior and practices of prevention and control measures against dengue fever

Role of multidetector computed tomography in the diagnosis of congenital thoracic vascular anomalies

Congenital vascular anomalies of the thorax represent an important group of entities that can occur either in isolation or in association with different forms of congenital heart diseases. CT scan is a non invasive and rapid technique used for evaluation of the pediatric vascular disease as an alternative to conventional angiography. To assess the role of MDCT scan in evaluation and its ability to diagnose congenital thoracic vascular anomalies as well as to recognize these anomalies early for proper treatment and post operative follow up. The studied group included 80 patients, who underwent MDCT angiography and had diagnosed of congenital thoracic vascular anomalies, post operative follow up or asymptomatic [incidentally discovered] were included in this study. CT angiography can diagnosis about 13% [n=6] of cases not seen very well by echocardiography [inconclusive] and 26% [n=12] of cases appear as different findings by CT scan than echocardiography. Three dimensions [3D] images allow excellent display of vascular anomalies that can be used as a vascular road map by surgeons. MDCT provides reliable diagnostic information on the normal anatomy of the aorta, pulmonary and vena cava as well as congenital anomalies in pediatric and adult patients. MPR and 3D VR images have increased the diagnostic value of CT. Furthermore, coronal and sagittal views of the vessels facilitate the orientation of a surgeon, and thus aid in planning surgery

Outcome of Total Thyroidectomy and Subtotal Thyroidectomy in Non Toxic Multinodular Goiter: Hospital Universiti Sains Malaysia Experience

Introduction: Thyroid enlargement is one of the common surgical presentations in the Department of Surgery, Hospital Universiti Sains Malaysia (HUSM). Among them, benign non-toxic multinodular goiter constitutes one third (30%) of patients who underwent thyroidectomy. Common complications of thyroidectomy include recurrent laryngeal nerve (RLN) injury, hypocalcaemia, and recurrence of the thyroid lesion. Objective & Methods: This is a retrospective study of patients diagnosed with multinodular goiter treated in HUSM between January 1996 and December 2005. A total of 111 patients were studied and 52 of them underwent subtotal thyroidectomy while 59 underwent total thyroidectomy. The outcome in terms of RLN injury, hypocalcaemia and mass recurrence were analyzed. Results: Post operative complications were studied in both groups. Permanent recurrent laryngeal nerve injury occurs in 2.4% (1 case) in subtotal thyroidectomy group compared to total thyroidectomy group (3.6%, 2 cases). Five cases from total thyroidectomy group suffered from permanent hypocalcaemia but none in the other group. 70.7% (29 cases) from subtotal thyroidectomy group have functional remnant of thyroid tissue. Recurrence rate post subtotal thyroidectomy after 5 years is only 4.9% (2 cases). Conclusion: The post operative outcome in patients who underwent subtotal thyroidectomy in HUSM from January 1996 to December 2005 was better than total thyroidectomy with significant functional thyroid remnant.

Infective endocarditis of the aortic valve caused by Pseudomonas aeruginosa and treated medically in a patient on haemodialysis

Infective endocarditis [IE] in patients on dialysis is a serious infection with a high mortality rate. It is usually caused by Gram positive bacteria with Gram negative organisms being relatively rare as a cause. Recommended treatment usually involves surgical valve replacement and the extended use of antibiotics. Successful treatment with antibiotics alone is rare. We report a case of IE caused by Pseudomonas aeruginosa in a patient on dialysis treated solely with antibiotics

Determinants Of Dna Yield And Quality From Different Non-Invasive Sampling Methods

Aim: The purpose of this study was to determine theDNA yield and quality from different non-invasivesampling methods and to identify the method whichgave the highest DNA yield. Method: Thirty-eightvolunteers had been recruited in this study whereblood, buccal cells and saliva were collected usingvarious collection techniques. Buccal cells werecollected by 1) cytobrush and 2) saline mouth rinsingor “swish”. Meanwhile saliva was collected by passivedrooling method. Upon processing the white bloodcell (WBC), buccal cells and saliva samples, DNAextraction was performed according to themanufacturer’s protocol. Quantification and quality(DNA ratio at A260/A280) of the extracted DNA weredetermined using NanoDropND-1000®. T-test wasperformed to compare means between DNA obtainedfrom various collection methods. Results: DNA yieldsfrom buccal cells collected with cytobrush, “swish”,saliva and WBC (mean ± SD) were (8.2 ± 5.9)ng/μl,(28.2 ± 14.9)ng/μl, (5.9 ± 9.5)ng/μl and (105.3 ±75.0)ng/μl respectively. Meanwhile the mean DNAratio at A260/A280 for cytobrush, “swish”, saliva andWBC were 2.3, 2.0, 1.7 and 1.8 respectively. Post hoctest with Bonferroni correction suggested that DNAyield from “swish” technique exhibited the least meandifferent as compared to the DNA extracted from WBC(p<0.05). There was no significant difference in themean quality of the DNA extracted from WBC, salivaand buccal cells collected in these non-invasivemethods (p=0.323). Conclusion: The “swish”technique of obtaining buccal cells yielded thehighest amount of DNA and was of the quality of DNAextracted from blood sample.Key words: buccal cells; non-invasive methods;cytobrush; “swish”; saliva; DNA yield; DNA quality

Physical activity, nutrition, and dyslipidemia in middle-aged women

Cardiovascular disease is a major cause of death throughout the world. The aim of this study was to assess the prevalence of overweight/obesity, central obesity, hypertension and dyslipidemia, as well as dietary factors contributing to the development of dyslipidemia among middle-aged women. The research design of the present study was a population-based cross-sectional study; anthropometric measures and blood chemistry were obtained. Physical activity was measured using the original International Physical Activity Questionnaires Long Form while food frequency questionnaire [FFQ] was used in assessing individual's habitual intake. Overall, 809 women, 30-50 years of age from fourteen active urban Primary Healthcare Centers [PHC] in Babol City, northern Iran, were obtained from 1,905 households across operational areas of 14 PHC using systematic random sampling method. The prevalence rates of women classified as overweight/obese, with central obesity, hypertension and dyslipidemia were 82.8%, 75.5%, 14.6% and 63.4%, respectively. Total physical activity did not correlate with cholesterol ratio. Soybean protein was inversely associated with cholesterol ratio [rho=-0.18, P? 0.001]. The adjusted OR for dyslipidemia in women with moderate protein intake was significantly higher than in women with high and low intake [OR=2.31; 95% CI= 1.61, 3.30]. No significant associations were found between dyslipidemia and carbohydrate, fat intake or physical activity. This study showed very high prevalence of cardiovascular disease risk factors among Iranian middle-aged women. A more detailed study is suggested to develop definitively recommendations for the primary and secondary prevention of cardiovascular disease for the Iranian population

Insulin resistance, steatosis, and fibrosis in Egyptian patients with chronic hepatitis C virus infection

Both nonalcoholic fatty liver disease [NAFLD] and chronic hepatitis C virus [HCV] infection are common in Egypt, and their coexistence is expected. There is controversy regarding the influence of NAFLD on chronic HCV disease progression. This study evaluates the effect of NAFLD on the severity of chronic hepatitis C [CHC] [necroinflammation and fibrosis] and assesses the relative contribution of insulin resistance syndrome to the occurrence of NAFLD in patients with chronic HCV infection. Untreated consecutive adults with chronic HCV infection admitted for liver biopsy were included in this study. Before liver biopsy, a questionnaire for risk factors was completed prospectively, and a blood sample was obtained for laboratory analysis. Our study included 92 male patients. Their mean +/- SD age and aspartate aminotransferase [AST] level were 42 +/- 7.7 years [range 20-56] and 68 +/- 41.7 U/L [range 16-214], respectively. The mean insulin level and insulin resistance index were 15.6 +/- 18.3 mlU/mL [range 5.1-137.4] and 5.9 +/- 15.2 [range 0.9-136.2], respectively. Fifty four percent of patients had steatosis and 65% had fibrosis. In multivariate analyses, steatosis was associated with insulin resistance and fibrosis was associated with high AST level, age >40 years, and steatosis. Steatosis is a histopathologic feature in >50% of patients with chronic HCV infection. Insulin resistance has an important role in the pathogenesis of steatosis, which represents a significant determinant of fibrosis together with high serum AST level and older age

Teratogenic effects of ciprofloxacin and pefloxacin in pregnant rats

The adverse effects of ciprofloxacin and pefloxacin on rat fetuses following oral administration to the pregnant rats were studied. Ciprofloxacin and pefloxacin were given daily to pregnant rats at two [therapeutic and double therapeutic] dosage levels during the period of organogenesis [from the 6[th] to the 15[th] of gestation]. Oral administration of ciprofloxacin at 4.5 and 9 mg/100 g.b.wt. to pregnant rats induced fetal resorption, death and growth retardation. Visceral examination of live fetuses showed microcephaly, hypoplasia of the heart and lungs and dilatation of renal pelvis. Skeletal examination reveated incomplete ossification of skull bones and absence of some coccygeal vertebrae. Pefloxacin at 7.2 6 mg/100 g. b. wt. decrease the number of live fetuses and caused microcephaly, hypoplasia of the heart and lungs, dilatation of the renal pelvis. It also induced incomplete ossification of skull bones and absence of sternbrae and phalanges of forelimbs. A great attention should be considered during the clinical use of ciprofloxacin and pefloxacin in pregnant women and animals to avoid their teratogenic effects

Plasma non-esterifi ed fatty acids in patients with multiple sclerosis

Objective: The purpose of this study was to investigate the levels of non-esterifi ed fatty acids in plasma from patients with multiple sclerosis and further to correlate these fi ndings with the neurological profi le as measured by the Kurtzke Expanded Disability Status Scale. Methods: Plasma non-esterifi ed fatty acids and esterifi ed fatty acids from 30 control subjects and 31 patients with multiple sclerosis were measured by gas chromatography. Results: Non-esterifi ed fatty acids C18:2n-6, C20:4n-6, C16:1n-7, C18:1n-7, C18:1n-9, C14:0, C16:0 and C18:0 were signifi cantly increased in plasma from patients with multiple sclerosis, P ≤ 0.01, while esterifi ed fatty acid C18:2n-6 was decreased, P = 0.003. Fatty acid PC C16:1n-7 and non-esterifi ed fatty acids C16:1n-7, C18:1n-7 and C18:1n-9 showed positive and fatty acids C18:1n-9, C20:0, C22:0 and C24:0 showed inverse correlations with the Functional System Scores. Conclusions: We have identifi ed increased monounsaturated non-esterifi ed fatty acids in plasma from patients with multiple sclerosis as indicative of a worse disease outcome. Further, the decrease in fatty acid C18:2n-6, with increases in non-esterifi ed fatty acids C18:2n-6 and C20:4n-6, suggested a role for

Dementia in Malaysia: Issues and Challenges

Objective: The number of people surviving until old age has been increasing worldwide. Reductions in both fertility and mortality rates, better living standards, nutrition and health care are claimed to be the key factors that increase the proportion of aged people within the population. Nevertheless, growing numbers of older adults also increases the susceptibility to diseases that commonly afflict the elderly, such as dementia. In this article, we discuss on the current issues of dementia in Malaysia and its challenge in providing a better management and services for this population. Methods and Results: Review of literature by searching the databases CINAHL, SCOPUS, MEDLINE and PsychINFO from June 2010 to November 2010 was done on the issues involving dementia patients in Malaysia such as ageing trend, awareness and availability of services. Conclusion: Despite a limited number of studies on dementia in Malaysia, literature revealed the importance of acknowledging the issues and improving the services for the patients. Efforts should be made by the government and private sectors to promote healthy ageing in Malaysia.

Enhancing nurses ' competency to maintain technologic devices at critical care units

The danger in critical care units technology and unplanned device removal presents a different life threatening scenario and tremendous burden for the nurses. Maintaining technologic access was the core problem identified in this study. This study aims to assess the enhancing nurses competency to maintain technologic devices at critical care units. A quasi experimental design was used. This study was carried out at critical care units of El-Demerdash Hospital [General Surgery] and Children hospital, affiliated to Ain Shams University. A purposive sample composed of 65 nurses, 25 were caring for children and rest of them 40 were caring for adults, and 45 critically ill patients [28 adult and 17 children] added to 22 physician from the above mentioned settings. Tools: 1] Self administered questionnaire to assess nurses' knowledge [pre/post tests], 2] An observation checklist to assess nurses practice [pre/post tests], 3] Patients assessment sheet [pre/post tests], and 4] Opinnionair sheet for physicians and nurses [pre test]. There are statistically significant differences between nurses' knowledge and practice in pre/post tests regarding to technologic devices maintenance at critical care units, added to significant reduction in the percentage of removing technologic devices among the studied patients in post tests. Enhancing nurses' competency through training program was helpful to maintain technologic devices at critical care units . Educational program should be held periodically for critical care nurses about technologic device maintenance. Further studies should be done to assess the long term effects of such program on patient's quality of life at the critical care units

Diagnostic value of electrocardiographic T wave inversion in lead aVL in diagnosing coronary artery disease in patients with chronic stable angina

The clinical value of T wave inversion in lead aVL in diagnosing coronary artery disease [CAD] remains unclear. This study aims to investigate the correlation between aVL T wave inversion and CAD in patients with chronic stable angina. Electrocardiograms [ECGs] of 257 consecutive patients undergoing coronary angiography were analyzed. All patients had chronic stable angina. All patients with secondary T wave inversion had been excluded [66 patients]. The remaining 191 patients constituted the study population. Detailed ECG interpretation and coronary angiographic findings were conducted by experienced cardiologists. T wave inversion in aVL was identified in 89 ECGs [46.8%] with definite ischemic Q-ST-T changes in different leads in 97 ECGs [50.8%]. Stand alone aVL T wave inversion was found in 27 ECGs [14.1%] while ischemic changes in other leads with normal aVL were identified in 36 ECGs [18.8%]. The incidence of CAD was 86.3%. Single, two-and multi-vessel CAD were found in 38.8%, 28.5% and 32.7% of cases respectively. The prevalence of left main, left anterior descending, left circumflex and right coronary arteries were 4.7%, 61.2%, 29.3% and 44.5%, respectively. T wave inversion in aVL was found to be the only ECG variable significantly predicting mid segment left anterior descending artery [LAD] lesions [Odds Ratio 2.93, 95% Confidence Interval 1.59-5.37, p=0.001]. This study provides new information relating to T wave inversion in lead aVL to mid segment LAD lesions. Implication of this simple finding may help in bedside diagnosis of CAD typically mid LAD lesions. However, further studies are needed to corroborate this finding

Effect of 12 weeks life-style activity modification [LAM] on adiponectin gene expression and plasma adiponectin in obese men

Central obesity down regulates adiponectin gene expression and plasma adiponectin concentration. The effects of lifestyle activity modification [LAM] training according to Centers for Disease Control [CDC] and American College of Sports Medicine ACSM guidelines on adiponectin gene expression and its secretion in obese people is not well known. The purpose of this study hence was to examine the effects of LAM on adiponectin gene expression and plasma adiponectin in obese men. Sixteen healthy middle aged men [42.06 +/- 6.01 years; mean +/- SD] participated in this study. The subjects were randomly assigned to the LAM [n=8] and control group [n=8]. Subjects in the LAM group walked 2 miles for 30 minutes for 4 days for 12 weeks on treadmill according to the CDC and ACSM guidelines. After 12 weeks LAM training, subjects were asked to avoid any high intensity physical activity for a week. The results showed that weight, BMI, body fat mass, body fat percent, central [visceral and subcutaneous] and peripheral subcutaneous fat volume, waist and hip circumstance and waist to hip ratio [WHR] were decreased significantly after 12 weeks in the LAM group, compared to the controls [P<0.05]. After one week detraining, body composition in the training group was maintained and did not change significantly. Also, maximum oxygen uptake, adiponectin gene expression on abdominal and hip subcutaneous adipose tissue were increased significantly in the LAM group compared to controls after 12 weeks [P<0.05]. On the other hand, after 12 weeks LAM training no significant differences were observed in plasma adiponectin and serum high sensitive C reactive protein [hs-CRP], levels between groups, while after one week detraining plasma adiponectin and serum hs-CRP levels were significantly increased and decreased respectively [P<0.05]. Although, twelve weeks LAM training improved body composition, cardiorespiratory fitness and adiponectine gene expression in obese men, but the intensity and time of these exercises are not enough to increase plasma adiponectin and hs-CRP reduction