Biochemical and cellular changes due to trihexphenidyl [parkinol] dependence in albino rats

Trihexphenidyl [Parkinol] is one of anticholinergics which is an important member of hallucinogens. It may be abused for its euphoriant and hallucinogenic effects, and it may be combined with street drugs for enhanced effect. To investigate the effect of trihexphenidyl [parkinol] dependence on biochemical parameter [liver functions tests] and histopathological examination of the liver and brain of albino rat. Twenty adult male albino rats of an average weight [150-200 grams] were divided into two equal groups as follow: Group I: [Control group]: Formed of 10 rats. Group II: [Dependent group]: Consisted of 10 rats that was given trihexphenidyl orally in gradually increasing doses until they reached the dependent dose in one month. Blood samples were collected. Biochemical parameter [liver functions tests] was done on the sera of the rats. Liver and brain tissues were taken for histological examination. Biochemical study, it was found that serum liver function tests, ALT and AST showed highly significant increased, P was <0.001, while serum albumin was significantly decreased P was<0.05 in dependent group than in control group. Histopathological examination of the liver, it showed small foci of hepatic cell necrosis with moderate periportal mononuclear cell infiltration, with subcapsular fatty degeneration and chronic venous congestion. On the other hand the brain of trihexphenidyl dependent group showed congestion, edema and degenerative changes in some neurons. From the present results, it can be concluded that trihexphenidyl [parkinol] abuse can lead to hepatotoxicity, as it affects liver function tests and the histological picture of the liver. Also trihexphenidyl abuse causes histopathological changes in the brain. So health educational programs should be held to pay attention about trihexphenidyl dependence and its deleterious effects on health and the relation between trihexphenidyl and other types of drug dependence. Neurologists and psychiatrists should be aware about the potential trihexphenidyl [parkinol] toxicity over the long term medical use by the patients, and its capability of being addicted. Also media and press should explain the deleterious effects of trihexphenidyl use for prolonged time

Study the effects of initiation of early breast suckling during the third stage of the labor on the maternal outcome

The aim of this quasi-experimental study is to examine the effect of early newborn suckling immediately after delivery on the time duration of placental separation and the amount of maternal blood loss during the 3[rd] stage of labor among Jordanian mothers. 60 mothers were recruited from labor and delivery department. Two groups were constituted: a group of 30 mothers who underwent the routine care provided by the department [control group], and a group of 30 mothers who have their newborn suckle at their breast for at least 5 minutes immediately after delivery. Time of the placental separation was counted for both groups, and the amount of blood loss through the first was measured by weighing the pad and towels used in delivery before and after using by the subjects. Chi square revealed a significant statistical differences between both group in relation to time duration of placental [P=0.031], while the amount of blood loss didn't revealed any significant differences [p.=0.442]

Problems encountered among women with gestational diabetes and pregnancy outcome

Gestational diabetes mellitus is the most common medical complication of pregnancy. It occurs in women who have insulin resistance and a relative impairment of insulin secretion. Identifying this group of women is important in not only preventing prenatal morbidity but also improving long-term outcomes for the mothers and their children[1]. Diagnosis and treating pregnancies complicated by gestational diabetes mellitus [GDM] are important for preventing adverse perinatal outcomes. Diagnosis is usually accomplished early in the third trimester of pregnancy because the insulin content of the amniotic fluid starts to increase between the 24[th] and 28[th] week of gestation[2]. The goals of treatment are to maintain blood glucose levels within normal limits during duration of the pregnancy or labor and ensure the well being of the fetus and mothers[3]. This study was conducted to identify problems that are found among parturient with gestational diabetes and assess pregnancy outcomes among parturient with gestational diabetes. A sample of 200 parturient women was selected from Zagazig University hospital or public Zagazig hospital with the following criteria: The women being in labor, having gestational diabetes and being either primigravida and multigravida. The women were selected from labor unit. The study tools included a questionnaire sheet. Maternal assessment sheet and neonatal assessment sheet using Apgar scoring, estimation of blood glucose level and assessment of the anthropometric measurements. The data were collected over a period of 12 months starting from May 2004 to the end of April 2005. The results revealed that, the most common maternal problems among parturient women on admission were polyhydramnios and vaginal infection in 20% and 22% respectively. Moreover, the quarter of the sample [25%] had preterm labor. Also three fourths of parturient women have encountered problems during labor [75%], the most frequent of these problems was cesarean section [60%]. Regarding the neonatal outcome, the results illustrated that the majority of neonates [82%] had their Apgar score at first minute between 5 and 7, at the fifth minute still about one third were in the range 0-4 while 24% reached the range 8-10. The most common neonates problems were hypoglycemia [54%], [50%] had macrosomia, 25% were preterm, and congenital anomalies accounted for 10% of the cases. So, it is recommended that women with gestational diabetes should be counseled regarding the potential hazards and risks involved for both maternal and neonatal outcome. Proper care during prenatal, natal and postnatal period can prevent maternal, fetal and neonatal complications through identifying those with higher risk of developing such complications, they should have a clear protocol for management of these complications

Outcome of preterm premature rupture of membranes

Preterm premature rupture of membranes is commonly used to refer to rupture of the membranes when it occurs before term. The period between preterm rupture of membranes and the onset of labor is called latency period. Membrane rupture may occur for a variety of reasons: weakening of the membranes or intrauterine infection. The complications resulting from premature rupture of membranes include preterm labor and delivery, intra uterine infection, and umbilical cord compression secondary to umbilical cord prolapse or oligo hydramnios. This study was conducted to identify the optimal outcome preterm premature rupture of membranes. A sample of fifty women was selected from the maternity hospital at Zagazig university hospitals with the following criteria: women with gestational age range from 32-36 weeks and with the diagnosis of preterm premature rupture of membranes. Setting: the women where selected from delivery unit. The study tools included a questionnaire sheet, maternal observation sheet until delivery, mode of deliver, and neonatal assessment using Apgar scoring and weight. The data were collected over period of 6 months starting from May 1[st], 2003. the results revealed that in more than three quarter [80%] of the women the temperature was up to 37 °C and only 10% of them had high blood pressure [140/90]. Also, more than half of the women were delivered by caesarian section [CS], the most common cause for CS was fetal distress. Regarding neonatal outcome, the results illustrated that 24% of the neonates needed NICU care, and 20% of them had high temperature. So, it is recommended that women with premature rupture of membranes [PROM] should be counseled regarding the potential hazards and risks involved for both maternal and neonatal outcome and they must be observed and managed at hospital with adequate intensive care facilities

study of self- deliberate poisoned cases admitted to Menoufiya poisoning control center MPCC over one year [2004]

Suicide can be conceptualized as deviated behavior to way out of a problem that is causing suffering, associated with feelings of despair and hopelessness. Deliberate self poisoning is a frequent mean for committing suicide worldwide and in developing countries. Progress continues in research into the biological, psychological and social causes of suicide. The aim of the study was to provide socio-demographic circumstances, clinical severity characters, psychiatric assessment and outcomes of intentional self poisoned cases. The study was carried out on suicide poisoned cases [232 cases] admitted to Menoufiya poisoning control center throughout the year 2004. The study reflects the prevalence of suicide poisoned cases that represented 12.35% of all admitted cases [1852 cases] despite of the behavior, psychic built of Egyptian community and the religious factors that condemn for committing suicide. The highest rate of admission was during September. The most vulnerable age group was that of l9-<36years commonly female gender and singles. 52.6% of the represented cases were unemployed. So stress in society affecting the most vulnerable sensitive young adults, who are usually have little experience in dealing with problems e.g. as failure in love affair or forcing a female to go married to a dislike person are the factors attributable to the problem. Suicidal cases from rural and urban areas were nearly equal. 99.2% of the studied cases committed suicide in the victim's home by oral ingestion and most commonly by cholinergic insecticides. 43.9% of the cases were more significant at age group 7-<19 years while significant use of drugs to attempt suicide was at age group >50 years. The majority of cases in this study were of mild clinical severity [71.1%] and cholinergic insecticides poisoning was significantly represented with all clinical severity grades [mild, moderate and severe]. The high percentage of mild cases and the low I mortality rate [0.86%] may indicate that most of the studied cases didn't really want to kill themselves but only aimed at gaining attention. The present study revealed significant increase of emotional motives for suicide in females in age group 7-<19 years as within this age group; there are many emotional and psychological changes and troubles to females rendering them prone to suicidal tendency. Psychopathological study by psychiatrist was done on 193 cases i.e 83.2% of the total self-deliberate poisoning cases. 24.9% of psychoanalyzed cases had planned for suicide while 75.1% of the studied cases were impulsive. Most of the cases had mild attempt degree, believed that they would be saved [60.1%], [62.7%] respectively. Only 5.2% of the studied cases had previous suicide attempts. The present study revealed that about half of the psychiatric studied cases [50.3%] had depression and 37.3% suffered from agitation. This confirms the strong relationship between suicide and depression. 60.4% of the cases in the present study revealed psychiatric disorders in the form of affective disorder, personality changes and psychotic changes [26.4%], [18.8%] and [13.9%] respectively. So patients who attempt suicide may have psychiatric illness and need careful psychiatric evaluation with treatment before discharge. Regarding family history for psychiatric disorders and suicidal attempts, the present study revealed that 22.8% of the studied psychiatric cases had family history for suicidal attempt, and 18.6% of cases had members of their family received psychiatric treatment. This may reflect genetic predisposition for attempting suicide. So, it is recommended to alarm the people about the dangers of drug overdoses and the toxicity of cholinergic insecticides with restriction of the use of the dangerous toxic types for licensed especial issues. Also, self-deliberated poisoned patients are determined as medically fit for discharge by both toxicologist and psychiatrist Researches to improve management and find out ways of reducing deliberate self harm are urgently required. Keywords: self- deliberate Poisoning - suicide - demographic - cholinergic insecticides. Psychiatric

study on cholinergic insecticide poisoned cases admitted during 2002 to Menoufiya poisoning control center [MPCC]

Organophosphates and carbamates are the most frequently used insecticides worldwide. The aim of the present work is to study the problem of cholinergic insecticides among the patients admitted to MPCC, The study included 465 cases where it is clear that the cholinergic insecticides poisoned cases represented about quarter of the total number of poisoned cases admitted to MPCC during the year of 2002. The highest rate of admission was in the summer months specially June and July due to the prevalent use of pesticides during the summer season for agricultural demand. 49.6% of cases were between the ages of >18-50 years which is the age group of field working and handling of the pesticides. As regard the sex, females showed slightly higher% age [56.99%] than males [43.01%]. Patients from rural areas showed% age [66.23%] than those from urban ones [33.76%] due to conducting the study in agricultural governorate. Single subjects were [87.1%]. 60.43% of the total cases were affected indoors which may be secondary to improper storage and illegal use of insecticides. Males were more affected than females outdoors in the age group of 18-50 years due to the fact that in this age group males are exposed in farms as most of the cases were in the rural areas. As regards to the circumstances of poisoning, it was found that accidental cases had the highest% age [72.69%] which was mainly in farmers, while suicidal cases were [26.88%] which was mainly in students and females at the age group of >18-50 years. This age in the female represents the age of changeable emotional and psychological factors together with the exposure to educational, marital andsocio-economical stresses. Oral route represented the highest% age [64.5%] of cases. Females were significantly higher than males at age group of >18-50 years in taking the pesticides orally for committing suicides. As regards frequency of clinical manifestations among studied cases, it appeared that latent cases were [35.7%] of cases, the main manifestations were muscarinic [64.3%] especially constricted pupils. Patients with predominant nicotinic manifestations represented [21.9%], and [16.3%] of cases were unconscious. The severe cases were higher in children less than 7 years. It was found that cholinesterase activity is not sensitive test to measure severity of the poisoning if it is less than 10%, but it is highly specific test [98.4%] in exclusion of poisoning, if its activity is more than 50% of normal value. Analytical toxicological screening by TLC showed [8 1.93%] of cases were +ve for organophosphates, [11.82%] of cases were +ve for carbamates while [6.25%] of cases were +ve for both of them. As regards the MPCC schedule of treatment it is clear that emesis, activated charcoal and cathartics were the most common lines used in 35.7% of cases. 28.8% of cases had gastric lavage activated charcoal, cathartics and atropine. As regarding physiological antidotes, 64.3% of cases received atropine and only [1.72%] of cases were given atropine and pralidoxime, all cases received supportive treatment. As regard period of admission, the highest% age of cases [69.89%] were discharged after one day admission, [28.81%] were discharged after 2-7 days and [1.29%] after more than one week. Prognostic data showed that [96.6%] of cases were discharged with complete cure and only very low or even negligible fatality [0.4%], this may be attributed to the well organized medical facilities and the increasing experience of the medical staff in the diagnosis andtreatment of pesticide poisoning. It is clear that early ambulance to the hospital, rapid approach to diagnoses and management, are mandatory for the best outcome of the cases. it is recommended to apply laws, which limit the use of these pesticides, and their manufacture in strict circumstances, to lessen their hazards

Surgery the first step in the treatment of stage III ovarian carcinoma

Fourty-two patients with primary malignant epithelial tumors of the ovary were studied, they were stage 3 because of the presence of omental deposits in 37 [88.1%], extra-pelvic intestinal involvement in 36 [85.4%], diaphragmatic metastasis in 22 [52.1%], para-aortic nodes in 14 [33.3%], other sites of spread were paracolic gutters in 13 [30.2%], anterior abdominal wall peritoneum in 7 [16.7%] and serosa of the liver in 2 [4.8%]. Operative treatment included complete excision in 10 [23.8%], debulking in 29 cases [69.7%] and biopsy only in 3 cases [7.1%]. Two patients died [4.8%] and postoperative morbidity was encountered in 14 [33.4%]. In 36 patients [90%] chemotherapy was started within two weeks after surgery, combination chemotherapy regimen included carboplatinum, farmrubicin and endoxan. The three years survival for the whole series was 35.7%, but there is proportional relationship between the three years survival and the magnitude of the surgical procedure

Pancreatic carcinoma, experience of 3 years at Cairo National Cancer Institute [Jan 1987-Dec 1989]

Fifty-nine cases of pancreatic cancer were admitted and treated at Cairo NCI in the period [January 1987 to December 1989]. It included 40 males and 19 females with a M/F ratio of 2: 1, the median age was 53.5 years and 49.8 years for both carcinoma of head and carcinoma of body and tail, respectively. The operative mortality of cases of carcinoma of head was 2 cases [25%]. Postoperative morbidity was mainly gastric delay and biliary or pancreatic fistula. Only 4 cases out of 8 of carcinoma of head of pancreas were alive and free of disease after one year. One case developed liver metastases and died within 14 months

End results of the surgical treatment of carcinoma of the esophagus

Three hundred and twelve cases with carcinoma of the esophagus were treated at NCI, Cairo University, in the period 1980-1985, 234 males and 78 females with a male: female ratio of 3:1, their age ranged between 20 to 84 years with a mean age of 53.7 years. The maximum incidence was in the 6th decade. Dysphagia was the predominant symptom and loss of weight was the predominant sign. The diagnosis is based on barium contrast radiology and endoscopy. Lower 1/3, 36% in middle 1/3 and 13% in upper 1/3. Squamous cell ca. constituted 80% in upper 2/3 and 40% in lower 1/3 while adenocarcinoma comprised 35% in lower 1/3 and less than 3% in upper 2/3. Surgical exploration was carried out in 62.8% cases, but resections was possible in only 24.4%, respectability was highest in the lower 1/3 [40.2%] and least in the middle 1/3 [7%]. The overall resection mortality was 30.5% for transthoracic excision mostly due to anastomotic leakage and mediastini were in lower 1/3, 36% in middle and 13% in upper 1/3. Squamous cell ca. was 75%, while the mortality for blaunt oesophagectomy without thoracotomy was 14%. The middle 1/3 lesions were most difficult to treat with very low resectability and prohibitive mortality with either surgical resection [62.5%] or surgical by pass [57%]

Surgical treatment of cancer rectum at NCI Cairo

Two hundred and six cases [132 males and 74 females with a male to female ratio 1.8: 1, their ages ranged between 15 years 85 years with a mean age of 44.9 years] of malignant tumors of the rectum were admitted and treated at NCI, Cairo University, in a 5 years period [1977-1981]. The main presenting symptom was bleeding per rectum. The level of the lesion was lower 1/3 [160 cases], middle 1/3 [28 cases], upper 1/3 [10 cases], unknown [8 cases]. The main pathological type was adenocarcinoma [160 cases]. Out of 206 cases, 170 were subjected to exploration, 50 cases proved to be inoperable [29.4%], 120 cases [70.5%] were subjected to curative resection. Abdominoperineal resection was done in 109 cases and anterior resection was done in 11 cases. Postoperative complications in cases subjected to curative resection [120] occurred in 47 cases representing [39.2%] and operative mortality was [6.4%]. Follow up period ranged between 6 months and 4 years, only 101 cases with curative resections had complete follow up data. Local recurrence occurred in 30 cases [29.7%], distant metastases in 18 cases [17.8%], while 11 cases [10.9%] had concomitant local recurrence and distant metastases. Forty-two cases [41.6%] were free in the follow up period