Variables Impacting Gfr Estimation Method For Drug Dosing In Ckd: Artificial Neural Network Prediction Model

Objective: This study aimed to measure concordance between different renal function estimates in terms of drug doses and determine the potential significant clinical differences. Methods: Around one hundred and eighty patients (≥ 18 y) with chronic kidney disease (CKD) were eligible for inclusion in this study. A paired-proportion cohort design was utilized using an artificial intelligence model. CKD patients refined into those who have drugs adjusted for renal function. For superiority of Cockcroft-Gault (CG) vs. modified diet in renal disease (MDRD) guided with references for concordance or discordance of the two equations and determined the dosing tiers of each drug. Validated artificial neural networks (ANN) was one outcome of interest. Variable impacts and performed reassignments were compared to evaluate the factors that affect the accuracy in estimating the kidney function for a better drug dosing. Results: The best ANN model classified most cases to CG as the best dosing method (79 vs. 72). The probability was 85% and the top performance was slightly above 93%. Creatinine levels and CKD staging were the most important factors in determining the best dosing method of CG versus MDRD. Ideal and actual body weights were second (24%). Whereas drug class or the specific drug was an important third factor (14%). Conclusion: Among many variables that affect the optimal dosing method, the top three are probably CKD staging, weight, and the drug. The contrasting CKD stages from the different methods can be used to recognize patterns, identify and predict the best dosing tactics in CKD patients.

In vivo Antiplasmodial Activity of the Stem Extracts of Balanites aegyptiaca (L) Delile.

Aims: To investigate in vivo antiplasmodial activity of the stem extracts of Balanites aegyptiaca (L) Del. Study Design: Animal model infected with Plasmodium berghei. Place and Duration of Study: Department of Biochemistry, Federal University of Technology, Minna, Niger State, Nigeria, between March 2011 and May 2011. Methodology: Twenty healthy Swiss albino mice of either sex weighing between 20-30g were selected and divided into five groups. One group served as control, another group as standard and the others as the test groups for hexane, ethylacetate and methanolic extracts respectively. The mice were infected with Chloroquine sensitive strain of Plasmodium berghei and left for 72hours for the infection to be established. 600 mgkg-1 bw day-1 dose was determined as safe and used for the analysis. After 72 hours of infection, the plant extracts were administered subcutaneously once daily for 4 days from D3 to D7. The control group was given 0.9w/v of normal saline. Thick and thin blood smears from the tail blood were examined for parasites. 5mg/kg bw of Chloroquine phosphate, used as control drug, was administered to the positive control. Results: None of the three fractions (Hexane, Ethylacetate and Methanolic extracts) of B. aegyptiaca was completely able to clear the parasites in circulation. In fact, the group of mice given methanolic extract of B. aegyptiaca died before the control group while both groups given ethylacetate and Hexane fractions died on the 14th day after infection. The mice administered with hexane and ethyl acetate extracts suppressed parasitaemia on the 6th and 10th day respectively, these suggest that purification and isolation of these crude extracts to know the active compound responsible for the decrease in parasitaemia can be use as drug target in the treatment of malaria, Conclusion: Stem extracts of B. aegyptiaca have suppressive effect on Plasmodium parasites but no curative effect. Further purification and isolation active compounds can help in discovery of a new antimalaria drug. It could thus be assumed that B. aegyptiaca is useful in the herbal malarial management by other mechanism other than plasmodicidal effect .Histological studies could establish reason(s) for the death of group treated with methanolic extract before the control group

[Determination of antimicrobial activity of various extracts of Stinging nettle [Urtica dioica]]

Urtica dioica, or stinging nettle, is traditionally used in much frequency in northern Iran. A total of nine extracts were prepared using different organic solvents and by two extraction methods, either by using soxhlet extractor or sequential partitions. The antibacterial and antifungal activities of crude extracts were tested. The main purpose of this study was to determine and compare two methods of extraction and the ability of different kinds of U. dioica crude extracts to inhibit various pathogenic microorganisms. A selection of extracts that showed any activity was further tested for the minimal inhibitory concentrations [MIC] on nutrient agar and minimal bactericidal concentrations [MBC] on Muller-Hilton agar. Only one extract, ethyl acetate extract of Method II [EAE II] was moderately active against Bacillus cereus, Bacillus subtilis, Vibrio parahaemyticus were 8.33, 8.33 and 0.13 mg/ml for both MIC, respectively. All others were practically inactive. Our finding showed that the method I had high effect on food poisoning bacterial than the method II especially against Bacillus cereus and Vibrio parahaemolytiucus

Pharmacokinetic concerns in the management of drug induced vomiting in co-morbid tuberculosis patient: A case report from Malaysia.

A 46 years old patient with history of type II diabetes mellitus (DM) approached chest clinic with complaints of productive cough, low grade fever and night sweating. Positive sputum smear and cavities in upper lobe of left lung confirmed him as a pulmonary tuberculosis patient (PTB). He was prescribed World Health Organization recommended six months therapy for tuberculosis (TB). During treatment, patient suffered from persistent vomiting for which he was prescribed metoclopramide tablet (10mg). Total duration of TB treatment was prolonged up to 10 months which was attributed to frequent vomiting and uncontrolled blood sugar level throughout therapy. Appropriate glycaemic control is cornerstone in management of PTB patients with type II DM. According to United State Pharmacopoeia, dissolution time specification for rifampicin in fixed dose combination (FDC) is 45 minutes. This indicates that anti TB drugs must remain in gastrointestinal tract for at least 45 minutes. Administration of metoclopramide at least one hour before taking anti TB drugs can trim down episodes of vomiting.

Field observation on the efficacy of Toxorhynchites splendens (Wiedemann) as a biocontrol agent against Aedes albopictus (Skuse) larvae in a cemetery

This study explored the efficacy of Toxorhynchites splendens, predator of Aedes albopictus as a biocontrol agent. There was a negative correlation between Ae. albopictus larval population and Tx. splendens larval population in ovitraps (r= -0.287, R2=0.0821). The correlation is higher between the mean number of Ae. albopictus larvae per ovitrap and the number of Tx. splendens larvae in an ovitrap (r=-0.987, R2=0.9737). Larvae of Tx. splendens were observed to co-exist with larvae of Ae. albopictus and Culex fuscocephala in the ovitraps placed in the study area. The existence of Tx. splendens larvae in the study area coincides with their habit, preferring to breed in bamboo stumps. A total of 480 ovitraps were inspected for 30-week study period and 281 ovitraps were positive with Ae. albopictus larvae respectively. There was a significant difference between numbers of ovitrap positive for Ae. albopictus larvae with number of Tx. splendens larvae in the ovitraps (ANOVA, F(4,475) 2.655, p< 0.05). Of 281 ovitraps positive with Ae. albopictus larvae, 255 ovitraps contained only one Tx. splendens larva each. Only one ovitrap contained four, the most number of Tx. splendens larvae (p< 0.05). Thus, Tx. splendens could be utilised as an alternative for dengue vector control programme.

Autoimmune polyglandular syndrome type 1 in Saudi children

To describe the clinical, biochemical, and immunological manifestations of autoimmune polyglandular syndrome type 1 [APS-1] in a Saudi population. The medical files of 7 consanguineous Saudi families with 20 affected siblings were retrospectively reviewed. They were followed at the Pediatric Endocrinology Clinic, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia for a mean duration of 6 years [January 2000 to December 2009]. The age of the affected children ranged from 2-17 years. The included patients had at least 2 out of the 3 major clinical diagnostic criteria of APS-1. Fourteen children had neonatal chronic mucocutaneous candidiasis affecting the nails and mouth. The most commonly presenting endocrine disease among APS-1 patients was hypoparathyroidism. Eight patients had autoimmune Addison's disease. Hypothyroidism was diagnosed in 3 patients, and 9 patients had alopecia universalis. Other endocrine and autoimmune disorders were infrequently seen including type 1 diabetes, growth hormone deficiency, celiac disease, autoimmune hepatitis, and keratoconjuctivitis. Autoimmune polyglandular syndrome type 1, although an uncommon disorder in Saudi children affects multiple endocrine glands, and is associated with several autoimmune diseases where alopecia universalis is a common finding

Peutz -jegher's syndrome: three case reports

Peutz-Jegher syndrome [PIS] is an autosomal dominant disease characterized by hamartomatous intestinal polyps associated with muco-cutaneous melanocytic macules. STK11 /LBK1 is proved to be the responsible gene for inheritanatcel[1] Patients with PIS have 15 fold increase risk of developing malignancy[2], which could be gastrointestinal as oesophageal, gastric, pancreatic and colonic or non intestinal cancer such as lung, breast, ovary and testicular cancer. Here we reported three patients presented to the Gastroenterology Department at Ibn Sina Hospital Sudan over the last ten years

Laparscopic cholecystectomy: a local experience in Sudan

poverty, pressing priorities and tropical diseases prevailed added to the factors that delay the implementation of laparoscopic cholecystectomy [LC]. The objective of this study was to assess the feasibility and safety of LC in this country [sudan]. from june 1995-may 1999, we enrolled 288 patients presented with symptomatic gallstone disease without pre selection criteria. 242 were females and 46 were males, mean age 48.1 years. LC was successful in 201 [94.81%] patients including 49 patients with acute cholecystitis. The operation was done the same day of admission and 60 [29.35%] were able to leave as a day case. There was no mortality and no common bile duct injury. LC is feasible, safe and cost effective in sudan

Rupture of the pregnant uterus: an analysis of risk factors

The purpose of our study was to evaluate the risk factors associated with uterine rupture or dehiscence after caesarean section. We also reviewed the clinical presentation, complications and management of the problem. During the study period there were 28494 deliveries. Among those deliveries there were 24 cases of ruptured and dehiscence of uterine scar. In four cases [16.6%], uterine rupture occurred in an intact uterus. The remaining 20 patients had one or more previous caesarean section delivery. Eight of those patient [33.4%] had uterine rupture, two of them following classical scar and the remaining six patients had two or more transverse caesarean scars. The remaining twelve patients [50%] had dehiscence of the caesarean scars. The remaining twelve patients [50%] had dehiscence of the caesarean section scar. Eighteen patients [75%] of all women who had uterine ruptured were admitted in labour,having had no previous antenatal care. Sixteen patients [66.6%] were grandmultipara. Hysterectomy was performed in 10 [41.6%] patients, while the remaining 14 patients were treated conservatively. In conclusion, we found that the risk of uterine rupture was increased in grandmultipara, in those patients who had no antenatal care, in patients who had classical scare, and in those who gave history of two or more cesarean deliveries

Diagnosis of gestational diabetes mellitus a study of 315 pregnant women at King Fahd hospital of the university, Al-Khobar, Saudi Arabia

The purpose of the study was to determine the best method for the diagnosis of gestational diabetes. A prospective study was conducted over a period of seven years in 315 pregnant women seen at the antenatal clinic at the King Fahd Hospital of the University, Al-Khobar, Saudi Arabia, between January 1987 and December 1993. Each one of those patients has one or more risk factors of developing gestational diabetes. All the patients were tested by both 100 gm oral glucose tolerance test and sugar profile. After analysing the results we got three different groups of patients. In one group which consists of 123 patients, all patients, have abnormal glucose tolerance test and abnormal sugar profile. This group was labelled as Group 1. In the second group which consists of 77 patients, all patients have abnormal glucose tolerance test, but normal sugar profile. This groups was labelled as Group 2. The third group which consists of 115 patients, all patients have normal glucose tolerance test and normal sugar profile. This groups was labelled as Group 3 and used as control group. The positive results were more common following 100 gm oral glucose tolerance test [33.3%] compared with the sugar profile tests [6.6%] with a highly significant differences. P-value < 0.001 which indicate a high false positive result when oral glucose tolerance test is used. The outcome of this study indicates that oral glucose tolerance test is a stress test, it is non- physiological with a high false positive result, it has a number of unpleasant side effects and lacks reproducibility. Sugar profile on the other hand is a non-stress, simple test and more convenient for the patient and far more representative of the patient's usual meal intake and dietary habits. It is highly acceptable by the patients and can be repeated many times throughout the pregnancy

Idiopathic hyperprolactinaemia: aclimical study of 140 patients

Report the findings and experience in the management of 140 patient with idiopathic hyperprolactinaemia treated at the King Fahd Hospital of the University, Al-Khobar, Saudi Arabia, and the effect of the treatment with bromocriptine on the restoration of normal menstrual pattern and fertility. Method: The study was conducted over a period of five years in 140 patients with idiopathic hyperprolactinaemia who were investigated and treated at the Endocrinological, Infertility and Gynaecological Clinics at the King Fahd Hospital of the University, Al-Khobar between January 1988 and December 1992. The initial serum prolactin levels ranged from 28.5 to 224 ng/ml, with a mean of 62 ng/ml. Among the 140 patients with idiopathic hyperprolactinaemia, 102 patients were complaining of infertility. All the patients in the study were treated with bromocriptine to normalise serum prolactin or to achieve pregnancy. Result: Out of the 102 infertile patients, 82 [80.3%] achieved pregnancy with bromocriptine therapy alone, and the remaining 20 patients received additional treatment with clomiphene and Human Chorionic Gonadotrophine for induction of ovulation. A total of 88 [86.2%] patients achieved pregnancy, 76 had full term pregnancy and 12 ended with abortion. There was no significant difference in the pregnancy rate, between the patients with initial low serum prolactin levels and those with high levels. Similarly, the presence of galactorrhea did not influence the pregnancy rate. No lethal congenital foetal abnormalities were observed in the patients. Bromocriptine therapy in the treatment of hyperprolactinaemia is safe and effective resulting in high pregnancy rate and resumption of normal menstrual pattern

use and misuse of ultrasound in obstetrics and gynecology

The goal of the present study was to analyze the results of 8,800 ultrasound scan examinations performed on a wide range of obstetrical and gynaecological patients over two years period at the King Fahd Hospital of the University, AI-Khobar, and the cost effectiveness of ultrasonic examination during the two years study period over 78% of the gynaecological and 80% of the obstetrical ultrasound scans performed were normal and only 22% of the gynaecological and 20% of the obstetrical ultrasonic examination showed some abnormality respectively

Unruptured tubal twin pregnancy

We report a tubal twin pregnancy which occurred after a spontaneous pregnancy presented with abdominal pain at ten week gestation. Two gestational sacs with two fetal echoes were found by ultrasonic examination. Emergency laparoscopy followed by laparotomy confirmed the diagnosis, and salpingectomy was performed. To the best of our knowledge this is the first case of tubal twin pregnancy to be reported

Mayer-Rokitansky-Kuster-Hauser syndrome: a study of fifteen cases

Although Mayer Rokitansky Kuster Hauser [MRKH] syndrome is a rare entity, it is a fairly common cause of primary amenorrhoea. The purpose of the study is to establish guidelines for the investigation of a patient suspected to have a MRKH and to look for some congenital defects which may be associated with this syndrome. We reviewed fifteen cases of MRKH seen at the King Fahd Hospital of the University, Al-Khobar, and Al-Madina Maternity and Childrens Hospital, Al-Madina, Saudi Arabia. The age of the patients ranged between 14 to 24 years old [mean 17.3 years old]. Eight of the patients complained of delayed menstruation, five of whom were unable to conceive, and two complained of dyspareunia. All patients were investigated by cytogenetic studies, hormonal profile, intravenous pyelography, pelvic ultrasound and a diagnostic laparoscopy. Cystogenetic studies revealed that all fifteen patients were normal females of 46XX karyotype. Hormonal studies in nine patients were within normal range, but in the other six the hormonal values correlated well with polycystic ovary syndrome and this was confirmed by pelvic ultrasound

Hyperprolactinaemia, diagnosis and treatment: a study of 150 cases

We reviewed the management of 150 patients with hyperprolactinaemia, who presented with infertility, amenorrhoea, menstrual irregularities and/or galactorrhoea during a 4 year period to evaluate the efficacy of treatment of the condition with bromocriptine. Radiographic evidence of pituitary microadenoma was seen in 23 patients and 7 had macroadenoma. The majority of our patients [53%] had no obvious cause for elevated prolactin levels. Seven patients were taking antidepressants, five had antihypertensive drugs and twelve had taken oral contraceptives for a period of six months or more. Patients with pituitary adenoma had a significantly higher baseline serum prolactin level than those with no adenoma. All patients in the study were treated with bromocriptine to normalise serum prolactin or to achieve pregnancy. The patients without an adenoma required a significantly smaller dose of bromocriptine than those with an adenoma. There was no significant difference in the pregnancy rate between the patients with and those without pituitary adenoma. Similarly, presence of galactorrhoea or a high level of prolactin did not influence the pregnancy rate. No lethal congenital foetal abnormalities were observed. The results obtained from this study indicate the efficacy and safety of bromocriptine therapy in the treatment of hyperprolactinaemia with and without pituitary adenoma

Gonadal biopsy for assessment of gonadal function in secondary amenorrhea

Gonadal biopsy provides an opportunity for the investigation of ovarian function and for diagnosing of ovarian dysfunction I. This procedure is particularly relevant in cases of primary amenorrhea, secondary amenorrhea, the polycystic ovary syndrome, resistant ovary syndrome and infertility2. Data thus collected assist the planning of logical management, the provision of accurate prognosis, and the assessment of response to treatment. The operation per se may have a therapeutic effect. We present here the results of investigations on 6 patients with secondary amenorrhea and discuss the value of gonadal biopsy

Depression in medical and arts students

High levels of depression in medical students have been reported in several studies and have been attributed to the stresses of medical education and training. In order to compare the severity of depression and to detect its prevalence among medical students and other students, we administered the General Health Questionnaire to 50 Medical Students and to 50 Arts Students from different academic levels and age groups. Arts students reported significantly more depression and physical symptoms related mostly to the daily studying time [D.S.T.] and academic level than medical students. Grade had nothing to do to the mood of the university students. Accordingly, depression may be lower in medical students than other graduate students