Surgical and Functional Outcome of Laparoscopic Vaginal Suspension Combined with Suture Rectopexy for Management of Pelvic Organ Prolapse

Abstract Purpose Laparoscopic techniques to treat pelvic organ prolapse are gaining popularity around the globe due to their low recurrence rates and better functional results compared to perineal techniques. However, the optimum surgical procedures are not yet determined. In the current research, we suggest a novel surgical approach, laparoscopic vaginal suspension with suture rectopexy, to treat multiorgan pelvic prolapse. Methods This prospective cohort trial was conducted from March 2018 to March 2022 and comprised 35 females with multiorgan pelvic organ prolapse with obstructed defecation symptoms. A residual rectal prolapse was still present despite the manual reduction of uterine prolapse. Patients' conditions before and after the operation were monitored regarding the obstructed defecation score, sexual function, need for laxatives, anorectal manometry pressures, anorectal sensations, and recurrence. The mean follow-up duration was one year. Results Modified Longo score for obstructed defecation significantly decreased at six and twelve months after surgery. Additionally, a significant reduction was reported in the number of patients who needed laxatives at six and twelve months after surgery. Anorectal manometry pre- and post-surgery showed a significant elevation in the mean squeeze pressure and a decline in all rectal sensations. All parameters of the female sexual function scoring system increased postoperatively. No recurrence was reported during follow-up. Conclusion For multiorgan pelvic prolapse, laparoscopic vaginal suspension combined with suture rectopexy has excellent functional outcomes, minimal morbidity, and low cost.

A case report of an uncommon presentation of cutaneous leishmaniasis: A nose lesion

@#Leishmaniasis is a widely spread zoonotic disease caused by the bite of infected sandflies, particularly in developing countries. Cutaneous leishmaniasis can have a diverse range of presentations, ranging from minor skin nodules to significant mucosal damage. However, nose involvement is infrequent. Our report highlights a 15-year-old female patient with a persistent skin lesion on her nose for three months, which is a rare manifestation of cutaneous leishmaniasis. The lesion started as a raised spot with a brownish-red color and a crust but eventually developed into an ulcer that spread over the entire lobe of the nose and even moved toward the eye. Microscopic examination revealed the presence of Leishmania amastigotes, and a biopsy confirmed a diagnosis of cutaneous leishmaniasis. The patient received daily intravenous sodium stibogluconate doses of 9 mg/kg for 20 days, and three weeks later, there was a significant clinical improvement, with the ulcer beginning to heal and no more amastigotes visible on microscopic examination. It is crucial to keep cutaneous leishmaniasis in mind as a possible diagnosis for patients with skin lesions, even in regions where the condition is not prevalent.

Protective effects of lutein against vancomycin-induced acute renal injury in mice via upregulation of peroxisome proliferatoractivated receptor gammauclear factor erythroid 2-related factor 2 and inhibition nuclear factor-kappaB/caspase 3

Vancomycin, an antibiotic used occasionally as a last line of treatment for methicillin-resistant Staphylococcus aureus, is reportedly associated with nephrotoxicity. This study aimed at evaluating the protective effects of lutein against vancomycin-induced acute renal injury. Peroxisome proliferator-activated receptor gamma (PPARγ) and its associated role in renoprotection by lutein was also examined. Male BALB/c mice were divided into six treatment groups: control with normal saline, lutein (200 mg/kg), vancomycin (250 mg/kg), vancomycin (500 mg/kg), vancomycin (250 mg/kg) with lutein, and vancomycin (500 mg/kg) with lutein groups; they were euthanized after 7 days of treatment. Thereafter, samples of blood, urine, and kidney tissue of the mice were analyzed, followed by the determination of levels of N-acetyl-β-D-glucosaminidase (NAG) in the urine, renal creatine kinase; protein carbonyl, malondialdehyde, and caspase-3 in the kidney; and the expression of PPARγ, nuclear factor erythroid 2-related factor 2 (Nrf2), and nuclear factor-kappaB (NF-κB) in renal tissue. Results showed that the levels of protein carbonyl and malondialdehyde, and the activity of NAG, creatine kinase and caspase-3, were significantly increased in the vancomycin-treatment groups. Moreover, the levels of Nrf2 significantly decreased, while NF-κB expression increased. Lutein ameliorated these effects, and significantly increased PPARγ expression. Furthermore, it attenuated vancomycin-induced histological alterations such as, tissue necrosis and hypertrophy. Therefore, we conclude that lutein protects against vancomycin-induced renal injury by potentially upregulating PPARγ/Nrf2 expression in the renal tissues, and consequently downregulating the pathways: inflammation by NF-κB and apoptosis by caspase-3.

Protective effects of lutein against vancomycin-induced acute renal injury in mice via upregulation of peroxisome proliferatoractivated receptor gammauclear factor erythroid 2-related factor 2 and inhibition nuclear factor-kappaB/caspase 3

Vancomycin, an antibiotic used occasionally as a last line of treatment for methicillin-resistant Staphylococcus aureus, is reportedly associated with nephrotoxicity. This study aimed at evaluating the protective effects of lutein against vancomycin-induced acute renal injury. Peroxisome proliferator-activated receptor gamma (PPARγ) and its associated role in renoprotection by lutein was also examined. Male BALB/c mice were divided into six treatment groups: control with normal saline, lutein (200 mg/kg), vancomycin (250 mg/kg), vancomycin (500 mg/kg), vancomycin (250 mg/kg) with lutein, and vancomycin (500 mg/kg) with lutein groups; they were euthanized after 7 days of treatment. Thereafter, samples of blood, urine, and kidney tissue of the mice were analyzed, followed by the determination of levels of N-acetyl-β-D-glucosaminidase (NAG) in the urine, renal creatine kinase; protein carbonyl, malondialdehyde, and caspase-3 in the kidney; and the expression of PPARγ, nuclear factor erythroid 2-related factor 2 (Nrf2), and nuclear factor-kappaB (NF-κB) in renal tissue. Results showed that the levels of protein carbonyl and malondialdehyde, and the activity of NAG, creatine kinase and caspase-3, were significantly increased in the vancomycin-treatment groups. Moreover, the levels of Nrf2 significantly decreased, while NF-κB expression increased. Lutein ameliorated these effects, and significantly increased PPARγ expression. Furthermore, it attenuated vancomycin-induced histological alterations such as, tissue necrosis and hypertrophy. Therefore, we conclude that lutein protects against vancomycin-induced renal injury by potentially upregulating PPARγ/Nrf2 expression in the renal tissues, and consequently downregulating the pathways: inflammation by NF-κB and apoptosis by caspase-3.

Comparing different bar materials for mandibular implant-supported overdenture: Finite-element analysis

Aim: This study was conducted aiming to optimize the selection of bar material that can minimize stresses on mandibular bone. Subjects and Methods: One finite-element model was created under ANSYS environment to evaluate the use of different materials as a bar-manufacturing material in mandibular implant-supported overdenture (OD). Model components were created on engineering computer-aided design software and then assembled under the finite-element package. A force of 200 N was unilaterally and vertically applied on the left second premolar area. Results: Within these study conditions, the polyether ether ketone bar produced the lowest Von Mises stress on OD and the maximum value of deformation. Stainless steel bar produced the maximum OD total deformation. Conclusions: Cortical and spongy bones are not sensitive to the bar material. Increasing bar material stiffness increases Von Mises stresses in the bar itself and reduces its total deformation, in what is called overconstrained system.

Incidence of human cytomegalovirus in breast carcinoma tissues is associated with a higher expression of growth factor receptor-bound protein 2

Background: female mammary carcinoma is the second most common cancer incidence among women and the fifth most common leading cause of cancer death worldwide. Premenopausal young women are more frequently targeted by inflammatory breast cancer (IBC), which is the most lethal form of breast cancer. The human cytomegalovirus (HCMV) has been identified as one of the viral infection with a higher frequency in carcinoma tissues of IBC than in non-IBC. The adaptor protein growth factor receptor-bound protein 2 (Grb2), was found to be upregulated in HCMV-infected cells and play as crucial role in cancer progression. Objective: this study aimed to assess the expression level of Grb2 in carcinoma tissues of IBC and non-IBC with HCMV infection. Patients and Methods: overall, 135 female diagnosed with breast carcinoma were enrolled in this study. Using conventional and real time polymerase chain reaction (PCR), we determined the incidence of HCMV and assessed the expression level of Grb2 mRNA in the breast cancer tissue samples. Results: Grb2 mRNA was significantly upregulated in HCMV+ IBC higher than in HCMV+ non-IBC. According to the molecular subtype, Grb2 mRNA was significantly higher upregulated in breast carcinoma tissues of HCMV+ hormonal positive (HP) than in triple negative (TN) counterparts. Conclusion: HCMV infection is associated with a high expression of Grb2 mRNA in IBC and that HP HCMV+ mammary carcinoma tissues confer upregulated Grb2 mRNA, suggesting a potential role of HCMV infection in enhancing of Grb2 mRNA expression in breast cancer with HP

Coconut Oil and Cholesterol as Challenge Agents to Induce Hyperlipidemia and Atherosclerosis in Hamster Animal Model

Hyperlipidemia is a condition of high lipid levels in the plasma and often linked with the deposition of lipid droplets in the aorta which initiate the progression of atherosclerosis. Atherosclerosis is a common cardiovascular disorder initiated by the formation of foams cells in the vascular wall which leads to turbulent blood flow, injury to the endothelial layer and subsequent vascular thrombosis. Since the early 1980’s, Golden-Syrian hamsters have been widely used as an animal model in the research of hyperlipidemia and atherosclerosis. The use of hamsters in the hyperlipidemic and atherosclerotic model is due to their lipoprotein profile that is closer to human setting, sensitive to high-fat high-cholesterol (HFHC) diet and a suitable rodent model. Atherosclerosis can be induced in hamsters through dietary challenge with HFHC diet. Over the decades, coconut oil (CNO) was commonly used as the source of fat in the diet design of high saturated fatty acids (SFA) composition. In this review, we summarized published literature with designs involving CNO plus cholesterol-induced hyperlipidemia, atherosclerosis or both. The factors that may influence the ability of CNO and cholesterol combination to induce hyperlipidemia such as the period of dietary intervention, hamster strains and the dietary amount were evaluated and summarized.

Isolation and identification of allergens and biogenic amines of Prosopis juliflora genotypes

Background: Prosopis, or mesquite (Prosopis juliflora (Sw.) DC.), was introduced in Saudi Arabia several decades ago and is heavily used in street, roadside, and park plantations. It shows great adaptation to the prevailing climatic conditions such as high temperature, severe drought, and salinity and spreads naturally in many parts of the Kingdom. This research was conducted to isolate allergen proteins and biogenic amines from the pollen grains of P. juliflora genotypes in Saudi Arabia from two regions, namely Al-Qassim and Eastern regions. Results: The results showed that 18 different allergen proteins were detected in P. juliflora genotypes, with molecular weight ranging from 14 to 97 kDa. Moreover, P. juliflora genotypes from the two studied regions contained eight biogenic amines, namely histamine, tyramine, tryptamine, ß-phenylethylamine, butricine, codapherine, spermidine, and spermine. All genotypes from the Al-Qassim region were found to contain all eight amines, while in the Eastern region, histamine was absent in three genotypes, spermine was absent in six genotypes, and spermidine was absent in three genotypes. Genotypes B23, E20, and E21 had the lowest biogenic amine quantity. Conclusions: All identified proteins from mesquite trees from both regions (Eastern and Al-Qassim) cause allergies in patients who are sensitive to pollen grains. Bioamines, except histamine and tyramine, were recorded at varying concentrations in different genotypes.

Finite Element Study on Continuous Rotating versus Reciprocating Nickel-Titanium Instruments

Abstract In the present study, GTX and ProTaper as continuous rotating endodontic files were numerically compared with WaveOne reciprocating file using finite element analysis, aiming at having a low cost, accurate/trustworthy comparison as well as finding out the effect of instrument design and manufacturing material on its lifespan. Two 3D finite element models were especially prepared for this comparison. Commercial engineering CAD/CAM package was used to model full detailed flute geometries of the instruments. Multi-linear materials were defined in analysis by using real strain-stress data of NiTi and M-Wire. Non-linear static analysis was performed to simulate the instrument inside root canal at a 45° angle in the apical portion and subjected to 0.3 N.cm torsion. The three simulations in this study showed that M-Wire is slightly more resistant to failure than conventional NiTi. On the other hand, both materials are fairly similar in case of severe locking conditions. For the same instrument geometry, M-Wire instruments may have longer lifespan than the conventional NiTi ones. In case of severe locking conditions both materials will fail similarly. Larger cross sectional area (function of instrument taper) resisted better to failure than the smaller ones, while the cross sectional shape and its cutting angles could affect instrument cutting efficiency.

Resumo As limas rotativas GTX e ProTaper foram comparadas numericamente com as limas reciprocatórias WaveOne pela análise de elementos finitos, com o objetivo de baixar custos, comparação fiel e exata, além de pesquisar o efeito do projeto das limas e de seu material sobre a durabilidade. Dois modelos tridimensionais de análise de elementos finitos foram especialmente elaborados para esta comparação. Utilizou-se um sistema de engenharia CAD/CAM comercial para construir o modelo totalmente detalhado da geometria das estrias das limas. Materiais multi-lineares foram definidos na análise usando dados reais de deformação por estresse de NiTi e M-Wire. Procedeu-se à análise estática não linear para simular a ação do instrumento dentro do canal radicular em ângulo de 45° na região apical, submetido a uma torsão de 0.3 N.cm. As três simulações realizadas no presente estudo demonstraram que o M-Wire é um pouco mais resistente a falhas que o NiTi convencional. Por outro lado, ambos os materiais são bastante similares em condições de travamento severo. No caso da geometria das limas, os instrumentos de M-Wire podem ter vida útil mais longa que os de NiTi convencional. Em condições de travamento severo, ambos os materiais terão falhas similares. Maior área transversal (em função da conicidade do instrumento) resiste melhor a falhas que as áreas transversais menores, ao passo que a geometria da área transversal e seus ângulos de corte podem afetar a eficiência de corte das limas.

Influence of implant-abutment angulations and crown material on stress distribution on central incisor: a 3D FEA

Aim: To investigate the effect of implant-abutment angulation and crown material on stress distribution of central incisors. Finite element method was used to simulate the clinical situation of a maxillary rightcentral incisor restored by two different implant-abutment angulations, 15° and 25°, using two different crown materials (IPS E-Max CAD and zirconia). Methods: Two 3D finite element models were specially prepared for this research simulating the abutment angulations. Commercial engineering CAD/CAM package was used to model crown, implant abutment complex and bone(cortical and spongy) in 3D. Linear static analysis was performed by applying a 178 N oblique load.The obtained results were compared with former experimental results. Results: Implant Von Misesstress level was negligibly changed with increasing abutment angulation. The abutment with higherangulation is mechanically weaker and expected to fail at lower loading in comparison with thesteeper one. Similarly, screw used with abutment angulation of 25° will fail at lower (about one-third)load value the failure load of similar screw used with abutment angulated by 15°. Conclusions: Bone (cortical and spongy) is insensitive to crown material. Increasing abutment angulation from15° to 25°, increases stress on cortical bone by about 20% and reduces it by about 12% onspongy bone. Crown fracture resistance is dramatically reduced by increasing abutment angulation. Zirconia crown showed better performance than E-Max one.

A finite element study on the mechanical behavior of reciprocating endodontic files

To evaluate the mechanical behavior of reciprocating endodontic files, comparing nickel-titanium NiTi and stainless steel 316L St.St. 316L as manufacturing material for such instruments. METHODS: A three-dimensional finite element model was designed for this study. The simplified instrument model geometry was created on commercial CAD/CAM software. Real strain stress curves of St.St. 316L and NiTi were used in the analysis. Non-linear static analysis was performed to simulate the instrument inside root canal at an angle of 45° in the apical portion, and subjected to torsion of 0.3 N.cm. RESULTS: Non-linear NiTi material showed super elasticity and high functionality in such applications. Very high levels of stress appeared in the file at 3 mm from the tip close to yield point. CONCLUSIONS: St. St. 316L is not suitable for manufacturing reciprocating instruments. Modeling of the instrument with equivalent circular cross-sectional area did not affect results quality. Reciprocating instruments have short lifespan, thus manufacturers recommend using one file per tooth. Reciprocating instruments are recommended for less experienced dentist...

finite element study on stress distribution of two different attachment designs under implant supported overdenture

Objective: This study aimed to evaluate stress patterns generated within implantsupported mandibular overdentures retained by two different attachment types: ball and socket and locator attachments

Materials and methods: Commercial CAD/CAM and finite element analysis software packages were utilized to construct two 3D finite element models for the two attachment types. Unilateral masticatory compressive loads of 50, 100, and 150 N were applied vertically to the overdentures, parallel to the longitudinal axes of the implants. Loads were directed toward the central fossa in the molar region of each overdenture, that linear static analysis was carried out to find the generated stresses and deformation on each part of the studied model

Results: According to FEA results the ball attachment neck is highly stressed in comparison to the locator one. On the other hand mucosa and cortical bone received less stresses under ball and socket attachment

Conclusions: Locator and ball and socket attachments induce equivalent stresses on bone surrounding implants. Locator attachment performance was superior to that of the ball and socket attachment in the implants, nylon caps, and overdenture. Locator attachments are highly recommended and can increase the interval between successive maintenance sessions

Cerebellar mutism following closed head injury in a child

Cerebellar mutism is a rare occurrence following paediatric trauma. Although it is quite common after posterior fossa surgery in children, this phenomenon has rarely been reported following other insults, such as trauma, and its pathophysiology remains poorly understood. We report a seven-year-old child who presented to the casualty department of Sultan Qaboos University Hospital in Muscat, Oman, in May 2013 with a traumatic right cerebellar contusion. The child presented with clinical features of cerebellar mutism but underwent a rapid and spontaneous recovery. The possible mechanism of this occurrence is discussed

Antiparasitic activity of silver and copper oxide nanoparticles against Entamoeba Histolytica and Cryptosporidium Parvum cysts

Nanoparticles [NPs] have received more attention as antiparasitic agents. In the present study, silver and copper nanoparticles were synthesized and characterized using scanning electron microscopy [SEM], transmission electron microscope [TEM] and X-ray fluorescence [XRF]. The antiparasitic activity of Ag and CuO nanoparticles were tested against two of the most environmentally spread parasites in Egypt [Entamoeba histolytica and Cryptosporidium parvum]. The average sizes of synthesized Ag NPs and CuO NPs were 9 and 29 nm respectively and a significant reduction for cysts viability [p > 0.05] was observed for CuO NPs against E. histolytica cysts and Ag NPs against C. parvum oocysts. Moreover, LC[50]-3h of CuO NPs for E. histolytica and C. parvum were 0.13 and 0.72 mg/l, while Ag NPs recorded 0.34 and 0.54 mg/l respectively. Accordingly, these NPs could be suggested as a new nanoform agent for safe and effective treatment of E. histolytica and C. parvum parasites

Some studies on E-Coli mastitis in cattle and buffaloes

The aim of this study is to identify the role E.coli in bovine, its virulence factors and antimicrobial sensitivity. Three hundred and sixty locating cows and buffaloes were examined clinically and by CMT, 210 were suffering from clinical mastitis with percentage of 62.7% and 39[20.4%] E.coli isolates were detected in clinical cases of mastitis, 90 cases were suffering from subclinical mastitis and 6[6.8%] E.coli isolates were detected from these samples. The percentage of E.coli in cows was 31[21.1%] while in buffaloes 8[18.3%] isolates. Serotyping of E.coli revealed that O55[30%], O111[15%], O124[15%], O119[10%], O114[10%], O26[5%], O157[10%] and O44[5%]. That's showing that O55, O111 and O124 were the most serotypes causing mastitis. PCR identification of TraT gene revealed 5 cases were positive and give positive reaction at 307 bp. and for eaeA gene revealed 6 cases and give positive reaction at 384 bp. the antimicrobial sensitivity indicated that the most effective antibiotics were lincospectine [56.6%], danofloxacin[56.6%], enrofloxacin[40%] and ceftifure [40%], while the lowest effective antibiotics were oxytetracycline and ampicillin

Prevalence of hepatitis C virus in an elderly population in rural areas of Sharkia governorate, Egypt

Background and aim: Egypt has the highest prevalence of hepatitis C virus [HCV] infection in the world. At an older age, infected patients usually have lower rates of HCV clearance as well as higher rates of cirrhosis. The aim of this work was to study the actual prevalence, characteristics, and risk factors of HCV infection in elderly Egyptian individuals [>60 years] living in rural areas of Sharkia governorate and to assess the role of associated diseases [e.g. diabetes mellitus and hypertension] that are common in this age group

Patients and methods: A total of 115 male and 99 female nonhospitalized elderly individuals [mean age 64.37 +/- 4.74 years] were enrolled in this study. They were recruited from rural areas in Sharkia by a systemic 1: 4 sampling procedure. A questionnaire on sociodemographic characteristics was conducted, and information on risk factors for HCV infection and history of other comorbid diseases was recorded. Serodiagnosis of HCV infection was performed and for the positive cases, abdominal ultrasonography and liver function tests were performed

Results: The prevalence of HCV was 28% among the group studied. No association was found between sociodemographic data and HCV prevalence. Among the risk factors, a history of schistosomiasis treatment, blood transfusion, previous use of glass syringes, previous surgery, previous endoscopic intervention, repeated dental manipulations, and the presence of other infected members in the family were all significant factors [P<0.05]. History of previous liver disease and renal dialysis were significantly [P<0.05] associated with the prevalence of HCV, whereas diabetes mellitus and a history of ischemic heart disease were not

Conclusion: There is a high prevalence of HCV among elderly individuals living in rural areas in Sharkia, with many risk factors suspected to be the cause

Growth performance, blood parameters, immune response and carcass traits of broiler chicks fed on graded levels of wheat instead of corn without or with enzyme supplementation

Four hundred and fifty one-day Cobb broiler chicken were used to investigate the effect of partial replacement with wheat grain without or with different commercial enzyme products supplementation on growth performance, immune response, blood serum parameters and some carcass characteristics of broiler chicken. Chicks were allotted into 9 equal groups [50 chicks of mixed sex per group]. Three experimental diet were formulated basel diet containing 100% corn and basal diet was replaced by wheat grain [w/w] and the diet adjust to be iso-nitrogenous and iso-caloric diets, each diet supplemented by Kemzyme plus dry or by Combozyme [enzyme blend commercial products] to be 9 experimental groups. The experimental period continued for six continuous weeks. It was observed that wheat inclusion at 25% instead of corn non significantly reduced body weight and gain of broiler chicken, while 50% replacement improved both parameters when compared with chick group fed on corn-soybean based diet. However, it was observed that wheat inclusion at 25 or 50% instead of corn grain in broiler chicken ration increased feed intake by about 1.3% and 9.8% respectively and consequently deteriorate FCR, PER, EEU and PI by about [4.6% and 4.6%], [8.2% and 6.5%], [4.9% and 4.0%] and [13.7% and [4.2%] respectively when compared with broiler chicken group fed on corn - soybean based diet. Moreover, enzyme supplementation in 25% wheat containing diet increased feed intake but, with 50% wheat inclusion decreased feed intake also, enzyme supplementation in wheat included ration improved FCR, PER, EEU and PI when compared with broiler chick group fed on the same diet without enzyme supplementation. On the other hand, wheat inclusion had no significant effect on blood serum total protein, albumin, globulin and glucose concentrations, while reduced blood serum triglycerides and cholesterol concentrations, also wheat inclusion in the broiler chicken diet had determinately effect on liver function through elevation of some blood serum enzymes when compared with chick group fed on corn-soybean based diet. Regarding immune response, it was observed that wheat inclusion instead of corn reduced phagocytic activity and index, and reduce antibody production against NDV while enzyme supplementation improve the health status of broiler chicken when compared with broiler chicken group fed on the same diet without enzyme supplementation. It was observed that both wheat grain inclusion without or with enzyme supplementation had no significant effect on carcass traits of broiler traits and the most prominent effect was leading to reduction of abdominal fat weight and relative weight and improve thymus gland weight of broiler chicks

Role of meloxicam and/or L-carnitine in L-arginine-induced multiple organ dysfunction syndrome in rats

Multiple organ dysfunction syndrome [MODS] occurs in several conditions including acute pancreatitis [AP]. Reactive oxygen species and activation of pro-inflammatory mediators are the main forerunners in development of MODS. In the present study, we aimed to investigate the possible role of meloxicam or/and L-carnitine in L-arginine induced MODS. Rats were allocated randomly into five groups. Control group, MODS was developed by a single dose of L-arginine [250 mg/100g, IP], rats treated with meloxicam [4mg/kg, IP], animals treated with L-carnitine [500mg/kg, IP] and rats treated with both meloxicam and L-carnitine. All treatments were once daily for seven consecutive days and started directly after L-arginine injection. Serum and tissues' samples were prepared for biochemical analysis. Other hepatic or pulmonary tissues were examined histopathologically. L-arginine markedly increased serum level of alanine aminotransferase [ALT], aspartate aminotransferase [AST] and alkaline phosphatase [ALP]. Furthermore, L-arginine significantly increased the hepatic and pulmonary tissues TNF-alpha, MDA and NO content and myeloperoxidase [MPO] activity, while it significantly depleted GSH level. Administration of either meloxicam or L-carnitine significantly ameliorated L-arginine-induced biochemical changes. On the other hand the combined therapy of meloxicam and carnitine has an ameliorative effect which was greater than each drug alone. Treatment with both meloxicam and L-carnitine is more effective than either drug alone. This may be attributed to augmentation of their antioxidant-antiinflamatory effects

Management options in hepatic hydatid disease

Objective: The aim of this retrospective study is to analyse the outcome of 4 different methods in management of hepatic hydatid disease

Patients and Methods: The study was carried out in the Military Hospital, Riyadh: 110 patients were included; 37 were treated medically; 26 patients were subjected to percutaneous drainage via ultrasound guidance. Fifty patients required surgical treatment, while the remaining 10 patients were managed endoscopically

Results: The study showed different responses of the 4 methods applied

Conclusion: This retrospective analysis revealed that percutaneous draiange of the hydrated cysts achieved the best yield among all other methods