Obesity may be erythropoietin dose-saving in hemodialysis patients

BACKGROUND: In dialysis patients, the obesity-survival paradox still requires an explanation. Anemia and high doses of erythropoiesis-stimulating agents (ESAs) are associated with worse outcomes in the hemodialysis (HD) population. In the present study, we explored the relation between obesity and anemia control in a sample of maintenance HD patients in Egypt. METHODS: This multicenter observational study included 733 patients on maintenance HD from 9 hemodialysis centers in Egypt. Clinical and laboratory data as well as average doses of ESAs and parenteral iron were recorded. The erythropoietin resistance index (ERI) was calculated. RESULTS: Obesity, defined as a body mass index (BMI) ≥ 30 kg/m2, was present in 22.6% of the studied population. The target hemoglobin level (10.0–11.5 g/dL) was achieved in 27.3% of non-obese and 25.3% of obese patients, with no significant difference. The median serum ferritin and the values of transferrin saturation index did not differ significantly between these two groups. The weekly ESA dose was significantly lower in obese than in non-obese patients (P = 0.0001). A trend toward higher ESA doses and ERI values was observed in patients with lower BMIs (P < 0.0001). Multiple linear regression revealed that the BMI and urea reduction ratio were the strongest predictors of the ERI. CONCLUSION: Our study adds more evidence to obesity-associated advantages in HD patients. BMI may determine ESA response, with better responses observed in patients with higher BMIs.

Use of onion and curcumin as radioprotectors against ionizing radiation induced hepato-testicular alterations in rats

Background: radiation protection concepts and philosophy have been evolving over the past several decades. The inadvertent exposure of human from various source of radiation causes ionization of molecules, setting off potentially damaging reactions via free radicals production. Onion, Allium cepa linn, is a major source of dietary flavonoids and has used since ancient times as a food plants. Curcumin is a yellow pigment from curcuma longa, is a major component of turmeric and has commonly used as a spice and food coloring materials

Aim: the aim of the present study is to evaluate the radioprotective role of both onion and curcumin extracted as antioxidant against gamma irradiation that induced some biochemical alterations in rats

Materials and Methods: animals were pretreated with onion or curcumin by orally administration using suitable stomach tube for two weeks prior to radiation exposure. The levels of malondialdhyde [MDA], glutathione content [GSH], superoxide dismutase [SOD], glutamic oxaloacetic transaminase [GOT], glutamic pyruvic transaminase [GPT] and testosterone were estimated in both serum and tissues

Results: the results revealed that exposure to ionizing radiation resulted in significant elevation in the levels of MDA, GOT and GPT activities, meanwhile, showed significant depletion in GSH content and SOD activity and testosterone concentration

Conclusion: administration of onion or curcumin by using suitable stomach tube pre-irradiation has significantly ameliorated the radiation induced disturbances in all of the investigated parameters

Study on the preventive effect of Mulberry [Morus alba l.] fruits in rats exposed to gamma radiation

Background: Ionizing radiation is known to generate and reactive oxygen species. This study was carried out to investigate the efficacy of mulberry fruit against -irradiation induced oxidative stress in rats

Materials and methods: Male albino rats were divided into four groups, Group [I]: [control group] rats fed on balanced diet for 4 weeks, Group [II]: rats fed on balanced diet contained 5% mulberry fruits powder [MFP], Group [III]: rats were exposed at the 1[st] week of the experiment to fractionated Gamma-irradiation dose of 8 Gy administered as 2 Gy, every other day and fed on balanced diet for 4 weeks, and Group [IV]: irradiated rats fed on balanced diet contained 5% mulberry fruits powder, at the end of the experiment, animals from each group were sacrificed, 24 hrs post the last dose of treatment, six rats from each group were sacrificed. Blood samples were taken and analyzed for Lipid peroxides as malondialdehyde [MDA] level, Xanthine Oxidoreductase system [XO and XDH], Glutathione [GSH] content, Superoxide dismutase [SOD], catalase [CAT], Aspartate Transaminase [AST], Alanine Transaminase [ALT], Gamma Glutamyl Transferase [GGT], Alkaline Phosphatase [ALP] activities and total bilirubin in rats

Results: The results showed that, irradiation induced high significant decrease in hepatic Glutathione contents [GSH], Xanthine Dehydrogenase [XDH], Superoxides Dismutase [SOD] and Catalase [CAT] activity. Moreover, a remarkable increase in the Malondialdehyde [MDA] concentration, xanthine oxidase activity [XO], the activity of some liver enzymes was observed in Gamma-irradiated rats. In contrast, administration of Mulberry Fruit Powder [MFP] to Gamma-irradiated rats was found to offer protection against Gamma-irradiation induced oxidative stress, by elevating the activity of antioxidant enzymes, enhancing liver function. All results in this study suggested that mulberry fruit had high potential to be developed as radio protective agent

Conclusion: Therefore, MFP could have a beneficial role in modulating oxidative stress by improving the natural antioxidant mechanism

Effect of cynara scolymus L. [artichoke] extraction on hyperlipidemic induced by gamma radiation in male rats

Excessive free radicals are caused by unnatural environmental influences such as air pollution, radiation, cigarette smoke, factories, pesticides, food contaminants and a myriad of other factor that are part of our modern life. Hypercholesterolaemia is directly associated with an increased risk of coronary heart disease [CHD]. Cynara scolymus L. [Artichoke] grows in Egypt and other countries. It is used as foods and has medicinal properties. Artichoke extracts have been shown to produce various pharmacological effects, such as the inhibition of cholesterol biosynthesis and low density lipoprotein [LDL] oxidation. The present study aims to evaluate the antioxidative activities and radioprotector role of cynara scolymus L. [artichoke] against hyperlipidemic induced by gamma- irradiation in male rats. Male Swiss albino rats were orally administrated by artichoke [head or leaves] [10% mg/rat/day] using suitable stomach tube [6weeks, 45 days] before exposure to a single dose [6.5 Gy] of whole body gamma radiation. Levels of lipids peroxides [MDA], reduced glutathione content [GSH], superoxide dismutase [SOD], total cholesterol [TC], triacylglycerol [TG], high density lipoprotein [HDL-C] and low density lipoprotein [LDL-C] were investigated in serum. The results revealed that gamma radiation led to significant increase in MDA, TC, TG and LDL, Meanwhile, significant decrease in GSH and SOD, but groups administrated with Artichoke [head and leaf] before whole body gamma irradiation, artichoke exerted noticeable amelioration against the radiation induced changes in most of the biochemical tested parameters

Specialty choices of medical students and house officers in Karachi, Pakistan

Understanding patterns of career choices in medicine is important for educators and policy-makers to plan the supply of specialists. This study analysed the career choices made by medical students and house officers in 2 private and 2 public medical schools in Karachi, Pakistan. An anonymous, self-administered questionnaire was completed by 850 students. Internal medicine, paediatrics, general surgery and obstetrics and gynaecology were the 4 highest ranked specialties, with internal medicine ranked top as both the 1st and 2nd choice. Internal medicine was the 1st choice for significantly more students in public than private medical colleges [22.2% versus 14.9%]. Students from private medical institutions chose a wider range of specialties than those from publicly-funded colleges. A high proportion of medical students and graduates in Karachi favour the same medical specialties, which may lead to saturation in those areas of specialization

Transposition of greater omentum for treatment of median sternotomy wound dehiscence

Sternal osteomyelitis after median sternotomy for cardiac surgery is associated with considerable morbidity and mortality. The ideal reconstruction after sternal debridement is still debated. Between January 2004 and July 2008, we treated 12 patients for sternal osteomyelitis with wound dehiscence after median sternotomy for cardiac surgery. Extensive debridement of the sternum were performed in all cases. The defect was covered by omental transposition followed by split-thickness skin graft 7-10 days later. Two-stage procedure was employed in all patients. Hospital stay ranged from 21 to 45 days. Five patients had previous muscle flaps. Partial necrosis of the omental flap occurred in one case. There was total resolution of the sternal infection in all patients. No recurrence of dehiscence was observed during 6 to 24 months of follow-up. Extensive d‚bridement along with omental flap transposition provides definitive control of the infection in cases of failure of other conservative or surgical interventions of median sternotomy wound dehiscence

Comparative study of different surgical modalities for treatment of sacrococcygeal pilonidal sinus

Pilonidal sinus disease of the natal cleft is a painful debilitating condition which often recurs despite different surgical procedures. In this thesis, the outcome of different methods for treatment of this disease are described and compared. A review of sixty patients were randomized into three groups. Group A were operated upon by sinus excision and leaving the resultant cavity to heal by granulation tissue. Group B were operated by excision with primary closure in natal cleft. Group C were operated by excision with oblique closure by z-plasty. Recurrence was highest in group B [25%] followed by group A [15%] and no recurrence occurred in group C. The mean satisfaction grading was 5, 2 in group A, 7.1 in group B and 9.3 in group c. Excision of pilonidal sinus and oblique closure by z-plasty offers improved patient satisfaction and no recurrence rate

Study of factors affecting left ventricular function and their relation to volume overload in haemodialysis patients

Technological innovations in haemodialysis [HD] have improved its quality and safety but cardiovascular morbidity and mortality still poses a great risk. Proper fluid removal is a critical component of HD, as both under and over hydration are associated with deleterious consequences. However, there is no single accurate measure for adequacy of dialytic fluid removal and assessment of dry weight is largely empirical. This may rely on clinical assessment, biochemical markers as natriuretic peptides, dilution methods, measurement of inferior vena cava diameter [IVCD], blood volume monitoring and bioimpedance analysis [BIA]. Plasma BNP was recently reported to be a sensitive marker both for volume overload and ventricular hypertrophy and/or dysfunction. We aimed to study some pathogenetic factors and diagnostic parameters of left ventricular hypertrophy and/or dysfunction in end- stage renal disease [ESRD] patients on maintenance HD. Emphasis was made on the utility of echocardiographic and BIA measurements in monitoring the development and assessment of volume overload during the inter- dialytic interval. Two groups of subjects were studied: 50 patients with ESRD on maintenance HD for >/= 6 months, and 15 age and sex matching controls. Patients were subjected to full clinical assessment, ECG, predialysis measurement of serum fasting blood sugar, creatinine, calcium, phosphorus, intact parathyroid hormone, lipid profile, uric acid, haemoglobin concentration and haematocrit value. Dialysis dose was assessed by urea reduction ratio and Kt/V. Plasma BNP, echocardiographic studies [for presence and geometric pattern of left ventricular hypertrophy, systolic and diastolic dysfunction and measurement of IVCD and right atrial pressure] and BIA were all done on two occasions 3 days apart: after termination of the end- of- the week HD session and before the start of the first session in the next week. Controls were subjected to assessment of clinical state, plasma BNP, and BIA. Both post- and pre- dialysis plasma BNP levels in patients were significantly higher when compared with the single plasma BNP reading in controls. Extracellular water [ECW] and its percent to total body water [ECW%] were higher in patients [both post- and pre- dialysis] compared to controls. The differences were statistically significant, except for post- dialysis ECW. The pre- dialysis values of mean velocity of circumferential fiber shortening, stroke volume, cardiac output, E/A ratio, Right atrial pressure, IVCD, ECW and ECW% were all significantly higher compared with the post- dialysis values. Left ventricular hypertrophy [LVH] was found in 47 [94%] patients, concentric LVH being the most frequent pattern [in 60%]. Pre- dialysis left ventricular mass index [LVMI] showed a statistically significant positive correlation with serum phosphorus, calcium phosphorus product, and plasma BNP. Pre- dialysis plasma BNP had a statistically significant negative correlation with pre- dialysis ejection fraction and fractional shortening. Volume overload plays a key role in the pathogenesis of LV hypertrophy and/or dysfunction in HD patients. BIA and IVCD are useful adjunctive measures for assessment of hydration status, keeping their limitations in mind. Plasma BNP concentrations have limited potential for the assessment of hydration status in HD patients, but it may be useful to have a baseline measure when the patient is at dry weight. Whether BNP can be used as a bedside test in the dialysis unit to measure adequacy of volume removal remains to be determined

sub-deltoid versus intra-peritoneal implantation of canine macro-capsule allogenic amniotic membrane; assessment of rejection and neo vascularization

Aim: pancreatic islets encapsulation is an alternative for using the immuno-suppression to prevent rejection. We used the amniotic membrane as a macro-capsulation. The main objective was to assess the re-vascularization of the allogenic amniotic membrane macro capsule in different sites to ensure the islet viability when using it for encapsulation

Methods: 30 amniotic membranes macro capsules were implanted in 15 dogs in two different sites; in the sub-deltoid shoulder region and in a piggy bag pouch in the recipient peritoneal cavity under general anesthesia. The capsules are removed after day 1, 3, 7, 10, 15, 21, 30 and 60 days. All the capsules are subjected to histo-pathological examination and immuno-histochemistry for neo-vascularization using VEGF, Factor VIII and CD4, CD8 for detection of rejection

Results: all specimens showed inflammation and congested blood vessels with no thrombosis or rejection. VEGF expression and Factor VIII were increased; neo-vascularization associated with vascular invasion but no inflammatory cells of acute rejection. CD4 and CD8 showed mild rejection

Conclusion: the implantation of the amniotic sac macro capsule was fixed nicely within the omental tissue and the sub-deltoid region with minimal or no sign of rejection. Our results should help the clinical application of using this capsule as an immuno-isolator for pancreatic islets transplantation

Impact of diagnostic laparoscopy on the management of gastric cancer

In this study, 50 patients with endosmotically proven gastric adencarcinoma were included. Ages of our patients ranged from 35 to 72 years [mean 54 years], with male predominance [male to female = 2.8:1]. The site of the tumours were in the antrum, body of the stomach, proximal 1/3 [20%],5 [10%], 4 [8%] and 2 [4%] cases, respectively. Ultrasonograhy, CT scan and laparoscopy were performed to patients. The sensitivity of the 3 modalities in detection of hepatic metastases were 26.7%, 46.7% and 86.7%, respectively, Also, the sensitivity of the 3 modalities in detection of peritoneal metastases were 33.3%, 16.7% and 83.3%, respectively. Laparoscopy avoided laparatomy in 18 [36%] of our patients We concluded that diagnostic laparasocopy is more accurate than other tests under investigations. It is of increasing imkportance in planning patient management with the use of non-operative methods of tumour palliation in patients with intraabdominal metastases

Longitudinal effect of health team education about geriatric health in Egypt

In Egypt, the number of people over 60 years old and over was 5.1% in the year 1986 census and is expected to increase to 7.7% by the year 2010 and 12.4% by the year 2025 [CAPMAS, 1996]. Increasing the number of elderly population added new health problems to the health authorities as the old people are more susceptible to many physical, mental, and social health problems [Kassem 2000]. the present study aimed to upgrade the knowledge, attitude and practice [KAP] of the PHC-providers towards the health needs and problems of the geriatric population in Egypt through implementation of health education course study [pre and post test] design. Analytical intervention study [pre and post test] was conducted in Five governorates in Egypt [Ismailia, Damietta, Al Dakahlia, Benisuef, and Assiuot]. Seven hundred and fifty PHC-providers, randomly selected from 5 govemorates in Egypt were invited to participate in the study, and after the pre-test they were engaged in the educational course [a self-directed learning package] on geriatric health needs and problems. The PHC-providers were 50 Physicians, 50 Nurses, and 50 Health educators from each governorate. A questionnaires of, 15 items for Physicians and Nurses and 17 items for Health educators based on current geriatric health needs and problems were used. The mean scores of knowledge, attitude and practice were calculated in pre and post tests for each group of physicians, nurses and health educators. A paired sample t-test was used to detect the differences between the means of knowledge, attitude and practice scores of pre-test and post-test. One way ANOVA test and Post Hoc test [Bonferroni test] were done to clarify the significant differences in [KAP] among the five govemorates at the pre-test and post-test and for the percentage of change between both tests. The SPSS [10.0] program was used for data analysis. The scores of knowledge, attitude and practice in the pre test were much lower than that in the post test scores and a statistical significant differences [P<0.05] were found among the participants PHC providers in all govemorates. Multiple comparisons [post Hoc tests] of knowledge, attitude and practice [KAP] of PHC providers in the five studied Govemorates revealed marked variations. 149. Tbis study displayed the important of ntinuing medical education, and also demonstrated the needs of PHC providers for medical education courses about geriatric health needs and problems

Surface to pography of adult Anchitrema sanguineum [Sansio,1894] Looss, 1899 and prosthodendrium [prosthodendrium] urna [looss, 1907] Dollfus, 1931 infecting bats in upper Egypt [Qena]

Anchitrema sanguineum and Prosthodendrium [Prosthodendrium] urna are two digenean trematodes infecting many species of bats in Egypt. The surface topography of them was studied by scanning electron microscopy. The examination of A. sanguineum revealed the presence of posteriorly directed broad-base spines all over the body. The oral sucker is bordered by several small sucker-like papillae and few irregularly distributed pores. The ventral sucker is smaller than the oral one and surrounded by several papillae. In P. [P.] urna, the body is covered with simple, spines posteriorly directed. The oral sucker has few papillae and its tegumental rim is slightly elevated. The ventral sucker is slightly larger than the oral one

Effect of some lipolytic enzymes on the ripening indices of Roquefort cheese

Roquefort cheese was made from a mixture of fresh cow's and buffalo's milk [25% and 75% of each, respectively] and considered as the control sample. Also, 6 treatments of Roquefort cheese were manufactured by adding 3 types of commercial lipolytic enzymes Capalase K, Italase C and Piccantase A to cheese curd at 2 levels [0.05 and 0.025%]. The enzyme treated cheeses had higher values of total volatile fatty acids [TVFA] and total carbonyl compounds [TCC] than the control. Fungal lipase Piccantase A was more effective in developing TVFA and TCC than animal lipase Capalase K and Italase C. The addition of high level of lipase resulted in more pronounced formation of TVFA, and less pronounced TCC in the resultant cheeses. All lipase treated cheese had higher soluble protein content than that in the control during the early stage of ripening, however, at later stages, a contrary behavior appeared. Also, animal lipase treated cheese, especially, Capalase K was more effective concerning of release tyrosine and tryptophan than fungal treated cheese

Effect of alkalinized lidocaine on onset and duration of epidural anesthesia in orthopedic surgery

Forty adult patients having epidural anesthesia for lower extremity orthopedic procedures were assigned to four groups. Group I patients were given a commercially prepared 2% lidocaine solution whose pH was 6.3. Group II patients were given commercially prepared 2% lidocaine solution plus ImEq [1m1] NaHCO3 per 10 ml of lidocaine whose pH was 6.8. Group III patients received the commercial solution of 2% lidocaine plus 3 ml molar NaHCO3 [3mEq] added per 10 ml lidocaine, the solution pH was 7.088. Group IV patients were given a commercially prepared 2% lidocaine solution plus 7 ml molar NaHCO3 [7mEq] freshly added per 10 ml anesthetic solution. The onset of epidural anesthesia was accelerated by alkalinization of lidocaine. Group IV had the fastest mean onset time. The duration of analgesia was significantly longer in the pH adjusted groups. There was a significant decrease in MABP from the preoperative value in all the four groups, and the baseline of systolic and diastolic blood pressure did not differ in the alkalinized and control groups

Effect of hypotensive technique using sodium nltroprusslde on hemodynamlc, acid base balance and serum cortisol level in major orthopedic surgery

This study was carried out on 20 healthy adult patients who were undergone major orthopedic surgery. Patients were premedicated by atropine sulphate and pethidine hydrochloride. Anaesthesia was induced by thiopentone sodium. Cuffed endotracheal tube was inserted after succinyl choline injection. Anaesthesia was maintained by nitrous oxide, oxygen, pancuronium and controlled ventilation. After stabilization of anaesthesia sodium nitroprusside 0.01% in 5% dextrose was infused at a rate of 20-40 drops/min.to maintain systolic blood pressure around 80 mmHg. It was found that the heart rate increased significantly and mean arterial pressure decreased significantly during infusion. The serum cortisol level was significantly increased, Pa02 was significantly decreased with a significant increase in Pac02. There were no significant change in PH, standard bicarbonate and base excess. At the end of operation, all the studied parameters returned to their preoperative values without any complication or residual effects

Effects of labetalol and diltiazem on the intraocular pressure responses to tracheal intubation

The effects of labetalol and diltiazem on intraocular pressure [IOP] during laryngoscopy and endotracheal intubation were investigated in 30 patients, scheduled for elective extraocular ophthalmic operations. Anaesthesia was induced by thiopentone Na followed by succinylcholine to facilitate tracheal intubation, anaesthesia was maintained by oxygen, and Halothane 1-2% manual inflation of the lungs, then spontaneous respiration. Pretreatment with labetalol [0.2 mg/Kg] 4 minutes before intubation lead to attenuation of the mean heart rate [MHR], and mean arterial pressure [MAP] changes, although these changes were still significant [t=6.79, 8.84]. Pretreatment with diltiazem [0.3 mg/Kg] 2 minutes before intubation lead to attenuation of the MHR, and MAP. These changes were still significant [t=5.58, 7.41]. The attenuation of MHR, MAP were less in labetal group than in diltiazem group. Both drugs produced a significant reduction in IOP at intubation, 2.5 and 5 minutes after intubation in relation to the preoperative value. The decrease in IOP was less in labetalol group than in diltiazem group. In conclusion, single dose of IV labetalol and diltiazem before intubation is a practical and effective method of attenuating hypertension, tachycardia and ocular hypertension in response to tracheal intubation