role of sentinel lymph-node biopsy in managing lip squamous cell carcinoma patients without clinical evidence of nodal metastasis

Squamous cell carcinoma [SCC] of the lip is a common oral malignancy. Lymph node metastasis occurs lately in the natural history of the disease but it is associated with poor outcome. Sentinel lymph node biopsy [SLNB] is an option that determines the potentially affected lymph nodes especially in clinically negative-node patients. The study aims to determine the feasibility of SLNB as a reliable staging tool in N0 stage lip SCC patients. Eighteen patients with N0 stage lip SCC were enrolled in the study. They were subjected to SLNB using the injection of the radiocolloid material and the Blue dye. The procedure was followed by bilateral supraomohyoid neck dissection in all patients. The pathological results of the harvested sentinel lymph nodes [SLNs] were compared with that of the dissection specimen in each patient. The patent blue dye could localize the SLN in 15/18 patients whilst the radioisotope scanning could successfully identify it in 17/18 patents. On average, 1.8 SLNs were harvested from each patient. Two of seventeen patients with identified SLNs [11.8%] have positive nodal metastases. One of them has two SLNs and the other has only one. No false negativity was reported in the study as all the excised SLNs reflected correctly the status of the lymph node basin. Sentinel lymphadenectomy is a safe and feasible procedure in managing neck of patients with node-negative lip SCC. It can accurately stage these patients

Radiofrequency ablation combined with percutaneous ethanol injection in patients with hepatocellular carcinoma

Hepatocellular carcinoma [HCC] is a major burden on health-care systems worldwide. Although radiofrequency ablation [RFA] is currently considered the best technique for coagulative necrosis, the superiority of concomitant use of RFA and percutaneous ethanol injection [PEI] needs to be determined. The study was designed to compare efficacy, safety and rate of survival of patients with HCC assigned to receive combined PEI-RFA versus RFA alone and versus PEI alone. This 3-year study enrolled 90 cirrhotic patients with HCC [Child's class A or B, but not class C]. They were randomly assigned for either PEI-RFA [group I], RFA alone [group II] or PEI alone [group III]. The primary end point was ablation of the tumour. The secondary end point was rate of survival and recurrence. After the first session, complete ablation was significantly higher in the combination group [87.9%] compared with the RFA group [54.54%]. After the second session, complete ablation was achieved in 97.0% of the combination group and in 84.8% of the RFA group. Regarding the PEI group, 75% had complete ablation, whereas 25% had partial ablation after multiple sessions. The survival rate, 1.5 years later, was significantly higher in group I [86.7%] compared with group III [63.3%]. The overall incidence of serious adverse events was nil. Combined treatment is superior to RFA alone and to PEI alone, in safety and efficacy in patients with HCC

Study of the relationship between serum cortisol and dehydroepiandrosterone sulfate [DHEAS] levels and degree of cognitive impairment in the aged with Alzheimer's disease and vascular dementia

Dementia is the general term that refers to the decline of mental abilities including memory and other thinking skills while a person is alert and awake. Dementia is considered a late-life disease because it tends to develop mostly in elderly people. The two most common forms of dementia in older people are Alzheimer's disease and multi-infarct dementia [vascular dementia]. Alzheimer's disease accounts for around 60% of all cases of dementia, while vascular dementia accounts for up to 20% of all cases of dementia. Cortisol and dehydroepiandrosterone [DHEA] and its sulfate ester [DHEAS] are adrenal steroid hormones. These hormones have been suggested to have a role in many aging related diseases and perhaps in aging itself. These hormones have been shown to multiple effects on the function of the hippocampus, which is involved in learning and memory processes. These adrenal steroids may thus be associated with cognitive impairment, which is a major symptom of dementia. To study the relationship between serum cortisol and dehydroepiandroesterone sulfate [DHEAS] levels and degree of cognitive impairment in the aged persons with Alzheimer's disease and vascular dementia. Study was conducted on 30 elderly demented patients selected randomly from the general population. Their ages ranged from 52 to 85 years with a mean of 68.5 years and they were 13 males and 17 females, they were divided into two groups; group I: 15 patients [7 males and 8 females] with probable Alzheimer's disease diagnosed according to diagnostic and statistical manual of mental disorder [DSM- IV criteria], group II: 15 patients [6 males and 9 females] with vascular dementia, group III consisted of 15 elderly healthy volunteers, matched for age and sex with no evidence of dementia have been served as control group. All were submitted to morning collection of blood for determination of the plasma cortisol and DHEAS measured by chemiilluminescence. The 30 points Mini Mental State Examination [MMSE] was used to assess cognition. The present study firstly showed that mean serum cortisol level increase while mean serum DHEAS level decrease with age and mean serum cortisol levels was higher in both AD and VD than normal controls while mean serum DHEAS levels in both AD and VD] was lower than normal controls. Gender did not play a significant role in variability of cortisol and DHEAS. Also, most of Alzheimer's disease patients were none educated in comparison to vascular dementia patients and this indicates that a low level of education has been associated with a greater risk of developing AD. There is an association between serum cortisol and DHEAS levels and severity and duration of dementia and cognitive decline in demented patients. There is a strong association between cortisol and DHEAS and prevalence of dementia in the elderly. There was a trend of high serum cortisol level in males and high serum DHEAS level in females but, gender did not play a significant role in variability of cortisol and DHEAS. Low level of education has been associated with a greater risk of developing dementia and there is association between serum cortisol and serum DHEAS levels and duration and severity of dementia

Endoscopic thoracic sympathectomy in the treatment of severe Raynaud's disease

To evaluate the results of endoscopic thoracic sympathectomy in severe cases of Raynaud's disease after medical treatment failure, with particular reference to the complications, safety and the effectiveness. We performed 22 endoscopic thoracic sympathectomies in 16 patients [12 males and 4 females] with severe Raynaud's disease after medical treatment failure. Their ages varies between 23 to 41 years. 10 patients underwent a unilateral endoscopic thoracic sympathectomy procedures, whereas 6 patients with bilateral symptoms underwent staged endoscopic thoracic procedures several weeks a part. Of the total 22 affected hands: 4 [18.18%] had severe intractable hand pain; 10 [45.45%] had trophic ulcers associated with terminal digital necrosis and 8 [36.36%] had gangrene of finger tips. All patients were evaluated clinically by history taking and physical examination as well as routine laboratory and radiological screening tests. All patients were carefully counseled on the potential complications of the procedure. We performed 22 endoscopic thoracic sympathectomy procedures [10 unilateral and 6 bilateral]. The mean post operative hospital stay was 1 day. The post-operative follow up ranged between 3 and 12 months with a mean of 6 months as regard to pain relief, healing of ulcers and spontaneous separation of gangrenous parts. There was no mortality and no serious morbidity detected in this study. The 4 hands [18.18%] with severe intractable hand pain were improved completely. Of the 10 hands [45.45%] with trophic ulcers associated with terminal digital necrosis, complete healing of ulcers as well as trophic lesions occurred in 8 of them [36.36%] while no healing detected in the remaining 2 hands [9%]. Of the 8 hands [36.36%] with gangrene of finger tips complete improvement of lesions and clear demarcation of the gangrenous parts occurred in 6 hands [27.27%] and the remaining 2 hands [9%] required later amputation at one or more distal inter-phalyngeal joint. Horner's syndrome occurred in 2 patients [12.5%] resolved in the first patient at 4 weeks and in the second patient at 4 months. Intercostal neuralgia detected in 2 patients. In one of them it appeared immediately after the operation, but in the 2nd it appeared 3 weeks later. The postoperative chest radiograms showed only a slight residual pneumothorax in one patient [6.25%] and non in the remaining cases. Endoscopic thoracic sympathectomy is safe-easy, reliable and effective way in the treatment of patients with severe Raynaud's disease after medical treatment failure

Outcome after distal revascularization and interval ligation [DRIL] for the tratment of dialysis-associated steal synrome

The purpose of this study was to determine the efficacy and durability of the distal revascularization and interval ligation [DRIL] procedure in relieving hand ischemia and in maintianing access patency in the setting of hemodialysis access-induced ischemia. The traditional operative treatment for ischemic steal intervention syndrome related to a functioning dialysis access arterio-venous fistula [A/V fistula] usually result in inconsistent limb salvage, loss of access function or both. This study describes the "DRIL" technique for correction of ischemic steal syndrome occurring as a complication of A/V fistulas. The study was conducted on 20 patients with a functioning upper extremity A/V fistulas associated with ischemic steal syndrome and treated by "DRIL" procedure at El Hussein University Hospital, Vascular Surgical Unit. The indications for surgery were ischemic hand pain in 9 patients [45%], tissue loss in 7 patients [35%], loss of neurologic function in 2 patients [10%] and pain during hemodialysis in 2 patients [10%]. The surgical technique used consisted of ligation of the brachial artery distal to the inflow anastomosis to the fistula and bypass graft from the brachial artery 5cm above the fistula by end to side anastomosis to a point just distal to the A/V anastomosis. The bypass material used in these patients was synthetic polytetrafluroethylene grafts [PTFE grafts] 6 mm in diameter. Of total 20 patients with ischemic steal syndrome affecting the upper extremities occurred after A/V fistulas treated by "DRIL" procedure, their ischemic symptoms improved immediately after surgery in 18 patients [90%]. The primary patency of the brachial artery bypass was 90% and the patency of A/V fistulas was 85% at 1 year. The "DRIL" technique is effective in alleviating symptoms of ischemic steal syndrome and preserving the hemodialysis access. It is considered as: the procedure of choice for correction of ischemic steal syndrome induced by A/V fistulas

Renovascular disease and cognitive impairment in elderly: a novel risk maker

Renal artery stenosis is most commonly due to either fibromuscular dysplasia or atherosclerosis. Atherosclerosis accounts for 90 percent of cases of renal-artery stenosis. Renal-artery stenosis may occur alone [isolated anatomical renal-artery stenosis] or in association with hypertension, renal insufficiency [ischemic nephropathy], or both. The aim of the present work was to study the role of renovascular disease as a novel risk marker of cognitive impairment in elderly. The study included 80 patients divided into 4 groups: Group 1: 20 cases of elderly patients above 65 years and suffering from grade 2 or 3 CKD. Group II: 20 cases aged 20-40 years and suffering from grade 2 or 3 CKD. Group III: 20 healthy controls aged above 65 years. Group IV: 20 healthy controls aged 20-40. They had been evaluated for their: Clinical condition, including physical examination and history taking, ECG, BMI estimation, MMMS examination, Routine investigation including: complete blood picture with differential counting, bleeding and coagulation time, liver functions tests, lipid profile, fasting and post-prandial plasma glucose, renal function tests, complete urine analysis, 24-hours proteins in urine, assessment of glomerular filtration rate [GFR] by MDRD and creatinine clearance and in addition specific laboratory investigations were done including: Serum CRP using turbidimetry, Microalbuminurea using turbidimetry, v-WF Ag by ELISA, s-ICAM. By ELISA and Duplex study was performed on carotid and renal arteries. The results of the present study showed that there was a significant increase in the BMI in groups land II in comparison to group III which was higher than group IV. The MMMS test was significantly lower in group I in comparison to groups II and III which were in turn significantly lower than group IV. Hemoglobin was significantly lower in groups I and II than group III and IV. Platelets count was significantly lower in groups I and II than group III which was also significantly lower than group IV. Creatinine clearance was significantly lower in groups I and II than in groups III and IV vWF levels were significantly lower in groups land II than in groups III and IV s.ICAM I was significantly higher in groups I and II compared to groups Ill and IV. CRP was significantly increased in groups I and II in comparison to groups III and IV Carotid plaque score was significantly higher in group I than group II which was higher than groups III. Resistive index was significantly lower in groups land II than in groups III and IV Acceleration index was significantly lower in groups I and II than in groups III and IV. A significant positive correlation was found between age and urinary albumin, CRP, and s.ICAM. A significant negative correlation between age and cereatinine clearance and MDRD in groups I, II and III. Reno vascular disease is common in elderly and the most important cause is atherosclerosis in this group of patients. There are many risk factors for cognitive impairment in patients suffering from renovascular disease and most of them are correctable. Renovascular disease can be considered as a novel risk factor of cognitive impairment through many interacting mechanisms

Doppler ultrasonogragshic evaluation of portal circulation in patients of portal hypertension treated by splenectomy, devascularization and oesophageal transection

The portal hypertension with bleeding oesophageal varicose is a major medical problem in Egypt, the risk of death from 10% to 40% in these patients due to massive secondary heamorrhage. Splenectomy, Devascularization and Oesophageal Transection is one of the most important lines was used to treatment of bleeding oesophageal varices in patients suffering from portal hypertension particularly after failure of upper gastrointestinal tract endoscopy. The doppler Ultrasonography is simple,non invasive investigation to determine the blood vessels diameter, direction of blood flow, blood volume and degree of vascular congestion. The portal circulation evaluated pre and post operative by doppler Ultrasonography in 50 patients [41 males and 9 females] suffering from portal hypertension and oesophageal varices [Child A or Child B] and treated by Splenectomy, Devascularization and Oesophageal Transection to determine the degree of correction of the hemodynamic state. The portal vein diameter decreased after the operation by 1.5 mm, cross sectional area by 0.42 cm while its flow velocity increased after the operation by 3.22 ' cm/sec Its flow volume increased after the operation by 49.2ml/min and its congestive index decreased after the operation by 0.07cm/sec.So the operation is effective in the treatment of portal hypertension and oesophageal varices as it improves liver blood flow and liver perfusion. It also eradicated oesophageal varices

Risk of acute otitis media in relation to acute bronchiolitis in children

A prospective study was carried out to evaluate the prevalence and the etiology of acute otitis media [AOM] In children with acute bronchiolitis. Also to determine whether AOM occurring with acute bronchiolitis "Which mainly due to respiratory syncytial virus [RSV]" is accompanied with another pathogens "which usually found in the middle ear aspirate [MEA]" or not. Thirty-six children with acute bronchiolitis aged 3 to 18 months that were admitted to pediatrics department, El-Minia University Hospital during the period from September 2005 to December 2005 were included In this study. In patients with AOM at entry or developed AOM within 14 days, Gram-stained smears, bacterial cultures, and enzyme-linked immunosorbent assay [ELISA] were performed on middle-ear aspirates to detect the presence of bacterial pathogens and RSV respectively. Twenty children [55.6%] with acute bronchiolitis had AOM at entry or developed AOM within 14 days, 9 patients [25%] had developed otitis media with effusion, and only 7 patients [19.4%] remained free of both AOM and otitis media with effusion, throughout the 2-weeks observation period. Of 27 middle-ear aspirates [13 unilateral and 7 bilateral], bacterial pathogens were isolated in 23 [85%] [10 bacteria alone "37%" and 13 mixed bacteria and RSV "48%"], RSV was identified in 15 [55.5%] of middle ear aspirates [mixed with bacteria in 13 and RSV alone in 2 cases [7.5%]], so RSV was identified in 15 of 20 patients [75%] with AOM. Streptococcus pneumoniae was isolated in 11 middle ear aspirates, Haemophilus influenza in 6, Moraxella catarrhalis in 4, Staphylococcus aureus in 2, Streptococcus pyogenes in one aspirate and Pseudomonas aeruginosa in one aspirate only. Of 20 cases of AOM, 15 [75%] responded clinically to usual dose of antibiotic [Amoxicillin and clavulanic acid and/or Cefotaxime]. Finally we concluded that bacterial AOM is a complication In most children with acute bronchiolitis. Streptococcus pneumoniae and Haemophilus influenza were the commonest organisms isolated from middle ear aspirate. RSV is identified in most cases of acute otitis media [75%] and mixed with bacterial pathogens. Accordingly, in patients with acute bronchiolitis and associated AOM, antimicrobial treatment is indicated

Evaluation of 32 F5 families derived from two interspecific Cotton crosses for late planting

32 F 5 Families derived from two interspecific cotton crosses, three parental lines and two check varieties were evaluated in season 2003 under three planting dates March 24, April 22 and May 20 at the Experimental Farm of the National Research Centre at Shalakan, Kalubia Governorate, Egypt. This was done in an attempt to; select short season cotton genotypes suitable for late cultivation after winter crops [such as bean or wheat] in Southern Delta and Upper Egypt and, to study the association between all studied traits and to identify the superior genotypes using classical selection index. Results obtained indicated that planting dates mean squares were found to be highly significant for all traits studied except position of first fruiting node. Genotypes mean squares were found to be highly significant for all traits evaluated under the three sowing dates and combined data. Combined analysis over three planting dates revealed highly significant genotypes x environment interactions for all traits except position of the first fruiting node. The average number of days to first flower for all populations studied were significantly decreased as planting date was delayed.Correlation coefficients between all possible pairs of traits studied were different in magnitudes from one planting date to another, also, the genotypic correlations were mostly higher in magnitudes than the phenotypic correlations. Path analysis revealed that boll number / plant had the highest direct effect on seed cotton yield followed by boll weight at the three sowing dates. Estimated value of selection index indicated that the ranking of cotton genotypes are not identical in the three sowing dates. It could be concluded that four lines [1,7, 14 and 27] selected in the late planting date may be exploited in breeding early cotton genotypes which tolerate heat stress in squaring, flowering and boll formation periods

Increased risk of ischemic heart disease in rheumatoid arthritis patients: possible methotrexate inducted hyperhomocysteinemia

A retrospective case-control study including 69 rheumatoid arthritis [RA] patients was conducted. They were all diagnosed and receiving a steady treatment regimen for the last three years at least. They all met the American College of Rheumatology [ACR] criteria for the classification of RA17. They were classified into three groups. In addition, a control group of 23 osteoarthritis patients was also included. The study concluded that the plasma levels of homocysteine appear to be increased in RA. However, this increase appears to be of a minor implication in the development of IHD, at least in the early years of the disease. The potent suppressors of inflammation, particularly MTX supplemented with folic acid, decrease the risk of IHD in rheumatoid patients

Productivity and quality of early matured light and dark color roselle varieties under bio-organic farming compared to the usual chemical fertilization treatment

A field trial was achieved during the two successive seasons of 2001 and 2002 at the Experimental Farm of Agriculture and Production of Medicinal and Aromatic Plants of National Research Centre, Giza, to investigate the growth productivity and quality of light and dark color roselle varieties cultivated under bio-organic farming in comparison with that received full dose of chemical fertilizers. The light color variety overcame the dark one regarding branches number/plant, fruits number/plant, fruits fresh weight/plant, sepals fresh and dry weights/plant, seeds dry weight/plant, fixed oil percent and estimated yields of dry sepals and seeds. While the dark color variety was superior in anthocyanin content. The biofertilizers as such or combined with biogas manure augmented each of fruits number/plant, sepals fresh and dry weights/plant in comparison with the positive control [100% NPK]. The percentage of increases ranged from 8.11 to 60.32, 4.70 to 43.10 and 7.8 to 45.5 consecutively for the previously mentioned parameters. The most prominent increases were induced due to the application of Azospirillum and Rhodotorula combined with either half or full dose of biogas manure especially for anthocyanin content and fixed oil percent, the percentage of increases over the positive control reached 3.25, 6.69, 10.60 and 12.10 respectively

Etiology of chronic dysphonia in children that attend E.N.T. clinic in Minia University Hospital

Our study was done to study the etiology of chronic hoarseness of voice in children. The study was done at E.N.T. clinic at Minia University hospital, 50 children, were included in the study, they complained of chronic hoarseness of voice and didn't have any medical diseases. The age range from 3 to 12 years, with, 40 boys and 10 girls. Complete E.N.T. examination was done with indirect laryrgoscopy, rigid laryngoscopy and vediostroboscopy. The pathological lesions that encountered are: Vocal nodules 68%, Laryngeal web 8% multiple papilloma 8%, chronic laryngitis [hypertrophied vocal cords] 6%, vocal cord paralysis 4%, vocal fold cyst 4%, and Laryrgoscleroma 2%. The common cause of chronic hoarseness of voice in children is vocal nodule that can be treated by voice therapy efficiently

Diclofenac sodium versus paracetamol preoperatively for tonsillectomy: effects on pain and haemostasis

Sixty children and adolescents [6-16 y] were randomized in this study to receive rectal paracetamol 13-20 mg kg-1 [group I] or diclofenac sodium 0.65-1.0 mg kg-1 [group II] preoperatively. Pain was evaluated postoperatively by means of the visual analogue scale and by recording the use of pethidine for rescue analgesia. Perioperative blood loss was estimated from The measured intraoperative blood loss, bleeding time, use of drugs to achieve haemostasis and the incidence of reoperations. Surgical duration was prolonged and blood loss was more in group II than those in group I, but nonsignificant. Bleeding time was prolonged [but within the normal range] in group II than group I. The postoperative pain was significantly less with diclofenac [group II] than paracetamol [group I]. This was clear from time from extubation to 1st pethidine dose [34 + 15 in group II vs. 25 + 11 in group I]. Pethidine consumption was 21.7 +/- 7.4 in group III vs. 29.5 +/- 8.1 group I. Desmopressine use was more with diclofenac and vomiting was more in group II

Correlation between permeability glycoprotein expression and tumor grade in squamous cell carcinoma of the head and neck

One established mechanism of multidrug resistance [MDR] in cancer chemotherapy is elevated expression of permeability-glycoprotein [Pgp], that functions as an efflux pump which excretes lipophilic chemotherapeutic drugs from cancer cells. The expression of Pgp by immunohistochemistry was examined in tissue specimens taken from 60 patients with head and neck squamous cell carcinomas using a monoclonal antibody, which is specific to human MDR1 gene product. The results showed that 80% of the tumors were stained by Pgp antibody with a statistically significant correlation between the degree of expression of Pgp and the degree of differentiation. The results showed also a wide variation in Pgp expression and high expression of Pgp in more undifferentiated tumors. So, Pgp can be used as a marker for diagnostic and prognostic value in the head and neck cancer

Transtympanic iontophoresis for treatment of secretary otitis media in children

This study was designed to compare the results of transtympanic iontophoresis of two different concentrations of dexamethasone into the middle ear to evaluate iontophoresis as a new method in management of SOM. The study group consisted of 70 patients [140 ears]. The mean age was 4.8 years + 1.39. All the patients had bilateral tympanogram type B, and MHL >20 dB at the start of the study. The patients were classified into the following groups: Group 1 [10 patients received saline solution iontophoresis in one ear/6 trials], group 2 [a- 30 patients received 0.4% dexamethasone in one ear/6 trials and b- 10 out of the 30 patients who continued iontophoresis for 10 trials], and group 3 [a- 30 patients received 0.8% dexamethasone in one ear/6 trials and b- 10 out of the 30 patients who continued iontophoresis for 10 trials]. All the patients received oral amoxicillin 40 g/kg/day/10 days. It started at the first day of iontophoresis. All received iontophoresis in one ear for 6 trials. Patients of groups 2b and 3b continued 10 trials. Each iontophoresis trials lasted 16 minutes. The iontophoresis was performed 3 times/week. The diagnosis was confirmed before and after iontophoresis by otoscopic examination and Siegle's pneumatic otoscopy, examination with operating microscope, hearing tests [pure tone audiometry, speech reception threshold [SRT] and tympanometry]. The tympanoaudiometric criteria for improvement were a gain in MHL of >15 db, or a change in tympanogram type from B to either A or Cl. The study showed a statistically significant gain in the iontophoresis ears when compared to the ears on the other side or those received saline [control group]. The mean gain in MHL was 11.43 dB in group 2A [0.4% dexamethasone] and 13.97 dB in group 3A [0.8% dexamethasone], compared to 6.5 dB and 6.6 dB on the other ears, respectively, or to 6 dB gain of saline iontophoresis ears. The study showed also a high correlation between SRT and MHL, which means that SRT can be used to monitor the progress of hearing instead of pure tone audiometry in young and uncooperative children. Iontophoresis of dexamethasone improved the tympanometric values of the treated ears. 26.7% of ears treated with 0.4% dexamethasone and 53.3% of ears treated with 0.8% dexamethasone have changed from type B to either A or Cl, in comparison to 10% and 13.3% in the other ears, respectively. The study showed also that increasing the concentration of dexamethasone from 0.4% to 0.8% has improved the audiometric and tympanometric results. The mean MHL gain was 13.97 dB in 0.8% group have changed to A or Cl, in comparison to 26.7% in 0.4% group. This effect is obvious when the tympanoaudiometric results of both groups were compared. While, the tympanoaudiometric results of group 0.4% were statistically insignificant, those of 0.8% group were found to be statistically significant. This showed clearly that increasing the concentration increases the improvement tympanoaudiometric results of SOM. Increasing the number of iontophoresis trials was shown to increase the improvement in the mean MFIL gain. In group 2B [10 trials 0.4% dexamethasone], the overall mean MHL gain alter the 10 trials was 17.3 dB compared to 9.4 dB after the initial six trials. In group 3B [10 trials 0.8% dexamethasone], the results were 21 dB and 14.5 dB, respectively. This increase in the mean MHL gain was statistically significant in both the group 2B and 3B. While, these patients had a statistically significant gain in the mean MHL, yet the improvement in their tympanometric results was lower than that of the patients who got 6 trials only

Gastrointestinal complication of NSAIDs therapy: the safest choice, risk factors, and avoidance

As, combination of misoprostol or PPIs plus NSAIDs or use of safer NSAIDs, including COX-2 inhibitors, may reduce the gastrointestinal complication associated with NSAIDs therapy. We aimed to demonstrate: the safest drug, risk factors, and plan of avoidance Fifty patients with rheumatological and cardiovascular indications for NSAIDs classified into: twenty patients treated by NSAIDs alone, fifteen patients treated by NSAIDs and proton pump inhibitors [used for a week every month of treatment course], and fifteen patients treated by anti COX2. Involved in this study, subjected to careful clinical examinations, upper endoscopies, with stress on the possible risk factors exaggerate gastrointestinal complication of NSAIDs. In hypertension, bronchospasm, and allergies there were no significant difference between patients treated by NSAIDs, NSAIDs plus PPIs, or Anti COX2. Heartburn was; 50%, 26.6%, and 33.3% in group 1, 2, and 3 respectively, GIT hemorrhage; 25%, 13%, and 6.6 for group 1, 2, and 3 respectively. With observation of higher percentage of heartburn, and GIT hemorrhage among patients treated by NSAIDs alone which was double this percentages observed among group treated by NSAIDs plus PPIs [addition of PPIs reduce GIT complications to the half]. However patients treated by Anti COX2 shown reduction in GIT manifestation by three folds. Only one case of death among group 1. In endoscopic examination there were noticed higher percentages of oesophagitis, gastritis, and peptic ulcer among patients treated by NSAIDs alone which were double this percentages noticed among group treated by NSAIDs plus PPIs [addition of PPIs reduce HCL related complications to the half]. However, deudenitis, cardiac incompetent, congestive gastropathy, and abnormal pylorus shown no significant difference between group 1, and 2. Patients treated by Anti COX2 shown reduction in GIT manifestation by three folds. Addition of PPIs with NSAIDs reduces GIT complications to the half as PPIs reduce HCL related complications. However, Patients treated by Anti COX2 shown reduction in GIT manifestation and HCL related complications by three folds. By further economical study for cost benefit from combined therapy versus Anti COX2

Effect of smoking on liver histological activity in chronic hepatitis C

Aims and methods: Toexaminetheassociation between smoking and histological liver lesions in chronic hepatitis C, we studied 50 patients [mean age 45.9 years] with laboratory proven chronic hepatitis C [HCV Ab. by ELISA]. Daily tobacco consumption before liver biopsy was recorded as the number of cigarettes smoked daily. The duration of tobacco consumption was recorded by years of smoking. Liver biopsy specimens were graded for histological activity and fibrosis according to the METAVIR scoring system

Results: the proportion of patients with mild, moderate ,and marked histological activity [,Al,A2,and A3] increased gradually with daily tobacco consumption: from 16 patients with marked histological activity grade A3 : '5[50% of heavey smokers >15 cig/day] comparing to, 7 [3 1. 9 % of 1-15 cig/days]and4[22.2% with no history of smoking] however, 17 patients of grade A2 moderate histological activity:6[33.3% non smokers],7[31.9% smoked 1 -15cig/day],and 4[40% smoked>15cig/day],lastly from 17patients of grade Al mild histological activity:8[44.'4%of non smokers],8[36.4% of 1-15 cig/day smokers],and l[10%of >15cig/day smokers][p<0.05].which mean ;a significance difference with smoking groups rather than other in grading of histological activity

Conclusion: This study suggests that smoking could aggravate the histological activity of chronic hepatitis C and that patients with chronic hepatitis C virus infection should be advised to stop smoking.Abbreviations: HCV, hepatitis C virus; CCL4; carbon tetrachloride; HBs Ag, Hepatitis B surface antigen

Neonatal septicemia in Al - Jahra hospital, Kuwait: Etiologic agents and antibiotic sensitivity pattems

Neonatal septicemia [NNS] occurs frequently in neonatal intensive care units [NICU] and is often associated with high morbidity and mortality. However, information on its incidence and causative agents in Kuwait hospitals is scanty. To investigate the bacterial causative agents of NNS in a NICU and their susceptibility patterns to antimicrobial agents. Between May 1 and December 31, 1996, blood cultures were performed on all admissions to the Neonatal Unit, Al-Jahra Hospital, Kuwait, with the Bactec 9240 instrument [Becton Dickinson, USA]. Microorganisms were identified by cultural characteristics, Gram stain and biochemical profiles and antimicrobial susceptibility patterns performed by disk diffusion and by measuring their minimum inhibitory concentrations. From a total of 995 neonates admitted to the neonatal unit during the study period, 117 [11.7%] had positive blood cultures. Eighty-seven [8.7%] of the neonates had confirmed septicemia. Gram-positive organisms were cultured from 65 [75%] and gram-negative organisms from 22 [25%] of them. The most frequent organisms isolated were Staphylococcus epidermidis [34%], Streptococcus viridans [28%] and Candida species [14%]. Resistance to ampicillin and cephalosporins was detected in both gram-positive and gram-negative organisms associated with sepsis. Conclusions: The study identified the common bacterial pathogens associated with NNS in a neonatal unit, their susceptibility patterns to antimicrobial agents and emphasized the importance of understanding local epidemiology of NNS in formulating an antibiotic policy

Lead and antioxidant vitamins levels in pregnancy induced hypertension and fetal growth retardation

This study was conducted to determine the relationship between maternal blood lead level and the antioxidant vitamins in a step to understand the mechanism of lead action and its possible influence on blood pressure and fetal growth. Ninety-six women were included in this study, 23 normal pregnant women [group I] as controls, 31 patients with fetal growth retardation [FGR] [group II] and 42 patients with pregnancy induced hypertension [PIH] [group III]. The results revealed that the maternal blood lead level was significantly higher in FGR and PIH groups compared with normal control. In contrast, the levels of vitamins E and C were significantly lower in both FGR and PIH groups. In addition, there was significant negative correlation between maternal blood level and the antioxidant vitamins in both FGR and PIH groups. It was concluded that high blood lead levels in pregnancy are associated with low vitamins E and C concentrations

Free oxygen padicals activity, some antioxidants and soluble intercellular adhesion molecule-1 in plasma of insulin dependent diabetics

The lipid peroxide malondialdehyde [MDA], a marker of free oxygen radicals activity [FORs], together with the three potent antioxidants, vitamin E, vitamin C and selenium as well as soluble intercellular adhesion molecule-1 [sICAM-1] were measured in plasma of 40 insulin dependent diabetic patients. Twenty age and sex matched healthy subjects were also studied as a control group. Plasma levels of the three antioxidants were significantly decreased in poorly controlled diabetic cases when compared to well controlled diabetics and controls. Also, vitamin E and selenium decreased significantly in well controlled diabetics compared to control group. Meanwhile, plasma level of both MDA and sICAM-1 increased significantly in diabetic patients compared to controls. In conclusion, FORs generation increased significantly in IDDM, while there was deranged antioxidant status in diabetics. Also, sICAM-1 levels increased significantly in diabetics and all these effects were more pronounced in poorly controlled cases