Utilidad de la quimioterapia con corticoides en la reducción de volumen de las lesiones en fetos con malformación congénita de la vía aérea pulmonar (MCVAP): serie de casos / Usefulness of chemotherapy with corticosteroids in reducing the volume of the lesions in fetuses with congenital pulmonary airway malformation (MCVAP): case series

RESUMEN OBJETIVO: el propósito es describir el efecto de los corticoides prenatales en la malformación congénita de la vía aérea pulmonar (MCVAP) mediante la evaluación secuencial del CVR y mostrar la experiencia en nuestro centro de terapia fetal. MATERIALES Y MÉTODOS: serie de casos en la cual se incluyeron ocho pacientes del Hospital de San José; con diagnóstico de MCVAP; se evaluó edad gestacional, el CVR (longitud x largo x ancho, en cms de la masa) x 0.523/circunferencia cefálica) como factor pronóstico, la desviación mediastínica, la presencia de hidrops, el tipo de MCVAP y la localización. Se aplicó betametasona a dosis de inducción de madurez pulmonar fetal. Se realizó la medición del CVR pre y pos tratamiento. Los datos obtenidos fueron analizados mediante el software estadístico SPSS (Versión 11.0 SPSS Inc. Chicago, IL). Se utilizaron la prueba Wilcoxon y el índice de correlación de Spearman según el caso. Un valor de p<0.05 se consideró significativo. RESULTADOS: ocho pacientes fueron incluidas. La mediana de la edad gestacional fue 30.5 semanas. Cuatro casos fueron tipo I, dos tipo II y dos tipo tres. Cuatro casos presentaron desviación mediastinal. Cinco casos fueron derechos y uno bilateral. Ningún caso presentó hidrops. El CVR pre tratamiento fue 0,93(RIQ:0,17-2,1) y pos tratamiento 0,55(RIQ:0,07-1,39). Se encontró una disminución del CVR pos tratamiento en todos los casos (p 0.0117) e índice de correlación de Spearman 0.9524 CONCLUSIÓN: Después de la aplicación de corticoides encontramos una disminución del CVR en todos los casos descritos. El uso de corticoides podría ser parte de la terapia prenatal con miras a mejorar el pronóstico.

ABSTRACT OBJECTIVE: The purpose of this study is to describe the effect of prenatal corticosteroids in the CPAM by sequential evaluation of the CVR, and to show the experience in our fetal therapy center. MATERIALS AND METHODS: Series of cases in which eight patients from the Hospital of San José were included; with diagnosis of CPAM; gestational age was evaluated, CVR (CVR = length x length x width cm, mass) x 0.523 / head circumference) as a prognostic factor, mediastinal shift, hydrops, type of CPAM, location. Betamethasone was applied to fetal lung maturation dose. In all patients underwent CVR measurement pre and post treatment. The data were analyzed using SPSS statistical software (Version 11.0 SPSS Inc. Chicago, IL). The Wilcoxon test and the Spearman correlation index were used according to the case. A value of p <0.05 was considered significant. RESULTS: eight patients were included. The median of gestational age was 30.5 weeks. Four cases were type I, two type II and two type three. Four cases were mediastinal shift. Five cases were rights and one bilateral. No case presented hydrops. The pretreatment CVR was 0,93(RIQ: 0,17-2,1) and post-treatment 0,55(RIQ: 0,07-1,39). We found a decrease in CVR after treatment in all cases (p 0.0117) and Spearman correlation index 0.9524 CONCLUSION: After application of corticosteroids are a reduction in CVR in all the cases described. The use of corticosteroids may be part of prenatal therapy to improve prognosis.

Comparison between placental site injection of vasopressin and bilateral internal iliac artery ligation to reduce blood loss during cesarean section for placenta praevia, a randomized controlled trial

Background: placenta praevia is an obstetric complication in which the placenta is inserted partially or completely in the lower uterine segment, A significant proportion of these cases is associated with life threatening hemorrhage during delivery, often by caesarean section in the vast majority of cases, many procedures introduced to overcome this problems, none of them is completely successful

Aim of the work: this study aimed to compare between local vasopressin injection in the placental bed and bilateral internal iliac artery ligation on the blood loss during caesarean section for placenta praevia

Patients and Methods: this a randomized-controlled prospective trial included 60 pregnant women with a diagnosis of placenta praevia, they were categorized into 3 equal groups according to methods to control blood loss during cesarean section for placenta praevia. Group 1 included 20 pregnant women who underwent vasopressin injection at placental site. Group 2 included 20 pregnant women who underwent bilateral internal iliac artery ligation. Group 3 included 20 pregnant women who underwent caesarean section without internal iliac artery ligation or local injection of vasopressin [The control group], comparison between groups were done and statistically analyzed

Results: there were statistical significant differences between the intervention and the control groups as regard estimated blood loss, P value was <0.001; group 3[Control] had more amounts of blood loss, there were no statistical significant differences between group 1 and group 2 as regard estimated blood loss, P value was > 0.05 . Comparison between group1 and group 2 showed that internal iliac artery ligation was significantly associated with prolonged operative time than vasopressin injection[P value was <0.001]

Conclusion and Recommendation: local injection of vasopressin at placental site seemed to be a promising modality for reducing blood loss during cesarean delivery for placenta praevia and was associated with similar reduction of blood loss and less operative time when compared with internal iliac artery ligation, may be done first before trying internal iliac artery ligation and needs no experience

Composición lipídica y evaluación de las actividades antioxidante y leishmanicida del basidiomiceto Ganoderma sp / Lipid composition and evaluation of the antioxidant and leishmanicidal activities of the basidiomycete Ganoderma sp

Introducción: los hongos del género Ganoderma han sido utilizados para el cuidado de la salud en la medicina tradicional asiática por más de 2000 años. Desde 1980 los estudios químicos han reportado un sin número de metabolitos secundarios con propiedades bioactivas. Objetivo: identificar compuestos lipídicos en el extracto etanólico del hongo Ganoderma sp., además de evaluar sus actividades antioxidante y leishmanicida. Métodos: la extracción de las fracciones lipídicas presentes en el cuerpo fructífero de Ganoderma sp. Se realizó por Cromatografía en Columna. La elucidación estructural se determinó por Espectrometría de Masas y Resonancia Magnética Nuclear. La actividad antioxidante del extracto etanólico fue evaluada con las metodologías del radical 2,2-difenil-1-picrilhidrazil (DPPH) y el radical catiónico 2,2'-azinobis (3-etilbenzotiazolina-6-ácido sulfónico) (ABTS); la actividad leishmanicida por citometría de flujo y la actividad citotóxica usando el ensayo colorimétrico de bromuro de 3-(4,5-dimetil-tiazol-2-il)-2,5-difenil tetrazolio (MTT) sobre la línea celular U937. Resultados: diecinueve esteres metílicos y ergosterol fueron identificados por espectrometría de masas en el extracto etanólico. Un compuesto triterpenoidal se elucidó usando Espectroscopia de Resonancia Magnética Nuclear. Los valores de concentración media inhibitoria (IC 50) de la actividad antioxidante del extracto etanólico para las metodologías de los radicales DPPH y ABTS fueron de 85,63 µg/mL y 62,82 µg/mL, respectivamente. Los valores de las actividades citotóxica y leishmanicida fueron > 200,0 µg/mL y 21,5 µg/mL ± 4,4 respectivamente. Conclusiones: las estructuras de los derivados de ácidos grasos elucidados corresponden a compuestos con diferentes grados de insaturación. En este estudio se realizó el reporte de la Ganoderona A, como compuesto triterpenoidal. La elevada actividad antioxidante en relación a otros trabajos sugiere que este organismo es una fuente importante de metabolitos secundarios con propiedades captadoras de radicales libres, aunque los valores de actividad leishmanicida no fueron significativos se recomienda continuar con el estudio de otras particiones del extracto etanólico(AU)

Introduction: Fungi from the genus Ganoderma have been used in Asian traditional medicine for more than 2 000 years. Since the year 1980 chemical studies have reported a large number of secondary metabolites with bioactive properties. Objective: Identify lipid compounds in ethanolic extract from the fungus Ganoderma sp. and evaluate their antioxidant and leishmanicidal activities. Methods: Extraction of lipid fractions from the fruiting body of Ganoderma sp. was conducted by column chromatography. Structural features were determined by mass spectrometry and nuclear magnetic resonance. Antioxidant activity of the ethanolic extract was evaluated with the methodologies for radical 2,2-diphenyl-1-picrylhydrazyl (DPPH) and cationic radical 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid (ABTS); leishmanicidal activity by flow cytometry, and cytotoxic activity with the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide colorimetric assay (MTT) on cell line U937. Results: Nineteen methyl esters and ergosterol were identified by mass spectrometry in the ethanolic extract. A triterpenoid compound was identified by nuclear magnetic resonance spectroscopy. Mean inhibitory concentration values (IC50) for antioxidant activity of the ethanolic extract using the methodologies for radicals DPPH and ABTS were 85.63 µg/ml and 62.82 µg/ml, respectively. Values for cytotoxic and leishmanicidal activities were > 200.0 µg/ml and 21.5 µg/ml ± 4.4, respectively. Conclusions: The structure of the fatty acid derivatives identified corresponds to compounds with varying degrees of unsaturation. The study included the report of Ganoderma A as a triterpenoid compound. Antioxidant activity was found to be higher than in previous studies, suggesting that this organism is an important source of secondary metabolites with free radical scavenging properties. Although leishmanicidal activity values were not found to be significant, it is recommended to study other partitions of the ethanolic extract(AU)

Abordaje endonasal endoscópico para neoplasias malignas de la base craneal / Endonasal endoscopic approach for malignant cranial base neoplasm

Introduction: Malignant cranial base neoplasm constitutes a heterogeneous group of lesions with common seat in this localization. In the last years endonasal endoscopic approach has been more used. Methods: It was carried out a descriptive retrospective study of the database of the Service of Neurosurgery of "Hermanos Ameijeiras" Hospital between September 2009 and September 2015 with the objective of determining the results of endoscopic treatment to these lesions. Results: They were treated a total of 12 patients with wicked lesions of the cranial base inside. Six of them corresponded to anterior cranial base: 5 carcinomas (2 indiferenciate carcinoma, 2 carcinomas of scamous cells and 1 adenocarcinoma) and a metastases of renal carcinoma. Other six corresponded to cordoma (3 patients) and hematopoyetic neoplasm (2 plasmocitomas and 1 linfoma). The age average was of 51,1 years with a masculine-feminine relationship of 1,1:1. Conclusions: Surgical resection according to oncological principles can be used with endoscopic technics that in fact are associate with less morbility, better vision, betercompartiments access, nasolacrimal system and medial canthal tendon, absence of facial scar, craniectomy and brain retraction.

Introducción: Las neoplasias malignas de la base craneal constituyen un grupo heterogéneo de lesiones con asiento común en esta localización. En los últimos años el abordaje endonasal endoscópico ha cobrado mayor auge. Métodos: Se realizó un estudio retrospectivo descriptivo de la base de datos del Servicio de Neurocirugía del Hospital "Hermanos Ameijeiras" durante el período comprendido entre septiembre de 2009 y septiembre de 2015 con el objetivo de determinar los resultados del tratamiento endonasal endoscópico a estas lesiones. Resultados: Fueron tratados un total de 12 pacientes con lesiones malignas de la base craneal, 6 de la base craneal anterior dentro de los cuales 5 correspondieron a carcinomas (2 carcinomas indiferenciados, 2 carcinomas de células escamosas y 1 adenocarcinoma) y una metástasis de carcinoma renal. De los 6 de fosa posterior 3 presentaron cordomas y 3 lesiones hematopoyéticas (2 plasmocitomas y 1 linfoma). El promedio de edad fue de 51,1 años con una relación masculino-femenino de 1,1:1. Conclusiones: La resección quirúrgica acorde a los principios oncológicos se puede realizar utilizando las técnicas endoscópicas que incluso se asocian a menor morbilidad, mayor visión, mejor acceso a determinados compartimentos, preservación del sistema nasolacrimal, del tendón cantal medial, ausencia de cicatriz facial, de craneotomía y de retracción cerebral.

Plasmocitoma solitario de la base craneal: Reporte de tres pacientes / Solitary cranial base plasmocytoma: Three cases report

Plasmocytomas constitute a group of malignant neoplasm arise from clonal plasmatic cells being solitary extramedular form infrequent. Here we report three patients with solitary anterior and middle cranial base plasmocytoma. The importance of these tumors in differential diagnoses of cranial base lesions and the role of endoscopic endonasal biopsy before deciding definitive clinical approach was emphasized.

Los plasmocitomas constituyen neoplasias malignas de las células plasmáticas clónales. La forma extramedular solitaria en la base craneal es infrecuente. Se reportan tres pacientes con plasmocitoma solitario de la base craneal anterior y media. Se enfatiza en la importancia de esta afección en el diagnóstico diferencial de las lesiones de base de cráneo así como la biopsia endonasal endoscópica antes de decidir el tratamiento definitivo.

Occupational injuries prone to infectious risks amongst healthcare personnel in Kuwait: a retrospective study

The study aimed at determining the prevalence of incident occupational exposure to blood and other potentially infectious materials [OPIM] among healthcare personnel [HCP] during 2010 and at evaluating the factors associated with these incidents. Subjects and an epidemiological, retrospective, record-based study was conducted. All self-reported incidents of occupational exposure to blood and OPIM among HCP from all healthcare settings of the Kuwait Ministry of Health during 2010 were included. The total number of the exposed HCP was 249. The prevalence of incident exposure was 0.7% of the HCP at risk. Their mean age was 32.31 +/- 6.98 years. The majority were nurses: 166 [66.7%], followed by doctors: 35 [14.1%], technicians: 26 [10.4%] and housekeeping personnel: 22 [8.8%]. Needle stick injury was the most common type of exposure, in 189 [75.9%], followed by sharp-object injury, mucous-membrane exposure and contact with nonintact skin. The majority of needle stick exposures, i.e. 177 [93.7%], were caused by hollow-bore needles. Exposure to blood represented 96.8%, mostly during drawing blood and the insertion or removal of needles from patients [88 [35.4%]] and when performing surgical interventions [56 [22.6%]]. Easily preventable exposures such as injuries related to 2-handed recapping of needles [24 [9.6%]] and garbage collection [21 [8.4%]] were reported. Exposures mainly occurred in the inpatient wards [75 [30.1%]] and operating theaters [56 [22.6%]]. Among the exposed HCP, 130 [52.2%] had been fully vaccinated against hepatitis B virus [HBV]. Needle stick injuries are the most common exposure among HCP in Kuwait, and nurses are the most frequently involved HCP category. A good proportion of exposures could be easily prevented. HBV vaccination coverage is incomplete

Outcome of the first trimester threatened miscarriage: study of the predicting factors

Background: Threatened miscarriage is a distressing condition to both pregnant woman and gynecologist. It is important to predict the outcome of threatened miscarriage through maternal history, biochemical tests, and fetal ultrasound for patient counseling and to avoid delay in management.Study designA prospective multiple logistic regression analysis study

Objective: To assess the power of factors which are maternal history [age, vaginal bleeding, parity and hypertension], biochemical tests [beta-hCG and serum progesterone level] and fetal ultrasound [crown rump lengthand fetal heart rate] for predicting the outcome of pregnancy [fetal demise and ongoing pregnancy] complicated by threatened miscarriage between 7-11 wks and to determine the time interval from onset of symptoms to fetal demise development

Patients and Methods: The study was carried out on 80 pregnant women at their 7-11 weeks of gestation suffering from vaginal bleeding attending Al-Elwiya Maternity Teaching hospital. They were subjected to ultrasound to confirm fetal viability, assay of serum progesterone and beta-hCG levels and pain with bleeding scores. All these were repeated on weekly basis for four weeks follow up to monitor the pregnancy and identify the period to fetal demise [if happened]. The data is gathered on questionnaire paper and then subjected to statistical study

Results: The beta-hCG [human chorionic gonadotrophin hormone] level was found to be the main predictor for pregnancy outcome [miscarriage/fetal demise and ongoing pregnancy] and highly statistically significant [P value<0.0012], followed by bleeding [p <0.002] and maternal age [p<0.01] respectively, while other variables [serum progesterone, fetal ultrasound, parity] showed no statistically significant effect [P value=0.47, 0.63, 1.146 respectively] on the risk of miscarriage/fetal demise. Serum progesterone level was highly significant in predicting ongoing pregnancy [P value=0.001]

Conclusion: Measuring of beta hCG levels is found to be a good predictor for the outcome of the first trimester threatened miscarriage whether ends in to fetal demise or continuing pregnancy, while other factors like ultrasound, serum progesterone levels and parity are useful in assessing an ongoing pregnancy but have no power in predicting possibility of fetal demise. Also measuring the interval from the onset of bleeding to fetal demise development can be useful to avoid delaying pregnancy management

Assessment of adverse donor reactions in Iraqi national blood bank

Background: Blood donation is a safe procedure and thousands of persons donate blood without any ill effect, however few donor's show adverse donor reactions

Objective: To assess the occurance of adverse donor reactions in a sample of blood donors attending Iraqi National Bank in Baghdad

Patients and Methods: This is a cross sectional study, carried out in INBB between October and December 2013. The donors included in the study randomly. Especial form was prepared for each donor and the required information was recorded including the adverse reactions that were observed during donation and later for 15 minutes

Results: The study included 200 blood donors, their mean of age was 35 years with range of [19-66] years, their mean of weight was 88 Kg with range of [62-152] Kg. Twenty seven 13.5% donors showed adverse reactions during the first 15 minutes post donation and the most frequent reaction was hematoma at the venipuncture site with frequency of 3.5% for each reaction, nausea and dizziness 3% for each, muscular twitching 1.5%, weaknesses and syncope 1% for each while the least frequent reaction was convulsion with a frequency of 0.5%. The results showed that donors taking breakfast and donors with previous donations showed less frequency of adverse reactions

Conclusion: Blood donation is a safe procedure and 13.5% of the studied donors show adverse donor reactions and the most frequent reactions were hematoma followed by pallor and sweating while the least frequent reaction was convulsion and donors taking breakfast and donors with previous donations showed significantly less frequency of adverse reactions

Non-invasive positive pressure ventilation versus invasive pressure support ventilation for post extubation respiratory distress in patients recovered from respiratory failure

Respiratory failure after a planned extubation is reported to be a common event, leading to reintubation and can occur in as many as 3-20% of extubated patients. It is crucial to identify the right time to extubate a patient, since re-intubation after pre-term extubation is associated with an increased risk for nosocomial pneumonia, prolonged intensive care unit [ICU] stay and death, and also accounts for substantially increased costs. This study was planned to assess the effectiveness of non-invasive pressure support ventilation [NIPPV] as a weaning technique in patients who develop respiratory distress after discontinuation of mechanical ventilation and extubation in comparison with conventional weaning through invasive pressure support ventilation. This is a randomized controlled study, sixty patients with either type I or II respiratory failure who developed post extubation respiratory failure were enrolled; they were randomly divided into two groups to receive either NIPPV or invasive pressure support ventilation. The primary outcome measure was the technique outcone; secondary outcome measures were incidence of complications, hemodynamic parameters, arterial blood gas parameters, ventilator parameters and length of ICU stay. Despite a longer time to failure observed with invasive pressure support ventilation, no statistically significant differences were observed in success rate, hemodynamic, and arterial blood gas parameters, although incidence of complications differs greatly according to the technique used. In a heterogonous group of patients; NIPPV is not superior to invasive pressure support ventilation in patients who developed post-extubation respiratory distress after successful weaning

Primary closure of the deltopectoral flap-donor site without skin grafting

Deitopectoral flap is a two staged flap requiring skin graft of the donor site. This study was conducted to evaluate the possibility of primary closure of the deltopectoral flap-donor site without skin grafting. The operations were conducted at Rizgari Teaching Hospital in the center of Erbil City, Kurdistan Region of Iraq. From January 2009 to December 2012, 14 deltopectoral flaps for reconstruction of oral/facial cancer ablative defects were done. Data on the age, gender, tumor site, and postoperative complications related to primarily closed deltopectoral flap-donor site [fistula, dehiscence, or hematoma leading to impairment of wound healing] and postoperative hospital stay were recorded. Of the 14 head-and-neck tumours, 10 were squamous cell carcinomas and four were ameloblastomas. Eleven of the patients were males and only three were females. The mean age [ +/- SD] of the patients was 59 +/- 13 years. There was no evidence of partial or complete loss of the flap in any of the patients studied. There was no case of breakdown of the primarily closed donor site. The only registered complication was slight localized dehiscence at the most proximal and distal part of the primarily sutured flap donor site in one patient. Primary closure of deltopectoral flap donor site is possible with minimal complication that overcomes the problem of skin grafting. Minimal wound breakdown in younger patients had been noted and left to heal by secondary intention

Comparison between infiltration and inferior alveolar nerve block anesthesia in extraction of non-vital mandibular posterior teeth [prospective clinical study]

Infiltration anesthesia for the posterior region of the mandible has been routinely avoided because of its questionable effectiveness related to the dense cortical bone of the mandible. The aim of this study was to evaluate the effectiveness of infiltration anesthetic technique on mandibular posterior non-vital teeth. Forty four patients aged between 13and 73 years who attended the Department of Oral and Maxillofacial Surgery in the College of Dentistry, Hawler Medical University for extraction of posterior non vital tooth were included in this study. For the infiltration anesthetic technique, patient's approval was taken. The patients were equally divided into two groups. Group [1] received 0.6 ml out of 1.8 ml of 2% lidocaine with 1:80000 adrenaline injection bucally and the same amount infiltration lingually opposite the intended tooth. Group [2] received 1.5 ml out of 1.8 ml of 2% lidocaine with 1:80000 and the remaining 0.3 ml was injected for long buccal nerve anesthesia. In group [1], 68.2% had no pain during extraction, showed statistically highly significant difference [P = 009]. Gender showed no significant difference. In group [2], 100 % of the patients had no pain during extraction. Infiltration anesthesia for non-vital mandibular molars is effective as a substitute for inferior alveolar block technique

Factors affecting the retention of nurses. A survival analysis

To identify and explore factors that mostly influence nurses' turnover and retention, and to estimate the length of employment for nurses in the hospital. This is a retrospective cohort study examining the standard Exit Questionnaires completed by all the female pediatric nurses who joined and left the hospital during the period between January 2006 and October 2010. The Developed Questionnaires where completed by nurses who were still employees in October 2010. The nurses who left the job will be considered as events and the nurses who are still working will be considered as censored. The study took place at the Pediatric Department, Prince Sultan Military Medical City [PSMMC], Riyadh, Saudi Arabia. A total of 254 nurses were included in the study. Most of the nurses left their jobs due to family reasons [39.7%] followed by other reasons [37.3%]. Seventy five percent of all the pediatric nurses remained in their jobs, on average, for 2.2 years. Both simple and multivariate analysis indicated a strong positive correlation between length of employment [turnover] and the demographic and organization factors. This study has identified several factors that played a key role in staff retention, which can help in predicting nursing turnover at PSMMC. The findings of this study could help PSMMC and its Nursing Administration, in particular, to understand the seriousness of the high turnover rates, to develop and implement strategies to reduce this problem, and improve the retention of nursing staff

Audit of physicians' adherence to the antibiotic policy guidelines in Kuwait

To audit physicians' adherence to the local antibiotic policy guidelines in government hospitals in Kuwait. The study was a retrospective review of patient records in nine hospitals between July 1 and December 31, 2008. Clinical notes and medication charts of the latest hospital admissions were checked for antibiotic prescribing. On the audit form, aspects of the prescribed antibiotic were benchmarked to the hospital antibiotic policy guidelines to evaluate adherence. Of 2,232 reviewed records, 1,112 [49.8%] patients had 1,528 antibiotic prescriptions. Patients who received antibiotics were significantly younger than those who did not [median age: 26.3 vs. 29.8 years, p < 0.001] and their hospital stay was significantly longer [median: 4 vs. 2 days, p < 0.001]. The choice of an antibiotic was appropriate and matched the policy in 806 [52.7%] prescriptions. Of such appropriate antibiotics, adherence to route of administration was observed in 768/806 [95.3%], to dose in 758 [94%], to frequency in 746 [92.6%] and to duration in 608 [75.4%]. Full adherence to all aspects of antibiotic choice, dose, route, frequency and duration was achieved in 464 [30.4%] prescriptions. In 382 [25%], the antibiotics administered were not indicated. There was low adherence to the local antibiotic policy guidelines. Physicians' antibiotic prescribing practices should be optimized. Adherence to, and update of, the policy is recommended

Lipohypertrophy: does it affect the control of diabetes in children?

The aim of this study was to find the prevalence of Lipohypertrophy [LH] in children with diabetes type 1, assess its effect on diabetes control and to study the parameters influencing its development. 119 children coming for regular follow up in the diabetes clinic were examined for the presence of LH by inspection and palpation. The last 4 readings of [Glycated hemoglobin] HbA1c levels and other factors that may affect LH e.g. duration of diabetes and the injection method were documented. The patient's age ranged from 2 months to 17 years with a median of 10 years. LH occurred in 54.9% of patients, more commonly in males [62.7%] vs. females [48.4%] [P= 0.074]. Grade 1 LH occurred in 42.5% and grade 2 in 12.4%. LH was related Significantly to the dose of insulin units per kg of body weight [F=5.741, P= .004], the duration of diabetes, [F=5.097, P=0.008.], adjusted body mass index [8MI] [X[2] = 20.024, P=0.003] and the injection method [X[2]=9.619, P= 0. 043]. HbA1c levels of patients with grade 1 and grade 2 LH did not differ from diabetics without LH [F =0.178, P=0.837]. In Children with LH need higher doses of insulin to achieve fair control compared to children without LH. The presence of LH was significantly related to the duration of diabetes, dose of insulin/ kg of body weight, the body mass index and the injection method. Further studies are needed to ascertain the clinical meaning of these findings

Possible teratogenic effects of antiepileptics in albino rats: comparative study between old and new generations: part I

All of the antiepileptic drugs [AEDs] are either known or suspected of being teratogenic. The possible mechanism of teratogenicity is likely to be multiple for the same drug. This is of major concern for all women with epilepsy using these drugs are delicately balanced between seizure control and the adverse effects the AEDs. The use of conventional AEDs eg. Carbamazepine control more than two thirds of the epileptic patients. In recent years, the number of commercially available AEDs has steadily increased eg. lamotrgine and levetiracetam.160 pregnant female albino rats were used in this study. Animals were classified randomly into eight groups; each group contained 20 pregnant female rats. Negative control group received nothing and positive control group received normal saline. Treated groups: each group received either the therapeutic dose or 1/4 LD50 of carbamazepine, lamotrigine or levetriacetam. The drugs were given by gastric tube from 6[th] day up to the 19[th] day of gestation. Teratological evaluation:the fetuses [both living and dead] in each group were weighted their crown rump length measured and morphological examination included: Head size and shape, orofacial development, vertebral column tail and abdomen, umbilicus and external genitalia Maternal findings showed high death rate in 1/4 LD50 of lamotrigine treated group; weight gain was dose dependant with highest effect in the lamotrigine treated groups. The fetal findings showed highest embrolethality and least litter siza in lamotrigine treated groups; while the fetal growth determined by weight gain and crown rumplength was retarded more in carbamazepine and lamotrigine treated groups than in levetiracetam treated groups. The morphological findings revealed that the highest percentage of congenital anomalies were in the dose of 1/4 LD50 of lamotrigine followed by carbamazepine and levetiracetam. The AEDs are potentially teratogenic and in utero exposure can increase the risk of adverse outcomes in off springs born epileptic mothers. The new AED lamotrigine caused gross fetal retardation even in therapeutic dose. Levetiracetam caused growth retardation in the therapeutic dose more than carbamazepine in the corresponding dose although it had the best effect on maternalparameters. As regard the congenital anomalies lamotrigine was the safest durg in the therapeutic dose

Management of obesity and outcomes of hepatitis C treatment

Obesity is a modifiable risk factor for nonresponse to chronic hepatitis C [CHC] treatment. We examined whether weight loss during pegylated interferon [IFN] plus Ribavirin therapy is associated with improved response. Rapid virological response, early virological response, end of treatment response, and sustained virological response [SVR] were compared among patients with or without weight loss [>/= 0.5 body mass index [BMI]] during therapy for hepatitis C virus. Among 324, who provided consent, 280 were treatment-naive patients and 200 started pegylated-IFN/Ribavirin therapy and were included in the study. Median pretreatment BMI was 28.8 +/- 5.7 [19.9-48.9] with 42.6% overweight and 31.6% obese [BMI 25-30 and >/= 30, respectively]. Hepatitis C virus genotype 1 was the prevalent genotype among the candidates of this study, affecting 99 cases of 136 [72.7%], whereas genotypes 2/3 affected 37 cases [27.3%]. For genotype 1, weight loss at 1 and 3 months was associated with higher SVR rates [59.5 vs. 36.8% at 1 month and 55.2 vs. 34.1% at 3 months, respectively, P values=0.02 and 0.03, respectively]. Hepatic fibrosis, elevation of high-density lipoprotein, and decline of homeostasis model of assessment-insulin resistance at 6-months follow-up were proven to be independent predictors for SVR. Weight loss during the first 6 months of IFN therapy was associated with improved SVR in patients with CHC genotype 1 rather than genotypes 2/3. Molecular changes associated with weight loss during CHC and its relation with treatment response need to be prospectively examined

relevance of image analysis in differentiating computed tomography guided fine needle aspiration biopsy of lung adenocarcinoma versus pleural mesothelioma in Egypt

Mesothelioma is a very serious illness that can have dangerous, long-term health effects. Catching the disease early on is often the best way to combat it, knowing the signs and process for diagnosis of the disease can help make it easier. Mesothelioma can be difficult to diagnose. This is because there are many different types of cells that can make up a mesothelioma tumor. Sometimes it can be very difficult for a pathologist to diagnose pleural mesothelioma as it can look like other types of lung cancer. The differentiation of mesothelioma and lung adenocarcinoma can be challenging, as proper classification is essential for determination of treatment regimen for these diseases. The present work aim to clarify if the use of image analysis can replace the more expensive immunohistochemical technique in differentiating lung adenocarcinoma from malignant mesothelioma [epithelial type] of the pleura. In our study we investigated computed tomography guided fine needle biopsy [CT-guided FNA] from 20 cases of pleural mesothelioma and 20 cases of lung adenocarcinoma. The pleural mesothelioma cases were confirmed by specific immunohistochemical panel then were investigated by image analysis. These data showed insignificant variation [p value <0.05] in the nuclear area and cell area in pleural mesotheliomas and lung adenocarcinomas. From the cytological morphology, the malignant pleural mesothelioma in fine needle aspiration has somehow a special pattern for arrangement with nuclear crowding then those of the peripheral lung adenocarcinoma. The results were not significant enough for the substitution of immunohistochemistry technique by image analysis on cytological specimens yet it may give different results when applied on tissue specimen which need further investigation

Hepatitis B and C viral infection: prevalence, knowledge, attitude and practice among barbers and clients in Gharbia governorate, Egypt

A study in Egypt determined the prevalence of hepatitis B and C virus infections among barbers [n = 308] and their clients [n = 308] in Gharbia governorate, and assessed knowledge, attitude and practices during hair-cutting and shaving. HBsAg was detected among 4.2% of barbers and 3.9% of clients [more urban than rural]. Anti-HC antibodies were detected in 12.3% of barbers and 12.7% of clients. HCV-RNA prevalence was 9.1% among both barbers and clients [more rural than urban]. Knowledge was high among the majority of participants and good practices during shaving and hair-cutting were observed for the majority of barbers. Barbers appeared to have no job-related risk of acquiring viral hepatitis

Influence of beneficial microbes and proline treatments on sugar beet under nitrogen limitation in saline-sodic soil

A field experiment on sugar beet [Beta vulgaris L.] yield and yield quality under saline-sodic soil conditions was conducted at Sahl El Hussinia Res. Station, El Sharkia Governorate, Egypt, during the winter season of 2008/2009. The influence of cyanobacteria and N[2]-fixing bacteria were compared either individually or in combination to supplementation with proline amino acid under two levels of mineral nitrogen fertilization [50 and 75% of nitrogen recommended dose]. Soil enzymatic activities [dehydrogenase and nitrogenase], total bacterial counts, total cyanobacteria counts and total nitrogen fixing bacteria counts were enhanced by the biofertilizers compared to proline treatment and controls, particularly when the combined inoculum of cyanobacteria and N[2]-fixing bacteria was applied in the presence of 75% N. In addition, inoculation with cyanobacteria and N[2]-fixing bacteria, either individually or in combination with 75%N, led to a slight decrease of pH and EC values of saline soil, while there was an increase in the availability of NPK as compared with control plots. Proline and biofertilizers showed a significant positive impact on some physiological properties of plants drown at 75% nitrogen level, such as chlorophyll in leaves, proline and phenolic compounds in roots. The highest responses for these traits were in proline-treated plots followed by the combined inoculation of cyanobacteria and N[2] fixing bacteria, while, there was no significant difference in root yield productivity between proline treatment and the combined inoculum of cyanobacteria and N[2] fixing bacteria with 75% nitrogen fertilizer. The combined inoculation positively increased N, P and K uptake and decreased the uptake of Na in roots. Also, the combined inoculum of cyanobacteria and N[2] fixing bacteria with 75% nitrogen led to a significant increase in shoot and root dry weight as well as root yield quality [sucrose and purity]. Results suggest that the beneficial effect of the cyanobacteria and N[2] fixing bacteria on sugar beet growth, yield and yield quality was attributed to the biologically active substances produced by these microbial strains besides the nitrogen fixation of the diazotrophs which compensate the reduction of the costly and the environmentally polluted mineral nitrogen fertilizers in the new reclaimed saline-sodic soil

Evaluation of the potential of two plant growth promoting rhizobacteria [PGPR] on the increase of wheat productivity under different salinity regimes

A POT experiments was conducted winter 2007-2008 at the experimental greenhouse of Microbiology Department, Soils, Water and Environment Research Inst., ARC, Giza, Egypt, to evaluate the response of the wheat cultivars, Sakha 93 and Gemiza 7, to be inoculated with Azotobacter sp. and Bacillus sp., under two salinity regimes [NaCl concentration 100 mM and 150 mM, respectively] for improving salinity tolerance in sandy soils. The results showed that dehydrogenase and nitrogenase activities were significantly inhibited by increasing salinity in the rhizosphere of all uninoculated plants. The chlorophyll-a [chl. a], chlorophyll-b [chl. b] and carotenoid contents of 30 days old seedlings were significantly reduced in response to increase of salinity levels in all treatments. Data also revealed that increasing salinity level caused an increased gradual accumulation of proline in the shoots of the stressed wheat plant in both cultivars. Bacterial amendment resulted in a significant increase in all measured yield parameters compared with the un-amended control. The mineral contents [N, P and K] in both wheat cultivars varied as a response to the saliniy regims and presence of Azotobacter sp. and Bacillus sp., N, P and K contents of grains were significantly decreased with increasing salinity in all treatments in both cultivars but most pronounced in Gemiza 7