Endocrine disruption and infertility: Circulatory hormone and bisphenol A concentrations in infertile Saudi women

Aim: Human infertility is a public problem and a cause of social and psychological complications affecting more than 50 million couples globally. Bisphenol A (BPA) is a ubiquitous environmental endocrine disrupting chemical and has been associated with infertility problems in women.The aim of the present study was to analyze concentrations of bisphenol A and circulating hormones in infertile Saudi women for evaluating the association of BPA with infertility.Methodology: The present study was done on 43 infertile women for evaluating possible association of systemic BPA concentrations with infertility in Saudi Arabia. The clinical indications were irregular menses, hyper-androgenism, multiple small ovarian cysts, polycystic ovarian syndrome and unexplained infertility. Blood samples from infertile women and a control group of 18 healthy fertile women were analyzed and compared for concentrations of BPA and circulatory hormones. Results: The results showed that BPA concentrations were not significantly different between infertile women and controls. BPA concentrations were also not correlated with systemic hormone concentrations in infertile women. Interpretation: Serum BPA levels had no association with hormone imbalance in this cohort of infertile Saudi women. However, considering the previous studies that have shown a relationship of BPA with female infertility, an argument can be made that there might be lower exposure of Saudi population to BPA in comparison to BPA analogues such as BPS (according to recent reports). Therefore, it is suggested to conduct more infertility studies that include detection of BPA and its analogues in infertile Saudi women

A rare case of colonic perforation presenting as Fournier’s gangrene

A 48-year-old obese gentleman with mild pain over abdomen for 10 days followed by pain and swelling in the right side of scrotum with skin discolouration for 2 days. Clinically necrotic patch with pus discharge was noted on the right side of scrotum. Extensive debridement over scrotum was done following which inflamed omentum and fecal contents were noticed from the inguinal canal. Patient underwent laparotomy and an ascending colonic perforation was found. A loop colostomy with partial omentectomy and inguinal hernia repair along with serial debridement of scrotal wound was done. Although uncommon, gastrointestinal perforations should be considered as a potential etiology in Fournier’s gangrene.

A comparative study on the effect of dispersed and undispersed Kuwait crude oil on egg hatching and larval survival of Epinephelus coioides

Aim: The objective of the present study was to investigate the effects of dispersed and undispersed Kuwait crude oil on egg hatching and larval survival of Epinephelus coioides. Methodology: In the present study, the toxic effects of crude and dispersed oil using three formulations of oil dispersants against multiple life stages of Epinephelus coioides was assessed. The lethal concentration was calculated by ToxCal® software developed by Tidepool Scientific, LLC. Results: Specifically, the following life stages were investigated: embryonated eggs (EE), larvae hatched during exposure (LHE) and hatched larvae (HL). Chemical analysis showed that Total Petroleum Hydrocarbon (TPH) concentrations were higher in dispersed than undispersed oil solutions, indicating accommodation of more petroleum hydrocarbons in the aqueous phase. Acute static toxicity tests produced variable LC50 values for all chemical preparations and all fish life stages. Crude oil dispersed with both Corexit® EC 9500A and Corexit® EC 9527A separately was more toxic to both EE and LHE stages than undispersed oil, but crude oil dispersed with Slickgone® NS resulted in lower toxicity. Furthermore, all three types of dispersed oil exerted higher toxicity than undispersed oil at HL stage. Interpretation: A life stage dependent effect demonstrated variation in the toxicity of both dispersed and undispersed crude oil to fish. Few life stages were more sensitive than others to either dispersed or undispersed crude oil toxicity. While dispersion of an oil slick with oil dispersant has proved to be an effective tool in the oil response strategy, the fate of dispersed oil can exert lethal effects on embryo-larval stages of marine fish present near the spill.

Stevens Johnsons Syndrome following Intravenous Vancomycin use: A Case Report.

Stevens –Johnsons Syndrome (SJS) is a rare autoimmune condition usually affecting the skin and mucus membranes. Stevens-Johnson syndrome is a minor form of toxic epidermal necrosis, with less than 10% body surface area (BSA) detachment. Various factors are notoriously known to cause this serious condition like medications, infectious and immunecompromised states, etc. We report the case of a 3 year girl with right sided pyothorax developing SJS during the course of her treatment and our subsequent management.

Post-traumatic synchronous twin inter-muscular abdominal and diaphragmatic hernias: A rare presentation.

Simultaneous occurrence of traumatic abdominal wall hernia (TAWH) and traumatic diaphragmatic hernia (TDH) is uncommon. Our report documents the rare delayed presentation of simultaneous occurrence of TAWH and TDH in a patient who sustained a bicycle handlebar injury as a consequence of the bicycle he was riding colliding with a motorbike in a road-traffic accident. Excellent outcome could be achieved in this patient with surgical repair without requiring the use of a mesh.

Morgagni hernia with down syndrome: A rare association.

We report a case of a 22-year-old male with Down syndrome and Morgagni hernia, who presented to us with complaints of cough, regurgitation and vomiting. He was successfully treated surgically and the defect was repaired with prolene mesh.

Rapid immunochromatography-based detection of mixed-species malaria infection in Pakistan.

We report the identification of mixed Plasmodium infections in four recent patients with malaria clinically refractory to empiric chloroquine therapy using the rapid antigen detection kit, NOW ICT Malaria Pf/Pv. A rapid in vitro immunodiagnostic test, the NOW ICT Malaria Pf/Pv test kit was used for the detection of circulating Plasmodium falciparum (Pf) and Plasmodium vivax (Pv) antigens in whole blood. Peripheral blood microscopy confirmed mixed-species infection in all the cases. Thick and thin peripheral blood films were made and stained with Giemsa stain and examined by both hospital laboratory staff and an experienced parasitologist who was blinded to the results of the rapid malarial antigen tests. Four recent patients (all male; mean age, 24 years) with mixed malarial infection were identified. All the subjects were males working for an oil company in a coastal area of Pakistan, and all had been diagnosed presumptively with malaria based on clinical grounds (without microbiologic confirmation), and were treated empirically with chloroquine without clinical response. Semiquantitative malaria counts via microscopy were as follows: P. vivax, scanty (2 patients) and moderate (2 patients); for P. falciparum--scanty (1 patient), moderate (2 patients), and heavy (1 patient). The present case series, although limited by the small number of patients with proven mixed P. falciparum-P. vivax infection, highlights the usefulness of the rapid antigen test in a highly malarious region of Pakistan where chloroquine resistance is prevalent. Although there was full concordance between the results of blood smear microscopy and rapid antigen testing, these techniques are potentially most useful when there is a discrepancy with microscopy findings. Accurate and rapid diagnosis of parasites, particularly in cases of mixed P. falciparum and P. vivax infection, is of immense importance for individual patient management and in reducing the burden of disease, especially in regions of chloroquine resistance.

Tropical pulmonary eosinophilia and filariasis in Pakistan.

Filariasis is a major health problem in South Asia, particularly India, Sri Lanka and Bangladesh. Pakistan was presumed to be not affected. We report for the first time confirmed cases of tropical pulmonary eosinophilia (TPE) in indigenous patients as a result of infection with Wuchereria bancrofti. Following clinical examination, total leukocyte and eosinophil counts were recorded. Parasitological examinations included blood for microfilariae and stool and urine for eggs of intestinal parasites. Total immunoglobulin (Ig) E and specific antifilarial IgG were measured. Suspected cases of TPE were treated with diethylcarbamazine, 6 mg/kg for four weeks and were followed up to 2 and 4 weeks after treatment. Four persons fulfilled the criteria for TPE. Their response to treatment was marked with clinical improvement, reduction in eosinophil count and reduced titers of specific antifilarial antibodies. Two persons had W. bancrofti antigen in their sera confirmed by filariasis antigen detection test. Tropical pulmonary eosinophilia due to Wuchereria. bancrofti, although rare, is present in Pakistan.

Metastatic adenocarcinoma rib presenting as chondrosarcoma.

A case of chondrosarcoma rib which turned out to be a case of metastatic adenocarcinoma on histopathological examination is being presented.

A study of effect of guggulsterone on hyperlipidemia of secondary glomerulopathy.

Hyperlipidemia in patients of secondary glomerulopathies, a well established entity with very little knowledge of its management modifies its prognosis by predisposing these patients to develop atherosclerosis, coronary artery disease, hypertension cerebro-vascular accidents and also thromboembolic phenomenon leading to renal vein thrombosis and renal failure. Guggulsterone was administered orally in these patients in a daily divided dose of 75 mg for a period of 8 weeks together with supportive measures like high protein diet, diuretics and hematinics. Total serum lipid, total serum cholesterol, triglycerides, phospholipids, HDL, LDL, and VLDL were analysed at 4 and 8 weeks of therapy. Significant reduction was observed in the values of total serum lipid and total serum cholesterol. Other parameters of lipid profile showed downward trend except rise of HDL with insignificant difference. There was no significant side effect throughout the study.

Clinicopathological profile of carcinoma of oesophagus at Aligarh.

Forty-seven patients with oesophageal carcinoma were managed in 6 years' time. Average duration of illness was 5.5 months. History of chronic smoking and/or tobacco chewing was present in 80.85% of patients. Carcinoma included squamous cell variety (80.85%) and adenocarcinoma (19.15%). Thirty-one patients were in stage III while 16 patients were in stage II. Surgery included oesophagogastrectomy/oesophagogastrostomy (16 patients), feeding gastrostomy (11 patients), Mousseau-Barbin tube insertion (10 patients), only 10 patients were subjected to palliative radiotherapy. All patients after palliative treatment died within one year whereas 3-year and 5-year survivals after oesophagogastrectomy/oesophagogastrostomy were 68.75% and 31.25% respectively. Local lymph node metastasis adversely affected the 5-year survival rate.

Hepatitis in patients with surgical complications of pulmonary tuberculosis.

During last six years, 2250 patients were treated in Cardiothoracic Unit for thoracic complications of pulmonary tuberculosis. During isoniazid/streptomycin/ethambutol treatment, 2 patients out of 710 (0.28%) developed hepatitis. During isoniazid/rifampicin/ethambutol therapy, 18 patients out of 1540 (1.17%) suffered from jaundice; all these patients were above 30 years of age, and many had gross anemia (Hb less than 9 gm%), hypoalbuminemia (less than 3 gm%) and radiologically far-advanced disease in comparison to those who did not develop jaundice (p less than 0.05). Jaundice subsided completely after discontinuation of isoniazid and/or rifampicin which were re-instituted successfully after recovery without recurrence of hepatitis. It is suggested that the development of hepatitis does not warrant total withdrawal of these two highly effective bactericidal drugs but they should be tried again cautiously after recovery from jaundice.

Cholecysto-cardiac link.

Thirty normotensive patients (ASA class I) and 30 treated hypertensives without any cardiac problem (ASA class II) were subjected to elective cholecystectomy under general anaesthesia. Patients' age ranged from 25-50 yr, and male:female ratio was 1:11. There were significant increases in heart rate and mean arterial pressure in both the groups (P less than 0.05) during surgical manipulations for removal of the diseased gall bladders. The alterations in the treated hypertensive patients were not only much more than in the normotensives, but also were associated with tachyarrhythmias in 33.33 per cent of hypertensive patients. All changes returned to the pre-induction level at the end of the surgery. Mediation through fifth thoracic spinal segment, a common source of sympathetic supply to heart and gallbladder, explained the observed cholecystocardiac link. Anaesthetists therefore need to be vigilant during cholecystectomies.

Conservative management of flail chest.

A total of 100 cases of flail chest were studied to find out the efficiency of the anti-lung contusion regimen containing a diuretic, a steroid and an enzyme preparation for some 10 days, along with pad and strapping. There were 80 males and 20 females. Majority (71%) of patients were between 16 and 45 years. Road side accident was the commonest cause, present in 65% cases followed by bull horn injuries (25%), fall from a height (8%) and gun shot injuries to chest (2%). Associated intrathoracic and extrathoracic injuries were recorded in 45% and 30% cases respectively and they were treated according to their merits. There were 11 deaths with an overall success rate of 89%.

A new role of bronchofibrescope in the removal of unusual intrapleural foreign bodies.

Successful removal of unusual intrapleural foreign bodies (surgical blades) by means of a bronchofibrescope (BFS) passed through the thoracostomy tube tract is reported. The potential role for the use of the fibreoptic bronchoscope for this purpose is emphasized.