Vitiligo in a patient receiving infliximab for refractory ulcerative colitis

Infliximab is a chimerical monoclonal antibody that inhibits pro-inflammatory activity of tumour-necrosis factor alpha [TNF alpha] and it is the primary biological agent used in the treatment of moderate-to-severe ulcerative colitis [UC]. We report a case of vitiligo following infliximab administration in a patient with refractory UC. The case serves as a reminder of adverse cutaneous reactions induced by TNF alpha -antagonist therapy

Peginterferon alfa-2b and ribavirin therapy in Kuwaiti patients with chronic hepatitis C virus infection

Few studies have been conducted in the Eastern Mediterranean region on chronic hepatitis C virus [HCV] infection with reference to genotypes. We investigated the response to standard combination therapy [pegylated interferon/ribavirin] of different genotypes of HCV in Kuwaiti patients and factors that could be associated with sustained virological response [SVR]. The records of all Kuwaiti patients treated for chronic HCV between January 2003 and May 2009 were retrospectively identified and reviewed. Of 108 patients studied, 27.8% were infected with genotype 1, 25.0% with genotype 3 and 47.2% with genotype 4. Overall, 64.8% of patients achieved SVR, 25.9%, were non-responders and 9.3% were relapsers. Baseline viral load and alanine aminotransferase level in addition to early virological response to pegylated interferon-based therapy may serve as a decision tool for clinicians to identify patients who are unlikely to achieve SVR

Adenomatous colorectal polyps in patients referred for colonoscopy in regional hospital in Kuwait

Adenomatous colorectal polyps [ACPs] are known to be the precursor lesions for colorectal cancer. The aim of the study was to determine the prevalence, endoscopic and pathological features of ACPs in patients referred for colonoscopy. The endoscopic and histological reports of adult patients who underwent complete colonoscopy in the gastroenterology unit of a regional Kuwaiti hospital between January 2008 and December 2008 were retrospectively studied. The specimens of polyps were reviewed by an experienced pathologist who was blinded to the clinical or endoscopic information. Non-neoplastic polyps were not included in the analysis. Of 530 eligible patients [mean age, 45 years; male-female ratio, 2:1], 54 [10%] had 103 ACPs. Of the patients with ACPs [mean age, 57 years], 43 [80%] were males and 36 [67%] were Kuwaitis. Histopathological examination of the most significant polyp in each patient revealed that 40 [74%] polyps were tubular adenomas [TAs]; 11 [20%], tubulovillous [TV] adenomas; and 3 [6%], villous adenomas. High-grade dysplasia was noticed in 4 [10%] adenomas. Fifteen [2.8%] of the 530 patients had advanced ACPs. Logistic regression analysis of some variables and their association with ACPs found that age [P<0.001; OR, 1.9; CI, 1.5-2.3], history of adenoma [P=0.001; OR, 6.4; CI, .2.1-19.4] and being Kuwaitis [P=0.029; OR, 2.1; CI, 1.1-4.1] to be independently associated with ACPs. The most common histological type of ACPs was tubular adenoma. Advancing age, being Kuwaiti nationals and prior removal of ACPs were significantly associated with the occurrence of ACPs

Job satisfaction among physicians in Al-Sabah hospital, Kuwait

The prevalence of dissatisfaction among doctors has been given considerable importance in recent years as it affects the quality of health care. The aim of the present study was to determine the level of job satisfaction among doctors working at AL-Sabah Hospital in Kuwait, identify aspects of dissatisfaction and factors that could be associated with. All sixty physicians currently working in the department of internal medicine were asked to participate. A self-administered close-ended questionnaire was used to obtain personal data and information from the physicians on various aspects of job satisfaction. It included 20 items divided into 5 aspects that are relevant to a number of job facets. A 5-point, Likert-scale was used. Analysis was carried out using Chi-square and Fisher Exact tests. The response rate was 83.3%. Overall, 50% of participating physicians were generally satisfied with their job. Higher scores of satisfaction were reported among male, married, with longer experience, with higher qualification. Proportions of satisfaction with each item were presented. No significant difference could be detected according to personal factors and working conditions regarding these items except for nationality. Higher proportions of satisfied non Kuwaiti physicians were recorded regarding the freedom to use their own judgment [62.2% versus 14.4%, P = 0.004] and to do their own method to do the job [59.5% versus 23.1%, P = 0.02], whereas only 18.9% of non-Kuwaiti physicians were satisfied with their payment as compared with 69.2% in Kuwaiti physicians [P= 0.002] It is urgent and necessary to improve physician working conditions and their working pattern to maintain job satisfaction. Physicians themselves, hospital administrators and the government should take the initiative to improve the working conditions in Kuwait hospitals. Larger multi-centric research about this issue is needed

Prevalence and factors associated with chronic diabetic complications among patients attending primary health care, a multi-centric study in Kuwait

A substantial proportion of patients with diabetes develop long-term macrovascular and microvascular complications. Many risk factors have identified for development and progression of these complications. The aim of the present study was to determine the prevalence of these complications among adult diabetic patients attending primary health care centers in Kuwait and to identify factors that could be associated with especially those factors that can be considered avoidable. This study was carried out in five primary health care centers representing the five health regions in Kuwait. The sample included 704 adult diabetic patients who had been diabetic for at least 2 years. The first phase of study was a cross sectional study to determine the prevalence of chronic diabetic complications. The second one was a case-control study, whereas all patients with chronic diabetic complications [case group, n = 434] were compared to diabetic patients free from chronic complications [control group, n = 270] to determine the associated factors with cases. Analysis was initially carried out based on a series of univariate comparisons followed by multiple logistic regression analysis. Out of 704 diabetic patients 61.6% n= had one or more chronic diabetic complications. Cardiovascular complications were diagnosed in 30.3%, nephropathy in 12.4%, neuropathy in 32.1%, lower limb complications in 21.9%, and retinopathy in 30.7% of patients. Logistic regression analysis revealed that age, nationality, type and duration of diabetes, glycemic control, hypertension, obesity, physical exercises, and compliance with diet recommendations were proved as significant predictors of these complications. The high economic burden raised by diabetes and its complications challenges the Kuwaiti health care system to prevent the development and progression of diabetic complications. The study identified a group of predictor factors as hypertension and hyperglycemia, enhancement of patient' compliance with regular follow-up visit, the role of health care providers in supplying patients with health information groups of patients who needed priorities of screening programs for development of complication

Endoscopic nodular gastritis in dyspeptic adults: prevalence and association with helicobacter pylori infection

To determine the prevalence and histological features of endoscopic nodular gastritis [NG] in adult dyspeptic patients and its relation to Helicobacter pylori infection. A retrospective endoscopic report review of 2,142 patients identified 67 patients with NG during the period from 1 September 2006 to 31 August 2007. A subset of 32 NG patients [group 1] who had had gastric biopsies during upper gastrointestinal endoscopy and had been evaluated for H. pylori infection were compared to 32 age- and gender-matched dyspeptic patients. They had undergone endoscopy during the same period, which yielded normal results, and had available biopsies that were similarly evaluated for H. pylori infection [controls, group 2]. Pertinent clinical data were obtained from the patients' records. An experienced pathologist assessed the biopsies for the presence and grade of inflammation, activity, glandular atrophy, intestinal metaplasia, presence and density of H. pylori and presence of lymphoid follicles or aggregates. NG was identified in 67 [3.1%] patients. On histological examination, group 1 had a significantly higher grade of gastritis [p<0.001]. The presence and density of H. pylori infection was significantly higher in group 1 [p <0.001]. The H. pylori density correlated significantly with the severity of gastritis [r = 0.57, p <0.001]. The endoscopic performance of NG on H. pylori infection had high specificity [96.8%] and positive predictive value [93.3%]. This study outlined the clinicopathological features of NG identified among a cohort of dyspeptic patients in Kuwait and confirmed the close association with H. pylori infection. However, our study has a limitation in that histopathologic assessment of all NG patients was not feasible

Anatomical variations of human paranasal sinuses: Computed tomographic analysis

The present investigation presents the anatomical variations of the human paranasal sinuses using computed tomography scanning [CT scan]. Paranasal sinus CT scans obtained from 300 subjects [120 male and 180 female] were analyzed. Their ages ranged from 15 to 55 years with a mean age [28.4 +/- 8.79]. The maxillary sinus revealed a number of anatomical variations in 30% of cases. They appeared in the form of septated sinus in 16%, sinus hypoplasia in 10 %, and the presence of a tooth in the sinus in 4% of the cases. Examination of the frontal sinus revealed extensive pneumatization of the sinus in 38% hypoplasia in 26 % and aplasia in 4 % of the cases. CT examination of the sphenoidal sinu reveald sinus hypoplasia in 4%, extensive pneumatization of the sinus in 6% and unseptated sphenoidal sinus in 10% of cases. impression of the optic nerve on the wall of sphenoidal sinus was found in 60% of the cases. The internal carotid artery bulged within the lumen of the sphenoidal sinus in 50% of the cases. Anatomical variations of the ethmoid sinus detected by CT included Aggernasi cell [72%], sphenoethmoidal [Onodi] cell [70%], pneumatized middle turbinate [concha bullosa] [56%], enlarged ethmoid bulla [34%], infraorbital ethmoidal [Hailer's] cell [30%], and paradoxically curved middle turbinate [20%].The uncinate process showed hypoplasia in 24%, elongation in 10%, pneumatization [uncinate bulla] in 8%, lateral deviation in 38% and medial deviation in 28% of cases. . It was concluded that various anatomical variations of paranasal sinuses detected by CT could be of great importance in understanding the pathophysiology of sinus diseases and in avoidance of iatrogenic complications during endoscopic sinus surgery

Effect of sevoflurane on ICP [intra cranial pressure] and associated anaestheic parameters in cranial surgery in comparison with isoflurane

This study was undertaken to assess-the effects of sevoflurane anaesthesia in adult patients undergoing Craniotomy as regarding intracranial Pressure [ICP], haemodynamics, Cerebral perfiisiom pressure [CPP] Brain swelling score [BSS] end tidal carbon dioxid, arterial oxygen saturation [PaO2] and emerganc critaria, In comparison with Isoflurane. 40 adult patients [16-78] year of age, ASA II or III scheduled for elective cranitomy 20 patient [group I] receive isoflurane and 20 patient [group II] receive sevoflurane as inhalational agent with fixed technique, [Induction, Maintianee, Brain protection, Recovery, Post operative] in both group.: and evolution the difference on the variable was done. Show no significant Intra group difference as regard HR, .MABP, ICP, BSS, end tidal carbon dioxid and PaO2 [P value>0.05]. In emergance from anaesthesia were generally rapid in both but the time to extubation was rapid in sevoflurane compared to isoflurane group and the time to commands was faster in sevofiurane group, time to orientation is more rapid in sevoflurane and the time-to reach modified-Alderete score was short in sevoflurane compared to Isoflurane group. Sevoflurane provide stable hemodynamic state with no significant effect on ICP. The Postanaesthetic recovery time was short in sevoflurane group than in Isoflurane group, this make the sevoflurane an attractive choice for a rapid emergenc

Human telomerase enzyme activity in human hepatoma cell line [HEPG2] and its interaction with the heme oxygenase gene

Objective: to examine the contribution of telomerase and HO-1 in the adaptive cellular response to survive exposure to oxidative stresses in human hepatoma cell line [HepG2]

Materials and Methods: induction and activities of HO and telomerase enzymes were assessed in HepG2 cells in response to oxidative stress [represented by treatment with heme, SnC12 and H202] and in the presence of the HO inhibitor stannic mesoporphyrin [SnMP]. Induction of HO and telomerase mRNA were assessed using RT-PCR and western blotting techniques, while HO and telomerase enzyme activities were assessed spectrophotometrically Cytoprotection against oxidative stress was measured by assessing cell viability using a novel colorimetric method

Results: upregulation of HO-1 provided cytoprotection against oxidative stress while its downregulation increased oxidative stress mediated cell injury without altering telomerase activity. Telomerase was active in hepatocellular carcinoma cell line [HepG2] and human telomerase enzyme catalytic subunit [hTERT] was expressed in telomerase positive cancer cells. However, telomerase activity was not affected by oxidants, heme and H[2]O[2] or downregulation of HO gene activity by SnMP, similarly. hTERT, which is considered as the major regulator of telomerase activity, was not affected by oxidants, inducers or inhibitors of HO activity. On the other hand, HO-1 gene induction stimulated cell proliferation and accelerates cell cycle in HepC2 cells, while inhibition of HO activity augmented the damaging effects of oxidants

Conclusion: Induction of HO-1 gene mediates protection against oxidants and increases cell survival by a mechanism independent of telomerase enzyme activity

Immune dysfunction in Egyptian children with Down syndrome

Children with Down syndrome [DS] have an increased rate of infection and it has been proposed that this is secondary to derangements of the immune system. Multiple immunologic disturbances were commonly observed in individuals with DS including abnormal proportions of peripheral lymphocytes subsets, cellular dysfunction and others. The present study was conducted on 20 children with Down syndrome. Sex distribution was 9 males to 11 females [1: 1.2] with age ranging from 1 month to 11 years [average 25.9 +/- 31.7 months]. Control group of 15 healthy children matched for age and sex were included. Karyotype by a standard technique, evaluation of the immune system by flow cytometry and estimation of serum cytokines [interleukin-1 Beta [IL-1Beta], interleukln-2 [lL-2] and tumour necrosis factor alpha [TNF-alpha]] were carried out. A Significant decrease of the absolute number of circulating lymphocytes, a marked significant decrease of B-lymphocytes and drarratic modifications of the T-cell subsets were observed. T-cell subpopulation studies revealed marked decrease in CD4+ subpopulation has been documented with inverted CD4/CD8 ratio, whereas CD8+ cells increased significantly in percentage. A derangement of cells bearing markers associated with natural killing [NK] activity such as CD19+ and CD56+ was observed. Among the most important alterations are the presence of a high number of CD56+ lymphocytes and significantly high percent of CD56+ CD8+ T cells. Regarding cytokine production, it was found that serum IL-2 levels were significantly decreased in DS children compared to the control group and its production was correlated inversely with age. On the other hand; lL-1Beta and TNF-alpha levels in DS Children showed no significant difference compared to normal subjects. We concluded that thymic alterations and molecular abnormalities due to gene over-expression of loci located on Chromosome 21 could be involved. On the other hand, the increased percent of CD56+ CD8+ T cells; as potent antitumour immunity; is emphasizing how rare are solid tumours in DS patients

Vertical and horizontal distributions of plant - parasitic nematodes associated with banana CV. Williams under flood irrigation regime

Under flood irrigation system, the vertical and horizontal distributions of plant-parasitic nematodes associated with soil and roots of banana cv. Williams were investigated. The sampling data generally indicated that the highest population density of parasitic nematodes viz. Criconemoides spp., Helicotylenchus exallus, Hoplolaimus spp. and Meloidogyne incognita were concentrated at soil depth layers of 0-15 cm, and 16-30 cm at the horizontal distance of just beneath the plant base [zero cm] and 40 cm from the banana pseudostem base which is correlated with the growth and distribution of the feeder roots of banana. These sites should be considered as the best sampling points for such coin habiting nematodes

Histopathological changes induced by either Root - Knot or spiral nematedes on banana roots

Cross and longitudinal sections in roots of banana cv. Williams infected by either Meloidogyne incognita or Helicotylenchus dihystera showed that the histological alterations induced in roots infected with M. incognita were displayed by the giant cell formation in both cortical and stelar regions. The giant cells were, always, in clusters each containing 3-6 cells. Roots infected with H. dihystera showed small brown lesions around the penetratedsites in the cortical layer causing considerable cell wall damage. The walls of the invaded cells by the nematodes were heavily stained with safranine indicating the presence of lignin, while healthy cell walls were lightly stained

Population dynamics of root-knot, spiral and stunt nematodes on sweetsop, annona squamosa [annonaceae] in relation to soil temperature

Twelve menatode genera were found in association with the rhizosphere of sweetsop. The nematodes recorded were Aphelenchus, Criconemoides, Diphtherophora, Ditylenchus, Helicotylenchus, Longidorus, Meloidogyne, Rotylenchulus, Trichodorus, Tylenchorhynchus, Tylenchus and Xiphinema. Of these, H. exallus, M. incognita and Tylenchorhynchus sp. were the most consistently encountered nematodes throughout the year. The population densities of these nematodes were found to have at least one distinguishable peak in August/September. These peaks were positively correlated with soil temperature range of 27-29C. However, the root populations of M. incognita reached its peaks in October and April, which negatively correlated with a moderate soil temperature [24]. This is the first report of nematodes associated with sweetsop Annona squamosa [Annonaceae] and its nematode population dynamics in Egypt

Mini laparotomy a valid cost effective option for cholecystectomy

Laparoscopic cholecystectomy is replacing the use of conventional open cholecystectomy and minilaparotomy cholecystectomy for removal of the gall bladder. The authors have studied the indications, technique, postoperative course and complications of minilaparotomy cholecystectomy on 154 patients with the aid of custom made retractors. The authors conclude that minilaparotomy cholecystectomy is a valid cost effective option for removal of the gall bladder in selected cases. Experience with the procedure is neccessary and it can be an excellent alternative to either laparoscopic cholecystectomy or conventional open cholecystectomy giving patients a short hospital stay and early recovery with a low complication rate together with a reduced cost omitting the need for sophisticated equipment

Survival, developmental and morphogenic deficiencies of parasarcophaga argyrostoma [diptera: sarcophagidae] induced by the biosynthesis inhibitor chlorfluazuron [IKI-7899]

To evaluate the activity of benzoylphenyl urea chitin biosynthesis inhibitor chlorfluazuron [IKI-7899] against Parasarcophaga argyrostoma, 7 doses were topically applied [once] onto early third [last] instar larvae, puparia, or newly pupa: 150, 100, 50, 10, 1, 0.5 and 0.25 mug/insect. After topical treatment of last instar larvae, the highest morality was caused by both highest dose and the lowest mortality was caused by the lowest dose. The lethal activity of IKI-7899 pronouncedly decreased as the treatment was lately carried out [at the puparial time]. IKI-7899 failed to cause cumulative mortality because no pupal or adult mortalities were observed, irrespective of the time of treatment. Treated larvae suffered the action of IKI-7899 because they had decreased weight gain. Except the lowest dose, the weight gain of larvae inversely correlated with the dose levels. IKI-7899 prolonged not only the larval duration, but also the pupal duration after topical treatment of last instar larvae with doses 50 - 0.25 mug/larva. With no exception, all doses topically applied onto puparia or newly formed pupae enhanced pupae to live longer. Topical application onto last instar larvae resulted in different degrees of reduction of pupation rate, but IKI-7899 could not affect the pupal morphogenesis after larval treatment except by its highest dose, which led to 8.33% pupal deformities and 7.69% larval-pupal intermediates. The dose 100 mug/larva topically applied onto last instar larvae obtained 7.69% permanent larvae, which suffered from the action of compound along 16 days and eventually perished without any external feature of puparium formation. A metamorphic effect of IKI-7899 pronouncedly appeared in the adult stage. Three higher doses completely arrested the adult flies

Detection of carcinoembryonic antigen [CEA] in breast cancer tissue and it's relation to some prognostic histological features

Carcinoembryonic antigen was searched for in tissue sections from 34 radial mastectomy specimens with breast carcinoma. These sections were stained using unlabelled peroxidase-antiperoxidase technique and polyvalent rabbit antiserum to CEA. The positivity of CEA staining in carcinoma cells was 44.11 percent of the total. Correlating this to the histological type and grading of tumour, lymphoid infiltrate in tumour bed and the auxillary lymph nodes metastases, no clear significant relation was detected between them

Significance of oxalate crystals in the sputum for the differentiation between bronchial and pulmonary diseases

Sixty patients with different broncho pulmonary diseases [34 asthmatics, 9 with chronic obstructive lung diseases, 2 with bronchiectasis and 15 with non-bronchial pulmonary diseases, working as, gardeners, farmers, bakers, housewives and others] together with 20 matched normal control persons were the subjects of this study. All the studied groups were clinically examined, radiological examination for chest and peak expiratory flow neter [PEFM] for the diagnosis of different broncho pulmonary diseases also direct microscopic examinat; on of sputum to search for oxalate crystals was done. Intradermal skin tests to the common allergens followed by precipitin formation were done to all subjects. It was found that, oxalate crystals in the sputum were present only in patients with bronchial tree affections and not present in the sputum of other groups. Only patients with extrinsic asthma gave + ve skin tests to the different allergens, the more prevalent was house dust antigens. One female patient only with intrinsic bronchial asthma gave + ve precipition to Asp. Fumigatus. One may conclude that, the presence of oxalate crystals in the sputum may be pathognomonic of bronchial tree affections