Effect of khat [Catha Edulis] use on the bioavailability, plasma levels and antimalarial activity of chloroquine

Objectives: This study aimed to evaluate the effect of khat [Catha edulis] on chloroquine [CQ] bioavailability in healthy Yemeni adults and its effect on CQ plasma levels and parasite clearance among malaria patients

Methods: This study took place between January and April 2007 in Bajil and Sana'a, Yemen. Two CQ doses [600 mg each] were given to 15 healthy males on separate occasions; the first dose was followed by a khat-chewing session [phase one] while controls abstained from khat-chewing for the second [phase two]. Additionally, 103 patients with Plasmodium falciparum-induced malaria, including both regular khat chewers [n = 57] and non-khat chewers [n = 46], were treated with CQ [25 mg/kg] over three days. Pharmacokinetic parameters were analysed among both controls and malaria patients. Parasite clearance was also investigated for the latter group

Results: The mean area under the concentration-time curve [AUC] was 2,108.9 versus 2,797.4 ng/hour/mL, mean peak plasma concentration [Cmax] was 415.6 versus 508.7 ng/mL and mean time to reach Cmax was 3.8 versus 3.6 hours for controls in phase one versus phase two, respectively; both AUC and Cmax levels were significantly reduced by khat-chewing [P <0.050]. For khat- versus non-khat-chewing malaria patients, mean plasma CQ concentrations were 266.4 ng/mL versus 427.5 ng/mL [P <0.001]. Furthermore, CQ was effective in 71.7% and 75.4% of non-khat- and khat-chewing malaria patients, respectively [P = 0.823]

Conclusion: Khat-chewing was found to significantly reduce plasma CQ levels among healthy volunteers and malaria patients. While receiving CQ treatment, patients should be advised not to chew khat

Detection of Giardia lamblia antigen in stool specimens using enzyme-linked immunosorbent assay

The aim of this study in Iraq was to determine the sensitivity and specificity of a commercial ELISA test for detection of Giardia lamblia antigen in stool. Of 84 stool samples from children in Duhok governorate, 42 were positive and 42 negative for G. lamblia or other parasites by direct and indirect microscopic examination. The sensitivity of the ELISA test for detection of G. lamblia versus microscopy was 76.4% and the specificity was 100%. We recommend using ELISA in epidemiological surveys in Iraq and to confirm the diagnosis in patients with typical clinical symptoms of giardiasis but negative results by direct microscopy

new method to decrease the occurrence of embolic events during total hip replacement

The goal of this study is to assess the efficacy of a modified surgical technique, designed to limit the increase in intramedullary pressure during insertion of the prosthesis and to reduce intra-operative embolic events. Forty patients treated with total hip replacement in Tanta university hospitals divided into 2 groups [group 1] treated with conventional cementing technique and [group 2] treated with a modified cementing technique with a cannula inserted into the intertrochanteric region of the femur to decrease the intramedullary pressure to avoid the increase of the intramedullary pressure after application of the cement and insertion of the stem. There was a significant difference between the incidence of embolism and increased pulmonary artery pressure [detected by trans-thoracic Echocardiography] between both groups of patients where the incidence of both were found to be much lower when the modified technique was used. Also the changes in the hemodynamic parameters [heart rate, blood pressure, and central venous pressure] accompanying the appearance of emboli in Echocardiography especially grades 2 and 3 embolism were found to be significant in the conventional cementing group [p<0.05]. The changes in the respiratory parameters [decreased oxygen saturation, decreased arterial oxygen tension, decreased end tidal CO2, and increased arterial CO2] accompanying the appearance of emboli in Echocardiography especially grades 2 and 3 embolism were found to be significant in the conventional cementing group [p<0.05]. Modified surgical technique [A vacuum drainage of the proximal femur along the linea aspera] was found to be effectively reducing the incidence of embolization during cemented hip arthroplasty

Trochanteric fractures, the best method of treatment

unstable trochanteric fracture is a problematic fracture especially in osteoporotic patients. No method of treatment can be considered to be a golden line of treatment for all types of fractures. The aim of this work is to compare the results of treatment of unstable trochanteric fracture by using dynamic hip screws, hooked plate and proximal femoral nail. This study was done in Tanta university hospitals during the period January 2000 till December 2006. Three hundred and thirteen patients were included in this study. However, 20 patients were excluded; 7 due to death and 13 were lost during the period of follow up. The patients were divided into 3 groups according to the method of treatment. Group A included 120 patients [68 males and 52 females] treated by DHS. Group B included 110 patients [46 males and 64 females] treated by hooked plate. Group C included 63 patients [30 males and 33 females] treated by PFN. According to Dubigne and Postel grading, in group A, 99 from 120[82.5%] were satisfied while 21 [17.5%] were unsatisfied. In group B, 61 patients from 110[55.5%] were satisfied and 49 patients [44.5%] were unsatisfied. However, in group C, 57 patients from 63 [90%] were satisfied while only 6 patients [10%] were unsatisfied. The average healing time was 14 weeks with using DHS, 19 weeks with using hooked plate and 12 weeks with using PFN. Post-operative X-ray showed a valgus position of the femoral neck in 18 [15%] out of 120 patients treated by DHS. Varus malposition had occurred in 30 patients [25%]. Valgus deformity occurred in 50% of patients with hooked plate while varus deformity occurred in 41.66% of the patients. On the other hand, only 4 patients [6%] in group C developed varus malposition. Lag screw cut out occurred in 13 patients [11%] in group A. Revision by arthroplasty was done in 7 cases and 6 treated conservatively due to the bad general condition of the patients. Implant removal was done after 2 years from complete union. In group C, only 3 patients [5%] had lag screw cut out; 2 treated conservatively and the lag had removed after union and only one required revision using arthroplasty. Implant failure had occurred in 11 patients [10%] in group B and revision was done in all of them. In treating unstable trochanteric fractures, PFN provides superior results on comparison with DHS or HP. DHS is another accepted alternative when the lag screw is inserted correctly and centrally. However, hooked plate is an inferior alternative when compared with PFN or DHS

Thrombophilia and pregnancy outcomes

Pregnancy complications are still a challenge for physicians, because knowledge of pathomechanisms and prophylactic measures is still limited. In recent years thrombophilia as a risk factor for pregnancy complications has gained much attention in the scientific community. To study the rate of thrombophillia gene in cases with recurrent abortion. In the period between January 2006 and May 2007, 40 consecutive patients with a history of recurrent failed IVF and abortion, defined as fetal loss before 16 weeks' gestational age, were screened by the following tests: Molecular diagnosis of 11 thromobophilia gene mutation, ACL IgG and IgM. PtC, PtS. ATIII and Lupus anticoagulants. 40 patients were included in this study and the following data was recorded: All cases were negative to protein C, S and anti T Ill. One case showed positive anti cardiolipin Ig M-3 cases positive for Lupus anticoagulant, all the cases were positive for multiple thrombophillia genes. The observed rate of successful pregnancies of women treated with aspirin, who had mild thrombophilia and a history of a single abortion, is much lower than it would haye been expected from patient treated with combined therapy

Role of leptin in acute leukemia

Acute leukemia is a neoplastic proliferation of the hematopoietic progenitor cells, characterized by appearance of immature cells [blasts] in the bone marrow replacing the bone marrow cells resulting in anemia, thrombocytopenia and an outpouring of the neoplastic blasts into the peripheral blood. As leptin acts as a feedback signal from the adipose tissue, it also acts synergistically with stem cell factor [SCF] in promoting proliferation of primitive hematopoietic progenitors in vitro. Leptin has a stimulatory effect on myeloid, lymphoid and erythroid colony formation. And also has proliferative and antiapoptotic activities in leukemic cells, which express the long and short forms of OB-R. The present study selected the patients with acute leukemia to assess and clarify the possible role of leptin in acute leukemia, and also to reveal the relationship between leptin and acute leukemia. This study involved 60 individuals grouped into patient groups [24 ALL cases and 17 AML case] and normal control groups [8 healthy controls for ALL cases and 11 healthy controls for AML cases]. All groups were subjected to estimation of serum leptin level by ELISA. In addition, 9 patients from ALL group, 8 patients from AML group and 9 healthy controls were subjected to B.M. leptin estimation level by ELISA. There was a highly statistical significant decrease in serum leptin level in both ALL and AML patients when compared with normal controls and also, there was a highly statistical significant decrease in B.M. leptin level in ANIL patients when compared with normal controls. As regards to all patients, serum leptin level was positively correlated with B.M. leptin level and height, also B.M. leptin level was positively correlated with hemoglobin and platelet count but negatively correlated with BMI and weight. As regards to all patients, serum leptin level was positively correlated with B.M. leptin level and bone marrow blasts but negatively correlated with hemoglobin, also B.M. leptin level was positively correlated with BMI but negatively correlated with TLC. Leptin alone and in combination with other cytokines has stimulative effects on proliferation of leukemia cells as well as antiapoptotic effects. These findings suggest the possibility that leptin plays roles in the pathophysiology of leukemia

Frequency of Giardia lamblia among children in Dohuk, northern Iraq

Out of 1261 stool specimens collected from children in Dohuk city, northern Iraq, the prevalence of Giardia lamblia infection was 38.5%. The highest rate of infection was in orphan care centres [48.1%] and the lowest in the paediatric hospital [31.3%]. The age group 10- 12 years had the highest rate [81.2%] and 7- 9 years the lowest [22.9%]; boys had a higher rate than girls. Some infected samples [70/ 486] showed double or triple infections and G. lamblia was combined with Hymenolepis nana, Blastocystis hominis, Entamoeba histolytica and Iodamoeba buetschlii

Brucellosis in children in south Jordan

Retrospectively we evaluated the records of 68 children with brucellosis. We found 58.2% had consumed unpasteurized milk and dairy products. Nonspecific manifestations included: arthralgia [78%], fever [75%] and sweating [60%]. Localized manifestations included limping [75%] and arthritis [54%]. Leukopenia was found in 51% of children and anaemia in 24%. Brucella species was cultured for blood of 16 [23.5%] patients. Combination therapy containing streptomycin was more effective than gentamicin combinations

Effect of naloxone on the recovery from experimental hemorrhage in dogs

In the present work experimental haemorrhage was induced and maintained For 30 min. in the first group [8dogs] bled animals were infused with the shed blood; and were considered as a controls group. In this group haemorrhage resulted in a highly significant drop in systolic, diastolic and pulse pressure; while the heart rate was significantly increased. [53.33 +/- 4.08; 32.5 +/- 4.18; 20.8 +/- 22.04; 181.6 +/- 25.6] these average values were maintained for 30 minutes; during which two dogs died. On infusion of the shed blood the alive animals recovered after 5 minutes and gradually the heart rate returned to normal after 30 minutes, while the systolic, diastolic and pulse pressure returned to normal after 45 minutes. In another group of experiments [8dogs] bled animals maintained in the state of shock for 30 minutes were injected with naloxone [1 mg/kg] immediately before infusion of the shed blood. The systolic, diastolic and pulse pressure as well as the heart rate returned to the normal levels within 5 minutes