Role of MRI in the Detection and Monitoring of Lower Limb Osteonecrosis after Chemotherapy in Pediatric Patients with Acute Lymphoblastic Leukaemia

Background:Magnetic resonance imaging (MRI) is the technique that demonstrated the highest sensitivity and specificity in the early diagnosis of osteonecrosis. It allows detecting initial typical signal intensity alterations of the bone marrow when other examinations showed nonspecific findings or even no alterations at all. The aim of this study is to assess the role of magnetic resonance imaging in detection and monitoring osteonecrotic lesions in pediatric patient with acute lymphoblastic leukemia after chemotherapy.Materials and Methods: This prospective study was performed on 30 pediatric patients ranged from 4 to 18 years with acute lymphoblastic leukemia on chemotherapy or after 3months from ending chemotherapy with symptoms suspicious for osteonecrosis (i.e., articular pain). All patients were explained about the procedure to be done. MRI study of whole lower limbs was done for all patients.Results:In the present study all patients were symptomatic. 24\30 patients (80%) had hip pain, 25\30 patients (83.3%) had knee pain and 8\30 patients (26.7%) had limping. We reported that knee pain was the most common complaint representing 83.3% of patients. 11\30 patients (36.7%) had no MRI findings. 19\30 patients (63.3%) had different positive findings; 4 patients (13.3%) had non -articular osteonecrosis (ON) only with no joint involvement (bone infarction), 2 patients (6.7%) had avascular necrosis of femoral head epiphysis without bone infarction and 13 patients (43.3%) had combined bone infarction and avascular necrosis with Joint involvement. Follow up by MRI was done for all patients (30 patients), 27 patients showed no change in MRI findings, one patient progressed from avascular necrosis of the femoral headepiphysis without deformity to avascular necrosis of the femoral head epiphysis with deformity. The other two patient showed regressive course.Conclusion:We concluded that MRI study is mandatory for early detection and monitoring of lower limb osteonecrosis in pediatric patients with acute lymphoblastic leukemia under or after chemotherapy.The radiologist and clinician must do MRI lower limbs routinely and follow up MRI after 4-6 months to first MRI due to some patients had regressive or progressive findings

Phenolic content, antioxidant potential and Aedes aegyptii ecological friend larvicidal activity of some selected Egyptian plants

Polyphenols constitute a distinct group of natural compounds of medicinal importance exhibiting wide range of physiological activities as antioxidant, immune-stimulant, antitumor and antiparasitic. Yellow fever and dengue fever are mosquito-borne infectious diseases transmitted by Aedes aegyptii, the presence of yellow fever in Sudan and dengue fever in Saudi Arabia are threats to Egypt with the re-emerging of Ae. aegyptii in Southern Egypt, larvae control is feasible than flying adults. This work was conducted targeting estimation of the relative levels of total phenolic content, antioxidant potential and larvicidal activity of 110 selected Egyptian plants. The highest total phenolic contents were estimated in aqueous extracts of Coronilla scorpioides L., Forsskaolea tenacissima L, Crataegus sinaica Boiss., Pistacia khinjuk Boiss. and Loranthus acacia Benth.; they were 916.70 +/- 4.80, 813.70 +/- 4.16,'744.90 +/- 4.93, 549.00 +/- 3.93 and 460.80 +/- 4.02 mg% while those of methanol extracts were estimated in Coronilla scorpioides, Forsskaolea tenacissima, Crataegus sinaica, Loranthus acacia and Pistacia khinjuk; they were 915.60 +/- 4.86, 664.60 +/- 4.16, 659.30 +/- 4.80, 590.80 +/- 4.49 and 588.00 +/- 3.85 mg% respectively. Investigation of the antioxidant potentials revealed that the most potent plants were Coronilla scorpioides, Forsskaolea tenacissima, Crataegus sinaica, Pistacia khinjuk and Loranthus acacia with calculated values of 454.80 +/- 4.83, 418.4+/-4.16, 399.10 +/- 4.90, 342.5 +/- 2.72 and 239.7 +/- 2.91% for aqueous extracts and 452.9 +/- 4.94, 389.6 +/- 4.6, 378.48 +/- 3.84, 352.3 +/- 3.06 and 346.5 +/- 2.98% for methanol extracts respectively while screening of larvicidal activity proved that Coronilla scorpioides, Forsskaolea tenacissima, Crataegus sinaica, Pistacia khinjuk and Loranthus acacia exhibited highest potency calculated as 22.53 +/- 2.01, 23.85 +/- 2.07, 28.17 +/- 2.06, 31.60 +/- 2.93 and 39.73 +/- 4.58 mg% aqueous extracts and 18.53 +/- 1.95, 18.8 +/- 1.67, 20.17 +/- 1.85, 23.28 +/- 2.7 and 28.48 +/- 3.9 mg% methanol ones respectively

Interrelation of antioxidant, anticancer and antilieshmania effects of some selected Egyptian plants and their phenolic constituents

Medicinal plants are the most potential resource of new therapeutic agents. They are diverse, largely productive, biologically active and chemically unique; among their constituents [polyphenol compounds group] one of the main determinant factors in evaluating the pharmacological potentials i.e. polyphenols display an array of pharmacological properties such as antioxidant, immunostimulant, antitumor and antiparasitic effects. Cancer is a dreadful human disease, increasing with changing life style, nutrition and global warming while current available anticancer drugs cause serious side effects in most instances. Several reports suggested the relationship between antioxidant, anticancer and antiparasitic effects; they suggested that they act indirectly through promoting host resistance, restabilizing body equilibrium and conditioning body tissues in addition to their direct effect on certain parasites involved in cancer etiology. This work was conducted for estimation of total phenolic, flavonoids, phenylethanoid glycoside and iridoid content of twenty-three selected Egyptian plants as well as screening of their anticancer, antioxidant and antileishmanial effects, the overall gained results for suggest that the most suitable medicinal plant used as anticancer and antioxidant is Petrea volubilis L. which contain adequate mixture of total phenolic compounds 88.7 mg% and flavonoids 50.80 mg% and also suggest that flavonoid compounds are the category of phenolic compounds possess significant antioxidant and anticancer effects while the antilieshamnia screening revealed that Thymus decussatus Benth. extract exhibited the highest effect due to the presence of flavonoids and iridoids in adequate combination where iridoid compounds 201 mg% and flavonoid content was 128 mg%

Biotechnological and phytochemical studies on Myrtus communis L. including determination of essential oil content and antioxidant activity

Shoot tips and nodes of Myrtle [Myrtus communis L. family miyrtaceae] were used as explants for callus formation in this study. Half salt strength of MS medium without plant growth regulators showed no callus formation and regeneration. The results clearly showed that half salt strength of MS basal solid medium supplemented with 1.0 mg/l NAA and 1.0 mg/l TDZ or 1.0 mg/l NAA and 1.0 mg/l BAP recorded the best results in callus production from shoot tip or node explants [5.29, 4, 98, 3.84 and 3.69, mg /jar fresh weights, respectively]. The same trend was obtained with the other parameters as 0.37, 0.35, 0.51 and 0.48 g / Jar dry weights, respectively, 98.66, 97.33, 63.55 and 54.29, callus percentage, respectively, 5.0, 4.85, 4.35, and 4.15, callus size [Degree] respectively. In regeneration, half salt strength of MS solid medium contained 1.0 mg/l IAA, 0, 5 mg/I BAP and 0.2 mg/I GA3 observed the highest records in that concern with callus obtained before from both types of explant [shoot tips or nodes] in the medium contained 1.0 mg/I BA and 1.0 mg/I NAA. In acclimatization, shoots without in vitro root formation were transferred to soil mixture of equal volumes of peat-moss and sand. The highest percentage of survival was recorded when these shoots were dipping in solution of 1.5 mg/I IBA and 1.0 mg/I 0A3. The quantity of essential oil of plant was equal 0.5% [V/W] of yellowish volatile oil, from analysis of the oil using GC and GC/MS; it was obvious that it contained 14 compounds where alpha-pinene represented the highest percentage [66%] while alpha-thugen was the lowest one [0.5%]. The antioxidant activity was investigated in leaf extracts of in vitro produced plants and in vivo grown plants [mother plants] which recorded 82% and 75% respectively. Total phenolic compounds and total flavoniodal contents were investigated in leaf extracts of in vitro produced plants and in vivo grown plants [mother plants] parameters were 112 micro g% and 125 .micro g%, respectively with the extract of in vitro leaves while the extract of in vivo leaves [mother plants] showed 102 micro g% and 114 micro g%, respectively

Evaluation of cardiac performance in infants with ventricular septal defect: effectiveness of captopril versus propranolol therapy

The objectives of the present study were to evaluate the effects of left ventricular [LV] preload due to ventricular septal defect [VSD] on cardiac performance, and to compare the therapeutic effects of captopril versus propranolol on infants with hemodynamically significant large VSD with heart failure. The study included 60 infants with VSD, classified into: large VSD [20 infants], moderate VSD [20 infants] and small VSD [20 infants]. Twenty healthy infants served as a control group. All infants were subjected to history taking, clinical examination, X-ray chest and heart and echocardiographic evaluation [using conventional echo-Doppler and tissue Doppler imaging]. Follow up was done in infants with large VSD after 3 months of therapy for two subgroups: group A [10 infants treated with pro pranolol] and group B [10 infants treated with captopril]. The results showed LV diastolic dysfunction, but no systolic dysfunction in large VSD, with decreased EIA ratio [by pulsed transmitral Doppler] and decreased e/a ratio [by tissue Doppler]. The tissue Doppler was more sensitive than the pulsed Doppler [sensitivity 90%vs. 40%]. Comparing both drugs used in large VSD; propranolol led to significant clinical improvement [respiratory rate, heart rate and weight gain], whereas captopril led to significant hemodynamic improvement of LV myocardial function [ejection fraction and fraction shortening], LV diastolic function, decreased cardiomegaly [by X-ray], decreased size of VSD and significant decrease of pulmonary to systemic flow ratio [Qp/Qs] [P<0.05]. Conclusions: Tissue Doppler is more sensitive than pulsed transmitral Doppler in detecting LV diastolic dysfunction in infants with large VSD. Captopril improves the hemodynamics of large VSD with congestive heart failure and corrects the LV diastolic dysfunction, whereas propranolol improves the clinical manifestations with better weight gain before surgical repair

Terbutaline sulphate hydrophilic matrix tablets

Terbutaline sulfate hydrophilic matrix tablets were prepared using different hydrophilic matrix forming polymers. Cellulosic polymers used were hydroxypropylmethyl cellulose [HPMC] 15 cps, 100 cps and 4000 cps. Other polymers were sodium alginate and xanthan gum each used in concentrations of 7, 14, and 28%. Combinations of HPMC with pectin were also used for the preparation of terbutaline sulfate hydrophilic matrix tablets. In vitro evaluation of the prepared tablets was performed by the determination of the hardness, friability and release profiles. Release of the prepared formulations was performed using USP Dissolution Tester Apparatus II. Results showed that terbutaline sulfate hydrophilic matrix tablets prepared using different polymers controlled the release of the water-soluble drug over an extended period of time. The release of terbutaline from tablets prepared using hydroxypropylmethyl cellulose of different viscosity grades showed marked decrease with the increase of the viscosity grade used, where after 8 hours 94.7%, 54.7% and 49.5% of the drug was released using HPMC 15 cps, HPMC 100 cps and HPMC 4000 cps, respectively. For tablets prepared using xanthan gum, increasing the concentration of xanthan gum showed a decrease in release of terbutaline sulfate, where increasing the concentration from 7% to 28% showed a decrease in release from 91.5% to 69.1% after 8 hours. Hydrophilic matrix tablets prepared using sodium alginate did not offer the desired control over drug release. Binary mixtures of hydroxypropylmethyl cellulose and pectin in different ratios optimized the release profile of terbutaline sulfate. It was found that increasing the ratio of pectin resulted in an increase in the release rate of the drug. Optimum release profile was achieved when the hydrophilic matrix tablet was prepared using HPMC 100cps and pectin in ratio of 4:1. Kinetic analysis of the release data showed that ideal zero order release was achieved for tablets prepared using this binary mixture

Biochemical studies on some recently developed plasma volume expanders in rats

Evaluation studies on two different preparations of hydroxyethyl starch; namely, hespan and pentaspan were carried out after single and repeated i.v. infusion in rats. These studies included the following determination: Blood glucose, serum alpha-amylase, total protein, polyacrylamide gel electrophoresis [PAGE]. In all cases, the results of the tests were favorable and no untoward reactions which may be attributed to the infusion fluid have been observed. All parameters were normalized

Osmotic fragility of normal human erythrocytes in solutions of different cations and anions

Osmotic fragility curves for normal RBCs bathed with each of four different cations [Na[+],K[+],Ca[2] and Mg[2+] and five different anions [Lactate, H[2]PO[-4], Cl[-],HCo[-3] and HPO[--4] were constructed The curves for cations were typical "S" shaped. The divalent cations [Ca[+2] and Mg[+2]] produced more hemolysis than monovalent ones [Na[+] and K[+]] at each osmolal concentration of the curves. HCO[-3] has the least hemozytic effect while lactate the greatest. Divalent phosphate [HPO[--4] has less hemolytic effect than monovalent one H[2]PO[-4]] at high osmolal concentrations [150-300 mosm/L], The reverse effect occurs at lower osmosal concentrations [50-150 mosm/L], It is not only the total osmotic pressure [O.P] of the solution or the diameter of the ion but also the ion charge and the presence or absence of specific ion which determines the osmotic behaviour of the cell

study on computerized tomography in schizophrenia

The aim of this work is [1] to find out CT changes in schizophrenia and look for the different factors that may affect such changes e. g. duration of illness, family history, type of symptoms [positive vs. negative ones] and ECT. [2] to verify whether CT changes in schizophrenia are associated with some cognitive deficits. The material of this study included sixty schizophrenics and twenty controls. The methods used entitled: [1] CT study e.g. ventricular dilatation, cortical atrophy, brain tissue density, [2] Organicity testing [Bender Gestalt test]. The results revealed the following: 1- Schizophrenics had significant enlargement of the third ventricle [central atrophy] compared to controls. 2- Schizophrenics with longer duration of illness [more than 2 years] showed more significant central atrophy. 3- Factors like family history, type of symptoms and ECT had no significant relation to the presence of central atrophy. 4- Cortical atrophy was not significantly different in patients compared to controls. 5- The density of grey and white matter showed significant decrease in schizophrenics compared to controls. 6- In Bender Gestalt test, two thirds of schizophrenics gave organic scores while one third gave functional scores. Impairment of cognitive function is more likely to occur in patients with central atrophy [enlargement of the third ventricle]