Efficacy and safety of oral low dose theophylline in Jordanian patients with stable chronic obstructive pulmonary disease treated at King Hussein Medical Center

Objective: to assess the efficacy of adding Slow-Release Theophylline to the regular treatment of Chronic Obstructive Pulmonary Disease [COPD] patients. The safety of Theophylline was also assessed as a secondary endpoint

Methods: prospective observational study of one hundred and nine patients, with moderate to very severe COPD, and treated in the pulmonology clinic at King Hussein Medical Center, between August 2014 and March 2015. Exclusion criteria included: acute exacerbation of COPD within the last 3 months; use of oral corticosteroids within the last 4 weeks; upper or lower respiratory tract infection within the last 4 weeks; recent unstable angina or arrhythmias; epilepsy; concurrent use of medications that might interact with Theophylline and excessive alcohol consumption. After enrolment, Forced Expiratory Volume in the first second [FEV 1] and Forced Vital Capacity [FVC], oxygenation at rest using 2 different pulse oximeters and level of disability assessed by the Medical Research Council dyspnoea scale were evaluated. A fixed dose of oral Theophylline was added to their regular treatment, as Theophylline [Quibron-T SR] 300 mg slow-release capsules once daily. The patients were followed up after 4 weeks, when the measurements were repeated. The patients were also evaluated for any side effects related to Theophylline. The pre and post-Theophylline data were compared. The safety profile of Theophylline was assessed by recording side effects related to the drug, any serious side effects, or Theophylline withdrawal

Results: out of the 109 patients in our study, 96[88%] were males, and 13[12%] were females. Their mean [ +/- SD] age was 69.0 +/- 7.8 years [range 46-83 years]. After 4 weeks of added Theophylline, there was a statistically significant improvement in FEVl from 53 .3 +/- 10.4 to 56.4 +/- 10.1 [% predicted mean +/- SD] [p= 0.03] and FVC from 70.4 +/- 10.0 to 73.1 +/- 9.8% [p= 0.05]. 61 % of the patients showed improvement in dyspnoea, with a significant improvement in the MRC score from 3.8 +/- 0.8 to 3.2 +/- 0.8 [p<0.0001]. The patients also showed an increase in saturation from 93.6% +/- 2.3 to 93.8% +/- 2.0, though this was not statistically significant [p= 0.490]. 5 patients [5%] had side effects related to Theophylline,though none were serious. The most common side effect was nausea [60%]. None of the patients who developed side effects stopped using Theophylline during the study

Conclusion: theophylline produced a significant increase in the lung function of patients with moderate, severe and very severe COPD and significantly improved their disability caused by dyspnoea, without any serious side effects. Use of Theophylline in stable COPD patients should be weighed however against the risk of possible non-serious side effects, mainly nausea

[Knowledge and life experience of mothers facing certain teenager's addictive behaviours in the region of Tunis]

We surveyed 415 mothers who regularly consult primary healthcare centres about their knowledge of addictive behavior in teenagers in relation to tobacco, alcohol and drugs. Most mothers considered the teenage period difficult. Apprehension of this period increased with the educational level of the mothers. Mothers did not often discuss the issue of addiction with their children, especially related to alcohol and drugs. Nevertheless, the mothers were aware of the risks of addiction. They considered information campaigns about this topic an efficient means of prevention. About half of the mothers had experience of addictive conduct involving a family member. They resolved the problems through family help or consultation with a specialist

Synthesis and in-vitro antibacterial activity of/N-piperazinyl quinlone derivatives with 5-chloro-2-thienyl group

Fluoroquinolones are an important group of antimicrobial agents that are used widely in the treatment of various infectious diseases. The purpose of the present study was to synthesize new N-piperazinyl quinolone derivatives with 5-chloro-2-theinyl group having possible antimicrobial activity. Reaction of ciprofloxacin [1], norfloxacin [2] and enoxacin [3] with alpha-bromoketone 10 or alpha-bromooxime derivatives 11a-c in DMF, in the presence of NaHCO[3] at room temperature, afforded corresponding ketones 4a-c or oxime derivatives 5-7[a-c], respectively. The synthesized compounds were tested against a series of Gram-positive and Gram-negative bacteria. The results of MIC tests against both Gram-positive and Gram-negative bacteria revealed that ciprofloxacin derivatives [compounds 4a, 5a, 6a and 7a] were more active than norfloxacin and enoxacin analogues. Compound 5a, containing N-[2-[5-chlorothiophen-2-yl]-2-hydroxyiminoethyl] residue provided a high in vitro antibacterial activity against Gram-positive bacteria, with MIC of 0.06, 0.125, 0.5 and 0.125 micro g/mL against S. aureus, S. epidermidis, E. feacalis and B. subtilis, respectively. Its activity was found to be 4 to 8 times better than reference drug [ciprofloxacin] against all Gram-positive bacteria with the exception of E. feacalis

diagnostic and prognostic significance of circulating and intrahepatic endoglin in liver fibrosis associated HCV infection

Endoglin [CD 105], a transforming growth factor-beta [TGF-beta 1] co-receptor, has been implicated in liver fibrogenesis and carcinogenesis. To determine CD 105 in liver tissue and serum of patients with chronic hepatitis C virus [HCV] infection and to correlate CD 105 expression to stage of fibrosis and serum markers of liver fibrosis; TGF-beta 1 and hyaluronic acid [HA]. Liver biopsies from 42 chronic HCV patients and 20 healthy subjects [donors for liver transplantation] were used for tissue quantification of CD 105 by ELISA and Western blot analysis then correlating findings with tissue TGF-beta 1. Serum CD 105 and HA from patients and control subjects were determined by ELISA. According to the stage of liver fibrosis assessed by Ishak scoring system, patients were classified into 3 groups: Group I: with mild fibrosis [stage 1-2] included 16 patients [11 males, 5 females, mean age 34.5 +/- 7.2 years], Group II: with moderate fibrosis [stage 3-4] included 15 patients [12 males, 3 females, mean age 36.5 +/- 4.1 years] and Group III: with severe fibrosis [stage 5-6] included 11 patients [8 males, 3 females, mean age 41.5 +/- 5.6 years]. Patients with severe fibrosis revealed significantly higher intrahepatic expression of CD 105 and TGF-13 1 than those patients with moderate fibrosis [p<0.05, p<0.001], mild fibrosis [p<0.01, p<0.001] and normal liver [p<0.001, p<0.001]. Serum levels of CDI 05 were 7.9 +/- 1.4 ng/mL, 5.4 +/- 0.54 ng/mL and 3.6 +/- 0.52 ng/mL for patients with severe, moderate and mild fibrosis respectively with a significant difference [p<0.001]. Interestingly, serum CD1O5 showed a positive correlation with severity of fibrosis and serum HA concentrations. At a cut off 3.12 ng/mL, CD 105 gave a sensitivity of 70%, specificity of 89% with area under curve [AUC] of 0.781 for diagnosis of liver fibrosis and at cut off 43.2 ng/mL. HA had a sensitivity of 80%, specificity of 96% and AUC of 0.903. Data from this study provide evidence for a new clinical application of endoglin [CD 105] as a complementary biomarker in diagnosis and prognosis of liver fibrosis as well as a possible therapeutic role of endoglin antagonist in the management of cirrhosis

[Evaluation of pain in patients with spinal cord injury]

The aim of this study is to evaluate the pain in patients with spinal cord injury and it recurrences on daily activities. We report a prospective study about 30 cases of patients hospitalized for a spinal cord injury between march and may 2002. Pain was evaluated regarding to the time of appearance, the duration, the frequency, the type based on the TASP, the intensity based on the visual analogic scale, the sleep and social repercussion and daily actvities consequences. We report a series of 14 women and 16 men with a mean age of 30,4 years. The mean time of spinal cord injury occurence was about 2, 9 years. Twenty four patients were suffering from pain [80%]. In 61%of cases, the pain was chronic evolving for at least three months. It was noxious in 45%of cases and neuropathic in 80%of them. There were sleeping disturbances in 66%of cases and social repercussions in 62, 5%of patients. A professional reintegration was acquired in onIy 33%of patients. Pain is a frequent symptom in spinal cord injury. The evaluation of the pain can improve the management of patients suffering from this pathology. The improvement of therapeutic results needs evaluating scales standardization

[Molecular mechanism of action of ezetimibe and recent therapeutics]

High blood Low density lipoprotein cholesterol is a major cardiovascular risk factor and must be the primary target of primary and secondary heart protection. Statines, 3-hydroxy-3-methylglutaryl-coenzyme A [HMG-CoA] reductase inhibitors, are the cornerstone of lipid-lowering therapy for reducing LDLc levels. However, some patients at high risk fail to achieve LDLc target despite high-dose statin therapy. Statins may also induce adverse effects. Ezetimibe is the first potent cholesterol absorption inhibitor. Several ongoing clinical interventional trials will shed more light on the association statin plus ezetimibe in high risk patients. A better understanding of intestinal cholesterol absorption will lead to novel approaches for the prevention and treatment of hyperlipidemia

Insulin therapy in diabetes type 2: indications modalities and results

After several years of evolution, insulin therapy becomes necessary in type 2 diabetes mellitus. However there is still an ongoing controversy in the studies devoted to this subject. The objective of our retrospective study was to evaluate the indications, the modalities and the results of insulin treatment in 106 patients with type 2 diabetes. Insulin treatment was temporary in 20 patients [18.86%] and definitive in 86 patients [81.14%]. The therapeutic protocol used a combined treatment with oral hypoglycaemic agents in 11 cases [10.38%], a conventional treatment in 48 cases [45.28%] or an intensive therapy in 47 cases [44.34%]. The outcome could be evaluated in 86patients after 6 months and 1 year. At the first follow-up [6 months], 59 patients [68.6%] had a significant reduction in fasting glycemia [7.8 vs 15.5 mmol/l], post prandial glycemia [8.9 vs 25.8 mmol/l] and glycated haemoglobin [6.9% vs 10.2%]. 69 patients [80.24%] had a mean weight gain of 7 +/- 5 kg and 8 [7.5%] had hypoglycaemic episodes. In the total number of 59 patients who improved with the insulin treatment, 46 patients 77.96% were treated with the intensive insulin protocol. Insulin treatment in type 2 diabetic patients seems to have a limited risk of hypoglycaemia but causes an important weight gain

[New relationship stress parietal - flow for non permanent fluid in no driving Newtonian deformable porous wall and Anisotropic Viscoelastic]

The goal of the present work is to elaborate a relationship between wall shear stress and flow rate in porous anisotropic and viscoelastic tubes, for pulsatile flows of non Newtonian fluids. This contribution is done for the case of small values of Womersley parameter. The use of this relationship enabled to directly solve the wall and integral equations. Then the influence of the power law index, the fluid consistency, the filtration coefficient and the anisotropy of the wall on the flow rate and the wall shear stress was analyzed. This study, considered as a step in modeling of flow in blood vessels, may also contribute to other important fields such as water desalination or gel filtration

Recent advances in facial plastic and reconstructive surgery

The evolving world of facial plastic and reconstructive surgery has, as in any other specialty or subspecialty, seen new trends and experienced tremendous bounds. In this review they will be discussed under two headings cosmetic surgery and reconstructive surgery. The aim of this paper is to help educate the nonspecialist about the most significant recent advances

Successful treatment of internal carotid artery fibromuscular dysplasia by percutaneous transluminal angioplasty

Fibromuscular dysplasia is sometimes a progressive disease which presents as transient neurological attacks, prolonged reversible ischaemic neurological deficits, completed strokes or subarachnoid haemorrhage. Therefore, several methods have been used to treat such potentially serious diseases including carotid endarterectomy, excision of the involved segment, graduated internal dilatation and more recently percutaneous transluminal angioplasty. We are presenting our experience with a 35-year-old Saudi male who suffered from two ischaemic attacks, and was discovered to have a significant stenosis [80% diameter reduction] of the right internal carotid artery [ICA] as diagnosed by colour Doppler ultrasound, confirmed subsequently by digital subtraction angiography [DSA]. The stenosis was a short segment in the proximal part of the right internal carotid artery just beyond the carotid bulb, probably due to fibromuscular dysplasia. This was successfully dilated percutaneously by a 5 mm balloon catheter [5f, 2 cm-long balloon, 6 atmosphere pressure]. No complications were encountered after the angioplasty. Careful selection of the patient is essential for the success of this technique

Neonatal hypoglycemia with nesidoblastosis in sibs, an evidence of an autosomal recessive inheritance

Persistent severe hypoglycemia in the neonatal period is a rare condition, and hyperinsulinism is the most common cause. Its diagnosis is of great importance as it may be exceedingly difficult to control. Nesidioblastosis is a term used to describe the presence of numerous abnormal clusters of insulin secreting cells histopathologically, Its aetiology is unknown, that there may be a genetic component with an autosomal recessive inheritance pattern Is suggested by its familial occurance. We report its occurance in 3 sibs of a Jordanian family. The first is a baby girl FTND, birth weight 4.1 kg., died at the age of 6 days due to severe hypoglycemia, the second is baby boy delivered by cesarean section because of a large fetus, birth weight 5 kg., died at the age of 31 days with histological evidence of nesidioblastosis, the third is a baby girl delivered at 36/40, birth weight 3.7 kg., hypoglycemic investigated and treated by 95% pancreatectomy, well and alive. Our report gives another evidence of Its mode of Inheritance and confirms the importance of early recognition and efficient treatment In preventing irreversable brain damage which is likely to result in survivors with subsequent mental retardation