Evaluating the effect of midodrine on renal resistance index in patients with liver cirrhosis and ascites

Background: Portal hypertension, which occurs as a consequence of liver cirrhosis, leads to splenic vasodilatation and alterations in the systemic circulation. Arterial vasodilatation in the splanchnic circulation appears to play a central role in hemodynamic changes and in the decline in renalfunction in cirrhosis. Peripheral vasodilatation, which occurs as a part of alterations in the systemic circulation, may decrease the renal blood flow and subsequently raise plasma renin activity. Midodrine is a agonist and acts as a peripheral vasoconstrictor; therefore, it may reduce plasma renin activity and improve renal function

Aim of the work: The aim of the study was to evaluate the relationship between renal resistive indices [RIs]in cirrhotic patients before and after oral administration of 7.5 mg midodrine three times dailyfor 3 days

Patients and methods:The study was conducted on 40 patients with liver cirrhosis and ascites and on 40 healthy controls from October 2014 to March 2015 at Al Azhar University Hospital, Assiut, where allpatients were subjected to history and clinical examination as well as to routine investigations such as total bilirubin, albumin, international normalized ratio, and serum creatinine. Patients underwent an abdominal ultrasound with duplex Doppler examination of the kidneys, and RIwas calculated before and 3 days after oral intake of midodrine

Results: Patients with liver cirrhosis and ascites had significantly higher RI in the right kidney[0.69 +/- 0.101 vs. 0.57 +/- 0.055, P < 0.001] and in the left kidney [0.69 +/- 0.097 vs. 0.59 +/- 0.047,P < 0.001] compared with healthy controls. After oral administration of midodrine for 3 days,RI showed significant improvement [RI = 0.928, P < 0.001] in the right kidney and in theleft kidney [R = 0.993, P < 0.001]. RI had significant positive correlation with Child-Pughscore [R = 0.75, P < 0.001, in the right kidney and R = 0.75, P < 0.001, in the left kidney] and significant positive correlation with Model for End Stage Liver Disease score [R = 0.536,P < 0.008, in the right kidney and R = 0.487, P < 0.005, in the left kidney]

Conclusion: Oral midodrine improved renal hemodynamics as assessed by RI in cirrhotic patients. RI is correlated with severity of liver disease as assessed by Child-Pugh and Model for End StageLiver Disease scores

Estimating the losses of honey bee colonies and their potential causes within the beekeepers at Assiut governorate [Upper Egypt], during three years survey by using questionnaire method

This study records the data of three years, 2009/2010, 2010/2011 and 2011/2012 survey of losses in managed honey bee colonies in Assiut governorate. The survey of colony losses and potential causes was obtained via questionnaire method. The surveyed beekeepers had loss a total of 4639 colonies between September and March. Colony loss percentages were 15.78 in 2009/2010; 28.11 in 2010/2011 and in 2011/2012 15.6. Survey information indicated that colony losses range widely depending on the operation size of the beekeepers. Commercial beekeepers [those operating more than >200 colonies] lost the lower number of colonies as compared to hobbyist, intermediate and semi-commercial beekeepers. Oriental hornets, poor quality queens, pesticides and CCD-like symptoms were the leading self-identified reasons of losses as reported by most beekeepers. Finally, it must circulate such as this questionnaire over all Egypt to understand the extent of the problem and try to find out the resolve

possible protective role of curcumin versus garlic in amiodarone-induced keratopathy in rats: light and electron microscopic study

Amiodarone is a highly effective antiarrhythmic drug. However, amiodarone-induced corneal keratopathy is one of the most common side effects in humans. Amiodarone toxicity is attributed to its metabolites, which induce a significant increase in inflammatory mediators and cytokine release as well as free-radical formation. To clarify the possible protective effect of the natural antioxidants curcumin versus garlic on amiodarone-induced keratopathy. This study was carried out on 40 male albino rats weighing 180-200 g. The rats were divided randomly into four main groups [10 rats each]: group I included rats that were used as controls. The rats in group II received amiodarone [30 mg/kg/day] daily by a gavage for 6 weeks. The rats in groups III and IV received curcumin [100 mg/kg/day] and garlic [300 mg/kg/day], respectively, plus amiodarone. After 6 weeks, blood samples were collected for the determination of malondialdehyde and superoxide dismutase serum levels. Then, corneal specimens were rapidly taken from all rats and processed for both light and electron microscopic examination. Light microscopic examination of group II corneal sections showed that the majority of the basal and intermediate epithelial cell layers of the corneal epithelium showed a vacuolated cytoplasm with pyknotic nuclei. The substantia propria became thick and showed abundant collagen bundles, focal masses of disorganized irregularly arranged collagen, and neovascularization. The Descemet's endothelial cell layer appeared thick with focal areas of stratification. In addition, the mean corneal thickness in group II was significantly increased [P<0.05]. Ultrastructural examination showed shrunken irregular basal and intermediate epithelial cell layers with multiple cytoplasmic vacuoles, wide intercellular spaces, and partial loss of the desmosomal junction. The keratocytes and stratified Descemet's endothelial cells showed numerous cytoplasmic vacuoles, lysosomes, and lamellar bodies. Moreover, the mean serum level of malondialdehyde was significantly increased [P<0.05] and the mean serum level of superoxide dismutase was significantly decreased [P<0.05]. In the rats of group IV, garlic significantly attenuated the amiodarone-induced corneal changes and the biochemical alterations compared with curcumin [group III]. Garlic exerts a greater ameliorative effect on amiodarone-induced keratopathy over curcumin and it can be recommended as an adjuvant therapy with amiodarone in patients treated with this drug for a long time

Risk factors for cerebral palsy among children under five-years old in Assiut governorate, upper Egypt

Cerebral palsy [CP] is the most frequent cause of motor handicap among children. Many etiologies and risk factors for the non-progressive lesion in CP are considered to be antenatal, delivery or neonatal. The present case control study aims to investigate the risk factors of cerebral palsy among children under five years in Assiut Governorate. Three hundred children randomly selected; 150 children with CP matched in number, age and sex with normal children as controls. The mean age of cases and controls were 1.99 +/- 1.34 and 1.98 +/- 1.33, respectively. The results revealed that significantly higher percent of cases were left handed compared with controls. Artificial feeding was common among cases. Significant statistical differences were found between two study groups regarding, socioeconomic status, birth order, family history of CP, premature rupture of membranes, low birth weight, birth trauma, cyanosis at birth, and history of encephalitis. No statistically significant differences were found between the two groups in malpresentations, twin pregnancies, recurrent abortion, history of meningitis. In conclusion, birth trauma, low birth weight, artificial feeding and encephalitis are the most frequent risk factors in children with CP in Assiut Governorate. Therefore, antenatal, natal and postnatal health life styles reduce baby's chances of developing cerebral palsy

Antagonistic effects of symbiotic bacteria isolated from midgut of honey bee workers against Ascosphaera apis, the causal pathogen of chalkbrood disease

Six biotypes of fungal isolates belonging to Ascosphaera apis were isolated by three media from infested honey bee larvae. Two isolates [A[7] and A[15]] were able to form sporocysts. However, the other four [A[3], A[4], A[8],A[9]] did not form sporocyts on cultivated Murashieg and Skoog medium [mMS]. Six isolates from symbiotic bacteria associated with midgut of honey bee workers have been insolated from healthy workers. Four isolates from endospore-forming bacteria belonged to Bacillus subtilis [B[2], B[4], B[10] and B[100]] and two isolates from non endospore-forming bacteria to Pseudomonas fluorescence [P[1[and P[5]] were isolated. Morphological features and physiological reactions of isolated bacteria were determined. Antagonistic effectiveness of both Bacillus subtilis and Pseudomonas fluorescence was tested against isolates of Ascosphaera apis, the causal pathogen of chalkbrood disease, in vitro. Data showed that Bacillus subtills isolate [B2], gave the highest antagonistic effect as inhibition zone and mycelial growth followed by Pseudomonas fluorescence [P[1]]. Highly significant differences among Bacillus subtilis [B[2]], Pseudomonas fluorescence [P[1]] and other bacterial strains were recorded.. Scanning electron microscope was used to examined the fungal hyphae and mature sporocysts of Ascosphaera apis which isolated from infested larvae and grown on [mMs]. Numerous distinguish differences were recorded. The examination showed that numerous bacterial cells of Pseudomonas fluorescence invaded fungal hyphae of Ascosphaera apis and caused disintegration the cell walls. Whereas Bacillus subtilis hyphae showed shrinking appearance. It could be conducted that such symbiotic bacteria can considered as a bioformula for controlling such disease in honey bee colonies

Macro- and micromorphology of the leaf, stem, stem bark and flower of Vangueria edulis cultivated in Egypt

Vangueria edulis belongs to Rubiaceae which includes about 620 genera with almost 13000 species which is widely distributed but mainly tropical. Biological studies showed that some species of the genus Vangueria showed antimicrobial activity, reported to have anthelmintic action and anti plasmodial activity and fed to cattle suffering from East Coast Fever. No detailed information could be traced concerning the macro- and micromorphology of the plant. This provoked the authors to carry out this study to identify the drug in both entire and powdered forms

Effect of fenofibrate on the experimentally induced hepatic ischemia/reperfusion injury in rats: biochemical, light, and electron microscopic studies

Liver ischemia/reperfusion [I/R] injury is a serious clinical problem. It is one of the main causes of hepatic failure after liver surgery. It was proved that reactive oxygen species and tumor necrosis factor-alpha [TNF-alpha] are important mediators in liver I/R injury. This study was designed to investigate the effect of preischemic treatment with fenofibrate [peroxisome proliferator-activated receptor-alpha activator] on the oxidative stress and inflammatory response to hepatic I/R injury in rats. Forty-eight male rats were equally divided into four groups: group 1 [sham group], group 2 [fenofibrate-treated sham group], group 3 [hepatic I/R group; hepatic I/R was induced by clamping the blood supply of the left lateral and median lobes of the liver for 60 min, followed by reperfusion for 4 h], and group 4 [fenofibrate-treated hepatic I/R group; the animals were pretreated with a single dose of fenofibrate [50mg/kg body weight, intraperitoneally] 1 h before ischemia]. After 4 h of reperfusion, blood samples were obtained to assess serum alanine aminotransferase and TNF-alpha. Then liver tissues were obtained to assess hepatic malondialdehyde and superoxide dismutase activity. In addition, liver specimens from each group were obtained and processed for light and electron microscopic studies. Hepatic I/R induced a significant elevation of serum alanine aminotransferase, TNF-alpha, and malondialdehyde. However, superoxide dismutase activity in the hepatic tissues showed significant reduction. Light microscopic examination of group 3 showed a disorganized hepatic architecture with congestion, multiple areas of hemorrhage, and focal necrosis. In addition, mononuclear cellular infiltrate was observed in the portal tract. The hepatocytes showed necrosis, apoptosis, and vacuolated cytoplasm. Moreover, there was a significant increase in the mean diameter of the central veins, blood sinusoids, portal vessels, and bile ducts [P<0.001]. Scanning electron micrographs showed dilated blood sinusoids packed with red blood cells and leukocytes. Ultrastructural study showed hepatocytes containing multiple cytoplasmic vacuoles and lysosomes. The mitochondria appeared swollen with cristolysis or with an electron-dense matrix. Moreover, Kupffer cells showed apoptotic bodies and multiple lysosomes in their cytoplasm. In addition, the hepatic stellate cells appeared surrounded by wide areas containing collagen fibers. In group 4, preischemic treatment with fenofibrate significantly attenuated the biochemical and histological alterations of I/R-induced liver injury. Fenofibrate could be promising as an adjuvant therapy before hepatic surgery for rescuing the liver from I/R injury

Light and electron microscopic study of thoracic aorta in premature menopause-induced rats and the possible protective role of ginger

Premature menopausal age increases the risk of atherosclerosis, hypertension, coronary heart disease and mortality. On the other hand, estrogen replacement therapy in menopausal women may increase the risk of breast cancer. To study the histological changes in thoracic aorta in premature menopause-induced rats and the possible protective role of Ginger. Thirty six adult female rats aged three months were used in this study Rats were divided into two groups: group A [control group, n=12 rats] and group B [experimental group, n=24 rats]. Bilateral ovariectomy was performed to the experimental group, which was then divided into two equal groups: group B I rats fed normal diet and group 132 rats fed ginger [500 mg/kg/body weight] enriched diet. Six-months after ovariectomy, specimens from the thoracic aorta were taken, processed and examined by light microscope and scanning and transmission electron microscope. Light microscopic study of thoracic aorta of group B1 showed a sub-endothelial mass of aggregated foamy cells was seen projecting into the lumen with focal degeneration in the elastic laminae below this mass. The tunica media showed large number of smooth muscles [SMCs] with vacuolated cytoplasm. Moreover, aortic aneurysm was also noticed. The mean intima-media thickness was significantly increased [103.84 +/- 7.5 micro m] [P<0.001]. Scanning electron microscopic study showed irregular luminal surface of the aorta with multiple elevated streaks. endothelial projections, erosions and a large thrombus attached to the endothelium. The ultrastructure study showed Lipid-loaded monocyts attached to the endothelium and Lipid-loaded SMCs in the media. Moreover the Lipid-loaded endotheial cells showed small condensed nucleus and discontinuous cell membrane with absence of the electron dense bodies. The internal elastic lamina appeared thin and electron dense. Meanwhile light and electron microscopic study of group B2 aorta showed attenuated histopathological changes and the mean intima-media thickness was significantly decreased [83.6 + 7.4 micro m micro m] [P<0.001]. Ginger significantly attenuated the premature menopause-induced morphological changes in the rat thoracic aorta. Therefore Ginger enriched diet could be recommended for early menopausal women as well as individuals with high risk of atherosclerosis, hypertension and coronary heart disease

Synthesis and physico-chemical studies of some polymers for removing of some heavy metal ions of industrial wastewater

The chemical contaminations of wide range of toxic derivatives in water, in particular heavy metal ions and dyes is a serious environmental problem owing to their potential human toxicity. Therefore, there is a need to develop technologies that can remove toxic pollutants from the wastewater. Adsorption is one of choices used for treating industrial effluents and a useful tool for protecting the environment. In particular, adsorption on synthetic, natural polymers and their derivatives is known to remove pollutants from water. The importance of the synthetic polymers has increased due to their high selectively, stability at elevated temperature and sensitivity to the high concentration of ions. One of the major applications of epoxy and its many derivatives is based on its ability to bind strongly heavy and toxic metal ions. This study will focus on the synthesis of two types of polymers, the first one was carried by suspension polymerization of epoxy resin, methyl methacrylate [MMA] and divinyl benzene [DVB] mixtures which have been modified though epoxy functions in two steps: [i] by treating with polyamine and [ii] by subsequent reaction with potassium chloroacetate. The second type which is a new low cost adsorbent was prepared by modified polysaccharides for example resin was polymerized epoxy resin and cross linked starch mixtures in two steps; [i] by treating with polyamine and [ii] by subsequent reaction with potassium mono chloroacetate, that to increase the efficient sorbet for removal of Cu[II] and Ni[II] ions

Serum levels of adiponectin and resistin in obese children: relationship with insulin resistance

Adiponectin and resist in are fat cell-derived hormones, which are thought to be respectively protective and disadvantageous with regard to the development of cardiovascular disease and diabetes mellitus type 2. The aim is to study the relationship between insulin resistance and serum adiponectin and resistin in obese children. A total of 60 obese and 30 nonobese children were enrolled and serum levels of adiponectin and resistin were measured by enzyme immunoassay. Compared with controls, higher insulin resistance by homeostasis model [HOMA-lR] and lower whole body insulin sensitivity index [WBISI] were found in obese children [all p=0.000]. The acliponectin levels in obese children and controls were 3.41 +/- 1.93 and 5.21 +/- 3.1 micro g/L with a significant difference [p=0. 001], while the difference of resistin levels was not significant [p=0.963]. Significant correlations between insulin resistance parameters [HOMA-lR and WBISI] and age, sexual development, body mass index, serum triglyceride, HDL-cholesterol, LDL-cholesterol, alanine aminotransferase, uric acid, or adiponectin levels [all p<0.05] were noted. On the other hand there was no significant correlation between insulin resistance parameters and serum levels of resistin[p>0.05]. In conclusion, These results suggest that adiponectin may play a protective role in obese children through decreasing insulin resistance

Quantitative and histochemical study on the adrenal medulla in post natal period of albino rat

The present work was based on the evaluation of histological, histochemical, and quantitative study on the adrenal medulla of the white albino rat in the different post natal age period. Sixty male albino rats were used in this study. The rats were classified to 4 main groups as follows: - Group one: One week old albino rats. - Group two: One month old albino rats. - Group three: Three months old albino rats. - Group four: Senile rats. Three main parameters were performed in this study, the first was the study of the morphological changes in the adrenal medulla in the different postnatal age groups. The second was concerned with the histochemical studies while the last parameter was the quantitative studies on the gland volume as well as its cellular count. These three parameters were performed by using different staining techniques. The results showed that medullary cells in the early age groups were arranged in non-differentiated groups and become more differentiated in the older age groups. Both reticular and elastic fibers in the older age groups showed a definite increase especially at the region of corticomedullary zone. The different types of chromaffin cells were more observed at the old age groups. The concentration of ascorbic acid granules was more marked in the senile group. The quantitative changes were in the form of increased medullary volume especially in the old age. The number of chromaffin cells as well as the concentration of ascorbic acid contents was more noticed in the old age group. The differentiation of both divisions of the adrenal gland was not noticed in the early age groups. Cellular and fibrous differentiations were more seen in older age groups which may reflects an idea about the degree of gland maturation

Histological and histochemical study of testicular tissue used in cases of [ICSI] [intra cytoplasmic sperm injection]

The advances in the technology of in vitro fertilization [IVF] increases the incidence of success in treatment cases of infertile patients with non-obstructive azoospermia. Evaluation of the microscopic changes in the obtained testicular samples was one of the main aims in this study for better prognosis of the results. In this study one hundred human testicular biopsies were obtained from Islamic reproductive centre and Department of Urology Al-Hussein University Hospital. Cases in this study were classified into 4 groups: Group I includes 5 cases of normal fertile persons free of any medical problems and with normal seminal parameters. Patients consent was performed before sampling. Group II includes 35 cases of infertile obstructive azoospermic patients. All of the rest of cases [60] were considered infertile non-obstructive azoospermic cases and were included in both the third and the fourth groups. Group III: includes 20 cases of infertile non-obstructive positive patients. Group IV: includes 40 cases of infertile non-obstructive negative patients. Cases were either of normal sized testis or of hypoplastic testis and were subdivided into the following subgroups: I- Cases with normal sized testes [30] infertile patients: Group IV A: Normal sized testis with arrested spermatogenesis; Group IV B: Normal sized testis with SCOS; Group IVC: Normal sized testis with mixed atrophy. II- Cases with hypoplastic testes [10] infertile patients: Group IV D: Hypoplastic testis. The testicular samples were prepared for Histological and Histochemical examination. Different staining techniques were used: 1- Haematoxylin and Eosin stain; 2- Mallory's trichrome stain; and 3- Histochemical techniques: a- Periodic acid Schiff [PAS] technique. B- Methyl green pyronin. The obtained results showed no Morphological changes in group II except mild vascular dilation and congested peritubular capillaries. Cases of non-obstructive positive azoospermia showed reduced number of spermatogenic layers while cases of group IVa showed reduced size of the tubules and lined only by Sertoli cells and there was marked reduction in the number of leydig cells. In this study there were definite histochemical changes observed in both the PAS positive material and the nucleic acid in the different elements of the obtained testicular samples, Clinical and microscopic evaluations in this study could be of complementary importance and may increases of the incidence of success

Synthesis of novel tricyclic heterocycles from 2- [3-Methyl - 1,2 dihydroquinoxalin - 2 -ylidene] malononitrile

A number of pyrrolo [1.2-a]quinoxalines [3a-f], pyrimidol [1,6-a]quino-xalines [5a-c. 10.13]. pyrido[1.2-a]quinoxalines [6, 7a.b, 8a.b. 14]. [1.3] thiazino-[3,4-]quinoxalines [9, 11] and [1.3] oxazino [3,4-a]quinoxalines [12a.b] were obtained via interaction of 2-[3-methyl-1.2-dihydrquinoxalin-2-ylidene]malono-nitrile 2 with different reagents

Spectrophotometric methods for the determination of dequalinium chloride and clidinium bromide using ion-pair complex formation with acid dyes

Dequlinium chloride is abisquaternary antiseptic, bactericidal against many gram-positive and gram negative bacteria, and effective against fungi. Clidinium bromide is a quatemary ammonium antimuscarinic with peripheral effects similar to those of atropine. It is used alone or with chlorodiazepoxide in pharmaceutical formulations for the symptomatic treatment of pepticulcer disease and other gastrointestinal disorders [1]. Spectrophotometric methods[2-11] have been reported for estimation of the two drugs in pure forms and in biological fluids. This paper describes the applicability of ion pair complexation reactions for spectra determination of [Deq] and [Clid] in pharmaceutical forms. The method involves the formation of ion-pair complexes between dequalinium chloride [Deq] and clidinium bromide [Clid] with BPB, BCG and BTB reagents. This method is applied successfully for the determination of [Deq] and [Clid] either in pure and in dosage forms, with good accuracy and precision. The results were compared with those given by the official method [12] where 1.2 gm of [Clid], accurately weighed, in 80 ml glacial acetic acid was added to 15 ml mercuric acetate and titrated with 0.1 M perchloric acid in dioxane. Each 1.0 ml of 0.1 M perchloric acid is equivalent to 43.24 mg of drug

Impact of endothelial dysfunction on stable angina versus unstable angina

Endothelial dysfunction is a systemic disorder and a key variable in the pathogenesis of atherosclerosis and its complications. Current evidence suggests that endothelial status is not determined solely by the individual risk factor burden but rather, an integrated index of all atherogenic and atheroprotective factors present in an individual, including known as well as yet-unknown variables and genetic predisposition. The aim of the present study is to examine the relation of impaired endothelial dependent dilatation of the brachial artery which is a sensitive marker of endothelial dysfunction and occurs early during development of atherosclerosis with stable and unstable angina pectoris. One of those new techniques is assessment of the peripheral vascular endothelial function testing as a non invasive indicator of coronary artery disease using brachial artery ultrasound. This study was carried out in Zagazig University hospitals, and included 120 patients divided into three groups; group I: chronic stable angina pectoris, group II: unstable angina pectoris and group III: control group. All the results were analyzed statistically to detect their significance. The study showed that there was a significant correlation between the FMD and the results of the coronary angiography and both systolic and diastolic functions of the cit ventricle. It also showed significant correlations between the brachial artery flow-mediated dilation of the brachial artery and most of the cardiovascular risk factors. The results support the notion that evaluation of peripheral vascular endothelial function can accurately exclude CAD in subjects undergoing noninvasive assessment for atherosclerosis. Determination of peripheral endothehial function can confirm a low probability of CAD in low-risk individuals and, thus, may obviate the need for more elaborate testing. Systemic endothelium-dependent vasoreactivity predicts recurrence of instability and cardiovascular event rates in patients with ACS. Assessment of systemic vasoreactivity measured by a minimally invasive test, provides important prognostic information in addition to that derived from traditional risk factor assessment in patients with ACS. Also, endothelium-dependent dilation of the brachial artery is a strong in dependent predictor of adverse outcome in survivors of ACS without ST-segment elevation

Study of factors affecting left ventricular function and their relation to volume overload in haemodialysis patients

Technological innovations in haemodialysis [HD] have improved its quality and safety but cardiovascular morbidity and mortality still poses a great risk. Proper fluid removal is a critical component of HD, as both under and over hydration are associated with deleterious consequences. However, there is no single accurate measure for adequacy of dialytic fluid removal and assessment of dry weight is largely empirical. This may rely on clinical assessment, biochemical markers as natriuretic peptides, dilution methods, measurement of inferior vena cava diameter [IVCD], blood volume monitoring and bioimpedance analysis [BIA]. Plasma BNP was recently reported to be a sensitive marker both for volume overload and ventricular hypertrophy and/or dysfunction. We aimed to study some pathogenetic factors and diagnostic parameters of left ventricular hypertrophy and/or dysfunction in end- stage renal disease [ESRD] patients on maintenance HD. Emphasis was made on the utility of echocardiographic and BIA measurements in monitoring the development and assessment of volume overload during the inter- dialytic interval. Two groups of subjects were studied: 50 patients with ESRD on maintenance HD for >/= 6 months, and 15 age and sex matching controls. Patients were subjected to full clinical assessment, ECG, predialysis measurement of serum fasting blood sugar, creatinine, calcium, phosphorus, intact parathyroid hormone, lipid profile, uric acid, haemoglobin concentration and haematocrit value. Dialysis dose was assessed by urea reduction ratio and Kt/V. Plasma BNP, echocardiographic studies [for presence and geometric pattern of left ventricular hypertrophy, systolic and diastolic dysfunction and measurement of IVCD and right atrial pressure] and BIA were all done on two occasions 3 days apart: after termination of the end- of- the week HD session and before the start of the first session in the next week. Controls were subjected to assessment of clinical state, plasma BNP, and BIA. Both post- and pre- dialysis plasma BNP levels in patients were significantly higher when compared with the single plasma BNP reading in controls. Extracellular water [ECW] and its percent to total body water [ECW%] were higher in patients [both post- and pre- dialysis] compared to controls. The differences were statistically significant, except for post- dialysis ECW. The pre- dialysis values of mean velocity of circumferential fiber shortening, stroke volume, cardiac output, E/A ratio, Right atrial pressure, IVCD, ECW and ECW% were all significantly higher compared with the post- dialysis values. Left ventricular hypertrophy [LVH] was found in 47 [94%] patients, concentric LVH being the most frequent pattern [in 60%]. Pre- dialysis left ventricular mass index [LVMI] showed a statistically significant positive correlation with serum phosphorus, calcium phosphorus product, and plasma BNP. Pre- dialysis plasma BNP had a statistically significant negative correlation with pre- dialysis ejection fraction and fractional shortening. Volume overload plays a key role in the pathogenesis of LV hypertrophy and/or dysfunction in HD patients. BIA and IVCD are useful adjunctive measures for assessment of hydration status, keeping their limitations in mind. Plasma BNP concentrations have limited potential for the assessment of hydration status in HD patients, but it may be useful to have a baseline measure when the patient is at dry weight. Whether BNP can be used as a bedside test in the dialysis unit to measure adequacy of volume removal remains to be determined

Propofol has minimal or no effect on the threshold of the acoustically evoked stapedius reflex

Today cochlear implantation is a widely used therapeutic approach for the treatment of deafness and severe hearing disorders. Postoperative fitting of the externally worn speech processor is very important for successful use of the cochlear implant. Intraoperatively measured stapedius reflex [SR] threshold values are routinely used for programming the speech processor. However, anaesthetic agents can increase the SR threshold up to total blockade. Unlike previous studies, which used various anaesthetic combinations, the aim of the present study was to evaluate substance-specific effects of propofol on the threshold of the acoustically evoked SR in normal hearing. Subjects Twenty patients undergoing elective ENT surgical procedures participated in this study. On the day before surgery, pure tone audiogram and immitance metry were done to help proper selection of patients. None of the patients received any premedication. Anaesthesia was induced with i.v. propofol in a dose of 1.5-2.5mg/kg BW. After induction of anaesthesia and loss of eyelid reflex, tympanometry and ipsilateral and contralateral SR measurement were performed. Statistical analysis included the arithmetic mean, standard deviation, standard error and hypothesis Student's [t] test, p-values <0.05 were considered significant. After i.v. injection of propofol, 17 out of 20 patients showed either no change or a slight, but statistically non-significant elevation of the SR threshold both ipsilaterally and contralaterally at all stimulus frequencies [p>0.05]. Paradoxically, three patients showed variable, yet statistically non-significant reductions in SR threshold at 500, 1000 and 4000 Hz. The results presented in this study show that propofol in a dose of 1.5-2.5mg/kg BW appears to influence the acoustically evoked SR threshold only very slightly, if at all provided it is administered as a sole anaesthetic. Thus. propofol can be especially suitable for anaesthesia in audio-logical diagnostic procedures. We recommed conducting a similar study on a larger group of patients combined with monitoring of the degree of hyponsis

combined effect of ketamine and remifentanil infusions as total intravenous anesthesia for scoliosis surgery in children

This study was designed to assess the effect of combination of ketamine and remifentanil infusions as total intravenous anesthesia [TIVA] during scoliosis surgery in children. Thirty two children, 8-14 yr of age, scheduled for posterior spinal fusion, were randomly allocated into two equal groups to receive either remifentanil infusion in a dose of 0.2 micro g/kg/minutes or same dose of remifentanil infusion combined with ketamine infusion in a dose of 1 micro g/kg/minutes after induction of general anesthesia. During surgery, hemodynamics, surgical bleeding, and electrophysiology monitors were recorded. After completion of surgery, recovery score, recovery time and rescue analgesia were assessed in post-anesthesia care unit [PACU] for 24 hours. The two groups were similar for age, weight, duration of surgery, and time to extubation. Intraoperative heart rate and arterial blood pressure were significantly decreased in remifentanil group when compared to remifentanil-ketamine group. The surgical bleeding and electrophysiological monitoring were not significantly affected by remifentanil-ketamine combination in second group. Recovery score and recovery time were not significantly increased in remifentanil-ketamine group. First pain scores recordings in arrival to [PACU] were significantly less in remifentanil-ketamine group than remifentanil group and the time passed to first patient controlled analgesia [PCA] demand dose was increased in remifentanil-ketamine group. The first 24 h morphime consumption was 38 +/- 17 and 28 +/- 10 mg [mean +/- SD] in remifentanil and remifentanil-ketamine groups, respectively. These data demonstrate that during posterior spinal fusion surgery in children, the combination of ketamine and remifentanil infusions as TIVAmay provide hemodynamic stability, satisfactory surgical requirements with reliable electrophysiological monitoring and adequate post operative pain relief supplemented by PCA morphine

Isolation and identification of a new homoisoflavan with potent antioxidant activity from commelina elegans

Potent antioxidative compounds have been isolated from the ethyl acetate extract of Commelina elegans, Commelinaceae, using a repeated column chromatography. On the basis of spectral analyses, the compounds were identified as brazilin, brazilein and the new homoisoflavan-3, 7, 9, 3', 4'-ol [4-4] dimer with X- and Y-conformers. The compounds inhibited both enzymatic lipid peroxidation using rat liver microsomes and mitochondria and non-enzymatic reactions. The compounds completely protected the activities of the mitochondrial enzymes NADH- and succinate-cytochrome c reductase. Furthermore, the radical scavenging activity on enzymatically and non-enzymatically generated superoxide anion was investigated. Electron spin resonance using the spin trapping method suggested that the compounds have potent superoxide anion scavenging activities