Single centre randomized comparative trial of lateral internal sphincterotomy versus 2% diltiazem in chronic anal fissure

Background: Anal fissures are often encountered in surgical practice with surgery the gold standard management for chronic anal fissures. Recently the widespread use of pharmacologic agents for chronic fissures has increased. In our study we compare topical 2% diltiazem with lateral sphincterotomy with respect to symptoms such as relief of pain, ulcer healing, and side effects of treatments.Methods: A prospective comparative study, a total of 80 patients were randomized into 2 groups 40 each. Group A patients were subjected to open internal lateral sphincterotomy and group B to 2% topical diltiazem. The patients in both groups were followed up at 1st, 4th, 14th weeks and 6 months in OPD and were assessed for pain, sphincter tone and complications.Results: In group A (lateral anal sphincterotomy), patients achieved a good pain relief with a mean pain score of 1.98 by one week post procedure whereas group B (2% diltiazem) had taken 14 weeks to achieve similar pain relief (pain score of 1.5). At the end of 6 months, healing of fissure was noted in 100% of group A and in 90% of group B. 4 patients (10%) had recurrences in group B. Flatus incontinence was reported in 2 patients (5%) in group A although transient.Conclusions: Lateral anal sphincterotomy is superior to 2% diltiazem especially in healing of fissure, pain relief, quality of life and recurrence. Pharmacologic agents should be reserved for patients who are unfit or unwilling for surgery or can be used as a bridge therapy till sphincterotomy can be planned.

Seroprevalence of cytomegalovirus Antibodies among pregnant women and it's correlation with spontaneous abortion in Khartoum state

Cytomegalovirus is a common virus that infects most people at some time during their lives. It becomes dormant for a while and may reactivate later. In pregnant women, intrauterine infection may be associated with congenital abnormalities, intrauterine growth retardation and intrauterine death of the fetus as well as late sequelae such as developmental delay, blindness and congenital deafness. The aim of this study was to determine the seroprevalence of CMV infection among women presenting with spontaneous abortion to major hospitals in Khartoum State and to find out the correlation between CMV infection and spontaneous abortion in the group under study. In this study a total of 180 spontaneously aborted females, and 80 normally delivered females [control] were included. Three mls of venous blood were collected from each subject under study in a plain container allowed to clot and after clot retraction centrifuged at 4000rpm. The sera were then separated and stored at -20c[degree] in a deep freezer. The stored sera were tested for CMV IgG and IgM antibodies using Enzyme Linked Immunosorbent Assay [BIOTECH - ENGLAND]. In the case group, 176 [97.8%] women were positive for Anti-CMV IgG and 69 [38.3%] for Anti-CMV IgM. The CMV antibodies significantly co related with increasing age [P-value = - 0.0185], the number of abortion [P-value = -0.0177] and congenital malformation in children [P value= 0.037]. Seroprevalence of CMV antibodies was found to be 97.8% and 38.3% for IgG and IgM respectively. There was significant association between CMV infection and frequency of abortion, age and congenital malformation in children

frequency of celiac disease, TB enteritis and giardiasis among children with chronic diarrhea

Chronic diarrhea is one of the most common causes of referral to a gastroenterology clinic. Chronic diarrhea may result from many different causes; celiac disease is one of them. Other important causes in our locality are infections such as TB and Giardiasis. This work was planned to determine the frequency of celiac disease, TB enteritis and Giardiasis among children referred to the gastroenterology unit with the complaint of chronic diarrhea and to evaluate the different methods used in the diagnosis of each disease. The study included 92 patients with chronic diarrhea. Their ages ranged from 6 months to 15 years. They were 56 males and 36 females, admitted to the Pediatric gastroenterology unit, Assiut University Hospital during the period from January 2005 to December 2006. Besides full history and thorough clinical examination, the following investigations were done for all cases: stool analysis for three consecutive days, CBC, ESR, total proteins and serum albumin, tuberculin test, accelerated BCG test [in tuberculin negative cases], serum antiendomysial antibodies. Upper GIT endoscopy with duodenal biopsy and aspiration and tissue staining by H and E and by immuno-histochemistry [anti-tTG moAbs] to detect tTG antigens in biopsy specimens. Lower GIT endoscopy with biopsy sampling and histopathological examination of biopsy specimens was also done. Out of the total patients, 18 cases [19.5%] were positive for celiac disease by AEM antibodies while 16 were positive by tTG immunostaining of biopsy specimens. Fourteen patients [15.2%] had tuberculous enterocolitis while 12 [13%] had biopsy proven Giardiasis. On the other hand 48 patients [52.1%] had other undiagnosed causes of chronic diarrhea. A very high index of suspicion for celiac disease should be maintained for patients who present with chronic diarrhea or iron deficiency anemia. The best method for diagnosis of celiac disease in such patients is serological testing followed by a small-bowel biopsy. The diagnosis of intestinal tuberculosis is difficult due to the lack of specific symptoms and signs. Colonoscopy with ileoscopy is a useful method for diagnosis of intestinal TB. Gastrointestinal endoscopy with biopsy examination is an important method of diagnosis and follows up of children with Giardiasis

Synthesis and evaluation of novel 2-thiouracil derivatives with analgesic, antiinflamatory and antipyretic activities

This study aims at the synthesis and evaluation of chemotherapeutic activity of a number of 5-substituted 2-thiouracils. Thiourea was reacted with ethyl cyanoacetate or ethyl acetoacetate and benzaldehyde or indole-3 carboxaldehyde in ethanolic sodium ethoxide producing thiouracils 1 and 2. The later was condensed with p-anisaldehyde in alcoholic NaOH giving a chalcone derivative 3 [Claisen-Schemidt reaction]. Compound 1 was chlorinated with POCI3 producing a chloroderivative 4 which inturn was reacted with 4-aminoantipyrine in presence of pyridine giving compound 5. In another pathway 2-thiouracil was chlorosulphonated giving a chlorosulphonyl derivative 6 which was reacted with p-aminobenzoic acid or 4-aminoantipyrine giving compounds 7 and 8 respectively. Finally 2-thiouracil was condensed with Paraformal-dehyde and 4-aminoantipyrine giving the Mannich base 9. The tested compounds were analogous to Metamizole sodium Novalgin and indomethacine, the incorporation of 2-thiouracil ring into antipyrine and indole ring might increase their activities. Here we proved that 2-thiouracil nucleus alone has a potent activity. This is exemplified by compound 7 which satisfied most requirements of analgesic activity

N-acetyl transferase 2 gene polymorphism in bladder cancer

N-acetyl transferases [NAT] play important roles in the bio-activation and detoxification of a number of aromatic and heterocyclic amines This suggests that polymorphism of genes encoding such enzymes may represent potential risk factors for cancer. The present study was undertaken to investigate the association between N-acetyl transferases polymorphism and incidence of different types of cancer, and to examine whether NAT 2 genotypes are risk factors for bladder cancer. 200 bladder cancer patients and 220 controls were undertaken over a period of 24 months. The NAT 2 genotypes were identified by PCR-RFLP method in peripheral blood DNA samples .Genotype frequencies among patients and controls were assessed by Chi-square and Fisher exact tests. The frequency of slow or fast acetylator genotypes was not significant in bladder cancer patients alone [OR=0.804, 95% CI: 0.344-1.877, p value=0.613] or in combination with tobacco users [OR=1.2. 95% CI: 0.291-4.949, p value=0.801] or with bilharzial involvement [OR=0.451, 95% Cl: 0.194-1.053, p value=0.061]. Results indicate that NAT2 genotype exhibits non-significant association with the risk of developing bladder cancer, either alone or with tobacco users or clinicopathological parameters of the disease [with exception of lymph node involvement]

Isolation and structural determination of two naturally occurring inhibitors for salivary alpha-amylase, a possible role as hypoglycemic drugs

To screen for human salivary alpha amylase [HSA] inhibitors, a possible role as hypoglycemic drugs. Different plants either randomly or based on the traditional use in diabetes mellitus control were collected. Total extract of each plant was prepared using different solvents and the inhibition study was performed on each extract using spectrophotometric and thin layer chromatography [TLC] methods. The two plant extracts which showed maximum inhibition, Hibiscus sabdariffa and Salix tetrasperma were chosen for study. The compound causing the inhibition was isolated from each plant and its chemical structure was determined. This work led to the isolation and characterization of two novel human alpha-amylase inhibitors. Alpha-amylase inhibitors lead to decrease in glucose absorption and subsequently decrease postprandial blood glucose level which is favorable for treatment of diabetes mellitus and obesity

Mass spectra of some pyrazolemd isothiazole

The mass spectra of di-[5-methyl-3-oxopyrazol-4-yl] methane [I], di-[1-phenyl-3-methyl-5-oxopyrazol-4-yl] methane [II], 4-amino-3, 5-di-[benzylidene-hydrazinocarbonyl] isothiazole [III], 4-amino-di-[m- bromobenzylidenehydrazinocarbonyl] isothiazole [IV], 3-[p- chlorobenzylidenehydrazinocarbonyl] isothiazolo [4, 3-d] pyrimidine-7 [6H]-one [V] and 5-hydroxy-3-[p-methoxybenzylidenehydrazinocarbonyl] isothiazolo-[4, 3-d] pyrimidine-7 [6H]-one [VI] have been thoroughly investigated

acetal like nature of carbon-5-in 5-aryl-4,5-dihydro-3-methoxycarbonyl isothiazolo [4,3-d] pyrimidine-7 [6H] -one

Hydrazinolysis of 5-substituted 4,5- dihydro-3-ethoxy carbonylisothiazolo [4,3-d] pyrimidine-7 [6H]-one derivatives [Ia-h] causes dihydropyrimidinone ring opening and formation of 4-amino-3-carbamoyl-5-hydrazinocarbonylisothiazole [II]. A rational for the case of the dihydropyrimidinone ring opening in such compounds by hydrazine and a plausible mechanism for the reaction were presented. An alternative route for the preparation of 5-aryl-4,5-dihydro -3-arylidenehydrazinocarbonylisothiazolo [4,3-d] pyrimidine-7 [6H]-one derivatives [VIIa-h] was given

Adsorption and release characteristics of papaverine hydrochloride

The adsorption studies of the antispasmodic, papaverine hydrochloride, by six different adsorbing agents were performed in aqueous solution at pH 4 and 25C. The adsorption data were found to follow the Langmuir equation. The effect of the tested additives on the adsorption of papaverine hydrochloride can be arranged in the following descending order: kaolin > veegum > magnesium trisilicate > aerosol > aluminium hydroxide > talc

Novel benzimidazole, benzothiazole and uracil derivatives as potential Antimicrobial agents

Hydrazinolysis of benzimidazole-2-thiol [la], benzothiazole-2-thiol [lb] and 6-methylthiouracil [lc] afforded the corresponding hydrazine derivatives II. These were condensed with the 1,3-dicarbonyl compounds III and V and alpha, beta-unsaturated carbonyl compounds VII giving compounds IV, VI and VIII, respectively. In addition, benzimidazole-2-thiol and benzothiazole-2-thiol were reacted with methyl chloroformate giving the S-carbonyl derivatives which upon reaction with hydrazine hydrate afforded the corresponding 2-[hydrazinocarbonyl] thio derivatives X. These acid hydrazides X were further condensed with the 1,3-dicarbonyl compounds III and V and alpha, beta-unsaturated carbonyl compounds VII giving compounds XI- XIII, respectively. Twelve of the newly synthesized compounds were evaluated for antimicrobial activity against variety of microorganisms

Novel substituted nicotinamide derivatives: synthesis and evaluation for antihypertensive activity

The synthesis of 2 novel series of nicotinamide derivatives VI and IX has been carried out. 3-[carboxyphenylaminocarbonyl] pyridine [III] was converted to its acid chloride IV which was reacted with different alicyclic and /or aromatic secondary amines to give the first series of nicotinamide derivative IX in a quantitative yield. The sodium salt of III was also reacted with different N-chloroacetyl derivatives of alicyclic and /or aromatic secondary amines giving the second series of nicotinyl derivatives VI. Compounds VI and IX were converted to their methyl iodide salts VII and X, respectively, which were reduced with sodium borohydride to yield 1,2,3,6-tetrahydropyridine derivatives VIII and XI, respectively. The structure of new products was substantiated by spectral as well as microanalytical data. Eight of the new synthesized compounds were tested for hypotensive activity in anesthetized normotensive rabbits

Synthesis of 2,6-Dimethyl-5carbethoxy-3-substituted pyridines of pharmaceutical interest

Condensation of 2,6-dimethyl-3,5-dicarbethoxypyridine [I] with hydrazine hydrate in different solvents [reaction media] afforded a mixture of 5-carbethoxy-2,6-dimethyl- pyridine-3-carboxyhydrazide [IIa] and 2,6-dimethylpyridine-3,5-bis [carboxyhydrazide] [IIb] in a ratio depending on the reaction time and the solvent polarity. Reaction of [IIa] with different aldehydes gave the corresponding arylidenehydrazides [III] which on reacting with acetic anhydride afforded the respective oxadiazolines [IV]. The 5-carbethoxylutidine- 3-carboxsemicarbazides [V] and the 3-carbox-thiosemicarbazides [VI] were obtained via condensation of [IIa] with some isocyanates and isothiocyanates, respectively

Synthesis of certain 3,5-disubstituted lutidine derivatives of pharmaceutical interest

Condensation of 3,5-dicarbethoxy lutidine [I] with a variety of aromatic aldehydes afforded the corresponding steryls [II]. Reacting 3,5-dicarboxhydrazide lutidine [Ia] with carbon disulfide in ethanolic potassium hydroxide gave the respective oxadiazole [III] which yielded the Mannich bases [IV] on being reacted with formalin and certain secondary amines. Treatment of the lutidine hydrazide [Ia] with nitrous acid afforded the corresponding azide [Ib] which on reacting with different amines and a number of alcohols gave the corresponding ureas and urethanes, respectively