Infants of diabetic mothers and associated complications in neonatal intensive care unit in Misurata Center

Infants of diabetic mothers (IDM) are at an increased risk of various complications. The aim of this study is to evaluate the prevalence, demographic and clinical characters of IDM admissions to the neonatal intensive care unit, and the factors associated with morbidity and mortality. The study is a 1-year retrospective observational study involving all the cases of IDM admitted to the neonatal intensive care unit at Misurata. The study examined the association of the following ante- peri- and postnatal factors to the morbidity and mortality rate of IDM. A total of 103 IDM were admitted to the NICU with mother age range of 31- 35 years. About 84% of the mothers had multiple pregnancies, 81.5% of the IDM were born through C-section. 72% of the mothers had gestational diabetes. 59% of IDMs were females. Median gestational age was 36 ­ 38 weeks which was associated with higher mortality rate (p = 0.041) ,40% of them were post term. Macrosomia was the most common complication; 41%. About 22% had hypocalcemia and 12% had RDS. Six cases had congenital heart disease (CHD). About 26% of the cases required intravenous fluid (IVF) which had a significantly higher mortality rate (25% vs. 1.3%) (p = 0.008). IDM are at a higher risk of congenital and acquired morbidities and mortality. Delayed birth and the mode of delivery (elective or urgent Csection) are associated with the severity of the gestational diabetes which is significantly associated with higher mortality rate.

PCOS women show significantly higher homocysteine level, independent to glucose and E[2] level

Background: it is reasonable to think that some biochemical characteristics of follicular fluid [FF] surrounding the oocyte may play a critical role in determining the quality of oocyte and the subsequent potential needed to achieve fertilization and embryo development

Objective: this study was carried out to evaluate the levels of FF homocysteine [Hcy] in IVF candidate polycystic ovary syndrome [PCOS] women and any relationships with FF glucose and estradiol [E[2]] levels

Materials and Methods: in this case control study which was performed in Dr. Tizro Day Care and IVF Center 70 infertile patients were enrolled in two groups: comprising 35 PCOS and 35 non PCOS women. Long protocol was performed for all patients. FF Hcy, glucose and E[2] levels were analyzed at the time of oocyte retrieval

Results: it was observed that FF Hcy level was significantly higher in PCOS patients compared with non PCOSs [p<0.01]. Observations demonstrated that in PCOS group, the Hcy level increased independent to E[2], glucose levels, BMI and age, while the PCOS group showed significantly higher BMI compared with non-PCOS group [p=0.03]. However, no significant differences were revealed between groups for FF glucose and E[2] levels

Conclusion: present data showed that although FF glucose and E[2] levels were constant in PCOS and non PCOS patients, but the FF Hcy levels in PCOS were significantly increased [p=0.01]

Long-term effect of ciprofloxacin on testicular tissue: evidence for biochemical and histochemical changes

This research studied the effect of ciprofloxacin [CPFX] on spermatogenesis. We aimed to estimate the effect of CPFX on serum levels of testosterone, LH and FSH. In this experimental study, a total of 24 mice were assigned to controlsham and test groups. We subdivided the test group into low [206 mg/kg] and high [412 mg/kg] dose CPFX groups. Control-sham animals received carboxymethyl cellulose [CMC]. All animals were treated orally for 45 days. Cytoplasmic carbohydrate, lipid accumulation, cytoplasmic lipase and alkaline phosphatase [ALP] ratios were examined. Serum levels of luteinizing hormone [LH], follicle stimulating hormone [FSH ] and testosterone were measured in the control and test groups. The spermatogenesis cell series exhibited low numbers of cells with periodic acid Schiff [PAS]-positive cytoplasm and higher numbers of cells with lipid-positive foci. The tissue to ALP ratio and germinal epithelium [GE] lipase synthesis increased in CPFX-treated animals. In contrast to the CPFX groups, control animals showed normal cytoplasmic carbohydrate, lipid, lipase and ALP ratios in all cellular layers. In the CPFX-treated groups there was a significantly lower serum testosterone level compared with the control group. The serum levels of FSH and LH in high dosetreated animals decreased. Our results suggest that following long time CPFX administration major alterations occur in GE intracytoplasmic biochemistry, which may lead to loss of physiological function and ultimately result in fertility problems. CPFX is able to imbalance serum levels of gonadotropins and testosterone levels by affecting Leydig cells

Comparative efficacy evaluation of amlodipne/ramipril combination with essential hypertension

The reduction of blood pressure lower than 130/85 mmHg provides additional benefits regarding both protection of organs and cardiovascular mortality. Amlodipine is a calcium channel-blocking agent with vasodilator activity and Ramipril is ACE inhibitor. The objective of this double-blind, comparative study evaluating the efficacy of Amlodpine 5 mg and Ramipril 1.25 mg in combination and as mono therapy in adult patient with essential hypertension. Double-blind, comparative study. This study was conducted in the department of Biochemistry, University of Karachi from February 2011 to July 2011. This was multicenter randomized, double-blind, comparative study. Patients were selected from different hospitals of Orangi Town Karachi from February 2011 to July 2011 and study was conducted in the department of Biochemistry, University of Karachi. Patients were randomized to receive Amlodopine [5 mg] once daily Ramipril [1.25 mg] once daily for 8 weeks. The analysis of antihypertensive efficacy and biochemical effects of a therapeutic regimen in the long term becomes important .In study patents were randomized to receive amlodipine 5 mg once daily, Ramipril 1.25 mg once daily, the combination of amlodipine 5 mg with Ramipril 1.25 mg once daily. In the patients treated with combination of Amlodipine 5mg and Ramipril 1.25 mg tablets blood pressure reduction was significantly lower, reaching values of 130.4 +/- 10.2 / 84.1 +/- 7.4 mmHg by the end of eight weeks of treatment. The results of this study demonstrated that the combination of amlodipine 5 mg with Ramipril 1.25 mg once daily has a high antihypertensive efficacy and showed synergetic effect

Testicular biohistochemical alterations following experimental varicocele in rats

The exact pathophysiology of testicular degeneration, following varicocele has not been completely understood yet. The current study was designed to determine the effect of varicocele on germinal epithelium [GE] cytoplasmic biohistochmical alterations. To follow-up this study, left varicocele was induced in test groups. Non-varicocelized rats were served as control-sham [n=6]. Following 4, 6 and 8 months, right and left testes were dissected out and the blood serum sample was taken. The GE cytoplasmic carbohydrate, lipid accumulation, lipase and alkaline-phosphates [ALP] ratios were analyzed. Serum levels of LH, FSH and testosterone were measured. Observations demonstrated that in varicocele-induced rats, the spermatogenesis cell lineage exhibited lower number of cells with periodic acid shift positive cytoplasm, higher number of cells with lipid and ALP positive stained cytoplasm in comparison to control animals. Lipase enzyme decreased by the time in the test animals. In varicocelized groups the number of Leydig cells decreased in to 2.25 +/- 0.41 and 1.16 +/- 0.75 per one mm[2] in left and right testicles respectively after 8 months, and these cells demonstrated an ALP positive feature. In test groups, the serum levels of LH and FSH reduced into 1.12 +/- 0.01 and 2.03 +/- 0.05 ng/ml respectively after 8 months. Although testosterone level diminished by the time in the test animals, and this decreasing was significant [p=0.031] after 8 months [3.08 +/- 0.10 ng/ml]. Our results suggest that following varicocele induction major alterations occur in GE, which may lead to loss of GE cells physiological function and ultimately result in fertility problems

[Evaluation of sperm quality, maturation and DNA integrity in adult mice treated with sulpiride]

Use of certain antipsychotic drugs has severe effects on fertility in males. Hypothalamus and hypophysial impressions and changes in plasma hormones concentration like prolactin, LH and FSH can affect sperm production. In this study, we investigated the effects of sulpiride on sperm quality, maturation and DNA damage. Twenty for adult male mice [age: 6-8 weeks] were divided into three groups. The treatment group received 40 mg/kg sulpiride solution and the control sham group was given carrier of the drug intraperitoneally [IP] daily for 45 days but the control group received nothing. Finally, all the mice were sacrificed by cervical dislocation and their cauda epididymis were removed surgically. The excised specimens were placed in 1 ml HTF medium and incubated for 30 min in CO2 incubator to allow the spermatozoa to swim out. Later, sperm count, motility and viability were analyzed. Additionally, sperm chromatin quality and DNA integrity were assessed by aniline blue and acridine orange staining. Significant decrease in sperm motility and count were observed in the treatment group while the number of abnormal sperm increased as compared with the other two groups. Sperm viability and DNA maturation showed significant reduction and the rate of DNA damage increased in comparison with the control sham and the control groups [P<0.05]. The study showed that sulpiride has negative effects on sperm parameters in treated animals and in some cases it could cause secondary infertility

Impact of overweight and obesity on ventilatory function among male medical students

To correlate the respiratory function among normal weight [BMI > 18.5 - 24.9 Kg/m[2]], overweight [BMI > 25 - 29.9 Kg/m[2]] and obese [BMI > 30 Kg/m[2]] male medical students who did not have evidence of obstructive or restrictive airway disease or other underlying diseases affecting their respiratory system. The other objective was to assess the correlation of respiratory function St body mass index [BMI]. Cross sectional controlled study was conducted among 113 eligible male medical students at college of medicine, King Saud University Riyadh, Kingdom of Saudi Arabia during August 2009 - July 2010. Body mass index was used to assess the obesity and forced expiratory volume in one second [FEV1] and forced vital capacity [FVC] were used to assess respiratory function. One way ANOVA was used to find the difference between BMI groups and bivariate correlation analysis was done to find out the strength of the relationship among BMI and respiratory function parameters. FEV1, FVC and FEV1/FVC ratio were linearly and mildly inversely related with BMI in overweight [r = -0.338, -0.291, -0.311 respectively] and obese [r = -0.375, -0.349, -0.040 respectively]. In normal weight subjects, FEV1 and FVC were mildly positively correlated [r = 0.136 and 0.219 respectively] and FEV1/FVC ratio was negatively correlated [r = -0.166] with BMI. Overweight and obesity are associated with pulmonary dysfunction among young male population

effect of tamoxifen on the fetal and neonatal ovarian follicles development in rats

The effect of tamoxifen as a selective estrogen receptor modulator which is widely used for treatment of early and metastatic breast cancer was investigated on the folliculogenesis in rat's fetuses and neonates. The pregnant rats assigned into test and control groups. Control group received olive oil and treatment groups received either 17-[3-estradiol [10 [micro g/kg/day] or tamoxifen [0.4 mg/kg/day] between days 8-13 of pregnancy. On day 20th of pregnancy the rats euthanized and the blood samples were collected for determination of FSH, E[2], and the fetuses fixed for histological studies. Another group of pregnant rats went forward to obtain their neonates and we euthanized the neonates and the genital system was collected for further histopathological analyses on day 5th. The histological examinations of the fetus's and neonate's ovaries and biochemical data showed significant changes in the rats which treated with tamoxifen. The absence of folliculogenesis and an increase in E[2] level in tamoxifen-treated group which accompanied with sharp decrease of FSH level in comparison with the control group were demonstrated. By contrary, E[2] treated group showed a positive progress in development in terms of the formation of secondary follicles and also supportive connective tissues in comparison with the control group. In conclusion, this study supports the previous findings showing that tamoxifen has effects on the development of ovaries and therefore, it should be avoided or used with great caution in pregnant women

Varicocele time-dependently affects DNA integrity of sperm cells: evidence for lower in vitro fertilization rate in varicocele-positive rats

We designed this study to clarify how varicocele can time-dependently affect sperm morphological parameters and DNA integrity. In this study, we intend to estimate the effect of various periods of varicocele on the in vitro fertilization [IVF] rate in rats. In this experimental study, left varicocele were induced as the test group [n=18] which was further sub-divided into three groups based on the study termination time [4, 6 and 8 months after varicocele induction]. The control-sham group [n=6] consisted of rats who received no treatment. Repopulation index [RI], tubular differentiation index [TDI], sperm viability and motility, morphological maturity, chromatin integrity and ability to undergo IVF were assessed. In addition, the potential impact of varicocele on serum total antioxidant capacity [TAOC] and total thiol molecules [TTM] were examined. Histological results showed that varicocele negatively influenced TDI and RI. All sperm morphological parameters were lower than those in the control-sham group. DNA damage was severely and time-dependently substantiated in all test groups. Varicocele significantly reduced the ability of sperm derived from varicocele rats to undergo IVF. Serum TAOC and TTM levels reduced in a time-dependent manner. Right testes varicocele-induced rats showed remarkably less damaged profile for all investigated parameters compared to the left testes varicocele. Our data suggested that experimentally induced varicocele negatively impacted sperm maturation and chromatin integrity in a time-dependent manner. This consequently caused a remarkable reduction in IVF ability. The detrimental effect of varicocele may be attributed to the significant reduction of antioxidant capacity of the serum

Validation of datascope accutorr plus [trade mark sign] using British hypertension society [BHS] and association for the advancement of medical instrumentation [AAMI] protocol guidelines

To assure the accuracy and reliability of blood pressure measurement by non-invasive blood pressure monitor using Datascope Accutorr Plus[trade mark sign] [Paramus, NJ,USA] against mercury manometer, among adult male participants. Eighty participants from a family physician's office at a teaching hospital were recruited. One hundred and sixty measurements of blood pressure were performed according to BHS technique protocol. Descriptive analysis was done according to the AAMI and BHS protocol guidelines. The limits of agreement between the device and the standard were plotted using the method of Bland and Altman plot. The mean difference +/- SD between the Datascope Acutorr Plus[trade mark sign] and observer was 2.7 +/- 5.2 mm Hg and 1.5 +/- 3.26 mm Hg for systolic and diastolic blood pressure, respectively. Datascope Acutorr Plus [trade mark sign] obtained A/A grading for both systolic and diastolic blood pressure. Datascope Accutorr Plus [trade mark sign] [Paramus, NJ, USA] satisfies BHS and AAMI validation protocols for both systolic and diastolic BP and may be recommended for everyday use for BP monitoring at home and in clinical use for adult population

Laparoscopic appendectomy for acute appendicitis: is this a feasible option for developing countries?

The role of laparoscopic appendectomy is still not well defined in the literature. This study was conducted to evaluate the feasibility of laparoscopic appendectomy at a university hospital in a developing country. Patients undergoing laparoscopic appendectomy [LA] from August 2002 to August 2006 were identified. For each case, a control was selected from patients undergoing open appendectomy [OA] during the same year by systematic sampling. The groups were compared in terms of duration of surgery, requirement of narcotic analgesia, length of hospital stay, postoperative complications and the overall cost for each patient. A total of 68 patients underwent laparoscopic appendectomy during the study period. Median duration of surgery was 82 minutes in LA group and 70 minutes in OA group [P < 0.001]. Forty-five patients in LA group and 64 in OA group required narcotic analgesia [P < 0.001]. Median length of hospital stay [P = 0.672] and postoperative complications [P = 0.779] were comparable in both groups. Median cost of hospital stay was Pakistani Rupees [PKR] 47121/in LA group and PKR 39318/in OA group, the difference being significant [P = 0.001]. Laparoscopic appendectomy is feasible in developing countries with similar postoperative outcome and less requirement of narcotic analgesia. The duration of surgery and overall cost were significantly higher and efforts should be made to develop expertise and reduce operative time with resultant decrease in cost. Development of standardized protocols for discharge of patients from the hospital after LA may further reduce the cost and benefit patients in developing countries

Comparison between electronic BP apparatus [dynamap/datascope] versus standard mercury sphygmometer

To assess the accuracy of blood pressure measurement in adult population by Datascope/Dynamap versus Standard Mercury Sphygmometer, in a family physician's office. A cross sectional study was conducted in June 2008 at a university based teaching hospital in the Kingdom of Saudi Arabia, Eighty adult male subjects were recruited from a family physician's office. Blood pressure was taken from each participant by primary investigator by two different monitors i.e. sphygmometer and Datascope/dynamap. Highly significant different observed in systolic as well as diastolic blood pressure measurement by Datascope vs. mercury sphygmometer [P value less than 0.0001]. Highly significant different was seen in systolic blood pressure measurement by Datascope. Mercury Sphygmometer and Palpatory methods [P value less than 0.0001]. Significant different also was seen in pulse rate, checked by manually versus Datascope [P value 0.0008]. There was highly significant different between time taken to check blood pressure by Datascope versus Mercury Sphygmometer [P value less than 0.0001]. This study concluded that the electronic blood pressure monitor [Datascope/Dynamap] is not as good and accurate as universally accepted Mercury Sphygmometer for measurement of blood pressure in adult male population

Total contact cast for neuropathic diabetic foot ulcers

To determine the outcome of diabetic neuropathic foot ulcers treated with Total Contact Cast [TCC] in terms of percentage of ulcers healed and time to heal. Department of Orthopaedic Surgery, Abbasi Shaheed Hospital, Karachi Medical and Dental College, from April 2005 to March 2007. The study included diabetic patients with non-ischemic neuropathic foot ulcers of upto grade 2 of Wagner's classification. Ulcers were debrided off necrotic tissues and Total Contact Cast [TCC] was applied. TCC was renewed every 2 weeks till healing. Cases were labeled as cast failure when there was no reduction in wound size in 4 consecutive weeks or worsening to a higher grade. Main outcome measures were the percentage of ulcers healed and time to heal in the cast. Thirty four [87.17%] patients were males and 5[12.82%] were females. The mean age was 62 +/- 13.05 years. All patients had NIDDM. Out of the 52 ulcers, 41[78.84%] healed with TCC in an average 2 casts duration [mean 32 days]. There were 11[21.15%] cast failure. Majority [63.63%] of cast failure ulcers were located on pressure bearing area of heel. Most [90%] of the ulcers on forefoot and midsole region healed with TCC [p<0.001]. Longer ulcer duration [mean 57.45 +/- 29.64 days] significantly reduced ulcer healing [p<0.001]. Total contact cast was an effective treatment modality for neuropathic diabetic foot ulcers of Wagner's grade 2, located on forefoot and midsole region

Sub-trochanteric valgus osteotomy for the treatment of non-union of the femur neck fracture

To evaluate the outcome [radiographic union and functional] of subtrochanteric valgus osteotomy in younger adults with nonunion of femoral neck fractures. It was an observational study. This study was conducted in the Department of Orthopaedic Jinnah Post Graduate Medical Center during the period from 01-08-2001 to 31-07-2003. Fifteen patients of ages between 18-50 years with nonunion of femoral neck fractures. Valgus subtrochanteric osteotomy was done and fixed with 120° double angle blade plate. Radio-graphic union and functional outcomes were observed on Salvati and Wilson hip score and Harris hip score. Average delay in presentation of patients was 9 months [range 2-30months]. At an average follow up of 13.5 months non-united neck fractures in 11[73%] out of 15 patients united. In these patients average Harris hip score was 88 and Salvati. In 3[%] patients severe head collapse developed after surgery and in 1 [%] patient fracture remained non united due to broken plate. For an active young patient with non-united or neglected femoral neck fracture, subtrochanteric val-gus osteotomy provides satisfactory results even in early stages of avascular necrosis of head of femur

Surgical management of non-union of humeral diaphyseal fracture

To evaluate results of operative management of established non-union of humeral diaphysis with Dynamic compression plating [DCP] and Rush pinning with cancellous bone graft. Hospital based prospective study. Conducted at Department of Orthopedic Surgery, Jinnah Postgraduate Medical Centre, Karachi. A total of 21 patients of established un-united humeral diaphyseal fracture, between 15 to 65 years were included in this study. Patients underwent DCP and Rush pinning with bone grafting. Union of fractures clinico-radiographically and functional outcomes with Modified Constant and Murley Scale for shoulder and range of motion for elbow were considered. Among 18 available patients, 14/18 nonunion [77.8%] united within 5.1 +/- 1.8 months. For DCP group 11/13 [84.6%] united in 4.45 +/- 0.96 months. For Rush pin group 3/5 [60%] united in 7.7 +/- 2.1 month [P< 0.001]. Modified Constant and Murley Scale for shoulder assessment, for DCP group, excellent 05, good 03, fair for 03, poor 02 and for Rush pin group excellent 00, good 00, fair 02 and poor 03. Average range of motion of elbow joint 71.7 +/- 15.3% to 82.7 +/- 16.0%. Persistent non-union in four, radial nerve palsy in one, implant failure in two and shoulder impingement in one case noticed. No severe deep infection occurred. Dynamic compression platting with bone graft has shown significantly higher union rate for non-union of humeral diaphysis, while the functional outcome regarding shoulder [P<0.03] and elbow movements [P<0.05] are also proved to be significantly better in DPT as compared to Rush pin