Prognostic Value of Leptin Gene Polymorphisms in Type 2 Diabetes Mellitus Patients in Egypt.

Aim: The work wasto study polymorphisms in the LEP gene in type 2 diabetics in Minia, Egypt and determined the relationship between the leptin and c-peptide levels in different genotypes and insulin resistance in obese patients. The study also has evaluated the role of leptin gene polymorphism in prediction of diabetes mellitus prognosis and its prevention. Study Design: Investigative. Place and Duration of Study: Samples were analyzed at Biochemistry Department, Faculty of Medicine- Minia University, Egypt, between August 2012 and April 2014. Methodology: This study was performed in 80 patients with type 2 diabetes mellitus (54 men and 26 women) and 15 normal controls (12 men and 3 women). In our thesis we measured HbAc, fasting blood glucose, leptin hormone and c-peptide. DNA extracted and the human leptin gene (for product 242 bp) was amplified by PCR, Restriction analysis of the PCR products was performed with restriction enzyme HhaI and genotyped at the restriction site located -2549 bp from the transcription initiation site of leptin gene. Presence of allele (C at -2549 bp) and absence of allele (A at the same position) were identified through the GCGC sequence. Results: Our study showed C-2549 A variant is associated with the fasting leptin levels, the results which are in agreement with previous studies. The polymorphism in leptin gene has an effect on the level of plasma leptin in different genotypes, and individuals with AA genotype have the lower plasma levels of leptin and also c-peptide than AC and CC variants. Conclusion: Our study reveals that both diabetic patients and their non-diabetic relatives have different basal leptin and c-peptide specific to different leptin genotypes. This suggests that the association between leptin and insulin in members of diabetic families may be controlled by inheritance.

Epidural dexamethasone for post-operative analgesia in patients undergoing abdominal hysterectomy: a dose ranging and safety evaluation study

Number of studies revealed that epidural bupivacaine-dexamethasone has the same analgesic potency as bupivacaine-fentanyl with opioid sparing and antiemetic effects. Different doses of dexamethasone were used in different studies. This study was designed to evaluate the optimum dose of epidural dexamethasone for post-operative analgesia. In this double-blinded randomized controlled study, we evaluated the efficiency and safety of different doses of epidural dexamethasone for post-operative analgesia in 160 patients aged 45-60 years scheduled for total abdominal hysterectomy. Patient were randomly allocated into four groups to receive a total volume of 10 ml epidural plain bupivacaine 0.25% in the control group [Group D0] with either 4 mg dexamethasone in [Group D4] or 6 mg dexamethasone in [Group D6] or 8 mg dexamethasone in [Group D8]. Patients then received general anesthesia. Sedation, satisfaction and visual analog pain scores [VAS] at rest and with effort were measured post-operatively. Meperidine was administered when VAS > or = 4. Intra-operative fentanyl dose, post-operative meperidine consumption and the time to first analgesic requirement were recorded by a blinded observer. Blood glucose was measured pre-operatively and at 4 h and 8 h after study drug administration. Wound healing and infection were assessed after 1 week. Intraoperative fentanyl requirements were comparable among groups. The time to first analgesic requirement was significantly prolonged 5.5 times in D8 Group but only 1.5 times in D6 and D4 Groups more than the analgesic duration in the control Group D0, with a P < 0.01. There was a significant reduction in post-operative meperidine consumption during the first 24 h in the D8 [75%] in comparison with D6 and D4 Groups [50%], respectively, [P < 0.01] and the control Group D0 [0%] [P < 0.01]. VAS scores were significantly lower and patient satisfaction score was significantly higher in the D8 and compared with Groups D6 and D4 [P < 0.01] and the control Group D0 [P < 0.01]. Post-operative nausea was significantly lower in the D8, D6 and D4 Groups versus the D0 Group [P < 0.05]. Epidural dexamethasone in a dose of 8 mg is probably more effective than lower doses to control moderate to severe post-operative pain. This dose is not associated with increased glucose level or delayed wound healing

Does preoperative gabapentin affects the characteristics of post-dural puncture headache in parturients undergoing cesarean section with spinal anesthesia?

Gabapentin is effective for treating different types of headache including post-dural puncture headache [PDPH], also used for prophylaxis against migraine. We studied the effect of pre-operative administration of gabapentin on the characteristics of PDPH in parturients undergoing cesarean section [CS] under spinal anesthesia. Women undergoing elective cesarean section under spinal anesthesia were randomized to receive preoperative gabapentin 600 mg or placebo. Spinal anesthesia was achieved with 12.5 mg hyperbaric bupivacaine plus 25 microg fentanyl. Babies were followed up by Apgar scores, umbilical artery blood gases, breastfeeding difficulties, and need for NICU admission. The mothers were followed up for any side effects of gabapentin for 24 h. Patients with PDPH were re-admitted and onset and duration of the headache were reported and severity was assessed using a visual analog scale [VAS] for 4 days from diagnosis. Paracetamol with caffeine and diclofenac were given for treatment, and the doses were adjusted according to VAS; also number of doses given for each group was recorded. Eighty eight patients were randomized, and 2 were excluded. The incidence of headache and co-existing symptoms were similar in both groups. The onset of headache was significantly delayed in gabapentin group [P < 0.05]. Also, severity and duration of headache were significantly less in gabapentin group [P < 0.05]. The incidence of sedation was more in gabapentin group 11 [26.19%] versus placebo group 3 [6.81%]. Neonatal outcomes were statistically insignificant between both groups. Pre-operative administration of gabapentin has no effect on incidence of [PDPH] but delays its onset and reduces its severity and duration in parturients undergoing cesarean section with spinal anesthesia without significant adverse effects on the mother or the baby

outcome of the Ahmad Glaucoma Valve implantation for refractory glaucoma in Kuwait

Aim: To assess the outcomes and incidence of postoperative complications of Ahmad Glaucoma Valve implant in eyes with complicated glaucoma performed in Kuwait

Method: This is a retrospective study done at the Al-Bahar Eye Center in Kuwait. Charts of all patients who underwent Ahmad Glaucoma Valve implant at the Al-Bahar Ophthalmic Center in Kuwait between 2006 and 2009 were reviewed. Surgical success was defined as intraocular pressure less than 22 mmHg and greater than 5 mmHg without additional glaucoma surgery and without loss of light perception

Results: A total of 33 eyes from 30 patients with complicated glaucoma not responsive to conventional medical and non-implant surgical treatment received Ahmad Glaucoma Valve implant. The success rate was 79% [26 cases]. 20/26 [77%] cases of them required antiglaucoma medications. The most common complication was encapsulated bleb [27%] and transient postoperative hypotony was found in 19% of the cases

Conclusion: Ahmad Glaucoma Valve implant appears to be effective and relatively safe for complicated glaucoma in Kuwait. The success rate is comparable with those reported in other studies

outcome of congenital cataract surgery in Kuwait

Congenital cataract is the most common cause of treatable blindness in children and the outcome of congenital cataract surgery has not been studied in Kuwait, so the purpose of this study is to evaluate the visual outcome and the postoperative complications. Medical records of children who underwent congenital cataract surgery between September 2000 and December 2008 at Al-Bahar Eye Center, Ministry of Health of Kuwait were retrospectively reviewed. In 100 eyes that fill the inclusion criteria visual acuity and postoperative complications were recorded. The mean follow up was 3.9 +/- 1.7 years with range from 3 to 6 years. The mean age of congenital/developmental cataract surgery is 8.9 +/- 8.7 months for bilateral cases and it was 5.75 +/- 4.61 months for unilateral cases. The mean final postoperative BCVA in unilateral cases was 1.0 [20/200] log MAR unit and it was 0.3 [20/40] log MAR unit for the bilateral cases. Four percent of the cases developed postoperative glaucoma and 2% of them developed significant opacification of the posterior capsule. Our findings provide evidence of recent improvement over time in the visual prognosis in bilateral, and to a lesser degree, unilateral cataract, in children in Kuwait

Treatment options for non-compliant children with amblyopia in Kuwait

The mainstay treatment for more than 250 years has been occlusion of the better eye by an opaque patch. Pharmacological penalization is an alternative therapy for noncompliant child. The aim of this study is to investigate the effects of atropine penalization in amblyopic patients who are noncompliant with conventional occlusion. This is a retrospective study of 114 children aged 24 to 78 months with unilateral Ambyliopia diagnosed at the Pediatric Ophthalmology unit of AL-Bahar Eye Center in Kuwait during the time period December 1999 to august 2005 and fulfilling the inclusion criteria. The mean follow up time after starting amblyopia treatment was 38.4 +/- 27.12 months. All children with amblyopia were prescribed 6 hours occlusion per day. Children who are non compliant with occlusion were instructed to instil 1 drop of atropine 1% into the nonambyliopic once per day. A total of 114 patients participated in the study.72 [63.16%] patients were compliant with occlusion, 64 of them [88.9%] reached cure within mean time of 23.23 +/- 16.89 months. The remaining 42[36.84%] patients who are not compliant with occlusion were instructed to use atropine 1% eye drops once per day. 38 of them [90.5%] were compliant with penalization and 36 [94.7%] of them reached cure with a mean time 12.9 +/- 9.7 months. Conclusion: The result of this study suggests that atropine penalization should be considered as an alternative therapy in those who are noncompliant with occlusion in treatment of amblyopia

Traumatic hyphema-comparison between different treatment Modalities

This prospective, randomised study was performed to determine the best treatment available for mild noncomplicated traumatic hyphema. This study comprised 120 patients who fulfill the criteria of our study. The patients were admitted in our center through the eye casulty department and they were randomly divided into three equal and similar groups, one group received Predforte [registered sign] eye drops, the other received Predforte [registered sign] and Cyclogel [registered sign] 1% eye drops and the control group received Tears Natural [registered sign] eye drops. For each patient, the following characteristics were recorded at presentation: age, sex, size of hyphema, initial visual acuity [IVA], intraocular pressure [IOP] and fundus examination. The outcome, hyphema resorption time, and occurrence of complications such as rebleeding and secondary glaucoma were recorded and compared between the groups. the resorption time was almost the same [4 days] regardlless of the treatment modality the patient received. Four [3.3%] patients developed a rebleed, two [5%] in the first [steroid only] group and 2 [5%] in the third [control] group. the final visual acuities [FVA] were 0.3 log MAR on discharge, the mean log MAR is 0.1.P value of [0.04]. The cause of the decline in final visual acuity in these 4 patients was the development of traumatic cataract rather than the treatment used. A total of 14 patients [11.6%] developed a mild had FVAto moderate elevation of IOP [23-29 mmHg]; 10 [25%] in the first [steroid only] group, 2 [5%] in the second [steroid cyclo] group and 2 [5%] in the third [control] group. In all cases, the IOP returned to normal either without treatment or with short term Timolol eye drops. In cases of mild simple traumatic hyphems not exceeding 50%, simple lubricating drops probably is most efficient and safe treatment. Using other such as Predforte and cyclopentolate did have any addional beneficiary effect

Effect of pretreatment with intravenous lidocaine and magnesium sulfate on onset and duration of rocuronium

Rocuronium is a steroidal non - depolarizing muscle relaxant that provides rapid onset with intermediate duration of action [1-5] Many drugs have been used to make its onset of action as short as that of succinyl choline[7, 8] The aim of this study is to evaluate the relaxant efficacy of low dose rocuronium 0.6 mg/kg either alone or pretreated with lidocaine 1.5 mg/kg or magnesium sulfate 30 mg/kg. Their effects on the time of onset and time of recovery [duration] of rocuronium muscle blockade and on the intubation conditions were assessed. A prospective randomized double blind clinical study was conducted on 75 ASA I and II adults undergoing short elective surgical procedures requiring tracheal intubation. They were divided into three groups 25 in each. In group I rocuronium was pretreated with normal saline. In patients of group II, rocuronium was pretreated with 1.5 mg/kg lidocaine. In group Ill, the patients were given 30mg/kg magnesium sulfate as pretreatment 3 minutes before rocuronium. Rocuronium was given in a dose of 0.6 mg /kg. The response of the adductor pollicis muscle of the non - dominant hand to train of four stimulation of the ulnar nerve at the wrist at 10 watch SX seconds intervals was measured using TOF watch [acceleromyography principle]. The mean onset time to T[1]= 25% and to complete disappearance of TOF trace [T[1]=0%] were measured [seconds]. All patients were intubated when T[1]=25% and intubation conditions were assessed on a four point scale as excellent, good, poor or inadequate according to the method described by Goldberg, et at., [12] [table I]. The mean times to initial recovery T[1]=10% and, clinical recovery, TOF ratio 75% were also measured. The mean onset time of rocuronium to T[1]= 25% and T1-0% were equally reduced by lidocaine in group II and magnesium sulfate in group Ill if compared with group I [control or saline]. Iidocaine pretreatment [group II] gave as excellent acceptable intubation scores as magnesium pretreatment [group III]. Intubation scores in groups II and m were statistically superior to those in group I - As regard recovery the mean times to initial recovery [T[1]=10%] and clinical recovery [TOF ratio 75%] were not affected by lidocaine while they were prolonged by magnesium sulfate. rocuronium [low dose] -lidocaine combination may be a safe alternative in rapid tracheal intubation of patients when succinyl choline is contraindicated especially when the surgery is of short duration. We recommend strict monitoring of neuromuscular block and titration of the dose of non - depolarizing muscle relaxants in patients on magnesium therapy

Effect of different esmolol doses on propofol required for induction of anesthesia

Esmolol a short acting beta[1]-receptor antagonist is known to reduce the cardiac output [CO]. Preinduction CO is a significant predictor for propofol dose required for induction of anesthesia. This study was designed to determine the effect of esmolol dose on propofol required for induction of anesthesia. Eighty patients were randomly allocated to placebo group I [saline] and esmolol groups Il, Ill, IV received esmolol bolus doses 0.5, 1 and 1.5 mg/kg respectively followed by i.v. infusion of 250 micro g/kg/min. After 5 minutes anesthesia was induced by propofol 10 mg/mI at 10 ml/min by infusion pump, the primary end point used was the propofol dose/kg at loss of response to command and duration of induction were recorded. CO, BP [Blood Pressure], HR [Heart Rate] and SpO[2]% saturation were monitored non-invasively. CO was measured before and after esmolol injection [at preinduction time]. Esmolol doses 0.5, 1 and 1.5 mg/kg. followed by esmolol infusion significantly reduced CO by 12%, 14.6% and 18.9% and reduced propofol dose required for induction of anesthesia by 15.3%, 23.38% and 3.6% from placebo group respectively. in addition the duration of induction was reduced significantly in group II, Ill and IV by 12.5%, 22.5% and 32.1% from placebo [group I] respectively in the same order. Esmolol dose reduced propofol induction dose and duration of induction of anesthesia in an inversely proportional manner possibly due to the effect of esmolol dose on preinduction cardiac output [CO]

comparative study between lidocaine iontophoresis, intravenous lidocaine, and magnesium sulfate pretreatment for reduction of pain during propofol injection

Propofol produces anesthcsia with rapid recovery[1]- It has become the induction agent of choice for elective surgery in many countries. However, it causes pain or discomfort on intravenous injection in 28 - 90% of patients, which is a recognized complication that is recalled post operatively by 52-62% of those who experience it, and several methods have been advocated to reduce its incidence and severity [2]. The aim of the study is to compare the efficacy of three different techniques in attenuating pain induced propofol injection, which are magnesium sulfate pretreatment prior to propofol administration, in comparison to iontophoretically applied lidocaine, which is a transdermal anesthesia technique and i.v. injection of 2% lidocaine prior to propofol injection. A prospective, randomized double blind clinical study was conducted in 90 ASA I and II adults undergoing elective surgery. After obtaining a written informed consent, they were divided into 3 groups 30 patients in each. Group I [lidocaine group] pretreated with 2 ml. 2% lidocaine [40 mg], the pretreatment injection given over 30 seconds, 1 minute before the start of propofol infusion. This is accompanied by venous occlusion for 1 min.In group II [lontophoresis group], the negative electrode containing 4% lidocaine in a hydrogel was placed on the test area on the dorsum of the hand while, the positive electrode was placed 10 cm proximally, and both electrodes were connected to the iontophoresis unit [lomed Phoresor 11, Croydon, UK]. Electric current was set at 0.0 mA and was increased gradually to a maximum 4.0 mA. lontophoresis was discontinued when 40 mA min-1 dose was delivered and the time required was recorded, since, drug delivery is proportional to the total electrical charge, measured as a product of the current strength and duration of application [units: miliampere x minutes, [mA.min-[1]][3]. In group III was pretreated with 2ml 50% magnesium sulfate [1 g] the pretreatment solutions were given over 30 seconds. 1 minute before the start of propofol infusion-This is accompanied by venous occlusion for 1 min. followed by propofol infusion. The infusion was stopped when the patient lost consciousness as detected by loss of eye lash reflex. Pain was assessed on a four point scale 0 = no pain, 1 = mild pain, 2 = moderate pain, 3= severe pain, at the start of propofol infusion and at 20 seconds intervals for 1 minute. The incidence of pain following i.v injection of propofol after pretreatment with lidocaine 2% was 17%in group I [lidocaine] compared to 39% and 46% in group II [lontophoresis] and group III [magnesium] respectively [P < 0.05]. Intravenous lidocaine pretreatment was more effective in attenuating pain during propofol administration than iontophoretically applied lidocaine and magnesium sulfate pretreatment. There was no statistically significant difference between group II and group Ill as regard pain reduction during propofol injection. intravenous lidocaine pretreatment is more effective in attenuating pain induced by propofol injection than topically applied lidocaine and magnesium sulfate pretreatment

In vitro studies of some detoxifying and antioxidant enzymes in cattle fasciolosis

This work was undertaken to investigate the effect of 15 and 50 micro g/ml Triclabendazole-sulphoxide [TCBZ-SX] the active metabolite of the fasciolocide TCBZ on the activities of superoxide dismutase and catalase [SOD and CAT] as antioxidant enzymes and glutathione-S-transfers [GST] as detoxifying enzyme in the liver of normal and Fasciola gigantica infected cows and buffaloes. Of this study revealed that the drug when used in vitro had no effect on the activities of SOD and CAT in normal and fastciola gigantic a infected cows and buffaloes as well as on the activity of GST in normal and Fasciola gigantica infected buffaloes. This indicated that the changes noticed in the activates of the studied parameters were due to the effect of infection rather than the drug itself except for the GST in normal cows which showed a significant increase in the activity as a result of drug treatment. Differences in the levels of these enzymes between cows and buffaloes may be due to species variation. We could conclude that the drug didn't later the capacity of the three tested antioxidant and detoxifying enzymes

Acute toxicity and anti acetylcholinesterase potential of some biphenyl derivatives to non target species.

Five newly synthesised biphenyl derivatives were evaluated for their acute contact toxicity (LC50) against rice weevil and honey bee and anti acetylcholinesterase potential (I50) against honey bee, fish, pigeon and rat. Amongst, O,O-dimethyl-O, p-Nitro-biphenyl phosphate was most potent against rice weevil, whereas p-(4-Nitrophenyl) phenyl-N-methyl carbamate against honey bee. Based on I50 values the biphenyl derivatives of phosphoric acid esters were more potent anti acetylcholinesterase (AChE) agents against rat and fish brain AChE while derivative of carbamic esters towards pigeon brain AChE. The anti AChE potency of both groups appear to be of the same order towards bee head AChE.

Relation between intensity of Schistosoma haematobium infection and clinical proteinuria, haematuria, and pyuria before and after treatment on a village level in children

A Field study was done in Kafre El-Bagaur health centre in Monofia Governorate. Urine and stool examination was done for 200 students to select the active urinary Bilharzial cases. 80 students [8 - 16 years old] were found to have urinary Bilharziasis. Microscopic examination for R.B.Cs., pus cells and quantitative detection of protein in urine were done. It was found that there is a correlation between intensity of Schistosoma haematobium infection and the clinical proteinuria, haematuria, and pyuria before treatment. Follow up of the cases one month after treatment with 3 doses of metrifonate [Bilarcil] showed that there was marked reduction in proteinuria, haematuria, and pyuria

Study of different helminthic infection among Al-Azhar University students

Stool examination by four different methods, Scotch perianal swab, and urine examination were done for 200 female medical students of Al-Azhar University. The number of positive case was 19 cases [9.5%] eleven Enterobius vermicularis, five Ascaris lumbricoides, three Taenia saginata and one Hymenolepis nana. Another 25 positive samples were collected from Al -Zahraa Hospital to help in evaluation of the methods of stool analysis and the efficiency of the tested drugs. Formol ether, Simple smear, kato technique and zinc sulphate methods revealed 27, 21, 19 and 19 positive cases respectively. 21 positive cases of E. vermicularis were detected by the Scotch perianal swab. The cure rates of mebendazol [vermox] and albendazol [zentel] were nearly equal being 83.3% and 82.6% respectively

Disseminated hymenolepis nana in bood of a filarial patient

A female patient aged 13 years, from Kafr-Osman, Giza governorate suffering from microfilaraemia showed disseminated Hymenolepis nana in her blood. The effect of filariasis and the immunosuppression of a corticosteroid treatment taken for an attack of cutaneous allergy are a possible cause for dissemination of a heavy intestinal H. nana adults. This is an important indication to exclude parasitic infestations before any immuno-suppressive treatment to limit the phenomenon of aberrant metastasising their larval forms

Synthesis of some thiophosphoric acid esters derived from 4-hydroxy-4'-nitrobiphenyl and their azo-analogues as new biocides

Extending our work on organophosphates of potential biological activated, we have now prepared certain new biphenyl analogues 3b-d of the known insecticide parathion [Ia] [O,O- diethyl-O-p-nitrophenyl phosphorothioate; E 605][5], and the phosphonothionate ester EPN [Ib] [O-ethyl O-p-nitrophenyl benzenephosphonothionate][5] for toxicological evaluation

simple preparation of 3-hydroxy-4-methoxytetraphenylmethane

Methods known for the preparation of 3-hydroxy-4-methoxytetraphenyl-methane la are indirect and lengthy. During our work on the reaction of alkyl phosphites with 4-triphenylmc-thyM,2-benzoquinone [II], we endeavoured the synthesis of [la] by the action of diazomethane on 3, 4-dihyd-roxytetraphenylmethane [Ib]