Potential neuroprotective of trans resveratrol a promising agent tempeh and soybean seed coats-derived against betaamyloid neurotoxicity on primary culture of nerve cells induced by 2-methoxyethanol / Potencial neuroprotetor do agente trans-resveratrol em cascas de sementes de soja e tempê derivadas da neurotoxicidade beta-amiloide na cultura primária de células nervosas induzidas pelo 2-metoxietanol

Resveratrol, a natural polyphenol found in tempeh, has not been investigated especially in vitro as a neuroprotective agent against 2-methoxyethanol (2-ME)-induced beta-amyloid cytotoxicity. Beta amyloid peptides (Aβ) could initiate neurotoxic events and neuron-inflammatory response via microglial activation. However, it remains unknown whether the neurotoxic effect of beta-amyloid and/or associated with the potential of 2-ME to induce neurotoxic effects on primary culture of nerve cells induced by 2-ME. This study investigated potential neuroprotective of trans-resveratrol a promising agent tempeh and soybean seed coats-derived against beta amyloid cytotoxicity on primary culture of nerve cells induced by 2-methoxyethanol. Biotium and MTT assays were used to analyze neurons, which were isolated from the cerebral cortex of fetal mice at gestation day 19 (GD-19). A standard solution of 2-methoxyethanol was dosed at 10 μL. The cultured cells were randomly divided into the following groups: (1) 2-ME group + resveratrol standard, (2) 2-ME group + resveratrol isolated from tempeh, (3) 2-ME group + resveratrol isolated from soybean seed coats, and (4) the control group, without the addition of either 2-ME or resveratrol. Exposure of the primary cortical neuron cells to beta-amyloid monoclonal antibody pre-incubated for 24 h with 10 µL of 4.2 µg/mL resveratrol and 7.5 mmol/l 2-methoxy-ethanol additions. Here, we report that the addition of 2-ME and resveratrol (standard and isolated from tempeh) of cell culture at concentrations of 1.4, 2.8 and 4.2 µg/mL showed that the majority of neurons grew well. In contrast, after exposure to 2-ME and Beta-amyloid, showed that glial activated. These findings demonstrate a role for resveratrol in neuroprotective-neurorescuing action.

O resveratrol, um polifenol natural encontrado em tempê, não foi investigado apenas in vitro como agente neuroprotetor contra a citotoxicidade beta-amiloide induzida por 2-metoxietanol (2-ME). Os peptídeos beta amiloides (Aβ) podem iniciar eventos neurotóxicos e resposta inflamatória dos neurônios via ativação microglial. No entanto, permanece desconhecido se o efeito neurotóxico do peptídeo beta-amiloide associado ao potencial do 2-ME causa efeitos neurotóxicos na cultura primária de células nervosas induzidas pelo 2-ME. Este estudo investigou o potencial neuroprotetor do agente trans-resveratrol em cascas de sementes de soja e tempê derivadas da citotoxicidade beta-amiloide na cultura primária de células nervosas induzidas pelo 2-metoxietanol. Ensaios de biotium e MTT foram utilizados para analisar os neurônios isolados do córtex cerebral de camundongos fetais no dia da gestação 19 (GD-19). As células cultivadas foram divididas aleatoriamente nos seguintes grupos: (1) grupo 2-ME + padrão de resveratrol; (2) grupo 2-ME + resveratrol isolado de tempê; (3) grupo 2-ME + resveratrol isolado de cascas de sementes de soja; e (4) grupo controle, sem a adição de 2-ME ou resveratrol. Houve exposição das células primárias dos neurônios corticais ao anticorpo monoclonal beta-amiloide pré-incubado por 24 horas, com 10 µL de 4,2 µg/mL de resveratrol, e adições de 7,5 mmol/l de 2-metoxietanol. A adição de 2-ME e resveratrol (padrão e isolado do tempê) da cultura de células nas concentrações de 1,4, 2,8 e 4,2 µg/mL mostrou que a maioria dos neurônios cresceu bem. Por outro lado, após a exposição ao 2-ME e beta-amiloide, a glia foi ativada. Esses achados demonstram um papel do resveratrol na ação neuroprotetora e de neurorresgate.

Potential neuroprotective of trans-resveratrol a promising agent tempeh and soybean seed coats-derived against beta-amyloid neurotoxicity on primary culture of nerve cells induced by 2-methoxyethanol

Abstract Resveratrol, a natural polyphenol found in tempeh, has not been investigated especially in vitro as a neuroprotective agent against 2-methoxyethanol (2-ME)-induced beta-amyloid cytotoxicity. Beta amyloid peptides (A) could initiate neurotoxic events and neuron-inflammatory response via microglial activation. However, it remains unknown whether the neurotoxic effect of beta-amyloid and/or associated with the potential of 2-ME to induce neurotoxic effects on primary culture of nerve cells induced by 2-ME. This study investigated potential neuroprotective of trans-resveratrol a promising agent tempeh and soybean seed coats-derived against beta-amyloid cytotoxicity on primary culture of nerve cells induced by 2-methoxyethanol. Biotium and MTT assays were used to analyze neurons, which were isolated from the cerebral cortex of fetal mice at gestation day 19 (GD-19). A standard solution of 2-methoxyethanol was dosed at 10 L. The cultured cells were randomly divided into the following groups: (1) 2-ME group + resveratrol standard, (2) 2-ME group + resveratrol isolated from tempeh, (3) 2-ME group + resveratrol isolated from soybean seed coats, and (4) the control group, without the addition of either 2-ME or resveratrol. Exposure of the primary cortical neuron cells to beta-amyloid monoclonal antibody pre-incubated for 24 h with 10 µL of 4.2 µg/mL resveratrol and 7.5 mmol/l 2-methoxy-ethanol additions. Here, we report that the addition of 2-ME and resveratrol (standard and isolated from tempeh) of cell culture at concentrations of 1.4, 2.8 and 4.2 µg/mL showed that the majority of neurons grew well. In contrast, after exposure to 2-ME and Beta-amyloid, showed that glial activated. These findings demonstrate a role for resveratrol in neuroprotective-neurorescuing action.

Resumo O resveratrol, um polifenol natural encontrado em tempê, não foi investigado apenas in vitro como agente neuroprotetor contra a citotoxicidade beta-amiloide induzida por 2-metoxietanol (2-ME). Os peptídeos beta-amiloides (A) podem iniciar eventos neurotóxicos e resposta inflamatória dos neurônios via ativação microglial. No entanto, permanece desconhecido se o efeito neurotóxico do peptídeo beta-amiloide associado ao potencial do 2-ME causa efeitos neurotóxicos na cultura primária de células nervosas induzidas pelo 2-ME. Este estudo investigou o potencial neuroprotetor do agente trans-resveratrol em cascas de sementes de soja e tempê derivadas da citotoxicidade beta-amiloide na cultura primária de células nervosas induzidas pelo 2-metoxietanol. Ensaios de biotium e MTT foram utilizados para analisar os neurônios isolados do córtex cerebral de camundongos fetais no dia da gestação 19 (GD-19). As células cultivadas foram divididas aleatoriamente nos seguintes grupos: (1) grupo 2-ME + padrão de resveratrol; (2) grupo 2-ME + resveratrol isolado de tempê; (3) grupo 2-ME + resveratrol isolado de cascas de sementes de soja; e (4) grupo controle, sem a adição de 2-ME ou resveratrol. Houve exposição das células primárias dos neurônios corticais ao anticorpo monoclonal beta-amiloide pré-incubado por 24 horas, com 10 µL de 4,2 µg/mL de resveratrol, e adições de 7,5 mmol/l de 2-metoxietanol. A adição de 2-ME e resveratrol (padrão e isolado do tempê) da cultura de células nas concentrações de 1,4, 2,8 e 4,2 µg/mL mostrou que a maioria dos neurônios cresceu bem. Por outro lado, após a exposição ao 2-ME e beta-amiloide, a glia foi ativada. Esses achados demonstram um papel do resveratrol na ação neuroprotetora e de neurorresgate.

Potential neuroprotective of trans-resveratrol a promising agent tempeh and soybean seed coats-derived against beta-amyloid neurotoxicity on primary culture of nerve cells induced by 2-methoxyethanol / Potencial neuroprotetor do agente trans-resveratrol em cascas de sementes de soja e tempê derivadas da neurotoxicidade beta-amiloide na cultura primária de células nervosas induzidas pelo 2-metoxietanol

Resveratrol, a natural polyphenol found in tempeh, has not been investigated especially in vitro as a neuroprotective agent against 2-methoxyethanol (2-ME)-induced beta-amyloid cytotoxicity. Beta amyloid peptides (Aß) could initiate neurotoxic events and neuron-inflammatory response via microglial activation. However, it remains unknown whether the neurotoxic effect of beta-amyloid and/or associated with the potential of 2-ME to induce neurotoxic effects on primary culture of nerve cells induced by 2-ME. This study investigated potential neuroprotective of trans-resveratrol a promising agent tempeh and soybean seed coats-derived against betaamyloid cytotoxicity on primary culture of nerve cells induced by 2-methoxyethanol. Biotium and MTT assays were used to analyze neurons, which were isolated from the cerebral cortex of fetal mice at gestation day 19 (GD-19). A standard solution of 2-methoxyethanol was dosed at 10 µL. The cultured cells were randomly divided into the following groups: (1) 2-ME group + resveratrol standard, (2) 2-ME group + resveratrol isolated from tempeh, (3) 2-ME group + resveratrol isolated from soybean seed coats, and (4) the control group, without the addition of either 2-ME or resveratrol. Exposure of the primary cortical neuron cells to beta-amyloid monoclonal antibody pre-incubated for 24 h with 10 µL of 4.2 µg/mL resveratrol and 7.5 mmol/l 2-methoxy-ethanol additions. Here, we report that the addition of 2-ME and resveratrol (standard and isolated from tempeh) of cell culture at concentrations of 1.4, 2.8 and 4.2 µg/mL showed that the majority of neurons grew well. In contrast, after exposure to 2-ME and Beta-amyloid, showed that glial activated. These findings demonstrate a role for resveratrol in neuroprotective-neurorescuing action.

O resveratrol, um polifenol natural encontrado em tempê, não foi investigado apenas in vitro como agente neuroprotetor contra a citotoxicidade beta-amiloide induzida por 2-metoxietanol (2-ME). Os peptídeos betaamiloides (Aß) podem iniciar eventos neurotóxicos e resposta inflamatória dos neurônios via ativação microglial. No entanto, permanece desconhecido se o efeito neurotóxico do peptídeo beta-amiloide associado ao potencial do 2-ME causa efeitos neurotóxicos na cultura primária de células nervosas induzidas pelo 2-ME. Este estudo investigou o potencial neuroprotetor do agente trans-resveratrol em cascas de sementes de soja e tempê derivadas da citotoxicidade beta-amiloide na cultura primária de células nervosas induzidas pelo 2-metoxietanol. Ensaios de biotium e MTT foram utilizados para analisar os neurônios isolados do córtex cerebral de camundongos fetais no dia da gestação 19 (GD-19). As células cultivadas foram divididas aleatoriamente nos seguintes grupos: (1) grupo 2-ME + padrão de resveratrol; (2) grupo 2-ME + resveratrol isolado de tempê; (3) grupo 2-ME + resveratrol isolado de cascas de sementes de soja; e (4) grupo controle, sem a adição de 2-ME ou resveratrol. Houve exposição das células primárias dos neurônios corticais ao anticorpo monoclonal beta-amiloide pré-incubado por 24 horas, com 10 µL de 4,2 µg/mL de resveratrol, e adições de 7,5 mmol/l de 2-metoxietanol. A adição de 2-ME e resveratrol (padrão e isolado do tempê) da cultura de células nas concentrações de 1,4, 2,8 e 4,2 µg/mL mostrou que a maioria dos neurônios cresceu bem. Por outro lado, após a exposição ao 2-ME e beta-amiloide, a glia foi ativada. Esses achados demonstram um papel do resveratrol na ação neuroprotetora e de neurorresgate.

The acetone crude extract of Quercus infectoria (Olivier) galls alters pH of the digestive vacuole of the malaria parasite, Plasmodium falciparum

@#The reduced efficacy of the mainstay antimalarial drugs due to the widespread of drugresistant Plasmodium falciparum has necessitated efforts to discover new antimalarial drugs with new targets. Quercus infectoria (Olivier) has long been used to treat various ailments including fever. The acetone extract of the plant galls has recently been reported to have a promising antimalarial activity in vitro. This study was aimed to determine the effect of the Q. infectoria gall acetone crude extract on pH of the digestive vacuole of Plasmodium falciparum. A ratiometric fluorescent probe, fluorescein isothiocyanate-dextran (FITC-dextran) was used to facilitate a quantitative measurement of the digestive vacuole pH by flow cytometry. Mid trophozoite stage malaria parasites grown in resealed erythrocytes containing FITC-dextran were treated with different concentrations of the acetone extract based on the 50% inhibitory concentration (IC50). Saponin-permeabilized parasites were analyzed to obtain the ratio of green/yellow fluorescence intensity (Rgy) plotted as a function of pH in a pH calibration curve of FITC-dextran. Based on the pH calibration curve, the pH of the digestive vacuole of the acetone extract-treated parasites was significantly altered (pH values ranged from 6.35- 6.71) in a concentration-dependent manner compared to the untreated parasites (pH = 5.32) (p < 0.001). This study provides a valuable insight into the potential of the Q. infectoria galls as a promising antimalarial candidate with a novel mechanism of action.

Sub-lethal concentrations of artemisinin alter pH of the digestive vacuole of the malaria parasite, Plasmodium falciparum

@#An appropriate pH maintenance within a membrane-enclosed organelle is vital for the occurrence of biological processes. Artemisinin (ART), a potent antimalarial drug has been reported to target the digestive vacuole (DV) of Plasmodium falciparum, which might alter the pH of the organelle, thereby impairing the hemoglobin degradation and subsequent heme detoxification. Hence, a flow cytometry-based technique using fluorescein isothiocyanate-dextran (FITC-dextran) as a ratiometric pH probe was employed to measure the pH of the DV of the malaria parasite treated with ART. Based on the pH calibration curve generated, the steady-state pH of the acidic DV of the non-treated parasites was 5.42 ± 0.11, indicating that FITC-dextran is suitable for detection of physiological pH of the organelle. The alteration of the DV pH occurred when the parasites were treated with ART even at the sub-lethal concentrations (15 and 30 nM) used. The similar effect was shown by the parasites treated with a standard proton pump inhibitor, concanamycin A. This suggests that ART might have altered the DV pH at lower levels than the level needed to kill the parasite. This study has important implications in designing new ART treatment strategies and in generating new endoperoxide-based antimalarial drugs pertaining to the interruption of the pH regulation of the malaria parasite’s DV.

Drug resistance mutations among virological failure HIV-1 infected patients in Malaysia

The determination of HIV drug resistance mutations (DRMs) towards antiretroviral (ARV) drugs among HIV-1 treated patients with virological failure is crucial for further management of the patient. This study aimed to assess the most common genomic mutation and to analyse subtypes among the HIV-1 patients with viral load level > 1,000 copies/mL. A total of 101 virological failure HIV-1 patients from four different regions of Peninsular Malaysia with a viral load measurement facility were included in the study. Majority of patients (89.1%) have at least 1 mutation associated with clinical resistance to either protease inhibitors (PIs), nucleoside reverse transcriptase inhibitors (NRTIs) or nonnucleoside reverse transcriptase inhibitors (NNRTIs). Major resistance mutations among the patients towards NRTIs and NNRTIs were 70.3% and 18.8%, respectively. The most common mutation for NRTIs was M184V while K103N mutation was detected in the majority of patients who were treated with NNRTIs. The most commonly observed mutations for major PI and minor PI seen among the study population were V82A/T and L10V, respectively. In HIV-1 subtype analysis, CRF33_01B was the most predominant HIV-1 subtype in this study group. The vast detection of DRMs in this study emphasized the importance of genotypic resistance test in the management of HIV patients as DRMs can alter patient’s susceptibility towards ARV drugs. Further study on larger number of samples is essential for the development of a database on HIV-1 DRMs among patients that experience virological failure in Malaysia.

Renal and Hepatic Dysfunctions in Early Phase of Experimental Trypanosoma brucei Infection of Nigerian Pigs.

Aim: The effects of infection with Trypanosoma brucei on renal and hepatic functions in early phase of disease were studied in experimentally infected pigs. The aim of this study was to identify serum biochemical changes that could serve as biomarkers of early renal and hepatic dysfunctions and also serve as basis for therapeutic management of T. brucei infections in man and animals. Study Design: A total of 15 growing pigs aged between 6 and 12 months old were used for the study. The pigs were selected at random into two groups. Group one was made up of seven animals and served as the infected group. The pigs were each infected with 1 x 106 parasites in 2mls of normal saline subcutaneously. The second group, made up of six animals, served as the un-infected control group. Place and Duration of Study: The pigs were housed in insect proof pens for two months while the experiment lasted. Methodology: Blood for serum obtained through venipuncture of the anterior venacava was used for determination of the serum total proteins, albumin, creatinine and urea concentrations as well as activities of alanine and aspartate aminotransferase post infection. Results: After infection there was a sharp increase in Total proteins (P = .05) accompanied by decrease in albumin but increase in globulin concentrations on Day 5. Increases in, serum creatinine and Blood Urea Nitrogen (BUN) concentrations and, activities of Alanine and Aspartate aminotransferases also occurred from this day. Conclusion: It was concluded that decrease in serum albumin concentration alongside increase in creatinine and urea levels as well as those of alanine and aspartate aminotransferase activities may be biomarkers of early onset of renal and hepatic pathology and determinants of ability to achieve self-cure from anemia in T. brucei infections of man and animals. This underscores the relevance of erythropoietin use in chemotherapy of African trypanosomiasis and the roles of renal and hepatic integrity in trypanotolerace.

Isolation and identification of anti-methicillin resistant Staphylococcus aureus compounds from Phyllanthus columnaris stem bark

Aim: Phyllanthus columnaris Müll.Arg. was found to possess anti-methicillin resistant Staphylococcus aureus (antiMRSA) activities. This study aimed at isolating, identifying and evaluating the active compounds from the stem bark of Phyllanthus columnaris Müll.Arg. against MRSA. Methodology and results: Stem bark extracts (methanol, acetone and aqueous) of Phyllanthus columnaris were subjected to anti-MRSA screening by disc diffusion method. MIC and MBC tests were carried out to compare the lowest concentration to inhibit and kill the sixteen MRSA tested among the three extracts. TLC bioautography were performed to detect the bioactive compounds. Isolation of the two active compounds was performed by means of preparative TLC. Morphological and ultra-structure alterations of the MRSA treated with bioactive compounds after 24 h were revealed by scanning and transmission electron microscopy. Both methanol and acetone extracts exhibited good anti-MRSA activity with the lowest minimum inhibitory concentration (MIC) value for both extracts were 0.78 mg/mL and the lowest minimum bactericidal concentration (MBC) were 1.56 mg/mL. Bioassay-guided chromatography by bioautography revealed two active anti-MRSA compounds from both tannin-free methanol and acetone extracts and characterized as stigmasterol and lupeol by nuclear magnetic resonance (NMR) spectral data. Scanning and transmission electron microscopy of MRSA treated with stigmasterol and lupeol showed cell wall disruption, release of cytoplasmic compounds and decreased in cellular volume. Conclusion, significance and impact of study: Results obtained herein, may suggest that the stem bark of Phyllanthus columnaris possess anti-MRSA and the two of the active compounds isolated were stigmasterol and lupeol. Their anti-MRSA effects up to the morphological and ultra-structure studies were not reported earlier

The integron prevalence of extended-spectrum beta-lactamase Malaysian teaching hospital

The increased frequency of antibiotic resistance is known to be associated with the dissemination of integrons in the Enterobacteriaceae. This study determined the prevalence and type of integrons amongst 160 extended-spectrum beta-lactamase producing enterobacterial isolates kept in our culture collection. Integrons were detected in 98(61.3%) isolates, including 28(62.2%) Escherichia coli, 34(64.2%) Klebsiella spp., 27(61.4%), Enterobacter spp. and 9(50.0%) Citrobacter spp. investigated in this study. Restriction analysis of the integron gene fragments revealed that class I integron was the principal integron detected in 92(57.5%) of our isolates. Class II integron was detected in 6(3.8%) of our isolates, while no class III integron was detected in this study. The high rates of integron prevalence particularly of the class I integron in the E. coli and Klebsiella spp. concur with previous studies in other geographical regions. The higher (>50%) integron prevalence of Citrobacter and Enterobacter isolates comparing to previous studies suggests the potential of these isolates as sources for dissemination of resistance determinants. The finding in this study serves as a basis for further study on the antibiotic resistance mechanisms of enterobacterial species in this teaching hospital.

Sexual dimorphism with respect to the macro-morphometric investigations of the forebrain and cerebellum of the grasscutter (Thryonomys swinderianus) / Dimorfismo sexual en relación con la investigación macro-morfométrica del cerebro y cerebelo del grasscutter (Thryonomys swinderianus)

This study was carried out to record the morphometric parameters of the brain of male and female grasscutters. Ten healthy grasscutters (5 males and 5 females) were used in this study. The mean brain weights were 9.80 + 0.50 g and 10.27 + 0.45 g for males and females respectively. The olfactory bulb mean weight was 0.57 + 0.05 g for males and 0.43 + 0.10 g for females. The cerebral and cerebellar mean lengths of 3.14 + 0.04 cm and 1.34 + 0.04 cm for males, 6.26 + 0.10 cm and 3.80 + 0.32 cm for females were observed. The cerebrum, cerebellum and olfactory bulb account for 70%, 12% and 6% of the total brain weight in males and 64%, 13% and 4% in the females respectively. The mean brain lengths were 5.63 + 0.07 cm and 6.26 + 0.1 cm for males and females respectively. There were significant differences in the body and olfactory bulb weights and also, in the whole brain and cerebral lengths between the males and females. In our present research, the ratios of 0.01 for males and 0.006 for females were observed. This suggests a relatively low brain weight in the ruminants. The olfactory bulb in the male is larger than that in the females. Females in turn have longer brain dimension than the males. Cerebellum has no sex variation both in weight and in length.

Este estudio se llevó a cabo para registrar los parámetros morfométricos del cerebro de grasscutters machos y hembras. Diez grasscutters sanos (5 machos y 5 hembras) fueron utilizados en este estudio. La media de peso del cerebro fueron 9,80 +/- 0,50 g y 10,27 +/- 0,45 g para los machos y hembras respectivamente. El peso medio del bulbo olfatorio fue 0,57 +/- 0,05 g para los machos y 0,43 +/- 0,10 g para las hembras. La longitud media del cerebro y del cerebelo fue de 3,14 +/- 0,04 y 1,34 cm +/- 0,04 cm para los machos, y 6,26 +/- 0,10 cm y 3,80 +/- 0,32 cm para las hembras, en las muestras observadas. El cerebro, cerebelo y el bulbo olfatorio representaron un 70%, 12% y el 6% del peso total del cerebro en machos y 64%, 13% y 4% en las hembras, respectivamente. La media de las longitudes del cerebro fueron 5,63 +/- 0,0 y 6,26 cm +/- 0,1 cm para los machos y hembras respectivamente. Hubo diferencias significativas en el peso del cuerpo y el bulbo olfatorio, y también en la longitud total del cerebro de machos y hembras. En nuestra actual investigación, los índices de 0,01 para los machos y de 0,006 para las hembras fueron observados. Esto sugiere un peso relativamente bajo en el cerebro de rumiantes. El bulbo olfatorio en los machos es mayor que en las hembras. A su vez, las hembras presentan una dimensión cerebral mayor que los machos. El cerebelo no tuvo variación según el sexo tanto en peso como en longitud.

Crohn's disease in a Saudi outpatient population: is it still rare?

To determine the epidemiology of Crohn's disease [CD] in an outpatient clinic and compare it with data previously reported from different centers in the Kingdom of Saudi Arabia and outside. The medical records of all patients with CD seen in the clinic in the period from January 1993 through December 2007 were reviewed. The demographic, clinical data and methods of diagnosis were retrieved. Over a period of 15 years, we saw 133 Saudi patients with CD. They were predominantly young, with a median age of 26.2 years and male preponderance [2.3:1]. The final diagnosis was established within 1 week of presentation in 47% of the patients. The leading symptoms were abdominal pain [88%], diarrhea [70%], bloating [61%], rectal bleeding [50%], weight loss [33%], constipation [24%] and perianal disease [23%]. The diagnosis was established by endoscopy and histopathology. Ileocecal involvement was encountered in 40% of the patients. From the current study, it is obviously possible to diagnose a large proportion of patients with CD in a gastroenterology outpatient clinic. The data revealed a strikingly increased incidence of CD in a mainly young Saudi population in the past few years

Abdominal access injuries in laparoscopic surgery, a retrospective study

This study was performed to assess the incidence, diagnosis, management and morbidity and mortality of laparoscopic access injuries. Using available injury based reports,patients documents and some available video tape recording of some laparoscopic procedures, 54 patients were collected and reported of having laparoscopic access injuries out of total 608 laparoscopic surgical and gynecological procedures done in Kasr Elaini teaching hospital during the period from August 2001 to April 2003 representing 8.8% of the total cases in comparison to what was reported in the literature which showed low incidence of these access injuries ranging from 5/10000 to 1.3%. Most of the reported injuries were minor vascular injuries [2.6%] and extraperitoneal gas insufflation [3.7%]. These minor complications caused only some technical difficulties during the procedures but they had no impact upon morbidity and mortality of the patients and were managed conservatively. Major retroperitoneal vascular injuries and visceral injuries, although represented minor incidence in our study 0.5% and 1.3% respectively, yet they were the major source of morbidity and mortality to the patients. Not only so but they also necessitate termination of the primary procedure and conversion to open surgery for their management. It seems that there is no single method of laparoscopic access safer than the other since there was no significant difference between them in inducing injury. In although laparoscopic access injuries seem to be of low incidence, yet they should be minimized. Since access injuries may be the result of integration between patient related factors, surgeons factors and the technique of access, so adoption of good laparoscopic technique, improvement of learning curve of junior surgeons proper site selection and port placement and proper choice of equipment, all may reduce the risk of access complications

Granular cell tumour of the ampulla of Vater.

Granular cell tumour (GCT) is a rare soft tissue neoplasm commonly encountered in the head and neck region, skin and subcutaneous tissue. GCT of the biliary system is most commonly reported in African-American females and usually presents as abdominal pain and obstructive jaundice. The neoplasm constitutes less than 10% of all benign tumours of the extra-hepatic biliary tree. No case of GCT involving the ampulla of Vater has been reported in the literature to date. We report a case of benign GCT involving the ampullary region in a 44-year-old Ethiopian male. Preoperative diagnosis was available on ERCP and deep biopsy. The patient was managed by debulking resection and biliary-enteric bypass and is symptom-free with no evidence of tumour progression after a follow-up of one year.

Inital factors predicting rebleeding and death in bleeding peptic ulcer disease

Bleeding peptic ulcer constitutes approximately half of the cases admitted with upper gastrointestinal bleeding. Although the bleeding episode stops spontaneously in most of them, rebleeding occurs in as much as 10-30% of them and has a mortality rate of 5-10%. In this study, we have evaluated the possible significant predictors associated with this adverse outcome. The records of 205 patients admitted to gastrointestinal bleeding unit [GIBU] in Riyadh Central Hospital, during the period May 1996 through to April 1999, with endoscopic confirmed diagnosis of bleeding peptic ulcer disease were reviewed for demography, clinical presentation, hematology, biochemistry, initial blood pressure, nasogastric lavage color, co-morbid disease and endoscopic findings. All the significant factors found initially [P<0.05] were entered into odds ratio and its 95% confidence interval and finally the unconditioned logistic regression model was used to find out the significant independent predictors for both rebleeding and mortality in these patients. The majority of patients [85%] were males and below the age of 60 [73%]. Duodenal ulcer was the source of bleeding in 84%. Endoscopy was performed in all patients within 24 hours of admission. Only 15% were actively bleeding at the time of initial endoscopy. Thirty-six patients [17%] rebelled, majority within 72 hours of initial hemostasis. Overall, 11 patients [5%] died, 6 of them were rebleeders. Initial presentation of systolic blood pressure <100 mm Hg, blood in nasogastric tube and visible vessel within the ulcer in endoscopy were independent predictors of rebleeding while initial systolic blood pressure <100 mm Hg and age >60-years were independent predictors of mortality. Improvement of outcome in patients with bleeding peptic ulcer disease can be achieved by early detection of those patients who are at risk of adverse outcome. Patients with the above mentioned independent predictors of rebleeding and mortality are best managed in the intensive care unit with endoscopic hemostasis and proton pump inhibitor [PPI] therapy for a minimum of 5- days of admission

Pulmonary function tests in posthepatitic cirrhosis

Pulmonary function tests were studied in II patients with documented posthepatitic cirrhosis by liver biopsy as well as 20 matched healthy subjects. all the patients and the control subjects were non-smokers and their chest were clinically and radiologically free. The pulmonary function tests included Flow - Volume Loop [F/V Loop] before and after sulbutamol inhalation [bronchodilator] and diffusion studies. Front the F/V Loop the following measurements were calculated: forced vital capacity [FVC], farced expiratory volume first second [FEVI], FEVI / FVC, Peak Expiratory Flow [PEF], Peak Inspiratory Flow [PIF] and Flow at 25 - 75% of vital capacity [F 25 - 75]. The diffusion studies included Pulmonary Diffusion Capacity for Carbon monoxide [DLco], Alveolar Volume [VA] and Diffusion Coefficient [Kco: DLco/Va]. The results of this study showed a mild significant obstructive ventilatory pattern at the level of both small and large airways and a significant diffusion defet among posthepatitic patients

glucometabolic effects of oral vitamin E in non-insulin dependent diabetes

This study included 20 patients with NIDDM selected from the Diabetes clinic, Cairo University Hospitals, all of them were under diet control and oral hypoglycemic drugs, for which estimation of fasting blood glucose and serum insulin levels, postprandial blood glucose and glycosylated haemoglobin levels were done before and after 6 weeks of oral intake of vitamin E in a dose of 600 mg/day in three divided doses. The results showed statistically significant improvement in the blood glucose, serum insulin and glycosylated haemoglobin levels after the intake of vit. E, thus oral supplements of vit. E to NIDDM patients may be of value in improving glucose metabolism

Prevalence of maternal versus paternal family history of diabetes among Egyptian type II diabetics

In this study, details about the family history of diabetes were availbe from total of 2187 non insulin dependent diabetic patients attendending the Diabetes Clinic of Cairo University Hospitals, from whom 1065 patients [752 females and 313 males] have positive family history for diabetes either in the mother's or father's family, further classification of the relatives affected was done into 1st, 2nd, 3rd and 4th degree relatives. It is considered only the patients whom had a definite side of inheritance [paternal or maternal]. The results showed that 48.6% of the patients at least have one diabetic relative, it also showed that the mother's family members were implicated with diabetes in significantly more than the father's family members, which was mainly influenced by the mother's history of diabetes whatever the sex of the patient. Thus it is concluded from this study the importance of the family history for diabetes especially among the maternal than the paternal family members as regarding the inheritance of NIDDM among Egyptians

Acute appendicitis diagnostic accuracy

Acute appendicitis remains a diagnostic challenge to the surgeon. In part, this is because of the variable presentation of the disease and many other diseases mimicking appendicitis, and in part, there is no absolutely accurate diagnostic test to diagnose acute appendicitis. In this study, we investigated the rate of diagnostic accuracy in patients who underwent emergency appendectomy because of suspicion of acute appendicitis in the emergency department of Kasr El-Aini hospital for a total number of 263 patients. Before operation the symptoms and signs of the patients were recorded on special forms, on which the operative findings, the result of the routine histopathologic examination of the removed appendices, and the laboratory studies of total and differential leucocytic count were also recorded. The patients were grouped into 4 groups according to whether it was simple appendicitis or perforated and whether there was surgical or non-surgical disease with the normal appendix. Based on histopathologic and operative findings, the diagnostic accuracy was 79 percent, 84 cases were found to have negative appendix, 6 of them had other surgical disorders indicating immediate surgery, thus diagnostic accuracy of acute appendicitis is 79 percent, but the overall accuracy for acute surgical disease is 80.5 percent

medial gastrocnemius myocutaneous flap with a laterally extended skin paddle

Eighteen gastrocnemius flaps were used to cover soft tissue defects in legs and feet of seventeen male patients. As defects were larger than the standard medial gastrocnemius myocutaneous flap in eight cases, the skin over the lateral belly was elevated medially based together with the flap to compensate for width discrepancy. Based on survival of these eight modified flaps and on a previous anatomical study [Kamal et al, 1992], we conclude that the skin paddle of the medial flap can safely be laterally extended to include the fasciocutaneous tissue overlying the lateral belly