Delayed Presentation of Severe Blunt Liver Trauma Following a 12-Foot Fall: A Case Report of a Grade 4 Hepatic Injury With a Concurrent Grade 1 Renal Injury.

The delayed presentation of a 15-year-old female with a complex Grade 4 liver injury and a concurrent Grade 1 renal injury sustained from a fall exemplifies the heightened vulnerability of adolescents to blunt hepatic trauma. Unlike typical presentations where symptoms like abdominal pain and internal bleeding appear immediately, this case emphasises the potential for delayed manifestation, posing unique challenges for diagnosis and management. This case, managed at a leading trauma centre, underscores the distinct challenges compared to adult cases due to adolescents' larger space available for the organ and immature livers. While presenting more management complexity than typical splenic injuries, prompt intervention with emergency laparotomy and hepatic packing proved crucial for the patient's successful outcome. This case emphasises the critical role of early identification, vigilant monitoring, and strict activity restrictions post-operatively for optimal adolescent liver trauma management and serves as a reminder of the spectrum of potential injuries, including bile duct and vascular damage alongside contusions and haematomas.

Assessing the hypolipidemic and gastro-liver protective activity of herbal combination with emphasis on PPI amid selected multiple antihypertensive drug combination in experimental animal models.

OBJECTIVE: Peptic ulcer (PU) and hypertension are chronic diseases affecting up to 10% and 30% of the adult population worldwide. Most of these patients will require treatment with a combination of antihypertensive medicines, which have adverse effects on the body's different organs. This study specifically focused on antihypertensive multi-drug induced PU disease and disturbance of liver function. MATERIALS AND METHODS: During a 14-day oral administration of antihypertensive drugs, Cilnidipine (1 mg/kg), Rosuvastatin (1 mg/kg), Bisoprolol (0.52 mg/kg), and Clopidogrel (7.81 mg/kg) were observed for their effects on the stomach lining and liver function in Wister albino rats. This study aimed to assess the potential of an herbal combination of (BO) + (BA) + (ZO) 0.26 mg/kg body weight (b.w.) Powder and water mixture on the ulcer, lipid profile, and liver function for 14 days in the treatment of the indomethacin-induced gastric ulcers in rats at doses of 30 mg/kg b.w. for three days. Esomeprazole (20 mg/kg b.w.) is used as a standard reference to evaluate antiulcer activity in rat models. The experiment suggests that the gastroprotective effect of the herbal combination can be attributed to its reducing effect on the peptic and the Serum Glutamic Pyruvic Transaminase (SGPT) levels and within the normal range of 34.67 ± 0.88 IU/L. RESULTS: The results for Total Cholesterol (TC), Triglyceride (TG), High-density lipoprotein (HDL) and Low-density lipoprotein (LDL) of the herbal combination were 52 ± 9.81495 (mg/dl), 70 ± 12.12435 (mg/dl), 23.33 ± 6.06446 (mg/dl), 14.5 ± 1.32790 (mg/dl), respectively, where the standard group (atorvastatin) 5 mg/kg TC, TG, HDL and LDL were 69.77 ± 9.92 (mg/dl), 47.7 ± 10.35 (mg/dl), 33.43 ± 5.70 (mg/dl), 26.8 ± 3.70 (mg/dl), and control group total cholesterol, triglyceride, HDL and LDL were 68.67 ± 2.20 (mg/dl), 124.07 ± 2.94 (mg/dl), 49.14 ± 1.05 (mg/dl), 54.11 ± 1.15 (mg/dl). CONCLUSIONS: CThis investigation reported that antihypertensive drugs did not produce gastrointestinal (GI) toxicity, and the morphological structure of the organ was not changed. So, it could be concluded that the herbal combination used in this experiment has a promising role in controlling lipid profile, liver function, and antiulcer effects. Moreover, multiple drug therapy for hypertension does not cause any harm to the stomach. Further investigations might be carried out on a larger scale to make these statements more valid.

Dual Energy X-ray Absorptiometry Scanning for Osteoporosis Detection: Analysis of Patients at a Tertiary Care Hospital.

INTRODUCTION: Dual-energy X-ray absorptiometry (DEXA) scanning is a rapid and accurate noninvasive procedure utilized to measure bone mineral density (BMD) and diagnose osteoporosis. The primary objective of this study was to assess the prevalence of osteoporosis in different regions of the body using DEXA scanning in patients attending a tertiary care private hospital. Additionally, we aimed to raise awareness about approved diagnostic methods for osteoporosis. METHODOLOGY: For this retrospective study, a sample size of 384 participants was determined. The selection of participants was based on convenience sampling, considering their availability and accessibility. Data were collected from adult patients aged 18 years and above who underwent DEXA scanning. The information was compiled using Microsoft Excel, obtained from the patient's treating physicians, and evaluated by two medical graduates. Statistical analyses were performed using IBM SPSS Statistics version 26.0 (IBM Corp., Armonk, NY). RESULTS: The findings unveiled an overarching osteoporosis prevalence of 38.5%, accompanied by distinctive figures of 38.7%, 8.9%, and 38.4% in the lumbar, hip, and forearm regions, respectively. Furthermore, the occurrence of osteopenia was found in 33% of participants in the lumbar region, 35.1% in the hip region, and 39.7% in the forearm region. Additionally, no significant association was found between gender and overall osteoporosis prevalence, suggesting that the susceptibility to osteoporosis did not significantly differ between genders. Moreover, the study emphasized the variations in bone density across different skeletal regions, with the forearm region displaying the lowest mean T-score and Z-score. CONCLUSIONS: The results of this study on osteoporosis prevalence in the lumbar, hip, and forearm regions indicate varying rates among these skeletal sites. Notably, both male and female patients demonstrated an equal susceptibility to developing osteoporosis. Interestingly, the forearm region emerged as the most common site for osteoporosis in males (34.6%), while the lumbar region was the most common in females (41.6%).

Does fetuin-A mediate the association between pro-inflammatory diet and type-2 diabetes mellitus risk? / ¿Fetuína-A media en la asociación entre la dieta proinflamatoria y el riesgo de diabetes mellitus tipo 2?

Introduction: recent studies indicate that diet increases T2DM risk via inflammation. Fetuin-A, identified as an acute-phase protein, plays a role in insulin resistance and is an independent predictor of type-2 diabetes. Objectives: the present study aimed to examine the association between diet and T2DM risk, and whether said association is mediated by fetuin-A, and to determine the effect of fetuin-A on T2DM risk. Methods: the case group included 40 individuals with T2DM, whereas 40 individuals without T2DM comprised the control group. The Dietary Inflammatory Index (DII), was used to determine the inflammatory potential of diet. A simple mediation analysis was used to investigate whether diet was associated with T2DM risk and whether the association was mediated by fetuin-A. Results: subjects who consumed a high pro-inflammatory diet had 2.0 times higher risk of developing T2DM (OR = 2.043; 95 % CI: 0.955 to 4.371, p = 0.066). In addition, subjects who had higher levels of fetuin-A had a 1,2 times higher risk of developing T2DM (OR = 1.155; 95 % CI: 1.030 to 1.296, p = 0.014). Both fetuin-A and hs-CRP had a significant full mediator role on the association between DII and HOMA-IR [respectively; β = 0.371 (95 % CI: -0.029-0.770), β = 0.424 (95 % CI: -0.007-0.856)]. Conclusion: these findings suggest that a pro-inflammatory diet, by creating an environment of increased inflammatory markers, affects in particular insulin resistance through these markers and ultimately causes T2DM. In addition, fetuin-A also acts as an important novel mediator between diet and T2DM by inducing insulin resistance (AU)

Introducción: estudios recientes indican que la dieta aumenta el riesgo de T2DM mediante la inflamación. La fetuína-A,identificada como proteína de fase aguda, desempeña un papel en la resistencia a la insulina y es un predictor independiente de la diabetes de tipo 2. Objetivos: el presente estudio pretende examinar la asociación entre la dieta y el riesgo de DMT2 y si la asociación está mediada por la fetuína-A y determinar el efecto de la fetuína-A sobre el riesgo de DMT2. Métodos: en el grupo de casos se incluyeron 40 individuos con DMT2, mientras que 40 individuos sin DMT2 se incluyeron en el grupo de control. El índice de inflamación de la dieta (DII) se usó para determinar el potencial inflamatorio de la dieta. El análisis de mediación simple se usó para investigar si la dieta estaba asociada con el riesgo de DMT2 y si la asociación estaba mediada por la fetuína-A. Resultados: los sujetos que consumieron una dieta más proinflamatoria tuvieron 2 veces más riesgo de desarrollar DMT2. Además, los sujetos que tenían niveles más altos de fetuína-A tuvieron 1,2 veces más riesgo de desarrollar DMT2. Tanto la fetuína-Acomo la hs-CRP tuvieron un papel significativo como mediadores completos sobre la asociación entre DII y HOMA-IR. Conclusión: estos hallazgos sugieren que la dieta proinflamatoria, al crear un ambiente con marcadores inflamatorios aumentados, afecta en particular a la resistencia a la insulina a través de estos marcadores y, finalmente, causa DMT2. Además, la fetuína-A también actúa como mediador novedoso importante entre la dieta y la DMT2 al inducir la resistencia a la insulina (AU)

Impact on the Utilization of Reproductive, Maternal, Newborn and Child Health Care Services at Primary Health Care Level During First Wave of COVID-19 Outbreak in Pakistan.

INTRODUCTION: Very little is known and predictable on how long the COVID-19 pandemic will last, even though dramatic preventive measures to flatten the curve and stop its transmission have been taken worldwide periodically since its start. These preventive measures coupled with people's fear of COVID-19, significantly altered people's health-seeking behavior and healthcare accessibility. This study aims to measure the impact of the COVID-19 pandemic on the utilization of reproductive, maternal, newborn, and child health (RMNCH) care services at primary health care (PHC) facilities in Pakistan.  Methods: A retrospective study was conducted in 22 districts using data from 1169 primary health care facilities. The District Health Information System (DHIS) was used to retrieve district-wise services utilization data from January to April 2020 i.e. January to February 2020 (pre-COVID-19) and March to April 2020 (during COVID-19). The monthly difference (in percentage change) for selected RMNCH services indicators was calculated using the expected number of clients (January to February average) versus the actual number of clients for March and April 2020. RESULTS:  We observed a decrease of 12.5% for March and 33% for April 2020 in the total number of clients who availed of primary health care services in Sindh as compared to the pre-COVID-19 monthly average. A decrease in first antenatal care visits (15.6% and 16.3%), delivery coverage (12.8% and 17.9%) and family planning client visits (31.6% and 36.3%) were observed for March and April 2020 respectively. The pentavalent vaccine results revealed a decrease of 19.3% and 63.1%, while a decrease of 17.3% and 54.3% were observed for children receiving the first dose of measles vaccine in March and April, respectively.  Conclusions: Our findings show that the number of clients who avail of routine care or RMNCH services at the primary health care level considerably declined during the initial phase of the first wave of the COVID-19 outbreak in Sindh, Pakistan. These results highlight a rising threat to poor RMNCH and outcomes.

Comparative Effectiveness of Laparoscopic Sleeve Gastrectomy in Morbidly Obese and Super Obese Patients.

Background Laparoscopic sleeve gastrectomy (LSG) is a modified procedure derived from a biliopancreatic diversion (BPD)-duodenal switch. The present study evaluated the role of LSG in morbidly and super obese patients and compare its efficacy between the two groups. Methodology A retrospective review was conducted in Dr. Sulaiman Al Habib Specialist Hospital, Riyadh, KSA, from January 2020 to April 2021. Patients' records were divided into two groups, morbidly obese (body mass index (BMI): 40-49 kg/m2) and super obese (BMI: 50-59 kg/m2), who were admitted to the department for laparoscopic sleeve gastrectomy during the study duration. However, patients with a history of gut surgery, hernias, comorbid use of illicit substances, and psychiatric disorders were excluded. For all patients, a routine preoperative investigation protocol was conducted. Postoperative surgical complications were also recorded. The Clavien-Dindo classification (CDC) score was applied to record surgical complications. Data collection was done using a semi-structured questionnaire. The Statistical Package for Social Sciences (SPSS) version 26 (IBM, Chicago, USA) was used to perform data analysis. Results A total of 176 patient records were included in this analysis, of which 126 (71.6%) were females. There were 101 (57.1%) patients who were morbidly obese and 76 (42.9%) who were super obese. The mean duration of follow-up records in this study was 23.2 ± 3.6 weeks, which was slightly longer in the morbidly obese group. Change in BMI was higher in the super obese patients (18.6 ± 3.1 versus 10.5 ± 1.9). Final body weight was still lower in the morbidly obese group as they were relatively slimmer even before the procedure. A higher reduction in excess weight loss (EWL) is seen in the morbidly obese group. Comorbidity resolution status was also remarkable with the procedure. Overall, there were procedure-associated complications in 11 (10.9%) patients in the morbidly obese group and 10 (13.2%) in the super obese group. Conclusion Laparoscopic sleeve gastrectomy is a safe procedure in morbidly and super obese patients. It is effective in sustainable total and excess weight loss over time. It is also effective in comorbidity resolution. Complications with LSG are minimal and nonserious. LSG should be the recommended procedure in morbidly and super obese patients with adverse health consequences to improve their morbidity, mortality, and overall quality of life.

Volatilization of toxic elements from coal samples of Thar coal field, after burning at different temperature and their mobility from ash: Risk assessment.

In present study, the volatilization of arsenic (As), cadmium (Cd), mercury (Hg) and lead (Pb) by the burning of coal samples in the electric furnace was evaluated. The coal samples were obtained from different blocks of newly developed Thar coal field, Pakistan. The replicate coal samples were heated/burned in an electric furnace at laboratory scale for three temperature intervals (200, 400 and 900 °C). The ash obtained after each temperature intervals were analyzed for selected toxic elements. The resulted data indicated that the total contents of As, Cd, and Pb in coal samples of block X and XI were found in the range of 16.8-18.5, 4.21-4.72, and 14.2-18.8 mg/kg, respectively. Whereas, 67.8-79.7%, 34.3-36.8% and 9.89-10.8% of As, Cd, and Pb, respectively, were volatized out after combustion of coal samples at 900 °C. The total contents of Hg in selected coal samples of block X and XI were observed in the range of 0.985-1.46 and 0.992-1.41 mg/kg, respectively. The contents of Hg volatilized out via burning in a furnace at 200 °C and 400 °C, were observed in the range of 32.0-36.5% and >91.0% of its total contents, respectively, whereas at 900 °C, it was not detected in ash. The partitioning and mobility of studied toxic elements in residue termed as (laboratory made ash) obtained after burning at 900 °C, was carried out by three-step sequential extraction scheme. The resulted data of present study will give a better knowledge about the quality of coal and its burning product, which may help to take measure to reduce the adverse effects on the environment in future.

Proteomic analysis of sperm proteins in infertile men with high levels of reactive oxygen species.

Oxidative stress is a significant risk factor for male infertility. A pro-oxidant testicular environment may alter the expression profile of functional sperm proteins and result in poor sperm quality. Patients and donors were divided into ROS (-) and ROS (+) groups. Using computational studies, and data mining of available literature on spermatozoa, oxidative stress and proteomics, we identified three core regulatory proteins angiotensin-converting enzyme (ACE), heat-shock protein (Hsp70) family A member 2 (HSPA2) and ribosomal protein subunit 27A (RPS27A) and seven interlink proteins NOS2, SUMO2, UBL4A, FBXO25, MAP3K3, APP and UBC. HSPA2 was validated by Western Blot, while the localisation of ACE, RPS27A, MAP3K3 and APP was identified by immunocytochemistry. The obtained results showed that HSPA2 was 1.2 (ROS+) and 2.1 (ROS-) fold downregulated in spermatozoa from patients with high levels of reactive oxygen species (ROS). ACE and APP were localised in the post-acrosomal region of spermatozoa, whereas RPS27A and MAP3K3 were localised either in the tail or sperm neck area. Our data show that these proteins may play a role in ROS-induced male infertility.

Maternal low-quality protein diet exerts sex-specific effects on plasma amino acid profile and alters hepatic expression of methyltransferases in adult rat offspring.

Nutrition during pregnancy and lactation is a critical factor in the development of the offspring. Both protein content and source in maternal diet affect neonatal health, but the long-term effects of maternal low-quality protein diet on the offspring are less clear. This study aimed to examine the effects of maternal low-quality protein diet on offspring's growth, development, circulating metabolites and hepatic expression of methyltransferases. Virgin Wistar rats were mated at 11 weeks of age. Dams were then maintained on either a chow diet with 20% casein as the control group (C), or a low-quality protein diet with 20% wheat gluten as the experimental group (WG) throughout gestation and lactation. After weaning, all offspring were fed a control chow diet until the age of 20 weeks. Male WG offspring had significantly lower body weight and energy intake, whereas female WG offspring had significantly higher body weight and energy intake when compared with controls. Early life exposure to WG diet had no significant effect on circulating metabolites. However, fasting insulin concentrations and homoeostasis model assessment-insulin resistance were decreased in WG male and female offspring. Maternal low-quality protein diet increased plasma aspartic acid, glutamic acid, histidine, cystathione and decreased lysine in male WG offspring. Conversely, the same amino acids were reduced in female WG offspring. Adult offspring exposed to WG diet had significantly upregulated hepatic DNMT3a and DNMT3b expressions. Our study showed that there were differential effects of maternal poor-quality protein diet upon adult offspring's metabolism.

Performance and stability analysis of curcumin dye as a photo sensitizer used in nanostructured ZnO based DSSC.

Environmental friendly natural dye curcumin extracted from low-cost Curcumina longa stem is used as a photo-sensitizer for the fabrication of ZnO-based dye-sensitized solar cells (DSSC). Nanostructured ZnO is fabricated on a transparent conducting glass (TCO), using a cost-effective chemical bath deposition technique. Scanning electron microscopic images show hexagonal patterned ZnO nano-towers decorated with several nanosteps. The average length of ZnO nano-tower is 5µm and diameter is 1.2µm. The UV-Vis spectroscopic study of the curcumin dye is used to understand the light absorption behavior as well as band gap energy of the extracted natural dye. The dye shows wider absorption band-groups over 350-470nm and 500-600nm with two peaks positioned at 425nm and 525nm. The optical band gap energy and energy band position of the dye is derived which supports its stability and high electron affinity that makes it suitable for light harvesting and effortless electron transfer from dye to the semiconductor or interface between them. FTIR spectrum of curcumin dye-sensitized ZnO-based DSSC shows the presence of anchoring groups and colouring constitutes. The I-V and P-V curves of the fabricated DSSC are measured under simulated light (100mW/cm2). The highest visible light to electric conversion efficiency of 0.266% (using ITO) and 0.33% (using FTO) is achieved from the curcumin dye-sensitized cell.

Complexation of ibuprofen with water soluble p-sulfonatocalix [4]arene: A potential candidate for drug delivery applicatio.

Complexation of ibuprofen with water soluble p-sulfonatocalix[4]arene (3) was evaluated. Both molecules exhibit a host and guest type complexation. pH, complex stoichiometry and binding constant were determined by UV-Vis and FT-IR spectroscopy. The maximum complexation of 3 with ibuprofen occurs at pH 2. Stability constant values (9.897) show that there is favorable complex formed due to vital role of p-sulfonatocalix[4]arene, while the thermodynamic parameters, i.e. δG, ΔH and δS have been found as -24.09 KJ/mol, 0.012 KJ/mol and 0.12 KJ/mol. K, respectively. The results show that 3 has efficiency to carry the drug at particular conditions and can be used for drug delivery as a carrier.

Negative outcomes in attention-deficit/hyperactivity disorder comorbid with oppositional defiant disorder.

OBJECTIVES: In children and adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD), the comorbidity of the oppositional defiant disorder (ODD) negatively affects the course of ADHD. The purpose of this study was to compare ADHD-diagnosed children with and without ODD comorbidity in terms of smoking, psychoactive substance use, disciplinary punishments at school, criminal behaviors, and unintentional injuries. METHODS: This study included 109 children diagnosed with ADHD alone and 79 children with the ADHD-ODD comorbidity from a child psychiatry outpatient clinic. The children who participated in the study were aged between 6 and 15 years. Diagnoses of the children were determined by child psychiatrists according to DSM-IV criteria, and the Turgay DSM-IV-based Child and Adolescent Behavior Disorders Screening and Rating Scale-Parents Form was used to support the diagnosis in initial evaluations of children. Forty-six to fifty months after the first admission, parents were questioned regarding all negative outcomes from the time of first diagnosis to the time of the evaluation by phone. RESULTS: The groups were compared in terms of smoking, psychoactive substance use, disciplinary punishments at school, criminal behaviors, and unintentional injuries over a period of 4 years. The ODD-ADHD group was determined to have higher rates of disciplinary punishments at school, smoking, and unintentional injuries compared with the ADHD group. No statistically significant difference was found between the two groups in terms of criminal behaviors and psychoactive substance use. CONCLUSIONS: The ODD comorbidity increases the risk of negative outcomes in children diagnosed with ADHD.

Effects of methylene blue in acute lung injury induced by blunt chest trauma.

BACKGROUND: We studied whether methylene blue (MB) treatment blunts chest trauma-induced lung injury in rats. MATERIAL AND METHODS: Forty male Sprague-Dawley rats, 200-300g, were used. The rats were divided into five groups (n=8): control, early contusion (EC), early contusion + methylene blue (2 mg/kg, EC+MB), late contusion (LC), and late contusion + methylene blue (2 mg/kg, LC+MB). RESULTS: Histopathological analysis showed increased hemorrhage, alveolar wall thickness, edema, and inflammatory cell infiltrates in the EC and LC rats, which decreased upon MB treatment. Immunohistochemical studies revealed that MB reduced activation of inducible nitric oxide synthase (iNOS) and the number of active terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL)-positive cells. A significant increase was observed in the malondialdehyde (MDA) and nitric oxide (NO) levels in the EC group compared to the control group (p<0.05). In addition, a significant decrease was reported in the glutathione (GSH), superoxide dismutase (SOD), and glutathione peroxidase (GPx) levels (p<0.01), but no significant difference was observed in the catalase (CAT) levels among the groups. The MDA level was significantly higher in the LC group compared to the control group, whereas the GSH level was significantly lower compared to the control group. The NO level in the EC+MB group was significantly lower when compared to the NO level in the EC group (p<0.05). CONCLUSION: The present study provides evidence that MB might serve as a therapeutic treatment for blunt chest trauma.

Changes in phenolic acid content during dry-grind processing of corn into ethanol and DDGS.

BACKGROUND: Nine fractions (1, ground corn; 2, cooked slurry; 3, liquefied slurry; 4, fermented mash; 5, whole stillage; 6, thin stillage; 7, condensed distillers soluble (CDS); 8, distillers wet grains (DWG); and 9, distillers dried grains with solubles (DDGS)) were collected at different steps from three commercial dry-grind bioethanol processing plants. Samples were analyzed for individual and total phenolic acid content by HPLC and the antioxidant capacity by ferric reducing antioxidant power (FRAP) assay. RESULTS: There were significant differences in phenolic acid (individual and total) content and the antioxidant capacity in the nine fractions collected from the three processing plants, but the changing trends in all three plants were very similar. The four phenolic acids identified in all fractions were caffeic, p-coumaric, ferulic and sinapic acids. Vanillic acid was present in all fractions except fractions 2 and 3. All fractions collected following fermentation, except fractions 6 and 7, had higher concentrations of phenolic acids than fractions before fermentation, with DWG having the highest phenolic acids content. CONCLUSION: The increased concentration of phenolic acid content after fermentation in four fractions (4, 5, 8 and 9) was primarily due to depletion of starch during dry-grind processing. Further research is needed to investigate the influence of enriched phenolic acid concentration in DDGS on diet palatability (sensory property) and animal health.

Efficacy of combined metformin-clomiphene citrate in comparison with clomiphene citrate alone in infertile women with polycystic ovarian syndrome (PCOS).

BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women and is associated with the reproductive and metabolic disorders. OBJECTIVES: To compare the ovulation and conception rates after the treatment with Clomiphene Citrate (CC) alone and in combination with metformin in infertile patients presented with polycystic ovarian syndrome (PCOS). MATERIAL & METHODS: This randomized controlled trial of independent cases and controls was conducted in the Department of Obstetrics and Gynecology, Hera General Hospital, Makkah, Saudi Arabia, during 2008. The 42 subjects diagnosed as PCOS were divided into group A and B (21 subjects in each) for the management with CC + metformin and CC alone, respectively. Group A received 500mg of metformin continuously, three times a day from the first cycle, for 6 months or until the pregnancy was confirmed. In both groups, CC was started with a dose of 50 mg from day-2 until day-6 of the menstrual cycle. The dose of CC was increased to 100 mg in the second and 150 mg in the third cycle, and then 150 mg remained for the rest of three cycles. With ovulation, the dose of CC was unaltered in both groups. Data were analyzed by using SPSS version 16. RESULTS: More than 50% of the females in both groups had a body mass index of >25. Group A achieved a higher rate of regular cycles, ovulation success, and conception than group B (71.4% vs. 38.1%; p=0.03), (76.2% vs. 38.1%; p=0.021) and (66.6% vs. 28.6%, p=0.01), respectively. CONCLUSION: Management with metformin + CC increased the ovulation and conception rates.

Modular femoral head and liner exchange for the unstable total hip arthroplasty.

Outcomes of femoral head and nonconstrained liner exchange in treating hip instability were evaluated. Forty-eight modular component exchanges performed in 45 patients for recurrent hip dislocations were retrospectively reviewed. Mean follow-up was 4.7 years. Overall success rate was 73% (35/48 hips). Thirty-two (67%) of 48 hips experienced no further dislocations. Three patients had 1 dislocation each with no subsequent dislocations. Ten patients (13 hips) had additional surgery to stabilize their hips (27% failure rate). Demographic, clinical, and implant variables were not associated with outcome. Isolated modular component exchange can be successful in treating recurrent hip dislocations; however, a significant failure rate, not easily predicted, exists. This represents the largest series of modular head and nonconstrained liner exchange for hip dislocation (122/125).

Parallel synthesis of libraries of anodic and cathodic functionalized electrodeposition paints as immobilization matrix for amperometric biosensors.

The integration of flexible anchoring groups bearing imidazolyl or pyridyl substituents into the structure of electrodeposition paints (EDP) is the basis for the parallel synthesis of a library containing 107 members of different cathodic and anodic EDPs with a high variation in polymer properties. The obtained EDPs were used as immobilization matrix for biosensor fabrication using glucose oxidase as a model enzyme. Amperometric glucose sensors based on the different EDPs showed a wide variation in their sensor characteristics with respect to the apparent Michaelis-Menten constant (KM(app)) representing the linear measuring range and the maximum current (Imax(app)). Based on these results first assumptions concerning the impact of different side chains in the EDP on the expected biosensor properties could be obtained allowing for an improved rational optimization of EDPs used as immobilization matrix in amperometric biosensors.

An ontology for collaborative construction and analysis of cellular pathways.

MOTIVATION: As the scientific curiosity in genome studies shifts toward identification of functions of the genomes in large scale, data produced about cellular processes at molecular level has been accumulating with an accelerating rate. In this regard, it is essential to be able to store, integrate, access and analyze this data effectively with the help of software tools. Clearly this requires a strong ontology that is intuitive, comprehensive and uncomplicated. RESULTS: We define an ontology for an intuitive, comprehensive and uncomplicated representation of cellular events. The ontology presented here enables integration of fragmented or incomplete pathway information via collaboration, and supports manipulation of the stored data. In addition, it facilitates concurrent modifications to the data while maintaining its validity and consistency. Furthermore, novel structures for representation of multiple levels of abstraction for pathways and homologies is provided. Lastly, our ontology supports efficient querying of large amounts of data. We have also developed a software tool named pathway analysis tool for integration and knowledge acquisition (PATIKA) providing an integrated, multi-user environment for visualizing and manipulating network of cellular events. PATIKA implements the basics of our ontology.