1,2-Dihydroxyanthraquinone: Synthesis, and induced changes in the structural and optical properties of the nanostructured thin films due to γ-irradiation.

1,2­Dihydroxyanthraquinone (Alizarin-AZ) is available, low-cost organic compound. Besides, AZ has multiple applications owing to its drawing attention photoactivity. This paper is devoted to study the influence of Gamma irradiation on the morphology, optical, and dielectric properties of AZ nanostructured thin films. Nanostructure powder of Alizarin is synthesized according to chemical routes. Subsequently, thin films of AZ are fabricated via thermal evaporator. The bared thin film is irradiated at different doses of 60Co γ-rays. Furthermore, the bared and irradiated films are characterized via X-ray diffraction (XRD), atomic force microscope (AFM) and UV-Vis-NIR spectroscopy. XRD investigations reveal that the bared film has a nanostructure and the average particle size increases gradually as the γ-irradiation dose increases. AFM images show remarkable increment in the surface roughness of the irradiated film over the bared one. In the light of structure induced changes, clear variations in the optical properties are addressed. Of these, the energy gap decreases gradually as the irradiation dose increases. The film irradiated at 45 kGy shows the highest optical conductivity. Based on our results we suggest AZ nanostructured thin films as potential candidate for optoelectronics devices.

The clinical significance of the alternative Wilms tumor gene overexpression-hypermethylation signature in acute myeloid leukemia.

BACKGROUND: Wilms tumor 1 (WT1) gene is overexpressed in numerous cancers, including acute myeloid leukemia (AML). The alternative WT1 gene (AWT1) is generated from alternative transcription start site in the WT1 first intron and encodes an N-terminal-truncated protein lacking the repressor domain. Although WT1 overexpression is a common feature in AML, the expression levels of the AWT1 and its underlying epigenetic alterations, as well as their clinical relevance in AML remain unknown. METHODS: Quantitative assessment of AWT1 gene transcripts was performed using real-time polymerase chain reaction (PCR). Bisulfite PCR followed by pyrosequencing was done to determine the methylation status of the AWT1 promoter. The bone marrow samples were collected at diagnosis and after completion of induction chemotherapy from 80 newly diagnosed AML patients. Forty non-malignant BM samples were recruited as controls. RESULTS: The AWT1 was significantly overexpressed in AML patients. Robust hypermethylation of the AWT1 promoter was found to be a highly specific and sensitive marker for AML (p < 0.001). Significant positive correlations between the AWT1 expression and methylation levels with BM blast counts at both initial diagnosis and after induction therapy were observed (p < 0.001). AWT1 overexpression at the initial diagnosis of AML was found to be an independent negative factor for complete remission response after induction therapy (p = 0.014). CONCLUSION: The AWT1 gene overexpression-hypermethylation signature is a characteristic marker that positively correlates with the leukemic burden in AML. AWT1 overexpression at AML diagnosis is an independent negative predictor for CR after induction chemotherapy.

Refractory patella tendinopathy with failed conservative treatment-shock wave or arthroscopy?

AIM: To identify whether the location of refractory patella tendinopathy (PT) has an effect on treatment modality (radial extracorporeal shock wave therapy (rESWT) or arthroscopic debridement). METHODS: Between 2012 and 2014, 40 patients with PT underwent a magnetic resonance imaging (MRI) scan. This confirmed the diagnosis as either involving the tendon itself (group A, 20) or with retropatella fat pad extension (group B, 20). All patients underwent rESWT. If there was no improvement patients proceeded with surgery in the form of arthroscopic debridement (by senior authors CW and AG). Outcomes were assessed before and after treatment using the Victorian Institute of Sports Assessment-Patella (VISA-P) score. RESULTS: There were 18 males and 2 females in group A and 15 males and 5 females in group B. The mean age was 41.4 years in group A (23-59) and 34.7 in group B (19-52). Seventeen of 20 in group A reported good or excellent outcomes and did not require surgical intervention (remaining three improved after second course of ESWT). All patients in group B failed to improve with rESWT, resulting in arthroscopic debridement and reported good or excellent outcomes. After 6 months, group A mean VISA-P score increased from 50.2 to 65.0 ( p = 0.01) and group B from 39.6 to 78.4 ( p = <0.001). CONCLUSION: An MRI should be performed to determine the precise location of tendinosis in patients with refractory PT who fail standard conservative management. If the MRI scan shows intratendon changes only, ESWT should be performed and those with extension into the fat pad should proceed to arthroscopic debridement without rESWT.

Condylar fractures of the proximal and middle phalanges.

We describe the treatment of 74 patients with phalangeal condylar fractures. Twelve patients presenting with undisplaced fractures were initially treated nonoperatively; of these, five displaced, requiring fixation. The remaining seven patients, all children, united uneventfully. Sixty-two patients presenting with displaced fractures were treated with internal fixation using a single lag screw through a lateral approach. The patients were treated semi-electively on a day surgery unit. Twenty-seven patients with unicondylar fractures, all operated on within 2 weeks of injury, regained full range of movement. Thirty-eight patients had loss of extension (range 10-35°) with fixed flexion contractures at the proximal interphalangeal and thumb interphalangeal joints and extensor lag at the distal interphalangeal joints (overall mean extension loss 10°). Although fixation was technically easier during the first week, a delay of 2 weeks before fixation made little difference to the outcome. In our experience, fractures can be taken down and fixed internally even 8 weeks after injury. If nonoperative treatment is initially embarked upon, close monitoring is required with weekly radiographs up to 3 weeks, as these fractures will frequently displace.

Seroprevalence and risk factors for hepatitis B and C virus infection in Damietta Governorate, Egypt.

Hepatitis B and C virus (HBV and HCV) infections remain major public health problems in Egypt and data are needed on risk factors for infection. This study determined the prevalence of anti-HCV and HBV surface antigen seropositivity in Damietta Governorate, Egypt, and evaluated potential risk factors for infection and the impact of HBV vaccination on seroprevalence. A household, cross-sectional study was conducted of 2977 individuals. About 20% were vaccinated against HBV. Only 1.1% were infected with HBV and 9.3% with HCV; both infections coexisted in 12 people (0.4%) (all unvaccinated). The main risk factors for both HCV and HBV were exposure to dental procedures, surgery, stitches, schistosomiasis treatment and contact with infected person. HBV and HCV prevalences in Damietta were lower than the national rate, likely due to the routine compulsory HBV vaccination in those aged < 19 years. There is a need to educate the general population about HBV and HCV transmission routes and avoidance of risky behaviours.

Two-stage revision for infected total knee arthroplasty: our experience with interval prosthesis.

INTRODUCTION: To review our practice of performing two-stage revision for infected total knee arthroplasty using articulating interval prosthesis and to compare the incidence of the recurrence of infection and re-operation rate in patients undergoing two-stage revision as planned with the group of patients who choose not to proceed to the second stage. METHOD: This study is a retrospective review of 60 consecutive patients undergoing a two-stage revision for infected total knee arthroplasty using articulating interval prosthesis. All cases managed by a single surgeon using a uniform peri-operative protocol, and short-course parenteral antibiotic therapy. RESULT: Thirty-four patients (57%) (Group 1) underwent the two-stage revision as planned. However, twenty-six patients (43%) (Group 2) opted not to have a second-stage procedure as the first-stage and interval prosthesis had eradicated the infection, resolved the pain and achieved good functional outcome. There were five cases of recurrent infection in the 60 patients (8%) at a mean follow-up 5 years. In those completing the two-stage revision, two patients had recurrent infection. Of the patients who retained the interval prosthesis, there were three recurrent infections. There was no statistically significant difference between the groups in terms of recurrence of infection or re-revision. CONCLUSION: Two-stage revision with interval prostheses represents a safe and reliable method of treating infected knee prosthesis; however, there may be a role for one-stage revision in selected cases.

Does it matter whom you see? - a fracture clinic audit.

INTRODUCTION: A consultant-led service for trauma in the UK has become the accepted norm. Practice in fracture clinics may vary widely between consultants and has an impact on the number of patients seen and, therefore, the time devoted to each patient. PATIENTS AND METHODS: A total of 945 patients attending our unit's fracture clinics were analysed over a 6-week period, representing one complete cycle of our trauma system. RESULTS: The overall discharge rate was 38% but this differed significantly between consultants. Patients re-presenting for the same complaint were evenly distributed between those discharging aggressively and those re-reviewing regularly. CONCLUSIONS: Re-reviewing patients has a significant impact on the number of patients seen in future clinics and, therefore, the time that can be devoted to each patient, individual consultant workload and teaching of junior staff. Since the re-presentation rate between those discharging aggressively and those re-reviewing more frequently was the same, discharge protocols are recommended for common trauma conditions to standardise the process. Specialist clinics are recommended for more complex trauma cases.

A review of wound healing following Maquet osteotomy.

Maquet osteotomy can be associated with an unacceptably high incidence of wound complications that may be as high as 37%. A consecutive series of 42 Maquet osteotomies has been performed between 1990 and 2002 by a single surgeon without a single wound problem or infection and this series is the subject of this report. The use of an anterolateral incision reduces the damage to the major lymphatics minimising the risk of wound oedema. Identification and preservation of the feeding musculocutaneous vessels on the lateral and medial sides facilitates extensive but safe mobilisation of the skin flaps permitting an easy closure over a substantially elevated tibial tubercle. The use of an anterolateral incision with knowledge of the blood supply of the leg has eliminated the wound complications associated with the standard anteromedial incision reported previously in the literature. This approach, preserving the blood supply and lymphatic drainage, avoids skin necrosis and wound dehiscence, obviates any requirement for plastic surgical procedures such as releasing incisions or skin grafts and minimises the risk of infection and osteomyelitis.

A controlled clinical trial of postoperative hand elevation at home following day-case surgery.

Although elevation of the upper limb is considered valuable for the prevention and of the reduction of swelling following major surgery or severe injuries to the hand, it is not clear how much elevation, if any, is required following minor surgery such as carpal tunnel decompression. We investigated this by randomizing patients undergoing carpal tunnel decompression into two groups - one having high elevation at home and one being treated with a simple sling. Volumetric analysis of the swelling of the hand 5 days postoperatively showed no significant difference between the two groups. In the trial group, the mean increase in volume of the operated hand was 11 ml (95% CI +4 to +17) or 2.7%. In the control group, the mean swelling was 13 ml (95% CI +4 to +21) or 3.6%. The findings of this study do not support the use of routine high arm elevation following day-case surgery of the hand.

Identification of the CD4(+) T cell as a major pathogenic factor in ischemic acute renal failure.

Leukocytes have been implicated in the pathogenesis of ischemic acute renal failure (ARF), but the roles of the individual cell types involved are largely unknown. Recent indirect evidence suggests that T cells may play an important role in a murine model of ARF. In the current study, we found that mice deficient in T cells (nu/nu mice) are both functionally and structurally protected from postischemic renal injury. Reconstitution of nu/nu mice with wild-type T cells restored postischemic injury. We then analyzed the contribution of the individual T cell subsets to postischemic injury and found that mice deficient in CD4(+) T cells, but not mice deficient in CD8(+) T cells, were significantly protected from ARF. Direct evidence for a pathophysiologic role of the CD4(+) T cell was obtained when reconstitution of CD4-deficient mice with wild-type CD4(+) T cells restored postischemic injury. In addition, adoptive transfers of CD4(+) T cells lacking either the costimulatory molecule CD28 or the ability to produce IFN-gamma were inadequate to restore injury phenotype. These results demonstrate that the CD4(+) T cell is an important mediator of ischemic ARF, and targeting this cell may yield novel therapies.

Seroepidemiological study of Toxoplasma gondii infection in the human population in the Eastern Region.

OBJECTIVE: Toxoplasma gondii is an an obligate intracellular protozoan parasite that causes toxoplasmosis. The infection is worldwide, particularly in warm and moist climates. Few studies have been conducted on the prevalence of subclinical or overt disease in Saudi Arabia. No population-based study was conducted or the seroprevalence of toxoplasmosis in humans in Saudi Arabia and this initiated the present study. The present study aimed at studying seroprevalence of Toxoplasma IgG and IgM antibodies in sera from 5 areas in the Eastern Region of Saudi Arabia. METHODS: A population based epidemiological approach, prevalence according to lifestyle (urban or rural), gender (male or female) occupation and age. RESULTS: Inactive toxoplasmosis (IgG levels) is of rather high prevalence in the human population in the Eastern Region of Saudi Arabia (25%). On the other hand, active toxoplasmosis (acquired during pregnancy) is of rather low prevalence in this study (5%). Active toxoplasmosis (IgM levels) is positively related to the level of exposure, high in farmers and employees in village rural areas and low in children and students in urban areas. CONCLUSION: Patients with active toxoplasmosis are to be treated and made aware of their situation. Hygienic conditions in areas of rather high prevalence of active toxoplasmosis are to be more strictly imposed to minimize transmission of the disease.

Dissemination in cutaneous leishmaniasis due to Leishmania major in different ethnic groups in Saudi Arabia.

BACKGROUND: Dissemination in patients with cutaneous leishmaniasis has previously been recorded in human infection with Leishmania major and L. tropica. In this study, the potential for dissemination in different ethnic groups in Saudi Arabia was compared. METHODS: The data were recorded from a group of 73 patients with suspected cutaneous leishmaniasis (43 Saudi and 30 non-Saudi) attending the Dermatology Clinics at King Fahd Hospital of the University and Al-Khobar Government Hospital at Al-Khobar, Eastern Region of Saudi Arabia. The patients were of various age groups (all male) between 1 and 55 years. The diagnosis of cutaneous leishmaniasis was confirmed clinically and by smear and skin biopsy. The following data were recorded for each patient: type, number, and anatomic sites of disseminative lesions and the frequency of co-occurrence of more than one type of lesion. RESULTS: Three types of disseminative lesions due to zoonotic cutaneous leishmaniasis were recorded in 16 patients (21.92%): subcutaneous nodules, satellite papules, and subcutaneous induration. The percentage of disseminative lesions in non-Saudi patients (36.66%) was higher than in Saudi patients (11. 63%). This was also true for the number of lesions: a mean of 12.27+/- 10 and 6.4+/-3, respectively. The coexistence of more than one type of disseminative lesion was higher in non-Saudi patients (63. 63%) than in Saudi patients (20.0%), as well as the occurrence of lesions on more than one body site: 36.4% in non-Saudi patients and 20.0% in Saudi patients. CONCLUSIONS: The potential for dissemination due to cutaneous leishmaniasis was significantly higher in the nonindigenous population than in the indigenous population in Saudi Arabia. Disseminative lesions must be clinically differentiated from other skin diseases and appropriately treated by avoiding the use of intralesional drugs or physical therapy.

An enzyme-linked immunosorbent assay using Schistosoma mansoni purified egg antigen for the diagnosis of schistosomiasis in Saudi Arabia.

The enzyme-linked immunosorbent assay (ELISA) using purified Schistosoma mansoni egg antigen (CEF6) was compared with standard parasitological diagnostic tests (potassium hydroxide digestion of faeces and urine filtration) for diagnosis of schistosomiasis in humans in Saudi Arabia. Faecal, urine and finger-prick blood samples were collected from 2 groups of individuals of both sexes, aged 1-50 years, in 2 areas in the western region of Saudi Arabia: 983 in a schistosomiasis endemic area (Al-Hijaz highlands) and 192 in a non-endemic area (Jeddah). In the non-endemic area, almost 90% of the blood samples gave optical density readings at 492 nm (OD) < 0.25. The mean OD in the schistosome endemic area (0.31) was much higher than in the non-endemic area (0.14). The prevalence of S. mansoni infection by faecal examination in the endemic area was 10.2% and the specificity and sensitivity of the ELISA using a cut-off OD of 0.25 were 55% and 90%, respectively. In the endemic area, there was a positive correlation between egg intensity and OD value. No S. haematobium was detected. In the non-endemic area, the specificity was 90%. The main reasons for false positive results may have been inapparent or cured S. mansoni infection.

Hamadryas baboons Papio hamadryas as maintenance hosts of Schistosoma mansoni in Saudi Arabia.

Free ranging hamadryas baboons (Papio hamadryas) in four localities in the west and north of Saudi Arabia were examined for natural infection with Schistosoma mansoni. Faecal examination revealed infection with S. mansoni on four occasions within one year (at a prevalence rate of 2.5-4.0%) in only one locality, the Al-Baha area. The eggs were viable, as shown by miracidial hatching tests, and were recorded at a density of 140-280 eggs/g of faeces (7000-14,000 eggs/day). Post-mortem examination of 13-24 baboons from each locality revealed infection with S. mansoni (adult worms and eggs in tissue) in only one locality, the Al-Baha area, at a prevalence rate of 4.16%. Viable eggs were found in the faeces and tissue of the infected baboons. The low prevalence rate of S. mansoni in hamadryas baboons in Saudi Arabia is in accordance with the low prevalence rate of S. mansoni in humans in the area. This natural baboon isolate was highly infective to snail intermediate hosts and mammalian hosts under experimental conditions. The epidemiological significance of the role of P. hamadryas (considering their large overall population of 250,000) as maintenance hosts of S. mansoni in Saudi Arabia is discussed.

Zoonotic intestinal parasites of hamadryas baboons Papio hamadryas in the western and northern regions of Saudi Arabia.

Six hundred and thirty-three faecal samples were randomly collected and examined for ova and cysts of intestinal parasites from five groups of hamadryas baboons of different population densities, with different human contact and in different ecological conditions (Al-Baha, Turabah and Al-Taif in south-western and Al-Rihat and Al-Akhal in north-western Saudi Arabia). Nine parasites were recorded (Giardia lamblia, Entamoeba histolytica, Escherichia coli, Balantidium coli, Enterobius sp., Trichuris sp., Hookworm, Hymenolepis nana and Schistosoma mansoni) in 274 samples (43.28%). The prevalence of parasites was high (36.0-58.5%) in areas of mild, cool climatic conditions, where baboons were at high density and had maximum human contact. However, in an area (Al-Akhal) of hot, dry climatic conditions, low baboon density and minimum human contact, the parasites' prevalence was very low (9.5%). The concentration of parasites (ova or cysts per g of faeces) was medium. Post-mortem examination of 24, 20, 19 and 13 baboons from Al-Baha, Al-Taif, Turabah and Al-Rihat revealed most of the parasites recorded in random faecal samples at prevalence rates of 37.5, 30.0, 36.0 and 23.0% respectively. The overall prevalence rate was 32.9%. Most of the parasites recorded in baboons were also recorded in humans in the areas of study.