Effect of omega-3 (n-3) fatty acid supplementation in patients with sickle cell anemia: randomized, double-blind, placebo-controlled trial.

BACKGROUND: Blood cell aggregation and adherence to vascular endothelium and inflammation play a central role in vaso-occlusive crisis in sickle cell disease. The antiaggregatory, antiadhesive, antiinflammatory, and vasodilatory omega-3 (n-3) fatty acids (DHA and EPA) are significantly reduced in patients with the disease. OBJECTIVE: The aim was to investigate the therapeutic potential of omega-3 fatty acids for patients with homozygous sickle cell disease in a randomized, placebo-controlled, double-blind trial. DESIGN: One hundred forty patients recruited from a single center in Sudan were randomly assigned and received, daily, 1 (age 2-4 y), 2 (age 5-10 y), 3 (age 11-16 y), or 4 (age ≥17 y) omega-3 capsules containing 277.8 mg DHA and 39.0 mg EPA or placebo for 1 y. Of these patients, 128 were followed up and the data were obtained. The primary and secondary endpoints-rates of clinical vaso-occlusive crisis and hemolytic events, blood transfusion rate, school attendance, and blood count-were analyzed by intention-to-treat analysis (n = 140). RESULTS: Omega-3 treatment reduced the median rate of clinical vaso-occlusive events (0 compared with 1.0 per year, P < 0.0001), severe anemia (3.2% compared with 16.4%; P < 0.05), blood transfusion (4.5% compared with 16.4%; P < 0.05), white blood cell count (14.4 ± 3.3 compared with 15.6 ± 4.0 ×10(3)/µL; P < 0.05), and the OR of the inability to attend school at least once during the study period because of illness related to the disease to 0.4 (95% CI: 0.2, 0.9; P < 0.05). CONCLUSION: The findings of this trial, which need to be verified in a large multicenter study, suggest that omega-3 fatty acids can be an effective, safe, and affordable therapy for sickle cell anemia. This trial was registered with Current Controlled Trials as ISRCTN80844630.

Hepatitis C virus infection in hemodialysis patients in Sudan: two centers' report.

Prevalence of HCV seropositivity among the hemodialysis population in Sudan is estimated to be around 34%. We undertook a cross sectional study in two major HD centers in Khartoum, Sudan for the prevalence of HCV seropositivity among the hemodialysis patients, during January to March 2005. Testing for HCV antibodies was performed using 3rd generation enzyme linked immunoadsorption assay (ELISA). A total of 236 patients were included in the study: 218 adults and 18 children. The mean age was 43.6 +/- 15.6 years, and the majority was males: 71.6%. The cause of renal failure was unknown in 168 patients (71.2%). The mean HD duration was 36.6 +/- 35.1 months. Prevalence of HCV seropositivity was 23.7%. Among 170 patients who were previously HCV seronegative, 30 (17.1%) seroconverted to positive in one year (estimated incidence: 63 new cases per year). HCV seropositivity was associated with longer duration of dialysis (p < 0.00001), previous surgery (p= 0.026), age of over 30 and years (p = 0.008), and dialysis in multiple centers (p= 0.005). We conclude that although HCV seropositivity in our study was lower than previously reported, it was still high among HD patients in Sudan. Nosocomial transmission of HCV among hemodialysis patients is a contributing factor.

[Antimicrobial susceptibility and frequency of occurrence of clinical blood isolates in Sfax-Tunisia (1993-1998)]. / Profil bactériologique des bactériémies et sensibilité aux antibiotiques des bactéries en cause dans la région de Sfax (1993-1998).

Antimicrobial susceptibility and frequency of occurrence of clinical blood isolates in Sfax-Tunisia (1993-1998). The choice of antimicrobial therapy for the treatment of bacteremia is often empirical and based on the knowledge of susceptibility profiles of the most common bacteria causing such infections. This study determines the bacterial etiology of bacteremic episodes and antimicrobial susceptibility patterns recorded at a teaching hospital, from January 1993 to December 1998. We collected 2979 strains responsible for bacteremia. Gram negative bacteria were predominant (60%). The organisms recovered most frequently were Staphylococcus aureus (18.9%), Escherichia coli (14.7%), Klebsiella pneumoniae (14%) and Pseudomonas aeruginosa (7.6%). The incidence of resistance to methicillin were 17.4% for Staphylococcus aureus and 26.8% for coagulase negative Staphylococcus. No resistance to glycopeptides was observed among the enterococci and staphylococci studied. 27.7% of enterobacteriaceae were resistant to third generation cephalosporins. Imipenem was the most active agent against gram negative bacteria. To carry out a surveillance of bacteremic episodes occurring at every hospital, it is necessary to provide valuable information which should be the basis for effective empiric therapy.

Efficacy of low level laser therapy in reducing postoperative pain after endodontic surgery-- a randomized double blind clinical study.

The aim of the study was to evaluate the effect of low level laser application on postoperative pain after endodontic surgery in a double blind, randomized clinical study. Fifty-two healthy adults undergoing endodontic surgery were included into the study. Subsequently to suturing, 26 patients had the operation site treated with an 809 nm-GaAlAs-laser (oralaser voxx, Oralia GmbH, Konstanz, Germany) at a power output of 50 mW and an irradiation time of 150 s. Laser treatment was simulated in further 26 patients. Patients were instructed to evaluate their postoperative pain on 7 days after surgery by means of a visual analogue scale (VAS). The results revealed that the pain level in the laser group was lower than in the placebo group throughout the 7 day follow-up period. The differences, however, were significant only on the first postoperative day (Mann-Whitney U-test, p<0.05). Low level laser therapy can be beneficial for the reduction of postoperative pain. Its clinical efficiency and applicability with regard to endodontic surgery, however require further investigation. This is in particular true for the optimal energy dosage and the number of laser treatments needed after surgery.

Efficacy of NaOCl/H2O2 irrigation and GaAlAs laser in decontamination of root canals in vitro.

BACKGROUND AND OBJECTIVES: To investigate the bactericidal effect of an 809 nm semiconductor laser alone, and in combination with NaOCl/H(2)O(2) irrigation in root canals in vitro. STUDY DESIGN/MATERIALS AND METHODS: A total of 72 human single-rooted teeth extracted for periodontal reasons were included. The crowns were removed, the roots shortened to a length of 12 mm, and the canals enlarged up to an apical size of #50 file. The specimens were autoclaved and incubated with a suspension of Streptococcus sanguinis (ATCC 10556). Laser irradiation was performed on a PC-controlled XY translation stage. A 200 micron optic fiber was used. Twelve specimens were irradiated at a power output of 1.5, 3.0, and 4.5 W in the cw-mode. The total irradiation time was 60 seconds per canal. Twelve specimens were rinsed with NaOCl and H(2)O(2) only, 12 were rinsed and laser treated, and 12 served as untreated controls. After laser treatment, the specimens were sonicated and the bacterial growth was examined by counting colony forming units on blood agar plates. Temperature changes at the outer root surface during irradiation were registered by means of thermocouples. Treated and control specimens were investigated by means of scanning electron microscopy. RESULTS: Mean bacterial reductions of 0.35 log steps at a power output of 1.5 W, 1.44 at 3.0 W, and 2.84 at 4.5 W were calculated. Bacterial reduction by the NaOCl/H(2)O(2) solution alone was 1.48 and comparable to that achieved by irradiation at 3.0 W. With a log kill 2.85, the combination of rinsing and laser irradiation at 3.0 W resulted in a further significant bacterial reduction as compared to rinsing alone (P = 0.004). Irradiation did not result in excessive heat generation at the root surface. Carbonization of the root canal wall was observed in single teeth at 3.0 and 4.5 W and no controlled sealing of the dentinal tubules could be achieved in the root canal. CONCLUSIONS: The application of the diode laser might be an adjunct to conventional endodontic treatment when used in combination with a NaOCl/H(2)O(2) solution.

Effect of diode laser irradiation on root surfaces in vitro.

OBJECTIVE: The objective of this study was to evaluate possible morphological alterations of root surfaces after GaAlAs-diode laser (809 nm) irradiation under standardized in vitro conditions. MATERIALS AND METHODS: Root specimens obtained from extracted periodontally diseased teeth were scaled and root planed with curettes followed by air-powder abrasive treatment prior to lasing. The variable parameters were power output (0.5-2.5 W) and exposure time (10-30 sec per specimen). Additionally, the effect of a saline solution and a human blood film on the root surface was investigated. The root segments were analyzed by means of a reflected light microscope. Photographs before and after irradiation were taken and evaluated. The scale of carbonization was quantified using a grid laid over the photographs. Specimens with distinct morphological changes were analyzed with a scanning electron microscope. RESULTS: Lasing dry specimens and specimens moistened with saline resulted in no detectable alterations, irrespective of irradiation time and power output applied. Depending on different settings, irradiation caused severe damages to the root surface when segments were covered by a thin blood film. Irradiation at a power output of 1 Watt and below had barely any negative effect on the root surface, whereas lasing at 1.5, 2.0, and 2.5 Watt resulted in partial or total carbonizations of the root samples. The angle of irradiation had a significant effect on the scale of the root surface damage (Mann-Whitney U test,p < 0.05). CONCLUSION: The diode laser may cause damage to periodontal hard tissues if irradiation parameters are not adequate.

Degradation of anthracycline antitumor compounds catalysed by metal ions.

The influence of some metal ions on the degradation of anthracyclines was examined. One of the degradation products is the 7,8-dehydro-9,10-desacetyldoxorubicinone, D* ( yen), usually formed by hydrolysis at slightly basic pH. D* is a lipophilic compound with no cytostatic properties. Its formation could be responsible for the lack of antitumor activity of the parent compound. The coordination of metal ions to anthracycline derivatives is required to have degradation products. Cations such as Na(+), K(+), or Ca(2+) do not induce the D* formation however metals which can form stable complexes with doxorubicin afford D*. Iron(III) and copper(II) form appreciable amount of D* at slightly acidic pH. Terbium(III) forms D* but its complex is stable only at slightly basic pH. Palladium(II) which does not form D*. The influence of the coordination mode of metal ions to anthracycline on the D* formation is discussed.

[Preservation of the liver with the University of Wisconsin solution. Clinical and experimental aspects]. / La conservazione del fegato con la soluzione dell'Università di Wisconsin. Alcuni aspetti clinici e sperimentali.

The University of Wisconsin solution discovered in 1987 by Belzer and associates, has dramatically changed the logistics associated with liver transplantation. The extension of hypothermic preservation time has mode at possible: a) to operate in a semi-elective situation, rather than urgent; b) to improve patient selection and to be able to admit them from distant locations, and c) to reduce postoperative complications with a better quality of organ preservation. In the present work we illustrate the pathophysiological background and the rationale behind the various chemical constituents included in the new solution, emphasizing the antiedemogenic effect. Furthermore we report some experimental data on the role of energy level (ATP) and intracellular pH in the monitoring of liver preservation. Together with the improvements of surgical technique and immunosuppression, the new solution of the University of Wisconsin represents a fundamental step in the development of organ transplantation.