Sclerosing encapsulating peritonitis: A rare cause of small bowel obstruction.

INTRODUCTION: Sclerosing encapsulating peritonitis (SEP), also known as abdominal cocoon syndrome, represents a rare cause of small bowel obstruction. CASE PRESENTATION: Herein we report an uncommon case of small bowel obstruction caused by SEP in a 30-year-old male with no prior surgical history who presented to the emergency department. The patient was diagnosed with SEP on preoperative CT scan and underwent a therapeutic laparotomy with extensive adhesiolysis. His symptoms resolved postoperatively and he was discharged in a good condition. DISCUSSION: Sclerosing encapsulating peritonitis is more prevalent in men, and has a higher incidence in tropical and subtropical countries. The exact pathophysiology of the disease in not well understood, but subclinical intra-abdominal inflammation is theorized to result in a thick fibrocollagenous membrane encapsulating intra-peritoneal organs which leads to intestinal obstruction. The disease is categorized into primary and secondary SEP depending on identification of a pathologic factor. It is further divided into 3 sub-types according to the extent of the peritoneal membrane encasement observed intra-operatively. Patients often present with recurrent history of small bowel obstruction in the absence of prior abdominal surgery. Computed tomography of the abdomen with experienced radiologist interpretation can aid in preoperative diagnosis. In patients with recurrent obstructions and failure of non-operative management, surgical adhesiolysis remains the gold standard. CONCLUSION: Sclerosing encapsulating peritonitis, is a rare cause of small bowel obstruction. The exact pathogenesis is not well understood. The main line of treatment is surgical adhesiolysis and excision of the intra-abdominal fibrocollagenous membrane.

Risk Factors for Avian Influenza H9 Infection of Chickens in Live Bird Retail Stalls of Lahore District, Pakistan 2009-2010.

This study was conducted to identify risk factors associated with AIV infections in live bird retail stalls (LBRS) in Lahore District, Pakistan. A cross-sectional survey of LBRS was conducted from December 2009-February 2010 using two-stage cluster sampling based on probability proportional to size. A total of 280 oropharyngeal swab sample pools were collected from 1400 birds in 8 clusters and tested by qRT-PCR for the matrix (M) gene of type A influenza virus and HA gene subtypes H9, H5 and H7. Thirty-four (34) samples were positive for the M gene, of which 28 were also positive for H9. No sample was found positive for H5 or H7. Data for 36 potential risk factors, collected by questionnaire, were analyzed by survey-weighted logistic regression and prevalence odds ratios (OR) for associated risk factors were calculated. A final multivariable model identified three risk factors for H9 infection in LRBS, namely obtaining birds from mixed sources (OR 2.28, CI95%: 1.4-3.7), keeping birds outside cages (OR 3.10, CI95%: 1.4-7.0) and keeping chicken breeds other than broilers (OR 6.27, CI95%: 1.7-23.2). Sourcing birds from dealers/wholesalers, keeping birds inside cages and avoiding mixing different breeds in cages could reduce the risk of H9 infections in LRBS.

Assessment of the protein interaction between coagulation factor XII and corn trypsin inhibitor by molecular docking and biochemical validation.

Essentials Corn Trypsin Inhibitor (CTI) is a selective inhibitor of coagulation Factor XII (FXII). Molecular modelling of the CTI-FXIIa complex suggested a canonical inhibitor binding mode. Mutagenesis revealed the CTI inhibitory loop and helices α1 and α2 mediate the interaction. This confirms that CTI inhibits FXII in canonical fashion and validates the molecular model. SUMMARY: Background Corn trypsin inhibitor (CTI) has selectivity for the serine proteases coagulation factor XII and trypsin. CTI is in widespread use as a reagent that specifically inhibits the intrinsic pathway of blood coagulation but not the extrinsic pathway. Objectives To investigate the molecular basis of FXII inhibition by CTI. Methods We performed molecular docking of CTI, using its known crystal structure, with a model of the activated FXII (FXIIa) protease domain. The interaction model was verified by use of a panel of recombinant CTI variants tested for their ability to inhibit FXIIa enzymatic activity in a substrate cleavage assay. Results The docking predicted that: (i) the CTI central inhibitory loop P1 Arg34 side chain forms a salt bridge with the FXIIa S1 pocket Asp189 side chain; (ii) Trp22 from CTI helix α1 interacts with the FXIIa S3 pocket; and (iii) Arg43 from CTI helix α2 forms a salt bridge with FXIIa H1 pocket Asp60A. CTI amino acid substitution R34A negated all inhibitory activity, whereas the G32W, L35A, W22A and R42A/R43A substitutions reduced activity by large degrees of 108-fold, 41-fold, 158-fold, and 100-fold, respectively; the R27A, W37A, W39A and R42A substitutions had no effect. Synthetic peptides spanning CTI residues 20-44 had inhibitory activity that was three-fold to 4000-fold less than that of full-length CTI. Conclusions The data confirm the validity of a canonical model of the FXIIa-CTI interaction, with helix α1 (Trp22), central inhibitory loop (Arg34) and helix α2 (Arg43) of CTI being required for effective binding by contacting the S1, S3 and H1 pockets of FXIIa, respectively.

Impact of an intervention programme on knowledge, attitude and practice of healthcare staff regarding pharmaceutical waste management, Gaza, Palestine.

OBJECTIVES: To assess knowledge, attitude and practice (KAP) of healthcare staff regarding pharmaceutical waste management; and to determine the impact of an educational programme on the KAP survey items. DESIGN: Pre-post-test intervention study. METHODS: The pre-intervention phase was performed using a sample of 530 out of 1500 healthcare workers. A predesigned interview questionnaire was used to assess KAP. Next, an educational programme was designed and offered to a subsample of 69 healthcare workers. KAP were re-assessed for the programme attendees using the same interview questionnaire, both immediately (post-test) and six months after the end of the programme (follow-up test). The parametric paired sample t-test was used to assess the difference between pre-test and follow-up test results. RESULTS: Poor knowledge and poor practice levels (scores 50%) detected in the pre-intervention phase were found to improve to satisfactory levels (scores ≥75%) in the follow-up phase. Attitude was found to be positive (score ≥75%) in all phases of the study. CONCLUSION: The educational programme led to a significant improvement in KAP of healthcare staff regarding pharmaceutical waste management (P<0.001).

Reassortant Avian Influenza A(H9N2) viruses in chickens in retail poultry shops, Pakistan, 2009-2010.

Phylogenetic analysis of influenza viruses collected during December 2009-February 2010 from chickens in live poultry retail shops in Lahore, Pakistan, showed influenza A(H9N2) lineage polymerase and nonstructural genes generate through inter- and intrasubtypic reassortments. Many amino acid signatures observed were characteristic of human isolates; hence, their circulation could enhance inter- or intrasubtypic reassortment.

A case-control study to identify risk factors associated with avian influenza subtype H9N2 on commercial poultry farms in Pakistan.

A 1:1 matched case-control study was conducted to identify risk factors for avian influenza subtype H9N2 infection on commercial poultry farms in 16 districts of Punjab, and 1 administrative unit of Pakistan. One hundred and thirty-three laboratory confirmed positive case farms were matched on the date of sample submission with 133 negative control farms. The association between a series of farm-level characteristics and the presence or absence of H9N2 was assessed by univariable analysis. Characteristics associated with H9N2 risk that passed the initial screening were included in a multivariable conditional logistic regression model. Manual and automated approaches were used, which produced similar models. Key risk factors from all approaches included selling of eggs/birds directly to live bird retail stalls, being near case/infected farms, a previous history of infectious bursal disease (IBD) on the farm and having cover on the water storage tanks. The findings of current study are in line with results of many other studies conducted in various countries to identify similar risk factors for AI subtype H9N2 infection. Enhancing protective measures and controlling risks identified in this study could reduce spread of AI subtype H9N2 and other AI viruses between poultry farms in Pakistan.

Coagulation factor XII protease domain crystal structure.

BACKGROUND: Coagulation factor XII is a serine protease that is important for kinin generation and blood coagulation, cleaving the substrates plasma kallikrein and FXI. OBJECTIVE: To investigate FXII zymogen activation and substrate recognition by determining the crystal structure of the FXII protease domain. METHODS AND RESULTS: A series of recombinant FXII protease constructs were characterized by measurement of cleavage of chromogenic peptide and plasma kallikrein protein substrates. This revealed that the FXII protease construct spanning the light chain has unexpectedly weak proteolytic activity compared to ß-FXIIa, which has an additional nine amino acid remnant of the heavy chain present. Consistent with these data, the crystal structure of the light chain protease reveals a zymogen conformation for active site residues Gly193 and Ser195, where the oxyanion hole is absent. The Asp194 side chain salt bridge to Arg73 constitutes an atypical conformation of the 70-loop. In one crystal form, the S1 pocket loops are partially flexible, which is typical of a zymogen. In a second crystal form of the deglycosylated light chain, the S1 pocket loops are ordered, and a short α-helix in the 180-loop of the structure results in an enlarged and distorted S1 pocket with a buried conformation of Asp189, which is critical for P1 Arg substrate recognition. The FXII structures define patches of negative charge surrounding the active site cleft that may be critical for interactions with inhibitors and substrates. CONCLUSIONS: These data provide the first structural basis for understanding FXII substrate recognition and zymogen activation.

Relative performance of surveys for the Old World screwworm fly, Chrysomya bezziana, in Iraq based on fly trapping and myiasis monitoring.

Fly traps are being used to monitor populations of Old World screwworm (OWS) flies in Iraq. We evaluated trapping systems for seasonality and trap type and compared the results with monitoring of OWS flies using myiases on animals. Fly catches increased during spring and autumn with low catches during the hot, dry summer and the cold winter. The effectiveness of the sticky trap/Swormlure and LuciTrap/Bezzilure for OWS flies could not be determined because no OWS were caught during the comparison period in 2009. The LuciTrap caught more flies of all other species than the sticky trap during this comparison. The numbers of myiases detected on animals in Iraqi provinces from 1996 to 2013 are provided. The high numbers of myiases in most provinces in the late 1990s were followed by lower numbers and subsequent apparent elimination in about half of the provinces. Myiases were detected mainly in sheep (77.0%) and goats (16.7%). A temporal comparison of OWS fly detection with traps and animal myiases in Babil province demonstrated a similar sensitivity and a weak correlation between the two methods. We recommend that both fly trapping and inspection of animals for myiases are used for the detection or monitoring OWS fly populations and that Iraq and the international organisations initiate an area-wide integrated OWS fly program, including the sterile insect technique, with the aim of eradicating the OWS fly from Iraq.

HLA-B50 polymorphism in the Saudi population.

The HLA-B50 serologic family is very frequent in people of Arabic origin. In Saudi Arabia, HLA-B50 is the most frequent HLA-B allele. The aim of this study was to investigate the distribution of HLA-B50 alleles in healthy Saudi individuals. A total of 162 healthy Saudi individuals were selected based on low-resolution HLA typing. DNA samples were typed by sequence-based typing method for exons 2, 3 and 4 of the HLA-B locus (Genome Diagnostics B.V.). The HLA-B*50 alleles were analysed using SBT engine software. HLA-B*50:01:01 was found in 161 of 162 individuals (99.4%), while HLA-B*50:09 was found in one individual (0.6%). HLA-B*50:01:01 is the most common HLA-B50 allele in Saudi Arabia.

A first principle study for the adsorption and absorption of carbon atom and the CO dissociation on Ir(100) surface.

We employ density functional theory to examine the adsorption and absorption of carbon atom as well as the dissociation of carbon monoxide on Ir(100) surface. We find that carbon atoms bind strongly with Ir(100) surface and prefer the high coordination hollow site for all coverages. In the case of 0.75 ML coverage of carbon, we obtain a bridging metal structure due to the balance between Ir-C and Ir-Ir interactions. In the subsurface region, the carbon atom prefers the octahedral site of Ir(100) surface. We find large diffusion barrier for carbon atom into Ir(100) surface (2.70 eV) due to the strong bonding between carbon atom and Ir(100) surface, whereas we find a very small segregation barrier (0.22 eV) from subsurface to the surface. The minimum energy path and energy barrier for the dissociation of CO on Ir(100) surface are obtained by using climbing image nudge elastic band. The energy barrier of CO dissociation on Ir(100) surface is found to be 3.01 eV, which is appreciably larger than the association energy (1.61 eV) of this molecule.

Drug dispensing systems in Gaza hospitals: a comparative study.

Implementing an appropriate drug dispensing system in hospitals is essential to ensure the safe and rational use of drugs. This study aimed to assess the unit-dose drug dispensing system (DDS) and the ward-stock DDS utilized in Gaza hospitals to ascertain which system is more beneficial. The quantitative, comparative cross-sectional design utilized structured interviews with pharmacists and head nurses, missing drug registration sheets and drug administration observation checklists. The number of missing units per drug item dispensed (mean 3.4 and 1.8 respectively) and medication administration errors per patient (mean 1.8 and 0.9 respectively) were statistically significantly lower in the hospital using the unit-dose DDS than the ward-stock DDS. The unit-dose DDS appeared to be safer, with fewer missing drugs, was more positively perceived by staff and was more supportive of good clinical pharmacy practice. Its use in other hospitals in the Gaza Strip is recommended.

Drug dispensing systems in Gaza hospitals: a comparative study

Implementing an appropriate drug dispensing system in hospitals is essential to ensure the safe and rational use of drugs. This study aimed to assess the unit-dose drug dispensing system [DDS] and the ward-stock DOS utilized in Gaza hospitals to ascertain which system is more beneficial. The quantitative, comparative cross-sectional design utilized structured interviews with pharmacists and head nurses, missing drug registration sheets and drug administration observation checklists. The number of missing units per drug item dispensed [mean 3.4 and 1.8 respectively] and medication administration errors per patient [mean 1.8 and 0.9 respectively] were statistically significantly lower in the hospital using the unit-dose DDS than the ward-stock DDS. The unit-dose DDS appeared to be safer, with fewer missing drugs, was more positively perceived by staff and was more supportive of good clinical pharmacy practice. Its use in other hospitals in the Gaza Strip is recommended

Impact of using essential drug list: analysis of drug use indicators in Gaza Strip.

A descriptive cross-sectional study evaluated the compliance of physicians with the Palestinian essential drug list (EDL) in all the government primary care clinics in the Gaza Strip. While 67.4% reported currently using the EDL 51.2% of these physicians reported problems in using it. The mean number of drugs per prescription was 1.92, the percentage of drugs prescribed from the EDL was 97.9% but the percentage of drugs prescribed by generic name was only 5.5%. A copy of the EDL was available in 28.3% of clinics and the availability of key drugs was 82.6%. The compliance of physicians with the EDL was generally good, but more efforts are needed to encourage prescribing by generic name and to ensure the supply of key drugs.

Impact of using essential drug list: analysis of drug use indicators in Gaza Strip

A descriptive cross-sectional study evaluated the compliance of physicians with the Palestinian essential drug list [EDL] in all the government primary care clinics in the Gaza Strip. While 67.4% reported currently using the EDL 51.2% of these physicians reported problems in using it. The mean number of drugs per prescription was 1.92, the percentage of drugs prescribed from the EDL was 97.9% but the percentage of drugs prescribed by generic name was only 5.5%. A copy of the EDL was available in 28.3% of clinics and the availability of key drugs was 82.6%. The compliance of physicians with the EDL was generally good, but more efforts are needed to encourage prescribing by generic name and to ensure the supply of key drugs

Risk factors associated with preterm birth in the Gaza Strip: hospital-based case-control study.

This study aimed to assess the main maternal risk factors associated with preterm birth in the Gaza Strip. A hospital-based case-control study was carried out at El-Shifa and Khan-Younis hospitals with 200 women with preterm births and 200 control women. Significant risk factors for preterm birth were: maternal age > or = 35 years, being a refugee, inadequate antenatal care, failure to gain adequate weight during pregnancy and previous history of preterm birth. Other significant risk factors included: short stature, short interval between the last 2 pregnancies, presence of congenital gynaecological abnormalities, previous history of caesarean delivery and previous history of stillbirth.

Risk factors associated with preterm birth in the Gaza Strip: hospital-based case-control study

This study aimed to assess the main maternal risk factors associated with preterm birth in the Gaza Strip. A hospital-based case-control study was carried out at El-Shifa and Khan-Younis hospitals with 200 women with preterm births and 200 control women. Significant risk factors for preterm birth were: maternal age >/= 35 years, being a refugee, inadequate antenatal care, failure to gain adequate weight during pregnancy and previous history of preterm birth. Other significant risk factors included: short stature, short interval between the last 2 pregnancies, presence of congenital gynaecological abnormalities, previous history of caesarean delivery and previous history of stillbirth

Postnatal management of antenatally diagnosed ureteropelvic junction obstruction.

OBJECTIVE: The management of antenatally diagnosed ureteropelvic junction obstruction (PUJO) is controversial. Here, we present our experience over a period of 13 years and discuss our management protocol. MATERIALS AND METHODS: We reviewed the files of 234 patients with antenatally diagnosed congenital hydronephrosis due to PUJO. Management was tailored to each patient, based on a combination of diethylenetetraminepentacetic acid renogram outcome, pelvic diameter, as well as the patient's symptoms. RESULTS: Pyeloplasty was carried out early in 52 kidneys. Of the total, 182 patients were managed expectantly. Out of these, 45 underwent delayed pyeloplasty. The remaining 137 patients (189 units) were managed non-operatively. In patients who underwent early pyeloplasty, the mean split differential renal function was 37% before and 40.05% after surgery. In those with delayed intervention, the mean renal function was 37.8% before and 42.2% after surgery. In patients who did not have surgery, the mean differential renal function was 45.7% initially and 48.2% at the last accepted follow up. The overall operative success rate was 97.9%. CONCLUSION: We believe that pyeloplasty is the proper treatment for babies with congenital PUJO and <40% split differential function and/or pelvic diameter >35 mm at the initial visit. In other patients a period of observation is warranted, and pyeloplasty should be carried out only if their kidney function deteriorates or the renogram curve does not show improvement. With the excellent results of pyeloplasty we believe that a safer approach is to operate on more kidneys rather than risk of losing valuable kidney function.

Establishing community-orientated medical schools: key issues and steps in early planning.

OBJECTIVES: To describe briefly the process of early planning and establishment of community-based medical schools with highlights of the key issues and milestones. DESIGN: After outlining some basic concerns and provisos for the Dean and suggested strategies for setting the stage (preparing the ground) for the innovation, three phases of early planning and action steps within each are listed to serve as a guide and a general checklist. SETTING: University of Gezira, Sudan and UAE University, AL-Ain. CONCLUSION: As the curriculum with its implications constitutes the driving force for establishing the schools, it has been given due emphasis and greater share in planning. The communication is concluded with further advice to founding Deans through the proposition of a five-star Dean.