Women's Perceptions and Knowledge Toward Episiotomy in Qassim Region, Saudi Arabia.

INTRODUCTION: Episiotomy, despite being one of the most common interventions during childbirth, carries significant risks and uncertain benefits. Previous global studies highlight varying awareness levels and practices, with decreasing episiotomy rates attributed to increased knowledge. This study aims to assess women's knowledge to enhance intrapartum decision-making and communication between patients and obstetricians, ultimately improving maternal outcomes in the region. METHODOLOGY:  The study was a cross-section design. It was conducted through an online survey that was distributed by different social media platforms (Twitter, WhatsApp, and Telegram) from February 2023 to January 2024. It included women living in the Qassim region, Saudi Arabia, who were 15 years old or older. Data was analyzed using the SPSS program (IBM, Chicago, Illinois, USA). RESULTS: Among the 402 participants, 62.7% demonstrated awareness of episiotomy, with 94.0% accurately identifying it as a surgical cutting with scissors. About 82.5% acknowledged that not all women require episiotomies, while 48.8% recognized the necessity of anesthesia before the procedure. Understanding the indications for episiotomy varied, with facilitating and accelerating childbirth (64.3%) and dealing with a large baby (62.3%) being the most recognized reasons. Impressively, 90.5% believed that there are methods to avoid perineal cutting, with knowing the correct mechanism for pushing during childbirth (69.4%) and exercise (54.4%) being the most acknowledged preventive measures. Regarding post-cutting care, antibiotics (61.5%) were identified as essential, followed by analgesia (52.8%) and laxatives (48.8%). CONCLUSION: The study reveals a notable awareness among participants, with a majority demonstrating a solid understanding of the procedure, its indications, and post-procedure care. It identified specific knowledge gaps, such as the need for anesthesia awareness and divergent beliefs about post-episiotomy care practices.

Therapeutic potential of ramipril, losartan, and spironolactone against sepsis-associated liver tissue injury induced by cecal ligation and puncture in rats.

OBJECTIVE: Sepsis-associated liver injury is responsible for the high morbidity and mortality rates seen with septic shock. Activation of the renin-angiotensin-aldosterone system (RAAS) is an essential counteractive mechanism during the hypotensive phase of sepsis; however, excessive activation is associated with exaggerated pro-oxidant and inflammatory response, which aggravates organ damage. This study aimed to evaluate the effect of RAAS inhibition on sepsis-induced liver damage. MATERIALS AND METHODS: The cecal ligation and puncture (CLP) model was employed as a model of sepsis. Rats were divided into five groups: sham-operated, vehicle-treated septic rats, septic rats treated with ramipril in a dose of 10 mg/kg, septic rats treated with losartan in a dose of 20 mg/kg, and finally septic rats treated with spironolactone in a dose of 25 mg/kg. Rats received the treatment one hour after induction. Twenty-four hours later, rats were euthanized, and serum samples and liver tissue were collected to evaluate liver function and hepatic oxidative, anti-oxidative, inflammatory, and apoptotic markers. The microscopic integrity of the hepatic tissue was also assessed. RESULTS: The results of our study showed that all the treatments used ameliorated sepsis-induced liver injury. This was reflected by improved liver function parameters and histopathological appearance of liver tissue. Treatment with ramipril, losartan, or spironolactone reduced tissue malondialdehyde (MDA), nitric oxide, activated caspase-3, and TNF-α. Moreover, these drugs increased hepatic reduced-glutathione (GSH) levels, superoxide dismutase (SOD) activity, and proliferating cell nuclear antigen (PCNA) expression. CONCLUSIONS: Administration of ramipril, losartan, or spironolactone after CLP produced a hepatoprotective effect in rats, possibly by reducing oxidative stress, inflammation, and apoptosis.

Quality of Life of Primary Caregivers of Children With Cerebral Palsy From a Family Perspective.

BACKGROUND: Cerebral palsy is a heterogeneous group of permanent non-progressive disorders affecting the development of movement and posture, varying in severity, interfering with daily activity, and associated with multiple comorbidities. Previous studies in different regions of Saudi Arabia have shown links between caregivers' mental health and children's well-being. However, the lack of such research in the Tabuk region necessitates the development of a new survey to assess caregivers' quality of life in this specific area. METHODOLOGY: This was a cross-sectional study, conducted during 2022-2023. It included the caregivers of Saudi children with cerebral palsy in the Tabuk region. Data was collected using an online questionnaire and was analyzed using the SPSS program (IBM Corp., Armonk, NY). RESULTS: The study included 63 participants. Mothers (50.8%) and fathers (46.0%) were the primary caregivers. The comorbidities of cerebral palsy children like seizures (28.6%) and learning difficulties (19.0%) were prevalent for cerebral palsy children. Around 20.6% of participants received home health care. In terms of family quality of life, the majority expressed satisfaction with family interaction, parenting, and emotional well-being, although mixed feelings were observed. CONCLUSION: The majority of caregivers reported satisfaction in various domains of family quality of life, particularly in family interaction and parenting. However, a notable percentage expressed dissatisfaction in some areas, highlighting the complex emotional and practical challenges faced by these caregivers.

Healthcare Providers' Perception and Practice Toward Anaphylaxis in Children in the Qassim Region of Saudi Arabia.

INTRODUCTION: Anaphylaxis is described as a severe allergic reaction, and prompt assistance is required by the patient to avoid any complications. The healthcare provider's knowledge plays an important role in the diagnosis and treatment of these cases. The aim of this study was to evaluate the knowledge among the primary healthcare providers working in the Qassim region of Saudi Arabia regarding the diagnosis and treatment of anaphylaxis. METHOD: This cross-sectional study was conducted in the four different governments of the Qassim region of Saudi Arabia. The calculated sample size for the study was 119 primary healthcare providers. A self-administered questionnaire was devised to collect data regarding the diagnosis and treatment of anaphylaxis patients. RESULTS: Thirty-six (28.8%) out of 119 physicians were 25-30 years old, followed by 33 (26.4%) who were more than 40 years old; 53 (42.4%) and 47 (36.7%) had less than five and more than 10 years of experience, respectively. Age and experience were found to be significantly associated with knowledge about the diagnostic criterion (p=0.003 and p=0.000, respectively), while experience was significantly associated with the correct identification of signs and symptoms (p=0.031). CONCLUSION: Knowledge about the diagnosis and management of anaphylaxis patients among primary healthcare providers was poor. Physicians are required to be educated to increase their level of knowledge to promptly diagnose and treat anaphylaxis cases.

Primary Healthcare Center's Healthcare Providers' Perception and Practice Toward Pediatric Cow's Milk Allergy in Qassim Region, Saudi Arabia.

BACKGROUND: Cow's milk allergy (CMA) typically first manifests in the first year of life, and it is the most challenging food allergy to detect since the clinical symptoms can vary significantly in both types and severity. This study is carried out to evaluate the level of knowledge and practice of healthcare providers (HCPs) in the Qassim Region regarding CMA. RESEARCH METHODOLOGY: This is a cross-sectional study conducted among HCPs in the Qassim Region, Saudi Arabia. A self-administered questionnaire was distributed among HCPs using face-to-face interviews compromising four governorates of Qassim such as Buraydah, Unaizah, AlRass, and Albukairyah. The questionnaire includes socio-demographic characteristics and questions to assess the knowledge and practice of HCPs regarding CMA. RESULTS: Among 124 HCPs, 29% were aged between 25 and 30 years, 50.8% were males and 49.2% were females. Over three-quarters (77.4%) were categorized as having poor knowledge levels, while poor practice was also prevalent (83.1%). Factors associated with increased knowledge and practice were being non-Saudi, being a consultant/specialist, and having more than 10 years of experience. There was a significant positive correlation between knowledge and practice scores (p<0.001). CONCLUSION: The knowledge and practice of HCPs regarding CMA were insufficient. Non-Saudi consultants/specialists with more years of experience tend to be more knowledgeable and have better skills in managing the disease. Further longitudinal studies are required to establish the level of knowledge and practices toward CMA.

Relationship Between Asthma and Headache Attacks in the Qassim Region, Saudi Arabia.

BACKGROUND: Headaches are a common complaint among asthma patients. However, there is no study to assess the relationship between asthma and headaches or to assess the prevalence of headaches among asthma patients in Saudi Arabia. We aim to study the relationship between asthma and headaches and also to assess the prevalence of headaches among asthma patients. RESEARCH METHODOLOGY: We conducted a cross-sectional study among 528 asthmatic patients. Participants were selected through non-probability sampling from the system of four hospitals (King Fahad Specialist Hospital, King Saud Hospital, Buraidah Central Hospital, and Qassim University Hospital). The duration of our study was one year from 11 September 2022 to 14 May 2023. Data collection was performed by using a pre-tested and self-administered questionnaire. Data were analyzed through IBM SPSS Statistics for Windows, Version 24 (Released 2016; IBM Corp., Armonk, New York, United States) by using the chi-square test to assess the relationship between the qualitative variables and independent t-test and ANOVA for comparing the quantitative variables with a significant level set at p-value < 0.05. RESULTS: Five hundred and twenty-eight asthmatics were studied for demographics, asthma management, and headaches. Most of the patients were male, married, and university-educated. Sixty-one percent had uncontrolled asthma, and 47.3 percent of individuals had headaches, mostly migraines. Uncontrolled asthma was linked to greater headache prevalence. Gender, educational level, and headache type did not affect headache prevalence in demographic and asthma control subgroups. Co-occurring asthma and migraines may benefit from asthma control and treatment. CONCLUSION:  The research emphasizes the significant frequency of uncontrolled asthma and headaches among asthmatic patients. The association between asthma control and headache prevalence was statistically significant, highlighting the necessity for appropriate management and treatment techniques for both disorders. These findings have significant implications for health care providers and politicians seeking to improve the quality of life for those with asthma and co-occurring headaches.

Intramuscular Versus Intravenous Treatment of Status Epilepticus: A Systematic Review.

Status epilepticus is a neurological emergency associated with high morbidity and mortality with fatal outcomes if not treated well. The goal of this study was to compare the intramuscular and intravenous treatment of individuals with status epilepticus. A search was performed on Scopus, PubMed, Embase, and Web of Science databases for articles published in the English language in peer-reviewed publications up to March 1, 2023. Studies were included if the treatment of status epileptics was compared either directly or indirectly between intramuscular and intravenous methods. In addition, relevant papers were manually screened for in the reference lists of the included studies. Non-duplicate articles were identified. Finally, five articles were included in the analysis, of which four were randomized controlled trials and one was a retrospective cohort study. The intramuscular midazolam group's time until the first seizure stopped was significantly shorter than the intravenous diazepam group's time (7.8 versus 11.2 minutes, respectively; p = 0.047). Moreover, the percentage of patients admitted was significantly lower in the intramuscular group than in the intravenous group (p = 0.01), but the lengths of stay in the intensive care unit and the hospital did not differ significantly between the groups. Regarding seizure recurrence, the intramuscular group had fewer incidences of recurrent seizures. Finally, there were no appreciable differences in safety outcomes between the two treatment arms. During the analysis, different outcomes reported after the use of intramuscular and intravenous treatments in managing patients with status epilepticus were categorized. This categorization led to a clear view of the efficacy and safety of intramuscular versus intravenous treatments in managing status epilepticus patients. The information at hand indicates that intramuscular therapy is just as successful as intravenous therapy in treating people with status epilepticus. The availability, adverse effect profile, logistics of administration, cost, and whether it is included in hospital formularies are some of the factors to be taken into consideration when choosing the drug administration technique.

Parents' Knowledge and Perception Toward Short Stature in Saudi Arabia.

Introduction Short stature is a common reason for referral to pediatric endocrinologists. A Saudi study highlights significant short stature prevalence, with parents exhibiting varied knowledge levels. Common normal variants of short stature are familial short stature, constitutional, and idiopathic short stature. Pathologic causes of short stature include growth hormone deficiency, genetic disorders, and chronic diseases. Parents' knowledge plays an important role in the diagnosis and early intervention of this condition. Insufficient studies prompt the authors to conduct a novel survey assessing Saudi parents' knowledge and perceptions of short stature, filling a research gap. Methodology This is a cross-sectional study conducted among Saudi Parents in five different regions of Saudi Arabia. A self-administered questionnaire was distributed among parents via an online survey. The questionnaire includes sociodemographic characteristics and questions to assess the knowledge and perception regarding short stature. Non-probability sampling targets parents living in Saudi Arabia. Data is analyzed by SPSS version 29 (IBM Inc., Armonk, New York). Results Our study on Saudi parents' knowledge of short stature reveals diverse awareness levels. While genetic causes are widely recognized in (71.6%; N=245) of parents (N=352), awareness drops for factors like low birth weight (23.9%; N=82) total of (N=352). Parents show uncertainty in recognizing short stature (51.4%; N=352) and varied beliefs on growth cessation. A majority (65.6%; N=231) of parents (N=352) prefer early intervention, with 41.5% (N=146) of parents (N=352) recognizing growth hormone therapy. Sociodemographic factors influence knowledge scores, with higher scores in males (21.03) and Central region residents (22.03; p<0.001). Notably, 83.4% (N=248) of parents (N=352) acknowledge psychological complications.  Conclusion Our study highlights varied awareness among parents regarding short stature, emphasizing genetic causes but demonstrating gaps in recognizing certain factors. Sociodemographic factors significantly influence knowledge scores. Psychological complications are widely acknowledged.

Les brûlures électriques par haut voltage de l'enfant, à propos de trois cas.

High-voltage electrical burn injuries are rare emergencies in pediatric units and always associated with a poor prognosis. Recklessness, lack of knowledge about electric currents and the lack of safety around public electricity infrastructures are the three main factors contributing to the occurrence of high-voltage electrical accidents in children. Mortality is due to acute cardiac and renal complications, and trauma associated with falls. Secondary evolution is dominated by the risk of infection and the severity of functional sequelae. Early diagnosis and prompt treatment is needed to prevent these complications. Therapeutic management is based on early resuscitation and surgical management of tissue damage. We report three cases of high-voltage electrocution in children, with electro-thermal burns associated with severe head injury in one case, and myocardial damage and a compartment syndrome with severe functional sequelae in the other two. These three case reports are an opportunity to discuss literature data.

Propofol-induced mitochondrial and contractile dysfunction of the rat ventricular myocardium.

Propofol is a short-acting hypnotic agent used in human medicine for sedation and general anesthesia. Its administration can be associated with serious cardiovascular side-effects that include decrease in arterial blood pressure and cardiac output. The aim of the present study was to evaluate propofol effects on mitochondrial respiration, myocardial contractility and electrophysiology in the same samples isolated from the heart ventricles of adult rats. Mitochondrial oxygen consumption was measured in permeabilized samples dissected from free walls of both ventricles using high-resolution respirometry. State LEAK was determined with malate and glutamate. Active respiration was induced by ADP (state PI) and further by succinate, a Complex II substrate (PI+II). Rotenone was injected to measure state PII. Antimycin A, a Complex III inhibitor was used to determine residual oxygen consumption (ROX). N,N,N',N'-tetramethyl-p-phenylenediamine dihydrochloride and ascorbate were injected simultaneously for respirometric assay of cytochrome c oxidase activity (CIV). Isometric contractions and membrane potentials were determined on multicellular preparations isolated from right and left ventricles. Propofol concentrations used ranged from 0.005 to 0.5 mmol/l. All respiratory parameters were significantly higher in the left control ventricles compared to the right ones. Propofol significantly decreased Complex I activity at concentration 0.025 mmol/l and papillary muscle contraction force at 0.1 mmol/l. Propofol did not affect action potential duration at any concentration studied. Our study suggests that mechanisms contributing to the impaired myocardial contraction during propofol anesthesia might include also mitochondrial dysfunction manifested by compromised activity of the respiratory Complex I.

[Composition of 359 kidney stones from the East region of Algeria]. / Détermination de la composition de 359 calculs du haut appareil urinaire collectés dans la région Est-algérien.

PURPOSE: Determine stones composition of the upper urinary tract in the eastern region of Algeria. METHODS: Our study focuses on a set of 359 stones of the upper urinary tract collected between January 2007 and December 2012 at hospitals in the eastern region of Algeria and analyzed by Fourier transform infrared spectroscopy. RESULTS: The male/female ratio was only 1.32. Calcium oxalate prevailed in 68.5% of stones and 49.3% of nuclei, mainly as whewellite (51.8% of stones and 37.9% of nuclei vs 16.7% and 11.4% respectively for weddellite). Carbapatite prevailed in 15% of stones and 29.8% of nuclei. The struvite, identified in 11.1% of calculi, prevailed in 3.9% of stones and 3.1% of nuclei. Among purines, uric acid prevailed with frequencies quite close to 8.9% and 7% respectively in the stone and in the nucleus while the ammonium urate prevailed in only 0.3% of stones and 3.3% of nuclei. The cystine frequency was 3.6% in both stone and nucleus. The frequency of stone with umbilication was 26.2%. Whewellite was the main component of umbilicated stones with Randall's plaque. CONCLUSION: Our results suggest that stones of the urinary tract in the Algerian east region resemble those observed in industrialized countries. Some features such as stones location, the whewellite prevalence, the frequencies of main components in both the stone and the nucleus as well as the formation of stones on renal papilla confirm this trend. LEVEL OF EVIDENCE: 4.

Reprint of "Baroreflex function in anurans from different environments".

Anurans from terrestrial environments have an enhanced ability to maintain mean arterial blood pressure (Pm) through lymph mobilization in response to desiccation or hemorrhage compared with semiaquatic or aquatic species. Because short term blood pressure homeostasis is regulated by arterial baroreceptors, we compared baroreflex function in three species of anurans that span a range of environments, dehydration tolerance and an ability to maintain Pm with dehydration and hemorrhage. The cardiac limb of the baroreflex loop was studied using pharmacological manipulation of Pm with phenylephrine and sodium nitroprusside (20-200µgkg(-1)), and the resulting changes in heart rate (fH) were quantitatively analyzed using a four-parameter sigmoidal logistic function. Resting Pm in the aquatic species, Xenopus laevis, was 3.6±0.3kPa and was significantly less (P<0.005) than for the semiaquatic species, Lithobates catesbeianus (4.1±0.2kPa), or the terrestrial species, Rhinella marina (4.7±0.2kPa). The maximal baroreflex gain was not different among the three species and ranged from 12.1 to 14.3beatsmin(-1)kPa(-1) and occurred at Pm ranging from 3.0 to 3.8kPa, which were slightly below the resting Pm for each species. Mean arterial blood pressures at rest in the three species were near the saturation point of the baroreflex curve which provides the animals with a greater fH response range to hypotensive, rather than hypertensive, changes in Pm. This is consistent with the hypothesis that arterial baroreceptors are key sensory components that allow anurans to maintain Pm possibly by mobilization of lymphatic return in response to hypotension.

Baroreflex function in anurans from different environments.

Anurans from terrestrial environments have an enhanced ability to maintain mean arterial blood pressure (P(m)) through lymph mobilization in response to desiccation or hemorrhage compared with semiaquatic or aquatic species. Because short term blood pressure homeostasis is regulated by arterial baroreceptors, we compared baroreflex function in three species of anurans that span a range of environments, dehydration tolerance and an ability to maintain P(m) with dehydration and hemorrhage. The cardiac limb of the baroreflex loop was studied using pharmacological manipulation of P(m) with phenylephrine and sodium nitroprusside (20­200 µg kg(− 1)), and the resulting changes in heart rate (f(H)) were quantitatively analyzed using a four-parameter sigmoidal logistic function. Resting P(m) in the aquatic species, Xenopus laevis, was 3.6 ± 0.3 kPa and was significantly less (P < 0.005) than for the semiaquatic species, Lithobates catesbeianus (4.1 ± 0.2 kPa), or the terrestrial species, Rhinella marina (4.7 ± 0.2 kPa). The maximal baroreflex gain was not different among the three species and ranged from 12.1 to 14.3 beats min( −1) kPa( −1) and occurred at P(m )ranging from 3.0 to 3.8 kPa, which were slightly below the resting P(m) for each species. Mean arterial blood pressures at rest in the three species were near the saturation point of the baroreflex curve which provides the animals with a greater fH response range to hypotensive, rather than hypertensive, changes in P(m). This is consistent with the hypothesis that arterial baroreceptors are key sensory components that allow anurans to maintain P(m) possibly by mobilization of lymphatic return in response to hypotension.

The Nebivolol action on vascular tone is dependent on actin cytoskeleton polymerization and Rho-A activity into ECs and SMCs.

Nitric oxide is implicated in the target action of Nebivolol, a selective ß1 adrenoceptor blocker used in hypertension treatment. As the Nitric Oxide (NO) production and the actin cytoskeleton are linked, the aim of this work was to study the involvement of actin cytoskeleton on mechanism of action of Nebivolol in cultured endothelial cells. We studied the effect of Nebivolol (200 µM) on actin filaments remodeling and its impact on NO production and eNOS activation. Results showed that Nebivolol perturbs actin filaments polymerization, increases NO production and eNOS activity between 30 minutes and 1 h. Stabilization of actin filaments with phalloïdine (50 µM) abolishes Nebivolol effects on eNOS activation and NO production. Furthermore, Rho-kinase activity decreased during the first hour of Nebivolol treatment, then increased after 3 h, while actin filaments repolymerized, eNOS activation and NO production decreased. In SMCs, Nebivolol induced a decrease in the Rho-kinase activity from 1 h until 24 h of incubation. In conclusion, we suggest that Nebivolol induced NO production in Endothelial Cells (ECs) via complementary actions between actin cytoskeleton remodeling inducing eNOS activation and Rho-kinase implication. The effect of Nebivolol on ECs occurs during the first hour, this effect on SMCs seems to be maintained until 24 h, explaining persisted action of Nebivolol observed in vivo.

Transmission dynamics of the 2009 influenza A (H1N1) pandemic in India: the impact of holiday-related school closure.

The role of social-distancing measures, such as school closures, is a controversial aspect of pandemic mitigation planning. However, the timing of 2009 pandemic provides a natural experiment for evaluating the impact of school closure during holidays on influenza transmission. To quantify the transmission intensity of the influenza A (H1N1) pdm'09 in India, by estimating the time varying reproduction number (Rt) and correlating the temporal changes in the estimates of Rt for different regions of India with the timing of school holidays. We used daily lab-confirmed case reports of influenza A (H1N1) pdm'09 in India (during 17 May'09 to 17 May'10), stratified by regions. We estimated the transmissibility of the pandemic for different regions from these time-series, using Bayesian methods applied to a branching process model of disease spread and correlated the resulting estimates with the timing of school holidays in each region. The North-west region experienced two notable waves, with the peak of the first wave coinciding with the start of a 4 week school holiday (September-October'09). In the southern region the two waves were less clear cut, though again the first peak of the first wave coincided with the start of school holidays--albeit of less than 2 weeks duration (August'09). Our analysis suggests that the school holidays had a significant influence on the epidemiology of the 2009 pandemic in India. We estimate that school holidays reduced the reproduction number by 14-27% in different regions of India, relative to levels seen outside holiday periods. The estimates of the reproduction number obtained (with peak R values below 1.5) are compatible with those reported from other regions of the world. This work reinforces past studies showing the significant impact of school holidays on spread of 2009 pandemic virus, and by inference the role of contact patterns in children on transmission.

Effect of serum lipoproteins on stereoselective halofantrine metabolism by rat hepatocytes.

Experimental hyperlipidemia has shown to decrease cytochrome P450 3A4 and 2C11 expression and to increase liver concentrations and the plasma protein binding of halofantrine (HF) enantiomers. The present study examined the effect of hyperlipidemic (HL) serum on the metabolism of HF enantiomers by primary rat hepatocytes. Hepatocytes from normolipidemic (NL) and HL (poloxamer 407 treated) rats were incubated with rac-HF in cell media with or without additional rat serum (5%). In those incubations with rat serum, the hepatocytes were preincubated or coincubated with serum from NL or HL rats. Rat serum-free hepatocyte incubations served as controls. Stereospecific assays were used to measure HF and desbutylhalofantrine (its major metabolite) enantiomer concentrations in whole well contents (cells + media). Concentrations of desbutylhalofantrine were not measurable. The disappearance (apparent metabolism) of (-)-HF exceeded that of antipode, but HF metabolism did not differ between hepatocytes from NL and HL rats. Coincubation of HL rat serum with NL hepatocytes caused a significant decrease in the disappearance of (-)-HF, whereas in HL hepatocytes, a substantially decreased apparent metabolism was noted for both enantiomers. Compared with NL serum, (-)-HF disappearance was significantly lowered upon preincubation of NL hepatocytes with HL serum. A combination of factors including diminished drug metabolizing or lipoprotein receptor expression, and increased plasma protein binding in the wells, may have contributed to a decrease in apparent metabolism of the HF enantiomers in the presence of lipoproteins from HL rat serum.

Comparative bioavailability study of cefuroxime axetil (equivalent to 500 mg cefuroxime/tablet) tablets (Zednad® versus Zinnat®) in healthy male volunteers.

This study was performed to investigate the bioequivalence of cefuroxime axetil tablets between a generic test product (A) Zednad® Tablet (500 mg cefuroxime/ tablet, Diamond Pharma, Syria), and the Reference Product (B) Zinnat® Tablet (500 mg cefuroxime/tablet, GlaxoSmithKline, Saudi Arabia). The bioavailability study was carried out for 24 healthy male volunteers. The subjects received 1 Zednad® Tablet (500 mg/ tablet) and 1 Zinnat® Tablet (500 mg/tablet) in a randomized, two-way crossover design fashion on 2 treatment days, after an overnight fast of at least 10 h, with a washout period of 7 days. 24 volunteers plus 2 alternatives completed the crossover. The bioanalysis of clinical plasma samples was accomplished by HPLC method, which was developed and validated in accordance with international guidelines. Pharmacokinetic parameters, determined by standard non-compartmental methods, and ANOVA statistics were calculated using SAS Statistical Software. The significance of a sequence effect was tested using the subjects nested in sequence as the error term. The 90% confidence intervals for the ratio between the test and reference product pharmacokinetic parameters of AUC0→t, AUC0→∞, and Cmax were calculated and found to be within the confidence limits of 80.00 - 125.00% for AUC0→t, AUC0→∞ and Cmax. The study demonstrated that the test product (A) was found bioequivalent to the reference product (B) following an oral dose of 500 mg tablet. Therefore, the two formulations were considered to be bioequivalent.

Polyelectrolyte multilayer film and human mesenchymal stem cells: an attractive alternative in vascular engineering applications.

Mesenchymal stem cells (MSCs) have tremendous potential as a cell source for regenerative medicine due to their capacity for differentiation into endothelial-like cells when seeded on nonmodified cover glasses. This absence of removable surface, preventing recovery of cell sheet, constitutes a critical obstacle to predict an application in tissue engineering. It remains unknown whether MSCs differentiation could be realized when the cells are cultivated on a scaffold that could be used in vascular engineering. In this study, we propose to differentiate human MSCs into endothelial-like cells on surfaces coated with polyelectrolyte multilayer film (PMF) and fibronectin (control surfaces). We quantified Platelet Endothelial Cell Adhesion Molecule (PECAM) and von Willebrand Factor (vWF) expressions (endothelial cell specific markers) and nitric oxide (NO) production, which is representative of the cell functionality. After only two weeks of differentiation, we showed, on PMF, that MSCs expressed PECAM and vWF, exhibiting a differentiation into endothelial-like cells, which functionality was explored by a significant production of nitrites. These results highlight the importance of PMF to get human MSCs differentiation and suggest that this film of nanometer thickness opens a new route for vascular bioengineering by pre-seeding hMSCs directly into a vascular graft functionalized by a removable coating.

Mechanical valve dysfunction in yemen.

BACKGROUND: Rheumatic heart disease is the most common cardiac disease in Yemen. It is associated with high morbidity and mortality. Valve replacement is the most common open heart surgery procedure in our cardiac center. The use of mechanical valves remains burdened with serious complications such as thrombosis. Valve thrombosis is still associated with high mortality(]) The reported mortality rate of the redo operation ranges from 8 to 20% and up to 37-54% in critically ill patients. OBJECTIVE: The aim of the present study was to investigate mechanical valve obstruction among Yemeni patients. PATIENTS AND METHODS: Between January 2003 and April 2007, 2794 patients underwent prosthetic valve replacement in our center, Al-Thawra Hospital. Of those patients, 129 (4.6%) underwent reoperation for te obstructive mechanical valve. Patients with clinical suspicion of prosthetic valve obstruction (PVO) were admitted emergently to the CCU and the diagnosis was confirmed with echocardiography. All patients had heart failure; 95% of them were in NYHA class IV. All were transferred directly from the CCU to the operating room. The mean age was 34.8 ± 13.4 years. Two patients received preoperative thrombolytic therapy that was not successful. Obstruction involved the mitral valve prosthesis in 47 (36.4%); the aortic prosthesis in 16 (12.4%) patients; both valves in 21 (16.3%) patients; mitral valve replacement with tricuspid valve repair in 22(17%); double valve replacement with tricuspid valve repair in 1 (0.8%); redo mitral valve replacement with aortic valve cleaning in 7 (5.4%) cases; aortic valve cleaning in 5 (3.9%) patients; mitral valve cleaning in 5 (3.9%); and 5 (3.9%) patients had redo mitral with aortic replacement. RESULTS: The operations were performed urgently. The etiology of the obstruction was thrombus in 111 (86%), pannus formation in 4 (3%), pannus and thrombus in 6 (4.8%), vegetation in 7 (5.4%) patients, and interposition of suturing materials in 1 (0.8%) patient. The in- hospital mortality was 23/129 (17.8%). CONCLUSION: The incidence of prosthetic valve obstruction remains high in Yemen. The vast majority of the patients who are referred to our hospital come from remote provinces in the country where regular INR measurement is not readily available. For those who are living in areas without good medical care, certain measures are necessary to avoid this disastrous complication: (1) good patient education, (2) free INR testing and free anticoagulant drugs such as warfarin; and (3) use of tissue rather than mechanical valves.