Endovascular Treatment versus Best Medical Treatment in Patients with Acute Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND AND PURPOSE: Endovascular treatment has emerged as a minimally invasive technique for patients with acute ischemic stroke to achieve recanalization. Our aim was to determine the effects of endovascular treatment on clinical and safety outcomes compared with best medical treatment. MATERIALS AND METHODS: Fifteen randomized trials that compared endovascular treatment with best medical treatment in patients with acute ischemic stroke met the inclusion criteria. We calculated pooled odds ratios and 95% CIs by using random-effects models. The primary end point was a favorable outcome defined by a modified Rankin Scale score of 0 (no symptoms), 1 (no significant disability), or 2 (slight disability) at 90 days postrandomization. RESULTS: Of the 2980 subjects randomized, the proportion of subjects who achieved a favorable outcome was significantly greater among those randomized to endovascular treatment compared with best medical treatment (2949 subjects analyzed; odds ratio, 1.82; 95% CI, 1.38-2.40; P < .001). Excellent outcome (modified Rankin Scale score of 0 or 1) was also significantly greater among those randomized to endovascular treatment (2791 subjects analyzed; odds ratio, 1.77; 95% CI, 1.29-2.43, P < .001). Risk of symptomatic intracranial hemorrhage was similar between endovascular treatment and best medical treatment (2906 subjects analyzed; odds ratio, 1.19; 95% CI, 0.84-1.68; P = .34). CONCLUSIONS: Compared with best medical treatment, the odds of achieving a favorable outcome or excellent outcome at 3 months postrandomization are approximately 80% higher with endovascular treatment among patients with acute ischemic stroke.

Screening of mutations in the GCK gene in Jordanian maturity-onset diabetes of the young type 2 (MODY2) patients.

Maturity-onset diabetes of the young type 2 (MODY2) is a genetic form of diabetes mellitus caused by mutations in the glucokinase gene (GCK). We assessed the frequency of GCK gene mutations in Jordanian suspected MODY2 patients. We screened exons 7, 8 and 9, which are specific for pancreatic glucokinase, for mutations at positions 682A>G, p.T228A; 895G>C, p.G299R, and 1148C>A, p.S383X, respectively, in 250 subjects (100 patients suspected to have MODY2 and 150 healthy controls without family history of diabetes mellitus). We did not find any association of these mutations in Jordanian suspected MODY2 patients or in healthy controls, different from data on Caucasian Italian patients screened for the same mutations.

Hymen care for unmarried Muslim females: role of the forensic consultant in gynaecology interventions.

This case series illustrates the role of the forensic consultant in hymen care for unmarried Muslim females exposed to gynaecology interventions. The age range of the 12 females attending University of Jordan Hospital in Amman was 35 days to 28 years. Gynaecology interventions included the use of a vaginoscope, circular resection of the hymen in cases of congenital imperforate hymen, evacuation of perineal abscess and evaluation of a torn hymen. The forensic consultant provides a valuable role in reassuring patients and parents about procedures used to avoid rupturing the hymen, and in protecting the gynaecologist's and patients' rights by providing reports of the status of the hymen before and after intervention in cases where damage is unavoidable.

Hymen care for unmarried Muslim females: role of the forensic consultant in gynaecology interventions

This case series illustrates the role of the forensic consultant in hymen care for unmarried Muslim females exposed to gynaecology interventions. The age range of the 12 females attending University of Jordan Hospital in Amman was 35 days to 28 years. Gynaecology interventions included the use of a vaginoscope, circular resection of the hymen in cases of congenital imperforate hymen, evacuation of perineal abscess and evaluation of a torn hymen. The forensic consultant provides a valuable role in reassuring patients and parents about procedures used to avoid rupturing the hymen, and in protecting the gynaecologist's and patients' rights by providing reports of the status of the hymen before and after intervention in cases where damage is unavoidable

8-Hydroxy-2'-deoxyguanosine (8-OHdG) as a short-term predictor of regional and occupational health problems.

Exposure to a large number of environmental toxins can induce damage to DNA and may play an important role in the pathophysiological processes of atherosclerosis. To examine the effect of some specific environmental conditions that predispose to sudden coronary atherosclerotic death on the level of 8-OHdG, urine samples were collected from cases of certain occupations and polluted regions that showed a high prevalence of premature deaths. The samples were then analyzed for 8-OHdG. Analysis of 108 cases and 45 controls showed a significant high level of 8-OHdG in relation to occupations, habits, residency and work shift. The mean +/- standard deviation (M +/- SD) for the control group was 4.5 +/- 2.3 ng 8-OHdG/mg creatinine (n = 45), compared to 9.1 +/- 3.1 ng/mg in taxi drivers (n = 9), 10 +/- 5.5 ng/mg in chemical factory workers (n = 16), 12.0 +/- 8.9 ng/mg in paint workers (n = 9), 14.6 +/- 11.1 ng/mg in gasoline station workers (n = 15), 15 +/- 6.1 ng/mg in cement factory workers (n = 12), 16.4 +/- 3.2 ng/mg in city center inhabitants (n = 18) and 18.6 +/- 3.2 ng/mg in smokers (n = 15). These conditions at least in the pilot study done by the author, showed some form of precipitation of sudden atherosclerotic coronary death. This work proved that the recently used 8-OHdG DNA damage biomarker may be an important marker of environmental conditions that are expected to have a serious long-term impact on the cardiovascular system.

Trypanosomiasis-induced infertility in dromedary (Camelus dromedarius) bulls: changes in plasma steroids concentration and semen characteristics.

The effect of Trypanosomiasis on concentrations of plasma steroids and semen characteristics was studied in 24 dromedary bulls. Based upon the parasitological and serological diagnosis, 18 bulls were found infected with Trypanosoma evansi (Group 2) and six were found to be free from infection and served as controls (Group 1). The infected animals exhibited signs of anaemia indicated by the decrease of packed cell volume (PCV) and haemoglobin concentration (Hb), pale mucus membranes, weight loss, lethargy, weakness and dullness. However, five animals (27.8%) of the infected group revealed elevated rectal temperatures and three animals (16.7%) revealed testicular degeneration upon palpation of their scrotal contents. Concentrations of plasma oestradiol-17beta (86.5 +/- 8.6 pg/ml versus 232.5 +/- 74.4 pg/ml) and testosterone (4.8 +/- 0.7 ng/ml versus 2.7 +/- 1.5 ng/ml) were significantly different (P < 0.05) between the control and infected bulls. Evaluation of the semen collected by electroejaculation and evaluated by a computerized cell motion analyzer revealed normal semen characteristics in the control animals compared to deteriorated ones in the infected bulls. There were highly significant (P < 0.01) decreases in sperm count (12.2 +/- 1.3/ml versus 6.5 +/- 4.9 x 10(6)/ml), motility percentage (68.2 +/- 6.7% versus 27.4 +/-15.6%), percentage of live spermatozoa (73.2 +/- 8.3% versus 35.8 +/- 8.2%) and increases in percentage of morphological abnormalities (3.3 +/- 0.6% versus 15.9 +/- 1.0%) in the infected group. An examination of the plasma hormonal profiles and semen characteristics in the infected bulls indicated that altered Sertoli cell function due to formation of immune complexes in four bulls (Group 2A), pituitary dysfunction in six bulls (Group 2B), testicular degeneration in three bulls (Group 2C) and finally trypanotolerancy in five bulls (Group 2D) are possible factors responsible for poor semen characteristics and infertility induced by T. evansi infection in dromedary bulls.

Use of a new computerized system for evaluation of spermatozoal motility and velocity characteristics in relation to fertility levels in dromedary bulls.

Three ejaculates from each of 14 dromedary bulls were collected at 7-day intervals and diluted to 50 x 10 (6) spermatozoa per ml with sodium citrate (2.9%) seminal extender. Spermatozoal concentrations, motility percentages and velocity measures were evaluated by a new computerized cell motion analyzer (CMA, medical Technologies Montreux SA, Switzerland) for assessing fertility rates in such animals. Greatest variability in concentrations and motility percentages was generally attributed to animal effect within the first ejaculate. Spermatozoal concentrations and kinematic variables in particular percentages of progressive motility, amplitude of lateral head displacement (ALH) and linearity (LIN) percentage were strongly correlated (P<0.01) with fertility rates of dromedary bulls. The CMA-derived measurements of velocity straight line (VSL), velocity curve line (VCL), and velocity averaged line (VAP) were significantly affected by the type of spermatozoal tracks. The present results evidenced that the CMA is a reliable system for determining spermatozoal concentrations, motility percentages and velocity measures and is considered as an accurate and rapid method for evaluating and predicting fertility in the one-humped camel bulls.

Liquorice (Glycyrrhiza glabra) and the adrenal-kidney-pituitary axis in rats.

The effect of oral administration of a water freeze-dried extract of Glycyrrhiza glabra (liquorice) has been studied at doses of 100, 250 and 500 mg/kg in rats on the plasma concentration of cortisol, adrenocorticotrophic hormone (ACTH), aldosterone, renin, sodium (Na) and potassium (K). The results indicated that treatment induced dose-dependent and mostly significant decreases in the concentration of cortisol, ACTH, aldosterone and K. There were concomitant dose-dependent increases in the concentrations of renin and Na. The results suggest a strong and dose-dependent suppression of the adrenal-pituitary axis, accompanied by stimulation of renin production from the kidney.

Effect of lead exposure on the erythrocytic antioxidant levels in goats.

Fifteen adult female goats were orally exposed to 5.46 mg lead (as lead acetate) per kg body weight daily for 2 weeks to study the antioxidant enzymes of the erythrocyte, lipid peroxide level, total thiol groups and total antioxidant status (TAS) in plasma. Ten goats served as unexposed control. Blood samples were collected before exposure (day 0) and on days 7 and 14. Ten per cent erythrocyte haemolysate was prepared and analysed for glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase (CAT), total thiol groups and lipid peroxide. TAS was determined in plasma. There was a significant (P < 0.05) increase of erythrocytic GPx, SOD, CAT, total thiol groups and TAS on day 7 which was followed by a significant (P < 0.05) decrease of all these parameters on day 14. Lipid peroxide level increased significantly (P < 0.05) and the maximum level was attained by day 14. The results obtained indicate a possible role of free radicals in lead poisoning pathogenicity.

Localized giant pseudopolyposis in ulcerative colitis.

Localized giant pseudopolyposis is an interesting but unusual manifestation of both ulcerative colitis and Crohn's disease. The purpose of this report is to present a case of localized giant pseudopolyposis complicating an ulcerative colitis, and review other cases reported in the literature. The clinical and pathological findings are described. The authors also discuss the possible aspect of proper management in this type of lesion.

Intratesticular morphometric, cellular and endocrine changes around the pubertal period in dromedary camels.

We obtained the paired testes from 66 clinically healthy camels during two consecutive breeding seasons. Testicular tissues were examined for peripubertal changes in histological structure as well as spermatogenic and steroidogenic activities. Cellular sizes (length microm x width microm) increased linearly (P< 0.05) throughout the first three years of the animal's life for Leydig cells and between two and a half and five years of age for Sertoli cells. A clear increase in the percentage of tubules demonstrating primary and secondary spermatocytes occurred between less than one and five years and a cohort of elongated spermatids was produced in 3.5 +/- 0.2% tubules in males of two and a half years old; the appearance of spermatozoa in 3.1 +/- 0.3% tubules was evident six months later. The basal values for intratesticular and plasma concentrations of oestradiol-17 beta and testosterone respectively, were measured in all animals up to one and a half years for oestradiol-17 beta and three years for testosterone. Thereafter, both steroids increased markedly (P< 0.01) peaking to 269.5 +/-27.1 pg/g and 83.4 +/- 8.3 pg/mL at three years for oestradiol-17 beta and to 164.7 +/- 16.8 ng/g and 6.8 +/- 0.7 ng/mL at five years for testosterone. The results suggested that a steroid hormonal shift around four and a half to five years of age could demarcate the beginning of pubertal period which culminates with the production of the first ejaculum containing higher concentrations of spermatozoa by dromedary camels of six years old.

Sylvatic transmission of arboviruses among Bornean orangutans.

Wild populations of nonhuman primates live in regions of sylvatic arbovirus transmission. To assess the status of arbovirus transmission in Bornean forests and the susceptibility of wild orangutans to arboviral infection, blood samples of wild orangutans, semi-captive orangutans, and humans were examined. Samples were tested by plaque reduction neutralization test for antibodies to viruses representing three families (Flaviviridae, Alphaviridae, and Bunyaviridae), including dengue-2, Japanese encephalitis, Zika, Langat, Tembusu, Sindbis, Chikungunya, and Batai viruses. Both wild and semi-captive orangutan groups as well as local human populations showed serologic evidence of arbovirus infection. The presence of neutralizing antibodies among wild orangutans strongly suggests the existence of sylvatic cycles for dengue, Japanese encephalitis, and sindbis viruses in North Borneo. The present study demonstrates that orangutans are susceptible to arboviralinfections in the wild, although the impact of arboviral infections on this endangered ape remain unknown.

Short report: differences in dihydrofolate reductase but not dihydropteroate synthase alleles in Plasmodium falciparum isolates from geographically distinct areas in Malaysia.

Dihydropteroate synthase (dhps) and dihydrofolate reductase (dhfr) alleles were typed in 67 Malaysian Plasmodium falciparum isolates. The isolates were collected from two geographically distinct locations: 51 from Sabah, Malaysian Borneo, where sulfadoxine/pyrimethamine (SDX/PYR) is used to treat uncomplicated malaria and 16 from Peninsular Malaysia where in vivo resistance to SDX/PYR has been reported. A total of seven dhps alleles were identified with no significant difference in allele frequency between the 2 populations. Two of the dhps alleles described here have not been previously reported. Four dhfr alleles were detected in 67 P. falciparum isolates. Eighty-seven percent of the isolates from the Peninsula, where clinical SDX/PYR failure has been reported, had dhfr alleles with triple point mutations while all of the isolates from Sabah had dhfr alleles with 2 or less point mutations. The difference in dhfr allele frequency between the two populations was highly significant. There was no correlation between in vitro PYR response and accumulation of dhfr point mutations.

Some studies on nutritional muscular dystrophy in Qassim region in Saudi Arabia. Effect of administration of Vitamin E-selenium preparation to pregnant ewes on serum muscle-specific enzymes in their lambs.

The prophylactic effect of parentral administration of a single dose of Vitamin E-selenium preparation given to pregnant ewes during the last third of pregnancy for protection against nutritional muscular dystrophy (NMD) in their lambs was studied. Based on determination of serum muscle-specific enzymes in the lambs, it was found that administration of Vitamin E-selenium preparation to pregnant ewes from a flock with a known history of NMD was associated with a significant decrease in serum muscle-specific enzymes levels in their lambs when compared with those from non-treated dams in the same flock. It was also observed that serum muscle-specific enzyme levels in lambs from non-treated dams in the flock with a known history of NMD were significantly higher than those in lambs from non-treated dams in a flock with no history of NMD (control group). The serum creatine phosphokinase (CPK) level was significantly higher in lambs of treated dams as compared to lambs from the control group, but no significant differences were seen between the two groups of lambs for the other serum muscle-specific enzymes measured. No lambs from the treated group showed clinical signs of NMD up through the time of weaning. It is concluded that administration of Vitamin E-selenium preparation to pregnant ewes in a flock with a known history of NMD was effective in preventing NMD in their lambs.

The effect of aqueous extracts of Cynomorium coccineum and Withania somnifera on testicular development in immature Wistar rats.

The effect of lyophilized aqueous extract of Cynomorium coccineum and Withania somnifera on testicular development and on serum levels of testosterone, ICSH and FSH was studied in immature male Wistar rats. There was a notable increase in testicular weight of animals treated with both extracts. Histological examination revealed an apparent increase in the diameter of seminiferous tubules and the number of seminiferous tubular cell layers in the testes of treated rats as compared with control ones. Extracts of both plants elicited notable spermatogenesis in immature rats but C. coccineum was more effective than W. somnifera in that respect. Serum testosterone and FSH levels were lower in animals treated with plants extracts than controls, whereas ICSH levels was higher in treated animals, specially in those treated with C. coccineum. It was concluded that extracts of both plants have a direct spermatogenic influence on the seminiferous tubules of immature rats presumably by exerting a testosterone-like effect.

Ewing's sarcoma of the talus in a four-year-old child.

Ewing's sarcoma is a rare malignant tumor of the foot in children. We report a case of Ewing's sarcoma of the talus in a four-year-old Chinese girl to highlight the initial difficulty in diagnosis and the clinical course of the disease. She was initially diagnosed as osteomyelitis of the talus and died eight months after presentation with pleural and spinal metastases. To the best of our knowledge, Ewing's sarcoma of the talus in a young child has never been reported in Malaysia.

Sensitivity of the nested-polymerase chain reaction (PCR) assay for Brugia malayi and significance of 'free' DNA in PCR-based assays.

The blood filtration method was used as the gold standard to determine the detection level of simple blood-spot sampling and nested-polymerase chain reaction (PCR) for Brugia malayi. Of 100 samples, 48 were filtration-positive. Of these, 26 had microfilaria counts that were low enough (<1-29 microfilariae/ml) to accurately assess the limit of detection by nested-PCR. Nested-PCR consistently detected B. malayi DNA in samples with > or = 10 microfilariae/ml. Post-filtration, microfilaria-depleted, blood-spots from microfilaria-positive samples were screened by nested-PCR and B. malayi specific 'free' DNA was detected in 51.7% of these samples. There was no evidence for 'free' DNA in microfilaria-negative individuals from this endemic community.

Age-related changes in plasma testosterone concentrations and genital organs content of bulk and trace elements in the male dromedary camel.

There is a paucity of information regarding the influence of plasma testosterone concentrations and inorganic cations secreted in the different seminal fractions on the spermatozoon activity throughout the reproductive life of the one-humped camels. To demonstrate these relationships, the genital organs of 12 prepubertal (<3 years), 9 peripubertal (3-<5 years), 16 mature (5-<15 years) and 15 aged (>/=15 years) camels were collected from the Buraidah slaughter house (Al-Qassim Province, Saudi Arabia) during two consecutive breeding seasons (November-April) over 2 years. Plasma testosterone concentrations (mean+/-S.E.) did not exceed 1.4 ng/ml in prepubertal animals with a 3-4 fold increase in peripubertal (3.2+/-0.4 ng/ml) and mature (4.8+/-0.6 ng/ml) camels followed by about 50% decrease (2.6+/-0.3 ng/ml) in aged ones. These hormonal changes were correlated significantly with concentrations of certain elements in the testes (highest Na, Ca and Cu contents), epididymides (highest P and Fe contents), prostate (highest Zn content), and bulbo-urethral glands (highest K and Mg contents). The significance of some interrelationships among the different cations and their biological effects on sperm production and metabolic activity were discussed.

The effect of extracts of Cynomorium coccineum and Withania somnifera on gonadotrophins and ovarian follicles of immature Wistar rats.

The effects of water extracts of Cynomorium coccineum and Withania somnifera on ovarian follicular development and serum levels of FSH and LH were studied in immature 17-day-old and 25-day-old-Wistar rats. Water extracts of the plants were given to the animals per os in a dose of 47 mg/100 g body weight for 6 days. Serum levels of FSH and LH were measured by ELISA. Folliculogenesis was studied with a light microscope. In 25-day-old rats, extracts of both plants elicited significant changes in gonadotrophin levels coupled with a significant increase in ovarian weight and profound folliculogenesis. Numerous primary, secondary, tertiary and antral follicles were present. A distinct zona pellucida was not seen and the oocyte was often detached. In 17-day-old animals there was a significant increase-in body weight but without significant changes in the ovarian weight and folliculogenesis.

Aluminum phosphide fatalities, new local experience.

Aluminum phosphide (AlP) pesticide is a highly toxic, low cost, and easily accessible rodenticidal agent. Its toxicity results from the liberation of phosphine gas upon exposure to moisture, which leads to multisystem involvement, resulting in serious consequences. The highly toxic parathion insecticide was a common cause of mortality in pesticide fatalities, prior to its banning. Its toxicity was familiar to the public as well as to physicians. Recently, ten fatalities due to AlP were encountered within a three-month period during spring, when it was used as a rodenticide in the vicinity of grain stores. The victims' ages ranged from 1-34 years. The circumstances of death were accidental in six cases, suicidal in two and possibly homicidal in two cases. Retrospectively, the clinical manifestations, scene investigation, autopsy, histological and toxicological findings supported the diagnosis of AlP intoxication. Immediate recognition was difficult due to unfamiliarity of the agent to the physicians. The occurrence of these fatalities might suggest changes of pattern in pesticide poisoning. This should raise the attention of the physician to the problem of AlP poisoning and also necessitates the awareness of the public to the hazards of this poison. Education, proper handling, strict observation and abiding by the regulations controlling this material are good protective measures against AlP poisoning.