Effect of melatonin on reproductive function in propylthiouracil induced hypothyroidism in adult male rats.

OBJECTIVE: Thyroid hormones are essential for regulating metabolism, reproduction, and growth. Hypothyroidism is connected with lower sperm count and motility, leading to male infertility. Oxidative stress is likely to be linked to this interaction. Melatonin, being known as an oxidative scavenger, may offer a feasible treatment method for reproductive dysfunction accompanying hypothyroidism in adult male rats. The purpose of this investigation was to determine the mechanism by which melatonin treatment affected spermatogenic and steroidogenic function in an experimental model-induced hypothyroidism in adult male rats. MATERIALS AND METHODS: Twenty-one male albino adult rats weighing between 150 and 210 g were used in this experiment. Rats were split into three groups and studied for 11 weeks. The control euthyroid group, in which rats received 0.9% Sodium Chloride (NaCl) solution by intraperitoneal injection [solvent for 6-propyl 2-thouracil (PTU)], 6 days/week for 8 weeks; the PTU-induced hypothyroid group, in which chemical thyroidectomy was induced by intraperitoneal injection of PTU at a dose of 10 mg/kg body weight, 6 days/week for 8 weeks; and the melatonin-treated hypothyroid group, which received 3 mg/kg melatonin intraperitoneally daily for 21 days plasma free Triiodothyronine (T3), free Thyroxin (T4), thyroid stimulating hormone (TSH), free testosterone, Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH) and prolactin were measured. Also, semen analysis, testicular tissue malondialdehyde (MDA), and tumor necrosis factor-α (TNF-α) were accessed. RESULTS: The results indicated that melatonin significantly increased sperm viability and motility compared to the untreated PTU-induced hypothyroid group (p<0.001). Testicular MDA and TNF-α showed a significant decrease in the melatonin-treated hypothyroid group compared with the PTU-induced hypothyroid group (p<0.05). In addition, plasma testosterone levels were significantly increased, accompanied by a significant reduction of plasma prolactin levels compared to the untreated hypothyroid group (p<0.05 for both). CONCLUSIONS: Based on the study findings, melatonin could mitigate gonadal dysfunction induced by hypothyroidism by improving several components of semen analysis, such as sperm motility and sperm viability, as well as by enhancing testosterone production focusing on oxidative and inflammatory stress as the underlying mechanisms.

Validity and reliability of Squegg device in measuring isometric handgrip strength.

OBJECTIVE: The quantitative measurement of handgrip strength is important in assessing and charting the progress of patients with neuromuscular diseases. The aim of this research was to determine the intra-rater and inter-rater reliability and the validity of the Squegg digital dynamometer. SUBJECTS AND METHODS: Twenty-one females and nine male participants with an age range between 18 and 40 years volunteered for the study. Three testers each took three measurements with a Squegg device and a Jamar dynamometer using standardized measurement techniques. Intra- and inter-tester reliability were calculated using the intra-class correlation coefficient (ICC). To investigate the relationship between hand measures and isometric handgrip strength, the Pearson correlation coefficient test was used. To determine the agreement between the two devices, a Bland Altman plot was constructed, and the concurrent validity of Squegg was calculated. RESULTS: The intra-rater reliability coefficients for both Jamar and Squegg were greater than 0.99 for all three testers, indicating excellent intra-rater reliability. The inter-rater reliability of Jamar (ICC=0.93) and Squegg (ICC=0.87) was excellent. With an ICC of 0.844 and an r-value of 0.720, Squegg with Jamar demonstrates good validity and statistical significance (p=0.001). CONCLUSIONS: The isometric handgrip strength and hand measures showed a moderate correlation in the study population. The Squegg isometric handgrip dynamometer has good concurrent validity and great intra- and inter-rater reliability in healthy individuals. The validity of Squegg in patients with neuromuscular diseases that affect hand function has to be investigated further.

Standarized Tribulus terrestris extract protects against rotenone-induced oxidative damage and nigral dopamine neuronal loss in mice.

Strong evidence proposes that brain oxidative DNA damage and microglia activation contribute to Parkinson's disease (PD) pathogenesis. Traditional therapeutic regimens for PD can only relieve the symptoms. Tribulus terrestris (T. terrestris), a flowering plant from family Zygophyllaceae, is used in traditional medicine for treating different disorders and exerts neuroprotective and antioxidant effects in experimental models. The current study attempted to test whether treatment with T. terrestris standardized extract (TTE) can improve motor dysfunction and alleviate rotenone induced oxidative DNA damage and neurotoxicity in mice. Six groups of male Swiss albino mice were utilized. Group (1) was the vehicle (oil) group, group 2 was the rotenone control group (1 mg/kg/48 hours, subcutaneously) for 9 times, groups 3 and 4 were injected with rotenone and treated with TTE (5 or 10 mg per kg, by oral gavage) for 17 days, groups 5 and 6 served as TTE (5 or 10 mg per kg) per se groups. Motor function was measured by the pole and the open-field tests. Then, mouse brains were dissected, one hemisphere was employed for biochemical assays and the other one was used in histopathological studies. Results demonstrated that TTE ameliorated the motor dysfunctions induced by rotenone as well as markers of inflammation and DNA damage (8-OHdG and MTH1 expression). Indicators of oxidative stress and upregulation of the microglia marker (CD11b) were suppressed by the higher dose of TTE (10 mg per kg). Finally, the higher dose of TTE improved the Cresyl violet staining and tyrosine hydroxylase immunostaining in the substantia nigra. In summary, TTE ameliorated the locomotor dysfunction and dampened the DNA damage and oxidoinflammatory stress in rotenone-parkinsonian mice. These results suggest TTE as a potential candidate for neurodegenerative diseases.

Effect of topical ofloxacin on bacterial biofilms in refractory post-sinus surgery rhino-sinusitis.

Bacterial biofilms have been shown to play a major role in many chronic infections, in addition, there is growing evidence that bacterial biofilms may play a role in some forms of refractory CRS that persists despite proper surgery and culture directed antibiotic therapy. The objective is to determine the effect of application of topical ofloxacin on nasal and sinus mucosa in patients with proven existence of bacterial biofilms and persistent chronic sinusitis after FESS. The study design is a prospective controlled study. The study included a total of 12 patients who had refractory CRS in spite of undergoing FESS for that specific reason (study group), and control group (involved 25 patients), for whom FESS was done, with complete improvement postoperatively in 15 of them, and persistence of symptoms in the other ten. Topical ofloxacin eye drops (0.3 %) tds for 12 weeks were prescribed for (study group), culture and sensitivity and scanning electron microscopy were done for middle meatal mucosal specimens for all patients and controls, all of them were followed up for a minimum of 9 months (range 9-18 months). Of the study group, 80 % showed marked improvement in the structure of the mucosa, with the regaining of normal respiratory epithelium, with complete disappearance of the biofilm surface, and the remaining 20 % showed only reduction in the number of inflammatory cells and regaining cilia with scattered patches of very thin biofilm. Biofilms formation plays an active role in perpetuating inflammation in CRS patients and enhanced the recurrence and resistance in those patients, we found a statistically significant improvement in patients' group (P < 0.001), after 12 weeks of topical ofloxacin (without any evidence of any side effects). So, we concluded that topical ofloxacin seems to be an effective, tolerable, convenient, cheap and even safe mode of treatment of refractory CRS after FESS due to biofilms' formation. Thus, we recommend such modality of treatment postoperatively especially in refractory cases of CRS.

Validity and accuracy of subciliary endoscopic-aided repair of orbital floor fractures.

UNLABELLED: Several approaches are used to reconstruct orbital floor fractures and restore orbital position and function, but many have the drawback of incomplete visualization, especially of the posterior part of the orbit. The aim is to assess the validity and accuracy of endoscopically aided subciliary approach repair of orbital floor fractures, as regards functional and cosmetic outcomes. Nine patients with orbital floor fractures were treated with iliac crest bone graft under complete endoscopically aided visualization, through a subciliary approach graft that was placed over the defect under complete visual control using endoscopes, through the same incision, to reconstruct the defect and assess the correction of the posterior edge of orbital floor defect. Improvement was assessed 2 weeks postoperatively. All operated cases had satisfactory results, both functionally and cosmetically. No permanent drawbacks from the incision were observed at 6 months follow-up. In case of repair of orbital floor fractures via a transciliary approach, the use of endoscopic aid through the same incision, allows better visualization of the posterior edge of the orbital floor and facilitates confirmation that all orbital soft tissues have been accurately elevated from the fracture site and that the bone grafts are placed in proper position. LEVEL OF EVIDENCE: 1b (individual inception study with >80% F/U).

Tragal cartilage augmentation in repair of cleft palate, a new technique and its clinical implications.

BACKGROUND: Cleft palate is one of the most common congenital anomalies of the head and neck worldwide. In addition to the evident feeding and growth problems, patients are involved with and suffer from speech, hearing and dental problems. Many surgical techniques and modifications have been advocated to improve functional outcome and aesthetic results, aiming at normal speech, minimizing growth disturbances, and establishing a competent velopharyngeal sphincter. Despite the variety of techniques described for repair of the clefts, there is still a relatively high incidence of postoperative fistula reaching up to 35%. This is mainly related to type and degree of the defect, and type of surgical repair. OBJECTIVES: To evaluate the efficacy of placement of tragal cartilage free graft between the oral and nasal mucosal layers of the neo-palate in improving success rates, and anatomical and functional outcomes in repair of cleft palate with reduction of the extent of dissection. PATIENTS AND METHODS: Fourteen patients were managed by our technique, only in large cases minimal von Langenbeck lateral release incisions were made. In all cases a tragal cartilage graft was interpositioned and fixed to the muscle layer of the neo-palate, 2-3 extramucosal trans-muscle sutures were placed for 3-4 weeks if needed, and the patients were followed up for a minimum of 12 months during which functional and anatomical assessments were done. RESULTS: Results, including both anatomical and functional outcomes, were favorable with no gross failures, permanent significant fistula formations (one case with minor non-significant fistula), nor donor site co morbidities. CONCLUSION: The use of tragal cartilage free graft to augment the area at the junction between the hard and soft palate appears to be a safe and effective method in repair of cleft palate that reduces the incidence of postoperative palatal fistulae, without donor site comorbidities.

To what degree does adenotonsillectomy affect neurocognitive performance in children with obstructive sleep apnea hypopnea syndrome due to adenotonsillar enlargement?

BACKGROUND: Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a common childhood problem; complications include possibly reduced neurocognitive performance. Treatment of OSAHS is usually by adenotonsillectomy, but whether surgery relieves both sleep disturbances and associated behavioral problems to the same degree or not is a reasonable question. OBJECTIVE: To correlate the degree of OSAHS due to adenotonsillar hypertrophy to the preoperative level of the intelligence quotient (IQ) of children, and to assess the degree of postoperative change, if any, in IQ. PATIENTS AND METHODS: The IQ of 84 children suffering from OSAHS due to adenotonsillar hypertrophy was assessed preoperatively and after adenotonsillectomy. The results were compared to a matched control group. RESULTS: The IQ was reduced in children with OSAHS; the degree of the reduction was correlated to the degree of apnea. The comparison of the pre- and postoperative values of the study group showed a significant improvement in IQ postoperatively, with postoperative values matching the control group. CONCLUSION: The IQ of children with OSAHS, as an indicator of neurocognitive function, is reduced, and this reduction can be correlated to the degree of obstruction; but the reduction is reversible and can be reduced even a short period after having experienced relief from the obstruction.

Skin manifestations of chronic hepatitis C virus infection in Cairo, Egypt.

We assessed the dermatological manifestations associated with chronic hepatitis C virus (HCV) infection and their association with liver status. Of 155 patients with chronic HCV infection in Cairo, Egypt, 71 (45.8%) had dermatological manifestations: pruritus without evident skin lesions (21.3%), pigmented purpuric eruption (5.2%), aphthous ulcer and lichen planus (3.9% each), leukocytoclastic vasculitis (2.6%), psoriasis (1.9%), tinea versicolor (1.3%) and other conditions (5.8%). Shrunken liver, splenomegaly and ascites were significantly associated with the presence of skin lesions (relative risk 8.0, 2.7 and 1.8 respectively), and shrunken liver was significantly associated with pruritus (relative risk 2.1). Sex was not associated with any of the skin lesions.

Skin manifestations of chronic hepatitis C virus infection in Cairo, Egypt

We assessed the dermatological manifestations associated with chronic hepatitis C virus [HCV] infection and their association with liver status. Of 155 patients with chronic HCV infection in Cairo, Egypt, 71 [45.8%] had dermatological manifestations: pruritus without evident skin lesions [21.3%], pigmented purpuric eruption [5.2%], aphthous ulcer and lichen planus [3.9% each], leukocytoclastic vasculitis [2.6%], psoriasis [1.9%], tinea versicolor [1.3%] and other conditions [5.8%]. Shrunken liver, splenomegaly and ascites were significantly associated with the presence of skin lesions [relative risk 8.0, 2.7 and 1.8 respectively], and shrunken liver was significantly associated with pruritus [relative risk 2.1]. Sex was not associated with any of the skin lesions

Detection of aflatoxin among hepatocellular carcinoma patients in Egypt.

The present research were tempted to investigate whether Aflatoxin is an additive factor in development of HCC through detecting its metabolite Aflatoxin Ml1 in serum and urine of HCC and cirrhotics in Egypt. Present study comprised (46) Hepatocellular Carcinoma (HCC) patients with mean age (56.28 +/- 8.08), 30 males and 16 females, (12) cirrhotic patients with mean age (47.83 +/- 18.20), 7 males and 5 females and (12) sex and age matched healthy controls. All were exposed to, liver function tests, abdominal ultrasonography and detection of Aflatoxin metabolite M1 in serum and urine by means of the reverse phase HPLC device. Aflatoxin M1 was detected in sera of HCC group, cirrhotics and controls (57.8%) (5.61 +/- 17.21 ng mL(-1)), (91.7%) (19.23 +/- 20.42 ng mL(-1)) and (50%) (0.66 +/- 0.84 ng mL(-1)), respectively and in urine (41.3%) (3.82 +/- 8.03 ng mL(-1)) (91.7%) (43.22 +/- 45.02 ng mL(-1)) and (50%) (0.98 +/- 1.4 ng mL(-1)), respectively representing significant increase in the serum of the cirrhotic group (p < 0.02) and a high significant increase in urine of the cirrhotic group (p < 0.0001). Among HCC group patients, there is high significant value of M1 concentration in urine of upper Egypt residents compared to those of lower Egypt (p < 0.002). The mean value of Aflatoxin M1 concentration among females of the HCC group was significantly higher than that among males (p = 0.006). There is higher statistical significance of aflatoxin prevalence and concentration in serum and urine ofcirrhotics than HCC patients and controls and in concentration in urine of HCC patients from upper than lower Egypt.

Acute hepatitis C without and with schistosomiasis: correlation with hepatitis C-specific CD4(+) T-cell and cytokine response.

BACKGROUND & AIMS: Immune responses during the first few months of acute hepatitis C virus (HCV) infection seem crucial for viral control, but the relationship of these responses to natural history is poorly characterized. METHODS: This prospective study investigated the HCV-specific CD4(+) and cytokine responses in patients with acute HCV hepatitis with or without Schistosoma mansoni coinfection, a parasitic infection with T helper (Th) 2 immune bias. HCV-specific CD4(+) proliferative responses and cytokine production in peripheral blood mononuclear cells were correlated with liver biopsy results at 6 months and at the end of follow-up. RESULTS: Whereas 5 of 15 patients with HCV alone recovered from acute HCV, all (17 of 17) patients with S. mansoni coinfection progressed to histologically proven chronic hepatitis. Coinfected patients had either absent or transient weak HCV-specific CD4(+) responses with Th0/Th2 cytokine production. The magnitude of the HCV-specific CD4(+) response at week 12 was inversely correlated with the fibrosis progression rate in chronically infected patients. CONCLUSIONS: Patients with acute hepatitis C and schistosomiasis coinfection cannot clear viremia and show rapid progression once chronic infection is established. This rapid progression is associated with a strong Th2 response in peripheral immune responses, suggesting that early development of vigorous Th1 responses not only facilitates clearance but delays disease progression.

Prefrontal cortex as the site of estrogen's effect on cognition.

The hippocampus has long been presumed the primary site of action of estrogens on cognition; and explicit memory is considered the cognitive function most vulnerable to menopausal loss of estrogen. We hypothesize instead that the prefrontal cortex and its neural circuitry are prime mediators of estrogen's role in cognition. We also propose that previously reported menopausal cognitive decline, presumed to be hippocampally mediated, may be secondary to executive dysfunction. We used a cross sectional design to compare the performance of nine menopausal women on hormone replacement therapy (HRT) and 10 menopausal women with no prior exposure to HRT on a battery of neuropsychological tests. The battery was comprised primarily of tests of memory and executive functioning. Executive functioning is mediated by the frontal lobes and encompasses working memory, directed attention, the inhibition of inappropriate responses, cognitive set switching, and behavioral monitoring. Unlike most previous studies, we used a memory measure that yields multiple scores reflecting various problem-solving strategies and error types, thus isolating spared and impaired cognitive processes. Results yielded both qualitative and quantitative evidence for disruption of cognitive processes subserved by the frontal lobes rather than the hippocampus: 1) despite intact free recall on a list-learning task (CVLT), untreated menopausal women were relatively impaired in correctly recognizing words previously learned and distinguishing them from items not on the list (discriminability), 2) untreated women also had difficulty inhibiting inappropriate responses in the form of perseverative errors, and 3) the non-HRT group consistently performed worse on the N-back test of working memory. The prefrontal cortex is critical for intact working memory and estrogen enhances performance on working memory tasks. In conclusion, this study provides preliminary evidence for executive dysfunction in untreated menopausal women as women with HRT outperformed women without HRT on tests requiring directed attention, inhibition of inappropriate responses, and cognitive set switching.

Bronchiolitis obliterans organizing pneumonia in a patient with chronic myelogenous leukemia developing after initiation of interferon and cytosine arabinoside.

A 59-yr-old man developed fevers, shortness of breath, persistent cough and weight loss, shortly after initiation of therapy with interferon-alpha 2a and cytosine arabinoside for treatment of chronic myelogenous leukemia. Radiologic pulmonary infiltrates and lung tissue biopsy were consistent with bronchiolitis obliterans organizing pneumonia (BOOP). After discontinuation of the chemotherapeutic drugs, the pneumonic symptoms and chest roentgenogram infiltrates resolved. This report suggests that treatment with interferon-alpha, in combination with cytosine arabinoside, may produce the rare complication of BOOP.

Pontomedullary rent. A specific type of primary brainstem traumatic injury.

Pontomedullary rent is a primary injury to the brainstem that may occur in high-speed accidents. We present a series of 13 autopsies with complete or partial pontomedullary rent documented over a 12-year period. Of the 13 cases, seven had associated basal skull fractures and three had fractures of the cervical spine. In five patients, the rent was an isolated traumatic lesion of the brain. While pontomedullary rents are mostly caused by traumatic craniocervical hyperextension, some authors feel that these rents could be a form of diffuse axonal injury caused by angular acceleration of the head. In this study, two patients had documented features of diffuse axonal injury. More than one mechanism of injury could therefore be involved. Pontomedullary rents could be underdiagnosed, as partial rent is compatible with survival and, when there are no associated fractures, these tears may be attributed to artifactual damage occurring during removal of the brain at autopsy.

Transverse vaginal septum. A case report.

A case occurred of imperforate, complete transverse vaginal septum in the lower third of the vagina. The patient presented at 16 years of age with primary amenorrhea and was found to have hematocolpos. The clinical impression was an imperforate hymen because of the very low position of the septum in the vagina. After excision the diagnosis of transverse vaginal septum was made histologically because of the presence of müllerian duct (mesodermal origin) tissue in the septum. The patient also had syndactyly of the second and third toes on her right foot. The association of these two congenital abnormalities has not been reported previously.

Non-Hodgkin's lymphoma in Saskatchewan. A review of 10 years' experience.

BACKGROUND: The incidence and treatment of non-Hodgkin's lymphoma (NHL) have changed in recent years. This study was intended to compare current features with a previous study (1966-1975) and assess the impact of these changes in our jurisdiction. METHODS: Clinical features and treatment of 547 patients with NHL registered at our center from January 1980 through December 1989 were reviewed, including reassessment of histologic type in each patient. Multivariate analysis of potential pretreatment prognostic factors was performed using the Cox proportional hazards model, and survival was analyzed in relation to treatment outcome. RESULTS: This review includes virtually all incident cases of NHL in a defined geographic area, representing an average annual incidence of 11.3/100,000 population. The male-to-female ratio was 1.1:1, median age was 65 years (range, 4-92 years). Median survival time (MST) of 482 patients with disease diagnosed antemortem was 4.8 years (95% confidence interval [CI], 3.7-6.1 years), 52% of whom have died. Thirty-nine percent of patients with disease classified by the International Working Formulation (IWF) had low-grade disease (MST, 103 months); 27% had intermediate disease (MST, 62 months), and 30% had high-grade disease (MST, 35 months). Sixteen percent of patients had associated neoplasms: 4 acute leukemias, 35 skin cancers, and 37 miscellaneous solid tumors. Results of radiation therapy (RT), chemotherapy (CT), and combined CT/RT were analyzed. Survival correlated strongly with responsiveness to treatment. Considering all patients treated with CT, anthracycline-containing CT was associated with the highest response rate, and survival time (more than 48 months) may have been affected by the addition of this agent. A survival advantage for patients with bulky Stage I and II disease treated with consolidative RT after CT is suggested, but not for more advanced stage disease. The proportional hazards model identified histologic type, disease stage, patient age, hemoglobin level, lactate dehydrogenase (LDH) level, bulky abdominal disease, and systemic "B" symptoms as significant independent prognostic factors influencing survival. CONCLUSIONS: The incidence of NHL has increased, and the survival of patients with high-grade disease has improved significantly since the previous study. A high incidence of other associated malignancies was demonstrated in this group of patients with NHL. Recognition of prognostic factors should permit a rational application of innovative treatments for patients in unfavorable prognostic categories.

Double-outlet single ventricle and an abdominal vascular mass: in utero diagnosis with pathological confirmation.

A fetal echocardiographic scan was performed when routine prenatal ultrasound screening failed to identify four cardiac chambers. The scan showed a single ventricle with an associated circoid varicosity. Because of these anomalies, amniocentesis was suggested and trisomy 18 confirmed. The presence of major cardiac structural anomaly should prompt careful and specific review of all fetal anatomy to screen for syndrome identification and consideration of amniocentesis.

Quantitation of the hepatic arterial buffer response to graded changes in portal blood flow.

Hepatic arterial blood flow changes inversely in response to altered portal blood flow. The hepatic arterial capacity to buffer portal flow changes was studied over a wide range of portal flow with arterial pressure held steady (the active buffer response) or uncontrolled. The active component of the buffer response led to nearly full dilation of the hepatic artery at low portal flows as shown by inability to dilate further in response to adenosine infusion; at high portal flows the hepatic artery was nearly fully constricted as shown by lack of further constriction to norepinephrine. With pressure uncontrolled, active and passive effects combined to produce an increased compensation with similar efficiency (44% +/- 4%) over the full range of portal blood flows. Thus, although the active component of the hepatic arterial buffer response becomes less efficient at very high and low portal flows, the combination of active and passive effects leads to a larger buffer capacity which is equally efficient over a wide range of portal blood flow changes.

Hepatic arterial pressure-flow autoregulation is adenosine mediated.

Pressure-flow autoregulation, although weak, was seen in the hepatic artery (HA) of every cat that also showed dilation to infused adenosine. Several means of quantitating autoregulation are described and evaluated, and all indices showed that the selective adenosine antagonists, 8-phenyltheophylline and 8-(p-sulfophenyl)theophylline, inhibited autoregulation as well as the vasodilator response to exogenous adenosine and the hepatic arterial buffer response (HABR; vasodilation of HA in response to reduced portal flow). The mechanism of HABR is proposed to be dependent on washout of locally produced adenosine into portal blood; reduced portal flow causes adenosine accumulation and dilation of HA. The present data suggest that local levels of adenosine can also be washed into HA blood so that reduced arterial flow will also lead to raised adenosine levels and arterial vasodilation. Thus the mechanisms of the HABR and HA pressure-flow autoregulation are suggested to be the same, i.e., washout of locally produced adenosine, probably from the space of Mall just prior to entry of the vessels into sinusoids.