Studies on the effect of curcumin and quercetin in the liver of male albino rats exposed to gamma irradiation.

Ionizing radiation produces deleterious effects on living organisms. The present investigation has been carried out to study the prophylactic as well as the therapeutic effects of treated rats with quercetin (Quer) and curcumin (Cur), which are two medicinal herbs known for their antioxidant activities against damages induced by whole-body fractionated gamma irradiation. Exposure of rats to whole-body gamma irradiation induced a significant decrease in erythrocyte (RBC), leukocyte (WBCs), platelet count (Plt), hemoglobin concentration (Hb), hematocrit (Hct %), mean erythrocyte hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and mean erythrocyte volume (MCV); a high increase in plasma thiobarbituric acid reactive substances (TBARS); a nonsignificant statistical decrease in the mean value of serum glutathione (GSH); a significant increase in plasma alanine transferase (ALT), aspartate transferase (AST), alkaline phosphates (ALP), serum total protein, serum total cholesterol levels, total triglycerides levels, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) levels; and with marked histological changes and structural changes measured by Fourier transform infrared (FTIR). Applying both quercetin and curcumin pre- and postexposure to gamma radiation revealed a remarkable improvement in all the studied parameters. The cellular damage by gamma radiation is greatly mitigated by the coadministration of curcumin and quercetin before radiation exposure.

In vitro culture, transformation and genetic fidelity of Milk Thistle.

This review article presents a consolidated explanation and provides a comprehensive description of various studies, carried out on in vitro culture and hairy root cultures of S. marianum which can be consider an alternative source of flavonolignans. To overcome the constrains of conventional propagation of silybum plant, tissue culture and advanced biotechnology proved to be an influential tool that can complement conventional breeding and accelerate silybum development. The present review is focused on biotechnological tools like in vitro culture, hairy root cultures and genetic fidelity of S. marianum which can be a potent tool for production of secondary metabolites from these cultures.

An educational programme on dengue fever prevention and control for females in Jeddah high schools.

A mass communication campaign was conducted at 20 randomly selected female high schools and 2 school supervision centres in Jeddah to improve knowledge, attitudes and practices of students, teachers and supervisors about dengue fever. A total of 5977 pre- and post-intervention questionnaires were completed and the intervention was conducted using lectures and audiovisual aids. A marked improvement in all areas of knowledge, attitudes and practices was observed after the programme in all groups. Students obtained the highest improvement in mean knowledge scores after the programme compared to the other 2 groups. There is a need to expand such programmes to all Jeddah schools.

An educational programme on dengue fever prevention and control for females in Jeddah high schools

A mass communication campaign was conducted at 20 randomly selected female high schools and 2 school supervision centres in Jeddah to improve knowledge, attitudes and practices of students, teachers and supervisors about dengue fever. A total of 5977 pre- and post-intervention questionnaires were completed and the intervention was conducted using lectures and audiovisual aids. A marked improvement in all areas of knowledge, attitudes and practices was observed after the programme in all groups. Students obtained the highest improvement in mean knowledge scores after the programme compared to the other 2 groups. There is a need to expand such programmes to all Jeddah schools

Patient satisfaction with primary health care services in two districts in Lower and Upper Egypt.

This study compares patient satisfaction with primary health care services and identifies factors associated with patient satisfaction in two health districts in Egypt where a project for upgrading primary health care services had been running for three years. An exit interview was conducted for 1108 patients using a structured questionnaire. The results revealed that most clients using primary health care services were females. Patient satisfaction was high for accessibility, waiting area conditions and performance of doctors and nurses. The main complaints centred on the availability of prescribed drugs and laboratory investigations. Additionally, level of privacy in the consultation room was described as unsatisfactory by 33% of patients. There was no association between overall patient satisfaction and age, gender, education level or type of service received.

Patient satisfaction with primary health care services in two districts in Lower and Upper Egypt

This study compares patient satisfaction with primary health care services and identifies factors associated with patient satisfaction in two health districts in Egypt where a project for upgrading primary health care services had been running for three years. An exit interview was conducted for 1108 patients using a structured questionnaire. The results revealed that most clients using primary health care services were females. Patient satisfaction was high for accessibility, waiting area conditions and performance of doctors and nurses. The main complaints centred on the availability of prescribed drugs and laboratory investigations. Additionally, level of privacy in the consultation room was described as unsatisfactory by 33% of patients. There was no association between overall patient satisfaction and age, gender, education level or type of service received

Biochemical changes of Culex pipiens larvae treated with oil and oleo-resin extracts of Myrrh Commiphora molmol.

The mosquitocidal plant extracts of the Myrrh, Commiphora molmol namely; oil and oleo-resin, were proved to demonstrate larvicidal activity against Culex pipiens larvae. Oleo-resin was found to induce significant higher toxic action than oil. Solvent (cremophore EL) did not perform any toxic activity. The Impact of both oleo-resin and oil extracts on the protein profile of the treated larvae was evaluated in order to explain their mode of action. Electrophoretic analysis of total proteins, lipoproteins and glycoproteins revealed inhibitory action of the used plant extracts on the protein contents. Larvicidal activity of the oleo-resin and oil was explained as to be related to the loss of certain enzymes inhibited by these extracts which affect the metabolic processes.

Application of Bacillus thuringiensis in poultry houses as a biological control agent against the housefly, Musca domestica sorbens.

The efficiency of Bacillus thuringiensis (B.t) as a microbial housefly control agent was evaluated in one of the natural maggot breeding medium, namely poultry faeces. Two commercial formulations, a wettable powder and a liquid concentrate were assayed against Musca domestica sorbens in synthetic fly breeding madia and in chicken faeces. The latter was found to favour maggot breeding when compared with the synthetic one. Both formulations resulted in significant reduction in maggot numbers,, pupal development and adult emergence. Concentration was found significantly affecting adult emergence. The liquid concentrate induced higher larvicidal activity than dry powder formulation. Contaminated faeces produced from orally fed chickens were found significantly toxic to the breeding maggots, reaching maximum larvicidal activity till the 4th day post-feeding faeces, and continued in less activity till the 6th day. Adding B.t. in chicken food in poultry mass breeding is recommended for housefly control.

Long-term survival and functional capacity in cardiac surgery patients after prolonged intensive care.

OBJECTIVE: To determine whether hospital discharge alone represents a good outcome for patients who had prolonged intensive care after cardiac surgery by studying their postdischarge survival and functional outcome. The secondary objective is to estimate the proportion of intensive care unit (ICU) resources used by the long-stay (> or = 10 initial consecutive ICU days) patients and to identify preoperative patient characteristics that are associated with a prolonged ICU stay and hospital and long-term survival. DESIGN: Inception cohort study. SETTING: The Cleveland Clinic Foundation, a tertiary care, academic teaching institution. PATIENTS: Cardiac surgery patients with an initial ICU stay of 10 or more consecutive days. INTERVENTIONS: Data were collected daily during hospitalization on every adult who underwent coronary artery bypass graft and/or valve surgery at one institution in 1993. Discharged patients who spent >10 initial consecutive days in the ICU after surgery were contacted by telephone to determine vital status and functional capacity using the Duke Activity Status Index. Total ICU and total hospital direct costs were obtained for each patient. MEASUREMENTS AND MAIN RESULTS: The primary outcome measurements were ICU length of stay, hospital mortality, after-surgery and postdischarge mortality and functional capacity, and relative resource utilization. Of the 2,618 cardiac surgery patients who met the inclusion criteria, 142 (5.4%) had an initial ICU length of stay of 10 or more consecutive days. Of these, 47 (33.1%) died in the hospital. Ninety-four of the 95 discharged patients were followed up (median follow-up, 30.6 months), and 44 of the 94 (46.8%) died during the follow-up period. The median Duke Activity Status Index for the 50 survivors was 26 out of a possible 58.2. The 142 long-stay patients used 50% of the total ICU days and 48% of the total ICU direct cost for all 2,618 patients. CONCLUSIONS: Many survivors of prolonged intensive care die soon after hospital discharge and many longer term survivors have a poor functional state. Therefore, hospital discharge is an incomplete measure of outcome for these patients, and longer follow-up is more appropriate. The relatively small number of patients who require prolonged intensive care consumes a disproportionate amount of the total ICU and total hospital direct cost.

Stimulation of anthraquinone production in suspension cultures of Cassia acutifolia by salt stress.

Suspension cultures of Cassia acutifolia were established by transferring callus tissues derived from root, hypocotyl and cotyledon explants onto liquid MS-medium supplemented with 1.0 mg/l 2.4-D and 0.1 mg/l kinetin and containing increasing levels of NaCl. The stress induced by salt NaCl raised anthraquinone content and reduced growth of cultures. The levels of anthraquinones and their glycosides as sennosides showed distinct changes in cells and media as well as in the different cultures initiated from various explants. Furthermore, the salt stress tended to affect more drastically the productivity of anthraquinones in hypocotyl and cotyledon cell cultures than in root cultures.

Adrenal dysfunction in hemodynamically unstable patients in the emergency department.

OBJECTIVE: Adrenal failure, a treatable condition, can have catastrophic consequences if unrecognized in critically ill ED patients. The authors' objective was to prospectively study adrenal function in a case series of hemodynamically unstable (high-risk) patients from a large, urban ED over a 12-month period. METHODS: In a prospective manner, critically ill adult patients presenting to the ED were enrolled when presenting with a mean arterial blood pressure < or =60 mm Hg requiring vasopressor therapy for more than one hour after receiving fluid resuscitation (central venous pressure of 12-15 mm Hg or a minimum of 40 mL/kg of crystalloid). Patients were excluded if presenting with hemorrhage, trauma, or AIDS, or if steroids were used within the previous six months. An adrenocorticotropic hormone (ACTH) stimulation test was performed and serum cortisol was measured. Treatment for adrenal insufficiency was not instituted. RESULTS: A total of 57 consecutive patients were studied. Of these, eight (14%) had baseline serum cortisol concentrations of <20 microg/dL (<552 nmol/L), which was considered adrenal insufficiency (AI). Three additional patients (5%) had subnormal 60-minute post-ACTH-stimulation cortisol responses (<30 microg/dL) and a delta cortisol < or =9 microg/dL, which is the difference between the baseline and 60-minute levels. This is functional hypoadrenalism (FH). There were no laboratory abnormalities that distinguished patients with AI or FH from those with preserved adrenal function (PAF). Rates of survival to discharge did not differ between the AI group (7 of 8) and PAF patients (21 of 46; p = 0.052). CONCLUSIONS: Adrenal dysfunction is common in high-risk ED patients. Overall, it has a frequency of 19% among a homogeneous population of hemodynamically unstable vasopressor-dependent patients. The effect of physiologic glucocorticoid replacement in this setting remains to be determined.

Perioperative predictors of extubation failure and the effect on clinical outcome after cardiac surgery.

OBJECTIVES: To determine perioperative predictors of extubation failure (requirement for reintubation and mechanical ventilation after prior successful weaning from ventilator support and extubation) after cardiac surgery and the effect on clinical outcome. DESIGN: Cohort study. SETTING: A tertiary-care, 54-bed, cardiothoracic intensive care unit (ICU). PATIENTS: ICU admissions (n = 11,330) after cardiac surgery over a 42-month period. INTERVENTIONS: Collection of preoperative, operative, and ICU data from a database. MEASUREMENTS AND MAIN RESULTS: Frequency of extubation failure, total duration of mechanical ventilation, length of stay in ICU and hospital, and death. There were 748 (6.6%) patients who were weaned from mechanical ventilation after cardiac surgery and required reintubation and ventilator support. The predictors of extubation failure were: age of > or =65 yrs; inpatient hospitalization before surgery; arterial vascular disease; chronic obstructive pulmonary disease; pulmonary hypertension; severe left ventricular dysfunction; cardiac shock; hematocrit of < or =34%; blood urea nitrogen of > or =24 mg/dL; serum albumin concentration of < or =4.0 g/dL (< or =40.0 g/ L); systemic oxygen delivery of < or =320 mL/min/m2; redo operation; surgical procedures involving the thoracic aorta; transfusion of blood products of > or =10 units; and cardiopulmonary bypass time of > or =120 mins. Extubation failure prolonged the length of total mechanical ventilation, as well as ICU and hospital stay, independent of the frequency of organ dysfunction or nosocomial infections but did not increase the risk of death after cardiac surgery. CONCLUSIONS: Extubation failure after cardiac surgery is uncommon. Although extubation failure increased the utilization of ICU and hospital resources, it did not affect mortality after cardiac surgery. Protocols for early extubation and ICU discharge should be modified in the presence of certain preoperative and operative predictors of extubation failure to avoid unnecessary increase in the cost of care after cardiac surgery.

Predictive model of coronary heart disease in Egypt (a disease with multiple risk factors).

As a multifactorial disease and with the need of primordial prevention coronary heart disease (CHT), a risk scoring system for the prediction of CHD was devised at Community Medicine Department Ain Shams University, Cairo, EGYPT. In this matched case-control study of 119 cases and 121 age and sex matched controls, current cigarette smoking, lack of siesta, hypertension, diabetes mellitus, low occupational physical activity, hypercholesterolemia, marital status, urban residence, level of education, work index, coffee consumption, positive family history, BMI, elevated W/H ratio, low HDL and elevated TC/HDL were studied for association with CHD. The additive risk scoring system based on the results of conditional multiple logistic regression identified the first six factors with statistical weights of 1, 5, 10, 6, 6, 11, respectively. On back validation receiver operating characteristic (ROC) curve, a total score of 17 was found to be the cut off point above which there was increased risk of CHD. The overall predictive accuracy of this system--equivalent to the area under the ROC curve--was 0.873. Future studies need to assess the risk scoring system in population based studies.

Undetected cardiogenic shock in patients with congestive heart failure presenting to the emergency department.

The purpose of this study was to examine the use of lactic acid levels and continuous central venous oxygen saturation (central venous oximetry) to stratify and treat patients with acutely decompensated end-stage chronic congestive heart failure (CHF) presenting to the emergency department. This prospective, convenience, non-outcome study was performed at an urban tertiary care hospital. Patients with end-stage CHF with an ejection fraction <30% presenting in decompensated CHF were eligible for the study. Patients were assessed using the Killip classification and New York Heart Association criteria. After lactic acid levels were obtained, patients were managed according to a standardized protocol guided by central venous oximetry. The patients were divided into high lactic acid (n = 22), low lactic acid (n = 5), and control groups (stable patients presenting to a cardiology clinic, n = 17) for comparison. There was no statistical difference in vital signs, or Killip and New York Heart Association criteria among the 3 groups. Central venous oxygen saturation was significantly lower in the high lactic acid group (32 +/- 12%) than in the normal lactic acid (51 +/- 13%) and control groups (60 +/- 6%) (p < 0.001). After treatment there was a significant decrease in lactic acid (-3.65 +/- 3.65 mM/L) and an increase in central venous oxygen saturation (32 +/- 13%) in the high lactic acid group compared with the normal lactic acid group (p < 0.001). A significant subset of patients with decompensated end-stage CHF present to the emergency department in occult shock and are clinically indistinguishable from patients with mildly decompensated CHF and stable CHF. Once identified, these patients require aggressive alternative management and disposition. Further study is necessary to identify whether this intervention impacts morbidity, mortality, and health care resource consumption.

The effects of preoperative therapy with angiotensin-converting enzyme inhibitors on clinical outcome after cardiovascular surgery.

OBJECTIVE: To determine the effect of preoperative therapy with angiotensin-converting enzyme (ACE) inhibitors on clinical outcome after cardiovascular surgery. STUDY: Inception cohort. SETTING: A tertiary care 54-bed cardiothoracic ICU. PATIENTS: All admissions to an ICU over a 42-month period after cardiovascular surgery. INTERVENTION: Extraction of preoperative, operative, and ICU data from a database. OUTCOME MEASURES: Incidence of acute organ dysfunction, length of mechanical ventilation, ICU stay, and death after cardiovascular surgery. RESULTS: The study cohort consisted of four groups: normal or moderately impaired left ventricular function control (group A, n=6,400); normal or moderately impaired left ventricular function treated with ACE inhibitors (group B, n=1,375); severe left ventricular dysfunction control (group C, n=1,905); and severe left ventricular dysfunction treated with ACE inhibitors (group D, n=1,650). The incidence of three or more organ dysfunction was similar on comparison of group A vs group B (5% vs 6%) or group C vs group D (15% vs 13%). There were no differences in the total duration of mechanical ventilation or length of stay in the ICU in group A vs group B or group C vs group D. Death occurred in 2% of groups A and B, and at 6% in groups C and D. Preoperative severe left ventricular dysfunction in both groups C and D was associated with an increased incidence of three or more organ dysfunction, duration of mechanical ventilation, length of stay in ICU, and death after surgery. Multivariate analysis indicated that therapy with ACE inhibitors did not affect the clinical outcome after cardiovascular surgery. CONCLUSION: Preoperative therapy with ACE inhibitors did not influence the clinical outcome after cardiac surgery. It is unlikely that therapy with ACE inhibitors can alter the clinical sequelae of cardiopulmonary bypass and cardiac surgical procedures performed in high-risk patients because of underlying severe left ventricular dysfunction.

Perioperative predictors of acute cholecystitis after cardiovascular surgery.

OBJECTIVE: To determine the incidence, diagnostic features, and perioperative predictors of acute cholecystitis after cardiovascular surgery. DESIGN: Inception cohort study. SETTING: A tertiary care 54-bed cardiothoracic ICU. PATIENTS: All patients admitted to an ICU after cardiovascular surgery during a 42-month period. INTERVENTION: Collection of relevant preoperative, operative, and ICU data from a database and medical charts. PRIMARY OUTCOME: Postoperative acute cholecystitis (AC). RESULTS: Out of 11,330 admissions, 876 patients stayed in the ICU more than 7 days and 30 of them (3%) developed postoperative AC. AC was diagnosed a median of 26 days after cardiovascular surgery (interquartile range, 11 to 41 days). All patients with AC developed at least two criteria of the systemic inflammatory response syndrome (SIRS), and 16 of them (53%) were vasopressor-dependent on the day of diagnosis. Trends in biochemical testing of liver function were not diagnostic for AC. Death occurred in seven of 17 patients (41%) who underwent cholecystectomy, three of nine patients (33%) treated with percutaneous cholecystostomy, and one of four patients (25%) treated conservatively (p=not significant). Specific earlier predictors of AC were arterial vascular disease, preoperative oxygen delivery less than 430 mL/min x m2, longer times on cardiopulmonary bypass, surgical re-exploration, ICU course complicated by cardiac arrhythmia, mechanical ventilation > or = 3 days, bacteremia, and nosocomial infections. CONCLUSION: The incidence of AC is low after cardiovascular surgery. Although SIRS and hemodynamic instability were common at the time of diagnosis, the delayed occurrence and lack of specificity of these features for AC limited their utility for early diagnosis. Specific predictors of AC should be sought in the ICU setting to identify patients who are at risk for AC after cardiovascular surgery. When identified, such predictors can prompt earlier diagnosis and treatment. Further evaluation of the selection criteria for different treatment options is needed in order to decrease the morbidity and mortality associated with AC.