Operative versus non-operative management of posterior fossa epidural hematoma: A systematic review and meta-analysis.

BACKGROUND: Posterior fossa epidural hematoma (PFEDH) is rare, occurring in less than 3% of head injuries. It can be managed either operatively or non-operatively. Management guidelines date from 2006, without recent updates providing class III evidence. METHOD: We searched PubMed and other databases for English language observational studies up to 2021 that compared the two treatment approaches for PFEDH and. RESULTS: Twenty-four of the 350 references, for involving 874 patients, met the study criteria. Conservative management showed higher GOS 5 scores and lower mortality. GCS 13-15 patients were more prevalent in the conservative group. Surgical cases often involved ventriculomegaly/compression, hydrocephalus or contusion. CONCLUSION: The study shed light on surgical versus conservative PFEDH management, although evidence is sparse. Generally, conservative methods showed better initial outcomes, and should be preferred. However, respect of individual patient traits and Brain Trauma Foundation guidelines is crucial: conservative management may not suit all cases. To enhance the evidence base, RCTs are important for optimal PFEDH management. Bridging this gap can substantially improve patient outcomes and clinical decision-making, emphasizing the need to consider both the available evidence and patient-specific factors for effective guidance.

GC-MS with Headspace Extraction for Non-Invasive Diagnostics of IBD Dynamics in a Model of DSS-Induced Colitis in Rats.

Inflammatory bowel diseases are extremely common throughout the world. However, in most cases, it is asymptomatic at the initial stage. Therefore, it is important to develop non-invasive diagnostic methods that allow identification of the IBD risks in a timely manner. It is well known that gastrointestinal microbiota secrete volatile compounds (VOCs) and their composition may change in IBD. We propose a non-invasive method to identify the dynamics of IBD development in the acute and remission stage at the level of VOCs in model of dextran sulfate sodium (DSS) with chemically induced colitis measured by headspace GC/MS (HS GC/MS). Methods: VOCs profile was identified using a headspace GC/MS (HS GC/MS). GC/MS data were processed using MetaboAnalyst 5.0 and GraphPad Prism 8.0.1 software. The disease activity index (DAI) and histological method were used to assess intestinal inflammation. The peak of intestinal inflammation activity was reached on day 7, according to the disease activity index. Histological examination data showed changes in the intestine due to different stages of inflammation. As the acute inflammation stage was reached, the metabolomic profile also underwent changes, especially at the short-fatty acids level. A higher relative amounts of acetic acid (p value < 0.025) and lower relative amounts of propanoic acid (p value < 0.0005), butanoic acid (p value < 0.005) and phenol 4-methyl- (p value = 0.053) were observed in DSS7 group on day 7 compared to the control group. In remission stage, disease activity indexes decreased, and the histological picture also improved. But metabolome changes continued despite the withdrawal of the DSS examination. A lower relative amounts of propanoic acid (p value < 0.025), butanoic acid (p value < 0.0005), pentanoic acid (p value < 0.0005), and a significant de-crease of hexanoic acid (p value < 0.0005) relative amounts were observed in the DSS14 group compared to the control group on day 14. A model of DSS-induced colitis in rats was successfully implemented for metabolomic assessment of different stages of inflammation. We demonstrated that the ratios of volatile compounds change in response to DSS before the appearance of standard signs of inflammation, determined by DAI and histological examination. Changes in the volatile metabolome persisted even after visual intestine repair and it confirms the high sensitivity of the microbiota to the damaging effects of DSS. The use of HS GC/MS may be an important addition to existing methods for assessing inflammation at early stages.

Knowledge of Healthcare Professionals on Hepatitis B Virus Infection and Vaccination Uptake in a Tertiary Hospital in Nigeria.

BACKGROUND/OBJECTIVES: Healthcare professionals (HCPs) play a key role in the prevention of hepatitis B virus (HBV) infection. HCPs are expected to have adequate basic knowledge of HBV and readily uptake HBV vaccination as they are a high-risk group, especially those that have direct contact with blood and/or blood products. This study was aimed at assessing the knowledge of and vaccination uptake of HBV among HCPs in a Nigerian tertiary hospital. METHODS: This was a cross-sectional study in which self-administered questionnaires were used to obtain data from different categories of HCPs in a tertiary hospital. The associations between categorical variables were tested using Chi-square test and a P value of 0.05 or less was considered significant. RESULTS: A total of 355 HCPs comprising 149 medical doctors, 180 nurses and 26 laboratory scientists participated in the study. Majority (90.0%) of the respondents correctly identified blood and/or blood products transfusion, needle stick injury, sharing of sharps and vertical transmission as routes of HBV transmission. About 83.4% of the participants were aware that HBV could be transmitted through unprotected sex. However, 39.2% and 15.8% of the participants reported kissing and HBV vaccination as routes of transmission, respectively. Their knowledge and uptake of HBV vaccination was, however, good. CONCLUSION: While majority of the HCPs had good knowledge of the routes of HBV transmission, few still had misconceptions about the routes of transmission, a situation which may cause social discord in the society especially among closely related individuals and potentially result in poor uptake of the highly effective HBV vaccine.

CONTEXTE/OBJECTIFS: Les professionnels de la santé jouent un rôle clé dans la prévention de l'infection par le virus de l'hépatite B (VHB). On s'attend à ce qu'ils aient des connaissances de base suffisantes sur le VHB et qu'ils acceptent facilement la vaccination contre le VHB car ils constituent un groupe à haut risque, en particulier ceux qui sont en contact direct avec du sang et/ou des produits sanguins. Cette étude visait à évaluer les connaissances et l'acceptation de la vaccination contre le VHB parmi le personnel soignant d'un hôpital tertiaire nigérian. MÉTHODES: Il s'agit d'une étude transversale dans laquelle des questionnaires auto-administrés ont été utilisés pour recueillir des données auprès de différentes catégories de professionnels de la santé dans un hôpital tertiaire. Les associations entre les variables catégorielles ont été testées à l'aide du test du chi carré et une valeur P de 0,05 ou moins a été considérée comme significative. RÉSULTATS: Au total, 355 professionnels de la santé, dont 149 médecins, 180 infirmières et 26 laborantins, ont participé à l'étude. La majorité (90,0 %) des personnes interrogées ont correctement identifié la transfusion de sang et/ou de produits sanguins, les blessures par piqûre d'aiguille, le partage d'objets tranchants et la transmission verticale comme étant des voies de transmission du VHB. Environ 83,4 % des participants savaient que le VHB pouvait être transmis lors de rapports sexuels non protégés. Cependant, 39,2 % et 15,8 % des participants ont déclaré que le baiser et la vaccination contre le VHB étaient des voies de transmission, respectivement. Leur connaissance et leur participation à la vaccination contre le VHB étaient cependant bonnes. CONCLUSION: Alors que la majorité des professionnels de santé avaient une bonne connaissance des voies de transmission du VHB, quelques-uns avaient encore des idées fausses sur les voies de transmission, une situation qui peut causer des discordes sociales dans la société, en particulier parmi les personnes étroitement liées, et potentiellement entraîner une faible utilisation du vaccin hautement efficace contre le VHB. Mots-clés: Virus de l'hépatite B, Professionnels de la santé, Vaccination, Connaissances.

An in Depth Look Into Intracranial Abscesses and Empyemas: a Ten-year Experience in a Single Institute.

Background: As the incidence of intracranial infections increase due to diagnostic procedures improvement, more real-life data is needed to reach a more solid informed management approach. Objective: This study aims to describe and analyse clinical features of intracranial abscesses patients treated at a tertiary hospital in North Jordan during a 10-year period. Methods: We retrospectively identified 37 patients treated at King Abdullah University Hospital (KAUH) from 2011 to 2020 in Irbid, North Jordan. Treatment consisted of either aspiration, open craniotomy excision (OCE) or conservative therapy. Extracted variables included demographic data such (age, gender), clinical presentation, lab findings, radiological findings as well as management plan. Retrieved data was compared between the patients who underwent a single operation and those who underwent reoperation after the initial procedure. Results: Thirty-seven patients with 55 intracerebral abscesses were identified, 29 of whom had intraparenchymal brain abscesses, 4 patients had epidural empyema, and 4 had subdural empyema. The mean age was 28.8 (± 20.7) years, with a male predominance (78.4%). Sixteen patients underwent open craniotomy excision (OCE), 14 patients were treated by aspiration and 7 patients were treated conservatively. When comparing the single operation and the reoperation groups, there was no statistically significant difference across variables. Conclusion: Our study presents valuable insight from a tertiary hospital in north Jordan on intracranial abscesses and empyemas. Our findings confirm that good recovery can be established after aspiration or OCE in the majority of patients. Similar results were obtained when comparing the SOP and the ROP groups.

Management of chronic subdural hematoma: A study from Jordan.

Objectives: Chronic subdural hematoma (CSDH) is a common condition encountered in neurosurgical practice. Few studies have reported the characteristics of CSDH patients in the Middle Eastern population. We describe the clinical presentation, surgical management, radiological findings, and post-operative outcomes in our hospital. Methods: We performed a retrospective cohort study in King Abdullah University Hospital, Northern Jordan, between 2009 and 2019. Data were extracted from patients' medical records and analyzed in patients treated with burr hole drainage (BHD). Univariate analysis was performed to identify correlations with age, laterality, and recurrence. Results: A total of 172 CSDH patients were identified, of whom 128 (74.4%) were treated surgically. The mean age of patients treated with BHD (n = 108) was 60.9 years with a male-to-female ratio of 2.38:1. Headache was the most common presenting symptom (64.81%) and was significant in patients aged 41-64 years (p = 0.004), whereas muscle weakness and unsteady gait were significant in patients ≥ 65 years (p = 0.004 and p = 0.033, respectively). A higher pre-operative maximum thickness was associated with bilateral presentation (p = 0.001), whereas a higher pre-operative midline shift was associated with unilateral presentation (p = 0.027). Regarding CSDH recurrence, only a preoperative midline shift was significant (p = 0.021). Conclusion: Clinical presentation was affected by age, as patients < 65 years commonly presented with headaches, whereas those ≥ 65 years presented with limb weakness, speech impairment, unsteady gait, and altered consciousness. BHD was the most utilized surgical option with low mortality and complication rates. Recurrence was only associated with a pre-operative midline shift.

Pre-Percutaneous Coronary Intervention TIMI Flow Grade in STEMI Patients Treated with Pre-Hospital Ticagrelor Loading.

Aim We hypothesised that pre-hospital ticagrelor loading would result in a higher proportion of STEMI patients presenting with pre percutaneous coronary intervention TIMI flow grade (ppTFG) 3 than had previously been reported in the clopidogrel era. Methods Retrospective observational analysis of all STEMI patients attending our centre from 01/01/2016 to 31/12/2019. Patients presenting with STEMI were required to have received pre-hospital load-ing with 180 mg ticagrelor. The coronary angiography images were assessed for each patient to determine the ppTFG in the infarct related artery. Results 590 patients met the inclusion criteria. 125 patients (21.2%) presented with ppTFG 3 on pre-PCI angiography with the remaining 465 patients (78.8%) presenting with ppTFG ≤ 2. In-hospital mor-tality was comparable between the two groups (4% vs 5.6%, p=0.48). Conclusion In STEMI patients loaded with ticagrelor in the field, over one-fifth present with ppTFG 3 on angi-ography pre-PCI. This data is comparable to data from the clopidogrel era.

ESTIMATION OF PATIENT RADIATION DOSES FROM MULTI-DETECTOR COMPUTED TOMOGRAPHY ANGIOGRAPHY PROCEDURES IN TANZANIA.

The aim of the present study was to estimate the volume CT dose index (CTDIvol), dose length product (DLP) and effective dose (ED) to patients from five multi-detector computed tomography angiography (MDCTA) procedures: brain, carotid, coronary, entire aorta and lower limb from four medical institutions in Tanzania; to compare these doses to those reported in the literature, and to compare the data obtained with ICRP 103 and Monte Carlo software. The radiation doses for 217 patients were estimated using patient demographics, patient-related exposure parameters, the geometry of examination and CT-Expo V 2.4 Monte Carlo-based software. The median values of the CTDIvol, DLP and ED for MDCTA procedures of the brain and carotids were 36.8 mGy, 1481.0 mGy∙cm and 5.2 mSv, and 15.9 mGy, 1224.0 mGy∙cm and 7.8 mSv, respectively; while for the coronary, entire aortic, and lower limbs were 49.4 mGy, 1493.0 mGy∙cm and 30.6 mSv; 16.2 mGy, 2287.0 mGy∙cm and 41.1 mSv; and 6.4 mGy, 1406.0 mGy∙cm and 10.5 mSv, respectively. The ratio of the maximum to minimum ED values to individual patients across the four medical centers were 41.4, 11.1, 4.6, 9.5 and 37.4, respectively, for the brain, carotid, coronary, entire aortic and lower limb CT angiography procedures. The mean values of CTDIvol, DLP and ED in the present study were typically higher than the values reported from Kenya, Korea and Saudi Arabia. The 75th percentile values of the DLP were above the preliminary diagnostic references levels proposed by Kenya, Switzerland and Korea. The observed wide range of examination scanning protocols and patient doses for similar MDCTA procedures within and across hospitals; and the observed relatively high patient doses compared to those reported in the literature, call for the need to standardize scanning protocols and optimise patient dose from MDCTA procedures.

Primary cervical glioblastoma multiforme as a presentation of constitutional mismatch repair deficiency: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Primary Glioblastoma Multiforme(GBM) of cervical spinal cord represent an extremely rare type of tumors in the pediatric age group. Constitutional mismatch repair deficiency (CMMRD) patients are known to develop uni- or multiple synchronous-high grade gliomas in the brain. CASE PRESENTATION: The authors report a 23 month old child presented with bilateral upper limb weakness for 7 days with imaging evidence of intramedullary mass lesion that extends from the level of the C3 to C7. The patient underwent excisional biopsy from C3 to C7 and laminoplasty. Immunohistology confirmed primary cervical GBM. CLINICAL DISCUSSION: Constitutional mismatch repair deficiency is cancer tendent syndrome associated with broad spectrum of malignancies. Screening for CMMRD is not a daily practice in oncology and thus prevalence might be underestimated. To authors' knowledge, no prior primary cervical GBM in CMMRD syndrome. CONCLUSION: This report highlights the challenges of CMMRD polymorphic presentations, diagnosis, complications, management and surveillance.

Repurposing of Guanabenz acetate by encapsulation into long-circulating nanopolymersomes for treatment of triple-negative breast cancer.

Poor patient response and limited treatment modalities are the major challenges against combating triple-negative breast cancer (TNBC). The high related mortality urges for novel cancer therapeutics. Guanabenz acetate (GA) is an orphan antihypertensive drug with a short half-life. Re-purposing (GA) by developing a polymersome (PS)-based cancer nanomedicine is an innovative approach in treating TNBC. Formulation and optimization of GA-loaded PEGylated Polycaprolactone PS through different process variables (solvent selection, the order of addition, pH of the aqueous phase, and drug to polymer ratio) were achieved by the nanoprecipitation method. The in vitro cellular uptake, anti-cancer, and anti-metastatic activity of GA and GA-loaded PS were tested in MDA-MB 231(TNBC cell line) and MCF-7 cell line. Western blot analysis was performed to elucidate the molecular anti-cancer mechanism. The in vivo biodistribution study and antitumor activity were investigated in the TNBC-xenograft model implanted in mice. Under optimized formulation conditions, GA-loaded PS had a nanosize of 90.5 nm with PDI < 0.2, a zeta potential -9.11 mV, drug encapsulation efficiency of 92.11% and sustained drug release for 6-days. GA-loaded PS exhibited enhanced cellular uptake and achieved a significantly lower IC50 in both breast cancer cell lines compared to free GA. Treatment with GA-loaded PS (60 µM) showed a significant reduction of 60.5 and 78.1% in cancer migration and metastasis in the case of MDA-MB 231 and MCF-7, respectively. Besides, drug-loaded PS increased phosphorylation of translational regulator eIF2α and decreased expression of Rac1 which were essential for decreasing cancer cell survival and metastasis. In vivo biodistribution study of GA-loaded PS showed long-circulating PS with high passively targeted tumor accumulation. Treatment with GA-loaded PS resulted in a significant decrease in tumor size and weight compared to free GA. In conclusion, GA-loaded PS is a new promising cancer therapeutics for the treatment of TNBC.

Paraparesis As a Rare First Presentation Of Primary Hyperparathyroidism-Related Brown Tumor in The Thoracic Spine: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Brown tumor (BT) is defined as osteolytic lesion of an underlying state of hyperparathyroidism. Hyperparathyroidism will activate osteoclasts which initiate active bone resorption foci of lytic-cysts with hemosiderin depositions that pigment it with its characteristic brown pathologic gross appearance. Devastating fractures and injuries can occur to affected bones and surrounding tissue that require emergent intervention and correction. CASE PRESENTATION: We present a case of a medically free 31-year-old female patient, who presented complaining of unsteadiness and progressive lower limbs weakness over 40 days of duration. Subsequent lab tests showed elevated PTH levels, along with 3.5 × 1.8 cm heterogeneous soft tissue mass involving the right pedicle on T7 level compressing the corresponding level of the spinal cord. Surgical management aimed to decompress the spinal cord and to obtain a biopsy for histopathologic examination which revealed a brown tumor. Neck ultrasound and Sestamibi scan indicated the presence of hyperactive and hyperplastic parathyroid tissue most suggestive of parathyroid adenoma. CLINICAL DISCUSSION: Various presentations of Brown Tumor depend on the bone affected, despite the rarity of spinal involvement, yet expanding tumors can manifest either with back pain, radicular pain, paresthesia, weakness, paralysis, or incontinence. The highest incidence rates of spinal brown tumors affect adults over the age of 40. Management goals are to decompress the neuronal tissue emergently and to prevent further bony lytic deterioration. CONCLUSION: The objective of this study is to provide an overview of primary hyperparathyroidism-related spinal brown tumors, presentation, and summary of previously reported similar cases in the literature.

SpraySyn-A standardized burner configuration for nanoparticle synthesis in spray flames.

In many scientific communities, the definition of standardized experiments has enabled major progress in process understanding. The investigation of the spray-flame synthesis of nanoparticles at a well-defined standard burner by experiment and simulation makes it possible to produce a comprehensive data set with various established and novel measuring methods. In this work, we introduce the design of the SpraySyn burner as a new standard for a free-jet type burner that offers well-defined and simulation-friendly boundary conditions and geometries as well as accessibility for optical diagnostics. A combustible precursor solution is fed through a centrally located capillary and aerosolized with an oxygen dispersion gas flow. The spray flame is stabilized by a premixed flat methane/oxygen pilot flame fed via a porous bronze matrix surrounded by a stabilizing nitrogen coflow emanating through the same porous matrix, providing easy-to-calculate boundary conditions for simulations. This burner design enables the use of a wide choice of solvents, precursors, and precursor combinations. Best-practice operating instructions and parameters are given, and large-eddy simulations are performed demonstrating the suitability of the SpraySyn burner for computational fluid dynamics simulations. For ensuring reproducible operation across labs, we define a consumer-camera-based flame characterization scheme for the quantitative assessment of the flame geometry such as flame length, diameter, tilt angle, and photometric distribution of visible chemiluminescence along the center axis. These parameters can be used for benchmarking the pilot and spray flame by each user of the SpraySyn burner with the reference flames.

Integrated Geophysical and Hydro-chemical Investigations of Impact of the Ijemikin Waste Dump Site in Akure, Southwestern Nigeria, on Groundwater Quality.

BACKGROUND: Improper waste disposal can negatively impact the ecosystem and constitutes a major human health risk. OBJECTIVES: The present study evaluated the environmental impact on groundwater quality of an open-air waste dump in Akure, southwestern Nigeria, using an integrated geophysical survey and hydro-chemical analysis of water samples. METHODS: The geophysical survey involved three dipole-dipole 2-D imaging profiles and seven vertical electrical soundings (VES) along three traverses. The dipole-dipole data were inverted using the Dipro for Windows software, while the VES data were quantitatively interpreted using partial curve matching and computer assisted 1-D forward modeling with the WINResist software. The VES interpretation results were used to generate geoelectric sections. For the hydro-chemical analysis, samples were taken from five hand-dug wells at various distances from the dumpsite. The samples were analyzed for temperature, pH, conductivity, total dissolved solids (TDS), and some major elements (calcium ion (Ca2+), magnesium ion (Mg2+), chloride ion (Cl-), nitrate (NO3 -), sulfate (SO4 2-)) whose concentration values were compared with World Health Organization (WHO) and Nigerian Industrial Standard (NIS) standards for assessment of groundwater quality. RESULTS: The VES curves revealed three distinct geoelectric/geologic layers with thicknesses and resistivities in the range of 0.7 - 2.0 m and 31 - 55 Ωm for topsoil, 6.2 - 14.6 m and 13 - 114 Ωm for the weathered layer, and a fresh basement with resistivity values ranging from 344 - ∞ Ωm.In the hydro-chemical analysis, pH values ranged between 7.57 - 7.8, electrical conductivity ranged from 884 - 1510 µS/cm, and TDS ranged between 588 - 1008 mg/l. Concentration values of Ca2+ and Mg2+ ranged between 78 - 132 mg/l and 1.8 - 19 mg/l, respectively. CONCLUSIONS: The results from the combined electrical resistivity methods showed relatively low resistivity values at the topsoil and weathered layers and the hydro-chemical assessment of water samples indicated that the topsoil and groundwater within the dumpsite may have been polluted by leachate. COMPETING INTERESTS: The authors declare no competing financial interests.

Using Properties of Tumor Microenvironments for Controlling Local, On-Demand Delivery from Biopolymer-Based Nanocarriers.

BACKGROUND: The 'tumor microenvironment' comprised of tumor cells, non-malignant stromal tissues, signaling molecules and the extracellular matrix. Tumor microenvironment has unique physical and physiological characteristics including vascular abnormalities, hypoxia, acidic pH, specific enzymes and growth factors upregulation and high reducing potential. It is these endogenous properties of the tumor environment that can be used to trigger the release of cancer therapeutics both locally and as a function of disease state. Biopolymers such as proteins, polypeptides and polysaccharides are actively being designed to be bioresponsive nanocarriers for drug delivery due to their relative biocompatibility, biodegradability and low immunogenicity. OBJECTIVE: This review focuses on the use of physicochemical attributes of the endogenous tumor microenvironment to provide the impetus for on-demand release of therapeutics from biopolymer-based nanocarriers that are sensitive to pH, enzymes, redox conditions and combinations thereof. CONCLUSION: The development of multifunctional nanocarriers based upon a rational approach for targeting and delivering therapeutics to tumors is an area of active research. Despite the huge amount of work done in this area, especially using pH as a means of eliciting drug release at tumor sites, there is a dearth of work whereby different stages during tumor development are targeted for treatment. Although nanocarriers that are able to react to multiple components of the tumor microenvironment are starting to become common-place, it seems that the ability to release various factors at specific times crucial to therapy has not been studied to a large extent as a means of regaining tissue homeostasis.

High seropositivity of IgG and IgM antibodies against cytomegalovirus (CMV) among HIV-1 seropositive patients in Ilorin, Nigeria.

BACKGROUND: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a major public health problem in sub-saharan Africa. Cytomegalovirus (CMV) has been reported to enhance HIV replication and accelerate the progression of HIV infection to AIDS. OBJECTIVE: This study reports on the high seropositivity of immunoglobulin (Ig) G and M antibodies against CMV and the risk factors for CMV infection among HIV/AIDS patients in Ilorin, Nigeria. METHOD: A total of 180 consented HIV-1 seropositive patients (age-range 16-56 years; 108 females and 72 males) were consecutively recruited. Socio-demographic/behavioral data and 5 ml blood samples were collected from each patient. Plasma of each sample was assayed for anti-CMV IgG/IgM using a CMV IgG and IgM Enzyme Linked ImmunoSorbent Assay (ELISA) kit. RESULTS: Twenty (11.1%) of the 180 HIV-1 seropositive subjects were positive for anti-CMV IgM antibody while 169(93.9%) were positive for anti-CMV IgG antibody. Age, marital status, number of sexual partners, CD4 cells counts and previous history of blood transfusion were the main correlates of CMV seropositivity among these patients. However, occupation, sex, highly active antiretroviral therapy (HAART) were not statistically associated with CMV seropositivity in this study. CONCLUSION: This study has shown that greater percentages of HIV-1 seropositive patients had active CMV infection. It has further shown that CMV is hyperendemic in HIV-1 seropositive patients in Ilorin, Nigeria.

Remote ischaemic preconditioning: is it a flag on the field?

Ischaemic preconditioning is one of several different techniques that have been proposed to render the heart more resistant to ischaemia/reperfusion injuries. A significant reduction of troponin release is 'proof of concept', however, whether ischaemic preconditioning leads to improved clinical outcomes is still to be proven. Moreover, the exact mechanism of action still remains unknown since very few studies have investigated the signal transmission in humans.

Bladder injuries during cesarean section in a University Hospital: a 25-year review.

OBJECTIVES: The objective was to determine the prevalence of bladder injury during cesarean section (CS) and identify the risk factors causing these injuries, their management and the outcome. METHODS: We retrospectively reviewed the medical records of all the patients who had bladder injury during CS over a period of 25 years (1983-2007) at the King Fahad Hospital, Al-Khobar, Saudi Arabia. Demographic data, obstetric, surgical details, mechanism of injury, anatomic location, diagnosis, management and outcome were assessed. RESULTS: Thirty-four cases of bladder injury were identified among 7,708 cesarean deliveries performed during this period with an overall incidence of 0.44%. Primary CS was found in 41.2% of the patients and 58.8% had repeat CS giving an incidence of 0.27 and 0.81%, respectively. Bladder injury occurred when surgical difficulties were encountered during opening of the peritoneal cavity and while developing the bladder flap over the lower uterine segment, mainly due to adhesions and scar tissue resulting from previous abdominal surgery. All the bladder injuries were recognized intraoperatively and repaired with an overall satisfactory outcome. Repeat CS and presence of adhesions were found to be statistically significant risk factors in the study, while operator experience and emergency nature of the CS were considered risk factors in a few cases of bladder injury. CONCLUSIONS: Data presented in this study indicates that bladder injury when adequately repaired is rarely associated with any complications. Multiple cesarean deliveries is a significant risk factor for bladder injury at the time of repeat CS and patients should be counseled regarding this risk before surgery.

Paediatric gastrointestinal endoscopy: experience in a Sudanese university hospital.

We investigated the indications for and findings of gastrointestinal (GI) endoscopy in all children < or = 16 years old referred for the procedure to the endoscopy unit at Soba University Hospital, Khartoum from January 2004 to January 2006. Thus 113 children were enrolled; 73% underwent upper GI endoscopy, 27% lower GI endoscopy (15% colonoscopy, 12% flexible sigmoidoscopy). Indications for upper GI endoscopy included haematemesis (24%), portal hypertension (21%), abdominal pain (16%) and vomiting (15%). Diagnoses included oesophageal varices (16%), gastritis (7%) and hiatus hernia (6%). Indications for lower GI endoscopy included rectal bleeding (87%), diarrhoea (19%) and anaemia (10%).

Paediatric gastrointestinal endoscopy: experience in a Sudanese university hospital

We investigated the indications for and findings of gastrointestinal [GI] endoscopy in all children </= 16 years old referred for the procedure to the endoscopy unit at Soba University Hospital, Khartoum from January 2004 to January 2006. Thus 113 children were enrolled; 73% underwent upper GI endoscopy, 27% lower GI endoscopy [15% colonoscopy, 12% flexible sigmoidoscopy]. Indications for upper GI endoscopy included haematemesis [24%], portal hypertension [21%], abdominal pain [16%] and vomiting [15%]. Diagnoses included oesophageal varices [16%], gastritis [7%] and hiatus hernia [6%]. Indications for lower GI endoscopy included rectal bleeding [87%], diarrhoea [19%] and anaemia [10%]

Isolation and characterization of cold-regulated transcriptional activator LpCBF3 gene from perennial ryegrass (Lolium perenne L.).

In plants, low temperatures can activate the CBF cold response pathway playing a prominent role in cold acclimation by triggering a set of cold-related gene expressions. CBF homologous gene, designated as LpCBF3, from a cold-tolerant perennial ryegrass (Lolium perenne L.) accession was identified. It carries the sequences for nuclear localization signal (NLS), AP2 DNA-binding domains and an acidic activation present in most of the plant CBF proteins. Southern analysis indicated the presence of three homologs of LpCBF3 gene in perennial ryegrass genome, and only one amino acid variation in LpCBF3 protein between cold-tolerant and -sensitive perennial ryegrass accessions. In their putative promoter regions, some differential regions were found. Northern blotting and RT-PCR analysis found that LpCBF3 reached the highest expression after 1.5 h of cold treatment (4 degrees C). The COR homologous gene, a downstream gene of CBF, can be expressed in the plant stem of cold-tolerant perennial ryegrass accessions without cold treatment. Without cold treatment, the COR gene cannot be activated in cold-sensitive perennial ryegrass accessions. Cold treatment can prompt expression levels of COR homologous genes in both perennial ryegrass accessions. In transgenic Arabidopsis, the overexpression of LpCBF3 with the 35S promoter resulted in dwarf-like plants, later flowering and greater freezing tolerance.

Emergency obstetric hysterectomy in a university hospital: A 25-year review.

Over the past 25 years, 43 peripartum hysterectomies were performed at the authors' institution, an incidence of 0.64/1,000 deliveries; 31 procedures followed caesarean section and 12 were performed for haemorrhage following vaginal delivery. The common indications for hysterectomy were abnormal placentation (39.5%), uterine atony (23.3%), uterine rupture (23.3%), and haemorrhage during caesarean section (11.6%). The risk factors for hysterectomy included advancing maternal age and parity, previous caesarean section scars and abnormal placentation. Subtotal hysterectomy was performed in 72.1% cases which appeared a quicker and safer procedure than total hysterectomy in desperately ill patients. Five (11.6%) maternal deaths occurred in the series. Mortality was associated with massive haemorrhage. With rising caesarean section rates worldwide, MRI and colour Doppler sonography is useful to diagnose antepartum placenta accreta/bladder involvement in order to plan elective surgery that is associated with reduced maternal morbidity and mortality. Early decision to perform an emergency hysterectomy is essential before the patient's condition deteriorates, besides availability of an experienced obstetrician to undertake a technically demanding operation.