Index medicus for the Eastern Mediterranean region

The study provides the rationale, history and current status of the Index Medicus for the World Health Organization Eastern Mediterranean Region. The Index is unique in combining the geographic coverage of peer-reviewed health and biomedical journals (408 titles) from the 22 countries of the Region. Compiling and publishing the Index coupled with a document delivery service is an integral part of the WHO Regional Office's knowledge management and sharing programme. In this paper, bibliometric indicators are presented to demonstrate the distribution of journals, articles, languages, subjects and authors as well as availability in printed and electronic formats. Two countries in the Region (Egypt and Pakistan) contribute over 50% of the articles in the Index. About 90% of the articles are published in English. Epidemiology articles represent 8% of the entire Index. 15% of the journals in the Index are also indexed in MEDLINE, while 7% are indexed in EMBASE. Future developments of the Index will include covering more journals and adding other types of health and biomedical literature, including reports, theses, books and current research. The challenges and lessons learnt are discussed.


Rationale
The Index Medicus for the WHO Eastern Mediterranean Region (IMEMR) has sustained its indexing policy, which has made it a vital current awareness information tool, for technical staff of the Regional Office, health care staff, and medical professionals who are able now to access heath literature published in the Region as soon as it is published. A document delivery service to support the Index has also been activated which will enable any user to acquire a copy of any article listed in the Index.
The cumulative version of the Index Medicus is available now on the Internet as part of EMRO web site. A CD-ROM version of the same is also being provided upon request.

Scope and Coverage
The IMEMR Current Contents is issued on a quarterly basis including the most recent articles added to Index Medicus for the Eastern Mediterranean Region (IMEMR) Database 1 .

Indexing Level
Each article has been indexed and assigned to a "Main Heading", plus added headings according to the Medical Subject Headings (MeSH) list of the National Library of Medicine (NLM). Up to five added headings (including the respective country) have been allowed. Subheadings (or qualifiers) are used in indexing to qualify MeSH headings by pinpointing some specific aspects of the concept represented by the heading, e.g. "LIVER-Drug Effects" indicates that the article is not about the liver in general, but about the effect of drugs on the liver.

Organization of the IMEMR Subject Index
The Index is organized in alphabetical order, according to the Main Subject Headings (MeSH). In most cases one main subject is assigned to each article. Under the main subject, entries are sorted by Subheading in alphabetical order also. Each entry includes the bibliographic information of the article e.g. title of the article, author(s), first author's affiliation, journal title, year (date of publication), volume number, issue number, page numbers, number of references, subject descriptors and geographic descriptors. Abstracts have been added and are searchable on the database on the Internet. (as shown in Figure 1)

Author Index
The IMEMR includes the author's index, which also indicates the subjects covered by each author. (Appendix I)

List of EMR Journals by Country
The IMEMR includes an updated list of EMR Journals, which are indexed in the index. The list is sorted in alphabetical order by the country of publication, which also indicates the number of journals in each country. (Appendix II)

List of EMR Journals by Title
The IMEMR includes an updated list of EMR Journals, which are indexed in the index. The list is sorted in alphabetical order by journal's title, which also indicates the status of indexing for each journal. (Appendix III)

Computer facilities
The Current Contents has been produced using the UNESCO WINISIS package. Countries or journals publishers interested in a subset of the database may be provided with data sets in WINISIS format upon request. viii

Availability of photocopies
Photocopies of articles cited in IMEMR may be obtained from EMRO Library free of charge upon request.
2 histopathological examination. The histopathological examination confirmed it to be Actinomycosis. The patient had an intensive antibiotic therapy prescribed in order to prevent a disease relapse because it was not sure whether the remaining part of omentum was affected by microscopic Actinomycosis.
5 mg] or group II patients [9.8 +/-2.8 mg]. The least VAS scores were recorded during knee movement [3.8 +/-1.1] in group III patients compared to group I [6.0 +/-1.8] and group II patients [4.8 +/-1.9]. Eight hours postoperatively, group III patients were more satisfied regarding the postoperative pain management. Combination of intravenous paracetamol and parecoxib provided better analgesia and higher patient satisfaction than each drug when used separately.
Anemia, Sickle Cell Abstract: Sickle cell disease is a congenital condition and its most common clinical manifestation is anemia due to chronic hemolysis. Persistent and accelerated hemolysis associated with multiple transfusions is a recognized risk factor for the development of cholelithiasis. The occurrence of gallstones is one of the most important manifestations of sickle cell disease in the digestive tract. Most gallstones are pigmented and characteristically occur at younger ages and the prevalence of cholelithiasis increases progressively with age, affecting 50% of young adults. Cholecystectomy is the most common surgical procedure performed in sickle cell disease patients. Anesthesia in this population of patients for major surgeries deserves special attention due to various complications particularly silent infarctions of end organs are common. We are reporting a 14-year-old girl diagnosed with sickle cell anemia and [beta+] thalassemia with cholelithiasis went for cholecystectomy under general anesthesia. Although the patient has both beta [+] thalassemia and sickle cell disease component, the latter is of more concern for anesthesia.
Anesthesia, Epidural adverse effects 6 received intrathecal mixture of 0.5% hyperbaric bupivacaine [8 mg] and clonidine 50 /microg. In group III [n = 70] patients received 0.5% hyperbaric bupivacaine [10 mg] intrathecally along with 50/microg of clonidine. Groups were compared using one-way ANOVA with the Bonferroni multiple comparison post hoc test. The proportion of adverse events was compared using the chi-square test [lambda[2] = 57.2410]. On adding 50 micro g clonidine, we were able to reduce intrathecal dose of bupivacaine for cesarean section to 8 mg. Patients receiving intrathecal clonidine along with bupivacaine had significantly long lasting analgesia with lower bupivacaine dose [246.21 +/-5.15   .0 group I. Addition of intrathecal clonidine causes some sedation in the postoperative period, but it provides adequate analgesia and motor paralysis at lower dose of bupivacaine. It also significantly prolongs postoperative pain relief.

Abstract:
The purpose of this study was to compare etomidate-lipuro and propofol and 50%, [1:1] admixture of these agents at induction with special reference to injection pain, hemodynamic changes, and myoclonus. Ninety patients were assigned at random to three groups in which induction was performed with either etomidate-lipuro, propofol or etomidate-lipuro-propofol admixture. After monitorization with bispectral index [BIS] all agents were given with infusion with a perfuser at a constant rate of 200 ml/min till the BIS values decreased to 40. Blood pressure and heart rate were measured every 30 s at this period. Patients were asked for pain at the injection site and observed visually for myoclonus. The time BIS values decreased to 40 (BIS 40 time) and total amounts of induction doses were measured. BIS 40 time measurements were P > E > 176.9 +/-31.6, 163.5 +/-20.6 s]. The hemodynamic [systolic, diastolic and mean blood pressures, heart rate] changes were minimal in group PE than other two groups [P = 0.017]. The intensity of myoclonus was graded as mild in 9, moderate in 12, and severe in 5 patients in the group E [76.3%]. Myoclonus was not observed in group PE and group P. There were no injection pain in group PE as the incidence were [83.8%] in group P and in [63.2%] group E. Incidence of hemodynamic changes, myoclonus, and injection pain is significantly lower in group PE. BIS 40 times is least in group PE. We concluded that 1:1 admixture of etomidate-lipuro and propofol is a valuable agent for induction.
Aneurysm, Dissecting surgery Surgical repair of delayed chronic type A dissection after previous coronary artery bypass grafting.
Studies; Tuberculosis, Pulmonary-prevention and control; Tomography, X-Ray Computed; Mass Chest X-Ray; Bronchoscopy Abstract: Occupational exposure to carbon, silica, and quartz particles are predisposing factors for bronchial anthracosis. In some cases anthracosis may be associated with mycobacterium tuberculosis. This study aims to investigate the clinical, radiographic, and bacteriologic findings in bronchial anthracosis patients and its association with tuberculosis, This is a prospective study conducted between 1998 and 2001, A total of 919 patients underwent diagnostic bronchoscopy for pulmonary diseases. Of these, 71 patients showed evidence of bronchial anthracosis, 32 [45.8%] males and 39 [54.2%] females, age range, 30-92 years. The distinctive clinical features, nature of bronchoscopic lesions, and radiologic findings were analyzed prospectively and summarized, Bacteriologic studies and results of laboratory examinations were also assessed, Forty-one [57,8%] patients had positive smears or cultures for mycobacterium tuberculosis. Of 71 patients with bronchoscopic evidence of pulmonary diseases, 30 had previous occupational exposure, and 41 stated no previous exposure, Cavitary lesions on chest radiography, positive purified protein derivative tests and high ESR were more prevalent in tuberculous patients than the others. Bronchial anthracosis was caused by active or previous tuberculous infection. Detailed examinations for the presence of active tuberculosis should be performed in patients with such bronchoscopic findings in order to prevent the spread of tuberculosis and to avoid unnecessary invasive procedures. Nigeria and Benin. This study was aimed to investigate the antiplasmodial potentials of the crude leaf and root extracts of this plant as well as their fractions in vivo in Plasmodium berghei berghei -infected mice to give scientific proof to the ethnobotanical claims and correlate with the reported in vivo activity. The ethanolic extracts of Carpolobia lutea leaf [245-735mg/kg/day] and root [7-21mg/kg/day] were screened for blood plasmocidal activity against chloroquinesensitive Plasmodium berghei in mice. The antimalarial activity in 4-day and curative tests was evaluated. Carpolobia lutea leaf extract [245-735mg/kg/day] and fractions exhibited significant [p<0.05-0.01] antiplasmodial activity both in 4day early infection test and in established infection with a considerable mean survival time which was incomparable to that the standard drug, chloroquine [5mg/kg/day]. The root extract [7 -21mg/kg/day] and fractions also demonstrated a promising blood schizontocidal activity in early and established infections. These plant extracts and fractions possess considerable antiplasmodial activities which justify their use in ethnomedicine and can be exploited in the control of malaria.

Anti-Bacterial Agents
fraction and valve insufficiency. Length of hospitalization, echocardiographic and clinical follow-up, complications and mortality were analyzed. Four patients [21%] died of non-valve-related complications. Major complications after operation were seen in three patients [15.8%]. Mean length of stay in the intensive care unit [ICU] was nine days, and the mean duration of hospitalization were 16 days. Comparison of pre-operative and post-operative clinical profiles of patients showed that left ventricle ejection fraction and seventy of aortic insufficiency were significantly altered [P<0.05]. Comparison of patients who survived with those who died showed that only cardio pulmonary bypass time had statistically significant difference [P=0.04]. Valve sparing aortic root reconstruction in patients with type A dissection can be performed with acceptable intra-operative mortality and morbidity and excellent results during followup.

APACHE
Apache-II score correlation with mortality and length of stay in an intensive care unit. All adult patients who were admitted in the ICU were included. APACHE-II score was calculated at the second and seventh days of admission in the ICU. Patients who were discharged alive from the ICU or died after first APACHE-II Score [at 2nd day] were noted as the primary outcome measurement. Second APACHE-II score [at 7th day] was used to predict the length of stay in the ICU. Pearson's correlation coefficient [r] was determined with significance at p < 0.05. In the lowest score category 3-10, 27 out of 30 patients [90%] were discharged and only 3 [10%] died. Out of those 39 patients whose APACHE-II score was found in high category 31 -40, 33 [84.6%] deaths were observed. This revealed that there might be more chances of death in case of high APACHE-II score [p=0.001]. Insignificant but an inverse correlation [r = -0.084, p < 0.183] was observed between APACHE-II score and length of ICU stay. The APACHE-II scoring system was found useful for classifying patients according to their disease severity. There was an inverse relationship between the high score and the length of stay as well higher chances of mortality.
Keywords: Synovial Fluid-therapeutic use; Outcome Assessment [Health Care]; Hospitals, Teaching; Treatment Outcome Abstract: Septic arthritis is one of the most common causes of joint destruction. The aim of this study was to assess management of definitive or suspected cases of septic arthritis in educational hospitals of Qazvin University of Medical Sciences within 2003 to 2008. This was an observational study performed based on existing data. The medical files of patients with arthritis in three hospitals were assessed. Patients were hospitalized in orthopedic, rheumatology and pediatrics wards. Intravenous antibiotic receivers for arthritis [more than three days] were analyzed [174 cases] and all necessary information was collected. Data were analyzed by SPSS software using descriptive statistics. Of total study population, 57.5% of cases were males, 70.6% under the age 12 years, and 85.2% with mono-articular involvement. The most common joint involved was knee in adults [39.6%] and hip in children [47.2%]. Trauma was the most common predisposing factor [73%] whereas limitation in movement found to be the most frequent [85.6%] clinical manifestation at the time of admission. Only 57 patients underwent arthrocenthesis and positive culture results were found in 8 cases. Essential considerations such as smear, gram staining and assessing the presence of crystals in synovial fluid were not accomplished to an acceptable level yet the less important criteria such as lactate dehydrogenase, protein, and glucose concentrations of synovial fluid were tested for majority of patients. Antibiotic regimen composed of an anti-staphylococcal agent in most cases. Within the first four hours following admission, 54.6% of cases received intravenous antibiotics and 24.7% of cases received IV antibiotic therapy for longer than two weeks. According, to inappropriate management of patients with definite and suspected septic arthritis, attempts should be made to consider parameters such as careful history and physical examination, correct duration of antibiotic therapy, and the process of determining the type of microorganisms causing septic arthritis including smear and culture of synovial fluid as well as taking necessary measures to improve the current conditions.

Arthritis, Rheumatoid
Expression of osteopontin in synovial tissue of rheumatoid arthritis: its relation to disease activity and severity. Immunohistochemistry; Blood Sedimentation; C-Reactive Protein; Knee Joint-radiography Abstract: To demonstrate the expression of osteopontin in synovial tissue of patients with rheumatoid arthritis and to correlate it with disease activity and severity in order to find out its possible role in the pathogenesis of the disease. This study was conducted on 30 RA patients and 10 control subjects with post traumatic knee injury. All patients were subjected to full medical history taking, thorough clinical examination with special attention to articular manifestations [Modified disease activity score] [DAS], and spread severity index [SSI]. Laboratory investigations included: CBC, ESR, CRP and RF. Radiological investigations included: plain x-ray of the affected knee joint using Larsen's score for assessment of joint damage and expression of osteopontin [OPN] in synovial tissues of both patients and controls was determined by immunohistochemical staining of formalin fixed, paraffin embedded synovial tissues. We demonstrated by immunohistochemistry that OPN was detected as brown cytoplasmic staining expressed predominantly in the lining layer of rheumatoid synovium rather than the sublining layer and it was absent in the lymphoid aggregates. In contrast, synovial tissue of the control group showed weak scattered staining for OPN. We found a highly statistical significant difference between RA patients and controls regarding the synovial expression of OPN which was highly associated with the activity. Also, percentage of OPN positive cells was highly associated with the severity of RA assessed clinically by SSI and radiological [p<0.01]. Osteopontin is critically involved in the pathogenesis of both inflammatory and joint-destructive processes in rheumatoid arthritis. OPN may reflect disease activity and can be used as a marker of disease severity.  [RV] and to assess the relationship between s Fkn level and RA disease activity. Twenty patients suffering from rheumatoid arthritis were included in this study. They were divided into two groups: 1] -RA group: included 10 patients suffering of RA with no clinical signs of vasculitis. 2] -RV group: included 10 patients suffering of RA with vasculitis. Another ten non rheumatoid subjects were chosen as control group. All were subjected to: full history clinical examination, serum Rheumatoid factor [RE], serum complement [C4] and human serum soluble fractalkine [sFkn]. Also vasculitis disease activity was assessed using Birmingham vasculitis activity score [BVAS] to RV group. Serum sFkn levels were significantly higher in patients with RA than in controls and were significantly higher in RV patients than in those without vasculitis complications. Statistically significant correlation was observed between serum sFkn levels in RA fibronectin [pFN] in patients with rheumatoid arthritis [RA] and compare these levels to normal healthy controls. The aim extends to determine the relation of these levels to clinical parameters of disease activity. Fifty patients with RA as well as twenty healthy persons-as a control group-were included into this study. All patients were subjected to full clinical assessment and laboratory investigations. sL-selectin and pFN were measured in patients and controls using the enzyme-linked immunosorbent assay technique, and their correlations with disease activity parameters were studied. Serum levels of sL-selectin and pFN were highly significantly increased in RA patients as compared to healthy controls [p<0.001]. These levels also showed a highly statistically significant correlation with some parameters of RA disease activity [p<0.001]. This rise was more evident in patients with severe disease activity sL-selectin and pFN levels are elevated in RA patients especially in those with a severely active disease. The might reflect their role in the pathogenesis of RA. The correlation of sL-selectin and pFN with clinical parameters of RA patients may help in evaluation of progression or remission of the disease.
12 were compared, based on disease duration [DD], disease activity, severity parameters and drug history. YORA I comprised 298 patients, 28.85% males, age 29.4 +/-6 and DD 4 +/-3.3 y, YORA II included 539 patients, 33.77% males, age 49.7 +/-6.1 y. and DD 6.5 +/-5.6 y. EORA included 348 RA patients 40.5% males, age 67.1 +/-6.6 y, DD 9.95 +/-7.2 y. Activity was increased in EORA compared to YORA I and YORA II, while severity decreased in EORA. ESR, CRP and degree of anemia were higher in EORA. RF titer was higher in YORA. In YORA peripheral joints of the hands and feet were more involved while, large joints in EORA. Rheumatoid nodules were increased in YORA I than EORA p= 0.04. Polymyalgia rheumatica was exclusively present in EORA group 25 patients 7.2%. YORA used methotrexate and its mean dose was higher than EORA. EORA on multiple DMARD 57.9% or biologics 0.8% was significantly lower compared with YORA 186.3% and 1.7%, p= 0.001. EORA has more active and less disabling and affects more males than YORA. The use of biologic therapy and combination DMARD therapy was less in EORA. to correlate it with the activity and severity of the disease as a preliminary study for their role in the disease pathogenesis. This study was conducted on 20 RA patients in addition to 10 healthy subjects as a control group. All patients were subjected to full history taking and thorough clinical examination. Assessment was done using modified DAS far disease activity, Speed severity index [SSI] for disease severity, and Larsen score for radiological assessment of the plain x-ray findings of both hands. Assessment of CD34+ stem cells count in the PB was done by using fluorescence-activated cell sorting [FACS]. In this study there was a significantly higher count of CD34+ stem cells in the PB of RA patients compared to the controls. Stem cells absolute count and percentage were significantly negatively correlated with modified DAS, SSI and Larsen score. Bone marrow stem cells [CD34 cells] could play a crucial role in RA. Their level is elevated in the PB of RA patients in comparison with controls. It is suggested that the reduced number of CD34[+] cells in the PB of patients with more severely destructed joints is due to their recruitment to sites of inflammation. Studies are required to further investigate the role of the bone marrow and stem cells in the disease pathogenesis of RA. It could be a future target of treatment in these patients. Nephrogenic ascites is a clinical entity that manifests as refractory and exsudative ascites with unknown etiology in patients with end stage renal disease and often undergoing hemodialysis. This entity presents in practice many diagnostic and therapeutic difficulties. The aim of this study is to focus on these difficulties through a new observation. We report one case of nephrogenic ascites in chronic renal failure related to an idiopathic neurologic bladder. It's a 38 years old patient on hemodialysis for three years who consulted for exsudative ascites with a low rate of leucocytes. We conclude that nephrogenic ascites is rare. Its diagnosis is an exclusion diagnosis based on exclusion of other causes of ascites, particularly exsudative forms with low leucocytes rate. Its management is based essentially on renal transplantation and its prognosis is very poor.

Abstract:
To determine the information about myths regarding asthma among internet users. An open access internet based close ended survey was hosted on a website which included questions related to common myths regarding asthma. Data was entered automatically into a database at the hosting servers. The survey invitations were sent by email by the authors with request to forward to the contact lists of recipients. After closure of survey, data from responses were recoded into new variables as correct and incorrect using the key made by the authors. Frequencies of correct responses were reported and analyzed on the basis of gender, educational status and profession.  [17.1%]. Frequency of correct responses was better in males. Lowest correct responses were given by unemployed and best responses were given by doctors. Self-employed persons fared better than bankers and people associated with education.Surprisingly nonmedical students fared better than medical students. There is a need to increase public awareness regarding asthma, as the status of relatively educated internet users is also inadequate.
diagnosis 47 year old patient with pseudo-asthma.
Altinsoy, Bulent; Altinta, Nejat; Celik, Zeynep Sonmez E-mail:balt1907@yahoo.com Afyon Chest Disease Hospital -Department of Pulmonary Disease 14 April 2008 were downloaded from its website. Each practiced item in our guidelines was compared with its equivalent of NICE guidelines, absent equivalent NICE guidelines on our list were immediately added and implemented. To ensure compliance, follow-up audits took place every 3 months for an 18-month period. Benchmarking demonstrated that most steps taken in our hospital match those of NICE guidelines, except for guidelines governing the preoperative phase. This phase was added to our policy and procedures guidelines and immediately implemented. The follow-up audits carried out every 3 months showed that the incidence of hypothermia fell from a previous 1.5 to 0.3%. Benchmarking is an evaluation of the current position of own practice compared to best practice to identify areas and means of performance improvement. Benchmarking must be part of quality improvement programs in healthcare. In this study, improvement in the service delivered to patients resulted in a drop in the incidence of inadvertent perioperative hypothermia. etiological backgrounds. To evaluate the pulmonary function changes during both rest and integrated cardiopulmonary exercise in patients with thalassemia major, we studied 30 thalassemia major cases with mean age of 18 +/-13.34 years. Nineteen healthy subjects were enrolled as a control group. Routine laboratory tests as well as assessment of pulmonary function test during both rest and integrated cardiopulmonary exercise were performed for cases and controls, Both forced vital capacity [FVC] and forced expiratory flow in the first second [FEV1] were significantly reduced in cases than in controls [p<0.01 for both], pointing to a restrictive pulmonary dysfunction. Seventy percent of cases had FVC below the normal predicted value. Functional capacity, anaerobic threshold and °2 pulse were significantly reduced in cases than controls [p<0.05]. There is a statistically significant inverse correlation between serum ferritin levels and functional capacity. In the studied thalassemics, restrictive pattern of pulmonary dysfunction is the predominant abnormality. Poor cardiopulmonary exercise performance occurs and is multifactorial. and birth process. The aim of this study was to determine the types and incidence of BF in two teaching hospitals. In a retrospective study all of the delivery files were reviewed in the birth and nursery rooms in two teaching general hospitals from Aug. 2006to Sept. 2007. Parameters related to mothers and neonates including the type of delivery presentation, long bone fractures, birth weight, and the known diseases of mother were recorded. During one year, 10722 deliveries occurred, 7823 of them were by vaginal and 2899 others by cesarean section. Twenty one deliveries were complicated by fractures [1.96%], 15 in clavicle and 6 in humerus. No statistically significant risk factors were noted with respect of known risk factors. Clavicle was the most common site of birth fracture, and many of these injuries occurred without a known risk factors. We conclude that most birth fractures are unavoidable or unpredictable, but every effort must be made to detect the high risk mothers and neonates before delivery. In these cases the cesarean section may be preferred as a safe method for neonate delivery.
Constitutional. Usually early diagnosis and treatment is worthwhile. We studied children with Constitutional short stature who came to the outpatient clinic of Pediatric Endocrinology in Loghman hospital between 2002 and 2008. Their final height has evaluated after puberty. SDS for the first and final height of the patients and their parents' height was calculated. Forty-nine patients [35 boys and 14 girls] were studied. Mean chronological age at the time of referral was 13.4 +/-1.4 years, mean delay of the bone age 2.6 +/-1.4 years, mean height 141.9 +/-7.5 cm, mean SDS of the first height -2.6910.69, mean parental height 163.8 +/-3.9 cm and SDS for parental height was -0.85 +/-0.47. Mean age at the time of evaluating final height was 18.7 +/-0.5 years and mean SDS for the final height was -1.23 +/-0.89 cm. All patients in our study reached their excepted final height. In this study final height of 9 patients [18.4%] was over 2 standard deviation lower than the mean of the community. Although, all of the patients reached to the normal range of final height, it was in the lower limit of the range. It seems medical interventions could be implemented for patients, whose first height was much lower than the mean.  -8.84]. Preoperative assessment shows no statistical significant difference as regarding cognitive, affective, behavioral and evaluative components of body image between both studied groups. While in postoperative assessment, women in MRM group showed higher levels of body image distress among cognitive, affective and behavioral aspects. For the evaluative aspect, there was no statistical significant difference between both groups. Body image is as important for postmenopausal women as for younger women. Even in developing countries, where the concept is ignored, we should not deprive postmenopausal breast cancer cases from their right of a less mutilating option of treatment as BCT. 2011; 12 (5): 513-519 (35 ref.) Keywords: Blood Glucose-drug effects; Lipids-blood; Diabetes Complications-drug therapy; Diabetes Mellitus, Type 2-blood; Vitamin D-analogs and derivatives; Diabetes Mellitus, Type 2-drug therapy; Hyperlipidemias-drug therapy Abstract: Vitamin D deficiency is prevalent worldwide. Low 25 hydroxyvitamin D3 concentrations inversely associated with type 2 diabetes, metabolic syndrome and insulin resistance. The aim of this study was the evaluation of effects of oral 1, 25 [OH] 2D3[ calcitriol] treatments on glycemic control and lipid profiles in patients with type 2 diabetes. This was an interventional study, conducted in Ghaem Hospital, Mashhad, Iran on 58 type 2 diabetic patients. Patients underwent calcitriol treatment with 0.5 microgram per day for 8 weeks. In all cases, clinical parameters including weight, systolic and diastolic blood pressure and laboratory parameters including levels of fasting blood glucose, insulin, lipid profile, calcium, phosphorous, HbA1C and insulin resistance [HOMA-IR] were measured, before and after the treatment period. The two sets of results were then compared with one another. Following treatment with calcitriol, FBS, HbA1C, Cholesterol, triglycerides and insulin resistance decreased but the changes were not significant [p>0.05]. LDL and diastolic blood pressure decreased significantly after treatment with calcitriol. [p=0.02 and 0.04 respectively]. Supplementation with active form of vitamin D did not have a significant effect on glycemic control but may be effective in control of hyperlipidemia and blood pressure in type 2 diabetic patients, findings which need to be confirmed in large randomized trials. Abstract: Most of pancreatic cysts are in fact pseudocysts. Only 10 to 20% are real cystic tumors. Intraductal papillary mucinous tumors of the pancreas represent nearly 15% of them. To illustrate, by an observation, the difficulties to diagnose a cystic tumor of the pancreas. We report the case of a 55 year old woman complaining of epigastric pain for one month with an elevated pancreatic enzymes level. Ultrasonography and computed tomography scan showed two cystic formations measuring 6 and 7cm localized respectively in the head and the body of the pancreas. The diagnosis of pancreatic pseudocysts was maintained. The appearance of a jaundice made us think about a pseudocyst's compression of the common bile duct. A cysto-gastric anastomosis was made. The recurrence of the jaundice associated to diabetes and a general state deterioration led to the practice of magnetic resonance cholangiopancreatography. It revealed an intraductal papillary mucinous tumor of the pancreas affecting secondary ducts. The presence of a peritoneal carcinosis led to therapeutic abstention. The diagnosis of intraductal papillary mucinous tumor of the pancreas must be referred to in case of pancreatic cystic tumor without extrapancreatic necrosis. This kind of tumor can simulate a pancreatic pseudocyst. Keywords: Cell Cycle Proteins; Immunohistochemistry; Cyclin E; Recurrence; Prognosis Abstract: Molecular markers that predict prognosis more than stage and grade remain the elusive holy grail of renal cell carcinoma [RCC researchers]. Many molecules have been identified, as a consequence of the elucidation of the molecular biology of RCC progression and metastasis, but few have remained significant above clinical and pathologic factors in multivariate analysis. The goal of the study was to evaluate Immunohistochemical expression of the cellcycle regulatory proteins p27 [Kipl] and cyclin E in normal human kidneys and renal cell carcinoma [RCC] tissues. Association was analyzed with cancer clinical parameters. We have examined the protein contents of cyclin E and p27 in 57 cases of RCCs, using immunohistochemistry. We found significantly increased expression of p27 in normal tissue relative to tumor [p=0.015]. Low protein content of p27 was associated with high TNM stage, lymph node status and poor prognosis for patients with renal cell carcinoma. No significant association with grade, gender or age we further observed substantial differences in the pattern of G1/S regulatory defects between the different RCC subtypes. The majority of both conventional and papillary cases expressed p2'7, however, chromophobe tumours generally showed low p27 staining. Conversely, high expression of cyclin E was demonstrated in renal cell carcinoma tissue relative to normal kidney [p=0.027] and was associated with high nuclear grade and stage. No significant association with lymph node metastases, gender, age, tumor recurrence, death or survival. We further observed that papillary RCCs exhibited high cyclin E than other two subtypes. In conclusion, this study shown that cyclin E as well as p27 were deregulated in renal cell carcinoma and that loss of p27[Kipl] expression is a risk factor for the disease recurrence and cancer-related patient death. He presented with pain and deformity of his left hand immediately after road traffic accident. He was unable to move his left hand. X-rays of the affected hand showed volar dislocation of all four medial Carpometacarpal joints. Dislocated joints were reduced, fixed with K-wires and immobilized in slab. K-wires were removed after 8 weeks. Hand function is satisfactory on the follow-up.

Cataract epidemiology
Risk factors associated with pre-senile cataract. Patients excluded from study were with hemorrhage secondary to brain tumors, to trauma, to hemorrhagic transformation of cerebral infarct and with previous history of hemorrhagic stroke. The patients' data was collected in a well designed Proforma. The volume of hematoma was calculated according to ABC/2 formula. Quantitative variables were described as mean with +/-SD. While qualitative variables were described as frequency and percentages. Age, GCS score and volume of hematoma compared to the outcome of the patients by receiver operating characteristics [ROC]

Cesarean Section
Prophylactic intravenous ondansteron and nalbuphine for reduction of subarachnoid fentanylinduced pruritus in patients undergoing elective cesarean delivery. However, it has a frequent incidence of pruritus and a substantial incidence of nausea and vomiting. tn this placebo controlled study, we compared the prophylactic efficacy of ondansetron and nalbuphine for the prevention of intrathecal fentanyl-induced pruri tus after cesarean delivery. Ninety elective parturients were assigned to one of the groups: Group 0 [Ondansetron 8mg IV n=30], Group N [Nalbuphine 4mg IV n=30] and Group S [Saline 0.9% IV n=30] as placebo. The study drugs were administered immediately after the umbilical cord was clamped. The occurrence of pruritus, nausea, pain and adverse reactions from ondansetron and nalbuphine was evaluated by pruritus score, 4point rating score and visual analog scale respectively, at 15 minutes in the first hour after the injection of the study drugs. Afterward, evaluations were performed at 1, 2, 3 and 4 hours after the administration of study drugs. The overall incidence of pruritus, it was significantly more frequent in Group S [62%] compared with both Group 0 [43%] and Group N [42.5%]. The incidence of pruritus during the different study intervals showed significant increase in Group S compared with the other groups mainly at 45mm and 1 hour. The pruritus score was significantly different between Group 0 and Group S and between Group N and Group S [p<0.0S] respectively, it was mostly mild in Group 0 and Group N and mostly moderate in Group S. Treatment for pruritus was requested by patients in, 10%, 11% and 29% of patients in the Group 0, Group N and Group 5, respectively. There was no significant difference in the overall incidence and the severity of nausea andlor vomiting at different time study intervals for all groups. However, the number of patients requesting treatment for nausea and/or vomiting was significantly less in Group 0 and Group N when compared with Group S. No significant adverse reactions related to the study drugs reported during the different study intervals. Although IV ondansetron and nalbuphine significantly decreased the incidence of of fentanyl-induced pruritus more than placebo after cesarean delivery, further studies are recommended to show the other possible mecha nisms might be involved in the pathogenesis of fentanylinduced pruritus. . Thus, the sample size studied was 2331 cesarean deliveries. Approval of the ethical committee for publication was obtained. The CS rate exceeded the acceptable 15% rate suggested by the World Health Organization [WHO] at our institution, and probably in many other hospitals in Saudi Arabia. Fetal distress, previous single CS, previous multiple CS, and breech presentation were the most common indications for CS. This high rate of CS will continue to increase due to the tendency to have large families, and the self-perpetuating character of each CS. efforts should be made at each hospital level, and nationwide, to control this tendency. Overweight-prevention and control; Body Mass Index Abstract: Since the prevalence and severity of childhood obesity is increasing, understanding the effective factors for prevention of this disorder is important. A total of 513 students of both sexes in the first year of primary schools, were recruited in this cross-sectional study. They were chosen randomly from 19 regions [of the ministry of education] from Tehran city. Their weight and height were measured, and information on infant birth and feeding characteristics [birth order, birth weight, the type of feeding in infancy, the duration of exclusive breast feeding, the duration of breast feeding and formula feeding] activity levels, the timing of the introduction of complementary foods were obtained. Descriptive statistical methods such as frequency distribution table, %C2 test and central and dispersion parameters were used to describe samples. Eight percent of the children were overweight and 11.7% were obese. There was no significant relation between the type of feeding [breast or formula feeding] and children's BMI. The duration of breast feeding was not significantly associated with children's BMI, Children's BMI had a negative linear association with the duration of exclusive breast feeding [r=-0.151, P=0.0001]. The duration of formula feeding was associated with children's BMI [r=0.108, P=0.007]. Children's BMI had an inverse linear relation with the time of introduction of complementary foods [r=-0.128, P=0.002]. This study shows the importance of duration of breast feeding in reducing the risk of childhood obesity.

Cholangiopancreatography, Endoscopic Retrograde adverse effects
Reduction of radiation doses to patients and staff during endoscopic retrograde cholangiopancreatography.
exposure for patients and staff. While optimization of the radiation dose is recommended, few studies have been published. The purpose of this study has been to measure patient and staff radiation dose, to estimate the effective dose and radiation risk using digital fluoroscopic images. Entrance skin dose [ESD], organ and effective doses were estimated for patients and staff. Fifty-seven patients were studied using digital X-ray machine and thermoluminescent dosimeters [TLD] to measure ESD at different body sites. Organ and surface dose to specific radiosensitive organs was carried out. The mean, median, minimum, third quartile and the maximum values are presented due to the asymmetry in data distribution. The mean ESD, exit and thyroid surface dose were estimated to be 75.6 mGy, 3.22 mGy and 0.80 mGy, respectively. The mean effective dose for both gastroenterologist and assistant is 0.01 mSv. The mean patient effective dose was 4.16 mSv, and the cancer risk per procedure was estimated to be 2 x 10[-5]. ERCP with fluoroscopic technique demonstrate improved dose reduction, compared to the conventional radiographic based technique, reducing the surface dose by a factor of 2, without compromising the diagnostic findings. The radiation absorbed doses to the different organs and effective doses are relatively low.  9], respectively. Surgical treatments included cysts excision with Roux-en-Y hepaticojejunostomy in three patients, cysts excision with cholangiojejunostomy in two patients, partial cyst excision with left lobectomy and Roux-en-Y hepaticojejunostomy, pancreatoduodenectomy, chemotherapy with implantable drug delivery system via hepatic artery and portal vein, and choledochotomy with T-tube drainage and metastatic lymph node biopsy in one patient, respectively. The survival time was from three months to 66 months with the mean survival of 19.1 +/-18.6 months. Choledochal cyst is a premalignant lesion and the incidence of malignancy increases remarkably with the increase in age. Patients require close monitoring so that recurrent carcinoma of the remnant bile duct can be identified as early as possible. improved dramatically in the past decades. Despite excellent long-term survival for patients with choledochal cyst who undergo elective surgery, many significant complications can occur in the patients being operated in emergency for rupture of the cyst. Spontaneous rupture of the cyst is one such problem resulting in considerable morbidity and mortality in these patients. Majority of surgeons manage these cases with T-tube external drainage. The conventional methods of T-tube placement for long period has remained simple as described in choledochotomies where there is no deficit of the walls of common bile duct [CBD]. The present technique has been designed specially for the cases of ruptured choledochal cyst, where the wall of the CBD gets necrosed leaving behind a long gap between the two ends. In these cases, placement of T-tube with conventional method is not possible because there is no wall to suture together, and make the CBD water tight again to prevent leakage of bile. We found only two patients of spontaneous rupture of choledochal cyst with a long gap between two ends of CBD because of necrosed anterior wall. In both of these patients, it was not possible to put T-tube with traditional method and one would have to opt for primary definitive repair despite poor general condition of patients. . Interactions may result without recognition which may lead to unforeseen toxicity, untoward effects or even therapeutic failure. Therefore, studies were conducted to investigate the effect of Ciprofloxacin on the pharmacokinetics of Carbamazepine in healthy adult male volunteers. The main objective of this study was to generate new knowledge regarding CBZ and Ciprofloxacin interaction for physicians and research workers dealing with these medicines. Eight healthy adult male volunteers were selected to assess the effect of ciprofloxacin on the pharmacokinetics of Carbamazepine. After overnight fast the selected male volunteers were given CBZ orally. Blood samples were drawn at different time intervals after medication. Then the same volunteers were given CBZ along with ciprofloxacin. Blood samples were again drawn at the same time intervals as done previously. Plasma was separated from the blood samples. Concentration of CBZ in the plasma samples was determined by using HPLC technique. Results of the present study indicated that ciprofloxacin significantly increased the plasma concentration of CBZ when given concurrently to the healthy adult male volunteers. Ciprofloxacin increased C[max], AUC and t [1/2] while it decreased the CL and Vd of CBZ when administered concurrently to the adult volunteers. Change in pharmacokinetic parameters was due to slow metabolism or elimination of CBZ when given concurrently with ciprofloxacin to the adult volunteers. This is probably due to the inhibition of CYP3A4 isoenzyme by ciprofloxacin which is responsible for metabolism of CBZ. Ciprofloxacin increased the plasma concentration of CBZ so dose adjustment as well as drug monitoring of CBZ is required when both the drugs are given concurrently. The knowledge regarding interaction between ciprofloxacin and CBZ would be helpful for the pharmaceutical industries, physicians and a blessing for the patients. To assess the bioequivalence of tablets formulations of Clarithromycin 500mg each of test and reference products. A single post oral dose of each formulation was given to 14 male healthy volunteers. The study was conducted phase 1, open-label, randomized , complete twoway crossover designed with 7 days wash out period. The plasma concentration of Clarithromycin was quantified by validated microbiological assay method. The precision of the method was evaluated using calibrated 14-hydroxyClarithromycin concentration was detected semi quantitatively as equivalent of Clarithromycin /ml. The peak plasma concentrations of [3.63 +/-0.80 ug/ml] and [-3.31 +/-0.35 ug/ml] was attained in about 1.42 hours and 1.49 hours for both test and reference Clarithromycin tablets respectively. The mean +/-SD values for total area under the curve [AUC] were 22.07 +/-4.90 and 20.16 +/-2.35 h.mg/L for both test and reference tablets respectively. This study indicated that the differences in all the bioequivalence parameters for test and reference Clarithromycin formulations are statistically non-significant; hence both formulations are considered bioequivalent.

Cleft Palate rehabilitation
Maxillofaciqal rehabilitation of a large cleft palate using fixed-removable prosthesis. However, in certain clinical scenarios, removable and/or fixed obturator prosthesis can be the only option available. The management of these critical cases should be planned after a detailed investigation and diagnosis, evaluation of the subject's expectations and demands, socioeconomic status, available technical facilities and utilization of a multidisciplinary team approach. This report discusses the intra oral rehabilitation of a complete, unilateral cleft palate along with dento-alveolar rehabilitation. A fixed-removable prosthesis was provided to gain functional as well as aesthetic results without extensive surgical correction. colleagues, auxiliaries and the community. Considering the scientific, legal and social changes, the deontology code should be revised periodically. The first Tunisian Medical Code of Deontology [TMCD] was promulgated in 1973 and abrogated in 1993 by the new Code. This version has never been reviewed and does not seem to fit the current conditions of medical practice. The TMCD does not contain texts referring to information given to the patient, pain control, palliative care and management of the end of life as well as protection of medical data. Furthermore, the TMCD does not include rules related to tissues and organs transplantation and medical assisted human reproduction in accordance with Tunisian legal texts. We aim in this paper at analyzing the insufficiencies of the TMCD and suggesting modifications in order to update it. . report a new case We describe the case of a 35 years old man presenting previously an anterior infarct with a tighten stenosis in the middle part of the left anterior descending artery [LAD]. The stenosis was treated percutaneously with a bare stent deployment. During an acute exacerbation of UC, the patient developed an acute coronary syndrome with ST elevation secondary to a late stent thrombosis, needing a primary coronary angioplasty. Following course is favorable. Based on this case, we'll discuss the relationship between UC and thrombosis, and therapeutic considerations inherent to thrombotic and bleeding risks. Abstract: Evaluate and show the importance of CRP, ACE and LDH in colorectal cancer. Our prospective study interested 30 patients, from 26 to 93 years old and present a colorectal cancer, confirmed histologically, during the period going from March 2003 to April 2004, and 30 healthy controls. A blood sample was collected from each patient respectively in preoperative, 48 hours before any treatment, and 6 months after surgical operation to measure serum LDH, CRP, and ACE. The mean serum of LDH, CRP and ACE values were significant higher in patients than those in controls [p respectively: 0,01; 0,04 et 0,01]. Moreover, the level of three parameters varied significantly with stages of tumor. After follow up, we have noticed e normalisation of the mean of the level of LDH, CRP and ACE with favorable evolution. Analysis of survival at 2 years showers that survival is better in patients with normal value of CRP, ACE and LDH. CRP, LDH and ACE values have a great importance during follows up after colorectal cancer surgery.

Lavage-methods; Therapeutic Irrigation; Review Literature as Topic
Abstract: Pulmonary alveolar proteinosis [PAP] is a rare disease that affects young population usually in the age group of 20-40 years, characterized by the deposition of lipoproteinacious material in the alveoli secondary to abnormal processing of surfactant by macrophages. We report a case of a 15-year-old female who had history of cough with sputum for 3 days along with fever. She was seen in another hospital and was treated as a case of pneumonia where she received antibiotic but with no improvement. Computerized tomography [CT] chest showed diffuse interlobular septal thickening in the background of ground glass opacity giving a picture of crazy paving pattern which was consistent with the diagnosis of PAP. The patient was scheduled to undergo, first right-sided whole lung lavage [WLL] under general anesthesia. Endobronchial intubation using left sided 37 Fr double lumen tube. Continuous positive airway pressure [CPAP] as described in our previously published report was connected to the right lumen of the endobronchial tube. CPAP ventilation was used during the suctioning of lavage fluid phase in order to improve oxygenation. WLL was done using 5 L of warm heparinized saline [500 i.u/litre]. The same procedure was repeated on the left side using 6 L of heparinized normal saline solution. In conclusion, anesthesia in alveolar proteinosis for patients undergoing WLL is challenging to the anesthesiologist. It requires meticulous preoperative preparation with antibiotics, mucolytics and chest physiotherapy. Also it requires careful intraoperative monitoring and proper oxygenation especially during the suctioning phase of the lavaged fluid. With this second case report of successful anesthetic management using the modified CPAP system we recommend with confidence the application of CPAP ventilation to improve oxygenation during WLL.

Contraceptives, Oral adverse effects
Desogestrel+ethinylestradiol versus levonorgestrel +ethinyles tradiol Which one has better affect on acne, hirsutism, and weight change. Six months later, changes of weight, acne, and hirsutism severity, as well as serum titers of sex hormone-binding globulin [SHBG] and free testosterone were compared between the 2 groups. Forty-five women were evaluated in the DSG+EE OCP group, and 46 women in the LNG+EE OCP group. The BMI was significantly higher in the second group [p=0.000] after 6 months duration. Likewise, the decrement of acne and hirsutism seventy was significantly higher in the DSG+EE users [p=0.000]. Mean changes of serum free testosterone [f=0.967] and SHBG [f=0.916] were comparable between the 2 groups. In comparison with the LNG+EE OCP, the DSG+EE OCP is a contraceptive pill that significantly decreases the severity of acne and hirsutism, without any significant change in weight. Abstract: This study was performed to study the impact of two different cardiac rehabilitation programs [high frequency versus low frequency exercises] on the cardiopulmonary outcome of patients with stable coronary artery disease. Relation of these exercise programs on the recurrence of myocardial morbidity was also defined. Fifty patients with stable ischemic heart disease were divided into two groups: Group 1: including 25 patients who were subjected to a six-week high frequency exercise training and Group 2: including 25 patients who were subjected to a six-week low frequency exercise training. All the patients were subjected to full clinical assessment, laboratory investigations and Doppler echo cardio graphic studies. A statistically significant difference [p<0.05] was found after both the cardiac rehabilitation programs were instituted regarding all the exercise test characteristics studied. As regards quality of life [Qol] questionnaire there was also a highly statistical significant difference p<0.001]. Exercise training has a welldocumented efficacy in the overall rehabilitation of patients with coronary artery disease. Beneficial effects of exercise training are evident along the different parameters of cardiac functions i.e. exercise capacity, exercise tolerance, cardiac hemodynamics as well as the patient's QoL.

Coronary Artery Disease
Sepsis affects about 700, 000 people annually in the United States alone. The neuropeptide nociceptin/orphanin [N/OFQ] and substance P [SP] are two neuropathies involved in control of pain pathways. They have been implicated in neural, immune, inflammatory process and cardiovascular system function. In this study we evaluated the N/OFQ plasma levels and SP serum levels in critically ill patients with severe sepsis. Blood samples were collected from twenty patients with the diagnosis of severe sepsis. They were admitted in the intensive care unit. Plasma N/OFQ concentrations were determined by radio immunoassay. SP in the serum was evaluated by enzyme-linked immunoassay. Samples were collected within twenty four hours of diagnosis of sepsis in all cases. Another set of samples were collected in nine patients before death [non-survivors] and eleven patient upon recovery from severe sepsis [survivors]. The results revealed significant high levels of N/OFQ in patients with severe sepsis [non-survivors] compared with the other group of survivors [p<0.031]. The levels were significantly high in cases near death [non-complications, and multiple modalities of management. Its multiple implications are still unaddressed. Since all the patients do not show a good response to medical modalities of treatment, a significant percentage of these patients are referred to the surgeon for the palliation of complications or for the ultimate curative treatment. Since most surgeons come across such patients only rarely, it is sometimes difficult for them to choose the appropriate procedure at the time of need. Moreover, the various surgical modalities available for the different presentations and complications of the disease have not been adequately discussed. The aim of this review is to offer insight and a detailed account of the management of CD from a surgical perspective. This review offers an overview of the various surgical options available, their utility in context, and an approach to various scenarios of complicated CD.

Crowns
Comparison of convergence angle of prepared teeth for full veneer metal ceramic crowns. and also the effect of tooth position and operator experience on convergence angle. Analytical study. The study was carried out at the Dental clinic, The Aga Khan University Hospital, Karachi, from January to June 2007. A minimum of 75 crown preparation dies including 25 dies in each group of teeth [anterior, premolars and molars] were collected retrospectively which were prepared by residents and specialists of operative dentistry. AutoCAD 2007 software was used for measurement of convergence angle. One sample t-test was applied to compare the mean practiced convergence angle values with its recommended values. Two way ANOVA was applied to measure difference in convergence angle values with respect to operator experience and tooth type with the level of significance being a=0.050. Mean reported convergence angle value was 22.72°, which was significantly greater [p < 0.001] than the recommended values. Statistically significant difference in convergence angle was found between anterior vs. molar teeth and between premolars vs. molar teeth [p=0.0001 and p=0.002, respectively]. There was a considerable disparity between the convergent angles values recorded in this study and the recommended guidelines. Measured convergence angle values were greater for posterior teeth as compared to the anterior teeth.

Neoplasms-immunology; Case-Control Studies
Abstract: To determine the cryptosporidiosis in immunocompromised and cancerous children referred to oncology center of Imam Khomeini hospital in Urmia city, West Azerbaijan province, Northwest Iran. This case -control study was performed on 72 children [case] with cancer who were referred to oncology clinic of Urmia Imam Hospital. Another 30 children with normal immune system were selected as controls. To determine the amount of contamination with Cryptosporidium, two fecal specimens were collected from each patient and control group. After being concentrated with Formalin-Ether, these specimens were examined using modified acid fast method. Three cases of cryptosporidiosis were seen in the patients [4.16%]. Of these, there were two patients from the rural area and one from urban region. There was no significant relationship between the presence of cryptosporidiosis and living in rural or urban areas. No oocystic form of Cryptosporidium was detected in the control group. Since children suffering from cancer are at risk of to acquiring many infections, general preventive measures against infection must be taken and patients must be screened for opportunistic parasites during chemotherapy. Abstract: Intravenous Ciclosporin is a promising alternative, rapidly effective, for patients with severe steroidrefractory colitis previously facing only surgical options, however its use is controversial because of the frequency of adverse effects and the doubt about the long-term response. This review will provide information on clinical pharmacology, clinical indications for use, methods of dose adjustment, monitoring of metabolites for efficacy and for potential side effects and the adverse event profile of ciclosporin in severe refractory colitis. Literature review. Toxicity is dominated by opportunistic infections. Renal and neurotoxicity are also recognized. Risks of toxicity can be reduced by using lower doses, by oral microemulsion or by monotherapy without corticosteroids. The drug should not be continued for more than 3 to 6 months. As a bridge to other maintenance therapy such as azathioprine or 6mercaptopurine ciclosporin can be an effective treatment. CSA is a viable alternative to emergency colectomy in severe UC in the short term. Although these benefits are not maintained in all patients, more than a half will also avoid colectomy in the longer term. Careful selection and monitoring of patients, use of lower doses, and oral therapy will help to reduce side effects. methanolic leaf extract of Cyperus scariosus. Antinociceptive activity was determined using a model of acetic acidinduced gastric pain in mice and anti-hyperglycemic activity through glucose tolerance test using glucose loaded mice. In writhing assays induced by acetic acid, the methanolic leaf extract showed dose dependent significant pain inhibition compared to control. The maximum writhing inhibition [46.62%] was found at a dose of 200 mg/kg body weight which was less than that of the positive control, aspirin [56.74%], when used at the same dose. Anti-hyperglycemic activity of the extract was also found to be significant in mice loaded with glucose at doses of 200 and 400 mg/kg body weight. Maximum tolerance [42.86%] was showed at 400 mg extract/kg body weight, which compared favorably with that of glibenclamide at 10 mg/kg body weight [57.62%]. In summary, the methanol extract of C. scariosus leaves has had beneficial effects as a pain reliever and also in reducing the elevated blood glucose level of hyperglycemic mice.
Iranian population. This is a cross-sectional survey. A consecutive sample of women who were routinely referred to health care centers for immunization of their two month infants after delivery were enrolled in this study. They were interviewed by a designated research nurse using the-Edinburgh-Postpartum-Depression-Scale [EPOS] and Abused-Assess-Scale [AAS]. Nearly two-third of women reported some kind of violence; 59.7% had experienced one or more types of emotional abuse, and 37.0% reported physical violence during the pregnancy. The prevalence of postpartum depression was approximately 45.8%. The highest odds ratio of postpartum depression were associated with husband's drug abuse, domestic violence, woman's education. The high prevalence of different types of domestic violence during pregnancy and postpartum depression and their significant relationship should be regarded as a priority for local and possibly National Health Service policy.
Abstract: Diabetes mellitus [DM] and glucose intolerance are commonly associated with liver cirrhosis and considered as important prognostic factors in liver cirrhosis. To determine the more sensisitive test for diagnosis of diabetes mellitus in liver cirrhosis. A total of 92 patients with liver cirrhosis were enrolled in a descriptive-analytic study. The levels of FBS and blood sugar two hours after ingestion of 75gr glucose [OGTT] were measured. FBS and 2-hPG concentrations were analysed for all subjects. Chi-square test and Fisher's exact test were used to analyse the data and p values <0.05 were considered as significant. A total of 92 cirrhotic cases with mean age of 54. Abstract: To assess the effect of an intervention targeted at primary care physicians [PCPs] in order to improve their management of diabetic patients. Diabetic patients seen by PCPs in King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia from January 2008 to July 2009 were included in this prospective cohort study. The PCPs were divided into intervention and control groups. The intervention group with the help of an assistant, utilized a customized designed computer program generating a checklist for the PCPs. The list included clinical and biochemical screening tests needed for the patient's current visit, according to evidence-based diabetes guidelines. For the control group, no assistant was used. At the end of one year, an independent reviewer evaluated the patients' files in both groups to assess the adherence to diabetes guidelines. We enrolled 162 patients in the control group and 517 patients in the intervention group. The intervention significantly improved the percentage of patients being screened for diabetic complications; retinopathy from 24.7-98.5%, neuropathy from 25.9-92%, and nephropathy from 37.8-73.7%. There was no improvement in glycemic control in both groups and glycosylated hemoglobin level [HbAlc] values were still above the 7% target. Management of diabetic patients in the primary care clinics is below standard. The intervention applied was effective in promoting better adherence to evidence-based diabetes guidelines. health sector because of the significant contributions that public health workers could do if properly trained, as they are placed close to the victims and possibly well acquainted with the community and its inhabitants. Community health nurse has a crucial role in prevention and intervention strategies to minimize such a problem. This can be achieved through her contacts frequently with women to identify, screen and support those experiencing domestic violence. To assess the impact of domestic violence against Saudi Arabian Married women on their reproductive health outcomes. Cross sectional descriptive design was used in this study. Setting: The study was conducted in two main settings namely King Fahd Hospital of the University [KFHU] and Family and Community Health Center FAMCO. AlKhobar, Saudi Arabia. Convenient sample consisted of 350 married women aged 15 to 49 during third trimester of pregnancy up to two months postnatal women participated in this study. Two tools were used in this study namely: "Structured Interview Sheet, to assess socio-demographic characteristics and reproductive health history, Domestic Violence Assessment Questionnaire, to assess different forms of domestic violence. According to the study, women who have low family income, low education and who first experience marriage suffer from violence more frequently. Abused women have higher numbers of live births, begin antenatal care late and have more number of abortions than non abused women. In addition, abused women have unplanned or unwanted pregnancy and lower using contraceptive methods. electrical stimulation on isokinetic strength for healthy quadriceps femoris muscle. Twenty healthy volunteers [range, 20-25; mean age, 20.9 +/-1.1 yr] participated in the study. All participants were divided into two groups [Group I and Group II]. Each group consisted of 10 subjects. While Group I received electrical stimulation with Russian current, Group II trained with maximal volunteer isometric exercises [10s contraction and 50 s relaxing periods with 10 repetitions] for three days per week for six weeks. Before and after the training program, each subject was evaluated using the following tests; anthropometrical measurements, fixed weight repetition, step-up, decline squat, single leg hop, and isokinetic assessments [peak torque, work per repetition, initial peak torque, fatigue index, total work done, %BW]. After a 6-week training program, significant differences in terms of physical functioning and isokinetic parameters in the two groups were found [p<0.05]. Physical functioning and isokinetic strength of quadriceps femoris muscle were seen to be increased in two group after training programs [p<0.05]. There were no significant differences between the groups [p>0.05]. Quadriceps femoris hypertrophy was only found in electrical stimulation group [p<0.05]. The results obtained from this study show that the two strengthening techniques just used in the study can be used to improve muscle strength, performance and isokinetic parameters in healthy quadriceps femoris muscle [p<0.05]. But, there is no superiority on each other. In conclusion, these results indicate that electrical stimulation and maximal volunteer isometric exercises can be used to increase isokinetic strength as an alternative for isokinetic dynamometer in clinical setting.

Dietary misconceptions in
prediction of severity of portal hypertension and presence of esophageal varices. Normal hepatic venous waveform shows a triphasic pattern. In cirrhosis, this pattern changes to a biphasic or monophasic pattern. We aimed to study the sensitivity of loss of normal hepatic venous waveforms in predicting large varices in a cross-sectional analysis. All patients, admitted or attending the outpatient department, with a diagnosis of cirrhosis were included in the study. All patients were subjected to oesophagogastroduodenoscopy and Color Doppler examination, and waveform patterns in hepatic vein were recorded. The sensitivity and specificity of changes in waveform in detecting large varices were studied. A total of 51 cases were examined.  Abstract: Non-alcoholic fatty liver disease [NAFLD] is a denomination that encompasses clinical and pathological spectrums, ranging from simple steatosis to Non-alcoholic steatohepatitis [NASH] , fibrosis and cirrhosis. Considering the importance of obesity as a risk factor of this disease and oxidative stress, as an effective factor in pathogenesis, coupled with inflamation and its progression to non-alcoholic steatohepatitis, this study was conducted to investigate the rate of overweight and obesity and oxidative stress status in patients with nonalcoholic fatty liver disease. In this case-control study, 50 NAFLD patients and 48 healthy controls were enrolled. Antropometric measurements were taken, according to standard protocol. Serum hepatic enzymes, lipid profile and total antioxidant capacity [TAG] were determined by the auto analyzer and Serum malondialdehyde [MDA] was measured by the feluorimetry method. Data was analyzed by SPSS [version 11.5], and statistical tests such as T-test and Chi-square were used. Correlations were performed using Pearson's correlation coefficient. Mean BMI was significantly higher in NAFLD patients, compared to controls. There was no significant difference between the two groups in relation to mean serum levels of MDA [p=0.1]. In contrast, the mean serum levels of TAC was significantly lower in patients than in controls [p=0.02]. Based on this study, combating overweight and obesity seems to be a preventive strategy for healthy people, thereby forestalling the progression of this disease. Furthermore, considering the lower level of TAC in NAFLD patients, the use of antioxidantrich foods and supplements can be therapeutically valuable. received a Duloxitine Hcl 60 mg daily for 3 months followed by measuring rCBF. There was a statistically highly significant lower [rCBF] in the thalamus and caudate nucleus in patients as compared to controls [p<0.01] but no such difference in the anterior, lateral and posterior cerebral cortices [p>0.05]. No significant difference clinically or radiologically was found comparing group Ia results before and after 12 weeks. There was a highly significant difference with fatigue and a significant difference as regard neck pain, headache, generalized body ache and morning stiffness when comparing group lb results before and after 12 weeks. The rCBF to thalamus and caudate nucleus showed a highly significant increase in group lb after 3 months. There was a significant difference in number of tender points, the duration of morning stiffness as well as thalamic and caudate blood flow comparing the change in Ia and lb. The decrease of regional cerebral blood flow to the thalamus and caudate nucleus in patients with primary FM may be the cause of their symptoms. Improvement of the symptoms by administration of duloxitine Hcl may be due to improvement of the cerebral blood flow.

Finasteride adverse effects
The effect of different doses of finasteride on epididymis and testosterone and DHT concentrations in rats.
Abstract: Finasteride is a widely used in the treatment of alopecia and prostatic hyperplasia. Our study was conducted to assess the effect of different doses of Finasteride on epididymis, testosterone and dihydrotestosterone concentrations in male Sprague-Dawley rats. This is experimental study conducted where thirty male rats are divided into three groups [10 rats in each group]; high dose, low dose and control groups. During 2 months period, testosterone and DHT were being measured and at the end of the experiment, rats were killed by cervical dislocation. Weight of the organs and histopathological examination were done. DHT was found significantly reduced by finasteride administation. Testosterone was unexpectedly reduced in our study. Reduction in glandular epithelium and stromal component was clearly evident in histopathological examination of the prostate. Weights of seminal vesicles, dorsal prostate and ventral prostate were significantly decreased with finasteride administration. Sperm count and motility were not significantly changed in low-dose finasteride-treated group but there was a significant reduction in sperm counts and motility in high-dose group. Finasteride has significant effects on testosterone, DHT. Also, it can affect epididymal functions if administered in high dose. It is evident from our results that there is a need for further clarification of the relation between finasteride administration and specific parameters in epididymal functions. where thirty male rats are divided into three groups [10 rats in each group]; high dose, low dose and control During 2 months period, Glutathione assay was done prepared blood samples the end of the experiment; rats killed by cervical dislocation. Sperm counts and morphology were assessed. Glutathione were found to be decreased significantly with increasing dose of administered finasteride which indicate statistically significant increase in the ROS levels. On the other hand, sperm motility was negatively affected only in high dose group. Abnormal sperm forms were also significant in the high-dose group. Sperm motility and morphology were not significantly changed in low-dose finasteride-treated group. Finasteride has significant effects on ROS production. Also, it can affect sperm motility and morphology negatively in high doses. Further studies clarifying the exact site and mechanism of action underlying the effects of 5 alpha reductase inhibition on spermatogenesis are needed. The aim of this study was to quantitatively assess the fire and explosion hazards as well as relative classification of such hazards in a petrochemical industry. This was a quantitative study in which the process units were selected based on parameters affecting the risk of fire and explosion. Later, these parameters were analyzed using DOW's fire and explosion index [F and EI]. Technical data to determine the index were obtained through process documents and reports as well as the fire and explosion guideline. Following calculating the DOW's index, the high and low risk process units were determined. The stripper column with a rank of 226 and the naphtha tank with a rank of 64 were determined as the most and least disastrous process units. The level of hazard was determined as severe for columns [F and EI>158], heavy for magna-former reactor and gasoline furnace [127< F and EI</=158], and moderate for hydrodealkylation reactor and naphtha tank [61< F and EI</=96]. The radius of exposure was calculated at 57 meters for stripper column. The fire and explosion index is a suitable measure to determine the high and low risk areas of an industry. The stripper column as the most disastrous process unit needs more sensitive methods for hazard assessment.

Evaluation of the dietary habits, body images and BMI of Turkish University students who live in dormitory.
Yildiz, Emine Akal; Demirduzen, Selahattin; Dogan, Vasfiye Burcu; Duman, Sercan; Turkmen, Nur; Yildiz, Ali Nad E-mail:eakal@hacettepe.edu.tr Hacettepe University -Faculty of Health Sciences -Department of Nutrition and Dietetic non-MDR and MDR isolates of M. tuberculosis. A total of 20 clinical isolates of MTB including 15 MDR and 5 non-MDR were investigated. Ethanolic extract of garlic was prepared by maceration method. Minimum inhibitory concentration [MIC] was performed by using 7H9 middle brook broth dilution technique. MIC of garlic extract was ranged from 1 to 3 mg/ml; showing inhibitory effects of garlic against both non-MDR and MDR M. tuberculosis isolates. Alternate medicine practices with plant extracts including garlic should be considered to decrease the burden of drug resistance and cost in the management of diseases. The use of garlic against MDR-TB may be of great importance regarding public health. Abstract: This study was conducted to provide sonographic measurements of the abdominal esophagus length in neonate and infants with and without gastroesophageal reflux disease [GERD] and to investigate its diagnostic value. GERD severity was also evaluated and correlated with esophageal length. It is a prospective case-control study. This prospective case-control study comprised 235 neonates and infants [120 without reflux and 115 with reflux]. There were 40 children without reflux in each of three age categories: less than 1 month, 1-6 months, and 6-12 months. Of the children with reflux, 40 were less than 1 month old; 37,1-6 months; and 38, 6-12 months. The abdominal esophagus was measured from its entrance into the diaphragm to the base of gastric folds in fed infants. GERD was sonographically diagnosed and confirmed by a barium meal. The number of refluxes during a 10-min period were recorded. Neonates and infants with reflux had a significantly shorter abdominal esophagus than subjects without reflux: the mean difference in neonates, 4.65 mm; 1-6 months, 4.57 mm; 6-12 months, 3.61 mm. Children with severe reflux had a shorter esophagus compared with those with mild and moderate reflux only in the neonate group. Therefore, thinking of GERD and carefully looking for its symptoms is necessary to avoid unnecessary utilization of healthcare resources in children with severe reflux.

Diagnosis, Differential
Abstract: A 63-year-old woman, with a significant past medical history for hypertension, was admitted to surgical department B of Charles Nicolle Hospital suffering since twenty years from diffuse abdominal pain and progressive increase in abdominal volume. No general state deterioration was reported. Abdominal exam showed two palpable masses. The first one localized in the upper right quadrant and measuring 15cm. The second mass, palpable in the left paraumbilical quadrant, measured 20cm. No jaundice was found. Computed tomography evidenced two septated cystic lesions in segment IV and VIII of the liver with peripheral calcification [Fig 1], a multi-cystic formation in the left sub hepatic area and a huge splenic cyst with multiple-septa [Fig 2]. Regarding high prevalence of hydatid disease in Tunisia, all cysts were considered as hydatid cyst. Patient received preoperatively albendazole [10mg/kg/day] during two weeks and was operated on through a median laparotomy. Intraoperative exploration found in the liver four contiguous cysts sitting on segment IV. After sterilization with hypertonic solution, multiple daughter cysts were evacuated. No communication between biliary ducts and cyst cavities was mentioned. Liver cysts were treated by unroofing procedure combined with omentoplasty. In the spleen, there was a cyst of 20cm of diameter suspended to its lower part. A partial resection of splenic cyst was performed after sterilization of cyst cavity and evacuation of daughter cysts. The cyst of the left sub hepatic area measured 10cm of diameter and had a partial contact with the posterior wall of the stomach. After the sterilization of the cyst, its content was aspirated but no hydatid liquid or daughter cyst was recuperated. A cystectomy was performed with a remnant cavity of only 2cm against the posterior wall of the first part of duodenum. The patient had an uneventful postoperative course and was discharged six days later. Pathology of this peritoneal cyst concluded to stromal tumor. The resection of this tumor was incomplete, since then patient was treated with imatinib-mesylate, 400 mg once daily. Computed tomography performed six months post operatively showed no residual tumor [Fig 3]. .05] was found between plasma estrogen and total ghrelin levels. It seems that because of a non significant increase in plasma ghrelin levels in the present study, there was no weight change of subjects during the training program and the short duration of the training program. However, the total ghrelin sub-fractions, acylated and non acylated, may have changed.

Glioma diagnosis [Convulsive crisis of a parturient taken for the account of an eclampsia: discovery of a cerebral tumour in post partum].
silkworm, in experimental acute mice liver injury and explore mechanisms. Mice were divided into five groups: control group, carbon tetrachloride [CC1[4]] group, and three treatment groups that received CC1 [4] and GSTsw at doses of 0.083mg-g[-1], 0.0415 mg-g[-1] and 0.0207 mg-g[-1] for 3 days. ALT in serum, GST, SOD and T-AOC in liver tissue homogenate, and changes in liver pathology in the five groups were studied. CC1[4] administration led to pathological and biochemical evidence of liver injury as compared to untreated controls. GSTsw administration led to significant protection against CCl[4]-induced changes in liver pathology. It was also associated with significantly lower serum ALT levels, higher GST -SOD and T-AOC level in live tissue homogenate. Thus, GSTsw showed protective activity against CCl[4]-induced hepatotoxicity in mice. In patients with rheumatic heart disease having combined mitral and aortic valve disease DVR should be performed whenever indicated as it has similar in-hospital mortality and better late survival as compared to isolated aortic or mitral valve replacement. growth failure and 14 normally growing children of the same age group. socioeconomic level and sex ratio as controls were included in the study. All were subjected to full history taking, clinical examination, anthropometry, laboratory investigations and upper endoscopy with gastric biopsy taking for diagnosis M helicobacter pylon infection by histopathology. Positive cases for helicobacter pylon infection were treated by eradication therapy; the group of children with growth failure were followed for 6 months and reevaluated. Helicobacter pylon infection was diagnosed in 77% of children with growth failure, while it was diagnosed in 43% of normal children [p<0.05]. After 6 months of eradication therapy, there was significant increase in height, weight and hemoglobin [p<0.001 for each]. Helicobacter pylon infection is a causative factor in growth failure in children.

Health Knowledge, Attitudes, Practice
inhibitors. We used a longitudinal before-and-after design that was conducted in two phases assessed retrospectively: Phase I was 6 months preceding the introduction of recombinant activated factor VII [rFVIIa] during which patients received on-demand usual care with plasma derived factor VIM regimes, phase two was 6 month treatment on rFVIIa. We determined the clinical response and the cost of treatment with NovoSeven in three patients with low titer inhibitors to factors VIM compared with other treatment regime previously used in these patients [Plasma derived factor VIM]. Total number of bleeding episodes, re-treatments and need of hospitalization were 21, 11 and 12 in phase 1 vs. 19, 0 and 0 in phase two respectively. Total cost of rFVIIa and plasma derived factor VIM treatment was USD 98600 vs. USD 77000. rFVIIa is clinically effective. It resulted in 100% reduction in the number of re-treatments, hospitalization and 21.9% reduction in the total cost compared to treatment with plasma derived factor VIM regime.
infections can be responsible for transmission to the husband and to the child during delivery. The purpose of this review is to analyze from the literature the mechanism of mother-to-child transmission and the consequences. We Hepatitis B virus transmission by sexual contact in low prevalence areas and infection occurs during either the perinatal period or early in childhood in moderate or high prevalence areas. In Tunisia, the prevalence of Antigen HBS [HBs Ag] with pregnant women is 3 to 4%. The risk of maternal-infant contamination is high, from 20 to 90 per cent according to the viral load in the mother. Mother-to-child transmission can be avoided by serovaccination of the newborn .The women with very high viral loads may receive lamivudine treatment at the end of pregnancy to diminish viral load and thus the risk of chronic carriage in the child; however the role of this drug in this situation is not yet clearly defined.
Abstract: Hepatitis C virus [HCV] infects more than 170 million people worldwide and around 20% of blood donors are seropositive by ELIZA to HCV Ab in Egypt. Renal manifestations may be the presenting features of chronic HCV infection. This work was carried out on 200 patients with chronic HCV in order to study the relationship between HCV and chronic kidney Disease and to stratify HCV patients according to the degree of albuminuria and to know the histopathological changes in kidney and liver by immunohistochemical study. II showed that screening for proteinuria in patients with chronic HCV is necessary due to high prevalence of renal affection in these patients. Assessment of microalbuminuria should be done in these patients as an early indicator for renal affection. Albumin creatinine ratio ACR] had a good reliability as a surrogate measure for routine screening of urine albumin excretion. Awareness of chronic kidney disease [CKD] stage in patients with HCV and renal affection help prediction and early management of renal disease. There was a documented link between cryoglobulinemic and non-cryoglobulinemic membranoproliferative glomerulonephritis and HCV infection. Hypocalcemia-etiology; Hypokalemia-etiology; Acidosis Abstract: The acid, base and electrolyte changes are usually observed in the perioperative settings. We report a case of prolonged laparoscopic repair of left-sided diaphragmatic hernia which involved a lot of tissue handling and fluid replacement leading to acid, base and electrolyte imbalance. A 42-year-old male underwent prolonged laparoscopic repair under general anesthesia. Intraoperatively, surgeon reported that contents of hernia includes bowel along with mesentery, spleen and lot of fatty tissue The blood loss was about 2 L which was replaced with 1 L of colloid and 7.5 L of lactated ringer. Near the end of surgery arterial blood gas analysis revealed metabolic acidosis, hyperkalemia, and hypocalcemia leading to delayed recovery. We conclude prolonged laparoscopic surgery involving lot of tissue handling including gut and fat should be monitored for acid, base, electrolyte imbalance and corrected timely to have uneventful rapid recovery. dominate for girls, whereas infectious and parasitic diseases and tumors touched more boys. Diabetes, signs and general symptoms, leukaemia and anaemia, were the most frequent pathologies. Taking care of teenagers is often parcelled out on several hospitable services. Therefore, the improvement of the greeting services, in order to answer the teenager's relational needs home a temporary solution, while hoping, the setting up of units or specific services of adolescents that showed evidence of their utility for the development of the medicine of the teenagers in the industrialized countries. Abstract: To determine the general home hygiene practices of housewives and to examine the relationship between hygienic practices in the home and the transmission of infectious diseases symptoms among housewifes. This is a cross-sectional study conducted on 339 housewifes. The questionnaire included questions about home hygiene practices: general cleaning, laundry, kitchen hygiene and sociodemographic characteristics and about illness information including whether or not some symptoms had been present within the previous 30 days. The dependent variable, infectious disease transmission was defined as the presence in two or more individuals within the same household of one or more of the same symptoms. In more than one-third of households [122 of 339, 36%], had symptoms during the previous 30 days. Transmission was 16.0% among women who used self-disinfecting sponge, 42.6% among women who used only sponge or cloth [p=0.001]. Transmission was found higher among those who used detergent or soap for floor cleaning than women who used bleach. Duration of sponge/clothe use in kitchen and frequency of using bleach was found significant. Home hygiene practices was found relevant to transmission of infectious disease symptoms among household members. Use of disinfectants in home cleaning can have an effective role in home hygiene and healthcare situations. patients and its use as predictive marker for premature cardiovascular diseases. National Institute of Cardiovascular Diseases and Dr. Ziauddin Hospital, Karachi, from June 2008 to October 2009. Familial hypercholesterolemia was clinically diagnosed by premature coronary diseases, xanthomas, arcus cornealis and family history of premature coronary heart diseases. Controls were age matched normal individuals without hypercholesterolemia. Their lipid profile was tested after overnight fasting. CIMT was measured in mm using B-mode ultrasonography using linear probe. Student t-test was applied to compare mean CIMT of cases and the control. The mean CIMT values of the FH cases were correlated with LDL using Pearson's correlation test. Forty cases with hypercholesterolemia gave consent to participate in the study. These patients had total cholesterol >200 mg/dL and LDL >/=160 mg/dL as compared to twenty controls of similar age with total cholesterol </=200 mg/dL and LDL </=130 mg/dL. Mean CIMT for the cases was 0.77 +/-0.18 mm while mean CIMT for control was 0.59 +/-0.08 mm. The mean CIMT for the cases ranged from 0.7-1.83 mm and 0.48-0.73 mm for controls. Among the FH cases, 25% [n=11] had arterial plaques. Mean CIMT was significantly correlated to LDL-cholesterol [r = 0.725**, p < 0.001]. In this study, CIMT was found to be significantly increased in familial hypercholesterolemia and it correlated with raised LDL-cholesterol. Both are predictive of premature cardiovascular diseases.  The creatine/phosphocreatine system is essential for cellular phosphate coupled energy storage and production, particularly in tissues subject to high metabolic demands. Male factor infertility is a common condition with unknown etiology in most of the cases. Sperm abnormalities could possibly lead to infertility. As sperm motility depends on intact mitochondrial function and energy levels. Thus reduced intracellular creatine stores may contribute to decreased sperm motility leading to male infertility as creatine /phosphocreatine system plays major role in making and breaking of ATP, thus in energy kinetics. We developed and validated a denaturing high performance liquid chromatograph [DHPLC] method for the molecular analysis of SLC6A8 and GAMT genes involve in creatine biosynthesis and transport as a possible source of human male infertility by analyzing DNA from 64, clinically confirmed, infertile men. No mutation/polymorphism was detected in the exonic regions of both genes in all the patients and in fertile healthy controls indicating that SLC6A8 and GAMT genes may not be directly involved in human male infertility. Eight chest x-rays were normal. Abnormalities were observed more frequently in the lower lobes [bilateral [n=66], unilateral [n=7]]. Computed tomography [CT] scans were performed in 18 cases with air-space consolidation and interstitial opacities. Cases with diffuse areas of airspace consolidation were followed-up after 3 months by high resolution CT imaging, which showed interstitial thickening. The predominant imaging findings in childhood influenza A [H1N1] were bilateral patchy areas of consolidation, followed by diffuse areas of airspace consolidation, normal radiographs, and lobar consolidation.

Inflammatory Bowel Diseases
informed consent not only as an ethical and legal obligation but also as a benefit to patients. In addition, KSA surgeons are more likely to adopt a paternalistic attitude during informed consent. They believe that information about harmful risks may dissuade their patients from undergoing the operation and they admit that the amount of information they provide to their patients is significantly influenced by a number of patient and non-patient related factors. It is concluded that surgeons in KSA should be more aware of the informed consent guidelines and they should adhere to them. In addition, there is room for the introduction of formal training on informed consent in both countries and for making written information more widely available particularly in KSA. Abstract: To improve glycemic control and prevent late complications, the patient and diabetes team need to adjust insulin therapy. The aim of this study is to evaluate the efficacy of thrice-daily versus twice-daily insulin regimens on HbAlc for type 1 diabetes mellitus by a randomized controlled trial in Hamedan, west of Iran, The study included 125 patients under 19 years of age with type 1 diabetes mellitus over a 3-month period. All patients with glycohemoglobin [HbAlc] >/=8% were followed prospectively and randomized into two trial and control groups The control group received conventional two insulin injections per day: a mixture of short-acting [regular] + intermediated acting [NPH] insulins pre-breakfast [twice daily], and the trial group was treated by an extra dose of regular insulin before lunch [three times daily]. Main outcome measure was HbAlc at baseline and at the end of 3 months. The mean blood glucose level and number of hypoglycemia were recorded. All patients underwent monthly intervals follow up for assessing their home blood glucose records and insulin adjustment. Overall, 100 patients completed the study protocol 52% were females, mean +/-SD of age of 12.91 +/-3.9 years. There were no significant differences in baseline characteristics including age, gender, pubertal stage, adherence to diet, duration of disease and total daily insulin dose [p>0. 05]. There was a significant decrease individually in both groups in HbAlc level [p<0.05], but there was no significant difference in HbAlc reduction in patients on twice-daily insulin injections and those on thrice-daily insulin injection groups [1.12 +/-2.12 and 0.98 +/-2.1% respectively, [p>0.05]. Compared with twice daily insulin, a therapeutic regimen involving the addition of one dose regular insulin before lunch caused no significant change in the overall glycemic control of patients with type 1 diabetes mellitus. Our results emphasize that further efforts for near normoglycemia should be focused upon education of patients in terms of frequent outpatient visits, more blood glucose monitoring and attention to insulin adjustments.

Intelligence
Risk factors associated with borderline intelligence in schoolchildren: a case-control study. Abstract: To determine risk factors associated with borderline intelligence during intra-uterine life, delivery and the neonatal periods. In a case-control study, 200 school children in first grade, age six years were recruited. A standard intelligence quotient [IQ] test was used for psychometric testing. Cases had a borderline intelligence [70 to 84 score] and normal controls had an IQ of 85 or above scores. Cases and controls were matched for gender. Regression analysis showed that mother's illiteracy [Adjusted OR=2.7, 95% Cl, 1.6-4.2, p=0.001], familial history of mental retardation [AOR=2.1, 95% Cl, 1.4-3.5, p=0.002] and maternal drug consumption during pregnancy [AOR=1.7, 95% Cl, 1.1-2.5, p=0.003] were the main adjusted risk factors associated with borderline intelligence in childhood. No significant association was found between adverse birth outcomes including low birth weight and prematurity and borderline intelligence in children. Intelligence quotient [IQ] of schoolchildren is affected by both prenatal and postnatal factors as well as social determinants such as parental education. Controlling these factors has important implications for preventive strategies in psychological, maternal and child health programs worldwide. efficiency of distal revascularization was also searched for the treatment of critical limb ischemia. From 1999 to 2009 32 patients underwent infrapopliteal revascularization procedure in our hospital for the treatment of critical limb ischemia. Demographic data of patients are: 23 male, 9 female and mean age was 60.  n:7]. Extremity viability and long term patency was detected with limb examination, Doppler Ultrasonography and angiography. The cases were evaluated for post operative mortality, morbidity and primary graft patency for one year. Mean follow up period was 21.3-/+15.9 monthes [12-60 monthes]. Two patients died in early post operative period. Eight patients underwent re-operation. Re-operations were performed on six patients for the treatment of acute graft thrombosis and two patients for the control of surgical bleeding. The long term graft patency was 38% and extremity recovery rate was 46%. In post operative early period two minor and one major amputation was performed. Infrapopliteal arterial revascularization procedure is an efficient method for the treatment of critical limb ischemia and high rate of long term patency is the main advantage of this procedure.
The study was conducted on 40 patients with chronic renal failure [CRF] and 20 healthy subjects of matched age and sex [control group]. Patients were divided into 2 groups. Group]: those with chronic renal failure treated conservatively [n=20] and Group II. those with end stage renal disease treated by hemodialysis [n=20]. Patients were selected randomly. The presence of polyneuropathy and its severity was assessed in all participants hi clinical, neurological examination and the following electro-physiological methods: 1] motor nerve conduction of the median, ulnar, tibial and peroneal nerves, 2] sensory nerve conduction studies of the sural, ulnar and radial nerves 3] F-wave study of the median, ulnar, tibial and peroneal nerves; and 4] Soleus H-reflex. The prevalence of polyneuropathy in group 1 and group 2 were 60% and 65%, respectively [with no significant difference between them]. Polyneuropathy was evident clinically in 37.5% of CRF patients and subclinical neuropathy [diagnosed only on electrophysiological basis] was found in 25% of GRE patients. Electrophysiological abnormalities suggested that the pathology was mainly axonopathy as there was a significant reduction of the CMAP amplitudes. The pattern of uremic neuropathy was axonal, affecting sensory fibers more than motor ones. It seemed that the most sensitive tests in detecting uremic neuropathy would be the H reflex, sural sensory nerve conduction, the peroneal and tibial F wave studies and the median, peroneal and tibial motor conduction studies. and 13.4% for controls], were detected among leukemic patients than controls, while none of the patients and controls were positive for HIV I and II markers. We conclude that HBV, HCV, CMV, and EBV infections are more prevalent among leukemic patients. There was an increase in the seropositivity rates of HCV, CMV, and EBV infections with increasing ages of leukemic patients. The male leukemic patients were more exposed to HBV, HCV, and EBV infections than females. patients with SCD in painful crises that was severe to justify hospital admission, Nineteen samples were collected among the cases when patients came to the clinic for follow up visit in steady state. Control group included fourteen healthy ethnically matched individuals. NGAL levels were quantitated by ELISA. Other haematological and biochemical parameters such as HG, RBC, WBC, bilirubin, CRP, LDH were also determined. The results revealed that NGAL concentrations were highly significantly elevated in sickle cell painful crises compared with steady state SCD [p<0.0001] and when compared with healthy controls. These results also showed the NGAL levels correlate with WBC, CRP and LDH. This work represents initial step to determine NGAL role as a biomarker involved in the inflammatory and immune modulatory functions reported in the pathogenesis of painful episodes in SCD and may be a valuable predictor marker in the progress to severe attaches [e.g. acute chest syndrome] or resolution of acute SCD crisis.

Injury-radiography
Abstract: Mammals have lungs to breathe air and they have no gills to breath liquids. When the surface tension at the air-liquid interface of the lung increases, as in acute lung injury, scientists started to think about filling the lung with fluid instead of air to reduce the surface tension and facilitate ventilation. Liquid ventilation [LV] is a technique of mechanical ventilation in which the lungs are insufflated with an oxygenated perfluorochemical liquid rather than an oxygen-containing gas mixture. The use of perfluorochemicals, rather than nitrogen, as the inert carrier of oxygen and carbon dioxide offers a number of theoretical advantages for the treatment of acute lung injury. In addition, there are non-respiratory applications with expanding potential including pulmonary drug delivery and radiographic imaging. The potential for multiple clinical applications for liquid-assisted ventilation will be clarified and optimized in future. and 20 healthy controls. We also examined main clinical and laboratory parameters, including autoantibody profile and clinical indices of disease activity. IL-12 serum levels were significantly higher in SLE and SS patients in respect to controls. IL-12 serum levels were significantly higher in SLE patients as compared to those suffering from RA, PsA and Scl. When we evaluated disease activity in SLE patients, we found significantly higher IL-12 serum levels in subjects without renal involvement, while no correlation was found in the other rheumatic autoimmune diseases. These findings suggest that IL-12, modulating cell and humoral immune responses, are involved in the pathogenesis of autoimmune rheumatic diseases, such as SLE and SS.

Lupus Erythematosus, Systemic
prognostic models can define a population at high risk for relapse following empiric chemotherapy, although such models do not account for underlying biologic differences among tumors. Despite recent advances in empiric chemotherapy, including interval reduction of CHOP [cyclophosphamide, doxorubicin, vincristine, prednisone] and the incorporation of anti-CD2O monoclonal antibodies, a significant proportion of patients still die of their disease. Gene expression profiling has shed light on the molecular heterogeneity within B cell lymphoma by highlighting similarities between subsets of tumors and normal B cells, identifying features associated with unfavorable responses to empiric combination chemotherapy and defining robust subtypes with comprehensive transcriptional signatures. Commonly observed genetic abnormalities that likely contribute to pathogenesis include translocations of BCL6, BCL2 and MHC delivery systems, transdermal drug delivery has some advantages, as it provides controlled drug delivery for an extended period of time. To develop new gel formulations that have suitable bioadhesion, the bioadhesive force of hydroxypropyl methylcellulose [HPMC] was assessed using an auto-peeling tester. The effect of drug concentration on drug release from 2% HPMC gel was studied using synthetic cellulose membrane at 37 +/-0.5°C. The drug concentrations tested were 0.5, 1, 1.5, 2, and 2.5%. The effect of temperature on drug release from the 2% drug gel was evaluated at 27, 32, 37 and 42°C. To increase the skin permeation of mepivacaine from HPMC gel, enhancers such as saturated and unsaturated fatty acids, pyrrolidones, propylene glycol derivatives, glycerides, and non-ionic surfactants were incorporated into the mepivacaine-HPMC gels. The enhancing effect of the enhancer on drug permeation was then examined in the modified Keshary-Chien cell. For the efficacy study, the anesthetic action of the formulated mepivacaine gel containing enhancer and vasoconstrictor was evaluated with the tail-flick analgesimeter. Among the various kinds of HPMC, HPMC-K100M gel showed the highest viscosity and bioadhesive force. As the viscosity of the HPMC gels increased, the bioadhesive forces increased. Increasing the drug concentration or temperature increased the drug release rate. Among the enhancers used, polyoxyethylene 2-oleyl ether showed the greatest enhancement of permeation. Based on the area under the efficacy curve of the rat tail flick test curve, mepivacaine gel containing polyoxyethylene 2-oleyl ether and tetrahydrozoline showed prolonged and increased local anesthetic action compared to the control. For bioadhesive mepivacaine gels with enhanced local anesthetic action, mepivacaine gels containing penetration enhancer and vasoconstrictor could be developed with the bioadhesive polymer, HPMC.

Metabolic Syndrome X epidemiology
The awareness and prevalence of metabolic syndrome in medical community of Bahawalpur. Thyrotoxicosis-radiotherapy; Hypothyroidism-chemically induced; Recurrence Abstract: The major complication of radioiodine therapy for thyrotoxicosis is hypothyroidism, the long-term management of which is often problematic. In this study, the long-term effects of continuous methimazole [MMI] therapy are investigated. One hundred and thirty-two patients, aged between 36-66 years, with Graves recurrence, were semi randomly randomized in 2 groups for continuous antithyroid and radioiodine treatment. The number of thyroid dysfunctions in each patient were recorded and serum TSH, FT4, Anti TPO, TRAb, FBS, HOMA IR, and lipid profiles were measured. Bone mineral density and echocardiography were performed. There was no significant differences in age, duration of symptoms and thyroid function between the 2 groups. No serious complications occurred in the MMI group and no difference in any of parameters was seen between groups 1 and 2. Goiter rate and anti TPO concentration were higher in group 1 than in group 2. Serum triglycerides and cholesterol were increased in group 2 as compared to group 1. Bone mineral density was more reduced in group 2, especially in the spine. Echocardiography showed diastolic dysfunction in group 2 as compared to group 1. Some parameters in neuropschyciatric evaluation were significantly better in the MMI group, as compared to the radioiodine one. Considering it is a safe treatment and has fewer complications, methimazole is another option for patients with recurrent Graves', who do not wish to use radioiodine.

Methylene Blue adverse effects
Oxygen desaturation following methylene blue injection: not always spurious. [Addisonian pigmentation] is characteristic of Addison disease. However, it can also occur as a paraneoplastic manifestation of tumours like bronchogenic carcinoma. Acquired ichthyosis starts later in life and can also be a paraneoplastic presentation.We report a unique combination of paraneoplastic Addisonian pigmentation and acquired ichthyosis as presenting features in a patient with undiagnosed multiple myeloma. To the best of our knowledge this combination of paraneoplastic dermatosis has not been documented before in multiple myeloma. It is concluded that the presence of more than one suspicious dermatosis may be an indicator of being paraneoplastic requiring necessary work-up. far above that of AMI. lndependently CRP level in the early phase of MI might be a simple marker for the magnitude of the inflammatory response to myocardial necrosis, potentially providing prognostic information regarding he risk of death and HF. However, it is not known whether inflammation plays a role in the time-course of heart failure [HF] in this clinical setting. Our aim was to study the relationship between high CRP levels and HF progression during the first week of hospitalization for AMI. This study included 59 patients admitted with acute myocardial infarction to the coronary care unit of the Suez Canal University hospital. CRP was assessed on the third and seventh day after admission. 42% of the study population developed heart failure. Among the patients with AMI, CRP was significantly higher in patients with HF than in patients without HF at .admission, after 48 hours and after 7 days of admission p=0.0001 and p=0.000 and p=0.001 respectively]. Prevalence :HF was significantly higher on admission in patients with isitia1 CRP serum level </=17mg/L. CRP levels after 48 hours admission showed significant positive correlation with peak CKMB [p=0.02] and peak CK levels [p=0.002] but they owed significant negative correlation with left ventricular ejection fraction [p=0.01]. On admission, hs-CRP level is a strong predictor of the incidence of heart failure in AMI setting. Hs-CRP is a good predictor of the amount of myocardial damage AMI and it may predict the left ventricular ejection fraction after AMI. irradiation therapy [group II]. Both groups subjected to physical examination, laboratory assessment including total lipid profile, fasting blood sugar and HbAIc. Carotid duplex study was done to all patients assessing intimamedia thickness, plaque existence and lumen reduction. Patients in group I [radiotherapy treated cancer patients] show statistical significant difference in numbers of TIAs and the audible carotid bruit [p value 0.04]. Measurement of Intima-Media thickness by carotid duplex show statistical significant increase in thickness in group I compared to group II [p value 0.01]. Neck irradiation should be considered a risk factor for occlusive carotid artery disease and yearly duplex scanning follow-up for all patients after neck irradiation is recommended. The medical folders of each patient were traced and the data collected includes diagnosis, type of operative procedure and outcome on follow-up. A total of fourteen patients had undergone neck dissection as a combined procedure with the'primary tumor surgical removal. There were five radical neck and one modified type two radical neck dissections. The rest were eight selective neck dissections [three anterior and five supraomohyoid]. Twelve patients underwent unilateral neck dissections and two patients underwent bilateral neck dissections. The average duration of hospital stay was seventeen days, the longest stay was two months and the shortest stay was four days. One patient died secondary to complication of the primary tumor and one had to undergo exploration due to chylous leak post operation. Neck dissection is a surgical procedure to control neck lymph nodes metastasis from primary carcinoma of the head and neck. The extent of the cervical nodes involvement determines the type of neck dissections and their outcomes. the prevalence of pediatric nephrolithiasis has increased in both developed and developing countries. North and West of Iran, as a country located in Afro-Asian stone-forming belt, has the highest incidence for renal stones among adults. This study aimed to determine the incidence of microlithiasis and nephrolithiasis among infants in a city at North West of Iran. It was a cross-sectional study on infants aged less than one year old, diagnosed as patients with microlithiasis and nephrolithiasis, over three months period [since March 2010] who were referred to pediatrician in a city of East Azerbaijan province. Demographic data [age, sex], number of stones, size of stones, presence of hydronephrosis in kidneys, history of jaundice and family history of stone disease were recorded. Incidence of microlithiasis and nephrolithiasis was 0.04866 and 0.03244, respectively. Fever [30%] was the main cause of complication. Male to female ratio was 4:1, and 20% of our subjects had a positive history of nephrolithiasis in their first degree relatives. This area has the highest incidence of microlithiasis and nephrolithiasis. Emergent population-based and case-control studies are needed to report its incidence/prevalence of nephrolithiasis in other parts of the country as well as to find its etiology. subscapular skin-fold thickness [SFT] for obtaining a measure to be used in evaluating nutritional status of children and adolescents for age and gender to determine the threat of adiposity in Turkish children. This cross-sectional study was carried out between October 2006 and May 2007 with 6917 students selected among those with pre-defined socioeconomic criteria and attending primary schools in Van city center. Based on these data, the subjects were distributed to age groups in 6-month intervals, beginning from the age of 7 up to the age of 17. Analysis of mean values of the thickness of triceps and subscapular SFT according to age in boy subjects demonstrated that these values generally increased with age up to thirteen years of age where peak values were observed, and the thickness decreased between 14 and 15 years of age, increasing again thereafter. A comparison of our data with the data reported from other countries revealed lower than median values of triceps and subscapular SFT in our study for both girls and boys regardless of the age group. Subcutaneous fat accumulation is lower in Turkish children compared to those in other countries and no risk of obesity is imminent, at least in the region where this study was carried out. . Obesity, especially visceral obesity , is associated with a cluster of metabolic complications increasing the risk of coronary heart disease. We stresson the importance of primary prevention and early management of obesity. 77 is currently the preferred technique for TUR surgery. Spinal anesthesia combined with obturator nerve block has also been used for TUR surgery in geriatric population. Blind, anatomical methods for identifying the obturator nerve are often unsatisfactory. Therefore, we conducted this prospective study to validate the efficacy of ultrasound-guided obturator nerve block [USONB] during TUR procedures. Eighteen male patients undergoing TURP surgery under spinal anesthesia were included in the study. Bilateral USONB with maximum 20 ml of 1% lidocaine per patient was performed. An independent observer was present to monitor any adduction movements during the operation and to record patient and surgeon satisfactions. In all patients, obturator nerve was visualized from the first attempt, requiring an average of 4.3 min for blocking of each side. USONB was successful [97.2%] in preventing an adductor spasm in all except one patient. Patient's and surgeon's satisfaction were appropriate. In all patients, adductor muscle strength recovered fully within 2 h following the surgical procedure. USONB is safe and effective during TUR surgery. It provides optimal intra-and postoperative conditions. Abstract: Ondansetron is a serotonin receptor antagonist which has been used frequently to reduce the incidence of post-operative nausea and vomiting in laparoscopic surgery. It has become very popular drug for the prevention of post-operative nausea and vomiting due to its superiority in-terms of efficacy as well as lack of side effects and drug interactions. Although cardiovascular adverse effects of this drug are rare, we found a case of symptomatic sinus bradycardia in a 43-year-old female patient, going for laparoscopic cholecystectomy, who developed the same after she was given intravenous ondansetron in operation theater during premedication. Hence, we report this case, as the rare possibility of encountering bradycardia effect after intravenous administration of ondansetron should be born in mind.

Occupational Diseases
reflex activation as well as functional performance in patients with symptomatic knee osteoarthritis. Twenty five patients suffering from primary OA of the knee [s] and joint pain [aged 42 to 58 years] together with twenty healthy subjects matched in age, gender and body mass index were included in this study. The severity of knee pain was evaluated by visual analogue scale [VAS]. Also pain severity impact on patient's global activity of daily living was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index for pain scale [WOMAC]. Scoring of OA impact on Patient's functional status was determined by Lequesne's functional index. Quadriceps muscle strength was assessed. Surface electromyographic [SEMG] activity of the quadriceps and hamstrings muscles evoked by postural responses to sudden unpredictable forward and backward translation of the support surface was studied. These data were measured at baseline and immediately after completion of 6 weeks of treatment program aimed at relieving knee [s] pain. Quadriceps muscle strength and postural evoked response SEMG testing of quadriceps and hamstrings muscles were obtained from the control group as well. Patients showed significant reduction in their pain VAS score accompanied with reduction of WOMAC and Lequesne's indices, increase in quadriceps muscle strength and improvement of postural evoked response of quadriceps and hamstrings muscles after 6 weeks treatment period. Percent change in pain VAS correlated significantly with Percent change in WOMAC, Lequesne's indices, quadriceps muscle strength and postural evoked SEMG parameters of quadriceps and hamstrings muscles. Pain is a central determinant of disability in OA of the knee interfering with the voluntary and reflex control of peri-articular muscles.  [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] years] patients in whom symptomatic OA at multiple joint sites was diagnosed. MR images were analyzed for various abnormalities of OA. All patients were interviewed concerning pain and stiffness in the knee that was imaged. There was significant correlation was found between patellofemoral osteophyte and pain. A large joint effusion was associated with pain and stiffness, an association was found between meniscal defects [tear] with pain and stiffness. All other imaging findings, including focal or diffuse cartilaginous abnormalities [reduction of thickness of cartilage], University Hospital, with ages >/=40 years, they were selected by systematic random sampling to clarify the magnitude of osteoporosis and its associated risk factors. Anthropometric measurements were done for each subject including.  Kg/m[2]]. The results illustrated that the significant life style and dietary risk factors of osteoporosis were: sedentary life, smoking, excessive tea and coffee intake and low milk consumption. Hypertension rheumatoid arthritis, calcium and vitamin D deficiency and using corticosteroids were the medical risk factors associated significantly with osteoporosis [p<0.001]. Late menarche, postmenopausal >/= 5 years and never using hormonal contraceptive or replacement therapy were the significant evident reproductive risk factors among females in this study. There is an association between the prevalence of osteoporosis and sedentary life style, dietary risk factors, medical risk factors and reproductive risk factors. Integrated health education programs with primary health care activities were recommended to increase awareness of adults about the major risk factors of osteoporosis and its important preventive measures. proprioceptive extension exercise on the risk of fall in these patients. This study included 20 postmenopausal osteoporotic women with kyphosis and ten controls. Patients had to be physically active, and older than 60 years. Clinical assessment was performed by physical activity score fall efficacy scale and pain scale. Balance assessment was done by computerized dynamic posturography [CDP]. Each patient underwent a program of back extension exercise using one kg of weight suspended between T10 to L4 through fitted harness. Patients were instructed to use this harness two hours twice daily for 4 weeks. Then they were reassessed clinically and by CDP. There was a significantly decreased balance score in osteoporotic kyphotic women compared to controls. There was a significant inverse correlation between balance score and the fall efficacy scale [r=-0.53  Assay; Estradiol-blood; Absorptiometry, Photon-utilization Abstract: To measure serum levels of TNF-alpha and TNFR-1 in women with postmenopausal osteoporosis and correlate them with serum level of estradiol. This study was conducted on 26 postmenopausal females. They were divided according to their BMD into two groups. Group [I] consisted of 16 patients with osteoporosis [T score < -2.5] and group [II] consisted of 10 patients with osteopenia [T score -1 to -2.5]. Ten healthy postmenopausal women with normal range of BMD [T score >-1] served as control group. The serum levels of TNF-alpha TNFR-1 were measured with ELISA and serum estradiol was determined with electrochemiluminescence immunoassay [ECLIA]. Bone mineral density was measured with dual-energy x-ray absorptiometry. Serum estradiol level was significantly lower in both osteoporotic [7.88 +/-3.14pg/ml] and osteopenic patients [8.54 +/-3.99 pg/ml] as compared to controls [13.62 +/-4.57 pg/ml]. Serum level of TNF-alpha and TNFR-1 were insignificantly highest among osteoporotic patients as compared to osteopenic patients and controls. There was no significant correlation between estradiol and TNF-alpha or TNFR-1 [r=0.12, p>0.05 and r=0.07, p>0.05] respectively. A significant negative correlation was found between femoral BMD of patients and serum p<0.05] and p<0.05]. TNF-alpha also showed significant positive correlation with weight [r= 0.41, p<0.05] as well as the BMI [r=0.44,p<0.05]. TNF-alpha has a role in the pathogenesis of postmenopausal osteoporosis, which seems to be independent of estradiol and may thus be a novel target for therapy in resistant cases of postmenopausal osteoporosis. all had their devices implanted on same day of explanation. Conclusion: Cardiac devices Redo procedures are major risk factors for CDI specially re-implantation on same day. Device related BE carries a serious morbidity and mortality yet surgical removal of the whole system is the management of choice. Blood stream bactraemia is a potential risk factor in patients with cardiac devices and warrant prophylaxis against BE. 83 intravenous magnesium infusion for the relief of postoperative pain in patients undergoing LVRS. Patients were operated under general anesthesia. Thirty minutes before the anticipated completion of skin closure in both groups, [Group A and Group B] 7 ml of [0.125%] bupivacaine calculated as 1.5 ml/thoracic segment space for achieving analgesia in dermatomes of T4, T5, T6, T7, and T8 segments, along with fentanyl 50 micro g [0.5 ml], was administered through the catheter, activating the epidural block, and the time was noted. Thereafter, in patients of Group A, magnesium sulfate injection 30 mg/kg i.v. bolus was followed by infusion of magnesium sulfate at 10 mg/kg/hr and continued up to 24 hours. Group B was treated as control. A significant increase in the mean and maximum duration of analgesia in Group A in comparison with Group B [P<0.05] was observed. Total epidural dose of fentanyl and bupivacaine required in Group A was significantly lower in comparison with Group B in 24 hours. Requirement of total doses of local anesthetics along with opioids could be minimized by magnesium infusion; therefore, the further downgradation of patients of LVRS may be prevented. Intravenous magnesium can prolong opioid-induced analgesia while minimizing nausea, pruritus, and somnolence. The imaging findings were analyzed and summarized. Pancreatic NFICT size ranged from 1.2-13 cm. The commonest pattern of enhancement was hypervascular and heterogenous enhancement. The spleen was the commonest invaded nearby local structure. The commonest pattern of enhancement noted in the metastatic liver lesions was hypervascular heterogenous enhancement. 26% of the liver metastatic lesions were associated with invasion/encasement of nearby vessels. Imaging features of pancreatic NFICT can overlap with other pancreatic neoplasms. Therefore combining the imaging features of pancreatic NFICT and its hepatic metastases helps in narrowing the differential diagnosis.

Abstract:
To determine the prevalent serotypes of Streptococcus pneumoniae and the rate of penicillinnonsusceptibility among pneumococci in Oman. Pneumococcal isolates encountered during the period of September 2002 to December 2007 in the Royal Hospital were serotyped. Clinical information as well as the penicillin susceptibility reports were retrieved from the hospital information system and medical records, 120 strains of Streptococcus pneumoniae were isolated of which 85 strains were seroptyped. 20 different serotypes were identified; the most common seroptypes were 9A, 6B, 19F, 14 and 23F. 56% of the strains were not susceptible to pencillin, while 99% of these were susceptible to ceftriaxone. 74.3% and 46.1% of the serotypes are covered by the pneumococcal polysaccharide vaccine and the 7-valent pneumococcal conjugate vaccine respectively, Certain few pneumococcal serotypes such as 9A, 6B and 19F are more prevalent in the Omani community than others. More than half of S. pneumoniae are not susceptible to penicillin while the great majority of the strains are susceptible to ceftriaxone.

Pneumonia, Aspiration prevention and control
Evaluating ranitidine, pantoprazole and placebo on gastric pH in elective surgery. Abstract: Concern about the grim nature of postoperative acid aspiration syndrome grew among the anesthesiologist over the years warranting the need for preemptive intervention. The aim of the study is to compare the effects of preoperative oral ranitidlne versus pantoprazole given in regulating gastric pH in elective surgery. This prospective, parallel group, controlled, randomized, single-blind study was conducted at a tertiary care postgraduate teaching institute at Kolkata, involving 120 participants of either sex, aged 18-60 years of American Society of Anesthesiologists physical status I and II, who were scheduled for elective surgery under general anesthesia lasting for more than 2 h. The participants were divided into three groups. In group A [n = 40] participants received placebo tablet, in group B [n = 40] participants received ranitidine tablet while in group C [n = 40], participants received pantoprazole tablet and their gastric pH estimated serially. The participants in the three groups were comparable in terms of age, sex, body weight, duration of surgery and type of surgery distribution. In regard to changes in gastric pH trends, there was no statistically significant difference between serial pH values in group A [Friedman test; P>0.05] and group C participants. [P>0.05]. However, the mean preoperative gastric pH values [7.140 +/-.7652] were significantly lower than mean pH values [7.253 +/-.7514] after 2 h postoperatively in group B participants [P<0.05]. From the observations and analyses of the present study, it can be inferred that ranitidine is more effective than pantoprazole to raise the gastric pH for prevention of aspiration pneumonitis. severe bronchospasm, who developed an occipital headache and neck pain on the third day of inadvertent dural puncture during placement of combined epidural spinal anaesthesia for caesarian section. It was diagnosed as postdural puncture headache until generalised tonic clonic siezures occurred the next day raising the suspicion of postpartum eclampsia or meningitis. Posterior reversible encephalopathy syndrome was diagnosed on MRI of the brain which showed features of reversible ischemia in the posterior region of the brain. With anticonvulsant therapy and antibiotics there was complete resolution of neurological symptoms. We highlight the importance of high index of suspicion of this reversible encephalopathy .In obstetric cases with intentional or inadvertent dural puncture, with headache similar to post-dural punctural headache, and the essential role of neuroradiology in confirmation of the diagnosis, as placement of an epidural blood patch would be highly detrimental in these cases.
haemorrhage. This study of case series was conducted in Civil Hospital, Karachi, Pakistan from July 2008 to December 2009 over a period of one and half years during which all the patients who needed BIAL for control of severe obstetric haemorrhage were included and their detailed characteristics were recorded on a proforma. Main outcome measure was the effectiveness to control haemorrhage, which was assessed by the per-operative assessment of arrest of intraperitoneal or vaginal bleeding and need of additional hysterectomy. During this period total eight patients underwent BIAL, three for PPH due to atony, two for placenta praevia and one each for placenta increta, ruptured uterus and coagulopathy. Three patients needed hysterectomy, out of which one followed BIAL because of failure to control bleeding [failure rate 16.66%]. While two other patients underwent hysterectomy before BIAL. Failure to control bleeding was evident immediately and no patient needed re-laparotomy. Two women developed wound infection one maternal death occurred due to coagulopathy and its complications. None of the patient had iliac vein injury or any ischaemic complications during inpatient stay. We conclude that BIAL is a safe and effective procedure for treating life threatening obstetric haemorrhage with preservation of future reproductive capacity. complicated by pre-eclampsia. Adverse pregnancy outcomes [APOs] are a group of common obstetric diseases and many studies have been conducted in an effort to clarify their risk factors It is well known that these risk factors can induce the synthesis of a group of highly conserved proteins, called heat shock proteins [Hsps]. The aim of the study was to measure serum heat shock protein [Hsp]70 in mothers with pre-eclampsia and adverse pregnancy outcomes [APOs] and to evaluate whether it can be applied as a useful indicator for the development of these conditions. Eighty pregnant women were included in this study [20 pre-eclamptic women, 20 women with threatened preterm labor, 20 women with intrauterine growth restriction and 20 healthy women with non-complicated pregnancy]. After obtaining informed consent, serum samples were collected from all participants to measure Hsp70 levels. The levels of Hsp 70 were measured using enzyme-linked immunosorbent assay. Measurement of serum Hsp 70 levels showed statistically higher values among pre-eclamptic patients compared to preterm, Intrauterine growth restriction [IUGR] and control groups [24.6 +/-12.7 ng/ml, 15.l +/-5.4 ng/ml, 14.3 +/-6.1 ng/ml, 11 .7 +/-4.9 ng/ml respectively, p </= 0.009]. Sensitivity, specificity, positive and negative predictive values and overall accuracy were calculated for serum Hsp 70 in pre-eclamptic mothers and in patients with adverse pregnancy outcomes [Threatened preterm labor, IUGR groups] and our results demonstrated high sensitivity, specificity, positive and negative predictive values and overall accuracy for serum Hsp 70 levels in pre-eclamptic group only [80%, 65%, 69.57%, 76.47%, 72.5% respectively]. Univariate odds ratios [OR] and 95% CI for serum Hsp 70 levels above the optimum cut-off limit [18, 14, 14 ng/ml respectively] were calculated between the studied preeclamptic, adverse pregnancy outcomes and control groups and demonstrated OR of 7.429, 1.256, 1.000, 95% CI=1, 778-409 3 1.041, 0.334-4.733, 0.259-3.867 for the pre-eclamptic, preterm and IUGR groups respectively. Also adjusted ORs and 95% CI for serum Hsp 70 above the optimum cut-off limit were calculated between the studied pre-eclamptic, adverse pregnancy outcomes and control groups and demonstrated OR of 5.444, 1.000, 1.333, 95% CI=1.408-21.055, 0.212-4.709, 0.300-5.926 respectively for the pre-eclamptic, preterm and IUGR groups. Serum Hsp 70 levels are elevated in pre-eclamptic women and circulating Hsp 70 may be a useful indicator for the development of pre-eclampsia However, further studies are needed to explore the underlying mechanisms for this elevation and its role in the pathogeriesis of hypertensive disorders of pregnancy. therapy A retrospective study of the outcome of cesarean section for women with severe pre-eclampsia in a third world setting.
assess the efficacy of pretreatment with various drugs to alleviate the propofol injection pain. One hundred American Society of Anesthesiology [ASA] I and II adults, scheduled for various elective surgical procedures under general anesthesia [GA], were included in the study. They were randomly divided into four groups having 25 patients in each group. Group A received pretreatment with intravenous [i.v.] magnesium sulfate, group B received i.v. granisetron, group C received i.v. nitroglycerine and group D was the control group. One-fourth of the total calculated induction dose of propofol was administered over a period of 5 seconds. The patients were asked about the pain on injection. The intensity of pain was assessed using verbal response. A score of 0-3 which corresponds to no, mild, moderate and severe pain was recorded. All the three drugs reduced the incidence and intensity of pain on propofol injection but the order of efficacy in attenuation of pain on the propofol injection was granisetron > nitroglycerine > magnesium sulfate > control. Granisetron was the most effective followed by nitroglycerine and magnesium sulfate in attenuating pain on propofol intravenous injection.
of affected children have the acute form of ITP, defined by duration of thrombocytopenia [<150 x 10[9]/L] of <6 months. Previous studies have shown that Fc gamma receptor [FcyRs] play crucial roles in platelet phagocytosis; antibodies bound to platelets have their Fc portion exposed which allows binding to monocytes/macrophages that express Fc receptors for lgG [FcgammaRs]. The Fc gammaRIIla Valine [V] has increased affinity for three separate lgG subclasses when compared with the FcgammaRIlIa Phenylalanine [F]. The aim of the present study was to assess the frequency of occurrence of the high affinity allelic variant FcgammaRllIa-158V in Egyptian children with ITP in comparison to normal individuals. Determination of FcgammaRlIIa genotype was performed for 30 ITP patients and 10 healthy control subjects by nested PCR followed by RFLP analysis. In our study, the allelic frequency of FcgammaRIlIa-158V was [76.6%] among ITP patient group in contrast to [20%] among the control group. These results suggest that FcgammaRllIa-158 V/F polymorphism contributes to the pathogenesis of childhood ITP by increased clearance of antibodysensitized platelets by the high affinity FcgammaRlIIa-158V allelic variant. Besides the epidemiologic and pathophysiologic interest, this knowl edge may be of use in the future designing of novel therapeutic interventions.
investigated in seven subjects during walking on a treadmill at the stance to swing transition period. The intensity of quadriceps [Q] EMG was increased throughout the gait cycle by using a modified knee orthosis. Pairs of spring were added to the orthosis to produce different levels of .muscular activity in Q during the midstance, transition period and terminal swing phase of gait. Electrical stimulation was applied to the common peroneal nerve [CRN] at these three instants of gait. The peak to peak amplitude of CPQ reflex was significantly increased with escalation of background EMG in Q during midstance [p<0.015] and terminal swing [p<0.04]. At the transition period however, despite significant increase in the Q activity no responses was evoked. The results were indicative of an active inhibition of the reflex pathway during transition period. This inhibition could help the unloading of the limb that is necessary for the initiation of the swing phase. 93 incidence of recurrent laryngeal nerve palsy varies between 1.5-14%. The aim of the present study is to assess the risk factors of recurrent laryngeal nerve injury during thyroid surgery. Patients who had thyroid surgery between 1990 and 2005 and were admitted to the surgical department of King Fahd hospital of the University, Al-Khobar, Saudi Arabia were enrolled for this retrospective review, Factors predisposing to recurrent laryngeal nerve injury were evaluated such as pathology of the lesions and the type of operations and identification of recurrent laryngeal nerve intraoperatively. Preoperative and postoperative indirect laryngoscopic examinations were performed for all patients. 340 patients were included in this study. Transient unilateral vocal cord problems occurred in 11 [3.2%] cases, and in 1 [0.3%] case, it became permanent [post Rt. Hemithyroidectomy]. Bilateral vocal cord problems occurred in 2 cases [0.58%], but none became permanent. There were significant increases in the incidence of recurrent laryngeal nerve injury in secondary operation [21.7% in secondary vs. 2.8% in primary, p=0.001], total/near total thyroidectomy [7.2% in total vs. 1.9% in subtotal, p=0.024], non-identification of RLN during surgery [7.6% in non-identification vs. 2.6% in identification, p=0.039] and in malignant disease [12.8% in malignant vs. 2.9% in benign, p=0.004]. However, there was no significant difference in the incidence of recurrent laryngeal nerve injury with regards to gender [4.1% in male vs 3.8% in female, p=0.849]. The present study showed that thyroid carcinoma, re-operation for recurrent goiter, nonidentification of RLN and total thyroidectomy were associated with a significantly increased risk of operative recurrent laryngeal nerve injury. Abstract: Inflammation plays an essential role in the insulin resistance process, and chemokines, such as chemerin, seem to play a pivotal role in the pathogenesis of insulin resistance. In this study we examined the effects of 12 weeks strength training on serum chemerin, CRP and TNF-alpha level in association with cardiometabolic risk factors,  Abstract: To evaluate the current practice in requesting and performing paranasal sinuses CT scan for patients scheduled for endoscopic sinus surgery, and to describe the current hospital's practice in performing these scans. This cross-sectional questionnaire study was conducted in the King Hussein Medical Center, Amman, Jordan between April and May 2010. Three forms were designed to collect data from our study groups, which included: Ear, Nose and Throat [ENT] surgeons, radiologists, and the radiology sections in 3 hospitals. The first was designed for ENT surgeons and aimed at investigating, whether or not they perform endoscopic sinus surgery, and if they have specific requirements for a CT scan of the sinuses. The second was designed for the radiologist to investigate their specifications in performing CT of the sinuses. The last was designed to evaluate the current practice of performing CT of the sinuses at the 3 hospitals. Twenty-four ENT surgeons participated, 83.3% surgeons performed endoscopic sinus surgery, and 83.3% requested specific specifications for the sinuses CT scan, and the most requested specification was coronal plane in 42%. Of the 24 radiologists, 71% prefer the prone position, 71% prefer the coronal plane, and to 500 ng mL[-1]. The proposed methods were applied for determination of Racecadotril in bulk powder with mean accuracy of 100.39 +/-1.239 for the spectrophotometric method and 100.09 +/-1.042 for the spectrofluorimetric method. The proposed methods were successfully applied for determination of Racecadotril in its pharmaceutical dosage form.  [LSS]. Fifty-six patients diagnosed as having LSS, on the basis of typical clinical features and compatible MRI findings, were included in this study. In addition to history and examination, patients were assessed for disease severity using the maximal walking distance and the visual analogue scale. MRI parameters of lumbar spinal stenosis were assessed. Needle electromyography of the paraspinal muscles and nerve conduction studies including F-wave and H-reflex were performed. Patients were 33 males and 23 females. The body mass index statistically significantly correlated with the patient scores on the visual analogue scale. No significant relation could be detected between age, sex, duration of disease and disease severity. Both of the smallest and the smallest two anteroposterior spinal canal diameters showed no statistical significant correlation with the disease severity. The fibrillations in electromyographic testing statistically highly significantly [p<0.001] negatively correlated with the maximal walking distance and positively correlated with the patient scores on the visual analogue scale. It also statistically highly significantly correlated with the age. MRI findings are related to the diagnosis but not to severity ot the clinical lumbar spinal stenosis. Electrophysiologic studies especially paraspinal muscles denervation potentials seem to be a more sensitive criterion in assessing the severity of symptoms in patients with LSS. On comparing the initial and follow up motor and functional recovery according to the clinical scales [MRC, NHPT and ARAT] in the three patient groups, group I and II exhibited highly significant [P<0.01] higher scores than group III. Correlation study showed a significant negative correlation between CMCT and MRC scale and ARAT, also there was a significant positive correlation between CMCT and NHPT while no significant correlation was found between resting motor threshold or amplitude of MEPs and the follow up clinical scales. Predictive value of CMCT for improvement of different scores [MRC, NHPT and ARAT] was 22, 38 and 36.6% respectively. CMCT of MEPs was the parameter with the highest predictive value to functional improvement of affected upper limb in stroke patients. These data can be helpful for clinicians to plan the program of rehabilitation according to the expected recovery of motor function. factors associated with functional changes after rehabilitation of MCA stroke. Sixty five hemiplegic patients due to MCA stroke were studied. Patients underwent complete neurological and functional evaluation on admission. Evaluation included stroke type, cardiovascular risk factors for stroke, associated neurological deficits, total motricity index [MI] of upper and lower extremities, motor function of the trunk assessed by Trunk Control Test [TCT], and Functional Independence Measure [FIM]. All patients were enrolled in an inpatient rehabilitation program. Patients were reevaluated at discharge. Statistical analyses were carried out to determine factors associated with functional outcome after rehabilitation of MCA stroke. The total MI and TCT improved significantly after rehabilitation. In addition, discharge total FIM score was statistically higher than admission total FIM score. Patients with hemineglect, impaired cognition, dysphagia, hemihypoesthesia incontinence or multiple neurological deficits had significantly lower discharge total FIM score than patients without such variables. The discharge FIM score correlated strongly with admission total FIM score [r= 0.88, p<0.001] moderately with admission TCT score [r= 0.69, p<0.001], fairly with admission total MI [r=0.37, P=0.002] and negatively with age [r= -0.2, p=0.01]. On multiple linear regression analysis, admission total FiM and TCT scores score were the only significant predictors of discharge FIM scores. Rehabilitation improved the functional outcome of MCA stroke patients. The initial functional status was the most important factor associated with functional improvement. Subcutaneous Emphysema complications reassessed by ultrasonography. Dexamethasone iontophoresis could be considered a simple, easy, safe, effective and non-invasive therapeutic option for epicondylitis. High resolution ultrasonography has a role in diagnosing epicondylitis but has no role in follow up.

Thoracotomy methods
Anesthesia for patients undergoing transsternal thymectomy for juvenile myasthenia gravis.
Stephenson, Lianne; Tkachenko, Igor; Shamberger, Robert; Seefelder, Christian E-mail:llstephenson@wisc.edu adolescence. When medical management fails, thymectomy is offered for these patients. Complete resection of the thymus is best achieved through transsternal thymectomy. Anesthetic management of patients with JMG is challenging, particularly in regards to the goals of postoperative pain control, respiratory function, and extubation. We retrospectively reviewed the medical records of 13 patients, ranging in age from 6 to 22 years, who underwent transsternal thymectomy for JMG. Information on patient demographics, characteristics of their disease and treatment, anesthetic management, and postoperative course were collected. All patients had undergone multiple treatment modalities and presented for surgery because of inadequate symptom control with medical management. As expected for a pediatric population, anesthesia induction was age dependent. 40% of the patients underwent an inhalation induction and 60% underwent an intravenous induction. Anesthesia was maintained with a low-dose inhalation agent in all patients, supplemented in 84% of patients with a remifentanil infusion, and in 69% of patients with an epidural infusion. Muscle relaxants were avoided in all patients. With this regimen, 92% of patients could be extubated successfully in the operating room. We found that avoidance of muscle relaxants and use of remifentanil with a lowdose hypnotic agent provided a stable intraoperative course, facilitated rapid emergence, and allowed early extubation in patients with JMG undergoing transsternal thymectomy. Epidural analgesia reduced the need for intra-and postoperative intravenous opioids and did not have an adverse effect on respiratory strength.

Tobacco Smoke Pollution
immediately centrifugated and the deposit was smeared onto a cleaned micro slide and immediately fixed into 95% ethyl alcohol for 15 minutes. The remaining two were prepared in the same manner, however, the second after two hours of collection and the third after four hours of collection. The degree of degeneration and thus the preservation were assessed by a table of chosen criteria, then ranked and analyzed using Friedman's nonparametric test, at p=0.05. The results showed a significant difference between the preservation and the delay in urine fixation, p<0.0001. Any delay in fixation of urine specimen for cytology affects the preservation of cells, which may result in miss diagnosis. It is recommended that urine samples for cytology should be fixed immediately after collection. increased fluid intake and dietary modification, medical therapies such as potassium citrate and use of extracorporeal shock wave lithotripsy [ESWL] and finally surgery methods are used for treatment of urolithiasis. The aim of this study was to evaluate the level of response to medical therapy with polycitra-K in children with urolithiasis. The study population comprised all patients less than 14 years old with urolithiasis visited at Mofid and Labafi Nejad hospitals within the last five years. All patients with an initial ultrasonography showing stone in urinary tract. At the end of study, the complete resolution or passage or a decrease in the size of stone in later sonography was defined as response to treatment. From 109 patients, 91 cases continued medical therapy with polycitra-k and 51 patients [56%] responded to treatment. Hypercalciuria and hyperuricosuria were found to be the etiological factors in 25% and 19% of patients, respectively. The stone analysis revealed that 50% were composed of ca-oxalate. Stone disease was more common between the ages 1-3 years and the most common complaint was hematuria [20%]. Calcium Oxalate stones were the most frequent stones which responded to polycitra. The response rate in girls and boys was similar and in different age groups it was almost equal. Based on the response rate of medical therapy with polycitra-k is recommended for treatment of urolithiasis in children. , in contrast to 0 to 3% of the patients treated with methimazole [MMI], the former being the most often reported for causing vasculitis, a disease seen most commonly in association with Graves' disease. Signs of PTU-induced vasculitis include fever, malaise, anemia, lymphadenopathy, skin lesions, arthralgia, hematuria/proteinuria, diffuse alveolar hemorrhage [DAH], pleural effusion, and crescentic glomerulonephritis. Once PTU-induced vasculitis is determined, the simple withdrawal of PTU usually causes resolution of the symptoms within 1-4 weeks. Overall prognosis of antithyroid drug-induced vasculitis is much better than that of primary vasculitis. Antithyroid medications such as PTU can induce [ANCA]-associated vasculitis. Its pathogenesis might be multifactorial. Diagnosis is based on the relationship between clinical vasculitis, and the antithyroid drugs prescribed, and the excluding of any other medical states that mimic vasculitis. After the diagnosis, antithyroid drugs should be discontinued immediately, and the prognosis is usually good. suboptimal risk assessment and inadequate prophylactic measure for this condition. The aim of this study was to determine knowledge, attitude and practice of surgeons about deep venous thromboembolism [DVT] prophylaxis. The knowledge and attitude of faculty member surgeons working in Kermanshah University of Medical Sciences were evaluated using a questionnaire. In addition, their practice was assessed by reviewing the hospital chart of 4105 patients who had elective or emergency surgery. Patients were categorized based on claget criteria into high, moderate and low risk for DVT. Mean knowledge score was 9.05 +/-1.07 [82.3% of best predicted] and for attitude was 21.9 +/-2.78 [73.1% of best predicted]. There were no statistical significant differences between surgical clinical groups. Nearly all of surgeons believed that use of low dose heparin was dangerous. Type of prophylactic measure was only low dose heparin. Only 9 [3.2%] patients from high risk group and 9 [1.08%] patients from moderate risk group received prophylactic treatment and no one from low risk group for DVT received prophylaxis. Degree of under use of prophylactic measure for DVT is higher in this study as to compare with other investigations. Increased awareness about optimal prevention and outcomes is needed. It is highly recommended that all patients undergoing surgery must be routinely assess for preoperative risk for DVT and consider aggressive prophylactic measure against this condition. Outcome Abstract: To assess the role of Computerized Dynamic Posturography in the diagnosis and rehabilitation of patients with vertigo. We studied 28 patients with chronic symptomatic vestibular deficits disorders of at least 3 months duration, and chief complaints of vertigo, imbalance, and/or motion intolerance. They were 20 females and 8 males; their ages ranged from 19 -66 years [mean 41.04 +/-.13]. Another ten 10 normal subjects were selected as controls. They were six females and four males with ages ranging from 30 to 60 years [mean 43.8 +/-9.8]. All were subjected to hearing assessment, pure tone audiometry, and Electronystagmography [ENG] test. Also postural stability was assessd using Computerized Dynamic Posturography [CDP] with sensory organization test [SOT]. Patients were assessed by Dizziness Handicap Inventory [DHI] score. Then patients submitted to vestibular rehabilitation as treatment modality by CDP and home exercises. Patients were assessed after their vestibular rehabilitation therapy [VRT] by DHI and SOT. The result showed highly significant statistical difference between patient and control groups as regards condition 5 and composite score of SOT. We observed larger increase in condition 5 and composite score of SOT, and decrease in DHI after VRT. This information showed that SOT by CDP is an adequate method to quantitative analysis to show the vestibular function increase in the Vestibular Rehabilitation, and CDP effective as rehabilitation in patients with vestibular affection.

Keywords: Cardiovascular Diseases-etiology; Risk Factors; Case-Control Studies; Cross-Sectional Studies; Cohort
Studies; Coronary Artery Disease-etiology Abstract: In cross-sectional studies, low serum levels of 25-hydroxyvitamin D are associated with a higher prevalence of cardiovascular risk factors. This study aimed to determine whether vitamin D deficiency is related to cardiovascular disease. This nested case-control study was performed within the framework of a population-based Cohort study [Tehran Lipid and Glucose Study, TLGS] among male and female participants, aged 30 years or older [mean [SD] age, 56.7 [10.6] years], free of diagnosed cardiovascular disease at initial blood collection. Using risk set sampling, controls [n=251] were selected in a 1:1 ratio and matched for age, sex and date of blood collection. We measured serum 25-hydroxyvitamin D levels in serum specimens, kept at -80°C until assay. Median serum 25 [OH] D was significantly lower in the CVD group than in controls [p<0.001]. For 25 [OH] D values of less than 10 ng/ml, compared with values more than 20 ng/ml [reference], the multivariable-adjusted OR [with 95% confidence intervals] for incident cardiovascular events was 3.21 [1. 75-5.88]. Low levels of 25[OH]D are independently associated with higher risk of cardiovascular events in a graded manner, even after adjustment for factors known to be associated with coronary artery disease.
Wound Healing drug effects Abstract: Diabetic ulcers especially foot ulcers and the delay in their healing is a major problem faced by most diabetic patients. Based on data available on the positive role of estrogen in accelerating wound healing, this research aimed at assessing the possible effect of topical estrogen on wound healing in diabetic rats. Sixty-six male wistar rats were divided into two groups [normal and diabetic] and each group was divided into 3 subgroups [control, sham and test]. A circular full-thickness wound with a diameter of 1.5 cm was created on the backs of streptozotocin [stz]induced diabetic and intact rats. In the test subgroup, the wounds were treated with a daily topical dose of 0.5 mg estrogen and in the sham subgroup, gentamicin ointment [dose 0.5 g] was used. The process of wound healing was assessed by macroscopic and microscopic studies on days 3, 5, 7, 14, 21, and 28. The macroscopic study, showed delays in healing of the diabetic group in comparison with the normal group and after the seventh day, wound healing showed considerable change in the test subgroup in both normal and diabetic rats [p<0.05]. In the normal group microscopic study, the only parameter which did not show any differerence was granulation tissue organization; however increasing of neoangiogenesis and re-epithelization was observed in the test subgroup. Also, in the diabetic group, the estrogen receiving subgroup showed impressive improvement compared to the sham subgroup. Topical that estrogen can accelerate the process healing of diabetic wounds.