Protective Effect of Irbesartan an Angiotensin (AT1) Receptor Antagonist in Unpredictable Chronic Mild Stress Induced Depression in Mice.

Objective: Oxidative stress and alternation of renin-angiotensin system has been implicated in the pathophysiology of various cardio vascular, endocrine including mood and anxiety disorders. The present study evaluated the role of irbesartan in stress induced different models of depression. Materials and method: Mice were treated with irbesartan (40 mg/kg), fluoxetine (25 mg/kg) alone in combination orally. Drugs treatment started after 2 weeks from the beginning of the unpredictable mild stress (UCMS) protocol. Behavioural tests were performed on week 6, at least 24 h after the last treatment. Modified forced swim test (MFST), tail suspension test (TST) and open field test (OFT) were used followed by antioxidant markers and 5-HT levels determination. Result: Irbesartan increased swimming, climbing and decreased immobility times in MFST, decrease immobility time in TST. Irbesartan also increased no. of field crossings; rearings and also increased time spent in the centre of OFT. Thus, antidepressant like activity in UCMS mice was observed. Combination of irbesartan with fluoxetine showed potentiating effect of behavioural parameters in all animal models. Combination groups also showed antioxidant effects and elevated the 5-HT levels in UCMS mice. Conclusion: Chronic administration of Irbesartan exerted antidepressant like effect, reduced oxidative stress and elevated brain 5-HT levels.

Value of D-dimers assay in diagnosis of pulmonary embolism.

OBJECTIVE: To determine the value of D-Dimers assay in the diagnosis of Pulmonary Embolism (PE) at Armed Forces Institute of Pathology, Rawalpindi, Pakistan from January to November 2000. METHODS: Forty three consecutive patients clinically suspected of suffering from pulmonary embolism and referred to Armed Forces Institute of Pathology for Ventilation-Perfusion scan of lungs were inducted in the study. A detailed history was taken and clinical examination was performed. All patients were then subjected to Perfusion and/or Ventilation scan, which was taken as the standard for the diagnosis of PE. Blood samples were collected from all patients in trisodium citrate. Platelet poor plasma obtained from the samples was tested for D-Dimers semi-quantitatively using latex agglutination method. RESULTS: Out of 43 patients 14 (32.6%) had completely normal ventilation-perfusion scan hence the diagnosis of PE was excluded. In 6 (13.9%) patients the results were considered indeterminate. Abnormalities suggestive of pulmonary embolism were detected in 23 (53.5%) patients. D-Dimers were less than the cut off value of 500 ng/ml in 19 (44.2%) patients, whereas in 24 (55.8%) the levels were more than 500 ng/ml. When compared with the results of ventilation-perfusion scan the sensitivity of D-Dimers was 91.3% and specificity was 100%. Positive predictive value of the test was 100% whereas negative predictive value was 87.5%. CONCLUSION: D-Dimers assay combined with high clinical evidence is a cost effective, readily available test which can safely exclude the diagnosis of pulmonary embolism in majority of the cases.

Usefulness of exchange transfusion in acute liver failure due to severe falciparum malaria.

Acute hepatic failure is a rare and serious complication of severe falciparum malaria. The management of uncomplicated falciparum malaria comprises of specific antimalarial drugs and supportive therapy. In a few patients who are critically ill because of severe falciparum malaria and heavy parasitaemia, exchange transfusion has been used. We describe a young male Saudi patient who presented with a 2-day history of fever, jaundice, and confusion. On examination he was deeply jaundiced, confused, and irritable. There were no signs of chronic liver disease. His laboratory workup revealed a markedly raised direct hyperbilirubinaemia and transaminases with prolonged prothrombin time. His serology was negative for HbsAg, HBc IgM, anti-HCV, HAV IgM, HEV IgM, and IgG. He was initially treated with parenteral quinine and other supportive treatment, without any improvement of his clinical and laboratory parameters. At this stage he was treated with whole blood exchange transfusion. He slowly improved, with complete normalization of his liver function tests and prothrombin time.

Primary gastrointestinal cancers in the Western Region of Saudi Arabia. Is the pattern changing?

OBJECTIVE: To determine the age, sex and relative frequencies of various gastrointestinal malignancies in patients registered with the National Cancer Registry from the Western Region of Saudi Arabia from January 1994 till December 1997, and compare this data with previous hospital based studies about the pattern of these malignancies in Saudi Arabia. METHODS: A National Cancer Registry was established in Saudi Arabia in 1992, and since 1st January 1994 all cancer cases in Saudi Arabia have been registered with the National Cancer Registry. All National Cancer Registry data on patients with primary gastrointestinal cancers from the Western Region of Saudi Arabia from January 1994 till December 1997 was retrieved and analyzed according to ethnic origin, site, age, sex and relative frequencies of various tumors. RESULTS: Out of a total of 1833 cases with primary gastrointestinal malignancies 1207 (66%) were Saudis, while the rest were Non-Saudis. Colorectal cancer was the the most common malignancy found in both population groups accounting for 28.5% of cases in Saudis and 36% in Non-Saudis. Malignancies of liver, stomach and esophagus followed in decreasing frequencies. The mean age of the Saudi population was 58+16 years (standard deviation) with male to female ratio of 1.67:1. About 80% of the patients were above 40 years of age and the peak of onset for most of the tumors was between 50 and 70 years of age. CONCLUSIONS: This study highlights that colorectal cancer is the most common gastrointestinal malignancy seen in the Western Region of Saudi Arabia followed by hepatocellular carcinoma. This is in sharp contrast to the previous hospital based studies from Saudi Arabia and national trends as seen in the cancer incidence report from the National Cancer Registry of Saudi Arabia. The factors for this changing pattern of gastrointestinal malignancy remain to the determined.