Platelet activation: a link between psoriasis per se and subclinical atherosclerosis--a case-control study.

BACKGROUND: Pathomechanisms of both psoriasis and atherosclerosis may involve platelet activation. Activated platelets show increased P-selectin; CD62 expression, and mean platelet volume (MPV). Impaired brachial artery flow-mediated dilatation (FMD) is related to atherosclerosis. OBJECTIVES: To determine the presence of subclinical atherosclerosis in patients with psoriasis (without overt cardiovascular complications or traditional cardiovascular disease risk factors), compared with controls. METHODS: In this case-control study, 25 patients with psoriasis and 25 age- and gender-matched healthy individuals were subjected to assessment of MPV, CD62 expression using flow cytometry, and brachial artery FMD and transthoracic echocardiography by cardiac ultrasound scanner. RESULTS: A statistically highly significant increased CD62 expression, but not MPV, was found in cases compared with controls, and in patients with moderate/severe psoriasis compared with either mild cases or controls (P < 0.001). CD62 expression was statistically significantly positively correlated with the Psoriasis Area and Severity Index (PASI) score (P < 0.001), baseline brachial artery diameter (P = 0.03) but not FMD and aortic root diameter (ARD; P = 0.03). ARD was statistically significantly higher in patients with moderate/severe psoriasis compared with controls (P = 0.017). Stepwise simple linear regression analysis revealed that PASI score was the most important factor affecting CD62 expression (P < 0.001). CONCLUSIONS: Our study showed increased atherosclerosis risk in patients with psoriasis, particularly those with moderate/severe disease, as evidenced by increased expression of platelet CD62 compared with healthy controls. Moreover, we found a positive correlation between CD62 expression and ARD (another possible marker of atherosclerosis), with positive correlation to the PASI score; the most important factor influencing CD62 expression. However, our data on MPV and FMD do not support the use of either value for diagnosing subclinical atherosclerosis in patients with psoriasis in further studies.

Curcumin-loaded hydroxyapatite nanocomposite as a novel biocompatible shield for male Wistar rats from γ-irradiation hazard.

Curcumin (CUR) is well known for its extraordinary benefits as an anti-cancer, anti-inflammatory, and wound healing agent. However, nano-formulation could maintain and regulate its pharmacological effect. Herein, we report the preparation of CUR/hydroxyapatite nanocomposite (CUR/HA NC) and its application in the protection of male Wistar rats from γ-irradiation carcinogenic consequences. TEM images of the nanocrystalline HA nanoparticles (NPs) had a rod-like form with average dimensions of 40±5 nm in length and 10 ± 5 nm in width. XRD analysis illustrated the formation of a single phase of hexagonal crystalline HA NPs. The presence of the CUR fingerprint is visible in its FTIR spectra of the CUR/HA NC. Biochemical analysis and histological examinations revealed that CUR/HA NC injection does not significantly affect non-irradiation rats compared to the control. However, when injected pre-irradiation, it controls the pro-inflammatory cytokines (tumor necrosis factor-alpha, interleukin-6) GSH level, kidney, and liver functions as proved by biochemical histopathological and immunohistochemical findings. This research introduces a novel effective protection modality for the γ-irradiation hazard via biocompatible CUR/HA NC injection.

Alternate routes for children with difficult central venous access.

BACKGROUND: Some children requiring chemotherapy, total parenteral nutrition, or repeated blood sampling for long periods have no more axillary, internal jugular, external jugular, saphenous, or femoral veins available for cannulation. In such patients, the central venous system can still be accessed via alternate routes e.g. the azygos vein, the gonadal vein or the inferior epigastric vein. PATIENTS AND METHODS: We report the use of: 1) The inferior epigastric vein for placement of the catheter into the IVC in 20 patients. 2) The right gonadal vein for placement of the catheter using a retroperitoneal approach in five pediatric patients. 3) The second and third right intercostal veins for placement of the catheter by right intrapleural thoracotomy in five pediatric patients. Pre-procedural assessment of the patency of these veins was done using colour Doppler ultrasonography and confirmation of occlusion of common sites used for central venous access. RESULTS: A total of 38 implantable venous access devices (IVAD) were inserted in 30 patients. The average age at operation was 1.4 years (range 1 month to 12 years). Infection was seen in two patients, venous thrombosis in two. The average longevity of IVAD is 6.5 months. Recovery from the procedure was uncomplicated and the patients were able to receive complete intravenous medication or nutritive mixtures after the insertion of the catheter. CONCLUSION: The knowledge of alternate routes to obtain central venous access for children requiring chemotherapy, total parenteral nutrition, or repeated blood sampling for long periods is critically important, and the azygos system, right gonadal vein or the inferior epigastric vein can be used when standard accessible veins are unavailable.

Admission delays' magnitude of traumatized patients in the emergency department of a hospital in Egypt: a cross-sectional study.

BACKGROUND: Injury is an escalating public health problem, representing about 9% of global mortality, which disproportionately impacts lower- and middle-income countries. There are approximately 12,000 annual fatalities from road traffic injuries in Egypt, but a little information about delays in seeking emergent care is available. OBJECTIVES: To measure the time interval between sustaining an injury and presentation to the emergency department of Ain Shams University Surgery Hospital and to identify possible causes of these delays. METHODS: We conducted a cross-sectional, facilitated survey of a convenience sample of trauma patients presenting to the emergency department of Ain Shams University Surgery Hospital from 1 February to 31 May 2014. Data obtained included: demographic information, trauma incident details, and injury assessment. RESULTS: The average reported transport time for patients from injury to hospital arrival was 3.8 h, while the mean ambulance response time was 45 min. Referral from other hospitals was revealed to be a significant cause of delay (P = 0.004), while ignorance of the local ambulance phone number could not be confirmed as a cause (P = 0.2). CONCLUSION: This study demonstrated that trauma patients at our hospital experience more than 3 h of delay until they reach the ED. It also identified the possible causes accounting for that delay. However, additional nationwide research is needed to establish the clear causation or association of these causes with the delay intervals.

Hybrid repair of aortic arch aneurysm.

BACKGROUND: Conventional surgical repair of the aortic arch using cardiopulmonary bypass and deep hypothermic circulatory arrest still carries a substantial rate of mortality and morbidity especially myocardial injury, and predicts a high incidence of permanent neurological injury. Endovascular stent-graft placement has been developed as an effective treatment modality in various diseases of the descending aorta. Technological improvements nowadays allow deployment in the distal arch in most instances. However, in case of total involvement of the aortic arch endovascular SG repair, the challenge is to maintain blood flow to the brain and upper extremities, that may require covering one or more aortic branches in order to establish a secure proximal landing zone, and to ensure complete exclusion of the lesion. The aim of this study is to report our ongoing experience with endovascular treatment of aortic arch aneurysms. METHODS: During two years, 16 patients were treated with thoracic stent-grafts, after aortic arch debranching for repair of aortic arch aneurysm. All patients were at high risk for open repair and not candidates for standard endovascular repair due to inadequate proximal landing zones. Device design and implant strategy were on the basis of evaluation of aortic morphology with spiral CT. Stent grafts were inserted to repair the arch after supra-aortic vessel transposition was performed. Follow-up was 100% complete (mean 18 +/- 2.5 months, range 12-24 months). Follow-up included clinical examination, chest X-ray and computed tomography at discharge, 6 months after stent-graft placement and yearly thereafter. RESULTS: Primary technical success rate was 100%. Patency of all endografts and conventional bypasses was 100%. No endoleak or graft migration was observed. There were no neurological complications. Surgical conversion was never required. CONCLUSION: Hybrid aortic arch repair is technically challenging but feasible. This novel approach may be an alternative to standard open procedures in high-risk patients and emergency cases. However, the promising early results need to be confirmed by longer follow-up and larger series.

Extractive Spectrophotometric Determination of Nortriptyline Hydrochloride Using Sudan II, IV and Black B.

A simple spectrophotometric methods has been developed for the determination of nortriptyline hydrochloride in pure and in pharmaceuticalformulations based on the formation of ion-pair complexes with sudun II (SII), sudan (IV) (SIV) and sudan black B (SBB). The selectivity of the method was improved through extraction with chloroform. The optimum conditions for complete extracted colour development were assessed. The absorbance measurements were made at 534, 596 and 649 nm for SII, SIV and SBB complexes, respectively. The calibration graph was linear in the ranges 0.5- 280. 0.5- 37.5 and 0.5 - 31.0 µg ml-1 of the drug usiny the same reagents, respectively. The precision of the procedure was checked by calculating the relative standard deviation of ten replicate determinations on 15 µg ml-1 of nortriptyline HCI and was found to be 1.7, 1.3 and 1.55% using SII, SIV, and SBB complexes, respectively. The molar absorptivity and Sandell sensitivity for each ion-pair were calculated. The proposed methods were successfully applied to the deterniination of pure nortriptyline HCI and in pharmaceutical formulations, and the results demonstrated that the method is equally accurate, precise and reproducible as the official method.

Ultrasound degradation of xanthan polymer in aqueous solution: Its scission mechanism and the effect of NaCl incorporation.

Degradation of xanthan polymer in aqueous solution by ultrasonic irradiation was investigated. The effects of selected variables i.e. sonication intensity, irradiation time, concentration of xanthan gum and molar concentration of NaCl in solution were studied. Combined approach of full factorial design and conventional one-factor-at-a-time was applied to obtain optimum degradation at sonication power intensity of 11.5Wcm-2, irradiation time 120min and 0.1gL-1 xanthan in a salt-free solution. Molecular weight reduction of xanthan gum under sonication was described by an exponential decay function with higher rate constant for polymer degradation in the salt free solution. The limiting molecular weight where fragments no longer undergo scission was determined from the function. The incorporation of NaCl in xanthan solution resulted in a lower limiting molecular weight. The ultrasound-mediated degradation of aqueous xanthan polymer chain agreed with a random scission model. Side chain of xanthan polymer is proposed to be the primary site of scission action.

Study of workload of general medicine specialists working in the health insurance clinics.

This study was conducted at 4 of the H.I.O. polyclinics in Alex. with the objective of examining the change in visit rate per 1000 beneficiaries for general medicine specialty at H.I.O. clinics during a 4-year period (1985-1988) and to detect any trends that may have a bearing on the H.I.O. standards for supply of specialists. Data were collected from H.I.O. statistics department, H.I.O. regulations, and also through researcher's observation and specialists' interview. The collected data was used to describe the workload in terms of annual visit rate, actual number of working hours, the specialists' average production hours per day, the specialists' average idle time per day, the estimated number of required specialist working hours per day, and the specialists' recommended working hours per day. The results revealed a rising trend in the rate of use of general medicine specialist services and a definite shortage of supply of general medicine specialists was found in all clinics compared to H.I.O. standards. On the other hand, recommended supply based on specialist opinion was less than the H.I.O. standards but more than the current supply. Accordingly H.I.O. should re-estimate the specialist population standard and should seek the commitment of specialists to the revised standards.

Assessment study for multi-barrier system used in radioactive borate waste isolation based on Monte Carlo simulations.

Radioactive waste generated from the nuclear applications should be properly isolated by a suitable containment system such as, multi-barrier container. The present study aims to evaluate the isolation capacity of a new multi-barrier container made from cement and clay and including borate waste materials. These wastes were spiked by (137)Cs and (60)Co radionuclides to simulate that waste generated from the primary cooling circuit of pressurized water reactors. Leaching of both radionuclides in ground water was followed and calculated during ten years. Monte Carlo (MCNP5) simulations computed the photon flux distribution of the multi-barrier container, including radioactive borate waste of specific activity 11.22KBq/g and 4.18KBq/g for (137)Cs and (60)Co, respectively, at different periods of 0, 15.1, 30.2 and 302 years. The average total flux for 100cm radius of spherical cell was 0.192photon/cm(2) at initial time and 2.73×10(-4)photon/cm(2) after 302 years. Maximum waste activity keeping the surface radiation dose within the permissible level was calculated and found to be 56KBq/g with attenuation factors of 0.73cm(-1) and 0.6cm(-1) for cement and clay, respectively. The average total flux was 1.37×10(-3)photon/cm(2) after 302 years. Monte Carlo simulations revealed that the proposed multi-barrier container is safe enough during transportation, evacuation or rearrangement in the disposal site for more than 300 years.