Misoprostol for open myomectomy: a systematic review and meta-analysis of randomised control trials.

BACKGROUND: Excessive blood loss is a significant risk of myomectomy with the potential need for hysterectomy. OBJECTIVE: To study the effectiveness of preoperative misoprostol compared with placebo at open myomectomy on intra- and postoperative outcomes. SEARCH STRATEGY: PubMed, Cochrane, Scopus, MEDLINE and EMBASE. SELECTION CRITERIA: Randomised control studies of women undergoing open myomectomy for symptomatic fibroids who were given either misoprostol or placebo preoperatively. DATA COLLECTION AND ANALYSIS: The revised Cochrane risk-of-bias tool for randomised trials was used to assess the risk of bias. Primary outcomes were blood loss, drop in haemoglobin and need for blood transfusion. Secondary outcomes were operative time, postoperative pyrexia and length of postoperative stay. Pooled effect sizes with corresponding 95% CI were calculated using random effects models. Data were analysed using two statistical models for statistical reliability. RESULTS: Eight studies were included with a total of 385 patients, of which 192 received misoprostol. Preoperative misoprostol was significantly associated with lower blood loss by -170.32 ml (95% CI -201.53 to -139.10), lower drop in haemoglobin by -0.48 g/dl (95% CI -0.65 to -0.31), reduced need for blood transfusion (odds ratio [OR] -0.48, 95% CI -0.65 to -0.31), and a reduction in operative time by -11.64 minutes (95% CI -15.73 to -7.54). There was no difference in postoperative pyrexia or length of postoperative stay. CONCLUSION: Moderate- to high-quality studies have established that misoprostol minimises blood loss and need for blood transfusion at open myomectomy. This low-cost and readily available drug should be routinely administered prior to open myomectomy to improve clinical outcomes. TWEETABLE ABSTRACT: Use of misoprostol at open myomectomy reduces blood loss and need for blood transfusion with no impact on postoperative pyrexia.

Comparison of Airway Measurements in Rheumatoid Arthritis and Non-rheumatoid Patients using Lateral Cephalometric Radiographs.

OBJECTIVE: The aim of this study was to investigate the potential relationship between the volumetric area of the upper airway and rheumatoid arthritis (RA) by comparing upper airway measurements between patients with and without RA. METHODS: This case-control study compared upper airway measurements between patients with and without RA using lateral cephalometric radiographs. Two distinct measurements were made: the area of the upper airway, which is defined as "the area extending from the point of the retro-palatal region to the base of the epiglottis," and the distance of the upper airway, which is defined as "the distance between the anterior border of the third cervical vertebra (C3) and the anterior border of the soft tissue of the neck". A single examiner performed all measurements, and the intra-examiner reliability was assessed. RESULTS: Sixty-one RA patients and 95 non-RA patients were included in the case and control groups, respectively. RA patients were significantly older in age and with higher BMI values. Patients with or without RA had Angle Class II as the most prevalent orthodontic classification. The upper airway was slightly narrower in RA patients, resulting in a smaller area, and the length of the upper airway was significantly longer in RA patients. CONCLUSION: Patients with RA have narrower upper airways as measured on lateral cephalometric radiographs. This may partially explain the high prevalence of obstructive sleep apnea among patients with RA. Focusing on airways measurements when cephalometric radiographs are taken for patients with RA could give some idea about which patient is likely to have OSA.

Prevlaence of chronic kidney disease markers in Kumbotso rural Northern Nigeria.

BACKGROUND: Data- on the epidemiology of Chronic Kidney Disease (CKD) from sub-SaharanAfrica are sparse. We investigated the prevalence of CKD and its early markers in Kumbotso, a rural community in northern Nigeria. METHODS: A total of 480 individuals were randomly selected from the general population using multistage stratified random sampling. Relevant- demographic and clinical data were obtained using a structured questionnaire. Biological samples (urine and blood) were drawn for relevant investigations. RESULTS: CKD (estimated glomerular filtration rate [eGFR <60 mls/min) was found in 117 participants (26%). Proteinuria was present in 106 persons (23.6%) and haematuria in 7 individuals (1.6%). The most common CKD stage was stage 1 (20%). CKD was associated with hypertension (P=0.002), diabetes (P=0.001), high cholesterol (P=0.030), smoking (P=0.015), increasing BMI (P=0.020), and increasing age (P=0.003). After adjusting for potential confounding with logistic regression modeling we found BMI, family history of hypertension, history of diabetes mellitus and family history of renal disease to be independent predictors of CKD. CONCLUSIONS: Early markers of CKD are common among rural inhabitants of northern Nigeria and this call for concerted efforts towards institution of preventive measures.

Mutations in VPS33B, encoding a regulator of SNARE-dependent membrane fusion, cause arthrogryposis-renal dysfunction-cholestasis (ARC) syndrome.

ARC syndrome (OMIM 208085) is an autosomal recessive multisystem disorder characterized by neurogenic arthrogryposis multiplex congenita, renal tubular dysfunction and neonatal cholestasis with bile duct hypoplasia and low gamma glutamyl transpeptidase (gGT) activity. Platelet dysfunction is common. Affected infants do not thrive and usually die in the first year of life. To elucidate the molecular basis of ARC, we mapped the disease to a 7-cM interval on 15q26.1 and then identified germline mutations in the gene VPS33B in 14 kindreds with ARC. VPS33B encodes a homolog of the class C yeast vacuolar protein sorting gene, Vps33, that contains a Sec1-like domain important in the regulation of vesicle-to-target SNARE complex formation and subsequent membrane fusion.

Brassica oleracea L. (Acephala Group) based zinc oxide nanoparticles and their efficacy as antibacterial agent.

Zinc oxide nanoparticles were synthesized from the leaf extract of Brassica oleracea L. Acephala group (collard green) followed by their characterization using Scanning Electron Microscope (SEM), and Energy Dispersive X-ray (EDX). The antibacterial properties of zinc nanoparticles were tested against Gram-negative bacteria, Pseudomonas aeruginosa (ATCC ® 9027™), Escherichia coli (ATCC ® 8739™), Klebsiella pneumoniae (ATCC® BAA-1705™) and Gram-positive bacteria, Staphylococcus aureus (ATCC ® 6538™) and Listeria monocytogenes (ATCC ® 13932™), at four different concentrations (50.00 µg/ml, 100.00 µg/ml, 500.00 µg/ml and 1 mg/ml) of zinc oxide nanoparticles suspension. Results revealed that the synthesized nanoparticles exhibit strong antibacterial effects against Pseudomonas aeruginosa, Listeria monocytogenes, Klebsiella pneumonia, Staphylococcus aureus and Escherichia coli at 500.00 µg/ml-1 mg/ml concentrations. An increase in efficacy of nanoparticles with the decrease of their size was also evident. This is a first ever report on Brassica oleracea, L. based nanoparticles which demonstrates that 500.00 µg-1 mg/ml conc. of zinc oxide nanoparticles have antibacterial activity against both Gram -ve and Gram +ve bacteria and have the potential to be considered as an antibacterial agent in future.

Prediction of soil seed bank of piedmont and alluvial environments of Dera Ghazi Khan, Punjab, Pakistan.

The current focus is on the overall pattern of seed storage present in the fragments of the soil of piedmont and alluvial landscapes of the environment. The present study predicted the seed banks of both soils of alluvial and piedmont zones in different ecological conditions and evaluate the potential of seeds in the restoration of both environments. The composition of the seed bank of soil is mainly affected by the alluvial environment and the structure of cleared area shows that more species of germinating annual grasses and growable seeds with the higher total number. Extant vegetation structures have an important role in the diversity of soil seed reservoirs, whose composition corresponded with the openness of the site. When in situ soil seed bank is recruited, it helps to restore only some components of the plant community in an alluvial environment. In our current research, it was confirmed that seed richness was higher in number at lower elevation (alluvial) than that at high elevation (piedmont). Seed richness showed a significant negative correlation with anions, cations, while significantly positive with altitude that suggests the richness pattern of the overall seed bank of the area is influenced by various environmental factors.

Prediction of soil seed bank of piedmont and alluvial environments of Dera Ghazi Khan, Punjab, Pakistan

Abstract The current focus is on the overall pattern of seed storage present in the fragments of the soil of piedmont and alluvial landscapes of the environment. The present study predicted the seed banks of both soils of alluvial and piedmont zones in different ecological conditions and evaluate the potential of seeds in the restoration of both environments. The composition of the seed bank of soil is mainly affected by the alluvial environment and the structure of cleared area shows that more species of germinating annual grasses and growable seeds with the higher total number. Extant vegetation structures have an important role in the diversity of soil seed reservoirs, whose composition corresponded with the openness of the site. When in situ soil seed bank is recruited, it helps to restore only some components of the plant community in an alluvial environment. In our current research, it was confirmed that seed richness was higher in number at lower elevation (alluvial) than that at high elevation (piedmont). Seed richness showed a significant negative correlation with anions, cations, while significantly positive with altitude that suggests the richness pattern of the overall seed bank of the area is influenced by various environmental factors.

Resumo O foco atual está no padrão geral de armazenamento de sementes presente nos fragmentos de solo do Piemonte e nas paisagens aluviais do meio ambiente. O presente estudo previu os bancos de sementes de ambos os solos das zonas aluvial e piemontesa em diferentes condições ecológicas e avaliou o potencial das sementes na restauração de ambos os ambientes. A composição do banco de sementes do solo é afetada principalmente pelo ambiente aluvial e a estrutura da área desmatada mostra que mais espécies de gramíneas anuais em germinação e sementes cultiváveis apresentam o maior número total. As estruturas da vegetação existente têm um papel importante na diversidade dos reservatórios de sementes do solo, cuja composição correspondeu à abertura do local. Quando o banco de sementes do solo in situ é recrutado, o mesmo ajuda a restaurar apenas alguns componentes da comunidade de plantas em um ambiente aluvial. Em nossa pesquisa atual, foi confirmado que a riqueza de sementes era maior em número em altitudes mais baixas (aluviais) do que em altitudes elevadas (Piemonte). A riqueza de sementes mostrou uma correlação negativa significativa com ânions, cátions, enquanto significativamente positiva com a altitude, o que sugere que o padrão de riqueza do banco geral de sementes da área é influenciado por vários fatores ambientais.

Prediction of soil seed bank of piedmont and alluvial environments of Dera Ghazi Khan, Punjab, Pakistan / Predição do banco de sementes do solo do piemonte e ambientes aluviais de Dera Ghazi Khan, Punjab, Paquistão

Abstract The current focus is on the overall pattern of seed storage present in the fragments of the soil of piedmont and alluvial landscapes of the environment. The present study predicted the seed banks of both soils of alluvial and piedmont zones in different ecological conditions and evaluate the potential of seeds in the restoration of both environments. The composition of the seed bank of soil is mainly affected by the alluvial environment and the structure of cleared area shows that more species of germinating annual grasses and growable seeds with the higher total number. Extant vegetation structures have an important role in the diversity of soil seed reservoirs, whose composition corresponded with the openness of the site. When in situ soil seed bank is recruited, it helps to restore only some components of the plant community in an alluvial environment. In our current research, it was confirmed that seed richness was higher in number at lower elevation (alluvial) than that at high elevation (piedmont). Seed richness showed a significant negative correlation with anions, cations, while significantly positive with altitude that suggests the richness pattern of the overall seed bank of the area is influenced by various environmental factors.

Resumo O foco atual está no padrão geral de armazenamento de sementes presente nos fragmentos de solo do Piemonte e nas paisagens aluviais do meio ambiente. O presente estudo previu os bancos de sementes de ambos os solos das zonas aluvial e piemontesa em diferentes condições ecológicas e avaliou o potencial das sementes na restauração de ambos os ambientes. A composição do banco de sementes do solo é afetada principalmente pelo ambiente aluvial e a estrutura da área desmatada mostra que mais espécies de gramíneas anuais em germinação e sementes cultiváveis ​​apresentam o maior número total. As estruturas da vegetação existente têm um papel importante na diversidade dos reservatórios de sementes do solo, cuja composição correspondeu à abertura do local. Quando o banco de sementes do solo in situ é recrutado, o mesmo ajuda a restaurar apenas alguns componentes da comunidade de plantas em um ambiente aluvial. Em nossa pesquisa atual, foi confirmado que a riqueza de sementes era maior em número em altitudes mais baixas (aluviais) do que em altitudes elevadas (Piemonte). A riqueza de sementes mostrou uma correlação negativa significativa com ânions, cátions, enquanto significativamente positiva com a altitude, o que sugere que o padrão de riqueza do banco geral de sementes da área é influenciado por vários fatores ambientais.

Cardiovascular risk factors in Nigerians with systemic hypertension.

BACKGROUND: Hypertension is the commonest risk factor for cardiovascular disease, and it frequently coexists together with other risk factors, thereby increasing the absolute cardiovascular risk. This study is primarily aimed at assessing cardiovascular risk factors in patients with hypertension in comparison with controls. It is also aimed at assessing target organ damage and absolute cardiovascular risk among the hypertensives. STUDY DESIGN: The study was case-control in design, conducted at the General outpatient and Cardiology Clinics of Aminu Kano Teaching Hospital, Kano, Nigeria. Three groups of patients (treated hypertensives, untreated hypertensives and controls), each 70 in number, were matched for age and sex. Patients were selected by balloting, using simple random sampling method. RESULTS: The most prevalent cardiovascular risk factor was Increased Body Mass Index, which was significantly more prevalent among treated (70%) than untreated (45.7%) hypertensives and controls (44.3%). Left Ventricular Hypertrophy was the most prevalent Target Organ Damage, found in 54.3% of treated and 42.9% of untreated hypertensives, and 0% of controls. Very high cardiovascular risk was detected in 75.6% of treated and 68.5% of untreated hypertensives. CONCLUSION: Even before the commencement of treatment, hypertenisves had high prevalence of cardiovascular risk factors and evidence of target organ damage. These were more pronounced in treated hypertensives. The basis and prognosis are discussed.

The diagnostic challenge of pulmonary Kaposi's sarcoma with pulmonary tuberculosis in a renal transplant recipient: a case report.

We report a case of a 39-year-old, HIV-negative, post renal transplant patient who developed mucocutaneous Kaposi's sarcoma with lung parenchymal involvement and concurrently culture proven pulmonary tuberculosis. To the best of our knowledge, this is the first case report of this combination, which presented with cavitating lung nodules and responded well to withdrawal of immunosuppressive drugs beside antituberculous treatment.

Treatment of obstructive sleep apnea with a self-titrating continuous positive airway pressure (CPAP) system.

Conventional manually adjusted continuous positive airway pressure (CPAP) is an effective therapy for sleep-disordered breathing. We prospectively investigated the efficacy of a self-titrating nasal CPAP system in the acute treatment of obstructive sleep apnea (OSA) syndrome. Twenty patients with moderately severe OSA [apnea hypopnea index (AHI) > 15/hour] were enrolled in a randomized, controlled, prospective clinical trial. An initial diagnostic sleep study was performed, followed by randomization to a manually adjusted CPAP titration on one night and self titrating CPAP on the other night. On the conventional CPAP night, the CPAP was manually adjusted until abolition of all apneas and electroencephalographic (EEG) arousals, whereas the self-titrating CPAP was set in automatic mode at lights out. The self-titrating CPAP system utilized an algorithm based on airway vibration patterns to detect airway stability. The AHI decreased from 50.8 +/- 28.8/hour [mean +/- standard deviation (SD)] at baseline to 3.8 +/- 3.1/hour (p < 0.005) during manually adjusted and 6.1 +/- 5.3/hour (p < 0.005) during self-titrating CPAP. The arousal index (Ar-I) decreased from 34.1 +/- 23.1/hour (baseline) to 11.2 +/- 5.0/hour on manual adjustment (p < 0.005) and 11.3 +/- 0.3/hour on self titration (p < 0.005), whereas total sleep time was unchanged. No significant differences in any measure of oxygenation or sleep architecture were observed between the manually adjusted and self-titrating CPAP nights except that the lowest arterial oxygen saturation (SaO2) was higher with manual titration (84.4 +/- 4.2% vs. 79.9 +/- 9.7%, p < 0.05). The maximum pressure required for abolition of apneas and arousals was significantly lower (p < 0.05) during the self-titrating study (10.1 +/- 3.8 cmH2O) as compared to manually adjusted CPAP (12.3 +/- 3.9 cmH2O). Failure to increase pressure and failure to maintain minimum pressure occurred in 7 of the 20 subjects during the self-titrating study. This required manual resetting of the system in five subjects, but the system self-corrected in two subjects. An unsupervised study would have resulted in undertreatment of OSA. Based on a single-night laboratory study, self-titrating CPAP was well tolerated and improved OSA and sleep architecture comparable to manually adjusted CPAP. The future modifications of this prototype will require further research to assess its efficacy and safety in the laboratory and home environments before its recommendation for general long-term use.

Susceptibility of LDL to oxidative stress in obstructive sleep apnea.

Cardiovascular diseases are more common in patients with obstructive sleep apnea (OSA) than in the general population. We hypothesized that severe hypoxemia during sleep in these patients may cause an imbalance between reactive oxygen species and the antioxidant reserve that is important for the detoxification of these molecules. We tested the hypothesis that low-density lipoproteins (LDL) in hypoxic OSA patients may be more susceptible to oxidative stress than LDL of nonhypoxic OSA patients and normal controls. Fifteen OSA patients were included in this study, six with severe hypoxia (hypoxic group) who spent more than 10 minutes during sleep with SaO2 < 85% (mean 96 minutes), and nine OSA patients (nonhypoxic group) who spent less than 10 minutes during sleep with SaO2 < 85% (mean 1.1 minutes). Six healthy nonsmoking males of the same age group were included as a control group. The susceptibility of each individual's LDL to oxidative stress was examined after free-radical challenge in vitro by assessing changes in levels of conjugated dienes. The LDL in OSA patients with severe hypoxia was not more susceptible to oxidative stress compared to the LDL of nonhypoxic OSA patients and normal controls. After 6 hours of exposure to an oxidative agent, the changes in the mean conjugated diene were not different among the three groups (p = 0.75). The time required to reach 50% of maximal absorbance was also not different, p = 0.199. Glutathione peroxidase and catalase activities in red blood cells in the hypoxic and nonhypoxic patient groups were not significantly different. One night of CPAP therapy in each patient group did not significantly change the level of the antioxidant enzymes. Our results did not show any difference in the susceptibility to oxidative stress between hypoxic and nonhypoxic OSA patients and normal controls.

Chronic eosinophilic pneumonia presenting with recurrent massive bilateral pleural effusion : case report.

We describe a rare case of a 29-year-old woman with chronic eosinophilic pneumonia (CEP) presenting with massive bilateral pleural effusion leading to respiratory failure, a complication that was not reported before with CEP. The patient was successfully managed with ventilatory support and steroid therapy. On long-term follow-up, she remained well, receiving a low maintenance dose of prednisone without evidence of relapse of the disease.

Treatment outcome of tuberculosis among Saudi nationals: role of drug resistance and compliance.

OBJECTIVE: Recent studies have demonstrated a high prevalence of multiresistant Mycobacterium tuberculosis (MDR-TB) in Saudi Arabia. In this study, we assessed the impact of this and other factors on the treatment outcome of tuberculosis among Saudi nationals. METHODS: We studied all patients (147 patients) with a culture-proven diagnosis of tuberculosis seen at the King Khalid National Guard Hospital (KKNGH), Jeddah, Saudi Arabia from June 1993 to June 1999. Treatment outcome was classified as success or failure based on the clinical assessment, improvement or deterioration of chest X-rays, and results of follow-up sputum examination. RESULTS: Of the 147 patients, only 126 completed the follow-up program. Treatment was found to be successful in 102 (81.0%) and unsuccessful in 24 (19.0%) of these 126 patients. However, treatment success is much less (102/147; 69.4%) and failure is much higher (45/147; 30.6%) if the 21 patients who were lost to follow-up are regarded as treatment failures. The prevalence of poor compliance and multiply drug-resistant Mycobacterium tuberculosis were found to be significantly higher among those with treatment failure than among those in whom treatment was successful. There was no significant difference in treatment outcome between the different age groups. However, failure of treatment was observed to be more common (P < 0.001) among males (35 patients; 46.7%) than among females (10 patients; 13.9%). This could be explained mainly by the significantly higher prevalence of non-compliance among males (44%) than among females (15.3%). There were no significant differences in the symptoms, radiologic findings, clinical presentation (pulmonary versus extrapulmonary), social background or drug resistance between genders. CONCLUSION: Successful treatment outcome among Saudi Nationals seen at the KKNGH in 1993-99 was below the rate recommended by the WHO, and failed treatment was associated with poor compliance, male gender and drug-resistant Mycobacterium tuberculosis. These results emphasize the importance of culture and sensitivity tests for Mycobacterium tuberculosis and close supervision of patients taking antituberculosis medications.

Increasing resistance of M. tuberculosis to anti-TB drugs in Saudi Arabia.

The incidence of drug resistance in Mycobacterium tuberculosis (MTB) isolated from our hospital between April 1996 and March 1998 was compared with an earlier study (1993-1995). Thirty (29.7%) of 101 MTB isolates were resistant to one or more anti-TB drugs and 21 (20%) of 101 were multi-drug resistant M. tuberculosis (MDR-TB). Resistance was most common to isoniazid (28.7%), followed by streptomycin (22.8%) and rifampicin (20.8%). Resistance to pyrazinamide and ethambutol was 7.9 and 6.9%, respectively. There was a three-fold increase in resistance compared with the earlier study.

A field trial of a single intramuscular injection of long-acting chloramphenicol in the treatment of meningococcal meningitis.

During an epidemic of meningococcal meningitis 86 patients with symptoms and signs of meningitis were treated with a single intramuscular injection of a long-acting oily preparation of chloramphenicol (Tifomycine). Treatment was given by auxiliary medical staff who worked in four separate village dispensaries under the supervision of the local medical officer. The clinical response to treatment was satisfactory; 79 of 86 patients (92%) recovered fully with few residual disabilities. There were five deaths (5.8%) but a definite diagnosis of meningococcal meningitis was established in only one of these patients. Treatment was changed because of a poor clinical response in two further patients. Diagnosis was eventually proved in 45 patients (52%). The response to treatment of patients in this group was similar to that observed in the remaining 41 patients. The results of this preliminary study show that a single dose injection of a long-acting chloramphenicol is of value in the management of epidemics of meningococcal meningitis in rural areas because patients can be treated locally and early in their village dispensaries, thereby minimizing the need to transport them to urban hospitals which are often distant and congested.

Yellow fever vaccination and pregnancy: a four-year prospective study.

During an outbreak of yellow fever (YF) in Nigeria in 1986-1987, women at various stages of pregnancy were vaccinated against YF, either because those pregnancies were not known at the time or because they requested vaccination out of fear of acquiring the disease. This offered an opportunity to assess the safety and efficacy of YF vaccine in pregnant women and the effect of this vaccine on their newborn children. Pre-vaccination and post-vaccination serum samples from the vaccinated pregnant women were tested by enzyme-linked immunosorbent assay and by neutralization tests for antibody to YF virus. The results showed that the antibody responses of these pregnant women were much lower than those of YF-vaccinated, non-pregnant women in a comparable control group. Follow-up of these women and their newborn children for 3-4 years showed no abnormal effect that could be attributed to the YF vaccine, which suggests that vaccination of pregnant women, particularly during a YF epidemic, may not be contraindicated.

Single injection treatment of meningococcal meningitis. 2. Long-acting chloramphenicol.

A single injection of a long-acting oily preparation of chloramphenicol (Tifomycine) was compared with a five-day course of crystalline and procaine penicillin in the treatment of 131 adult patients with meningococcal meningitis. The clinical response to treatment was similar in the two groups of patients. Serial lumbar punctures showed a parallel fall in CSF cell count, protein and lactate and all posttreatment cultures were sterile. Single injection chloramphenicol treatment was cheaper and much easier to administer than penicillin. Long-acting chloramphenicol is thus an effective form of treatment for meningococcal meningitis and is likely to prove of particular value in the management of epidemics in areas with limited medical resources.

Single injection treatment of meningococcal meningitis. 1. Long-acting penicillin.

A single injection of a long-acting preparation of penicillin (Triplopen) was compared with a five-day course of crystalline and procaine penicillin in the treatment of meningococcal meningitis. The clinical response of patients treated with Triplopen was very similar to that of patients treated with crystalline penicillin and much more convenient to administer. However, four patients treated with Triplopen had a positive CSF culture 48 or 72 hours after their injection. One injection of Triplopen cannot, therefore, be recommended as an entirely safe form of treatment for meningococcal meningitis unless patients can be carefully followed.