Destructive effects of UVC radiation on Drosophila melanogaster: Mortality, fertility, mutations, and molecular mechanisms.

The detrimental effects of ultraviolet C (UVC) radiation on living organisms, with a specific focus on the fruit fly Drosophila melanogaster, were examined. This study investigated the impact of heightened UVC radiation exposure on D. melanogaster by assessing mortality and fertility rates, studying phenotypic mutations, and investigating the associated molecular mechanisms. The findings of this study revealed that UVC radiation increases mortality rates and decreases fertility rates in D. melanogaster. Additionally, phenotypic wing mutations were observed in the exposed flies. Furthermore, the study demonstrated that UVC radiation downregulates the expression of antioxidant genes, including superoxide dismutase (SOD), manganese-dependent superoxide dismutase (Mn-SOD), zinc-dependent superoxide dismutase (Cu-Zn-SOD), and the G protein-coupled receptor methuselah (MTH) gene. These results suggest that UVC radiation exerts a destructive effect on D. melanogaster by inducing oxidative stress, which is marked by the overexpression of harmful oxidative processes and a simultaneous reduction in antioxidant gene expression. In conclusion, this study underscores the critical importance of comprehending the deleterious effects of UVC radiation, not only to safeguard human health on Earth, but also to address the potential risks associated with space missions, such as the ongoing Emirate astronaut program.

The Utility of Multimodal Intraoperative Neuromonitoring in Spine Surgery: Case Series from a Lower-Middle-Income Country Perspective.

OBJECTIVE: Multimodal intraoperative neuromonitoring (IOM) using somatosensory-evoked potentials and motor-evoked potentials is a sensitive and specific tool for detecting intraoperative neurologic injury during spine surgery. This study aimed to evaluate the use of multimodal IOM in a lower-middle-income country (LMIC) during cervical and thoracic spine surgery in order to prevent and predict new postoperative neurologic deficits early on. This is the first report of multimodal IOM application in LMICs. METHODS: The neurophysiologist raised the cutoff warning criteria of 50 patients who underwent surgery for different cervical and thoracic pathologies to decrease postoperative neurologic deficits. We retrospectively reviewed the medical charts and neuromonitoring traces of these patients followed by calculating the sensitivity, specificity, positive predictive value, and negative predictive value of combined IOM for postoperative neurologic deficit occurrence. RESULTS: A significant relationship was found between the reversibility of alerts and the development of new postoperative deficits (P < 0.001). There was no relationship between the cause of alerts and the reversibility of those alerts after corrective measures were carried out (P = 0.455), or the frequency of alerts and the development of new deficits postoperatively (P = 0.578). Sensitivity, specificity, positive predictive value, and negative predictive value of combined somatosensory-evoked potential and motor-evoked potential monitoring were 100%, 80%, 62.5%, and 100%, respectively. CONCLUSION: Because of the limited experience and the many technical difficulties faced in LMICs, we found that this cutoff limit resulted in more false-positive warnings but helped to avoid any false-negative results, thus enhancing the safety of surgery.

Primary Spinal Melanoma: Case Report and Systematic Review.

INTRODUCTION: Primary malignant melanoma of the spinal cord (PSM) is a rare condition with limited evidence regarding its diagnosis (clinical and radiographic), management, and prognosis. Our aim was to report an extremely rare two cases of primary malignant melanoma of the spine one of them is sacral melanoma which represents the second reported case in the literature and to conduct a systematic review of the relevant literature. METHODS: The diagnosis and management of these cases were retrospectively reviewed. Using the PRISMA guideline, we conducted a systematic review of the literature to analyze different management strategies and the prognosis of such pathology. RESULTS: All two patients were operated on, and received gross total removal of their tumors, with extended follow up for tumor recurrences. One of the cases involved a sacral tumor, which was resected without adjuvant therapy. The other one was seen by oncology and received post-operative chemo- and radio- therapy. In addition to the aforementioned cases, we present a comprehensive review of the literature on PSM from 1950 to the present, demonstrating that PSM is a very rare tumor, with a limited counted number of cases reported worldwide. CONCLUSION: In conclusion, we report an exceedingly rare two cases of primary malignant melanoma of the spine. Early surgical intervention is key to the management of these rare and aggressive tumors. GTR should be attempted if possible.

Incidence and impact of totally occluded culprit coronary artery in patients with non-ST segment elevation myocardial infarction acute coronary syndrome.

BACKGROUND: Significance of totally occluded culprit coronary artery in patients presenting with non-ST segment elevation myocardial infarction (NSTEMI) is underestimated. The aim of the study was to evaluate the incidence and impact of totally occluded culprit artery on in-hospital and 6 months follow-up outcomes of NSTEMI acute coronary syndrome (ACS) patients. RESULTS: We collected retrospectively data of 500 NSTEMI patients who presented to our hospital from June 2016 to June 2017. All patients underwent PCI within 72 h of presentation. We excluded patients with cardiogenic shock, prior CABG, and STEMI. Patients were divided into two groups according to pre-procedural culprit vessel thrombolysis in myocardial infarction (TIMI) flow. Group 1, TIMI flow 0 total coronary occlusion, included 112 patients (22.4%). Group 2, TIMI flow 1-3 non-total occlusion, included 388 patients (77.6%). Group 1 patients had significantly higher incidence of smoking (p=0.01), significantly higher level of cardiac enzymes (p<0.001), significantly more collaterals (p<0.001), and significantly more LCX and RCA as the culprit vessel (p<0.01), while group 2 patients had significantly higher incidence of diabetes (p=0.02) and significantly more LAD as the culprit vessel. There were no significant differences between the two groups regarding the major adverse cardiac and cerebrovascular events (MACCE) in-hospital (5.3% in totally occluded group vs. 1% in non-totally occluded group, p=0.07), but group 1 patients had significantly higher incidence of in-hospital arrhythmia (8.9% in group 1 vs. 1% in group 2, p=0.007). After 6 months follow-up, there were no significant differences regarding MACCE between the 2 groups after 6 months follow-up (5.4% in group 1 vs. 4.6% of group 2, P=0.24). CONCLUSION: 22.4% of NSTEMI patients have a totally occluded culprit artery. The presence of an occluded culprit artery did not significantly affect the clinical outcomes of NSTEMI patients either in-hospital or after 6 months follow-up but was associated with significantly higher incidence of in-hospital arrhythmia.

Endoscopic endonasal skull base surgery during the COVID-19 pandemic: A developing country perspective.

BACKGROUND: Although primarily a respiratory disorder, the coronavirus pandemic has paralyzed almost all aspects of health-care delivery. Emergency procedures are likely continuing in most countries, however, some of them raises certain concerns to the surgeons such as the endoscopic endonasal skull base surgeries. The aim of this study is to present the current situation from a developing country perspective in dealing with such cases at the time of the COVID-19 pandemic. METHODS: A cross-sectional analytical survey was distributed among neurosurgeons who performed emergency surgeries during the COVID-19 pandemic in Cairo, Egypt, between May 8, 2020, and June 7, 2020. The survey entailed patients' information (demographics, preoperative screening, and postoperative COVID-19 symptoms), surgical team information (demographics and postoperative COVID-19 symptoms), and operative information (personal protective equipment [PPE] utilization and basal craniectomy). RESULTS: Our survey was completed on June 7, 2020 (16 completed, 100% response rate). The patients were screened for COVID-19 preoperatively through complete blood cell (CBC) (100%), computed tomography (CT) chest (68.8%), chest examination (50%), C-reactive protein (CRP) (50%), and serological testing (6.3%). Only 18.8% of the surgical team utilized N95 mask and goggles, 12.5% utilized face shield, and none used PAPRs. Regarding the basal craniectomy, 81.3% used Kerrison Rongeur and chisel, 25% used a high-speed drill, and 6.3% used a mucosal shaver. None of the patients developed any COVID-19 symptoms during the first 3 weeks postsurgery and one of the surgeons developed high fever with negative nasopharyngeal swabs. CONCLUSION: In developing countries with limited resources, preoperative screening using chest examination, CBC, and CT chest might be sufficient to replace Reverse transcription polymerase chain reaction. Developing countries require adequate support with screening tests, PPE, and critical care equipment such as ventilators.

Distally Based Medial Hemisoleus Muscle Flap for Wound Coverage in the Distal Third of the Leg.

Wound healing and coverage of soft tissue defects of distal tibia are challenging. Free tissue transfer is treatment of choice for distal tibial defects. However, resources for free tissue transfer are not readily available and they increase morbidity to host. Local and regional flaps play a key role in management of these defects with less demanding or specialized requirements. The soleus muscle flap is the workhorse flap for midtibia soft tissue defects and is used in reverse fashion to reach the distal third of the tibia. Despite minor complications, distally based medial hemisoleus flap is reliable in limb salvage cases.

Antagonism of Histamine H3 receptors Alleviates Pentylenetetrazole-Induced Kindling and Associated Memory Deficits by Mitigating Oxidative Stress, Central Neurotransmitters, and c-Fos Protein Expression in Rats.

Histamine H3 receptors (H3Rs) are involved in several neuropsychiatric diseases including epilepsy. Therefore, the effects of H3R antagonist E177 (5 and 10 mg/kg, intraperitoneal (i.p.)) were evaluated on the course of kindling development, kindling-induced memory deficit, oxidative stress levels (glutathione (GSH), malondialdehyde (MDA), catalase (CAT), and superoxide dismutase (SOD)), various brain neurotransmitters (histamine (HA), acetylcholine (ACh), γ-aminobutyric acid (GABA)), and glutamate (GLU), acetylcholine esterase (AChE) activity, and c-Fos protein expression in pentylenetetrazole (PTZ, 40 mg/kg) kindled rats. E177 (5 and 10 mg/kg, i.p.) significantly decreased seizure score, increased step-through latency (STL) time in inhibitory avoidance paradigm, and decreased transfer latency time (TLT) in elevated plus maze (all P < 0.05). Moreover, E177 mitigated oxidative stress by significantly increasing GSH, CAT, and SOD, and decreasing the abnormal level of MDA (all P < 0.05). Furthermore, E177 attenuated elevated levels of hippocampal AChE, GLU, and c-Fos protein expression, whereas the decreased hippocampal levels of HA and ACh were modulated in PTZ-kindled animals (all P < 0.05). The findings suggest the potential of H3R antagonist E177 as adjuvant to antiepileptic drugs with an added advantage of preventing cognitive impairment, highlighting the H3Rs as a potential target for the therapeutic management of epilepsy with accompanied memory deficits.

Characterization of human serum albumin's interactions with safranal and crocin using multi-spectroscopic and molecular docking techniques.

Interaction mechanisms of human serum albumin (HSA) with safranal and crocin were studied using UV-Vis absorption, fluorescence quenching and circular dichroism (CD) spectroscopies as well as molecular docking techniques. Changes in absorbance and fluorescence of HSA upon interactions with both compounds were attributed to their binding to amino acid chromophores located in subdomains IIA and IIIA. Fluorescence secondary inner filter effect was excluded using 278 nm and 340 nm as the wavelengths of HSA's excitation and fluorescence while safranal and crocin absorbed at 320 nm and 445 nm, respectively. Stern-Volmer model revealed a static quenching mechanism involve the formation of non-fluorescent ground state complexes. Stern-Volmer, Hill, Benesi-Hilbrand and Scatchard models gave apparent binding constants ranged in 4.25 × 103 - 2.15 × 105 for safranal and 7.67 × 103 - 4.23 × 105 L mol-1 for crocin. CD measurements indicated that 13 folds of safranal and crocin unfolded the α-helix structure of HSA by 7.47-21.20%. In-silico molecular docking revealed selective exothermic binding of safranal on eight binding sites with binding energies ranged in -3.969 to -6.6.913 kcal/mol. Crocin exothermally bound to a new large pocket located on subdomain IIA (sudlow 1) with binding energy of -12.922 kcal/mol. These results confirmed the formation of HSA stable complexes with safranal and crocin and contributed to our understanding for their binding characteristics (affinities, sites, modes, forces … etc.) and structural changes upon interactions. They also proved that HSA can solubilize and transport both compounds in blood to target tissues. The results are of high importance in determining the pharmacological properties of the two phytochemical compounds and for their future developments as anticancer, antispasmodic, antidepressant or aphrodisiac therapeutic agents.

The Impact of using the term "Diabetic Ear" for the patients with Skull Base Osteomyelitis.

BACKGROUND: Diabetes and ear disease are some of the most widespread health concerns. The focus here is on the impact of using the term "Diabetic Ear" for patients with skull base osteomyelitis (SBM) in the context of malignant otitis externa (MOE). The aim of this study was to discover the awareness of general practitioners (GPs), residents, specialists, and consultants at Primary Health Care Centers about necrotizing otitis externa (NOE), also known previously as malignant external otitis (MOE), assess their deficiencies and provide solutions; also assist them for the early detection and possible prevention of diabetes- related ear diseases and their complications. MATERIALS AND METHODS: A cross-sectional study was conducted among a random sample of physicians (residents, specialists, and consultants) working at the Primary Health Care Centers in Al-Khobar and Dammam cities of the Eastern Province, Saudi Arabia. Data was collected using a standardized questionnaire. SPSS was used for data entry and analysis. RESULTS: The total number of medical practitioners was 84. Their mean age was 33.97 (±9.55). The proportion of females was higher than males, only 28.3% of the participants responded correctly when asked about MOE. Similarly, very few were aware of the risks of MOE (2.5%), complications associated with it (17.3%) and the necessary procedures for managing patients (24.2%). The awareness of doctors in the primary health clinics about MOE was significantly better than those in hospitals (P = 0.002). CONCLUSION: There was a significant deficiency in the knowledge of GPs on MOE. Therefore, health education and awareness programs on MOE are recommended. Furthermore, we recommend that it is necessary to encourage the use of the term "Diabetic EAR "to increase the level of awareness of physicians about MOE.

Oxidation characteristics of porous-nickel prepared by powder metallurgy and cast-nickel at 1273 K in air for total oxidation time of 100 h.

The oxidation behavior of two types of inhomogeneous nickel was investigated in air at 1273 K for a total oxidation time of 100 h. The two types were porous sintered-nickel and microstructurally inhomogeneous cast-nickel. The porous-nickel samples were fabricated by compacting Ni powder followed by sintering in vacuum at 1473 K for 2 h. The oxidation kinetics of the samples was determined gravimetrically. The topography and the cross-section microstructure of each oxidized sample were observed using optical and scanning electron microscopy. X-ray diffractometry and X-ray energy dispersive analysis were used to determine the nature of the formed oxide phases. The kinetic results revealed that the porous-nickel samples had higher trend for irreproducibility. The average oxidation rate for porous- and cast-nickel samples was initially rapid, and then decreased gradually to become linear. Linear rate constants were 5.5 × 10-8 g/cm2 s and 3.4 × 10-8 g/cm2 s for the porous- and cast-nickel samples, respectively. Initially a single-porous non-adherent NiO layer was noticed on the porous- and cast-nickel samples. After a longer time of oxidation, a non-adherent duplex NiO scale was formed. The two layers of the duplex scales were different in color. NiO particles were observed in most of the pores of the porous-nickel samples. Finally, the linear oxidation kinetics and the formation of porous non-adherent duplex oxide scales on the inhomogeneous nickel substrates demonstrated that the addition of new layers of NiO occurred at the scale/metal interface due to the thermodynamically possible reaction between Ni and the molecular oxygen migrating inwardly.

Insights into glycan biosynthesis in chemically-induced hepatocellular carcinoma in rats: A glycomic analysis.

AIM: To evaluate the qualitative and quantitative changes in N-linked glycosylation, which occurred in association with diethyl nitrosamine-induced hepatocellular carcinoma (HCC) in rodents. METHODS: Liver tissues of (1) normal (non-tumor-bearing) rats; and (2) tumor-bearing rats; were collected and were used for histological and GlycanMap analyses. Briefly, GlycanMap analysis is a high-throughput assay that provides a structural and quantitative readout of protein-associated glycans using a unique, automated 96-well assay technology coupled to matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and custom bioinformatics. Histopathological studies were carried out to ensure the development of HCC in the tested animals. RESULTS: The N-glycomic analysis revealed 5 glycans; Glc1Man9GlcNAc2, Gal2Man3GlcNac4Fuc1Neu1, Man4GlcNac2, Gal2Man3GlcNac4Neu3OAc3, and Man3GlcNac5 Fuc1, which showed significant changes in rat HCC tissues when compared with normal liver tissues. Four glycans were increased (P < 0.05) and Glc1Man9GlcNAc2 was decreased (5.89 ± 0.45 vs 3.54 ± 0.21, P < 0.01) in HCC tissues compared to normal liver tissues. An increase (66.5 ± 1.05 vs 62.7 ± 1.1, P < 0.05) in high-mannose structures in HCC rats was observed compared to normal rats. Importantly, HCC rats showed an increase (P < 0.05) in both tumor-associated carbohydrates and in branched glycans. The changes in glycans correlated well with glycan flow changes reported in the glycan biosynthetic pathway, which indicates the importance of enzyme activities involved in glycan synthesis at different subcellular localizations. CONCLUSION: The reported HCC-associated changes in glycan flow and subcellular localization explain the increase in high mannose glycans and siayl Lewis glycans common in HCC liver tissues.

The effect of glucagon-like peptide-1 in the management of diabetes mellitus: cellular and molecular mechanisms.

Incretins, such as glucagon-like peptide-1 (GLP)-1, have been shown to elevate plasma insulin concentration. The purpose of this study is to investigate the cellular and molecular basis of the beneficial effects of GLP-1. Normal and diabetic male Wistar rats were treated with GLP-1 (50 ng/kg body weight) for 10 weeks. At the end of the experiment, pancreatic tissues were taken for immunohistochemistry, immunoelectron microscopy and real-time polymerase chain reaction studies. Samples of blood were retrieved from the animals for the measurement of enzymes and insulin. The results show that treatment of diabetic rats with GLP-1 caused significant (P < 0.05) reduction in body weight gain and blood glucose level. GLP-1 (10(-12)-10(-6) M) induced significant (P < 0.01) dose-dependent increases in insulin release from the pancreas of normal and diabetic rats compared to basal. Diabetes-induced abnormal liver (aspartate aminotransferase and alanine aminotransferase) and kidney (blood urea nitrogen and uric acid) parameters were corrected in GLP-1-treated rats compared to controls. GLP-1 treatment induced significant (P < 0.05) elevation in the expression of pancreatic duodenal homeobox-1, heat shock protein-70, glutathione peroxidase, insulin receptor and GLP-1-receptor genes in diabetic animals compared to controls. GLP-1 is present in pancreatic beta cells and significantly (P < 0.05) increased the number of insulin-, glutathione reductase- and catalase-immunoreactive islet cells. The results of this study show that GLP-1 is co-localized with insulin and seems to exert its beneficial effects by increasing cellular concentrations of endogenous antioxidant genes and other genes involved in the maintenance of pancreatic beta cell structure and function.

Mechanism of the beneficial and protective effects of exenatide in diabetic rats.

Glucagon-like peptide 1 (GLP1) agonists are promising therapeutic agents in the treatment of diabetes mellitus. This study examines the mechanism of the protective effects of exenatide in experimental diabetes, employing four groups of ten rats each, in which two groups were streptozotocin-induced diabetic and two were control groups. One control and one diabetic group were treated with exenatide (1 µg/kg body weight (BW)) for 10 weeks. Blood plasma was taken for biochemical analyses while pancreatic tissue was taken for immunofluorescence and immunoelectron microscopy studies and real-time PCR to examine the expression of genes. The results show that exenatide improved BW gain and reduced blood glucose in diabetic rats compared with controls. Similarly, exenatide enhanced insulin release from the pancreatic fragments and improved liver and kidney functions and lipid profile in diabetic rats compared with controls. Exenatide not only induced significant increases in serum insulin level but also elevated the number of insulin-, GLP1- and exenatide-positive cells compared with untreated controls. Exenatide also elevated the number of catalase- and glutathione reductase-positive cells in diabetic rat pancreas compared with controls. Exenatide caused significant elevation in the expressions of pancreatic duodenal homeobox-1, heat shock protein-70, glutathione peroxidase, insulin receptor and GLP1 receptor genes in the pancreas of both control and diabetic rats compared with untreated animals. The results have demonstrated that exenatide can exert its beneficial and protective effects by elevating the levels of endogenous antioxidants and genes responsible for the survival, regeneration and proliferation of pancreatic ß-cell.

Medicinal Chemistry and Applications of Incretins and DPP-4 Inhibitors in the Treatment of Type 2 Diabetes Mellitus.

Diabetes mellitus (DM) is a major metabolic disorder currently affecting over 200 million people worldwide. Approximately 90% of all diabetic patients suffer from Type 2 diabetes mellitus (T2DM). The world's economy coughs out billions of dollars annually to diagnose, treat and manage patients with diabetes. It has been shown that the naturally occurring gut hormones incretins, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) can preserve the morphology and function of pancreatic beta cell. In addition, GIP and GLP-1 act on insulin receptors to facilitate insulin-receptor binding, resulting in optimal glucose metabolism. This review examines the medicinal chemistry and roles of incretins, specifically, GLP-1 and drugs which can mimic its actions and prevent its enzymatic degradation. The review discussed GLP-1 agonists such as exenatide, liraglutide, taspoglutide and albiglutide. The paper also identified and reviewed a number of inhibitors, which can block dipeptidyl peptidase 4 (DPP-4), the enzyme responsible for the rapid degradation of GLP-1. These DPP-4 inhibitors include sitagliptin, saxagliptin, vildagliptin and many others which are still in the experimental phase.

Detection of human papillomavirus genotypes in cervical intraepithelial neoplasia and invasive cancer patients: Sharkia Governorate, Egypt.

BACKGROUND: Cervical cancer (CCA) is the 2nd most common cancer among women worldwide. For approximately 2 years now, CCA has been converted from an oncological disease to an infectious disease, almost certainly caused by Human papillomavirus (HPV). Development of effective vaccines against the virus has created considerable issue world-wide and has major implications for both primary and secondary prevention strategies. The objective of this study was to establish the prevalence and genotype distribution of HPV in preinvasive, cervical intraepithelial neoplasia (CIN II and III) and invasive CCA in Sharkia governorate, Egypt. METHODS: This study included 42 patients with CIN II and III, 30 patients with invasive CCA, and 45 controls who had undergone hysterectomy for any cause other than CCA. HPV detection and genotyping in cervical biopsies by Polymerase Chain Reaction (PCR) and Restriction Fragment Length Polymorphism (RFLP). RESULTS: HPV DNA was detected in 85.7% (36/42) patients with CIN II and III. HPV genotypes were arranged in order of decreasing frequency as follows: HPV 16 being detected in 50.0% (21/42), HPV 45 in 143% (6/42) HPV 33 in 11.9% (5/42), HPV 18 in 9.5% (4/42) and HPV 31 in 7.1% (3/42) cases. In patients with invasive CCA, 93.3% (28/30) were positive for HPV DNA. In order of decreasing frequency, HPV genotypes were: HPV 16 being detected in 66.7% (20/30), HPV 18 in 16.7% (5/30), HPV 33 in 10.0% (3 /30) and both HPV 31 and HPV 45 in 6.7% (2/30) cases. About 13.3% invasive cervical cancer and 7.1% CIN II & III specimens exhibited multiple infections without significant difference (P > 0.05). HPV 16 and 33 infections show a higher risk for development of advanced stages of invasive CCA but without a statistically significant difference. CONCLUSIONS: The high prevalence of HPV genotypes 16, 18, and 45 in Sharkia governorate, Egypt, deserves attention as it has important implications for the usefulness of vaccine in prevention of a significant proportion of CCA and the choice of diagnostic methods.

Reconstruction of skull base defects in sphenoid wing dysplasia associated with neurofibromatosis I with titanium mesh.

Sphenoid wing dysplasia occurs in 3-7% of patients with neurofibromatosis type 1 (NF1). The typical radiological features are partial or complete absence of the greater wing of the sphenoid. This condition is slowly progressive and may result in temporal lobe herniation into the orbital cavity, producing pulsating exophthalmos and gross facial deformity. Thus, reconstruction of the orbit is important for both cosmetic and functional reasons. Traditional surgical treatment of sphenoid dysplasia involves split bone grafting and repair of the anterior skull base defect. However, several reports have demonstrated complications of graft resorption and recurrence of proptosis and pulsating exopthalmos. In this case series, we present two patients suffering from pulsating exophthalmos due to sphenoid dysplasia. Radiological and MRI studies demonstrated orbital enlargement and complete absence of the greater wing of the sphenoid. Surgical management of these patients involved dural defect repair, and the use of titanium mesh in conjunction with bone graft to act as a barrier between the orbit and the middle cranial fossa. The mesh was fixed by fine screws. Proptosis improved markedly post-operatively and resolved within a few weeks. Ocular pulsation subsided and remained quiescent with at least 1-year follow-up.

Successful separation of craniopagus parasiticus.

OBJECTIVE: Craniopagus parasiticus is an extremely rare condition. The first attempt to separate such twins was performed in the Dominican Republic in 2004. The infant died 7 hours after surgery. The aim of this report is to present a case in which surgical separation was successfully performed on February 18, 2005. In February 2006, the child was still alive and in relatively good health. METHODS: The authors operated on a patient with craniopagus parasiticus at Benha Pediatric Hospital in Egypt, 45 km north of Cairo. The child was 10 months old when the surgery was performed. By minimizing the time of surgery and adequate control of intraoperative bleeding, a successful surgical separation was achieved. Computed tomography, magnetic resonance imaging, magnetic resonance angiography, and computed tomographic angiography provided the information necessary to perform surgery. RESULTS: The child underwent operation at the age of 10 months; the duration of surgery was 9 hours. Bleeding was the most serious problem, with the child receiving four liters of blood. The main arterial supply to the parasite was via the middle cerebral artery and was ligated in the Sylvian fissure. Bleeding, however, was mostly venous and was mainly controlled by diathermy and thrombin soaked packs of Surgicel, as well as clipping. After separation of the parasitic head, the dura was repaired using artificial dural grafts. Free bone flaps from the parasite were used to cover the osseous defect in the autosite. Skin flaps from the parasite were also used to cover the cranium. CONCLUSION: This is the second case of craniopagus parasiticus in which separation was attempted. The first patient, operated on in the Dominican Republic, died 7 hours after surgery. In the present case, the child is still alive and without neurological deficit.

The protective effect of Tribulus terrestris in diabetes.

Tribulus terrestris L (TT) is used in the Arabic folk medicine to treat various diseases. The aim of this article was to investigate the protective effects of TT in diabetes mellitus (DM). Diabetes is known to increase reactive oxygen species (ROS) level that subsequently contributes to the pathogenesis of diabetes. Rats were divided into six groups and treated with either saline, glibenclamide (Glib), or TT for 30 days. Rats in group 1 were given saline after the onset of streptozotocin (STZ)-induced diabetes; the second diabetic group was administered Glib (10 mg/kg body weight). The third diabetic group was treated with the TT extract (2 g/kg body weight), while the first, second, and third nondiabetic groups were treated with saline solution, Glib, and TT extract, respectively. At the end of the experiment, serum and liver samples were collected for biochemical and morphological analysis. Levels of serum alanine aminotransferase (ALT) and creatinine were estimated. In addition, levels of malondialdehyde (MDA) and reduced glutathione (GSH) were assayed in the liver. The tested TT extract significantly decreased the levels of ALT and creatinine in the serum (P < 0.05) in diabetic groups and lowered the MDA level in liver (P < 0.05) in diabetic and (P < 0.01) nondiabetic groups. On the other hand, levels of reduced GSH in liver were significantly increased (P < 0.01) in diabetic rats treated with TT. Histopathological examination revealed significant recovery of liver in herb-treated rats. This investigation suggests that the protective effect of TT for STZ-induced diabetic rats may be mediated by inhibiting oxidative stress.