most common otolaryngology, head and neck diseases at King Abdul-Aziz university hospital emergency department [tertiary hospital]

Objective: To know the most common ENT diseases which were presented to King Abdul-Aziz University Hospital, ENT emergency department in the year 2012, and the most common presentation in each ENT subspecialty and to evaluate the triage time

Design: Retrospective study

Subjects: A total of 1937 patients who presented to the emergency department

Setting: ENT Emergency Department, King Abdul-Aziz University Hospital, Riyadh, Saudi Arabia

Interventions: Information taken from emergency department database records

Main outcome measures: We considered the following parameters: age, nationality, gender, shift time, triage time, diagnosis and final plan

Results: Of the 1937 patients who presented to the emergency department, 92.6% of them were Saudis. Around 77.8% of the patients were seen in less than 30 minutes, while 16.4% were seen in 30 - 60 min. The most common diseases presented to the emergency department were nasal trauma and epistaxis [11.2% and 10.3%, respectively]. The subspecialty presentation were as follows: otology [38%], rhinology [35.7%], pharyngolaryngology [9.6%], and head and neck [6.1%]

Conclusions: The most common otolaryngology, head, and neck diseases presented to ENT emergency department was nasal trauma. Otology represents the most common subspecialty and most of the patients were seen in less than 30 minutes

Depression, anxiety and stress among Saudi Arabian dermatology patients: cross-sectional study

Objectives: This study aimed to determine the prevalence of depression, anxiety and stress among Saudi Arabian dermatology patients and to assess associations with sociodemographic and clinical characteristics

Methods: This cross-sectional study was conducted among 300 consecutive dermatology patients visiting King Abdulaziz Medical City in Riyadh, Saudi Arabia, in August 2015. The Arabic version of the Depression, Anxiety and Stress Scale was used to screen for symptoms of depression, anxiety and stress. Quality of life [QOL] was assessed using the Dermatology Life Quality Index

Results: A total of 254 dermatology patients participated in the study [response rate: 84.7%]. The prevalence of depression, anxiety and stress was 12.6%, 22.1% and 7.5%, respectively. The presence of at least one of these negative emotional states was noted among 24.4% of the cohort [95% confidence interval: 19.3-30.2%]. Depression was significantly higher among subjects who lacked family support [26.5% versus 10.7%; P = 0.006] while anxiety was less common among patients who engaged in physical exercise [14.5% versus 29.4%; P = 0.005]. According to the multivariate logistic regression analysis, poor QOL and a lack of family support were significant predictors of a negative emotional state

Conclusion: Almost a quarter of the studied Saudi Arabian dermatology patients were found to suffer from at least one negative emotional state. A lack of family support and poor QOL were the primary factors associated with a negative emotional state. Interventional studies are needed to examine the effects of social and family support on psychological conditions among Saudi Arabian dermatology patients

Determinants of hand hygiene compliance in Egypt: building blocks for a communication strategy

Hand hygiene of health-care staff is one of the most important interventions in reducing transmission of nosocomial infections. This qualitative study aimed to understand the behavioural determinants of hand hygiene in order to develop sustainable interventions to promote hand hygiene in hospitals. Fourteen focus group discussions were conducted with nurses in 2 university hospitals in Egypt. The interviews were tape recorded and transcribed. Thematic analysis was conducted by 2 independent investigators. The findings highlighted that nurses did not perceive the benefits of hand hygiene, and that they linked the need to wash hands to a sense of dirtiness. Knowledge of hand hygiene and related products was limited and preference for water and soap was obvious. Environmental constraints, lack of role models and social control were identified as barriers for compliance with hand hygiene. A multi-faceted hand hygiene strategy was developed based on existing cultural concepts valued by the hospital staff

assessment of dentists' knowledge about medical emergencies

Medical emergency when occurs in a dental environment should be handled efficiently and effectively in order to sustain life until medical help arrives. This study aimed to enhance knowledge amongst dental practitioners about the possible risks of a medical emergency to improve patient care. A questionnaire based study was conducted in the dental teaching hospitals of the twin cities, Rawalpindi and Islamabad in 2015. The questionnaire comprised of three sections to assess dentists' perception and dentists' knowledge on the commonly faced medical emergencies along with dentists' confidence in performing Basic Life Support [BLS]. 215 questionnaires were distributed out of which 192 were returned. The study sample included 122 female and 70 male dentists with a minimum clinical experience of one year. The results showed 71.4% received a formal BLS training while 84.4% wanted to receive thetraining. Moreover, the mean medical emergency score obtained was 5.28 out of a maximum of 10. 55.2% of the dental practitioners felt confident in performing Cardio Pulmonary Resuscitation [CPR], out of which, 80.5% had the correct knowledge of performing a CPR according to this study. The most significant finding was almost half of the dentists lack the knowledge and necessary training. Hence, in order to improve quality of patient care annual BLS courses should be made mandatory

Health beliefs related to diabetes mellitus prevention among adolescents in Saudi Arabia

The incidence of type 2 diabetes mellitus [T2DM] is growing rapidly in the Saudi population. The purpose of this study was to assess the constructs of the health belief model [HBM] as they relate to T2DM lifestyle and prevention behaviours among adolescents. A cross-sectional study was conducted between May and October 2013 among 426 non-diabetic secondary school students from randomly selected schools in Riyadh, Saudi Arabia. An Arabic version of an adapted English language questionnaire was used to assess knowledge and attitudes related to the severity and prevention of T2DM. A preventative behaviour assessment was also conducted to assess physical activity and dietary habits. The majority of the students [63.4%] had at least one diabetic family member. Obesity was more frequent in males compared to females [P = 0.013]. Awareness about the importance of maintaining a healthy body weight to prevent T2DM was lower in males than females [P = 0.037], although males engaged in routine exercise more often [P = 0.001]. Males were less likely than females to recognise the risks for T2DM, including obesity [P = 0.030], heredity [P = 0.013] and high fat intake [P = 0.001]. An alarmingly high number of Saudi students were unaware of T2DM severity and associated risk factors. Female students were more aware of the benefits of T2DM preventative lifestyle behaviours than males, although males engaged in routine exercise more often. Raising adolescents' awareness about the primary prevention strategies for T2DM should be a public health priority in Saudi Arabia. The HBM could inform further research on diabetes prevention among Saudi adolescents

Validation of the arabic version of the epworth sleepiness scale

The Epworth Sleepiness Scale [ESS] is a questionnaire widely used in developed countries to measure daytime sleepiness and diagnose sleep disorders. This study aimed to develop an ESS questionnaire for the Arabic population [ArESS], to determine ArESS internal consistency, and to measure ArESS test-retest reproducibility. It also investigated whether the normal range of ESS scores of healthy people in different cultures are similar. The original ESS questionnaire was translated from English to Arabic and back-translated to English. In both the English and Arabic translations of the survey, ESS consists of eight different situations. The subject was asked to rate the chance of dozing in each situation on a scale of 0-3 with total scores ranging between 0 [normal sleep] and 24 [very sleepy]. An Arabic translation of the ESS questionnaire was administered to 90 healthy subjects. Item analysis revealed high internal consistency within ArESS questionnaire [Cronbach's alpha = 0.86 in the initial test, and 0.89 in the retest]. The test-retest intra-class correlation coefficient [ICC] shows that the test-retest reliability was substantially high: ICC = 0.86 [95% confidence interval: 0.789-0.909, p-value < 0.001]. The difference in ArESS scores between the initial test and retest was not significantly different from zero [average difference = -0.19, t = -0.51, df = 89, p-value = 0.611]. In this study, the averages of the ESS scores [6.3 +/- 4.7, range 0-20 in the initial test and 6.5 +/- 5.3, range 0-20 in the retest] are considered high in Western cultures. The study shows that the ArESS is a valid and reliable tool that can be used in Arabic-speaking populations to measure daytime sleepiness. The current study has shown that the average ESS score of healthy Arabian subjects is significantly higher than in Western cultures

Chloral hydrate versus midazolam as sedative agents for diagnostic procedures in children

To compare sedation outcomes for chloral hydrate [CH] and midazolam [MD] as sedative agents for diagnostic procedures in children. A prospective, randomized, double-blinded study conducted between July 2005 and October 2006, at the Pediatric Day Care Unit [DCU], King Abdulaziz Medical City, Riyadh, Saudi Arabia. After meeting the inclusion criteria and getting informed consent, patients were randomized, given the study drug, and monitored for sedation outcomes. Two hundred and seventy-five patients who had 292 sedation sessions for diagnostic procedures were included in the study. Due to missing data, 286 sedations were included in the final analysis; 144 in the CH and 142 in the MD group. Both groups were comparable with respect to demographic and baseline characteristics. The CH compared to MD group, had a higher sedation success rate, shorter time to achieve sedation, shorter length of stay in DCU, and longer sedation duration. In both study groups, patients who required a second dose tended to be older and heavier. No major side effects were encountered. The CH group had a significantly higher mean sedation scores at 15, 30, 45, and 60 minutes. Chloral hydrate compared to MD, had a shorter time to achieve sedation, a higher success rate, less need for a second dose, and decreased the time spent in the DCU. Older and heavier patients are more likely to require a second dose of the study drug to be sedated

Immature reticulocyte fraction is an early predictor of bone marrow recovery post chemotherapy in patients with acute leukemia

To establish the benefits of immature reticulocyte fraction [IRF] measurement using an automated hematology cells analyzer over absolute neutrophil count [ANC] in predicting bone marrow recovery post induction chemotherapy. A prospective observational study was carried out in the Departments of Pathology, Medicine, and Pediatrics, Universiti Kebangsaan Malaysia, Medical Center [UKMMC], Kuala Lumpur, Malaysia during a period of 19 months from April 2009 to December 2010 to assess the bone marrow recovery in patients with acute leukemia. A total of 22 patients in remission induction phases were enrolled in this study. The blood specimens were collected from day zero after chemotherapy, and every 3 days until patients recovered hematologically. All blood samples were measured for ANC and IRF using an automated hematology analyzer [Beckman-Coulter LH750]. The percentage of patients showing IRF recovery earlier than ANC recovery was 63.6% [14 out of 22 patients]. There was a significant difference in the mean number of days for IRF recovery as compared with ANC recovery [14.05 and 17.18 days], p=0.005. This study proved that IRF was more useful in predicting bone marrow recovery in a patient with acute leukemia post induction chemotherapy compared with ANC. The IRF is not affected by infection, is easily measured, and inexpensive; thus, it is a reliable parameter to evaluate bone marrow reconstitution

Possible causes of treatment failure of asthmatic children attending the asthma clinic of Alexandria University Children's Hospital

Objectives: The present study was conducted to identify possible causes of treatment failure among asthmatic children attending asthma clinic of Alexandria University Children's Hospital [AUCH]

Study Design: This study was carried out on a convenient sample of 100 asthmatic children attending the Asthma Clinic at Alexandria University Children's Hospital [AUCH]. Face to face interview with caregiver using an interviewing questionnaire include data about socio-demographic characteristics of both parents and child clinical data, environmental exposures and treatment behavior

Results: The mean age of studied children was 6.26 +/- 3.11 years and male children constituted two thirds [68%] of the study sample. Out of 100 asthmatic children only 42 children were controlled comparing to 43 children were partially controlled and 15 children were uncontrolled. Several variables were significantly associated with treatment failure include rural residency, school or daycare center attendance, in-appropriateness of asthma treatment, inadequate doses of drugs, poor compliance with the prescribed treatment and incorrect technique of inhaler intake. Continuous exposure to triggers [as smoking, URTI], associated co-morbid diseases and family history of asthma or other allergic conditions were not significant factors in this study; they are important factors that affect asthma control

Conclusion: The current study shows that asthma control remains unsatisfactory, with less than half of children having an acceptable level of control. Several variables were found to be associated with poor asthma control

Serum Troponin-I as a prognostic marker in acute exacerbated chronic obstructive pulmonary disease patients

Background: Chronic Obstructive Pulmonary Disease [COPD] is a major cause of chronic morbidity and mortality worldwide. It is the fifth leading cause of death worldwide. The spectrum of cardiovascular complications associated with COPD is clearly broad, right ventricular [RV] dysfunction and pulmonary vascular disease are common in COPD and progress with time. In RV failure, cardiac Troponins [cTn] are suspected to be elevated secondary to RV ischemia or micro infarction

Objective: To evaluate the prognostic value of cardiac Troponin I level in acute exacerbated chronic obstructive pulmonary diseases [AECOPD] and its impact on the hospital outcome in those patients

Patients and methods: This study was performed on 60 patients with AECOPD, admitted at Chest Department and respiratory ICU; Zagazig University hospital. All patients were subjected to: thorough history taking, clinical examination, electrocardiography and echocardiography, arterial blood gas [ABG] analysis, measure forced vital capacity [FVC] and forced expiratory volume in first second [FEV1], serum assay of cTnI level which is considered -ve if <0.01 ng/ml and +ve if >/=0.01 ng/ml

Results: cTnI was positive in 42 AECOPD patients. cTnI positivity was more prominent among patients with very severe exacerbation of COPD and in those with past history of LTOT, MV, ICU admission. Also, cTnI positivity was more in patients admitted to ICU rather than those managed in the ward and among patients who needed MV rather than who did not need it and in patients who failed weaned rather that who succeeded weaned. P-pulmonate, Rt. ventricular strain, high pulmonary artery pressure, hypoxemia and hypercapnia showed a great effect upon cTnI positivity. The duration of hospitalization was longer among cTnI +ve patients than cTnI ?ve ones, Tropinin cutoff value for the prediction of death was >0.055 ng/ml with Sensitivity = 75%, Specificity = 68%

Conclusion: Positive cTnI in AECOPD patients may suggest exacerbation severity and the occurrence of pulmonary hypertension and right ventricular dysfunction. Positive cTnI is considered as good prognostic marker for the possibility of a need for MV and a longer duration of hospitalization. MV may further elevate cTnI in AECOPD patients and with possible weaning failure. Negative cTnI and cTnI

Bone disease in upper Egyptian transfusion dependent pediatric B-thalassemia major

Thalassemia and the blood transfusion complications associated with it predispose children to poor bone health. This study was conducted to determine the prevalence of bone-related abnormalities within this population. Forty two transfusion-dependent beta thalassemic subjects 5-19 years old in Assiut, Egypt, participated in this cross-sectional study. Medical history by interview and review of medical records, physical examinations including anthropometric measures and puberty assessment, and bone densitometry using DEXA and height adjustment were performed. The incidence of underweight and short stature was 73.8% and 69%, respectively, which were indicators of malnutrition among thalassemic subjects in this study. Low bone density [BMD Z-scores < -2] was detected in the lumbar spine and femoral region in 54.7% and 95.2% of subjects, respectively. But after height adjustment they became 11.9% and 64.3%, respectively. Forty-seven percent of patients had a history of fractures and the cumulative risk for which increased almost with age. Seventy-eight percent of patients reported bone pain, whilst back/hip pain was present in 69% of thalassemic children and adolescents. Genu valgus deformity and scoliosis were seen in 40.5% and 11.9% of patients. High incidence of low bone density and deficit in other aspects of bone health among thalassemia patients makes routine bone health assessment necessary for this vulnerable group. Considering influencing factors, dietary counseling and preventive supplementation therapy for this high risk group of children and adolescents may be necessary, although this should be assessed by intervention studies

Evaluation of Punica granatum peel against diabetic wound infection

Foot infections are a common and serious problem in diabetic patients. To investigate the antibacterial activity of some medicinal plants used by traditional healers for diabetic wounds and to examine in-vivo wound healing activity of active extracts. An experimental study in which fifteen plant extracts subjected to preliminary antibacterial screening against six standard organisms [Bacillus subtilis, Escherichia coli, Klebsiella pneumoniae, Proteus vulgaris, Pseudomonas aeruginosa and Staphylococcus aureus] using cup-plate agar diffusion method and the result was compared with activity of commonly used antibiotics. The minimum inhibitory concentration [MIC] was determined for active extracts using agar plate dilution method. The two extracts was screened against 180 clinical isolates obtained from diabetic wound infection. In this study the wound healing effect of methanolic extracts of Punicagranatum peels was tested on open skin wound model on Swiss Wistar Albino rats. Fourteen extracts [93.3%] exhibited inhibitory activity against one or more of the six organisms. The MICs of the methanolic and aqueous extracts of Punica granatum were very low against all organisms. 180 clinical isolates were obtained from diabetic wound infection, the results of identification showed that 30 were Escherichia coli, 15 Klebsiella pneumoniae, 45 Proteus spp, 15 Pseudomonas aeruginosa, 60 Staphylococcus aureus and 15 Staphylococcus epidermidis. The methanolic extract of Punica granatum peels had inhibitory effect against 99.4% of the isolates at concentration l00mg/ml. The aqueous extract has inhibitory effect against 91.7% of the isolates. Results were obtained by measuring the wound healing percentage. In the first group, healing was completed in 15 days. In the second group and third group, 13 days were required for the completion of healing. The results of this study indicated that the methanolic extract of Punica granatum had high antibacterial activity and have wound healing activity

Comparison of the tuberculin skin test and Quanti-FERON-TB Gold In-Tube [QFT-G] test for the diagnosis of latent tuberculosis infection in dialysis patients

Dialysis patients are more likely than the general population to develop active tuberculosis [TB]. In these patients, the availability of a highly sensitive and specific test to diagnose latent TB will ensure earlier treatment and decreased progression to active disease. In the current study, the Quanti-FERON-TB Gold In-Tube [QFT-G] test was compared with the tuberculin skin test [TST] for the diagnosis of latent tuberculosis infection [LTBI] among 200 hemodialysis patients and 15 confirmed TB disease cases in a tertiary care center in Saudi Arabia. Among the LTBI cases, 26 [13%] were TST positive, and 65 [32.5%] were positive by the QTF-G test, with an overall agreement between the 2 tests of 75.5% [k = 0.34] being observed. Among the confirmed tuberculosis disease cases, none were positive by TST, and 10 [66.7%] were positive by the QTF-G test, resulting in an overall agreement of 33.3% [k = 0]. A comparison between the TST and the QTF-G test was performed based on the sensitivity, specificity, and area under the curve [AUC] obtained for the tests. The QTF-G test was more sensitive and less specific than the TST in predicting the confirmed TB disease cases. When we tested the correspondence of the AUC values between the 2 diagnostic modalities, the obtained p-value was 0.0003. In conclusion, the AUCs of the examined diagnostic modalities are significantly different in predicting LTBI and tuberculosis

Seroprevalence of hepatitis B and C viruses among tuberculosis patients

Tuberculosis is a common health problem in the world. Sudan is among the countries with the highest prevalence for tuberculosis and HBV, HCV infections. Co-infection with viral hepatitis [HBV, HCV] among tuberculosis patients increases the risk of hepatotoxicity occurring during tuberculosis treatment, so it is important to know the seroprevalence of hepatitis B and C viruses among tuberculosis patients. To investigate seroprevalence of HBV and HCV among adult tuberculosis patients in tuberculosis center at Tropical Diseases Teaching Hospital [TDH]. This is a prospective cross sectional study, conducted in the period from December 2010 to October 2011 in tuberculosis center in TDH- Sudan. 200 adult tuberculosis patients [age 19years and above] were enrolled in this study, data were collected by using questionnaire. All patients' blood samples were tested for HBsAg and hepatitis C virus antibodies. Results were analyzed by using SPSS16 [Statistical package for social science16]. A total number of 200 confirmed tuberculosis patients were studied. 127 patients [63.5%] were males. The seroprevalence of HBV and HCV in this study were9.5% and 3.5% respectively.Two patients [1%] were infected with both infections. The HBV vaccination among the study group was 6%.The HBV and HCV infections are common among tuberculosis patients with seroprevalence of 9.5%and 3.5% for HBV and HCV respectively. Our study also showed that there are multiple risk factors for contracting HBV and HCV infections in our patients, so screening for these viruses should be included in the national TB control program.

Pattern of presentation of coronary artery disease in hypertensive patients

Hypertension is a major risk factor for coronary artery disease [CAD] and left ventricular hypertrophy [LVH]. Hypertensives have a threefold increase in cardiac death [due to either CAD or to cardiac failure]. In Sudan hypertension complications were increasing in incidence and prevalence. Evaluating chest pain in hypertensive patients presents challenges because of left ventricular hypertrophy as a cause of chest pain besides CAD. There are limited data on different aspects of hypertension complications. To assess the CAD as a cause of chest pain, to see the pattern and severity of CAD and to find the correlation between ECG, ECHO and coronary angiography findings in hypertensive patients 135 known hypertensive patients presented with chest pain were assessed through ECG, ECHO and coronary angiography. The participants' ages ranged between 39 and 90 years, with mean age of 59 years .73.3% of them were found to have CAD. The left anterior descending [LAD] artery was the most involved one. Left main [LM] artery was the least involved. Electrocardiography [ECG] showed that LVH is found in more than 50%of patients with CAD. BMI was>25 in 41.5%. Percutaneous coronary intervention [PCI] was recommended in [31.4%], coronary artery bypass graft [CABG] in[21.6%]. 33% and 25% of these consecutively have hypertension for 10 years or more. CAD is the main cause of chest pain in hypertensives. Aging, body mass index, duration and magnitude of hypertension and LVH have strong and frequent association with CAD

Interchangeability and comparative effectiveness between micronized and non-micronized products of glibenclamide tablets

During the last few years there was wide debate about the interchangeability and effectiveness between circulated products containing Glibenclamide in the market. This study aimed to compare the effectiveness of this product "non-micronized" to the originator's product of Glibenclamide tablets "of micronized" sulfonylurea. 12 volunteers received a dose of 5mg of Glibenclamide [from test and standard products] under fasting conditions in two separate sessions using randomized crossover design. Blood glucose level for the volunteers was monitored to avoid the development of hypoglycemia. Plasma samples were collected over 24 hours and analyzed using HPLC. The maximum concentration Cmax for the test and reference products were 2.508 +/- 0.104 and 3.526 +/- 0.118 [micro g/ml] respectively and the area under the curve AUC0-[were 3.511 +/- 0.153 4.572 +/- 0.202 [micro g.h/ml] for these products respectively, with a difference of about 24% between the test and reference products in its AUC. The results indicate that the test product is not bioequivalent to reference product. The difference in formulation between micronized product and non-micronized product of Glibenclamide tablets has impact on clinical outcomes

Effect of calcitonin on experimentally induced osteoarthritis in adult male rabbits: biochemical, histomorphometric, and immunohistochemical study

Osteoarthritis [OA] is the most common joint disease. This disease progresses slowly and develops over years. Conservative treatment regimens for OA treat the symptoms but not the disease. The purpose of this study was to investigate the role of salmon calcitonin in the changes that occur in the articular cartilage and subchondral bone following experimentally induced OA in rabbits. Thirty adult male New Zealand white rabbits were used. They were divided into three groups: control; osteoarthitic; and calcitonin-prophylactic. On sacrifice, blood samples were withdrawn to estimate serum alkaline phosphatase, calcium, and phosphorus levels. Articular cartilage and subchondral bone were processed for histological, immunohistochemical, and morphometric studies. Estimation of bone calcium and phosphorous concentrations was also carried out. Articular cartilage of osteoarthritic rabbits showed a disrupted articular surface with a reduction of the subchondral bone thickness. An irregular or a doubled tide-mark was also seen. There was a change in the normal distribution of the chondrocytes with loss of the superficial layer. Weak Periodic Acid Schiff's and Alcian blue staining with a negative BCL-2 reaction were also present in the articular cartilage. Bone calcium and phosphorus concentrations were significantly decreased in OA compared with those of the control group. Serum alkaline phosphatase level was significantly increased in the OA group compared with the control group. In the calcitonin-prophylactic group, there was an improvement in biochemical, histological, and immunohistochemical changes. Calcitonin had a protective effect on the OA changes induced in the articular cartilage of rabbits. Also, it played a role in improving bone calcium and phosphorus content and integrity of the bone matrix

Effect of diltiazem on the changes induced by monosodium glutamate in the ovary of adult rats: histological and immunohistochemical study

Monosodium glutamate [MSG] is a popular taste enhancer that is used widely. It has been reported that MSG is toxic to human and experimental animals. To investigate the histological and immunohistochemical effects of MSG on the ovary and to study the possible role of diltiazem [L-calcium channel blocker] in the prevention of these effects in adult female rats. Thirty adult female albino rats were used and divided into three groups: control; treated; and prophylactic. The control group received fixed amounts of grower's marsh without adding MSG daily for 14 days. The treated group was given 6 g of MSG daily thoroughly mixed with equal amount of feeds [grower's marsh] for 14 days. In addition to MSG, the prophylactic group was given diltiazem daily dissolved in water by an oro-gastric tube [5 mg/g body weight] for 14 days. The rats were sacrificed on day 15 of the experiment. The ovaries were processed for histological and immunohistochemical reaction for induced nitric oxide synthase. The ovary of the MSG-treated group had some atretic follicles and vacuolated stromal cells arranged in clusters. The other types of follicles were distorted, showing a degenerated oocyte surrounded by disorganized cells of follicular granulosa cells with darkly stained nuclei and vacuolated theca folliculi cells. There was a significant decrease in the number of ovarian follicles and a significant increase in the optical density of induced nitric oxide synthase reaction in the treated group compared with the control group. In the diltiazem-prophylactic group, there was an improvement in the histological and immunohistochemical changes. Diltiazem had a protective effect on the histological and immunohistochemical changes caused by MSG toxicity in the ovary of adult rats

Effect of quinine therapy on plasma glucose and plasma insulin levels in pregnant women infected with Plasmodium falciparum malaria in Gezira state

To determine if quinine has a metabolic effect during treatment of severe or complicated malaria, we studied its effects on plasma glucose and plasma insulin levels in 150 pregnant women with malaria referred to Madani maternity teaching hospital, Gezira state and 50 healthy pregnant controls. Levels were determined at baseline [day 0] before the start of quinine treatment, after 2 days of treatment [2 hours after the 4th dose] and after 7 days of treatment [day 8]. There was a statistically significant increase in plasma insulin concentrations during the quinine infusion and fall in plasma glucose concentration [P<0.001]. Quinine administered at the recommended dose and rate can disrupt plasma glucose homeostasis although it is still the drug of choice for severe and complicated malaria in Sudan

Coital retrograde menstruation as a risk factor for pelvic endometriosis

To investigate coitus during menstruation as a possible predisposing factor for endometriosis 78 patients were asked about their coital habitus during menstruation and subsequently were examined by ultrasound transabdominally, transvaginally, or both, before laparoscopy or surgery. MRI was used in six patients only. There was a statistically significant relationship between endometriosis and coital practice during menstruation. The incidence of endometriosis in patients with history of coitus in menses was 66% while the incidence was 34% in patients with no such history. It is concluded that coitus during menses could be a predisposing factor for endometriosis