Therapeutic potential of Calotropis gigantea extract against invasive pulmonary aspergillosis: In vitro and in vivo study

Objective: To characterize the antifungal activity of methanolic leaf extract of Calotropis gigantea alone or in combination with amphotericin B against invasive pulmonary aspergillosis in mice. Methods: GC/MS was used for analysis of active constituents of Calotropis gigantea extract. Spore germination assay and broth micro-dilution method were used to determine antifungal potential of Calotropis gigantea/amphotericin B against Aspergillus fumigatus. Neutropenic mice were randomly assigned into 5 groups: group 1 was neutropenic (control); group 2 was infected with Aspergillus fumigatus; group 3 was infected with Aspergillus fumigatus, and treated with Calotropis gigantea extract; group 4 was infected with Aspergillus fumigatus and treated with amphotericin B; group 5 was infected with Aspergillus fumigatus and treated with both Calotropis gigantea extract and amphotericin B. Fresh lung tissues were histopathologically examined. Fungal burden and gliotoxin concentration were evaluated in lung tissues. Catalase, superoxide dismutase, and malondialdehyde content were determined in lung tissues. Myeloperoxidase, tumor necrosis factor-alpha, interleukin-1, and interleukin-17 were also estimated by the sandwich enzyme-linked immuno-sorbent assay. Results: Calotropis gigantea/amphotericin B had a minimum inhibitory concentration and minimum fungicidal concentration of 80 and 160 μg/mL, respectively, for Aspergillus fumigatus. Additionally, Calotropis gigantea/amphotericin B significantly reduced lung fungal burden by 72.95% and inhibited production of gliotoxin in lung tissues from 6 320 to 1 350 μg/g lung. Calotropis gigantea/amphotericin B reduced the oxidative stress of the lung via elevating the activity of antioxidant enzymes and decreasing the levels of lipid peroxidation. Myeloperoxidase activity and the production of pro-inflammatory cytokines were also significantly reduced. Scanning electron microscopy revealed deteriorations in the hyphae ultrastructure in Calotropis gigantea/amphotericin B treated Aspergillus fumigatus and leak of cellular components after damage of the cell wall. In vivo study revealed the suppression of lung tissue damage in mice of invasive pulmonary aspergillosis, which was improved with Calotropis gigantea/amphotericin B compared to the control group. Conclusions: Calotropis gigantea/amphotericin B is a promising treatment to reduce lung fungal burden and to improve the drugs' therapeutic effect against invasive pulmonary aspergillosis.

Therapeutic potential of Calotropis gigantea extract against invasive pulmonary aspergillosis: In vitro and in vivo study

Objective: To characterize the antifungal activity of methanolic leaf extract of Calotropis gigantea alone or in combination with amphotericin B against invasive pulmonary aspergillosis in mice. Methods: GC/MS was used for analysis of active constituents of Calotropis gigantea extract. Spore germination assay and broth micro-dilution method were used to determine antifungal potential of Calotropis gigantea/amphotericin B against Aspergillus fumigatus. Neutropenic mice were randomly assigned into 5 groups: group 1 was neutropenic (control); group 2 was infected with Aspergillus fumigatus; group 3 was infected with Aspergillus fumigatus, and treated with Calotropis gigantea extract; group 4 was infected with Aspergillus fumigatus and treated with amphotericin B; group 5 was infected with Aspergillus fumigatus and treated with both Calotropis gigantea extract and amphotericin B. Fresh lung tissues were histopathologically examined. Fungal burden and gliotoxin concentration were evaluated in lung tissues. Catalase, superoxide dismutase, and malondialdehyde content were determined in lung tissues. Myeloperoxidase, tumor necrosis factor-alpha, interleukin-1, and interleukin-17 were also estimated by the sandwich enzyme-linked immuno-sorbent assay. Results: Calotropis gigantea/amphotericin B had a minimum inhibitory concentration and minimum fungicidal concentration of 80 and 160 μg/mL, respectively, for Aspergillus fumigatus. Additionally, Calotropis gigantea/amphotericin B significantly reduced lung fungal burden by 72.95% and inhibited production of gliotoxin in lung tissues from 6 320 to 1 350 μg/g lung. Calotropis gigantea/amphotericin B reduced the oxidative stress of the lung via elevating the activity of antioxidant enzymes and decreasing the levels of lipid peroxidation. Myeloperoxidase activity and the production of pro-inflammatory cytokines were also significantly reduced. Scanning electron microscopy revealed deteriorations in the hyphae ultrastructure in Calotropis gigantea/amphotericin B treated Aspergillus fumigatus and leak of cellular components after damage of the cell wall. In vivo study revealed the suppression of lung tissue damage in mice of invasive pulmonary aspergillosis, which was improved with Calotropis gigantea/amphotericin B compared to the control group. Conclusions: Calotropis gigantea/amphotericin B is a promising treatment to reduce lung fungal burden and to improve the drugs' therapeutic effect against invasive pulmonary aspergillosis.

Closure of the cystic duct comparison ultrasonic Harmonic Scalpel versus clip application in Laparoscopic Cholecystectomy

Background: Laparoscopic cholecystectomy [LC] is usually performed using titanium clips [TC] for occlusion of the cystic duct and cystic artery. The use of Harmonic scalpel [HS] in LC has been reported

Aim: This study aimed to compare effect of HS and clips application for closure of the cystic duct and artery in patients undergoing LC

Patients and Methods: Totally 50 patients were operated using LC technique from April 2010 to April 2012. Patients were retrospectively, divided into 2 groups according to the instruments used for division of the cystic artery and duct as well as for dissection of the liver bed. On the one hand, group 1 consisted of 30 patients who were all treated with the ultrasonic harmonic scalpel as the sole instrument used in the whole procedure. On the other hand, group 2 comprised 20 patients in whom dissection and coagulation were performed using monopolar coagulation, and occlusion of the artery and duct with clips. The operative time, postoperative hospital stay, morbidity, and mortality for each group were analyzed and compared with each other

Results: The 2 groups were comparable for age, sex, indication for cholecystectomy, and combined procedures. Patients were randomly treated either with the ultrasonic HS or with clips. Postoperative hospital stay of all patients in the group 1 and group2 was 2 days. Superficial wound infection seen in one patient [2%] in group 2 which was treated by oral antibiotics. During the follow-up period, one port-site hernia was detected in one patient [2%] in group 2. One case [2%] of peritoneal fluid collection seen in [group 1] and treated with percutaneous drainage was found

Conclusions: The use of harmonic scalpel was accepted as a reasonable alternative for closure of cystic ducts < 4 mm in diameter. This Study has shown that the HS is an effective and safe tool for the closure of both the cystic duct and artery in patients who undergo LC

Efficacy of extracorporeal shockwave lithotripsy using dornier sii in different levels of ureteral stones

The objective of this study was to evaluate the efficacy and safety of the Dornier lithotripter S II system in the treatment of ureteral calculi. A total of 97 cases which consists of 54 males and 43 females with ureteral stones were treated by extracorporeal shock wave lithotripsy [ESWL]. Mean age was 42.6 years. Inclusion criteria were solitary radiopaque ureteral stones of radiological stone size of

Histological study of the effect of bone marrow-derived mesenchymal stem cells on healing of skin defect in adult male albino rats

Despite advances in wound care, skin loss results in significant morbidity and mortality. There is increasing evidence that bone marrow-derived mesenchymal stem cells [BM-MSCs] are useful for tissue regeneration because of their multipotency and easy isolation and culture. The objective of this study was to evaluate the efficacy of local administration of in-vitro-expanded BM-MSCs in the healing of experimentally induced full-thickness excisional wounds in adult male albino rats. Thirty-five adult male albino rats were used. They were divided into three groups. In group I rats, BM was isolated and cultured and skin specimens were obtained as a control. In group II rats, a full-thickness circular skin wound of 5mm in diameter was inflicted on the mid back of each rat and was examined on days 3, 7, and 14. In group III rats, the wound was inflicted as in group II, which was then treated with BM-MSCs and examined as in group II. The wound areas were excised and used for histological and immunohistochemical studies for CD105. Morphometric analysis was performed for assessment of epidermal thickness, area percentage of collagen and elastic fibers, and number of CD105-positive cells. Wounds treated with BM-MSCs [group III] showed evidence of re-epithelialization, increased epidermal thickness, hair follicle formation, collagen, and elastic fibers compared with wounds in group II. Similarly, the number of CD105-positive cells was prominently increased in the skin of the same group. Local administration of in-vitro-expanded BM-MSCs accelerates and promotes healing in full-thickness excisional wounds

Evaluation of volume-targeted versus pressure-limited ventilation for Preterm Neonates with respiratory distress

Objectives: To evaluate the efficiency of volume targeted versus pressure-limited ventilation for preterm infants with respiratory distress

Methods: 60 newborn infants with gestational age 28-34 weeks in the NICU at Alexandria University Children's Hospital randomly divided in to 2 groups ventilated with either volume targeted ventilation [VTV] or pressure limited time cycled ventilation [PLV] as primary mode or secondary to failure of NCPAP using SLE 4000 or 5000 ventilators

Results: The demographic and clinical characteristics, values of tidal volume [VT], peak inspiratory pressure [PIP], mean airway pressure [MAP], fraction of inspired oxygen [Fio2], alveolar arterial oxygen gradient [A-aDo2], carbon dioxide tension, and pH were similar for all participating infants initially. During the follow-up, the PIP, MAP and FIO2 levels were significantly decreasing in the VTV group during the first 48 hrs. Moreover, The VTV group showed significantly lower incidence of hypocarbia and non-permissible hypercarbia. The VTV group showed significantly shorter duration of ventilation. There was no statistical significant difference between both groups as regards IVH, air leaks BPD, PDA or nosocomial infection

Conclusion: The use of VTV achieves adequate gas exchange using lower MAP and with less variability in tidal volume reducing the risk of hypocarbia and non-permissible hypercarbia. The use of VTV also shortens the duration of ventilation in premature infants with respiratory distress

Shock wave lithotripsy for lower calyceal stone

To evaluate the effect of SWL, anatomical influence on fragmentation and stone clearance. The success of Shock Wave Lithotripsy [SWL] arises from effective fragmentation and stone clearance. One hundred patients [65 males and 35 females] with lower calyceal stones treated with SWL were enrolled in the study and analyzed retrospectively, at Al-Azhar Lithotripsy Unit, Al-Hussein University Hospital. Stone was single in 90 patient and multiple in 10 patients. Regarding stone radiodensity, the stones were hyper dense in 35 patients, dense in 50 patients and radiolucent in 15 patients. Those patients were divided into two groups, Group I includes 60 patients, they were considered to be completely stone free 6 months after SWL, and forty patients were having residual stones in Group II. The mean size of stones in group I was 0.9cm in diameter, while in group II the mean size was 1.7cm. The PC angle, diameter of lower calyx infudibulum and lower pole calyceal pattern were determined from intravenous urography. Residual stones were found in 100% of patients with PC angle<90°, in 100% of patients with an infundibular diameter<4mm, and in 100% of patients with complex lower calyceal pattern. From the presenting results the PC angle, lower calyx infundibular diameter and anatomy of lower pole calyx SWL for lower calyceal stones

Synthesis, biological evaluation and molecular modeling investigation of some new benzimidazole analogs as antiviral agents

A set of heterocyclic benzimidazole derivatives bearing 1,3,5-triazine group with different substituents at C-2 and C-5 of the benzimidazole ring have been synthesized and evaluated for their antiviral activities against HSV-1. The structures of these compounds have been established by analytical data, IR spectra, [1]H NMR, and mass spectra. Compounds 8a and 8b proved to be the most active antiherpetic agents in this study, at EC[50]% concentrations of 2.9, 3.4 mg/ml, respectively. Computational evaluation of the quantum chemical descriptors such as hydrophobicity [log P], HOMO and LUMO, and the gap energy, were calculated and correlated with the antiviral activity. The tested compounds showed proper degree of hydrophobicity [<0.5 - >5]. The HOMO-LUMO gap energy values of the tested compounds are comparable with the observed values for the antiviral drug, Acyclovir

Randomised comparison of different insufflation pressures in diagnostic and minor gynecologic laparoscopic surgery

Determine the influence of low-pressure pneumoperitoneum on intraope-rative heamodynamic effects and postoperative shoulder-tip pain [STP] in patients undergoing diagnostic and minor gynecologic laparoscopie procedures. Prospective randomized study conducted in the endoscopic unites at Zagazig and Benha university hospitals. The study comprised 80 women undergoing diagnostic and minor laparoscopic procedures where pneumoperitoneum with high Co2 pressure [13-15 mHg] used in 40 women [group A] and with low Co2 pressure [7-10 mNg] in another 40 women [group B]. There was significant increase in the mean arterial pressure [MAP] in both groups at [5 mm.] after insufflation and tilting the patient to Trendelenberg position but there was significant decrease of [MAP] in [group B] as compared to [group A] [P< 0.05]. Both the frequency and intensity of postoperative shoulder-tip pain were lower in [group B] than in [group A], [[20%], [5.1]] versus [[35%], [7.4]] and the differences were statistically significant, especially at [6, 12, 24, 48] hours postoperatively. There was significant reduction of the mean amount consumed analgesic [declophenac potassium] in [group B] compared to [group A] [75 mg] versus [131.25 mg]. Low-pressure pneumoperitoneum used in diagnostic and minor gynecologic laparoscopic procedures allows more stable intraoperative hemodynamics of the patients and reduction of both frequency and intensity of postoperative shoulder-tip pain, with reduction of postoperative analgesics used

Pattern of chromosomal abnormalities among referral casesin a tertiary health care facility in Riyadh, Sudi Arabia

To evaluate the cytogenetic findings among Saudi referred for suspected chromosomal anomalies that caused a variety of clinical disorders. Secondly, to estimate the frequency of chromosomal abnormalities in these patients and to compare our results with those reported in Saudi Arabia and elsewhere. Thirdly, to evaluate if there overuse by some clinicians who refer cases for cytogenetic study before exhausting other less expensive and time-consuming tests that may lead to the final diagnosis. Chromosomal analysis was performed on three hundreds and twenty five cases referred to the Cytogenetics Laboratory between June 2005 and May 2006 at King Fahad Medical City, Riyadh, Saudi Arabia [SA]. Indications for referrals for exclusion of chromosomal abnormalities was multiple congenital anomalies, dysmorphic features, unclassified mental retardation, developmental delay, primary amenorrhea, recurrent abortions and positive consanguinity. Data were collected from the referred patients' files. Lymphocyte culture was carried out according to standard procedures. Various types of chromosomal anomalies were recorded in 39 [12%] of the studied group of those, 35 [89.7%] showed numerical chromosomal abnormalities in the form of trisomy 21 [28; 71.7%]; trisomy 18 [2; 5.1%], trisomy 13 [2; 5.1%]; trisomy X [1; 2.5%] and monosomy 21 [2; 5.1%]. The remaining cases [4] showed structural chromosomal abnormalities in the form of dysmorphic features; 2 [5.1%]; mental retardation; 1 [2.5%] and Turner syndrome; 1 [2.5%]. Our results were compared to other studies results in SA and worldwide. Trisomy 21 was the most frequent chromosomal abnormality in this study. This study in addition to other similar studies in the same community figure out the chromosomal aberrations pattern in this area. It was concluded that awareness of the chromosomal aberrations frequencies will help clinicians working in Saudi Arabia and surrounding countries to determine the priority of requesting cytogenetic study in individual cases

Impact of a new scoring system on selection of endoscopic retrograde cholangiopancreatography or magnetic resonance cholangio-pancreatography prior to cholecystectomy in patients with suspected common bile duct stones

Background: Endoscopic retrograde cholangiopancreatography [ERCP] with stone extraction is the gold standard for the management of common bile duct [CBD] stones. Many scoring systems had developed aiming at prediction of CBD stones prior to cholecystectomy to avoid unnecessary ERCP. On the other hand Magnetic Resonance Cholangiopancreatography [MRCP] had proved efficiency in diagnosis of CBD stones and was replacing ERCP in some centers but with additional cost for therapeutic ERCP in case of CBD stones

Aim of the work: the aim of this study was to evaluate the validity of the scoring system, predicting CBD stones, in selecting patients with suspected CBD stones for ERCP or MRCP prior to cholecystectomy

Patients and methods: One hundred twenty consecutive patients with cholelithiasis and suspected CBD stones were enrolled in this study between July 2001 and Dec. 2004. They were randomized into three groups, group 1 for ERCP, group 2 for MRCP followed by ERCP if there was stone and group 3, according to the scoring system, for either MRCP if the score is < 4 or ERCP if the score is >/= 4

Results: CBD stones were found in 67 out of 120 patients [56%]. The success rate for diagnostic ERCP was 100%, and successful therapeutic ERCP was 98.5%. The incidence of unnecessary ERCP was reduced significantly from 40% [Group 1] to 5.9% [Group 3A] [P< 0.001]. Also additional ERCP after +ve MRCP was reduced significantly from 55% [Group 2] to 21.7% [Group 3A] [P <0.05]

Conclusion: This study confirms the validity of this new scoring system, predicting CBD stones, in selecting patients for ERCP or MRCP prior to cholecystectomy to avoid unnecessary ERCP

Effect of different patterns of potassium fertilization on growth and yield of canola [Brassica napus L.] grown under different levels of saline irrigation

Two pot experiments were conducted during the winter seasons of [2002/2003 and 2003/2004] in the green house of the National Research Centre, Dokki, Giza Egypt to study the effect of different methods of potassium application on growth, yield and chemical constituent of canola grown under different levels of saline irrigation. Salinity has a depressing effect on various growth and yield parameters. Method of potassium application might have a stimulating effect on alleviating the adverse effects of salinity. Foliar application with 5.6 cm 3/L potassein plus soil application of potassium with the rate of 24 kg K 2O/ fed have stimulating effect on most growth parameters i.e. number of leaves and branches, dry weight of leaves, stem and whole plant and photosynthetic pigments as well as yield parameters i.e. number and weight of pods, straw and seed yield, seed index and oil percentage

Magnetic resonance imaging for primary fistula in ano

This was a prospective study designed to determine the therapeutic impact of magnetic resonance imaging [MRI] in primary fistula in ano, and to assess its effect on outcome. Thirty patients with suspected primary fistula in ano underwent preoperative MRI, and the findings were revealed during surgery following examination under anaesthesia [EUA]. Any effect on operative approach was noted. Outcome was assessed at a median of 12 months. Two patients had sinuses, one had no sepsis and 27 had fistulas: five superficial, seven intersphincteric, 14 trans-sphincteric and one suprasphincteric. MRI and EUA agreed in 15 patients and MRI findings altered the surgical approach in a further three [10 per cent]; two of the latter patients were believed to have a sinus at EUA, which MRI correctly identified as a fistula, allowing definitive treatment. The therapeutic impact of MRI was therefore 10 per cent. Persisting disagreement between MRI and EUA in 12 patients mostly related to minor discrepancies in classification. Only one patient required further unplanned surgery, which was for skin-bridging rather than any new sepsis. In experience hands, MRI has a therapeutic impact of 10 per cent for primary fistula in ano, precipitating surgery that is likely to reduce recurrence in a small, but important, proportion of patients

role of MR imaging in medial collateral ligament injuries

A total of 38 patients with multiple signs of medial collateral ligament [MCL] sprain was selected on the basis of clinical diagnosis and investigated with magnetic resonance [MR] to determine multiple signs of MCL injuries including the location and associated bone bruises and evaluate the accuracy of MR imaging in grading these patients. Then, these MR imaging signs were correlated with standards used to determined MCL injury at a clinical evaluation. The grade of MCL injury as determined by MR imaging criteria was compared with the clinical findings. All signs demonstrated with MR imaging were specific. The most sensitive signs were edema and loss of demarcation from adjacent fat. The MR imaging was accurate and sensitive for the diagnosis of MCL injuries

Eosinophil cationic protein as a serological marker of disease activity in childhood bronchial asthma

To study the value of eosinophil cationic protein [ECP] as a serological marker of disease activity in childhood bronchial asthma, ECP levels were measured in 20 healthy control children and 25 asthmatic children, during and 2 weeks after acute exacerbation. The mean serum ECP level of all asthmatic patients, during and after exacerbation, was significantly higher than the control group and was significantly higher during attacks than 2 weeks after their termination. ECP levels were highest in severe attacks, but did not differ between mild and moderate attacks. ECP levels in asthmatic patients 2 weeks after mild and moderate attacks were comparable to normal; after severe attacks levels remained higher than normal. Measurement of serum ECP will be helpful in determining asthma activity and deciding the use of anti-asthma drugs

Effects of melatonin on the teratogenicity of alcohol in albino rat

Teratogenicity of alcohol has been widely studied in humans and laboratory animals. Alcohol seems to produce its deleterious effects through its capability to release harmful free radicals. The aim of the present study was to determine the potential role of exogenous melatonin as a free radical scavenger [antioxidant] against the teratogenicity of alcohol. Twenty four pregnant albino rats were randomly divided into four equal groups: control, alcohol, melatonin and melatonin-alcohol. Treatment was given intragastrically daily from day 6 through day 12 of gestation. Twenty days full term rat fetuses were then collected. Two thirds of the fetuses were fixed in Bouin's solution for external and visceral examinations. Skeletons of the remaining third of the fetuses were stained with alizarin red for their evaluation. The present study revealed the teratogenicity of alcohol even in its mild dose of 15 ml/kg BW [ethanol, 25% v/v]. In the experimental rats, it increased the rate of resorptions and delayed the fetal growth. It also affected the ossification of the skeletal system and produced different congenital abnormalities. Exogenous melatonin given in this study in a dose of 9 mg/kg BW did not affect significantly the fetal growth and development and did not produce any congenital abnormalities. However, all developmental parameters assessed in this study were found to be normal in the melatonin-alcohol group when compared to the control group. Also, no congenital abnormalities were detected. The results obtained from this study indicate that melatonin probably acts as a negative coteratogen as it counteracts the teratogenic effects of alcohol. The present results also support those reported by previous workers which indicated the role of free radicals in mediating the teratogenicity of alcohol. According to the present findings, it is suggested that any substance known to release free radicals should be prohibited during pregnancy. If it is necessary, it should be combined with a potent antioxidant, to avoid its teratogenic effects

Synovial fluid interleukin-1 beta in psoriatic arthritis

Synovial fluid from the knee joints of 20 psoriatic arthritis patients [8 with polyarthritis and 12 with mono / oligoarthritis] were studied to detect the value of interleukcin-1 beta. ESR and serum C-reactive protein were also measured. Quantitative immunoassay method showed a significant increase of interleukin-1 beta in the synovial fluid of polyarthritis group as compared to mono/oligoarthritis group, while, ESR, C-reactive protein and synovial fluid total protein, acid phosphatase and WBCs showed non significant changes between the two groups. So, the synovial fluid interleukcin-1 beta is one of the parameters which differentiate between the two groups. Synovial fluid interleukin-1 beta showed significant correlation with the number of affected Joints and Joint score and non-significant correlation with ESR and C-reactive protein. Results confirm the role of interleukin-1 beta in the pathogenesis of psoriatic arthritis as well as to select those who will be in need for aggressive and non conventional treatment