Anti-hyperglycemic and anti-hyperlipidemic effects of a methanolic extract of Debregeasia salicifolia in Alloxan-induced diabetic albino mice

Abstract Diabetes mellitus (DM), an endocrine syndrome characterized by high blood glucose levels due to abrogated insulin activity. The existing treatments for DM have side effects and varying degrees of efficacy. Therefore, it is paramount that novel approaches be developed to enhance the management of DM. Therapeutic plants have been accredited as having comparatively high efficacy with fewer adverse effects. The current study aims to elucidate the phytochemical profile, anti-hyperlipidemic, and anti-diabetic effects of methanolic extract D. salicifolia (leaves) in Alloxan-induced diabetic mice. Alloxan was injected intraperitoneally (150 mg kg-1, b.w), to induced diabetes in mice. The mice were divided into three groups (n=10). Group 1 (normal control) received normal food and purified water, Group II (diabetic control) received regular feed and clean water and group III (diabetic treated) received a methanolic extract of the plant (300 mg kg-1) for 28 days with a typical diet and clean water throughout the experiment. Blood samples were collected to checked serum glucose and concentration of LDL, TC, TG. The extract demonstrated significant antihyperglycemic activity (P 0.05), whereas improvements in mice's body weight and lipid profiles were observed after treatment with the extract. This study establishes that the extract has high efficacy with comparatively less toxicity that can be used for DM management.

Resumo Diabetes mellitus (DM) é uma síndrome endócrina caracterizada por níveis elevados de glicose no sangue devido à atividade anulada da insulina. Os tratamentos existentes para o DM têm efeitos colaterais e vários graus de eficácia. Portanto, é fundamental que novas abordagens sejam desenvolvidas para aprimorar o manejo do DM. As plantas terapêuticas foram acreditadas como tendo eficácia comparativamente alta com menos efeitos adversos. O presente estudo visa elucidar o perfil fitoquímico, efeitos anti-hiperlipidêmicos e antidiabéticos do extrato metanólico de D. salicifolia (folhas) em camundongos diabéticos induzidos por aloxana. Alloxan foi injetado por via intraperitoneal (150 mg kg-1, b.w), para induzir diabetes em camundongos. Os camundongos foram divididos em três grupos (n = 10). Grupo 1 (controle normal) recebeu ração normal e água purificada, Grupo II (controle diabético) recebeu ração regular e água limpa, e o grupo III (tratamento diabético) recebeu extrato metanólico da planta (300 mg kg-1) por 28 dias com uma dieta típica e água limpa durante todo o experimento. Amostras de sangue foram coletadas para verificar a glicose sérica e a concentração de LDL, TC, TG. O extrato demonstrou atividade anti-hiperglicêmica significativa (P 0,05), enquanto melhorias no peso corporal e no perfil lipídico dos camundongos foram observadas após o tratamento com o extrato. Este estudo estabelece que o extrato tem alta eficácia com comparativamente menos toxicidade e pode ser usado para o controle do DM.

Histomorphological, Histochemical and Ultrastructural Studies on the Healthy Liver of Yemen Veiled Chameleon (Chamaeleo calyptratus) in Southern Saudi Arabia / Estudios Histomorfológicos, Histoquímicos y Ultraestructurales en el Hígado Sano del Camaleón Velado de Yemen (Chamaeleo calyptratus) en el Sur de Arabia Saudita

SUMMARY: The livers of reptiles are being studied as a model for the link between the environment and hepatic tissue. There have been few investigations on the histology of reptile livers, and very few or no studies have examined the histology of liver of veiled chameleon (Chamaeleo calyptratus). This paper describes the histomorphological, histochemical and ultrastructural characterization of the liver of veiled chameleons in southern Saudi Arabia. Seven Chamaeleo calyptratus were captured in the summer season in Abha City, Aseer region, southern Saudi Arabia. Chamaeleon liver samples were processed for histomorphology, histochemistry and ultrastructure analyses. Morphologically liver of Chamaeleo calyptratus was observed as a large dark brown organ with lighter speckles, which represent melanin deposits. It located at the ventral part of abdominal cavity forward of the stomach. Its dimensions approximately were 3.7 x 2 cm. The liver was a bilobed organ divided into two lobes, right and left lobes. The right one was bigger than the others. The gallbladder was well developed and had an elongated shape, situated between the two lobes and contained the bile for the digestion. Microscopically, the liver was found to be covered by a thick layer of connective tissue, which formed the hepatic capsule. Hepatic parenchyma probably appeared in cross sections as hepatic glandular-like alveoli "acini" or follicular structures with various diameters, each acinus contains approximately four to six hepatocytes, surrounded by sinusoidal capillaries filled with abundant melanomacrophages, which are absent in birds and mammals. Melanomacrophages are common in the hepatic parenchyma's perisinusoidal areas, particularly near portal spaces. Hepatocytes are polyhedral or pyramidal with and mostly contained large, rounded nuclei mostly peripherally located, with prominent dark oval nucleoli. Some of nuclei are eccentric or central position. The cytoplasm appeared spongy or vacuolated and more eosinophilic when stained by hematoxylin-eosin and strongly reactive to PAS staining technique, indicating abundant glycogen content. The reticular fibers that surround hepatocytes, blood arteries, and sinusoids supported the hepatic parenchyma. The blood sinusoids are seen interspersed among hepatocytes of varying sizes. The sinusoidal lumen was bordered by flattened endothelial cells and includes elliptical nucleated erythrocytes and liver macrophages as phagocytes, which are also known as Kupffer cells. Branches of the portal vein, hepatic artery, small bile duct, and lymph vessels were detected in the hepatic portal area "tract" or triad which made up of connective. Hematopoietic tissue was observed in subcapsular region and portal triads. Ultrastructurally, the hepatocyte appeared polyhedric containing a single large rounded basal or eccentric vesicular nucleus with prominent nucleolus. Extensive network of rough endoplasmic reticulum (RER) often arranged in an array parallel to the nuclear membrane with many mitochondria, and Golgi apparatus were described. The cytoplasm contained glycogen granules, vesicles or vacuoles scattered throughout the cytoplasm especially at the apical region were reported. The bile canaliculi and the hepatic "Kupffer" cells were also discussed. This is the first study on the histological characterization of the healthy liver of Yemen veiled chameleon in southern Saudi Arabia. The findings reported here should be used as a reference to compare with the pathological abnormalities of the liver in this animal.

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Effects of high intensity-interval training on cardiovascular risk, body mass index and metabolic markers in healthcare workers / Efecto de entrenamiento por intervalos de alta intensidad sobre riesgo cardiovascular, índice de masa corporal y marcadores metabólicos en personal de salud

Background and Objectives: The obesity epidemic in Mexico has caused a health crisis. This places great importance in the identification of useful methods to manage it across all populations. In this present study we evaluate the effect of high intensity interval training in healthcare workers. Materials and Methods: An intervention was carried out that consisted in 60 sessions of high intensity interval training during a 12 week period aimed at health care workers working at the General Hospital in Montemorelos, Mexico. Variables regarding body composition, cholesterol and arterial blood pressure were evaluated for each individual both before and after the intervention. Pearson coefficients were estimated between the initial and final values. Results: 8 participants were included, 55.6% men aged 32.8 ± 10.9 years with a BMI of 31.69 ± 2.9. A statistically significant difference was found between the initial and final values ​​of weight, BMI, total cholesterol, mean arterial blood pressure, and cardiovascular risk at 10 years. Conclusions: These results reveal a significant decrease in our variables related to obesity in healthcare workers after a HIIT intervention in an uncontrolled setting. We recommend the further implementation of similar studies with greater sample size, intensity and duration to target obesity which is the root cause of chronic non-communicable diseases. Further studies are required to confirm the effect of this intervention in the prevention, treatment of obesity in health care workers and to describe its long term effects.

INTRODUCCIÓN: La obesidad juega un papel importante en las enfermedades crónicas no transmisibles que ha provocado una crisis de salud en México. Es de gran importancia encontrar métodos útiles para enfrentarla en todas las poblaciones. OBJETIVOS En el presente estudio evaluamos el efecto del entrenamiento por intervalos de alta intensidad en trabajadores de la salud. MATERIALES Y MÉTODOS: Se realizó una intervención que consistió en 60 sesiones de entrenamiento con intervalos de alta intensidad durante un período de 12 semanas dirigido a trabajadores de la salud que laboran en el Hospital General de Montemorelos, México. Se evaluaron las variables de composición corporal, colesterol y presión arterial de cada individuo antes y después de la intervención. Se estimaron coeficientes de Pearson entre los valores inicial y final. RESULTADOS: Se incluyeron 8 participantes de 32,8 ± 10,9 años con un IMC de 31,69 ± 2,9. Se encontró diferencia estadísticamente significativa entre los valores inicial y final de peso, IMC, colesterol total, presión arterial media y riesgo cardiovascular a los 10 años. CONCLUSIONES: Estos resultados revelan una disminución significativa de nuestras variables relacionadas con la obesidad en el personal de la salud tras una intervención HIIT en un entorno no controlado. Recomendamos la implementación adicional de estudios similares con mayor tamaño de muestra, intensidad y duración para abordar la obesidad.

Efectos de la promoción de estilo de vida saludable en los médicos generales del Instituto Oncológico Nacional marzo-abril 2021 / Healthy lifestyle promotion and its effect on general practitioners at National Oncology Institute March ­ April 2021

Introducción: La población médica se considera una representación de salud integral. Sus características laborales predisponen a cada integrante a ser cómplice de una práctica y promoción inconsciente de un estilo de vida poco saludable. El objetivo de este trabajo fue describir los efectos sobre el estilo de vida de una intervención educativa en médicos generales en un ambiente laboral activo. Métodos: Este estudio incluyó a 18 médicos generales laborando en el Instituto Oncológico Nacional de Panamá. Consistió en 10 sesiones educativas virtuales impartidas por profesionales capacitados durante 2 meses. Resultados: Se reportaron cambios positivos y mejoría en todas las variables medidas, incluyendo aumento de frecuencia de las sesiones de ejercicio, aumento de duración de cada sesión, aumento de consumo de frutas, verduras, legumbres y semillas, aumento de horas de sueño, mejoría en el puntaje de la escala de estrés percibida y una disminución en el consumo de alimentos con baja calidad nutricional. Discusión: Muy poca evidencia existe en relación con intervenciones educativas de promoción de estilo de vida dirigida a los profesionales de la salud. Esta población tiene una alta predisposición a formar un estilo de vida de pobre calidad ya que el ambiente laboral en donde se desenvuelve el médico lo expone a situaciones adversas como horarios rotativos y largas jornadas de trabajo con privación de sueño. Conclusiones: Esta intervención educativa práctica y de bajo costo logró mejoras en el estilo de vida de los médicos. Por esta razón recomendamos la replicación de intervenciones similares y su documentación.

Introduction: The medical population is considered a representation of integral health. Its work characteristics predispose each member to be complicit in an unconscious practice and promotion of an unhealthy lifestyle. The aim of this work was to describe the effects on lifestyle of an educational intervention in general practitioners in an active work environment. Methods: This study included 18 general practitioners working at the "Instituto Oncológico Nacional de Panamá". It consisted of 10 virtual educational sessions delivered by trained professionals for 2 months. Results: Positive changes and improvement in all measured variables were reported, including increased frequency of exercise sessions, increased duration of each session, increased consumption of fruits, vegetables, legumes and seeds, increased hours of sleep, improvement in the perceived stress scale score and a decrease in the consumption of foods with low nutritional quality. Discussion: Truly little evidence exists regarding lifestyle promotion educational interventions aimed at health professionals. This population has a high predisposition to form a poor-quality lifestyle since the work environment in which the physician develops exposes him/her to adverse situations such as rotating schedules and long working hours with sleep deprivation. Conclusions: This practical and low-cost educational intervention achieved improvements in the lifestyle of physicians. For this reason, we recommend the replication of similar interventions and their documentation.

Tratamiento y control de la diabetes con intervención de estilo de vida en pacientes ambulatorios: Serie de Casos y Actualización / Diabetes treatment and control using lifestyle intervention in outpatient setting: Case Series and Update

Las cifras de prevalencia de la diabetes nos obligan a identificar métodos más eficientes a largo plazo para lograr el buen control de los pacientes. En este trabajo se reporta el curso clínico de 4 pacientes con diagnóstico de diabetes y prediabetes quienes fueron atendidos en la consulta externa y recibieron asistencia no intensiva para cambio de comportamiento en salud, orientada a aumentar consumo de fibra alimentaria y a aumentar sus niveles de actividad física. Se reportan cambios en indicadores bioquímicos y antropométricos. El paciente 1 en 5 meses logró suspender hipoglucemiantes orales, disminuyendo un 10% de su peso corporal y logrando criterios de prediabetes (remisión parcial). El paciente 2 en un período de 8 semanas logró alcanzar criterios de diabetes controlada, disminuyendo en 50% el índice HOMA IR. Además, se documentó pérdida de 4 kg de masa grasa corporal con ganancia de 3 kg de masa magra. Lo anterior se acompañó de una disminución del 23% del colesterol total y 38% de triglicéridos. La paciente 3 alcanzó criterios de remisión de DM2 durante un seguimiento de 18 meses(HBA1C 11.4% inicial y 5.3% final). La paciente 4 evolucionó a remisión de prediabetes y disminución de 5.9% de peso corporal total en un periodo de 3 meses.

The prevalence of diabetes demands the identification of more efficient long-term methods to achieve good patient control. This paper reports the progress of 4 patients diagnosed with previously poorly controlled diabetes and prediabetes with comorbidities that were attended in an outpatient clinic, they received orientation regarding lifestyle change and were instructed to increase consumption of dietary fiber and physical activity. Body composition and biochemical markers were followed and changes were reported. In a 5 month period Patient 1 achieved criterion for controlled diabetes and was able to suspend oral hypoglycemic agents, reducing his body weight by 10%. Within a 8 week period Patient 2 experienced a 50% decrease of HOMA IR and was able to achieve criteria of controlled diabetes. Furthermore a 3 kg increase in lean body mass and a 4 kg body weight decrease were documented. These findings were accompanied by a 23% and 38% decrease in total cholesterol and triglycerides respectively. Patient 3 achieved criteria for type 2 diabetes remission within a 18 month time span(Inicial HBA1C 11.4% Final HBA1C 5.3). Patient 4 progressed to remission of prediabetes and a decrease of 5.9% in total body weight in a 3 month period.

Hepatotoxicity-induced by the therapeutic dose of acetaminophen and the ameliorative effect of oral co-administration of selenium/Tribulus terrestris extract in rats / Hepatotoxicidad inducida por la dosis terapéutica de acetaminofén y el efecto de mejora de la administración conjunta de extracto de selenio Tribulus terrestris en ratas

SUMMARY: Over dose or long-term clinical use of therapeutic doses of acetaminophen (APAP) causes hepatotoxicity. Various strategies attempted to ameliorate APAP-hepatotoxicity have been found to be unsuitable for clinical practice. This study was aimed to illustrate the histopathological changes induced by therapeutic dose of APAP and investigate the hepatoprotective role of oral co-administration of selenium/ Tribulus terrestris (TT) extract concurrently against hepatotoxicity induced by APAP in rats. Fifty-four healthy male albino Wistar rats were randomized into nine groups (G1-G9) of six rats each, and administered with APAP and TT orally for 30 days as follows: Control (2ml normal saline), APAP (470 mg/kg), APAP (470 mg/kg) + selenium (2 mg/kg), APAP (470 mg/kg) + TT (98 mg/kg), APAP (470 mg/kg) + selenium (2mg/kg) + TT (98 mg/kg), APAP (470 mg/kg) + silymarin (200 mg/kg), selenium (2 mg/ kg), TT (98 mg/kg) and silymarin (200 mg/kg) groups. The results demonstrated that exposure of rats to therapeutic dose of APAP for 30 days caused significant histopathological changes parallel to elevated blood chemistry parameters. Co-administration of selenium/TT extract showed significantly reduced histopathological lesions and, restored or decreased levels of the examined blood chemistry parameters. Liver histology in selenium/TT extract showed normal hepatic architecture with mild changes and silymarin treated rats showed no histopathological changes. Histochemically PAS staining, showed that APAP-induced hepatotoxicity was characterized by hepatocytes glycogen depletion. Selenium/TT co-supplementation plays a potential role in preventing APAP-induced glycogen depletion by increasing detoxification and scavenging the reactive metabolites. Selenium/TT extract oral co-administration possesses a significant hepatoprotective property and mitigates APAP-induced hepatotoxicity by enhancing its antioxidant role and improving tissue integrity. Selenium/TT supplementation could represent an effective treatment against APAP-induced hepatotoxicity. Further studies are needed to elucidate the exact mechanism underlying the protective role of TT extract.

RESUMEN: La dosis excesiva o el uso clínico a largo plazo de dosis terapéuticas de acetaminofeno (APAP) causa hepatotoxicidad. Se ha descubierto que varias estrategias que intentaron mejorar la hepatotoxicidad por APAP no son adecuadas para la práctica clínica. Este estudio tuvo como objetivo ilustrar los cambios histopatológicos inducidos por la dosis terapéutica de APAP e investigar el papel hepatoprotector de la administración conjunta de extracto de selenio / Tribulus terrestris (TT) simultá- neamente contra la hepatotoxicidad inducida por APAP en ratas. Cincuenta y cuatro ratas Wistar albino machos sanas se aleatorizaron en nueve grupos (G1 - G9) de seis ratas cada una, y se administraron con APAP y TT por vía oral durante 30 días de la siguiente manera: Control (2 ml de solución salina normal), APAP (470 mg / kg), APAP (470 mg / kg) + selenio (2 mg / kg), APAP (470 mg / kg) + TT (98 mg / kg), APAP (470 mg / kg) + selenio (2 mg / kg) + TT (98 mg / kg), APAP (470 mg / kg) + silimarina (200 mg / kg), selenio (2 mg / kg), TT (98 mg / kg) y silimarina (200 mg / kg). Los resultados demostraron que la exposición de las ratas a la dosis terapéutica de APAP durante 30 días causó cambios histopatológicos significativos paralelos a parámetros elevados de química sanguínea. La administración conjunta de extracto de selenio / TT mostró lesiones histopatológicas significativamente reducidas y niveles restaurados o disminuidos de los parámetros de química sanguínea. La histología hepática en el extracto de selenio / TT mostró una arquitectura hepática normal con cambios leves y las ratas tratadas con silimarina no mostraron cambios histopatológicos. La tinción histoquímica de PAS mostró que la hepatotoxicidad inducida por APAP se caracterizó por la pérdida de glucógeno de los hepatocitos. La suplementación con selenio / TT juega un papel potencial en la prevención de la pérdida de glucógeno inducido por APAP al aumentar la desintoxicación y eliminar los metabolitos reactivos. La administración conjunta de extracto de selenio / TT posee una propiedad hepatoprotectora significativa y mitiga la hepatotoxicidad inducida por APAP al mejorar su papel antioxidante y la integridad del tejido. La suplementación con selenio / TT podría representar un tratamiento efectivo contra la hepatotoxicidad inducida por APAP. Se necesitan más estudios para dilucidar el mecanismo exacto que subyace a la función protectora del extracto TT.

Renal histological alterations induced by acute exposure of titanium dioxide nanoparticles / Alteraciones histológicas renales inducidas por la exposición aguda de nanopartículas de dióxido de titanio

SUMMARY: Titanium dioxide nanoparticles (TiO2 NPs) are widely used in many commercial products, nanomedicine, agriculture, personal care products, different industries and pharmaceutical preparations with potential risk in human health and the environment. The current work was conducted to investigate the renal damage that might be induced by the acute toxicity TiO2 NPs. A total of 40 healthy male adult Wistar albino rats (Rattus norvegicus) were exposed to TiO2 NPs (126, 252, 378 mg/kg bw) for 24 and 48 h. Fresh portions of the kidneys from each rat were processed for histological and histochemical alterations. In comparison with respective control rats, exposure to TiO2 NPs has marked the following glomerular, tubular and interstitial alterations including the followings: glomerular congestion, Bowman's capsule swelling and dilatation, inflamed glomeruli, renal tubules cloudy swelling, karyorrhexis, karyolysis, infiltration of inflammatory cells, congestion, necrosis, hydropic degeneration, dilatation and congestion of blood vessels, hyaline droplets and hyaline casts precipitation, interstitial edema and fibrosis. From the findings of the current work one may conclude that TiO2 NPs are capable of inducing kidney damage with more insulation in the cortex and the proximal convoluted tubules than the medulla and the distal ones respectively. In addition, it might be concluded that renal damage induced by these nanomaterials is dose and duration of exposure dependent. Further hematological, biochemical, immunohistochemical, and ultra-structural studies are recommended.

RESUMEN: Las nanopartículas de dióxido de titanio (TiO2 NP) se usan ampliamente en muchos productos comerciales, nanomedicina, agricultura, productos para el cuidado personal, diferentes industrias y preparaciones farmacéuticas con riesgo potencial para la salud humana y el medio ambiente. El trabajo actual se realizó para investigar el daño renal que podría ser inducido por la toxicidad aguda NP de TiO2. Un total de 40 ratas Wistar albinas adultas sanas (Rattus norvegicus) fueron expuestas a TiO2 NP (126, 252, 378 mg / kg de peso corporal) durante 24 y 48 h. Las muestras de los riñones de las ratas se procesaron para estudios histológicos e histoquímicos. En comparación con las ratas control, la exposición de las ratas a TiO2 NP presentaron las siguientes alteraciones glomerulares, tubulares e intersticiales: congestión glomerular, dilatación de la cápsula de Bowman, inflamación glomerular, túbulos renales aumentados, cariorrexis, cariólisis, infiltración de células inflamatorias, congestión, necrosis, degeneración hidrópica, dilatación y congestión de vasos sanguíneos, gotas y precipitaciones hialina, edema intersticial y fibrosis. A partir de los hallazgos del trabajo actual, se puede concluir que las NP de TiO 2 son capaces de inducir daño renal con más aislamiento en la corteza y en los túbulos contorneados proximales que en la médula y los túbulos contorneados distales, respectivamente. Además, se podría concluir que el daño renal inducido por estos nanomateriales depende de la dosis y la duración de la exposición. Se recomiendan estudios adicionales hematológicos, bioquímicos, inmunohistoquímicos y ultraestructurales.

Retinal Redetachment After Pneumatic Retinopexy – The Importance of Case Selection

Pneumatic retinopexy is known as one of the treatment options for a specific type of retinal detachment. It is done in an office setting and may be the most cost-effective means of retinal reattachment surgery. Location and size of the retinal break remain as the major criteria for a successful outcome. We describe a case that fulfilled all except one major criteria for pneumatic retinopexy and underwent multiple procedures but failed. Fluctuation in the resolution of the retinal detachment such as in this particular case suggested possibility of early treatment failure.

Bilateral Compressive Optic Neuropathy Secondary to Tuberculum Sella Meningioma in Pregnancy

A 37-year-old primigravida in her second trimester presented with bilateral painless progressive visual loss. Her vision was hand motion in both eyes. Both pupils were dilated with sluggish reaction to light. Both fundus appeared myopic with bilateral optic atrophy. Magnetic resonance imaging (MRI) of the brain revealed a suprasellar mass with optic chiasm compression and bilateral optic nerve atrophy. As the mass has compromised her vision, a semiemergency craniotomy and excision of tumour was performed. Histopathological examination confirmed the diagnosis of low grade meningothelial meningioma. Both mother and foetus were well after the surgery. However, post-operatively her vision remained poor due to optic nerve atrophy.

Patterns of Polypoidal Choroidal Vasculopathy among a Multiracial Population in a Malaysian Hospital

Polypoidal choroidal vasculopathy (PCV) is a retinal disorder characterized by aneurismal polypoidal lesions in choroidal vasculature. PCV appears to preferentially affect pigmented individuals and is considerably high among Asians. Most reports on patterns of PCV around Asia are based on a homogenous race (e.g. Chinese, Japanese) and very few descriptions from a multiracial population like those seen in Malaysia. The present study aimed to describe the demographic features, clinical and investigative characteristics of PCV in a multiracial group at Universiti Kebangsaaan Malaysia Medical Centre (UKMMC). Ninety one eyes of 86 PCV patients, comprising of Chinese (65.1%), Malays (31.4%), Indians (2.3%) and Eurasian (1.2%) were retrospectively reviewed. All underwent complete ophthalmic examination and investigations. Mean patient age was 70.4 years with a male preponderance (59.3%), and mostly unilateral presentation (94.1%). The logMAR mean presenting visual acuity was 0.78 ± 0.64. Polypoidal vascular lesions were located generally within the macula area (86.8%), manifesting mainly as submacular hemorrhage (59.3%). Interestingly a number of eyes (43.9%) had associated drusen. Optical coherence tomography largely demonstrated exudative changes (75.9%) and almost all patients (97.7%) had loss of external limiting membrane (ELM) and IS/OS interface. On indocyanine green angiography, majority of eyes had multiple polyps (82.4%) with ‘cluster’ (58.2%) being the commonest configuration. In conclusion, although the patterns of PCV in UKMMC were mainly similar to other Asian patients, a number of our patients had associated drusen. This indicates that PCV in our population could be a variant of neovascular age related macular degeneration and not solely idiopathic in nature.

Comparative study of laparoscopic versus open surgery in 42 cases of liver hydatid cyst.

Background: Hydatid disease is endemic mainly in the Mediterranean countries, the Middle East, South America, India, Northern china and other sheep rearing areas. Liver is the commonest site of affection (55-70 %) followed by lung (18-35%). In the last decade, laparoscopic treatment of hepatic hydatid disease has been increasingly popular and has undergone a revolution parallel to the progress in laparoscopic surgery. This study presented our experience with 42 cases of liver hydatid cyst comparing laparoscopic approach and open approach for surgery during a period of one and a half years at our institute. Objectives: The main objective of the present study was to study retrospectively, the merits of laparoscopy over that of open approach for surgery during a period of one and a half years at our institute. Objectives: The main objective of the present study was to study retrospectively, the merits of laparoscopy over that of open surgery in treatment of hydatid cyst of liver. Material and methods: This study comprised of 42 patients who diagnosed to have liver hydatid cyst treated during the period of January 2013 to June 2014 at our Hospitals. They were treated either by laparoscopic approach or by open method for liver hydatid cyst. Patients not fitting into inclusion criteria were excluded from study. Predefined proforma was filled up and results were analyzed. Results: Conversion to open surgery occurred in two cases (4.84 %). The mean cyst diameter was 6.62 cm (range, 2–15 cm) in group 1 and 7.23 cm (range, 2-18 cm)in group 2 (p = 0.699). The mean operative time was 90 min (range, 70-110 min) in group 1 and 110 min (range,90-130 min) in group 2 (p\0.001). The general complication rate and abdominal wound complication rate were respectively 0 % and 0 % in group 1 (p = 0.023) compared with 5.23 and 8.72 % in group 2 (p =0.015). The mean hospital stay was 6.42 days (range, 1-21 days) in group 1 and 11.7 days (range, 4–80 days) in group 2 (p = 0.001). The mean follow-up period was 24.2 months (range,6-32 months) in group 1 and 28.4 months (range, 6-40 months) in group 2. No recurrences were observed in either group during this period. Conclusions: Laparoscopic surgery provides a safe and efficacious approach for almost all types of hepatic hydatid cysts. Large, prospective, randomized trials are needed to confirm its superiority.

Molecular epidemiology of nasal isolates of methicillin-resistant Staphylococcus aureus from Jordan

Asymptomatic carriage of methicillin-resistant Staphylococcus aureus [MRSA] can predispose the host to a wide range of infections. To inform public health strategies, this study sought to determine the prevalence and the phenotypic and genotypic characteristics of MRSA from nasal swabs of health care workers [HCWs] and other healthy individuals in Jordan. Overall, 716 nasal swabs were collected from 297 HCWs, 141 adults and 278 children in the community. MRSA was recovered from 56 [7.8%] nasal swabs, which represented carriage rates of 10.1%, 4.3% and 7.2% among HCWs, adults and children, respectively. The MRSA isolates were resistant to oxacillin [100%], erythromycin [42.8%], tetracycline [37.5%], clindamycin [5.3%], fucidin [5.3%], and ciprofloxacin [3.5%]. A total of 17 different spa types belonging to eight different clonal complexes [CCs] were identified. All isolates were mecA positive, and mecC-MRSA was not detected. Analysis of the staphylococcal cassette chromosome mec [SCCmec] elements revealed that the majority [54; 96.4%] of the samples harbored the smaller type IV and V elements [the most common were SCCmec IVa or IVc, and there were two each of the IVg and V elements], and two were nontypable. The genes for Panton-Valentine leukocidin [luk-PV] were detected in 5.4% of the study isolates. A tst-positive, CC22-MRSA-SCCmecIVa clone [spatype t223] was identified as the dominant MRSA lineage among the nasal carriage isolates from both HCWs and other individuals [adults and children] in the community. These findings provide important information for public health personnel for the formulation of effective infection prevention and control strategies. Studies to further our understanding of the distribution, pathogenicity, transmissibility and fitness of this lineage would be prudent

Radioiodination and Biological Evaluation of Epinephrine as a Possible Adrenergic Receptors Imaging Agent.

An adopted method for the preparation of high radiochemical purity [125I] iodoepinephrine was developed in order to characterize the binding properties of adrenergic receptors. Direct radioiodination of epinephrine was carried out using chloramine-T as oxidizing agent. The reaction proceeds well within 15 min at ambient room temperature up to 25+1ºC and afforded a radiochemical yield up to 94%. Different chromatographic techniques (electrophoresis and paper chromatography) were used to evaluate the radiochemical yield and purity of the labeled product. Biodistribution studies were carried out in normal Albino Swiss mice and the results showed rapid and high cardiac uptake of 125I-epinephrine. The result indicates the possibility of using radioiodinated epinephrine as myocardial imaging agent.

Comparative Study of Monopolar Cautery and Bipolar Vessel Sealing System in Laparoscopic Appendectomy.

Background: Laparoscopic appendectomy has gradually become widespread especially in the last decade. Although laparoscopic techniques are similar, different instruments, such as endoscopic stapler, endoscopic clip, monopolar hook cautery, harmonic scalpel, and vessel sealing instrument, can be used in appendiceal mesentery dissection 1, 2. BVS is an effective and safe system to be used at the dissection of appendiceal mesentery and haemostasis and is definitely effective in decreasing the operation period. Objectives: The main objective of the present study was to studyretrospectively, the effects of using monopolar cautery and vessel sealing system on the operation period in the appendix mesentery dissection. Methods: Hundred patients, operated laparoscopically for acute appendicitis in between June 2010 and June 2011, are evaluated retrospectively. Monopolar cautery was used in 50 patients and bipolar vessel sealer was used in 50 patients. No intraoperative or postoperative complication was seen in any of the patients. None of the patients required conversion to open surgery due to dissection problems of the appendiceal mesentery. Results and Interpretation: The mean duration of operation was 51.08 min in the monopolar cautery group whereas 36.68 minutes in the bipolar vessel sealing system group. Conclusion: Bipolar vessel sealeris safer and time saving as compared toMonopolar cauteryin laparoscopic appendectomy.

Reported Experiences of Stalking Behavior from Patients towards Psychiatrists from the Atlantic Provinces of Canada.

Aim: A study was conducted to assess the magnitude of stalking experienced by psychiatrists, its’ effects and actions taken to ameliorate the problem. Methods: A cross sectional study to assess the magnitude of stalking the consequent effects on the psychological, social and occupational life of psychiatrists; and any preventative measure taken was conducted from July 2009-April 2010. A questionnaire was sent to 301 psychiatrists practicing in Atlantic Canada. Local Ethics approval was obtained. Results: Of the 308 psychiatrists sent surveys, 116 responded (37.6%; 67 males and 47 females). One questionnaire was invalid. (Twenty-nine (15 males and 14 females) reported experiences of stalking. Fifty-eight (50.4%) were above age 50, 49(42.6%) were between ages 35-50 and (8) 7% were younger than 35. In the study cohort, 39(33.6%) psychiatrists were in pure clinical practice, 4(3.4%) were in academic practice and 71(61.2%) had combined clinical and academic practice. Among the subspecialties, 73(62.9%) psychiatrists were practicing general adult psychiatry, 19(16.4%) were child and adolescent psychiatrists, 6(5.2%) in geriatric psychiatry, 4(3.4%) in consultationliaison, 5(4.3%) in forensic, 1(0.9%) in developmental disability and 7(6.0%) were in other psychiatric specialties. Of 115 psychiatrists, 53(46.1%) were in practice for more than 15 years, 16 (13.9%) were from 11–15 years, 29 (25.2%)-from 5 to 10 years and 17(14.8%) were in practice for less than 5 years. There was no significant differences [OR (Odds Ratio values), p-values>0.05) in reported stalked for age or length of psychiatric practice. However, there was strong association of stalking with the distress experienced by the psychiatrists (p=0.00). Conclusion: The problem of stalking does exist in the Atlantic Provinces of Canada and causes immense psychological, professional and social distress among psychiatrists who fall victim to stalking behavior. The majority of mental health professionals are unaware of any laws against stalking in Canada. There is a need for more effective education, support services and redress if we are to ameliorate the burden associated with stalking behaviours.

Iodine-125-Chlorambucil as Possible Radio Anticancer for Diagnosis and Therapy of Cancer: Preparation and Tissue Distribution.

Chlorambucil (CLB) is an aromatic nitrogen mustard and an alkylating agent. It has been mainly used in the chemotherapy. A method for radiopharmaceutical preparation of [125I]- iodo-Chlorambucil a potential cancer therapeutic agent is described. The method is based on direct electrophilic radioiodination of Chlorambucil with [125I] in the presence of chloramine-T (CAT) as oxidizing agent. The reaction conditions were optimized in order to obtain a radiochemical yield higher than 98% of [125I]-iodo chlorambucil. Different chromatographic techniques (electrophoresis, and high pressure liquid chromatography (HPLC)) were used to evaluate the radiochemical yield and purity of the labeled product. Biodistribution studies of 125I- chlorambucil were carried out in both normal and tumor bearing Albino Swiss mice. The results revealed that this new tracer, 125I-chlorambucil, has a high affinity to be localized in the tumor site for a long period which indicates the specificity of this tracer to the tumor cells. The results indicate the possibility of using [125I]- iodo chlorambucil for imaging and treatment of cancer.

effectiveness of using modified transcutaneous spinal electroanalgesia on patients with acute sickle cell painful episode

To evaluate the effectiveness of modified Transcutaneous Spinal Electroanalgesia [mTSE] on acute painful episode in sickle cell disease [SCD]. Prospective Non-Randomized Experimental Study. Pediatric and Medical Ward, Qatif Central Hospital, Eastern Province of Saudi Arabia. A prospective study conducted between April to July 2004. It included all SCD patients admitted in pediatric and medical wards with moderate/severe acute pain involving lower back and/or lower limbs, not responding to the initial management over the first four hours of presentation. Modified Transcutaneous Spinal Electroanalgesia [mTSE] was used for 90 minutes. Data entry and analysis were done by Epi-Info software [Version 3.2.2]. One hundred seven patients were included in the study. Age ranged between 5 and 50 years. Males were 57 [53.27%]; 50 [51.10%] of the females were adults and 32 [56.14%] of the males were pediatrics. The mTSE had lowered the pain level to mild in 20 [38.46%] adults, compared to 32 [58.18%] children. Twenty-eight [49.12%] males showed improvement, compared to 28 [56%] females. Post-mTSE pain score was 3.6 +/- 2.5, compared to 7.5 +/- 2.1 pre-mTSE, [p-value<0.01]. The response to mTSE was more apparent in pediatrics [3.1 +/- 2.7] compared to adults [4.1 +/- 2.2], P-value=0.01. Pediatric male patients responded better to mTSE [2.8 +/- 2.6] compared to adult male patients [4.1 +/- 1.8], P-value=0.005. Our preliminary study reveals the efficacy of mTSE in controlling bony pain of acute painful episodes in SCD patients

Methicillin-resistant Staphylococcus aureus nasal carriage among primary school-aged children from Jordan: prevalence, antibiotic resistance and molecular characteristics

Colonization with methicillin-resistant Staphylococcus aureus [MRSA] increases the risk for subsequent infections with an increased mortality and morbidity. Children were suggested to be a major asymptomatic reservoir for community-associated [CA] MRSA with an ability to quickly spread the MRSA within community. Therefore, the availability of epidemiological and antibiotic susceptibility data of CA-MRSA will be useful for the infection control and management policies. This study aimed to assess the nasal carriage, molecular characteristics and antibiotic susceptibility of MRSA in primary school-aged children from Jordan. A total of 210 nasal swabs were collected from children aged 6-11 years. Isolated MRSA and its SCCmec typing, Spa type and PVL [Panton-Valentine Leukociden] toxin were identified following culture, biochemical and PCR. Antibiogram was determined by the disc diffusion method. The prevalence of CA-MRSA was 7.1%. Allergic rhinitis and recent antibiotic exposure were the only significant risk factors for MRSA nasal carriage among children. Resistance to erythromycin, trimethoprim-sulfamethoxazole and tetracycline was 33.4, 20 and 13.4%, respectively. All isolates were susceptible to the remaining non-p-lactam antibiotics used in this study, in particular linezolid and mupirocin. All MRSA isolates were SCCmec type IV and PVL toxin negative and the majority were Spa type t223. This is the first study to assess the MRSA prevalence among children aged 6-11 years in Jordan. The prevalence in community children is within the range compared with other studies in other countries. The antibiogram, SCCmec and Spa types of the isolated MRSA are much similar to what was found previously in Jordan. However, all isolates were PVL toxin negative. The study recommends increasing the public awareness of MRSA and the proper antibiotics dispensing. Future studies to follow-up on the changing epidemiology of the CA-MRSA in Jordan are also recommended

Prevalence of Methicillin Resistant Staphylococcus aureus nasal carriage and its anti-biogram in healthcare workers from South of Jordan

Healthcare workers [HCWs] can act as asymptomatic carrier in transmitting Methicillin Resistant Staphylococcus aureus [MRSA]. Availability of epidemiological and antibiotic susceptibility data is necessary to limit the spread of HCWs-associated MRSA infections, and to help physicians in choosing the appropriate empirical antibiotic for management of such infections. To assess nasal carriage and antibiogram of MRSA in healthcare workers from Southern Jordan. A total of 276 nasal swabs were randomly collected from the HCWs. MRSA was identified by culture, biochemical and molecular methods. Antibiotic susceptibility was determined by the disc diffusion method. The HCWs-MRSA nasal carriage was 8.7%. There was significant difference for nasal carriage of MRSA by nurse occupation [p value = 0.007], education level of less than a university degree [p value = 0.039] and years of HCW experience [p value = 0.023]. No significant difference by age, sex, antibiotic exposure or smoking. Antibiotic resistance to Trimethoprim-Sulfamethoxazole and Tetracycline was detected in 37.5% and 12.5% of all MRSA isolates respectively. No resistance to the other antibiotics used in this study and no multidrug resistance was encountered in all MRSA isolates. MRSA nasal carriage among HCWs in this study was 8.7% with no alarming antibiotic resistance pattern. Nurses, less educated and more experienced HCWs are at increased risk of MRSA nasal carriage. Therefore, we strongly recommend screening and decolonizing positive HCWs who can act as asymptomatic carriers in MRSA transmission cycle

A rare case of massive systemic embolisation secondary to atrial myxoma- case report

We report a case of a 21 year old girl who presented with sudden onset of abdominal, back and bilateral leg pain, paralysis with unexpected collapse at home. Physical examination was suggestive of acute aortic occlusion. CTangiogram revealed multi-system thrombo-embolic shower. She proceeded to urgent aortic thrombectomy and fasciotomy of the bilateral lower limb. Further investigation revealed atrial myxoma and we report the patient's postoperative progress and eventual transfer to rehabilitation facility.