Histomorphometric features of placentae from women having malaria and HIV coinfection with preterm births.

Background: Malaria and HIV are associated with preterm births possibly due to partial maternal vascular malperfusion resulting from altered placental angiogenesis. There is a paucity of data describing structural changes associated with malaria and HIV coinfection in the placentae of preterm births thus limiting the understanding of biological mechanisms by which preterm birth occurs. Objectives: This study aimed to determine the differences in clinical characteristics, placental parenchymal histological, and morphometric features of the terminal villous tree among women with malaria and HIV coinfection having preterm births. Methods: Twenty-five placentae of preterm births with malaria and HIV coinfection (cases) were randomly selected and compared to twenty-five of those without both infections (controls). Light microscopy was used to determine histological features on H&E and MT-stained sections while histomorphometric features of the terminal villous were analyzed using image analysis software. Clinical data regarding maternal age, parity, marital status, level of education, gestational age and placental weight were compared. Results: Placental weight, villous perimeter and area were significantly lower in cases as compared to controls 454g vs. 488g, 119.32µm vs. 130.47µm, and 937.93µm2 vs. 1132.88µm2 respectively. Increased syncytial knots and accelerated villous maturity were significantly increased in the cases. The relative risk of development of partial maternal vascular malperfusion was 2.1 (CI: 1.26-3.49). Conclusion: These findings suggest that malaria and HIV coinfection leads to partial maternal vascular malperfusion that may lead to chronic hypoxia in the placenta and altered weight, villous perimeter and surface area. This may represent a mechanism by which malaria and HIV infection results in pre-term births.

Can lifetime exposure to intimate partner violence predict suicidality in a sample of Egyptian pregnant women: a cross-sectional study?

Background and objectives: Research on suicidal behaviors during pregnancy in Egypt is limited; being apparently rationalized by pregnancy is a protective period. This study aimed to address the current suicide risk (CSR), and evaluate its correlates of among pregnant women in Egypt.MethodsIt is a cross-sectional study which included 835 of Egyptian pregnant women who were receiving their antenatal care at Zagazig University Obstetrics and Gynecology Outpatient clinics, during the period from 1 October 2017 to 30 September 2018. The sociodemographic and clinical data were collected by a simple semi-structured questionnaire. The psychometric assessment included Beck Suicidal Ideation Scale (BSS), Zagazig Depression Scale (ZDS), Hamilton Anxiety Rating Scale (HAM-A), and Structured Clinical Interview for DSM-IV-TR Axis II Personality Disorders (SCID-II) for assessment of CSR, and comorbid depression, anxiety and personality disorders, respectively.ResultsAmong pregnant women, 23.4% reported CSR. This included suicidal ideation of 21.6% and suicidal attempt of 1.8%. Predictors of CSR were history of intimate partner violence (IPV) exposure (OR 8.8, 95% CI: 2.8, 27.7), identification of their current pregnancy as a female baby (OR 6.9, 95% CI: 2.0, 23.5), previous history of fetal loss (OR 3.9, 95% CI: 1.5, 10.6), and moderate-to-severe depression (OR 3.0, 95% CI: 1.0, 8.7).ConclusionsOur findings suggest that CSR, including suicidal ideation and attempts, is not rare during pregnancy. Exposure to IPV is the most robust predictor of CSR. Pregnant women should be routinely screened for suicidal behaviors, violence exposure and depressive symptoms, as part of their antenatal assessments. (AU)

Possible Tracheal Relaxant and Antimicrobial Effects of the Essential Oil of Ethiopian Thyme Species (Thymus serrulatus Hochst. ex Benth.): A Multiple Mechanistic Approach.

The genus Thymus is traditionally used for the treatment of hyperactive airways complaints. The purpose of the current study is to investigate the potential tracheal relaxant effect and possible mechanism(s) of the essential oil of Thymus serrulatus (TS Oil) in isolated guinea pig tracheal tissues. The essential oil was obtained from the fresh erial parts of Thymus serrulatus, and its phyto-components were identified by GC-MS analysis. Guinea pig tracheal preparations were used for testing the tracheal relaxant effect of TS Oil with the determination of the mechanism(s) involved in this relaxation. GC-MS findings reveal that terpenes, fragrance constituents, saponins, and higher fatty acids are present in TS Oil. In isolated guinea pig trachea, TS Oil inhibited carbachol (CCh, 1 µM) and K+ (80 mM)-induced contractions in a pattern similar to that of dicyclomine. TS Oil, at 0.3 mg/ml, shifted parallel CCh-curves towards the right, followed by a non-parallel shift at higher concentration (1 mg/ml), thus suppressing maximum response in the same manner as produced by dicyclomine. Pretreatment of tissues with TS Oil (1 and 3 mg/ml) also produced a rightward shift of Ca++ concentration-response curves (CRCs) in the same manner as caused by verapamil. Further, TS Oil at low concentrations (0.3 and 1 mg/ml) shifted isoprenaline-induced inhibitory CRCs towards the left and increased cAMP levels in isolated tracheal homogenates similar to papaverine, a phosphodiesterase (PDE) inhibitor. In the antimicrobial assay performed by the agar well diffusion method, TS Oil was found most active against Candida albicans and Staphylococcus aureus where the zone of inhibition measured was 28 mm. Additionally, there was little difference between standard strains of gram-positive and gram-negative bacteria. However, methicillin-resistant S. aureus (MRSA) showed a small zone of inhibition as compared to standard strains (22 mm). From these results, it can be concluded that the essential oil of T. serrulatus has the potential to produce antimicrobial effects while causing tracheal relaxation mediated possibly by anticholinergic effects, Ca++ channel blockade, and PDE inhibition whereas additional mechanism(s) cannot be ruled out.

Evaluation of bronchodialatory and antimicrobial activities of Otostegia fruticosa: A multi-mechanistic approach.

Otostegia fruticosa, a plant belonging to the family Lamiaceae, is endemic to Ethiopia. In Ethiopian traditional medicine, O. fruticosa has been used for the treatment of several respiratory-related disorders. The present study was designed to evaluate the bronchodilatory and antimicrobial activities of O. fruticosa leaves crude extract (Of.Cr). Ex-vivo experiments were conducted on guinea-pig trachea provided with physiological oxygenated buffer solution using emkaBath setup. The crude extract was analyzed by gas chromatography-mass spectrometry. Of.Cr, showed the presence of terpenes, fragrance components, saponins, and higher fatty acids. Of.Cr when tested on contracted tracheal chains with carbamylcholine (CCh, 1 µM) and high K+ (80 mM) produced relaxation by showing higher potency against CCh with incomplete inhibition of high K+. Dicyclomine, used as a positive control, also showed selectively higher potency to inhibit CCh when compared with its effect against K+. In the anticholinergic curves, Of.Cr at 1 mg/mL deflected CCh-induced concentration-response curves (CRCs) competitively to the right like dicyclomine (0.03 µM) and atropine whereas a higher dose of Of.Cr (3 mg/mL) produced a non-parallel shift in the CCh curves like a higher dose of dicyclomine (0.1 µM). In the calcium channel inhibitory assay, Of.Cr at 3 & 5 mg/mL, deflected CRCs of Ca++ to the right like verapamil, used as positive control. Of.Cr, at concentrations (1-3 mg/mL) increases cAMP levels in isolated tracheal homogenates, similar to positive control phosphodiesterase inhibitor (papaverine). When tested for antibacterial activity against standard and clinical strains, Of.Cr was found more active (MIC 475 µg/ml) against S. aureus (NCTC 6571), while the maximum inhibition (MIC 625 µg/ml) was observed by the extract when tested against MRSA. These results determine the mechanistic pathways of the observed bronchodilatory effect of Otostegia fruticosa with a combination of anticholinergic and dual inhibition of phosphodiesterase and voltage-gated Ca++ channels.

Comparative environmental and human health evaluations of thermolysis and solvolysis recycling technologies of carbon fiber reinforced polymer waste.

This quantitative research aims to compare environmental and human health impacts associated with two recycling technologies of CFRP waste. The 'baseline' recycling technology is the conventional thermolysis process via pyrolysis and the 'alternative' recycling technology is an emerging chemical treatment via solvolysis using supercritical water (SCW) to digest the thermoset matrix. Two Gate-to-Gate recycling models are developed using GaBi LCA platform. The selected functional unit (FU) is 1 kg CFRP waste and the geographical boundary of this comparative LCIA is defined to be within the U.S. The results of this comparative assessment brought to light new insights about the environmental and human health impacts of CFRP waste recycling via solvolysis using SCW and, therefore, helped close a gap in the current state of knowledge about sustainability of SCW-based solvolysis as compared to pyrolysis. Two research questions are posed to identify whether solvolysis recycling offers more environmental and human health gains relative to the conventional pyrolysis recycling. These research questions lay the basis for formulating two null hypotheses (H0,1 and H0,2) and their associated research hypotheses (H1,1 and H1,2). LCIA results interpretation included 'base case' scenarios, 'sensitivity studies,' and 'scenarios analysis.' The results revealed that: (a) recycling via solvolysis using SCW exhibits no gains in environmental and human health impacts relative to those impacts associated with recycling via pyrolysis and (b) use of natural gas in lieu of electricity for pyrolyzer's heating reduces the environmental and human health impacts by 37% (lowest) and up to 95.7% (highest). It is recommended that on-going experimental efforts that focus only on identifying the best solvent for solvolysis-based recycling should also consider quantification of the energy intensity as well as environmental and human health impacts of the proposed solvents.

Selective inhibition of metabotropic glutamate type 1 alpha receptor (mGluR1α) reduces cell proliferation and migration following status epilepticus in early development.

The present study examined whether a single or multiple episode(s) of status epilepticus induced with kainic acid (KA) during the first 3 weeks of postnatal (P) development would aberrantly stimulate proliferation zones that alters migration to potentially injured areas and whether they would be blocked by selective Group I mGluR antagonists. mGluR1α (LY367385) and mGluR5 (MPEP) antagonists were administered 2h following KA-induced status epilepticus and animals were examined after 7days. Proliferating cells of the subventricular zone (SVZ), third ventricle, hippocampus, amygdala cortical complex were analyzed with the proliferative marker, Ki67; and two complementary retrograde dye tracers. Proliferation increased in extrahippocampal limbic structures when KA was administered on P13 or P20 which correlated with number of injured cells at the older age. LY367385 post-treatment caused striking decreases in proliferation in all limbic structures in the presence and absence of injury, whereas a reduction with MPEP was observed only within the amygdala cortical complex (Amg/ERcx) in the presence of multiple seizures (3×KA). After 3×KA and LY367385 post-treatments, diminished co-staining of dye tracers with Ki67 was observed within the Amg/ERcx despite high levels of progenitors marked by the retrograde tracers in this region. This indicates that not only was local proliferation within the SVZ and distant structures inhibited, but also that migration itself was reduced indirectly since there were less cells to migrate from the SVZ. Co-labeling with biomarkers provided evidence for neuronal differentiation suggesting potential aberrant integration may occur in distant locations, and that targeting of mGluR1α receptors may be a potential therapeutic strategy for future development.

Bilateral atraumatic tibial tubercle avulsion fractures: case report and review of the literature.

An avulsion fracture of the tibial tubercle is an uncommon injury, comprising less than 1% of all physeal injuries. The occurrence of such injuries bilaterally is even rarer. We report a case of bilateral atraumatic tibial tubercle avulsion fractures and its presentation, mechanism of injury, surgical management, post-operative rehabilitation and implications for clinical practice. A 17-year-old healthy male presented to the emergency department with severe pain on the anterior aspect of both knees and was unable to walk, having been brought in by ambulance after hearing a crack whilst jogging. On examination, there was significant swelling of both knees which were held in extension. On both sides there was a prominent deformity on the region of the tibial tubercle with a palpable gap, although no open skin wound. He was unable to actively move either knee joint. No neurovascular deficit was present. Plain radiographs revealed bilateral tibial tubercle avulsion fractures. Gentle manipulation was performed in the emergency department to the fragments in order to remove the tension from the skin. The fragments were reduced and fixed surgically with 4mm cannulated screws in an anterior to posterior direction. Both limbs were placed in temporary casts in 20 degrees of flexion. Postoperatively, the patient was kept non-weight bearing for four weeks then placed into a range of motion brace and movement commenced. Full weight bearing was permitted at the one month stage and he was advised to avoid any sporting activity until the 8 week stage and contact sports until the 10 week stage. Full movement of both joints was regained and the patient returned to full sporting activity in the absence of symptoms. This case emphasises the need for a high degree of vigilance when faced with such a presentation and a low threshold for further investigation and surgical intervention.

A randomized clinical comparison of the Intersurgical i-gel and LMA Unique in non-obese adults during general surgery.

BACKGROUND: The i-gel is a cuffless, single-use supralaryngeal airway device designed to provide a more effective seal than the laryngeal mask airway (LMA). Although the superiority of the i-gel compared to the LMA Classic was determined in a previous study, no studies have been performed that compare it to the disposable LMA Unique. The aim of this study was to compare the Intersurgical i-gelTM against the LMA UniqueTM (uLMA) in terms of ease of placement, time of insertion, and adequacy of placement through a randomized, controlled clinical trial. METHODS: Following Institutional Review Board (IRB) approval and written informed consent, 50 adult patients were recruited for this study. All enrolled patients were ASA 1-2, Mallampati I-II, and scheduled to receive general anesthesia. Patients were randomized to have either the i-gel or the uLMA placed for airway management. After standardized induction techniques, the airway was secured with the assigned device. All patients were interviewed postoperatively for sore throat, hoarseness, and dysphagia. Standard vital signs, end-tidal CO2, tidal volumes, and peak pressures were recorded. Insertion time, leak pressures, and anatomic placement as assessed fiberoptically for the i-gel were recorded. Ease of placement and complications were also recorded. RESULTS: The insertion time was significantly less with the i-gel (21.04±12.6 s vs. 30.04±14.1 s, P=0.02). An inadequate seal was noted in three patients with the i-gel, and it was exchanged for the uLMA in all three cases. There were no significant differences in the ease of insertion, leak pressures, or fiberoptic view. Most of the fiberoptic views, as assessed through the drain tube, demonstrated esophageal mucosa (22/25). Patients receiving the i-gel were significantly more likely to require a second attempt at insertion by the anesthesiologist (OR 8.11, CI 1.1-58.6, P=0.03). Finally, patients receiving the size 5 i-gel were significantly more likely to complain of immediate postoperative symptoms, such as sore throat and dysphagia (OR 29.32, CI 1.4-613.1, P=0.03). CONCLUSION: Although the i-gel had a faster insertion time in comparison to the uLMA, there was a greater need for repeat insertions. The weight criteria established by the manufacturer may need to be readjusted to recommend a larger size device in some patients less than 90 kg because all of the repeat insertions were in patients weighing more than 80 kg. In all other aspects of its use, the i-gel performed similarly to the uLMA.

[Prevention of the acute tolerence with fentanyl by ketamine]. / Prévention de la tolérence aigue au fentanyl par la kétamine à faible poids.

INTRODUCTION: The objective of this study is to evaluate in under developed country where post operative pain management inadequate the efficiency of the prevention of this acute tolerance with opioids by the ketamine. MATERIALS AND METHODS: We did a prospective study on months period (January 2004 to June 2004). The setting was the HPD surgical unit recovery room. The patients of more than 15 years and less than 60 years who underwent painful or fairly painful surgical operation under general anaesthesia were included. The patients intubés,ventilated and sedated in the recovery room were excluded from the study .The patients were divided into two groups: in group 1 the patients were given 100 microg/kg of ketamine 15 mn before induction. In group 2 the patients where given a placebo 15 mn before induction. The fentanyl was used systematically during induction at the dosage of 5 microg/kg. The quality of per-operative analgesia was evaluated by the appreciation of the heart rate and the blood pressure. The DPO was evaluated by the analogical visual scale (EV A) at the entrance and the exit of the recovery room, and at the 4th, 8th, 12th and 24th hour after the surgery. RESULTS: Hundred and thirteen (113) patient were included in the study (groupel with ketamine: 56 patients, groupe 2 without ketamine: 57). The average age was 30 years with extremes from 16 to 60 years. In group 1 and preoperatively 5.9% of the patients receided additional fentanyl ranging from 50 to 100 microg/kg against 47.7% in group 2. In the post-operative period, the morphine consumption was 22.02% for the Group 1 and 43.37% for Group 2. The difference between the two groups is statistically significant. A case of restlessness was noted in group 1. CONCLUSION: The low dose ketamine seems to be effective for the prevention of the postoperative severe pain induced by the fentanyl. It allows also an improvement of the quality of per-operational analgesia.

Enzymological and physiological consequences of restructuring the lipoyl domain content of the pyruvate dehydrogenase complex of Escherichia coli.

The core-forming lipoate acetyltransferase (E2p) subunits of the pyruvate dehydrogenase (PDH) complex of Escherichia coli contain three tandemly repeated lipoyl domains although one lipoyl domain is apparently sufficient for full catalytic activity in vitro. Plasmids containing IPTG-inducible aceEF-IpdA operons which express multilip-PDH complexes bearing one N-terminal lipoyl domain and up to seven unlipoylated (mutant) domains per E2p chain, were constructed. Each plasmid restored the nutritional lesion of a strain lacking the PDH complex and expressed a sedimentable PDH complex, although the catalytic activities declined significantly as the number of unlipoylated domains increased above four per E2p chain. It was concluded that the extra domains protrude from the 24-meric E2p core without affecting assembly of the E1p and E3 subunits, and that the lipoyl cofactor bound to the outermost domain can participate successfully at each of the three types of active site in the assembled complex. Physiological studies with two series of isogenic strains expressing multilip-PDH complexes from modified chromosomal pdh operons (pdhR-aceEF-IpdA) showed that three lipoyl domains per E2p chain is optimal and that only the outermost domain need be lipoylated for optimal activity. It is concluded that the reason for retaining three lipoyl domains is to extend the reach of the outermost lipoyl cofactor rather than to provide extra cofactors for catalysis.

Leishmanicidal activity of Nystatin (mycostatin): a potent polyene compound.

The susceptibility of promastigote of Leishmania major to Nystatin in vitro was examined. L. major (MHOM/PK/88/DESTO) promastigote were cultured in medium 199 supplemented with 10% heat inactivated foetal bovine serum and 2% urine. The growth of the promastigote was monitored in the absence and presence of the experimental compound (Nystatin) for upto 5 days post-inoculation. The EC50 value (the concentration of drug necessary to inhibit the growth rate of cells to 50% of the control value) obtained for Nystatin against the promastigote of L. major was less than 9.76 iu ml. Certain polyene compounds like Amphotericin-B and Nystatin (mycostatin) are familiar for their fungicidal activity. Amphotericin-B is used since long as antileishmanial drug as well. Results obtained suggest that Nystatin has a very good anti leishmanial activity in vitro. The mode of action proposed for this drug is same as for Amphotericin-B as both of these polyene compounds interact with the various sterols present on the surface of the parasite, thus unusual gaps and pores are formed on the surface that results in the leakage of the ions. This leakage finally leads to the destruction of the parasite.

Evaluation of enzyme-linked immunosorbent assay [ELISA] in serodiagnosis of pulmonary tuberculosis

A total of 45 patients with pulmonary tuberculosis and 45 healthy individuals were subjected to chest examination, radiography and ELISA tests for IgA and IgG antibodies. Sputum smear and culture were performed for all tuberculous patients. Evaluated against clinical and radiological diagnosis, ELISA's specificity exceeded 90% in detecting specific IgA and IgG antibodies. The parallel application of ELISA and microscopic examination of sputum yielded 80% sensitivity compared with clinical and radiological examination and 100% sensitivity compared with culture. ELISA alone can be used in ruling out pulmonary tuberculosis but not in diagnosing the disease. However, coupled with microscopic examination, it can be used instead of culture to provide positive diagnosis within 24 hours

Pulmonary function changes after laparoscopic surgery: relation to the sites of ports and the duration of pneumoperitoneum.

Pulmonary function tests were performed for 50 patients who were undergoing different laparoscopic surgical procedures. Measurements were made 1 to 2 h before, and 24 h after the operation. There was a highly significant reduction (p < 0.001) in forced vital capacity (-10.97 +/- 1.78), forced expiratory volume in the first second (-15.39 +/- 2.43), forced expiratory volume in the third second (-13.18 +/- 2.07), peak expiratory flow rate (-20.08 +/- 3.57), forced expiratory flow rate 25-75% (-21.45 +/- 3.57), and peak inspiratory flow rate (-14.97 +/- 5.81). These changes reflect a restrictive as well as an obstructive dysfunction. Explanations have been proposed for these changes. The pulmonary function changes were found to be more pronounced with upper abdominal procedures, where the laparoscopic ports were placed in the upper half of the anterior abdominal wall, than with lower abdominal and pelvic laparoscopy, where the ports were placed in the lower half. However, the differences between these two groups did not reach the level of statistical significance for any of the tests. The duration of pneumoperitoneum proved to have a minimal influence on the changes in the first three functions, and almost no influence on the last three. The findings of this study verify the safety of laparoscopic surgery concerning pulmonary functions, irrespective of the site of ports and the duration of pneumoperitoneum.

Bilateral clicking ribs.

Congenital abnormalities of the ribs, including slipping or clicking rib, are well recognised but rarely give rise to symptoms. Slipping rib has previously been described as a unilateral condition. We report an unusual case of symptomatic bilateral slipping ribs treated successfully by surgery.

Comparative study of 3 aminoglycoside antibiotics and aztreonam on M.I.F. production by splenic lymphocytes of mice in vitro.

The aminoglycosides gentamicin, tobramycin, netilmicin and aztreonam were tested for their effects on migration inhibition factor production by mouse lymphocytes challenged by phytohemagglutinin in vitro. The three aminoglycosides were found to depress its production while aztreonam was devoid of this depression effect.