Local T1-T2 distribution measurements in porous media.

A novel slice-selective T1-T2 measurement is proposed to measure spatially resolved T1-T2 distributions. An adiabatic inversion pulse is employed for slice-selection. The slice-selective pulse is able to select a quasi-rectangular slice, on the order of 1 mm, at an arbitrary position within the sample.The method does not employ conventional selective excitation in which selective excitation is often accomplished by rotation of the longitudinal magnetization in the slice of interest into the transverse plane, but rather a subtraction based on CPMG data acquired with and without adiabatic inversion slice selection. T1 weighting is introduced during recovery from the inversion associated with slice selection. The local T1-T2 distributions measured are of similar quality to bulk T1-T2 measurements. The new method can be employed to characterize oil-water mixtures and other fluids in porous media. The method is beneficial when a coarse spatial distribution of the components is of interest.

A novel association between IL1-Ra (receptor antagonist) gene polymorphism and T1DM in Al-Madina Al-Mounawra.

OBJECTIVE: The Interleukin-1 receptor antagonist (IL1-Ra) is initiated to terminate the acute pro-inflammatory event and prevent chronic inflammation from damaging healthy cells. We aim to draw the attention of IL1-Ra (VNTR) gene polymorphism and determine whether IL1-Ra confer susceptibility to type 1 diabetes mellitus (T1DM) and evaluate the genotype and allele distribution of IL1-Ra gene in a Saudi population. PATIENTS AND METHODS: Case control study included (100) T1DM Saudi children, plus 102 healthy unrelated individuals as control group. They were evaluated for variable number of tandem repeat (VNTR) of IL1-Ra gene polymorphism. Polymerase chain reaction amplification of VNTR of 86bp in intron 2 of IL1-Ra was performed. RESULTS: A1A1 and A1A2 genotypes with alleles A1 and A2 frequency were the most common both in cases and controls (healthy population); prevalence (28%, 56% & 57.8%, 39.2% respectively) and (58%, 38% and 77.5%, 22.5% respectively). In addition IL1-Ra gene polymorphism had higher risk significantly different between diabetic children and controls. (A1/A2) genotype had higher frequency statistically significant in DM patients than controls [56% vs. 39.2%, p < 0.02] and had twice time risk [OR = 1.97, 95% CI = 1.1-3.4, p < 0.02]. With further stratification, there was strong association between diabetic patients carriage IL1-Ra (A2) allele and controls [38% vs. 22.5%, p = 0.001] which had higher risk [OR = 2.11, 95% CI = 1.4-3.2, p = 0.001] for susceptibility of diabetes. CONCLUSIONS: This study emphasizes a positive association between IL1-Ra (VNTR) polymorphism and DM among Saudi children. This may suggest that (A2) allele may play important role in disease susceptibility.

Recovery of Hafnia alvei from diseased brown trout, Salmo trutta L., and healthy noble crayfish, Astacus astacus (L.), in Bulgaria.

Hafnia alvei was isolated in Bulgaria from healthy noble crayfish, Astacus astacus (L.), and then from farmed diseased brown trout, Salmo trutta L., with signs of haemorrhagic septicaemia. The isolates were identified initially with conventional phenotyping and commercial Merlin Micronaut and API 20E rapid identification systems, followed by sequencing of the 16S rRNA gene. Hafnia alvei Bt1, Bt2 and Aa4 were of low virulence to rainbow trout and brown trout, although cytotoxicity was demonstrated by Bt1 and Bt2, but not by Aa4.

La(0.7)Sr(0.3)MnO3 nanoparticles based ultra-high sensitive ammonia chemical sensor.

A facile, reliable, reproducible and ultra-high sensitive aqueous ammonia chemical sensor has been fabricated based on the utilization of La(0.7)Sr(0.3)MnO3 nanoparticles (LSMO NPs), as efficient electron mediators, and reported in this paper. The LSMO NPs were prepared by hydrothermal protocol followed by the annealing process and characterized in detail in terms of their mophological, structural and compositional properties. The I-V technique based aqueous ammonia sensor exhibits an ultra-high sensitivity of 494.68 +/- 0.01 microA cm(-2)mM(-1) and very low-detection limit of 0.2 microM with a response time less than 10 s. To the best of our knowledge, this is the first report in which LSMO is used as an efficient electron mediator for the fabrication of aqueous ammonia chemical sensor. Moreover, by comparing the literature, it is confirmed that the fabricated sensor exhibits highest sensitivity towards the detection of aqueous ammonia. This LSMO nanomaterial based research broadens the range of efficient electron mediators utilized for the fabrication of ultra-high sensitive chemical sensors.

Frequency of Mediterranean mutation among a group of Saudi G6PD patients in Western region-Jeddah.

Glucose-6-phosphate dehydrogenase deficiency (G6PD), a common human enzymatic defects characterized by extreme molecular and biochemical heterogeneity is found to have a variable frequency in different regions. The molecular basis of polymorphic variants in Saudi Arabia have yet to be fully addressed to. Accordingly, a study was designed to determine the frequency of G6PD gene mutations in G6PD deficient cases. From forty-seven unrelated G6PD-deficient subjects, DNA was extracted individually from peripheral blood samples and exons 6 and 7 of the G6PD gene were amplified by PCR. Mutation analysis was carried out by using conformation sensitive gel electrophoresis (CSGE), followed by direct DNA sequencing. The results showed definite altered CSGE patterns. Two mutations were resolved in exon 6 of G6PD gene; Mediterranean mutation and Sibari mutation, not previously reported so far; while no mutation was detected in exon 7. The frequency of exons 6 mutations responsible for G6PD deficiency (Mediterranean type) is reported for the first time from this region, with a figure of 50.1%. The absence of other mutations in exon 7 causing G6PD deficiency points to the low genetic diversity in the studied population.

Microbiological quality changes in the intestine of hybrid tilapia (Oreochromis niloticus x Oreochromis aureus) in fresh and frozen storage condition.

AIMS: The goal of this study was to monitor the quantitative and qualitative bacterial flora in the intestine of hybrid tilapia in fresh fish and fish kept in frozen storage conditions for 1 year. METHODS AND RESULTS: Quantitative and qualitative analyses of the bacterial flora associated with the intestine of hybrid tilapia (Oreochromis niloticus x Oreochromis aureus) in fresh fish and fish kept in frozen storage conditions for 1 year were carried out. In fresh and frozen fish, aerobic plate count (APC) ranged from 1.6 +/- 1.2 x 10(8) to 1.5 +/- 0.9 x 10(5) CFU g(-1) in the intestine of tilapia collected from pond 1, 8.7 +/- 2.3 x 10(7) to 6.5 +/- 3.8 x 10(4) CFU g(-1) in the intestine of tilapia from pond 2, and 1.9 +/- 2.9 x 10(8) to 6.2 +/- 2.8 x 10(4) CFU g(-1) in the intestine of tilapia from pond 3. APC for all the groups of fish decreased c. 2-log cycles after 1 months frozen storage; thereafter, counts slowly declined during frozen storage for 1 year. Altogether, 16 bacterial genera were identified: Gram-negative rods (67%) dominated. Both in fresh and frozen conditions, four bacterial species viz. Shewanella putrefaciens, Corynebacterium urealyticum, Aeromonas hydrophila and Flavobacterium sp. were always present, with a prevalence of 10% in most cases. Shewanella putrefaciens was the most dominant organism (15% of the total isolates) throughout the studied period. During frozen storage some of the bacteria were not recovered, but most of the bacteria survived after prolonged freezing. CONCLUSIONS: This study describes the aerobic heterotrophic microflora found in the intestine of fresh and frozen tilapia. The unique aspect of this study concerns the data revealing the micro-organisms, which are viable after prolonged freezing. Contamination of edible portions of fish could originate from gastrointestinal sources. SIGNIFICANCE AND IMPACT OF THE STUDY: The present results may enhance knowledge in controlling the storage life of fish, and fish product quality. Bacterial activity is by far the most important factor influencing fish quality, so bacterial numbers can be used as an index of quality. Storage of frozen tilapia without evisceration could be avoided.

Pregnancy in patients on dialysis--experience at a referral center.

OBJECTIVE: Pregnancy is infrequent in women with end-stage renal disease. The frequency of conception in dialysis patients has been reported as 0.3% to 1.4% in different studies from different countries. In the present study the frequency and outcome of pregnancies from a referral center in Saudi Arabia from January 1992 to December 2003 is reported. METHODS: All females on maintenance hemodialysis (MHD) and chronic peritoneal dialysis (CPD) were reviewed. Files of the patients in childbearing age (less than 50 years) were analyzed for the frequency of pregnancy, mode of dialysis, complications and outcome. Of the 192 females taken for MHD and CPD, 113 were of the childbearing age. Five patients were already on HD when they became pregnant, the period on HD varied from 7-34 (mean = 24) months and in 4 dialysis was initiated during first pregnancy. (Abortion was defined as termination of pregnancy before 22 weeks of gestation. Perinatal mortality was taken as death of a viable fetus after 22 weeks of gestation or within 4 weeks after delivery. Preterm was defined as delivery before 37 weeks of gestation and low birth weight as a baby weighing less than 2500 gm at birth). RESULTS: Twelve pregnancies were noted in 9 patients (7.9%) with a yearly frequency of 0.66%. All pregnancies were noted in patients on MHD and none on CPD. Seven pregnancies (58%) ended in live births and all were preterm deliveries in the range of 27-36 (mean 31.5) weeks. All babies were low birth weight ranging from 1115-2300 (mean 1700) gram. Three deliveries were spontaneous vaginal and 4 underwent lower segment cesarean sections. Two deliveries ended in perinatal mortality. Three pregnancies ended in spontaneous abortions between 10-20 (mean 12) weeks. One woman had 3 pregnancies, the last one ending in antepartum hemorrhage, hysterotomy and hysterectomy for rupture of uterus. Another patient had 2 pregnancies. No congenital abnormalities were noted in any of the live births. CONCLUSION: Pregnancy though uncommon in women on dialysis can occur. Preterm deliveries with low birth weight are usual though live birth rate of 58% was observed. In view of the need for increased frequency of dialysis for successful outcome, planning the pregnancy and high chances of dangerous complications, early diagnosis of pregnancy in a patient on dialysis essential.

Eleven years of experience with dialysis associated tuberculosis.

BACKGROUND: The aim of this retrospective study was to evaluate the incidence of tuberculosis (TB) in dialysis patients and to determine its clinical features and results of short-course (6 months) chemotherapy, mortality and risk factors of mortality. METHODS: The study included 48 TB patients among 330 patients on dialysis of whom 37 were on hemodialysis and 11 were on peritoneal dialysis at Security Forces Hospital in the period from October 1989 to October 2000. The diagnosis of TB was established by a combination of clinical, radiological, biochemical, microbiological and histological examinations. Treatment with anti-TB drugs, the results of therapy and the outcome of patients were noted. RESULTS: There were 32 males and 16 females with age ranges of 18 -89 (mean = 53.4) and 40 - 70 (mean 57.9) years, respectively. Their duration on dialysis ranged from 1 month to 10 years (mean = 26 months). The presenting clinical features were fever (32), cough (16), weight loss (9), and anorexia (7). The organ systems involved were pulmonary (23), peritoneal (15), lymphadenopathy (11), pericardial (4), bone TB (3), bone marrow (2), epididimo-orchitis (1), right infraclavicular chest wall cold abscess (1), right infrascapular cold abscess (1) and right renal mass (1). Single organ system involvement was noted in 36 patients, 2 systems in 10 patients and 3 systems in 2 patients. Two patients were treated empirically with good response. Evidence of tuberculosis was obtained from chest X-rays (23), bone X-rays (3), spinal MRIs (1), AFB (stain and culture) of sputum and fluid (15), ascitic fluid examination with exudate and raised adenine deaminase (ADA) levels (12), lymph node biopsy (8), pleural fluid examination with exudate and raised ADA levels (5), bone marrow aspiration (2), exudative pericardial fluid with raised ADA levels (2), nephrectomy and histopathology (1), dorsal spine biopsy (1) and laparotomy and biopsy ofperitoneum (1). Thirty-two patients received 4 anti-TB drugs: isoniazid (INH), rifampicin (Rif), pyrazinamide (Pyra) and ethambutol (Eth), 10 received 3 drugs (INH, Rif and Pyra or Eth), 2 received 2 drugs (INH + Rif) and a modified regimen was used in 3. The drug toxicities noted were hepatoxicity (5) and INH encephalopathy prior to the routine use of pyridoxine 100 mg daily (3), INH-induced SLE (1) and pyrazinamide-induced thrombocytopenia (1). The outcome of the patients was cured (35), expired (13), and 1 patient expired before starting therapy. Tuberculosis was not the direct cause of death in any of the patients. CONCLUSION: The incidence of TB in dialysis patients is 26 times more common than in the general Saudi population and a high index of suspicion is needed for early diagnosis and treatment. Extrapulmonary TB was noted in 52% of the patients. Short-course (6 months) chemotherapy is effective. INH-induced CNS toxicity is significant.

Calciphylaxis: case report and literature review.

Tissue calcification is a well-recognized common metabolic disease, but calciphylaxis still remains an enigmatic rarity. The latter may be induced experimentally and acquired naturally in human diseases. Although many chronic azotemic or end stage renal disease patients (ESRD) with hyperparathyroidism (HPT) are at risk of calciphylaxis not all of them do develop the disease, even non-renal, patients may also develop this disease. Out of a total of about 2000 hemodialysis, 15,000 dermatology and 26,000 medical patients seen over a three year period in a busy Saudi Arabian tertiary medical centre, we report a sentinel nephrology patient with sudden excruciatingly painful cutaneous calciphylaxis that necessitated acute dermatology emergency consultation, and present a review of the medical literature. In order to institute appropriate total quality management of this life-threatening, rare disease, it is advisable that a high index of suspicion should be entertained by dermatologists, general physicians, nephrologists, and pulmonologists in an appropriate clinical scenario.

Hepatitis C Virus Sero-status in Hemodialysis Patients Returning from Holiday: Another Risk Factor for HCV Transmission.

Hepatitis C virus (HCV) infection is an endemic disease in most hemodialysis (HD) units in Saudi Arabia. We observed that many of our HD patients seroconvert shortly after returning from "holiday dialysis" in other units. We investigated this issue together with other possible factors related to HCV transmission. During the study period, 56 patients were being dialyzed in our unit. Systematic screening was performed on all patients for anti-HCV antibody utilizing ELISA 2.0 and/or RIBA 3.0 and HBsAg every three months together with aminotransferases activity. The same tests were carried out on patients returning from "holiday dialysis" in other units. Test for HCV-RNA was performed in patients with elevated aminotransferases and negative HCV serology. HCV-antibody was positive in 32 patients (57%) of whom 15 (27%) were already positive at the time of starting HD and 17 (30%) seroconverted after starting HD. A total of 24 patients (43%) remained sero-negative. Comparing the sero-converters (SC) to the remained sero-negatives (RSN), the SC had been out for "holiday dialysis" more than the RSN with a mean number of such HD treatments of 16 versus 4 (P= 0.006). The SC had longer duration on dialysis, 38 versus 19 months for the RSN. The two groups did not have significant difference in their age, sex, number of blood transfusions or prior kidney transplantation. Fourteen out of 17 SC (82%) had seroconverted after a mean duration of 100 days from leaving our unit for "holiday dialysis". Eight out of 24 (33%) of the RSN had dialysis outside our unit and remained sero-negative; HCV-RNA confirmed infection in three of them, all of whom had high amino transferase levels. Our study suggests that patients who have "holiday dialysis" in units with high prevalence of HCV-antibody, run a high risk of sero-conversion and may play a role in unit to unit transmission of HCV.

Renal infarction - presentation and causes: a case report and literature review.

Renal infarction usually occurs in patients with severe atherosclerosis or heart disease. We report a 68-year-old lady who presented with total occlusion of the left renal artery of acute onset. Detailed work up did not reveal any specific cause and the infarction was considered to be idiopathic. The patient presented two-and-half years later with atrial fibrillation, which was managed with anti-arrhythmic drugs. Retrospectively, we believe that the cause of renal infarction was embolization secondary to paroxysmal atrial fibrillation. She is doing well on anti-coagulants and anti-arrhythmic drugs and was maintaining sinus rhythm when last seen.

Parental perceptions of fever in children.

BACKGROUND: Fever is a common medical problem in children which often prompts parents to seek immediate medical care. The objective of this study was to survey parents about their knowledge and attitude concerning fever in their children. PATIENTS AND METHODS: The study involved the random selection of Saudi parents who brought their febrile children to the emergency rooms or walk-in clinics of four hospitals in Riyadh. Parents of 560 febrile children were interviewed using a standard questionnaire to obtain sociodemographic information and current knowledge of fever. Approximately 70% of the respondents were female, and the ages of the most were in the range of 20-40 years. More than 80% of the parents had two or more children. RESULTS: More than 70% of parents demonstrated a poor understanding of the definition of fever, high fever, maximum temperature of untreated fever, and threshold temperature warranting antipyresis. About 25% of parents considered temperatures less than 38.0 o C to be fever, another 25% did not know the definition of fever, 64% felt that temperatures of less than 40.0 o C could be dangerous to a child, and 25% could not define high fever. Another 23% believed that if left untreated, temperatures could rise to 42.0 o C or higher, but 37% could not provide an answer, and 62% did not know the minimum temperature for administering antipyretics. Approximately 95% of parents demonstrated undue fear of consequent body damage from fever, including convulsion, brain damage or stroke, coma, serious vague illness, blindness, and even death. CONCLUSION: Parental misconceptions about fever reflect the lack of active health education in our community. Health professionals have apparently not done enough to educate parents on the condition of fever and its consequences, a common problem.

Thyroiditis induced by interferon in dialysis.

We describe a dialysis patient who acquired acute Hepatitis C infection. Her primary renal disease was systemic lupus erythromatosis. She was having goitre but clinically euthyroid and her thyroid function test was normal. To avoid long term complications of Hepatitis C we elected to treat her with Interferon 3 million units subcutaneously 3 times a week. During treatment she developed some transient side effects initially which subsided but later she felt pressure symptoms around her neck. When we checked her TSH and thyroid antibodies these were elevated. Though this could be related to HCV, rarely, but we think the thyroid change is mostly related to Interferon. Some possible explanation of the effect of Interferon on thyroid have been reviewed and we think patients getting such drugs should be under close monitoring to avoid permanent thyroid dysfunction.

Megacystis-microcolon-intestinal hypoperistalsis syndrome associated with megaesophagus.

Megacystis-microcolon-intestinal hypoperistalsis syndrome is a rare congenital disorder characterized by megacystis and hypoperistalsis of the gastrointestinal tract. About 80 cases have been reported, predominantly in females. We present a female newborn with typical features of the syndrome associated with megaesophagus.

Renal artery stenosis in renal transplantation presentation and management.

A review of the angioplasty records between 1990 and 1995 at the King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia revealed ten cases of transplant renal artery stenosis (RAS). The diagnosis in these cases was confirmed by renal angiography and all were treated by angioplasty. All study patients presented with uncontrolled hypertension in spite of multiple medications; eight had renal functional impairment and two patients had recurrent unexplained pulmonary edema in addition. Six patients had undergone end-to-end anastomosis, while four had end-to-side anastomosis of the artery during transplantation. Four had cadaveric renal transplants and six had living donor renal transplants. Eight of these patients responded well to angioplasty with marked improvement in their renal function and reduction in the number of anti-hypertensive medications. In one patient, it was not possible to pass the catheter through the stenosis and the patient underwent surgical reconstruction, while in another patient there were multiple stenotic lesions involving the external iliac and the transplant renal arteries suggesting atherosclerotic changes. We conclude that renal artery stenosis should be suspected in patients after renal transplant if they have uncontrolled or worsening hypertension, unexplained renal impairment or presentation with unexplained recurrent pulmonary edema. Renal angiography should be considered as part of the investigation of hypertension in renal transplant patients, and if the RAS is confirmed, angioplasty should be the procedure of choice.

Paroxysmal nocturnal hemoglobinuria and renal failure.

In this report we present two cases of acute renal failure in paroxysmal nocturnal hemoglobinuria (PNH) patients, who both eventually recovered their renal function. We also highlight some of the possible pathophysiological changes, which may contribute to renal failure in patients with PNH.