Successful use of a bivalirudin treatment protocol to prevent extracorporeal thrombosis in ambulatory hemodialysis patients with heparin-induced thrombocytopenia

Heparin-induced thrombocytopenia (HIT) is an uncommon problem in hemodialysis (HD) patients. There have been a few reports on the use of lepirudin, argatroban, or danaparoid in the management of extracorporeal thrombosis (ECT) during dialysis in these patients, because heparin is contraindicated. Here, we report the first long-term use of bivalirudin to prevent ECT. Our study was conducted at Fahd Bin Jassim Kidney Center in Doha, Qatar. All patients diagnosed with HIT were included. A bivalirudin treatment protocol was developed with the initial dosage and dosage adjustments based on the value of activated partial thromboplastin time (aPTT), the risk of bleeding, and the recurrence of ECT. Eight patients were positive for HIT AB. Among them, three were excluded: two due to the use of warfarin for atrial fibrillation and one due to a negative repeat HIT AB test with no ECT. Five patients who were positive for HIT AB and experienced recurrent ECT events during dialysis were included. These patients were monitored while on bivalirudin protocol for a mean of 4.6 ± 2 months, during which they received a mean number of HD treatments of 66 ± 24. There were no bleeding events or adverse reactions related to bivalirudin during the study. Here, we report the first long-term successful use of a bivalirudin protocol to prevent ECT in ambulatory HD patients with HIT. This protocol allowed for a simple dosing initiation with easy adjustment based on weight, aPTT, and recurrence of ECT events. The protocol provided excellent safety.

The accuracy of clinical symptoms in detecting cauda equina syndrome in patients undergoing acute MRI of the spine

A large number of patients do not have cauda equina syndrome (CES) on MRI to account for their clinical findings; consequently, the majority of urgent scans requested are normal. We aimed to determine whether any clinical manifestation of CES, as stated in Royal College of Radiology guidelines, could predict the presence of established CES on MRI. We also aimed to support a larger study to develop a more universal assessment tool for acute lower back pain.A retrospective analysis of consecutive patients who warranted urgent MRI was conducted. Seventy-nine patients were eligible for study. The Kendall's tau test was used for statistical analysis of all data. A p value of less than 0.05 was considered to be significant. MRI was performed in 62 patients out of 79.A total of 32.9% of patients had scans within 24 hours of admission. Nine of these patients were referred to neurosurgery for urgent neurosurgical review. Of these, 6.3% of patients had an established CES on MRI scan. One patient who had an out-patient MRI spine (15 days from hospital presentation) was found to have an established CES, was urgently referred to spinal surgery and underwent primary fenestration excision of the lumbar vertebra. No clinical features that were able to predict the presence of an established CES on MRI were elucidated. Findings included decreased anal tone 7.6% (p=0.282), faecal incontinence 3.8% (p=0.648), urinary retention 7.6% (p=0.510), bladder incontinence 8.9% (p=0.474), constipation 2.5% (p=0.011) and saddle anaesthesia 8.9% (p=0.368). Patients who had an abnormal MRI spine for back pain prior to this presentation showed a correlation with a newly diagnosed CES on MRI (p=0.016) with a correlation coefficient of 0.272.

The Curse of the Nine-Banded Armadillo: Case Report and Review

Hansen's disease (leprosy) is an ancient condition characterized by hypopigmented patches that progress to become plaques with hypoesthesia. Several case reports suggest that armadillos may be a source of Mycobacterium leprae for clinical cases, and contact with armadillos has been shown to be a significant risk factor in several case-control studies. Early diagnosis and treatment result in an excellent prognosis and provide an effective means to prevent complications of peripheral nerve injury, social stigma, and disability. We present a case of Hansen's disease in a previously healthy veteran and provide an overview of the diagnosis, classification, and treatment of the condition. Clinicians should consider leprosy in the differential diagnosis when confronted with chronic skin lesions in the appropriate clinical setting.

DNA-rescuable allosteric inhibition of aptamer II ligand affinity by aptamer I element in the shortened Vibrio cholerae glycine riboswitch

Glycine riboswitches contain two aptamers and turn on the expression of downstream genes in bacteria. Although full-length glycine riboswitches were shown to exhibit no glycine-binding cooperativity, the truncated glycine riboswitches were confirmed to bind two glycine molecules cooperatively. Thorough understanding of the ligand-binding cooperativity may shed light on the molecular basis of the cooperativity and help design novel intricate biosensing genetic circuits for application in synthetic biology. A previously proposed sequential model does not readily provide explanation for published data showing a deleterious mutation in the first aptamer inhibiting the glycine binding of the second one. Using the glycine riboswitch from Vibrio cholerae as a model system, we have identified a region in the first aptamer that modulates the second aptamer function especially in the shortened glycine riboswitch. Importantly, this modulation can be rescued by the addition of a complementary oligodeoxynucleotide, demonstrating the feasibility of developing this system into novel genetic circuits that sense both glycine and a DNA signal.

Towards realistic estimates of HCV incidence in Egypt

Accurate incidence estimates are essential for quantifying hepatitis C virus (HCV) epidemic dynamics and monitoring the effectiveness of public health programmes, as well as for predicting future burden of disease and planning patient care. In Egypt, the country with the largest HCV epidemic worldwide, two modelling studies have estimated age-specific incidence rates that, applied to the age pyramid, would correspond to more than 500 000 Egyptians getting infected annually. This is in contrast to figures of the Egyptian Ministry of Health and Population that estimates new infections to be approximately 100 000 per year. We performed new analyses of nationwide data to examine the modelling assumptions that led to these estimates. Thus, we found that the key assumption of these models of a stationary epidemic is invalid. We propose an alternate approach to estimating incidence based on analysing cohort data; we find that the number of annual new infections is <150 000.

Positron annihilation on defects in silicon irradiated with 15 MeV protons

Microstructure and thermal stability of the radiation defects in n-FZ-Si ([P] ≈ 7 × 10(15) cm(-3)) single crystals have been investigated. The radiation defects have been induced by irradiation with 15 MeV protons and studied by means of both the positron lifetime spectroscopy and low-temperature measurements of the Hall effect. At each step of the isochronal annealing over the temperature range ∼60-700 °C the positron lifetime has been measured for the temperature interval ∼30-300 K, and for samples-satellites the temperature dependences of the charge carriers and mobility have been determined over the range ∼4.2-300 K. It is argued that as-grown impurity centers influence the average positron lifetime by forming shallow (E(b) ≈ 0.013 eV) positron states. The radiation-induced defects were also found to trap positrons into weakly bound (E(b) ≤ 0.01 eV) states. These positron states are observed at cryogenic temperatures during the isochronal annealing up to T(anneal.) = 340 °C. The stages of annealing in the temperature intervals ∼60-180 °C and ∼180-260 °C reflect the disappearance of E-centers and divacancies, respectively. Besides these defects the positrons were found to be localized at deep donor centers hidden in the process of annealing up to the temperature T(anneal.) ≈ 300 °C. The annealing of the deep donors occurs over the temperature range ∼300-650 °C. At these centers positrons are estimated to be bound with energies E(b) ≈ 0.096 and 0.021 eV within the temperature intervals ∼200-270 K and ∼166-66 K, respectively. The positron trapping coefficient from these defects increases from ∼1.1 × 10(16) to ∼6.5 × 10(17) s(-1) over the temperature range ∼266-66 K, thus substantiating a cascade phonon-assisted positron trapping mechanism whose efficiency is described by ≈T(-3) law. It is argued that the value of activation energy of the isochronal annealing E(a) ≈ 0.74-0.59 eV is due to dissociation of the positron traps, which is accompanied by restoration of the electrical activity of the phosphorus atoms. The data suggest that the deep donors involve a phosphorus atom and at least two vacancies. Their energy levels are at least at E > E(c) - 0.24 eV in the investigated material.

Fungal peritonitis in patients undergoing continuous ambulatory peritoneal dialysis in Qatar

Introduction: This study was conducted at Hamad General Hospital to determine the incidence of fungal peritonitis and to describe its clinical and microbiological findings in patients undergoing continuous ambulatory peritoneal dialysis in Qatar. Methodology: The medical records of these patients between 1 January 2005 and 31 December 2008 were retrospectively reviewed and the collected data were analysed. Results: During the study period, 141 episodes of peritonitis were observed among 294 patients. In 14 of these episodes (9.9%), fungal peritonitis was reported in 14 patients with a rate of 0.05 episodes per patient year, while the bacterial peritonitis rate was 0.63 per patient year. Thirteen (93%) patients had one or more previous episodes of bacterial peritonitis that was treated with multiple broad-spectrum antibiotics, 11 (85%) had received broad-spectrum antibiotics within the preceding month, 12 (92%) within three months, and 8 (62%) within six months. Candida species were the only fungal species isolated from the dialysate with predominance of non-albicans Candida species (especially Candida parapsilosis). Therapeutic approach was immediate catheter removal, followed by systemic antifungal therapy and temporary haemodialysis. Nine patients (64.3%) were continued on haemodialysis, whereas five patients (35.7%) died. Conclusions: Prior antibiotic use was an important risk factor predisposing patients to the development of fungal peritonitis. Early detection of fungal peritonitis would lead to early institution of appropriate therapy and prevention of complications.

Fast-charging compact seed source for magnetic flux compression generators

Flux compression generators (FCGs) are some of the most attractive sources of single-use compact pulsed power available today due to their high energy density output and mobility. Driving FCGs requires some seed energy, which is typically provided by applying a high seed current, usually in the kiloampere range for midsized helical FCGs. This initial current is supplied by a high-current seed source that is capable of driving an inductive load. High-current seed sources have typically been comprised of discharging large capacitors using spark gaps and overvoltage triggering mechanisms to provide the prime power for FCGs. This paper will discuss a recent design of a self-contained (battery powered with full charge time less than 40 s), single-use compact seed source (CSS) using solid-state components for the switching scheme. The CSS developed is a system (0.005 m(3) volume and weighing 3.9 kg) capable of delivering over 360 J ( approximately 12 kA) into a 5.20 muH load with a trigger energy of microjoules at the TTL triggering level. The newly designed solid-state switching scheme of the CSS incorporates off-the-shelf high-voltage semiconductor components that minimize system cost and size as necessary for a single-use application. A detailed evaluation of the CSS is presented primarily focusing on the switching mechanics and experimental characterization of the solid-state components used in the system.

New concept of schistosomiasis lesions of urinary bladder versus development of bladder cancer

Schistosomiasis haematobium precancerous lesions of urinary bladder included group 1: preneo-plastic non papillary (flat) lesions [reactive atypia, flat hyperplasia, keratinizing squamous metaplasia, glandular metaplasia, dysplasia, carcinoma in-situ (CIS)] and group 2 preneoplastic papillary lesions (typical papillary hyperplasia, atypical papillary hyperplasia, papilloma). The present work studied the content of the schistosomiasis precancerous lesions of the urinary bladder using image analyzer, thereby shedding more light on the significance on the early diagnosis of the high risky group. A total of 140 previously diagnosed schistosomiasis urinary bladder lesions (124 precancerous and 16 cancers as controls) were stained by H & E, and Feulgen stain. The mean SPF was high in CIS (22.7), dysplasia (19.6) & low in atypia (7.91). DNA ploidy, non-diploidy DNA was high in CIS (53%), papilloma, dysplasia and atypical papillary hyperplasia than flat hyperplasia, glandular metaplasia, keratinizing squamous metaplasia and typical papillary hyperplasia that were diploid indicating more tendency and aggressiveness of the first group to turn malignant than the second group.

Pain relief following thoracoscopic sympathectomy for palmar hyperhidrosis: a prospective randomised double-blind study

BACKGROUND

Acute pain management following thoracoscopic sympathectomy (TS) has been described in the literature. The combination of interpleural (IP) injection of bupivacaine and intramuscular injection. (I.M) NSAIDs has not been reported. Therefore we conducted this randomized controlled trial to compare this technique to other reported techniques described for postoperative analgesia following TS.

METHODS

40 patients scheduled to have TS under general anesthesia for the treatment of hyperhidrosis were randomly allocated into 4 groups. Group 1 received 1.5 mg/kg b.w I.M pethidine at end of surgery. Group 2 received ketoprofen 100 mg I.M at end of surgery. Group 3 received 0.4 ml/kg b.w interpleural bupivacaine 0.5%. Group 4 received a combination of I.M ketoprofen (100 mg) in addition to interpleural bupivacaine (0.4 ml/kg). Postoperative pain was assessed using the 11- point numeric rating score (NRS) at 7 different intervals. First, immediately on admission to PACU, every 2 hours for the next 8 hours then at 12 and at 24 hours. Pain was assessed at rest, during deep inspiration and while coughing. ANOVA was used for statistical analysis and Chi-square test for comparing of the data where P values <0.05 were considered significant.

RESULTS

The NRS at rest was 3.2 (1.9), 2.4 (1.6), 3 (1.9) and 0.7 (0.9) at Groups 1, 2, 3 and 4 respectively with significant difference in Group 4 versus other Group (P < 0.05) at 2 hours postoperatively and up to 24 hours postoperatively. The same trend was also found during maximal inspiration and while coughing. Opioid consumption in 24 hours was significantly reduced in Group 4 compared to other Groups.

CONCLUSIONS

Combination of IP bupivacaine and I.M ketoprofen provided superior analgesia when compared to each modality alone and was better than intramuscular pethidine injection in terms of NRS and the consumption of rescue morphine postoperatively. Further studies are needed on large sample size to confirm our results.

Study of stability of methotrexate in acidic solution Spectrofluorimetric determination of methotrexate in pharmaceutical preparations through acid-catalyzed degradation reaction

Study of the degradation reaction of methotrexate (MTX) in acidic solution was carried out. Optimization of the experimental parameters of MTX acid hydrolysis was investigated. Spectrofluorimetric method for determination of MTX through measurement of its acid-degradation product, 4-amino-4-deoxy-10-methylpteroic acid (AMP), was developed. Stability of the standard solution of MTX prepared in sulfuric acid was discussed in the view of accelerated stability analysis. Two other comparative spectroflourimetric methods based on measuring the fluorescence intensities from either a condensation reaction with acetylacetone-formaldehyde (Hantzsch reaction) or a reaction with fluorescamine were also described. Beer's law validation, accuracy, precision, limits of detection, limits of quantification, and other aspects of analytical merit are presented in the text. The proposed methods were successfully applied for the analysis of MTX in pure drug and tablets dosage form. The sensitivity of the developed methods was favorable, so it was possible to be adopted for determination of MTX in plasma samples for routine use in high-dose MTX therapy.

Simultaneous spectrofluorimetric determination of thiamin, pyridoxine and riboflavin in pharmaceutical multivitamin preparations

Independent spectrofluorimetric methods have been described for the assay of thiamin, pyridoxine and riboflavin in combination. Thiamin determination is based on the spectrofluorimetric measurements of thiochrome formed by the oxidation with N-bromosuccinimide (N-BS) in isopropanol. The method proved to be a stability indicating method. Pyridoxine and riboflavin are estimated by measuring their independent fluorescence in buffer solution pH = 7. The methods are highly specific and can be performed without prior extraction or separation of the individual vitamins. The sensitivity ranges are 1.5-3.5, 0.5-2.5 and 0.4-2.0 micrograms X ml-1 for thiamine, pyridoxine and riboflavin respectively.

Intellectual differences of adult men related to age and physical fitness before and after an exercise program

Fluid and crystalized intelligence differences among high-fit, young; high-fit, old; low-fit, young, and low-fit, old groups were investigated before and after an exercise program. The high-fit group had higher fluid intelligence than the low-fit group. Likewise, the young group scored higher than the old group. The four groups scored higher at the posttest on two of the fluid intelligence subtests of the Cattell Culture. Fair Intelligence Test. No differences were observed on crystallized intelligence. It is uncertain how biological factors and psychological changes, either individually or in combination, produce differences in cognitive functioning due to physical fitness.