Polycyclic aromatic hydrocarbons (PAHs) in vegetables and fruits produced in Saudi Arabia

Popular varieties of vegetables were collected from major cities of Saudi Arabia and analyzed for polycyclic aromatic hydrocarbons (PAH) contents. Eight important PAH congeners were analyzed. Total PAH contents of the root vegetables like potato and carrot showed higher values (11 μg kg(-1)), whereas turnip showed relatively lower contents at 9.26 μg kg(-1). For the fruit vegetables, all the peels were found to be more contaminated than cores. For leafy vegetables, maximum PAH level was shown by cabbage (8.34 μg kg(-1)), which turned out to be more than any of the cores of fruit vegetables. Among individual PAH congeners, anthracene showed higher levels in all vegetables. For benzo(a)anthracene, maximum concentration (2.21 ± 1.75 μg kg(-1)) was encountered in turnip cores. Highest benzo(e)pyrene concentration was found in potato (2.90 ± 1.10 μg kg(-1)) followed by turnip (2.10 ± 1.09 μg kg(-1)). Benzo(b)fluoranthene and benzo(k)fluoranthene showed relatively lower levels in all samples studied. Human exposure to PAH by consumption of these vegetables is estimated, by using typical Saudi intake rates. The study revealed that cumulative dietary exposure of Saudi population to PAHs ranges from 0.20 to 0.85 μg p(-1) d(-1).

A case with unilateral hypoglossal nerve injury in branchial cyst surgery

An 11 years old boy came, with complain of mild dysarthria. Examination revealed marked hemiatrophy of left side of the tongue. Five months back he underwent ipsilateral branchial cyst operation. To our knowledge, no case was reported. After branchial cyst operation if there is any residual remnant chance of recurrence is very high.

Bedside teaching in undergraduate medical education: issues, strategies, and new models for better preparation of new generation doctors

Bedside teaching is a vital component of medical education. It is applicable to any situation where teaching is imparted in the presence of patients. In teaching in the patients' presence, learners have the opportunities to use all of their senses and learn the humanistic aspect of medicine such as role modeling, which is vital but difficult to communicate in words. Unfortunately, bedside teaching has been on the decline. To investigate the reasons for the decline in bedside teaching, its importance and its revival, a review of literature was carried out using PubMed and other data bases. The review revealed that the major concerns of bedside teaching were time constraint, false preceptors' concern about patients' comfort, short stay of patients in hospitals, learner distraction by technology, lack of experience and unrealistic faculty expectation. Whatsoever the reasons, bedside teaching cannot be replaced with anything else. There are newer approaches of effective bedside teaching, and the core focus of all such approaches is educational process. A bedside teacher must learn how to involve patients and learners in the educational processes. Moreover, bedside teaching is the process through which learners acquire the skills of communication by asking patients' permission, establishing ground rules, setting time limit, introducing the team, diagnosing learner, diagnosing patient, conducting focused teaching, using simple language, asking patient if there is any question, closing with encouraging thanks, and giving feedback privately. It is most important to ensure a comfortable environment for all participants, the learner, the patient and the bedside teacher. Ongoing faculty development programs on educational processes and realistic faculty expectations may overcome the problems.

Anti-vascular endothelial growth factor agents for diabetic maculopathy

The management of diabetic macular oedema is changing. The therapeutic armamentarium for diabetic macular oedema (DMO) includes a new group of drugs that inhibit vascular endothelial growth factor (VEGF). These anti-VEGF agents are already being used widely in DMO in clinical practice despite that several phase III trials on these drugs are still underway. There are no established protocols on the use of these agents in DMO, but short-term results are appealing. This review provides an update on the use of anti-VEGF agents in DMO. Although intravitreal delivery of anti-VEGF agents is a relatively safe procedure, the long-term local and systemic effects of these agents in the diabetic population remain unknown. In this regard, this review also highlights the need for close surveillance of the use of these drugs in this high-risk population.

Trends in hepatitis B virus infection among blood donors in Kelantan, Malaysia: a retrospective study

The objective of this study was to determine the prevalence and trends in hepatitis B infection among blood donors attending the Transfusion Medicine Unit at the Hospital Universiti Sains Malaysia, Kelantan, Malaysia. A retrospective study was carried out by reviewing the results of HBsAg among blood donors for the years 2000 to 2004. During this period, 44,658 blood donors were studied. We noted that there was a significant difference in the prevalence of hepatitis B infection between regular and first time donors. There was also a decreasing trend noticed in both study groups. The mean prevalence was significantly different between first time (1.83%) and regular donors (0.45%) (p < 0.005). There is a need to improve public awareness programs to lower the incidence of hepatitis B infection in the general population and consequently first time blood donors. Future studies are also required to determine the trends and outcomes of these programs.

High risk of sensitization after failed islet transplantation

Human Leukocyte Antigen (HLA) antibodies posttransplant have been associated with an increased risk of early graft failure in kidney transplants. Whether this also applies to islet transplantation is not clear. To achieve insulin independence after islet transplants multiple donor infusions may be required. Hence, islet transplant recipients are at risk of sensitization after transplantation. Islet transplant recipients were screened for HLA antibodies posttransplant by flow-based methods. A total of 98 patients were studied. Twenty-nine patients (31%) developed de novo donor specific antibodies (DSA) posttransplant. Twenty-three patients developed DSA while on immunosuppression (IS). Among recipients who have discontinued IS, 10/14 (71%) are broadly sensitized with panel reactive antibody (PRA) >or=50%. The risk of becoming broadly sensitized after transplant was 11/69 (16%) if the recipient was unsensitized prior to transplant. The majority of these antibodies have persisted over time. Appearance of HLA antibodies posttransplant is concerning, and the incidence rises abruptly in subjects weaned completely from IS. This may negatively impact the ability of these individuals to undergo further islet, pancreas or kidney transplantation and should be discussed upfront during evaluation of candidates for islet transplantation.

Pretransplant HLA antibodies are associated with reduced graft survival after clinical islet transplantation

Despite significant improvements in islet transplantation, long-term graft function is still not optimal. It is likely that both immune and nonimmune factors are involved in the deterioration of islet function over time. Historically, the pretransplant T-cell crossmatch and antibody screening were done by anti-human globulin--complement-dependent cytotoxicity (AHG-CDC). Class II antibodies were not evaluated. In 2003, we introduced solid-phase antibody screening using flow-based beads and flow crossmatching. We were interested to know whether pretransplant human leukocyte antigen (HLA) antibodies or a positive flow crossmatch impacted islet function post-transplant. A total of 152 islet transplants was performed in 81 patients. Islet function was determined by a positive C-peptide. Results were analyzed by procedure. Class I and class II panel reactive antibody (PRA) > 15% and donor-specific antibodies (DSA) were associated with a reduced C-peptide survival (p<0.0001 and p<0.0001, respectively). A positive T- and or B-cell crossmatch alone was not. Pretransplant HLA antibodies detectable by flow beads are associated with reduced graft survival. This suggests that the sirolimus and low-dose tacrolimus-based immunosuppression may not control the alloimmune response in this presensitized population and individuals with a PRA > 15% may require more aggressive inductive and maintenance immunosuppression, or represent a group that may not benefit from islet transplantation.

Enhancing the success of human islet isolation through optimization and characterization of pancreas dissociation enzyme

A major obstacle to successful human islet isolation has been the variability of the enzymatic digestion phase. The aim of this study was to define optimal enzyme activity ranges normalized by the pancreas weight and to identify valid parameters for the optimal selection of successful lots of collagenase enzyme blends. Our results from 251 islet isolations showed that optimization of thermolysin dosage based on Caseinase unit/g pancreas contributed considerably to islet isolation outcome but that collagenase dosage measured by the manufacturer (Wünsch unit/g pancreas) was not a major determinant of islet isolation outcome. We also found that lot-to-lot inconsistency of enzyme performance was not explained by the activity values provided by the manufacturer, but rather by an in-house assay of class I collagenase (CI) and class II collagenase (CII); using a lot with a lower CII/CI resulted in a higher success rate. The odds of successful isolation was 8.67 times higher when a vial with CII/CI ratio <0.204 was used than when a vial with CII/CI >or=0.204 was used, suggesting that CII/CI ratio may be a strong predictor to distinguish potential lot success. This study provides a framework for improved enzymatic digestion in human islet isolation.

Aposthia: a birth defect or normal quantitative recessive human genetic trait?

Aposthia (natural circumcision) is the condition of being born without a prepuce. Usually sporadic cases are reported in the medical literature. In this paper for the first time we present the genetic profile of 3 families with aposthia trait and discuss the possible genetics.

Unilateral Hydrocephalus Due to Foramen of Monro Stenosis

Unilateral lateral ventricular dilatation due to foramen of Monro stenosis or constriction can present with headache. Fundoscopy can be normal. This condition is congenital, radiological appraisal can disclose the diagnosis, and treatment depends upon the symptomatology. The condition can be treated well with insertion of a ventriculoperitoneal shunt.

The incidence and severity of injury in children hospitalised for traumatic brain injury in Kashmir

A large number of people experience traumatic brain injury each year, often with severe consequences. This is a public health problem that requires ongoing surveillance to follow trends in the incidence, risk factors, causes, and outcomes of these injuries. In 2003, a prospective study of all children below 15 years admitted to hospitals with a diagnosis of head injury was conducted in the Accident & Emergency Department of Sher-e-Kashmir Institute of Medical Sciences, Srinagar (India) to determine the incidence and severity of accidental head injury among children and the circumstances of injury. The highest incidence of head injury was seen at ages 6-10 years. Head injury rates were higher in males than in females. The leading causes include falls and motor vehicle accidents. More than 50% falls occurred in the age group of 4-6 years. Ninety per cent patients, who recovered, were discharged within 16-24 h after admission. Lack of supervision, non-implementation of safety measures and poor implementation of traffic rules leads to many injuries. The ability of the health care system to deal with increasing trauma in Jammu & Kashmir is limited. Nevertheless, prevention can be low cost strategy to overcome this problem. The results of epidemiological studies are affected by factors like demography, geographic region and socioeconomic status. This study emphasizes the need for intensified effort for prevention, minimising risk factors, strict legislative measures, observing traffic rules, implementation of safety measures, establishing appropriate trauma care at district level, adult supervision, and creating awareness.

On the effect of a radiation field in modifying the intermolecular interaction between two chiral molecules

The change in the mutual energy of interaction between a pair of chiral molecules coupled via the exchange of a single virtual photon and in the presence of an electromagnetic field is calculated using nonrelativistic quantum electrodynamics. The particular viewpoint adopted is one that has an intuitive physical appeal and resembles a classical treatment. It involves the coupling of electric and magnetic dipole moments induced at each center by the incident radiation field to the resonant dipole-dipole interaction tensor. The energy shift is evaluated for fixed as well as random orientations of the molecular pair with respect to the direction of propagation of the field. A complete polarization analysis is carried out for the former situation by examining the effect of incident radiation that is linearly or circularly polarized and traveling in a direction that is parallel or perpendicular to the intermolecular distance vector. After tumble averaging, all polarization dependence of the energy shift vanishes. In both cases the interaction energy is directly proportional to the irradiance of the applied field, and is discriminatory, changing sign when one optically active species is replaced by its enantiomer. The asymptotic behavior of the energy shift at the limits of large and small separations is also studied.

Does the circadian pattern for acute cardiac events presentation vary with fasting?

BACKGROUND

Over one billion Muslims fast worldwide during the month of Ramadan. The impact of fasting on circadian presentation with acute cardiac events is unknown.

AIM

To determine if fasting has any effect on the circadian presentation of acute cardiac events.

SETTING AND DESIGN

A prospective study in a general hospital.

MATERIALS AND METHODS

Patients with acute coronary events were divided into two groups based on the history of fasting. Information about age, gender, cardiovascular risk factor profiles and outcome was collected. The relationship of time of presentation of initial symptoms with fasting was evaluated using Student's t-test, Mann-Whitney U-test and chi2 analysis.

RESULTS

Of the 1019 patients hospitalized during the study period, 162 were fasting. Although, fasting patients were more likely to present to the emergency department in the time periods 5-6 AM (10.5% vs 6.3%) and 11 PM (11.1% vs 7.1%) and were less likely to present in the time periods 1-2 PM (3.7% vs 7.2%) and 5-6 PM (3.7% vs 7.0%); these differences were not statistically significant. Fasting patients were less likely to have their symptoms start between 5 and 8 AM (11.1% vs 19.4%) and more likely to have symptoms between 5 and 6 PM (11.1% vs 6.0%) and 3 and 4 AM (11.1% vs 6.9%). These differences for time of initial symptoms were statistically significant (P=0.002).

CONCLUSION

Exogenous factors associated with fasting, namely, the changes in food intake and/or sleep timings, affect the circadian rhythm and influence the timing of presentation of acute coronary events.

Spousal Abuse Against Women and Its Consequences on Reproductive Health: A Study in the Urban Slums in Bangladesh

OBJECTIVES

Spousal violence is common and results in costly problems both for society and for the reproductive health of women. Despite the recognition that violence may be associated with serious consequences for women's reproductive health, our understanding of the relationship between the two remains limited. In this study, we assessed the association between spousal violence and women's reproductive health.

METHODS

Data from an interviewer-administered questionnaire assessing socioeconomic, demographic, behavioral profiles, and spousal violence-related information was collected from 496 women. Subjects were chosen from eight randomly selected urban slums from four metropolitan cities.

RESULTS

Spousal violence was significantly higher amongst the group of less educated women who had been in several marriages; indicating that the social and behavioral traits of women act as catalysts for spousal violence. Abusive husbands also had been married several times and were more likely to be addicted to alcohol or drugs. This demonstrates that the behavioral traits of husbands were also responsible for spousal violence. Spousal violence injuries adversely affect the health and well-being of women. More than three-quarters of physically violated women suffered injuries as a result of this violence. About 50% of these injuries were minor and about 10% serious. Sexual violence adversely affected women's health; more than 80% of sexually violated women complained of pelvic pain, more than 50% reported reproductive tract infections, and more than 50% reported symptoms of irritable bowel syndrome. Abused women suffered from gynecological problems at the time of pregnancy significantly more than non-abused women (p<0.05) and abused women suffered from reproductive tract infections significantly more than non-abused women (p<0.01). Abusive husbands suffered from sexually transmitted diseases (STD) significantly more than non-abusive husbands (p<0.05). Abused women used contraception significantly less than non-abused women (p<0.01). Logistic regression analysis suggested that spousal violence was the most important contributing factor for reproductive health problems in women.

CONCLUSIONS

The findings of this study may enhance our understanding of the impact of spousal violence against women and their reproductive health and therefore highlight the importance of spousal violence prevention measures. Increasing the awareness and understanding of the relationship between violence against women and reproductive health could be achieved if lawyers, researchers, clinicians, practitioners, and government workers from multiple disciplines and agencies worked together.