Donor Gender Balance in a Living-Related Kidney Transplantation Program in Oman

It has been observed in several Eastern and Western countries that there is a gender imbalance among kidney donors. In the international experience, approximately 65% of live kidney donors have been women. We retrospectively studied the distribution of female and male donors or recipients among living kidney transplantations performed from 1980 to 2005, namely 198 Omani recipients of living-related kidney transplantations. To examine cultural influences, transplantations performed or expatriates were excluded from the study. For the whole period, 98 out of 198 donors (49.5%) were women. The number of female recipients 75 of 198 (38%) versus males were 123 (62%) recipients. We then subdivided the period into three intervals: 1980 to 1990, 1991 to 2000, and 2001 to 2005. The numbers of female donors for these three periods were 29 of 64 (45%), 42 of 89 (47%), and 27 of 45 (60%), respectively. There was a persistent preponderance of male recipients ranging from 58% to 66% during these periods. We concluded that there was no gender imbalance for kidney donors. Nevertheless, there was a male preponderance in the recipient group.

Complete Regression of Cutaneous B-Cell Lymphoma in a Renal Transplant Patient After Conversion From Cyclosporin to Sirolimus

Posttransplant lymphoproliferative disease remains a serious morbidity. Herein we have reported a case of complete regression of a biopsy-proven B-cell lymphoma that occurred in the posttransplant period. A 48-year-old man received a living donor renal transplant for end-stage renal disease due to undetermined etiology. His initial immunosuppression consisted of corticosteroid, mycophenolate mofetil, and cyclosporin. The patient developed severe pneumonia within the first 2 months after transplantation due to Acineotobacter, fungus, and cytomegalovirus infections. He experienced a complete recovery and was discharged for regional follow-up. Four months after discharge, he was referred again because of presence of two nodules on his trunk. A biopsy of the nodules revealed B-cell lymphoma. Cyclosporin was stopped and he was converted to sirolimus. The lesions regressed progressively and completely within 7 weeks. The patient remains well without clinical relapses at 19 months after conversion. Renal functions remained stable. We postulated that the antincoplastic properties of sirolimus may have played an active part in the positive outcome.

An anatomical comparison of Blair and facelift incisions for parotid surgery

BACKGROUND

The rhytidectomy approach for parotidectomy allows the incision to be hidden, and post-operative scarring minimised. Furthermore, separate elevation of the Superficial Musculo-Aponeurotic System (SMAS) reduces the incidence of Frey's syndrome, and provides vascularized soft tissue for contour reconstruction. The technique has gained popularity particularly with plastic surgeons, but concerns persist that with this approach, particularly with lesions located anteriorly, access to the gland may be inadequate, and facial nerve identification may be compromised.

MATERIALS AND METHODS

We undertook an anatomical study to quantitatively compare the surgical access achieved using the facelift approach with the conventional Blair incision, by comparing the distances between the parotid edge and the retracted flaps.

RESULTS

Despite reduced tissue elasticity due to formaldehyde fixation, it proved possible to demonstrate all regions of the parotid gland to the operating surgeon with either approach. There were no significant differences in the distance between the parotid edge and the retracted skin flaps (P > 0.1; paired t-test).

CONCLUSIONS

The facelift approach provides at least equal access to all regions of the parotid gland when compared to a Blair's incision. It is a superior approach aesthetically and its more widespread use in parotid surgery is advocated.

An approach to the management of paroxysmal laryngospasm

OBJECTIVE

To review the presentation, risk factors and management of paroxysmal laryngospasm.

STUDY DESIGN

Retrospective review of cases.

SETTING

A teaching hospital otolaryngology department with a subspecialty interest in airway disorders.

PATIENTS

All patients diagnosed with laryngospasm over a two-year period were reviewed. Information was obtained about disease presentation, risk factors, management and symptom resolution.

RESULTS

Laryngospasm was diagnosed in nine women and six men. The average age at presentation was 56+/-6.5 years, and there was an 80 per cent association with gastroesophageal reflux disease. Proton pump inhibitors led to complete symptom resolution in six patients and to partial symptomatic relief, requiring no further treatment, in a further four patients. Of the remaining five patients unresponsive to proton pump inhibitor therapy, two continued to experience syncopal episodes due to laryngospasm. Both these patients achieved complete remission after laryngeal botulinum toxin injection. Symptoms recurred after three to four months and were successfully treated with a repeat injection.

CONCLUSIONS

The primary risk factor for spontaneous laryngospasm is laryngopharyngeal reflux. Symptoms are distressing and may be relieved in most cases by treatment aimed at suppressing gastric acid secretion. Laryngeal botulinum toxin injection appears to be a viable treatment modality in selected patients with refractory symptoms.

Amodiaquine and artemether-lumefantrine select distinct alleles of the Plasmodium falciparum mdr1 gene in Tanzanian children treated for uncomplicated malaria

The artemisinin-based combination therapies artemether-lumefantrine (AL) and amodiaquine (AQ) plus artesunate have been adopted for treatment of Plasmodium falciparum malaria in many African countries. Molecular markers of parasite resistance suitable for surveillance have not been established for any of the component drugs in either of these combinations. We assessed P. falciparum mdr1 (Pfmdr1) alleles present in 300 Tanzanian children presenting with uncomplicated falciparum malaria, who were enrolled in a clinical trial of antimalarial therapy. Pfmdr1 genotype analysis was also performed with isolates from 182 children who failed AQ monotherapy and 54 children who failed AL treatment. Pfmdr1 alleles 86Y, 184Y, and 1246Y were more common among treatment failures in the AQ group than among pretreatment infections. The converse was found in the AL-treated group. Children presenting with the 86Y/184Y/1246Y Pfmdr1 haplotype and treated with AQ were significantly more likely to retain this haplotype if they were parasite positive during posttreatment follow-up than were children treated with AL (odds ratio, 33.25; 95% confidence interval, 4.17 to 1441; P, <0.001). We conclude that AL and AQ exert opposite within-host selective effects on the Pfmdr1 gene of P. falciparum.

Outcome of Imported Liver Allografts and Impact on Patient Access to Liver Transplantation

Liver allografts declined by local transplant centers are then offered regionally or nationally as imported grafts. Most of these grafts are declined because of poor donor quality. We retrospectively reviewed the medical records of patients who underwent liver transplantation between January 2004 and December 2005. There were 102 liver transplants in 98 recipients. They were divided into two groups: imported graft recipients (n = 37) and locally procured grafts recipients (n = 61). Eighty-six percent (32 of 37) of imported grafts were obtained from extended criteria donors defined as subjects treated with high doses of ionotropes with elevated liver enzymes, donor age over 70 years, macrosteatosis above 25%, positive hepatitis C or hepatitis B core antibody serology, systemic disease, history of cancer, hypernatremia, or with infection. The remaining grafts were declined due to unavailability of suitable recipients or social history. Recipient age and etiology of liver disease were similar for both groups. The mean MELD score was 22.1 +/- .9 among the imported graft recipients and 26.1 +/- 1 for the locally procured graft recipients (P < .01). There was no difference in blood loss or postoperative complications. Postoperative mean peak total bilirubin was similar in both groups. However, imported graft recipients had significantly higher mean peak AST (2436 +/- 282 vs 1380 +/- 165 U/L, P < .001) and ALT (1098 +/- 114 vs 803 +/- 87 U/L, P < .05). Primary graft nonfunction as well as 30 day and 1-year patient and graft survivals were similar for both groups. In conclusion, imported grafts can be transplanted in selected patients with outcomes comparable to locally procured grafts.

Development knowledge and experience--from Bangladesh to Afghanistan and beyond

PROBLEM

In Afghanistan the challenges of development are daunting, mainly as a result of many years of conflict. The formation of a new government in 2001 paved the way for new initiatives from within and outside the country. BRAC (formerly Bangladesh Rural Advancement Committee), a Bangladeshi nongovernmental organization with a long history of successful work, extended its development model to Afghanistan in 2002.

LOCAL SETTING

Provincial Afghanistan.

APPROACH

BRAC has implemented programmes in Afghanistan in the areas of health, education, microfinance, women's empowerment, agriculture, capacity development and local government strengthening, and has taken many of these programmes to scale.

RELEVANT CHANGES

With a total staff of over 3000 (94% Afghan and the rest Bangladeshis), BRAC now works in 21 of the country's 34 provinces. BRAC runs 629 non-formal primary schools with 18 155 students, mostly girls. In health, BRAC has trained 3589 community workers who work at the village level in preventive and curative care. BRAC runs the largest microfinance programme in the country with 97 130 borrowers who cumulatively borrowed over US$ 28 million with a repayment rate of 98%.

LESSONS LEARNED

Initial research indicates significant improvement in access to health care. Over three years, much has been achieved and learned. This paper summarizes these experiences and concludes that collaboration between developing countries can work, with fine-tuning to suit local contexts and traditions.

A bifid intra-tympanic facial nerve in association with a normal stapes

A rare facial nerve anomaly was incidentally discovered whilst performing a tympanoplasty and ossicular reconstruction on a patient with an acquired unilateral conductive hearing loss. The nerve was seen to bifurcate and straddle a normal stapes superstructure as it ran posteriorly through the middle ear, a unique and as yet unreported combination. This case highlights the importance of vigilance regarding facial nerve anatomical variations encountered during middle-ear surgery thus avoiding inadvertent damage. The purported embryological mechanism responsible for such anomalies of the intra-tympanic facial nerve is discussed.

A technique for tracking intravascular fluorescent microspheres for the determination of arteriolar blood flow in rats

Fluorescent microspheres have been used in multiple particle tracking studies. Our laboratory is working towards the use of fluorescent microsphere particle tracking in the study of the retinal circulation. The first stage of this project was to develop a technique for measurement and analysis of the particle tracking data. We intravenously injected 2.0 microm diameter, polystyrene microspheres, labeled with fluorescent dye, in anesthetized rats. Using a microscope with a fluorescence attachment, we viewed the fluorescent particles flowing through the surface vessels of the intestine. Data was recorded then analyzed frame by frame. The path of each microsphere was plotted on a transparency sheet and measured. Using a magnification ratio, the velocity and blood flow rate were calculated for 235 particles in five different blood vessels. We found this technique to be an effective method for studying blood flow in an arteriole. The results were comparable to other blood flow studies and showed characteristic trends of typical laminar blood flow.

Airway obstruction: a rare complication of thrombolytic therapy

Bleeding into head and neck structures as a complication of thrombolysis is extremely rare but potentially lethal. It is usually associated with local trauma. We describe a case of a 67-year-old woman who developed spontaneous, massive pan aerodigestive tract haemorrhage precipitating airway obstruction following administration of streptokinase for myocardial infarction; a previously unreported complication. This case highlights the importance of being vigilant of airway symptoms following such treatment, prompting early involvement of anaesthetic and otolaryngology personnel.

Drug resistance of Mycobacterium tuberculosis in selected urban and rural areas in Bangladesh

The magnitude of anti-tuberculosis drug resistance in Bangladesh is not precisely known. We studied the drug resistance patterns of Mycobacterium tuberculosis in an urban and a rural area of Bangladesh. A tuberculosis (TB) surveillance system has been set up in a population of 106,000 in rural Matlab and in a TB clinic in urban Dhaka. Trained field workers interviewed all persons > or =15 y at Matlab to detect suspected cases of tuberculosis (cough >21 d) and sputum samples were examined for acid-fast bacilli (AFB). The first 3 AFB positive patients daily from the urban clinic were included. AFB positive cases diagnosed between June 2001 and June 2003 from both settings were cultured and drug susceptibility tests were performed. Of 657 isolates, resistance to 1 or more drugs was observed in 48.4% of isolates. Resistance to streptomycin, isoniazid, ethambutol and rifampicin was observed in 45.2%, 14.2%, 7.9% and 6.4% of isolates, respectively. Multidrug resistance was observed in 5.5% of isolates. It was significantly higher among persons who previously had received tuberculosis treatment of > or =1 month (15.4% vs 3.0%, adjusted OR: 6.12, 95% CI: 3.03-12.34). The magnitude of anti-tuberculosis drug resistance in Bangladesh is high. Further evaluation is needed to explain the high proportion of streptomycin resistant M. tuberculosis. Appropriate measures to control and prevent drug resistant tuberculosis in Bangladesh to reduce mortality and transmission are warranted.

Selective protein adsorption on micro-textured P-type and N-type silicon wafers

There has recently been a great deal of effort put towards the development of bioMEMS-based electrochemical biosensors for use in implantable devices. Currently, the primary issue limiting the lifespan of implantable sensors is protein and cell adhesion (biofouling) to the sensor surface, which impedes the sensor's access to analyte. To better understand this problem, it would be useful to have an understanding of how silicon-based microdevices interact with proteins in a physiological environment. To help answer this question, we investigated the interactions of proteins with microtextured silicon wafers. Bulk micromachining techniques were used to create micro-textures that varied between 5 and 80 microns in size nd spacing. We used n-type and p-type silicon wafers with a <100> crystal orientation. Shapes such as rectangles, circles, and triangles were fabricated that were recessed into the silicon substrate. The features were estimated to be between 3 and 8 microns in depth. After the features were created, the wafers were coated with a layer of silicon dioxide. Once fabrication was complete, the wafers were incubated in vitro ith fluorescently tagged Albumin (500 microg/ml in Phosphate-Buffered Saline, PBS) for 5 minutes. The wafers were then rinsed with PBS solution and viewed using an epifluorescence microscope. Albumin adsorbed selectively onto the micropatterned wafers. Depending on the type of wafer we found that albumin adsorbed selectively onto either the bulk surface, the sidewalls, or the bottom of the etched feature.

Gender difference in treatment seeking behaviors of tuberculosis cases in rural communities of Bangladesh

This descriptive cross-sectional study was conducted to investigate gender differences in the epidemiological factors associated with the treatment seeking behaviors of TB cases in the rural communities of Bangladesh. The study reveals that there is significant gender difference in treatment seeking behaviors of rural TB cases and the majority of them (52%) have taken prior treatment from various traditional healers, 70% of them are females who attended health centers (UZHCs) as the other choice (adjusted OR: 4.2, 95% CI: 2.0-8.4). It was found that the mean patient delay was 63 days (range 14-210 days) where half of the females delayed more than 60 days while they were spreading their disease. The study findings reveal gender differences in treatment seeking behaviors associated with socio-cultural barriers, particularly among females in their access to TB care. Fifty-five percent of cases wanted the diagnosis of TB remain confidential to avoid being labeled as TB patients, where 82.7% were female, 85.6% of female TB patients had problems in their relationships with their spouse (61%) and family members (58%) after being diagnosed with TB. The results of the TB service factors found that 39% of females were not satisfied with their provider's behaviors, which was significantly associated with treatment seeking behavior (adjusted OR: 2.6, 95% CI: 1.0-6.6). The study findings strongly suggest that there was a significant gender difference in treatment seeking behavior in rural Bangladesh. Based on the study findings, we recommend developing an appropriate gender strategy for developing a TB control program, comprised of operational, socio-cultural and community awareness interventions aimed at treating undiscovered reservoirs of female TB cases in rural Bangladesh.

Design and testing of a fluorescence glucose sensor which incorporates a bioinductive material

One main hurdle in the development of implantable biosensors is that their lifetime is limited by scar tissue formation around the implant. One way to ameliorate this issue would be to use a bioinductive coating to allow normal tissue ingrowth around the sensor. Here, we report design, development and in vitro testing of a prototype fluorescence-based glucose sensor that incorporates a bioinductive material at its tip. Glucose is sensed via a fluorescence-based assay system (Amplex reagent) which is confined to a small chamber separated from the bulk glucose solution by a semipermeable membrane. Excitation is provided by a 530 nm laser, while the emitted light is detected by a photomultiplier tube. In vitro testing of this prototype was done in the presence and absence of a bioinductive material covering the membrane at the sensor/solution interface. In response to a step change in glucose concentration, the output of the sensor increased linearly over time due to accumulation of fluorescent marker molecules as glucose diffused into the recording chamber. The slope of this response increased linearly with increasing glucose concentration, with a sensitivity if 2.1 x 10(-4) V/min per ml glucose/dl solution. The presence of the bioinductive layer did not alter the function of the sensor at the lowest glucose concentrations tested, although responses to higher concentrations saturated, presumably because of depletion of the Amplex reagent within the chamber. In summary, we report that the use of a bioinductive material in an implantable biosensor does not appreciably alter sensor function.

Identification of serogroups of beta hemolytic streptococci in children with tonsillo-pharyngitis

Rheumatic fever and post streptococcal glomerulonephritis are common sequelae of beta hemolytic streptococci among Bangladeshi children. The occurrence of these serious complications of beta hemolytic streptococcal throat infections are related to the epidemiology of group A beta hemolytic streptococci. Little is known about the epidemiology of beta hemolytic streptococci in Bangladesh. We have studied 6890 school boys and girls of Narayangonj to find out the prevalence of beta hemolytic streptococcal infections of throat. From them we selected 2175 children, who were suffering from tonsillo-pharyngitis. This cross sectional study was conducted during March-December 1999. All statistical analysis was done by using statistical package SPSS windows version 8. The mean (SD) age of the children was 11.1 (3.3) years. Four hundred and twenty eight isolates of beta hemolytic streptococci were recovered from tonsillo-pharyngeal swab cultures obtained from 428 children. Among the isolated beta hemolytic streptococci, 92 (21.5%) belonged to group A, 5 (1.2%) to group B, 14 (3.3%) to group C and 317 (74.0%) to group G. These findings demonstrated the predominance of group G followed by A infection among school children. Therefore special attention should be paid not only to group A but also to group G. Further studies to determine prevalence of M serotypes are necessary.

Antioxidant vitamins improves hemoglobin level in children with group a beta hemolytic streptococcal infection

A study was done on school children infected with group A beta hemolytic streptococci to examine whether antioxidant vitamins play a role in improving the hemoglobin level. A total of 606 primary school children aged 5 to 15 years were randomly divided into two intervention groups. Group 1 (n=299) was treated with pehnoxymethyl penicillin V and group 2 (n=307) was treated with phenoxymethyl penicillin V plus antioxidant vitamins for eight weeks. From each group two blood samples were drawn in acute and convalescent (after eight weeks) states. Before treatment, mean hemoglobin values were 11.0 and 10.8 mg/dL in groups 1 and 2 respectively. After treatment hemoglobin values were 10.5 and 11.6 mg/dL respectively. Values were significantly decreased in group 1 (P=0.0001), whereas increased in group 2 (P=0.001). Adjustment for age and sex by ANCOVA confirmed the difference in hemoglobin levels between group (LS means-0.5 vs 0.8 in groups 1 and 2 respectively (P=0.0001). Hemoglobin level increases after antioxidant vitamin supplementation in children suffering from group A beta hemolytic streptococcal infection.

Do weak adapting backgrounds uncover multiple components in the electroretinogram of the horseshoe crab?

The lateral eye of the horseshoe crab, Limulus polyphemus, has been used as a model system for over a century to study visual and circadian processes. One advantage of this system is the relative simplicity of the retina. The input pathway of the retina consists of photoreceptor cells that are electrically coupled to the dendrite of a second-order cell, which sends action potentials to the brain. Electroretinograms (ERGs) recorded from the lateral eye show a biphasic shape, with a leading negative wave and a later positive peak. The purpose of these experiments was to determine whether adapting backgrounds could be used to uncover multiple adaptation mechanisms within the ERG. To test this idea, ERGs were elicited using variable intensity flashes presented under dark-adapted conditions, as well as in the presence of weak adapting backgrounds. Flashes and backgrounds were generated using green LEDs (lambda max = 525 nm) under software control. ERGs were recorded using a corneal wick electrode placed on the lateral eye of the horseshoe crab. Preliminary results suggest that ERGs recorded in the presence of adapting backgrounds are linearly scaled versions of dark-adapted FRGs. This suggests that there is a single adaptation stage in the Limulus retina. This is in contrast with analogous results from mammals, including mouse, cat and monkey, which show multiple stages of adaptation within their more complex retinas.

Effect of high-hydrostatic pressure and temperature on rheological characteristics of glycomacropeptide

The influences of high pressure and temperature on the rheological characteristics of glycomacropeptide (GMP) were studied using a controlled rate rheometer. GMP dispersions at a concentration of 12.5% (w/w) were subjected to high pressure from 100 to 400 MPa for 30 min and temperature from 20 to 80 degrees C for 15 min followed by rheological measurements at a shear rate ranged between 0 and 200 s-1. Shear stress-shear rate data of both pressure and heat induced GMP samples fitted Herschel-Bulkley model well with yield stress. It exhibited shear-thinning behavior with flow behavior index ranged between 0.882 and 0.996. Consistency coefficient and apparent viscosity increased with pressure up to 300 MPa while those parameters decreased at 400 MPa. The rheology of GMP was influenced by temperature. The consistency coefficient and apparent viscosity at 100 s-1 obeyed the Arrhenius relationship with activation energies ranged between 8.17 to 12.38 kJ/mol. Lower activation energy signified lesser molecular aggregation or unfolding of protein molecules during thermal treatment of GMP.