Assessment of eating habits, lifestyle and physical activity among medical and dental students of Faisalabad Medical University

Objective

To assess the eating habits, lifestyle and physical activity and their impact on health of students of Faisalabad Medical University (FMU) Faisalabad Pakistan.

Methods

A descriptive cross-sectional study was prepared on 328 medical and dental students at Faisalabad Medical University from June, 2022 to October, 2022. Three Factor Eating Questionnaire Revised 21 (TFEQ-R21) was used to assess the eating habits among medical students and physical activity was assessed using the International Physical Activity Questionnaire (IPAQ) short version. A self-constructed questionnaire was used to assess lifestyle patterns.

Results

According to the study, 191(58.2%) students out of 328 practiced unrestricted eating. While 229(69.8%) students demonstrated cognitive restraint and 128(39%) students indulged in emotional eating. Less than half of the students, 52(15.9%) lead unhealthy lifestyles compared to 276(84.1%) who had healthy habits. Out of 328 students, 104 (31.7%) engaged in low, 137(41.8%) in moderate, and 87(26.5%) in high levels of physical activity. Whereas a higher proportion of female students engaged in low to moderate physical activity (61.5% and 52.6%, respectively), while a higher proportion of male students (63.2%) were involved in intense physical activity.

Conclusions

A large proportion of medical students exhibited poor dietary habits with low physical activity. Obesity and other metabolic diseases are more likely to strike medical students who engage in these unhealthy eating habits. As future health providers, health interventions must be implemented to avert future harm.

High-dose pulse methylprednisolone vs. dexamethasone standard therapy for severe and critical COVID-19 pneumonia: Efficacy assessment in a retrospective single-centre experience from Malaysia

INTRODUCTION

The use of dexamethasone (DXM) has been associated with decreased mortality in the patients with hypoxemia during the coronavirus disease-2019 (COVID-19) pandemic, while the outcomes with methylprednisolone (MTP) have been mixed. This real-life study aimed to evaluate the outcomes of patients with severe respiratory failure due to COVID-19 who were treated with high doses of MTP.

MATERIALS AND METHODS

This retrospective cohort study enrolled hospitalised patients between May 2021 and August 2021, aged 18 years and above, with severe respiratory failure defined by a ratio of oxygen saturation to fraction of inspired oxygen (SF ratio) of less than 235. The treatment protocol involved administering high-dose MTP for 3 days, followed by DXM, and the outcomes were compared with those of patients who received DXM alone (total treatment duration of 10 days for both groups).

RESULTS

A total of 99 patients were enrolled, with 79 (79.8%) receiving pulse MTP therapy and 20 (20.2%) being treated with DXM only. The SF ratio significantly improved from a mean of 144.49 (±45.16) at baseline to 208 (±85.19) at 72 hours (p < 0.05), with a mean difference of 63.51 (p < 0.001) in patients who received ≤750 mg of MTP. Additionally, in patients who received >750 mg of MTP, the SF ratio improved from a baseline mean of 130.39 (±34.53) to 208.44 (±86.61) at 72 hours (p < 0.05), with a mean difference of 78.05 (p = 0.001). In contrast, patients who received DXM only demonstrated an SF ratio of 132.85 (±44.1) at baseline, which changed minimally to 133.35 (±44.4) at 72 hours (p = 0.33), with a mean difference of 0.50 (p = 0.972). The incidence of nosocomial infection was higher in the MTP group compared with the DXM group (40.5% vs. 35%, p = 0.653), with a relative risk of 1.16 (95% CI: 0.60-2.23).

CONCLUSION

MTP did not demonstrate a significant reduction in intubation or intensive care unit admissions. Although a high dose of MTP improved gas exchange in patients with severe and critical COVID-19, it did not provide an overall mortality benefit compared to standard treatment.

Medical students' knowledge about curriculum development and implementation in public and private medical institutes

Objective

To assess the knowledge of undergraduate medical students about curriculum development and implementation.

Methods

A quantitative descriptive study was conducted at a public sector institute and a private sector institute from September, 2022 to December, 2022. Simple random sampling was used and all the undergraduate MBBS students were included in study. Sample size was calculated using open epi and keeping confidence interval at 95% as 316 for FMU students and 218 for AFMDC students. Ethical approval was taken from FMU and permission to collect data was obtained from AFMDC. A Questionnaire was made and distributed among the students and data obtained was analyzed using SPSS 25.0.

Results

Two hundred and forty-seven (49.4%) participants responded that the students don't have any say in their curriculum, 400 (80%) were of the view that the students must have their opinion in the curriculum and 397 (79.4%) said that students must be involved in the process of planning and implementation of curriculum. When asked about the areas of deficiencies in the current curriculum, 101 (20.2%) pointed new skill, 84 (16.8%) indicated New information, new skills, teaching Methodology and effective teachers, 68 (13.6%) said teaching methodology while 51 (10.2%) indicated new skills and teaching methodology both. Five main themes were identified from the comments of students regarding curriculum, its development and implementation including; 1. Content revision, 2. Teaching methodologies, 3. Assessment, 4. Guidance and orientation and 5. Teacher student relationship.

Conclusion

The undergraduate medical students are aware of the terms related to curriculum, its development and implementation but they are not being involved in any of this process. Content revision, clinical integration from initial years, quality assessment and faculty development are few areas that need improvement from students' perspectives.

Addition of transglutaminase enzyme in camel milk yoghurt to increase its sensorial aspects

Camel milk was obtained from A-block UVAS Ravi Campus Pattoki. After pasteurization at 72 °C (15 sec) it was cooled to 42 °C, then glutathione treated transglutaminase enzyme was added with the concentration of 0.5 g/300 mL, 1 g/300 mL, 1.5 g/300 mL, 2 g/300 mL while control sample with the addition of 1.5 g/300 mL gelatin. Then inoculation of milk was done with standard cultures of Yoghurt Lactobacillus delbrueckii subsp bulgaricus and Streptococcus thermophilus at the rate of 2% for 3-4 hours at 42 °C. Samples were stored at 4 °C and were analyzed on 1st day and 28th day of storage. In our findings, there was slight increase in sensorial properties of all the samples. It was also observed that syneresis was reduced with the increase of enzyme quantity.

Genetic variation between hybrid (Labeo rohita ♂, Cirrhinus mrigala ♀ and Labeo rohita) by RAPD marker

The present work was to study the genetic variability between the major carps Labeo rohita and Cirrhinus mrigala and their hybrids of L. rohita (male♂) and C. mrigala (female♀). Genetic variability was studied by employing RAPD molecular markers. 25 samples of each target species having different sizes with the same age group for the determination of interspecific variation were collected. The morphometric parameters such as body weight, total length, tail length, and lengths of dorsal and anal fins of each individual were recorded and results showed that wet body weight, total length, dorsal fin, anal fin, and tail fin length are positively correlated and then the DNA was extracted using the inorganic salt-based method and conformed by Gel electrophoresis. Twenty-four arbitrary decamer primers were used to get species-specific RAPD analysis Distinct and highly reproducible RAPD profiles with significant genetic variability was detected among species. Only five primers showed amplification. The RAPAD primer OPB-05 produced a total of seven bands out of these 5 monomorphic and 2 polymorphic, so in this case, the percentage polymorphism was 28.57%. The Hybrid show more than a 50% difference from the Labeo rohita. This shows that the Hybrid more resembles C.mrigala. Phylogenetic analysis demonstrated that hybrid (L. rohita ♂ X Cirrhinus mrigala ♀) is the closest to C. mrigala and the farthest from L. rohita. Overall data are presented concerning the applications of RAPD markers for hybrid identification, genetic diversity assessment, and studying taxonomic relationships at a molecular level.

Burnout Among Basic Sciences Faculty; A Mixed Method Research

Objective: To study the burnout and its associated factors among the faculty of basic sciences in Faisalabad. Study Design: Mixed-method research. Place and Duration of Study: Basic sciences faculty of Public and Private Sector Medical Institutes of Faisalabad Pakistan, from Sep to Dec 2021. Methodology: Oldenburg Inventory was used to assess burnout among the faculty of basic medical sciences after taking the authors' permission. SPSS version 23:00 was used to analyze data, and those who had shown a higher level of burnout were interviewed. Recorded interviews were later own transcribed, and thematic analysis was done. Results: The mean exhaustion score for the whole basic sciences faculty was 2.35 ± 0.27, while for disengagement from work, it was 2.24 ± 0.24. Value was 0.62 and 0.144 for exhaustion and disengagement, respectively, showing no difference between the burnout level of faculty members in public and private sectors in both domains. Lack of acknowledgement, Lack of resources, Motivational factors and Lack of progress system were the main themes that emerged after an in-depth exploration of faculty members. Conclusion: The faculty from basic sciences are facing burnout, and the major causes are lack of acknowledgement and appreciation, decreased number of faculty, inadequate resources and ambiguity about future growth in basic sciences. The faculty member advocated the need to develop faculty training, mentoring and post-graduation programmes for the survival and strengthening of basic sciences.

Outcome Of Laparoscopic Percutaneous Extra Peritoneal Closure Versus Open Repair For Paediatric Inguinal Hernia

BACKGROUND

Laparoscopic inguinal hernia repair (LIHR) has many benefits like less frequency of metachronous contralateral hernias, minimum complications, comparatively less duration of operation and better cosmetic outcome as compared to the open technique. Objective of the study was to compare the outcome of laparoscopic percutaneous extra-peritoneal closure (LPEC) and open repair for paediatric inguinal hernia in terms of contralateral metachronous hernia, operative time and recurrence.

METHODS

A randomized controlled trial was conducted at the Department of Paediatric Surgery, Children Hospital Lahore. Non-probability purposive sampling was used, and 296 cases were divided into group-1(managed with conventional open repair) and group-2 (managed with laparoscopic Percutaneous Extra-peritoneal closure). After taking informed consent, data was collected, and cases were studied for operative time, contralateral metachronous hernia and recurrence till 6 months postoperatively. Data analysis was done through SPSS 22.0. Chi-square and independent sample t-test was used for comparison. p-value ≤0.05 was taken as significant.

RESULTS

The mean operative time was statistically less in the LPEC group (24.79±3.44 minutes) when compared to the open repair group (28.71±4.54 minutes), p-value <0.001. In the Open repair group, there were 19 (12.8%) cases that had contralateral metachronous hernia, while in the LEPC group, 2 (1.4%) cases had contralateral metachronous hernia p-value <0.001. In the Open repair group, 4(2.7%) cases had a recurrence, while in LPEC group 1 (0.7%) cases had a recurrence, with statistically same recurrence rate, p-value >0.05.

CONCLUSIONS

The LPEC technique is better than conventional open repair in terms of CMIH, operative time, and recurrence rate.

Preparedness of Medical Graduates to serve in clinical settings independently: An exploratory qualitative study

Objectives:

To assess the preparedness of fresh medical graduates to perform the duties of an effective house officer in clinical settings independently.

Methods:

A qualitative exploratory descriptive study was conducted at a public sector tertiary care teaching hospital from September to October, 2021. A total of 14 interviews of the serving house officers were conducted (7 were from Medicine and Allied and seven were from Surgical and Allied). A verbatim Thematic analysis was done.

Results:

Initial analysis revealed 45 codes which were ultimately reduced to five main themes namely 1. Transition from studentship to house officers with sub-themes (1a) Sense of responsibility, (1b) Hectic and long duty hours, (1c) Proper orientation and guidance, 2. Deficient skill Training during educational journey with, (2a) Deficiency of practical and applied aspects, (2b) inconsistent and varying training patterns, (2c) self-perception and evaluation of preparedness, 3. Lack of awareness about Hospital settings and working system with sub-themes (3a) Support from other doctors, (3b) Being recognized as a doctor in hospital, 4. Inter-professional co-ordination gaps having sub-themes (4a) Communication gap, (4b) Mutual respect as a team and 5. Impact of COVID-19 with sub-theme (5a) Online teaching with no interaction and (5b) segue and progressive skill training.

Conclusion:

Medical graduates are not confident and well prepared to take the responsibility of patient care independently in clinical settings. Reforms in undergraduate curricula regarding skill training, hospital setup and workings and inter-professional education are advocated by young doctors to enhance their competencies for professional life.

Limiting amino acids supplementation in low crude protein diets and their impacts on growth performance and carcass composition in Labeo rohita (rohu) adult fish

Ninety days study was conducted in hapas installed in earthen ponds. Fish of an average initial weight (220g) were evenly distributed in triplicate groups within fifteen hapas. Five experimental diets labeled as T1 (25% CP and NRC recommended amino acid level) as control diet, T2 (with 2% low protein and 5% amino acid supplementation), T3 (with 2% low protein and 10% amino acid supplementation), T4 (with 4% low protein and 10% amino acid supplementation) and T5 (with 4% low protein and 20% amino acid supplementation) were prepared. Fish were fed with @3% of their body weight twice a day at 10.00 & 16:00 hour. Significantly higher percent weight gain (420.18 ± 66.84a) and specific growth rate (13499.33±1273.54a) along with improved feed conversion ratio (1.29 ± 0.09b) and hundred percent survivals were recorded during the trial. Furthermore proximate analysis of meat showed significant improvement in the crude protein level (81.77 ± 0.19a) served with diet containing 20% limiting amino acids mixture. Therefore, limiting amino acids can be a source of cost effective feed and use safely in L. rohita diet.

Resuming elective hip and knee arthroplasty in the COVID-19 era: a unique insight into patient risk aversion and sentiment

INTRODUCTION

There has been guidance from the government and orthopaedic community on how best to ensure the safety of our patients and colleagues as we recommence elective surgery in the UK. The primary aim was to determine what proportion of patients feel they should proceed with their elective hip and knee arthroplasty surgery during the COVID-19 climate. The secondary aim was to investigate what variables affected this decision.

METHODS

Patient information from a single surgeon's waiting list in a district general hospital were recorded. A standardised telephone discussion was had with all the patients noting the severity of pain and the potential reasons for not wanting to proceed with surgery.

RESULTS

A total of 70.6% (96/136) of patients wished to proceed with surgery; 29.4% (40/136) did not wish to proceed. The decision to proceed with surgery was not correlated with sex, American Society of Anesthesiologists grade or COVID-19 risk. Those who wished to proceed with surgery had a mean age of 68.5 years while those who did not had a mean age of 72.4 years (P = 0.03). Within the matched subgroups, patients under the age of 70 years were more willing to proceed with primary hip arthroplasty surgery (87.9%) compared with primary knee arthroplasty surgery (57.1%; P = 0.007); 75% of the patients who did not wish to proceed with surgery expressed concerns about perioperative COVID-19 infection.

CONCLUSION

There is a significant proportion of arthroplasty patients on waiting lists who would be willing to accept the increased risks associated with COVID-19 to undergo surgery on an urgent basis. The subgroup of younger patients awaiting hip arthroplasty is more willing than those awaiting knee arthroplasty to proceed with surgery.

Students' perception about assessment environment of University of Lahore - Dental School: A cross-sectional survey

OBJECTIVE

To evaluate the perception of undergraduate dentistry medical students about the assessment environment at their institution.

METHODS

The cross-sectional descriptive study was conducted at the University of Lahore, Lahore, Pakistan, from April 2017 to September 2017, and comprised undergraduate dentistry medical students who were asked to complete the Assessment Environment Questionnaire. Students' individual perception scores were calculated and the means of both individual domain and global score were compared in terms of different academic years. SPSS 20 was used for statistical analysis.

RESULTS

Of the100 subjects, 50(50%) each were from 1st year and 2nd year. Overall, the students perceived their assessment environment positive yielding a global mean score of 49.84}10.84 out of the maximum 80. Second year students scored significantly higher compared to first year students in all domains except feedback mechanism (p=0.0017), learning and performance (p=0.0014), information on assessment (p=0.0064), and total mean score of 53.5}8.24 compared to 46.12}11.7 (p=0.0004).

CONCLUSIONS

The students' perception of the assessment environment was more positive than negative.

Learning to cure with care: awareness of faculty and medical students about student's roles related to patient safety

OBJECTIVE

To explore the awareness of faculty and medical students about students' roles with respect to patient safety and to define the domains that should be made a part of undergraduate curriculum.

METHODS

The descriptive exploratory qualitative research was conducted from December 2016 to March 2017 at Islamic International Medical College, Rawalpindi, Pakistan, and comprised faculty members and final year medical students. World Health Organisation patient safety curriculum guideline for undergraduate medical schools was taken as the reference. Initially 12 codes for faculty and 18 for students were formed which were later reduced to 6 themes: importance of patient safety education; importance of strong student-patient relationship; code of conduct; students and effective team; students' part in management plans; and students and medical errors. Sub themes were also defined. Thematic narrative analysis was done using Atlas ti software.

RESULTS

Of the 30 participants, 12(40%) were faculty members and 18(60%) were students. All (100%) the participants were of the view that patient safety is an important issue, especially for the future doctors and young professionals. All (100%) the participants were aware of the importance of a strong and trustworthy relationship between the patients and doctors. All (100%) the participants suggested that the students must follow proper code of conduct when they come to the wards. The participants advocated the need of establishing a system and culture where students can go and report an error comfortably. The participants identified defective communication to be one of the leading causes of medical errors.

CONCLUSIONS

The need to bring reforms in medical curriculum with respect to patient safety was stressed.

Measuring empathy of medical students studying different curricula; a causal comparative study

OBJECTIVE

To determine the difference in empathy level of undergraduate medical students studying two different curricula.

METHODS

This cross-sectional study was conducted at Independent Medical College of Faisalabad and Islamic International Medical Collegeof Islamabad, both in Pakistan, from July to September 2016. The two medical colleges had two different types of curriculum systems; the integrated modular system and the discipline-based curriculum. The Toronto empathy questionnaire was used to calculate empathy scores. The responses were scored between 0 and 64 by taking sum of all the 16 questions. T-test was used to compare the mean scores and empathy levels between the two groups. SPSS 20 was used for data analysis.

RESULTS

Of the 160 students, there were 80(50%) belonging to each institute. In the integrated modular system, 44(55%) students were females, whereas in the discipline-based system 45(56%) students were males. Students enrolled in the integrated modular system had a higher mean empathy score than students in the discipline-based system (44.2±6.59 versus 39.7±6.54, p<0.001).

CONCLUSIONS

Interventions during the educational journey about empathy had positive influence on students' personalities and their future practices.

Cancer-related knowledge, attitudes, and risk perception among 6 grade students in Jordan

Elementary schools in Jordan have included health education material in curricula to promote healthy lifestyles among younger school children. However, the relation between healthy lifestyles and the prevention of chronic diseases such as cancer has not been an explicit component in school curricula of younger age groups. We sought to explore the level of knowledge among 6th grade students as well as their attitudes with respect to cancer. This comes as part of a pilot project to develop an educational series on cancer prevention that aims to meet knowledge gaps specific to the community of students in this age group in Jordan.

METHODS

A questionnaire composed of items measuring knowledge about cancer and cancer prevention through healthy practices, attitudes towards cancer, and intentions to engage in healthy behaviors was developed. Questionnaires previously used in similar age groups elsewhere were used as a reference. Our questionnaire was reviewed and approved by the Ministry of Education - School Health &amp; Nutrition Department. Sixth graders in a convenience sample of four schools selected by the Ministry of Education completed the self-administered questionnaire.

RESULTS

Ninety-six 6th graders from four schools answered the baseline survey, but 28% of the surveys were excluded from the analysis (data quality problems) leaving 69 student participants. In the original sample of 96 students, 48 (69.6%) were girls. Among the 69 student participants, 67 (97.1%) had heard of cancer, but fewer than 44 (63.8% knew it was not a contagious disease. Regarding fear, 29 (42%) would not play with a cancer patient. Concerning prevention of the most prevalent cancers in Jordan as research has shown that certain risk factors increase the chance that a person will develop cancer. The most common risk factors are smoking, Poor diet, lack of physical activity, or being overweight, 25 (36.2%) knew breast cancer was preventable, and 28 (40.6%) and 24 (34.8%) knew this regarding lung and colorectal cancers, respectively. About 40 (57.8%) students identified healthy dietary behaviors (e.g., low fat, low sugar), but only six could identify the ideal frequency for exercise (60 minutes daily). Fifty-eight (84.1%) agreed that cigarettes harmed the health. However, only 21 (30.4%) found it easy to avoid exposure to secondhand smoke. Nine (13%) reported smoking water pipes, but only one reported smoking cigarettes. Forty-eight (69.6%) and 47 (68.1%) agreed that daily physical activity and healthy eating were important, respectively. Fifty-two (75.4%) students found it easy to eat healthy at home, but only 37 (53.6%) found it easy to do so at school. Finally, 63 (91.3%) students wanted to learn more about cancer.

CONCLUSION

Although a significant number of our sample of students has heard about cancer and students exhibit some knowledge regarding healthy practices, our results show that knowledge gaps exist with regard to the nature of cancer as a noncontagious disease, the preventability of specific cancers, and the link between specific risk factors and cancer.

Role of the calcarine cortex (V1) in perception of visual cues for saccades

OBJECTIVE

To determine the initial level at which the pathways for cue perception, saccades and antisaccades diverge.

METHODS

Two procedures: single pulse transcranial magnetic stimulation (sTMS) over posterior occiput and backward masking were used. A visual cue directed saccades to the left or right, either a pro-saccade (to the side of the cue but beyond it) or an antisaccade, i.e., contraversive saccade. No visual target was presented.

RESULTS

Latencies of the two types of saccades did not differ. Focal sTMS applied unilaterally over V1 suppressed both perception of a cue flashed 80-90ms earlier contralaterally (but not ipsilaterally) and the appropriate saccade. Masking at a delay of 100ms abolished the appropriate saccade and cue perception.

CONCLUSIONS

V1 is essential for the perception of a flashed cue and for executing appropriate pro- and contraversive saccades. Masking may occur beyond V1, where the pathways for perception and for saccades at least to the next visual processing level start separating.

SIGNIFICANCE

VI is needed for rapid, accurate perceptual and motor responses to the crudest (left versus right) cues. It is unlikely that the "where" system can have a major direct input bypassing V1.

Comparing the depositional architecture of basin floor fans and slope fans in the Pab Sandstone, Maastrichtian, Pakistan

Basin-floor fans and slope fans present major differences in their internal architecture related to changes in: (1) margin morphology, (2) relative sea-level change, and (3) sediment supply. These variations are illustrated in the outcrops of the Pab Sandstone in Pakistan. The Pab Sandstone third-order sequence was deposited on the Indo-Pakistani margin during the Upper Maastrichtian. Uplift of the margin induced erosion on the shelf, incision of submarine canyons on the slope and the development of a sand-rich, high-efficiency basin-floor fan extending over hundreds of kilometres on the basin floor. During transgression, sediment accumulated in backstepping shoreface deposits on the shelf, and a minor mud-rich slope fan was deposited in the basin. Finally, a sand-rich braided delta prograded across the shelf, feeding a sand-rich slope fan where it reached the shelf margin. This slope fan was of more limited lateral extent. The Lower Pab basin-floor fan shows the effects of flow funnelling and confinement due to a canyon incised into the slope. It consists mainly of channel complexes deposited by superconcentrated density flows to low-density turbidity currents. In contrast, the Upper Pab slope fan shows little confinement and low transport efficiency. It consists of tabular lobes, aggrading mid-fan channels and conglomeratic channels in the upper fan. The low transport efficiency of the gravity flows probably explains the low degree of organization of the slope fan.

Mitochondrial K(ATP) channel as an end effector of cardioprotection during late preconditioning: triggering role of nitric oxide

Nitric oxide (NO) has been implicated in the "second-window" of ischemic preconditioning (PC). However, the identity of the end effector after initiation of preconditioning by NO is not known. It is likely that NO is involved in opening of mitochondrial ATP-sensitive potassium (mitoK(ATP)) channels. We hypothesized that NO is an important trigger for the opening of mitoK(ATP) channels in the late phase of preconditioning and inducible nitric oxide synthase (iNOS) up-regulation via NF kappa B plays a critical role in diazoxide-induced cardioprotection. To examine this, diazoxide (7 mg/kg) was administered to wild-type (WT) mice and mice lacking the gene 24 hours before 40 minutes of global ischemia. Hearts were perfused in a Langendorff mode and effects of activation of mitoK(ATP) channel and other interventions on functional, biochemical and pathological changes in ischemic hearts were assessed. In hearts from WT mice treated diazoxide, left-ventricular-developed pressure, end-diastolic pressure and coronary flow were significantly improved after ischemia/reperfusion (I/R); lactate dehydrogenase (LDH) release was also significantly decreased, while ATP contents were significantly higher. Administration of 5-HD, a specific blocker of mitoK(ATP) channel or l -NAME, an inhibitor of iNOS before I/R, during diazoxide-pretreatment completely blocked the late cardioprotection against ischemia. Late cardioprotection was also blocked by inhibition of either PKC- delta by rottlerin or NF kappa B by DDTC before diazoxide pretreatment. Diazoxide pretreatment significantly increased nuclear translocation of p65 which was blocked by protein kinase C (PKC) or nitric oxide synthase (NOS) inhibition. Diazoxide was totally inefffective in iNOS knockout mice. These results suggest that diazoxide activates NF kappa B via PKC signaling pathway and that leads to iNOS up-regulation after 24 hours. NO which is generated upon ischemic stress triggers the opening of mitoK(ATP)channel as an end effector of cardioprotection during late PC.

Mitochondrial K(ATP) channel activation reduces anoxic injury by restoring mitochondrial membrane potential

Mitochondrial membrane potential (DeltaPsi(m)) is severely compromised in the myocardium after ischemia-reperfusion and triggers apoptotic events leading to cell demise. This study tests the hypothesis that mitochondrial ATP-sensitive K(+) (mitoK(ATP)) channel activation prevents the collapse of DeltaPsi(m) in myocytes during anoxia-reoxygenation (A-R) and is responsible for cell protection via inhibition of apoptosis. After 3-h anoxia and 2-h reoxygenation, the cultured myocytes underwent extensive damage, as evidenced by decreased cell viability, compromised membrane permeability, increased apoptosis, and decreased ATP concentration. Mitochondria in A-R myocytes were swollen and fuzzy as shown after staining with Mito Tracker Orange CMTMRos and in an electron microscope and exhibited a collapsed DeltaPsi(m), as monitored by 5,5',6,6'-tetrachloro-1,1',3,3'-tetraethylbenzimidazolcarbocyanine iodide (JC-1). Cytochrome c was released from mitochondria into the cytosol as demonstrated by cytochrome c immunostaining. Activation of mitoK(ATP) channel with diazoxide (100 micromol/l) resulted in a significant protection against mitochondrial damage, ATP depletion, cytochrome c loss, and stabilized DeltaPsi(m). This protection was blocked by 5-hydroxydecanoate (500 micromol/l), a mitoK(ATP) channel-selective inhibitor, but not by HMR-1098 (30 micromol/l), a putative sarcolemmal K(ATP) channel-selective inhibitor. Dissipation of DeltaPsi(m) also leads to opening of mitochondrial permeability transition pore, which was prevented by cyclosporin A. The data support the hypothesis that A-R disrupts DeltaPsi(m) and induces apoptosis, which are prevented by the activation of the mitoK(ATP) channel. This further emphasizes the therapeutic significance of mitoK(ATP) channel agonists in the prevention of ischemia-reperfusion cell injury.

Downregulation of protein kinase C inhibits activation of mitochondrial K(ATP) channels by diazoxide

BACKGROUND

The mitochondrial K(ATP) (mitoK(ATP)) channel has been shown to confer short- and long-term cardioprotection against prolonged ischemia via protein kinase C (PKC) signaling pathways. However, the exact association between PKC or its isoforms and mitoK(ATP) channels has not yet been clarified. The present study tested the hypothesis that the activity and translocation of PKC to the mitochondria are important for cardiac protection elicited by mitoK(ATP) channels. Methods and Results-PKC was downregulated by prolonged (24-hour) treatment with phorbol 12-myristate 13-acetate (4 microgram/kg body weight) before subsequent experiments in rats. Langendorff-perfused rat hearts were subjected to 40 minutes of ischemia followed by 30 minutes of reperfusion. Effects of PKC downregulation on the activation of mitoK(ATP) channels and other interventions on hemodynamic, biochemical, and pathological changes were assessed. Subcellular localization of PKC isoforms by Western blot analysis and immunocytochemistry demonstrated that PKC-alpha and PKC-delta were translocated to the sarcolemma and that PKC-delta was translocated to the mitochondria after diazoxide treatment. In hearts treated with diazoxide (80 micromol/L), a significant improvement in cardiac function and an attenuation of cell injury were observed. In PKC-downregulated hearts, protection was abolished because mitoK(ATP) channels could not be activated by diazoxide.

CONCLUSIONS

These data suggest that PKC activation is required for the opening of mitoK(ATP) channels during protection against ischemia and that this effect is linked to isoform-specific translocation of PKC-delta to the mitochondria.

Calcium preconditioning inhibits mitochondrial permeability transition and apoptosis

We tested the hypothesis whether calcium preconditioning (CPC) reduces reoxygenation injury by inhibiting mitochondrial permeability transition (MPT). Cultured myocytes were preconditioned by a brief exposure to 1.5 mM calcium (CPC) and subjected to 3 h of anoxia followed by 2 h of reoxygenation (A-R). Myocytes were also treated with 0.2 microM/l cyclosporin A (CsA), an inhibitor of MPT, before A-R. A significant increase of viable cells and reduced lactate dehydrogenase release was observed both in CPC- and CsA-treated myocytes compared with the A-R group. Cytochrome c release was predominantly observed in the cytoplasm of myocytes in the A-R group in contrast with CPC- or CsA-treated groups, where it was restricted only to mitochondria. Similarly, the cell death by apoptosis was also markedly attenuated in these groups. Electron-dense Ca(2+) deposits in mitochondria were also less frequent. Atractyloside (20 microM/l), an adenine nucleotide translocase inhibitor, caused changes similar to those in the A-R group, suggesting a role of MPT in A-R injury. Protection by inhibition of MPT by CsA and CPC suggests that MPT plays an important role in reoxygenation/reperfusion injury. The data further suggest that preconditioning inhibits MPT by inhibiting Ca(2+) accumulation by mitochondria.

Low serum paraoxonase: a risk factor for atherosclerotic disease?

Serum paraoxonase (PON1) hydrolyses organophosphate (OP) insecticides and nerve gases and is responsible for determining the selective toxicity of these compounds in mammals. PON1 has two genetic polymorphisms giving rise to amino acid substitutions at position 55 and 192. The 192 polymorphism is the major determinant of the PON1 activity polymorphism towards organophosphates. However, the 55 polymorphism also modulates activity. PON1 also may be a determinant of resistance to the development of atherosclerosis by protecting lipoproteins against oxidative modification perhaps by hydrolysing phospholipid-hydroperoxides. The PON1 polymorphisms are important in determining the capacity of high-density lipoprotein (HDL) to protect low-density lipoprotein (LDL) against oxidative modification in vitro and this may explain the relationship between the PON1 alleles and coronary heart disease in case-control studies.

Serum paraoxonase after myocardial infarction

HDL has been shown to prevent the oxidative modification of LDL. The antioxidant activity of HDL is believed to reside in its enzymes, particularly paraoxonase. Human serum paraoxonase (PON1) is closely associated with a specific HDL subfraction also containing apoA1 and clusterin. Recently PON1 has been implicated in the pathogenesis of atherosclerosis. We have examined the activity, concentration, and specific activity of PON1 in 50 patients on admission to hospital immediately after acute myocardial infarction (MI) and in 48 age- and gender-matched controls. Serum PON1 activity and concentration were significantly lower in patients with MI than in controls (activity, 221.5 [99.3 to 303.2] nmol. min-1. mL-1 in controls and 130.1 [78.9 to 230.3] nmol. min-1. mL-1 in MI patients [P<0.05]; concentration, 95.7 [73.2 to 135.5] microg/mL in controls and 35.4 [21.6 to 51.3] microg/mL in MI patients [P<0.001]). PON1-specific activity was significantly higher in patients with MI than in controls (1.5 [0.9 to 2.9] versus 3.4 [2.0 to 8.5] nmol. min-1. microg-1 [P<0.001]) due to the much lower PON1 concentration. PON1 activity had risen significantly (P<0.05) to 158.1 (85.4 to 282.0) nmol. min-1. mL-1 at day 42 but was still significantly less than that of controls. No significant variation in PON1 concentration occured in the days after MI or at 6 weeks. Also, no significant variation in specific activity was seen after MI. When the patients were divided into subgroups based on whether or not they received thrombolytic therapy on admission to hospital, no significant difference in PON1 levels was observed. Serum HDL cholesterol in patients with MI on admission was not significantly different than in controls, and the decrease that occurred by the fifth day after MI did not explain the lower PON1 levels. We conclude that low serum PON1 activity in patients with MI may be a consequence of the coronary event itself or could have been present before MI. The low PON1 activity was also not explicable on the basis of PON1 genotypes because the prevalence of genotypes associated with low activity was not sufficient to explain fully the difference in activity levels between patients and controls. The explanation for the low PON1 activity was most likely a decrease in serum PON1 concentration. The importance of PON1 as a predictive risk factor for MI should be assessed in future studies.

Idiopathic chronic active hepatitis: a diagnostic and therapeutic dilemma

A 56-year-old Saudi male was admitted with abnormal liver chemistry values and a > 5-month history of lethargy, malaise, anorexia, and jaundice. Extensive investigations did not establish an etiological diagnosis. Liver histology confirmed the clinically apparent aggressive hepatitis with fibrosis but gave no clue to its etiology. The patient was empirically treated with alpha-interferon for presumed non-A, non-B hepatitis, with clinical and biochemical worsening. Interferon was discontinued and the patient was started on immunosuppression. Dramatic clinical and biochemical improvement occurred, with normalization of the liver chemistry within 4 weeks. The patient has been followed-up for 12 months and has not suffered a relapse. This case highlights the etiological heterogeneity of chronic active hepatitis. The entity of autoimmune chronic active hepatitis is unclear, and perhaps it is better defined as steroid-responsive hepatitis. Steroid-responsive hepatitis should always be considered in cases of cryptogenic chronic active hepatitis.

Histologically advanced chronic hepatitis C treated with recombinant alpha-interferon: a randomized placebo-controlled double-blind cross-over study

Chronic hepatitis C is common in Saudi Arabia and most often presents in an advanced stage. To assess the response of patients to interferon, a randomized placebo-controlled double-blind study was undertaken. All but 1 patient had cirrhosis or fibrosis before interferon. After a 24-week observation period patients received alpha 2a interferon, 3 mega units sc tiw or placebo for 24 weeks, then the opposite treatment for another 24 weeks followed by 24 weeks of observation. Liver biopsies were performed before and after each of the treatment phases. Twenty-two out of 24 patients completed the study. The mean alanine aminotransferase (ALT) levels fell from 150.7 +/- 118.7 units/l to 91.0 +/- 42.6 units/l after 6 months interferon treatment (P = 0.03) but only 3 patients (14%) had complete normalization of mean ALT levels and 4 (18%) had > 50% reduction. The mean hepatitis activity index fell from 12.2 +/- 2.6 immediately before to 11.6 +/- 2.5 just after interferon (P = 0.4). After interferon there was an insignificant raise in 6-month mean ALT. Hepatitis C virus-RNA was positive in all 17 patients tested and remained so after treatment. Side-effects were mild and well tolerated. Alpha interferon 3 mega units tiw for 24 weeks is not an effective treatment of histologically advanced chronic hepatitis C.

Anti-Brucella activity of Ro 23-9424, a dual-action antibacterial

The in vitro activity of dual-acting antibacterial Ro 23-9424 was determined by the agar dilution method against 126 clinical isolates of Brucella melitensis. It was compared with fleroxacin, ciprofloxacin and five conventional drugs. MIC50 and MIC90 for Ro 23-9424 were 1.0 and 4.0 mg/l, respectively, as compared with 0.25 and 0.5 mg/l for fleroxacin and ciprofloxacin. One strain which was resistant to other fluoroquinolones, with an MIC of > 8.0 mg/l, did not show cross-resistance to Ro 23-9424 and had an MIC of 4.0 mg/l. All the strains were susceptible to conventional drugs like gentamicin, streptomycin rifampicin, tetracycline and trimethoprim-sulfamethoxazole, with MICs ranging between 0.12 and 2.0 mg/l. Ro 23-9424 did not exhibit in vitro synergy with any of the conventional drugs.

Susceptibility of Salmonella typhi and Brucella melitensis to the new fluoroquinolone rufloxacin (MF 934)

The antimicrobial activity of the new fluoroquinolone rufloxacin (MF 934) was evaluated by a standardized agar dilution method against recent clinical isolates of Salmonella typhi (67 strains) and Brucella melitensis (108 isolates). The results were compared with 5 other commercially available or investigational fluoroquinolones. All the isolates of S. typhi were inhibited by 1.0 mg/l of rufloxacin as compared to 4-8 mg/l for B. melitensis. Minimum inhibitory concentrations of rufloxacin against both S. typhi and B. melitensis were 4-16 times higher than those of other fluoroquinolones.

Brucella peritonitis

We report the case of a patient with peritonitis caused by Brucella melitensis who also had chronic liver disease. At first the patient was treated for bacterial peritonitis but when a lymphocytic ascites was aspirated antituberculosis chemotherapy was given. However, the serological tests for brucellosis were strongly positive and subsequently B. melitensis was isolated from ascitic fluid.

Chronic non-A, non-B hepatitis complicated by end-stage renal failure treated with recombinant interferon alpha

Chronic non-A, non-B hepatitis occurs in 50% of Saudi patients with end-stage renal failure and requires long-term hemodialysis since it is a contraindication to renal transplantation. Thirteen patients with biochemical and histological documented chronic non-A, non-B hepatitis (11 with HCV antibodies) entered a double-blind placebo controlled cross-over study, in which Roferon A 3 MU or placebo were administered subcutaneously 3 times weekly after hemodialysis for 6 months. The mean ALT fell significantly from pretreatment levels of 74.7 (95% confidence interval (CI) 54.7, 92.5) (13 patients in the 6-month run-in period) and 66.8 (CI 47.7, 85.8) (7 patients in the run-in period + 6 patients in the placebo period) (difference NS) to 37.6 (CI 21.0, 54.2) during interferon treatment (P < 0.005). In 10/13 patients (77%) ALT levels became normal. In the 6-month follow-up period immediately after therapy, the mean ALT was 45.2 (CI 28.0, 62.0). Although this change was not significant (P = 0.49), only 7 of these 10 patients sustained biochemical remission in the 6-month follow-up period. The corresponding total Histological Activity Index improved from 8.9 (CI 7.5, 10.3), 8.9 (CI 7.2, 10.7) (difference NS) to 6.2 (CI 3.9, 8.5) (P < 0.05; P = 0.052, respectively). Intralobular inflammation and periportal inflammation showed the most significant changes. Five of 13 (39%) and 2/13 patients (15%) had complete resolution of piecemeal necrosis and intralobular inflammation, respectively. Toxic effects of interferon were mild, early and self-limiting.(ABSTRACT TRUNCATED AT 250 WORDS)

Primary hepatic vipoma

A 35-yr-old male presented with a 3-yr history of voluminous watery diarrhea. He had episodes of severe generalized weakness which responded to fluid and electrolyte replacement therapy. Investigations revealed a solitary liver mass and an elevated vasoactive intestinal polypeptide level. An extensive work-up did not show any other extrahepatic primary lesion. Surgical resection ameliorated all of his symptoms, accompanied by a decrease in the vasoactive intestinal polypeptide level. We believe that this patient represents a case of primary hepatic vipoma syndrome. To our present knowledge, this has not been reported previously. We discuss the clinical manifestations, investigations, and management of the case.

Comparative in vitro activity of Ro 09-1428, a novel cephalosporin with a catechol moiety

The in vitro activity of Ro 09-1428, a new parenteral cephalosporin, was compared with that of other beta-lactams and aminoglycosides in 1230 clinical isolates from 1028 consecutive patients. Using an agar dilution method, the drugs were tested against 625 isolates of Enterobacteriaceae, 68 Pseudomonas aeruginosa, 36 Xanthomonas maltophilia, 20 Aeromonas hydrophila, 54 Acinetobacter, 373 staphylococci, and 54 strains of enterococci. More than 98% of Enterobacteriaceae were susceptible to Ro 09-1428, with a minimal inhibitory concentration of less than 0.03 to 4.0 micrograms/ml. Ro 09-1428 also inhibited 99% and 72% of the clinical isolates of P aeruginosa and X maltophilia, respectively. All isolates of methicillin-susceptible Staphylococcus aureus (MSSA) were susceptible to this cephalosporin. However, only 46% of the 54 strains of enterococci exhibited in vitro susceptibility. Ro 09-1428 was found to be superior or comparable to most penicillins, cephalosporins, and aminoglycosides against both gram-negative bacteria and MSSA.

Encephalopathy following jejunoileostomy

A neurological syndrome characterized by episodes of confusion, slurred speech, and unsteadiness is described in patients who have undergone jejunoileostomy for obesity. This syndrome has been noted in seven of 110 patients studied, although it may be more common. It appears to subside spontaneously or may respond to oral food restriction, with or without intravenous fluid plus vitamins and minerals. Episodes tend to recur in a given patient. Reversible changes in the EEG have been observed. Pertinent clinical and laboratory findings are described but no definite etiologic factor has been identified. The possible mechanisms involved in this syndrome of metabolic encephalopathy following jejunoileostomy are discussed.

Gallstones, obesity, and jejunoileostomy

An attempt has been made to identify the causes of increased cholesterol gallstone formation in obese patients both before and following jejunoileostomy. The prime lithogenic mechanism in obesity seems to be increased cholesterol mobilization and excretion in the bile. In jejunoileal bypass, a host of factors, including possible limited bile salt synthesis, increased bile salt loss, and bacterial alteration of bile acids, along with the effects of rapid weight loss, may play a role. The identification and understanding of these factors will be important if attempts at prevention by administratin of antibiotics to reduce bacterial overgrowth, or by giving chenodeoxycholic or ursodeoxycholic acid to replenish the diminished bile acid pools, are to be carried out.