Key comorbidities and laboratory findings: insights from first prospective, observational and Multi-Center Malaysia Heart Failure (MYHF) registry

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Novartis Corporation Sdn Bhd

Background

In real world settings, factors that may affect prognosis of HF patients include comorbidities, lack of guideline-directed medical therapies (GDMT) and laboratory findings in particular elevated cardiac biomarkers.

Purpose

This report aimed to provide insights into these important clinical characteristics in hospitalized HF patients.

Methods

MYHF registry is a prospective, observational study of symptomatic HF patients (NYHA II-IV) hospitalized in 18 tertiary care centers in Malaysia over a period of 3 years starting in 2019. The key comorbidities, GDMT and natriuretic peptides (NP) utilization in hospitalized HF patients enrolled in MYHF Registry will be analyzed.

Results

A total of 2,717 patients, mean age 60.17 years (SD 13.62) and predominantly males (66.8%) were recruited. Mean left ventricular ejection fraction (LVEF) was 36.5% (SD 15.3); with 64.6% HFrEF (LVEF ≤40%), 21.6% HFpEF (LVEF ≥50%) and 11.3% HFmrEF (LVEF 41-49%). Hypertension was the most common comorbidity (71.5%), followed by diabetes (59.8%), ischemic heart disease (55.9%), dyslipidemia (46.6%) and chronic kidney disease (30.9%). At admission, mean SBP was 137.6 mmHg (SD 29), with 5.9% and 42.6% of patients with SBP < 100 mmHg and ≥ 140 mmHg, respectively. Mean HbA1c value was 7.56% (SD 2.0). Mean total cholesterol and LDL-C were 4.30 mmol/L (SD 1.66) and 2.62 mmol/L (SD 1.34), respectively. At admission, mean serum creatinine was 145.76 umol/L (SD 119.64) and 1 out of 2 patients (55.1%) had eGFR <60 mL/min/1.73 m2. Utilization of natriuretic peptide as biomarker was low (16.5%), with NTproBNP being more commonly used (81.5%). Half (49.2%) of patients with NT-proBNP measured had values >=5000 pg/ml. Hospitalization has been known to provide good opportunity for GDMT optimization. Although about two third (59.2%) of patients in this registry had previous history of heart failure hospitalization, only 33.7% of patients were on dual GDMT (ACEi/ARB/ARNI +BB) and 1 out of 10 (13.5%) were on triple GDMT (ACEi/ARB/ARNI+BB+MRA) during admission.

Conclusions

Hospitalized HF patients in MYHF registry are generally young, with high prevalence of co-morbidities, worse laboratory findings and had under-utilization of GDMT. The knowledge gained will be crucial for guiding management of HF patients to improve the prognosis.

Assessment of the effect of amantadine in patients with traumatic brain injury: A meta-analysis

BACKGROUND

Traumatic brain injury is a global burden. We aimed to perform a meta-analysis to determine the efficacy of amantadine for cognitive performance after traumatic brain injury.

METHODS

The systematic review was prospectively registered on the International Prospective Register of Systematic Reviews website under the registration number CRD42017080044. We used Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to report the steps of meta-analysis. The search included electronic databases (PubMed, PsycINFO, Embase, Cochrane Library databases, CENTRAL, ProQuest and ClinicalTrials.gov trial registry). Critical care medicine journals and clinical neurology specialty were searched using www.scimagojr.com. There was no publication date restriction. Two authors assessed studies' relevance and extracted data. Studies were assessed for quality using the Cochrane risk of bias tool. Data were analyzed using Comprehensive Meta-analysis Program versions 2.0 and 3.0.

RESULTS

Twenty-six studies out of 3,440 records were included in the systematic review, of which only 14 clinical trials and 6 observational studies were included in the meta-analysis. Amantadine significantly enhanced the cognitive function relative to control group (mean difference [MD], 0.50; 95% confidence interval [CI], 0.33-0.66; p < 0.001, 16 studies, 1,127 participants, low certainty evidence). Consistent significant difference in favor of amantadine relative to control group was found (MD of 0.79 [95% CI, 0.34-1.24], very low certainty evidence, for cohort studies vs. MD of 0.40 [95% CI, 0.25-0.56], moderate certainty evidence, for RCTS). Starting amantadine in the first week after TBI had a significant effect on improving cognitive function (MD, 0.97; 95% CI, 0.45-1.49; 16 studies, 1,127 participants, low certainty). Amantadine showed a better effect when administered for less than 1 month (MD, 0.83; 95% CI, 0.56-1.11; low certainty) and to patients below 18 years of age (MD, 0.66; 95% CI, 0.32-0.99; low certainty) or to patients with less severe traumatic brain injury (MD, 0.40; 95% CI, 0.18-0.62; low certainty). No statistically significant difference existed between amantadine and the control concerning the adverse events (OR, 1.74; 95% CI, 0.88-3.44; p = 0.11, moderate certainty). Metaregression of the different clinical parameters, which are onset of treatment, age, and severity of traumatic brain injury, showed a statistically significant relation between onset of treatment and the effect size of amantadine. The relation between the other two parameters and the effect size of amantadine showed a marginal statistical significance.

CONCLUSION

Amantadine may improve the cognitive function when used after TBI. Further research with high validity is needed to reach a solid conclusion about the use of amantadine in traumatic brain injury.

LEVEL OF EVIDENCE

Systematic review/meta-analysis, level III.

Phyto- and Bio-Chemical evaluation of Diospyros kaki L. cultivated in Egypt and its biological activities

Diospyros kaki L. or Costata cultivar is the main persimmon variety progressively consumed in the Egyptian market and exportation. The objective of this study was to investigate the bioprotective effects of the alcoholic extract of fruits as well as leaves of D. kaki using in-vivo rat models. Petroleum ether extracts of fruits and leaves were analytically characterized for saponifiable and unsaponifiable compounds by GC/MS. Main flavonoids were chromatographically isolated from 80% aqueous methanol extract of leaves. Chemical evaluation for fruits and leaves namely, content of moisture, ash, proteins, fatty acids, amino acids, fat and water soluble vitamins, minerals, carotenoids was carried out. Total antioxidant activity was determined by radical scavenging effects using DPPH assay. The effect on biochemical parameters and its biological activity were also performed. Results revealed the identification of the major compounds of saponifiable and unsaponifiable matters of fruits and leaves. Scopoletin, as well as, kaempferol, luteolin, rutin and apigenin 7-O-glucoside were isolated and identified. It showed that this plant can provide a good nutritional value and it is safe regarding the kidney and liver functions, good source that help in enhancing the antioxidant defense against free radicals. No abnormal effects were found in lipids profile on experimental animals and there were good results in the ratio of HDL and LDL cholesterol. Also, this plant can help in optimizing blood sugar, enhancing the level of blood haemoglobin. It is concluded that D. kaki displays a good source of nutrients and bioactive compounds that may contribute to its therapeutic benefits against the risk of disease complications.

β-Cell-targeted blockage of PD1 and CTLA4 pathways prevents development of autoimmune diabetes and acute allogeneic islets rejection

Protection of β cells from autoimmune destruction potentially cures type 1 diabetes mellitus (T1D). During antigen presentation, interactions between cytotoxic T-lymphocyte antigen-4 (CTLA4) and B7 molecules, or programmed death 1 (PD1) and its ligand PDL1, negatively regulate immune responses in a non-redundant manner. Here we employed β-cell-targeted adeno-associated virus serotype 8 (AAV8)-based vectors to overexpress an artificial PDL1-CTLA4Ig polyprotein or interleukin 10 (IL10). β-Cell-targeted expression of PDL1-CTLA4Ig or IL10 preserved β-cell mass and protected NOD mice from T1D development. When NOD mice were treated with vectors at early onset of hyperglycemia, PDL1-CTLA4Ig or IL10 alone failed to normalize the early onset of hyperglycemia. When drug-induced diabetic mice received major histocompatibility complex (MHC)-matched allo-islets, with or without pretreatment of the PDL1-CTLA4Ig-expressing vector, PDL1-CTLA4Ig-expressing islets were protected from rejection for at least 120 days. Similarly, transplantation of PDL1-CTLA4Ig-expressing MHC-matched islets into mice with established T1D resulted in protection of allo-islets from acute rejection, although islet grafts were eventually rejected. Thus the present study demonstrates the potent immuno-suppressive effects of β-cell-targeted PDL1-CTLA4Ig overexpression against T1D development and allo-islet rejection. The gene-based simultaneous inhibition of PD1 and CTLA4 pathways provides a unique strategy for immunosuppression-free tissue/organ transplantation, especially in the setting of no established autoimmunity.

Synthesis, antimicrobial, antioxidant activities of novel 6-aryl-5-cyano thiouracil derivatives

A series of 6-aryl-5-cyano thiouracil derivatives (2a-c to 11a-c) was synthesized from 6-aryl-4-hydrazino-2-thioxo-1,2-dihydropyrimidine-5-carbonitriles (1a-c). The products were characterized by analytical and spectral data (IR, (1)H NMR, (13)C NMR and mass spectra). All compounds were screened for their in-vitro antibacterial and antifungal activities. Compounds 7a, 7g and 9a-c showed pronounced antimicrobial activity than standards. Some of the newly synthesized compounds were evaluated for antioxidant activity. Compounds 1c, 5c and 8c displayed promising free radical scavenging activity and found to be more potent than standard, ascorbic acid (vitamin C).

Imidacloprid induced alterations in enzyme activities and energy reserves of the land snail, Helix aspersa

The in vivo sublethal toxic effects (0.2 and 0.6 LD50) of topically applied imidacloprid on biochemical biomarkers in the land snail, Helix aspersa was examined. Biochemical perturbations were assessed by measuring the three enzymatic (Acetylcholinesterase, AChE; catalase, CAT and glutathione-S-transferase, GST) activities and three energy reserves (protein, glycogen and lipids) in the snails. Snail samples were taken from each sublethal dose and control groups at 1, 3 and 7 days after treatment. The results revealed that there were overall decrease in AChE activity as well as depletion of lipids and glycogen contents in the imidacloprid-treated snails compared to control groups. The CAT and GST activities of treated snails with the sublethal doses of imidacloprid were significantly higher than those of untreated controls along the three times of exposure. Moreover, an increase in the level of total proteins was observed in animals treated with 0.6 LD50 imidacloprid compared to control groups. The alterations in all tested biochemical perturbations were most pronounced with the 0.6 LD50 than 0.2 LD50. This study suggests that alterations of the enzyme activities and energy reserves in this species that could be useful as biomarkers of imidacloprid exposure in the evaluation of terrestrial impacts of this insecticide.

[Identification of endogenous control genes for gene expression studies in peripheral blood of patients with coronary artery disease]

The selection of stable endogenous control genes is critical for normalization of quantitative real-time PCR (qPCR) data. In this study, we aimed to identify a suitable set of control genes to be used as endogenous references for gene expression evaluation in human peripheral blood samples among coronary artery disease patients. The expression levels of 12 endogenous control genes procured from TATAA Biocenter (Goteborg, Sweden) were measured in five acute coronary syndrome patients and five chronic stable angina patients. Gene expression stability was analyzed using two different software applications i.e geNorm and NormFinder. Results suggested that beta-glucuronidase is the most stable endogenous control, followed by hypoxanthine-guanine phosphoribosyltransferase. The NormFinder analysis further confirmed that beta-glucuronidase and hypoxanthine-guanine phosphoribosyltransferase were on the first rank order with the most stable expression among endogenous control genes analyzed and 60S acidic ribosomal protein P0. Besides this, the expression levels of 18S rRNA were revealed to be highly variable between coronary heart disease patients. We thus recommend the use of beta-glucuronidase and hypoxanthine-guanine phosphoribosyltransferase as reference genes for accurate normalization of relative quantities of gene expression levels in coronary artery disease patients using qPCR. Also the use of 18S rRNA as a control gene should be avoided.

Detection of a new erm(X)-mediated antibiotic resistance in Egyptian cutaneous propionibacteria

A total of 107 antibiotic-resistant propionibacteria were isolated from the face of 102 Egyptian acne patients, dermatology staff and controls. Erythromycin-clindamycin-resistant propionibacteria were chosen to detect erm(X) gene and it was detected in 29 of 107 (27%) strains. However, just 7 strains had IS1249I, 3 of them had also Tn5432. The erm(X) gene which is not carried on Tn5432 confers inducible resistance to telithromycin by erythromycin or clindamycin. The DNA sequences of the PCR amplification products of this new erm(X)-mediated antibiotic resistance showed >99% identity to the erm(X) gene isolated from a Corynebacterium jeikeium. Southern blotting analysis of the erm(X)-specific probe shows that there were two copies of this resistance gene integrated within the chromosomal DNA. This is the first report of erm(X) being carried by Propionibacterium acnes outside Europe. Whilst the gene is associated with Tn5432 in some strains, the data suggests other genetic element carrying erm(X). The high carriage of erm(X) may affect the efficacy of clindamycin and macrolides for acne treatment in Egypt.

Seasonal variation in emergency referrals to a Surgical Assessment Unit

OBJECTIVES

To identify any seasonal variation in the pattern of referrals to the Surgical Assessment Unit (SAU).

METHODS

Admission data to the SAU were collected prospectively during two audit periods of 13 weeks each (winter 2004/2005 and summer 2005). The data were analysed comparing numbers of admissions over the two audit periods and variations in the presenting complaint.

RESULTS

There were a significantly greater number of referrals to the SAU in the summer compared with winter (999 vs. 849, p = 0.026). Whilst there were no significant differences in the sex distribution of patients presenting with general surgical symptoms, a significantly greater proportion of male patients presented with urological symptoms. Additionally, a significantly greater proportion of patients presented in the summer with scrotal/testicular symptoms compared with the winter (13.9% vs. 8.5%, p = 0.02). There was no significant difference between the two periods in terms of other diagnoses. In both study periods, the SAU was busy during weekdays compared with weekends. Whilst most patients arrived in the SAU between 9 am and midnight a smaller but not insignificant number arrived outside of these hours.

CONCLUSIONS

Summer compared with winter was a busy period for the SAU. This may be important in managing emergency surgical admissions. A significantly greater proportion of patients presented with scrotal/testicular symptoms during the summer, the reasons for which are unclear. The SAU diverts workload away from busy Accident & Emergency departments.

Distribution and environmental impacts of some radionuclides in sedimentary rocks at Wadi Naseib area, southwest Sinai, Egypt

The present study examines the natural radioactivity in some sedimentary rocks and their associated environmental impacts at Wadi Naseib area. Exposure rate (ER), dose rate (DR), radium equivalent activity (Ra(eq)), external hazard index (H(ex)), internal hazard index (H(in)) and radioactivity level index (I(gamma)) were calculated. Wadi Naseib area is covered with sedimentary rocks of early to late Paleozoic age. These rocks are classified into two types: mineralized and non-mineralized sediments. The radiometric investigations revealed that uranium and thorium contents reached up to 710 and 520 ppm, respectively, in the mineralized rocks. This was attributed to the presence of some secondary uranium minerals. All sediments had low values of eTh and K content. The exposure and dose rates exceeded public permissible values in the mineralized sediments. Exposure and dose rates were within the safety range for workers and the public in the non-mineralized sediments. The expected environmental impacts may be low due to the limited occurrence of U-mineralization and corresponding areas for radiation exposure. Some precautions and recommendations were suggested to avoid any possible environmental impacts from areas and/or raw materials of high intensity of natural radiation sources.

Synthesis of new 2-thiouracil-5-sulphonamide derivatives with antibacterial and antifungal activity

2-Thiouracil-5-sulphonic acid N-(4-acetylphenyl) Amide (1) was reacted with a series of aromatic aldehydes giving chalcones 2 (Claisen-Schemidt reaction), some of these chalcones were reacted with urea and thiourea giving pyrimidine-2-one and pyrimidine-2 thione derivatives respectively of the type 3a,b and 4a,b. In addition many chalcones were reacted with hydroxylamine hydrochloride giving isoxazoline derivatives 5a,b. They could also reacted with phenylhydrazine to give pyrazoline derivatives 6a,b, chalcones also were reacted withethylcyano acetate and/or malononitryl in pyridine giving pyran derivatives 7a,c and 8a,c. In another pathway chalcones were epoxidised by H2O2 giving epoxides 9a,c which in turn were reacted with phenylhydrazine giving 4-hydroxypyrazoline derivatives 10a,c. In another reaction chalcones were reacted with ethylcyanoacetate in presence of amm.acetate giving pyridone derivatives 11a,d which could be prepared also in exellent yield from compound 1 by its reaction with certain aromatic aldehydes and ethylcyanoacetate in presence of ammonium acetate. Finally, compound 1 was reacted with semicarbazide giving semicarbazone intermediate 12 which in turn was reacted with thionyl chloride giving thiadiazole derivative 13. The biological effects of some of the new synthesized compounds were also investigated.

The surgical assessment unit--effective strategy for improvement of the emergency surgical pathway?

A special unit was set up in an associate teaching hospital to provide a fast-track route for the assessment of acute adult surgical and urological referrals. During an audit period of eight weeks, this surgical assessment unit had 550 referrals, of which 196 (36%) came via the accident and emergency (A&E) department; the other 354 came directly from general practitioners or other hospital departments. Mondays, Tuesdays and Fridays were the busiest days of the week; 57% of all patients arrived between 8 am and 5 pm. 68% were seen by a doctor within 1 hour of their arrival. 68% were either discharged or admitted to the main surgical wards within 4 hours. The study showed that, over the course of a year, the surgical assessment unit might divert some 2301 patients away from the A&E department. To achieve this total it would need to be open and appropriately staffed 24 hours a day. Such a unit offers a strategy for limiting the A&E workload and streamlining the assessment of patients with surgical and urological emergencies.

The Surgical Assessment Unit—Effective Strategy for Improvement of the Emergency Surgical Pathway?

A special unit was set up in an associate teaching hospital to provide a fast-track route for the assessment of acute adult surgical and urological referrals. During an audit period of eight weeks, this surgical assessment unit had 550 referrals, of which 196 (36%) came via the accident and emergency (A&E) department; the other 354 came directly from general practitioners or other hospital departments. Mondays, Tuesdays and Fridays were the busiest days of the week; 57% of all patients arrived between 8 am and 5 pm. 68% were seen by a doctor within 1 hour of their arrival. 68% were either discharged or admitted to the main surgical wards within 4 hours. The study showed that, over the course of a year, the surgical assessment unit might divert some 2301 patients away from the A&E department. To achieve this total it would need to be open and appropriately staffed 24 hours a day. Such a unit offers a strategy for limiting the A&E workload and streamlining the assessment of patients with surgical and urological emergencies.

Synthesis of new 2-thiouracil-5-sulfonamide derivatives with biological activity

2-Thiouracil-5-sulfonylchloride 1 reacted with a series of aromatic and heterocyclic amines to give 2a-j. The same compound 1 was reacted with a series of sulphonamides giving different sulphonamides of type 3a-e. On the other hand compound 1 was allowed to react with p-aminoacetophenone givining compound 4 which in turn was allowed to react with derivatives of alkyl thiosemicarbazides to give thiosemicarbazones of type 5a-e, also compound 4 was monobrominated to give compound 6 which in turn was reacted thiosemicarbazones of some aldehydes to give the corresponding thiazole derivatives 7a-f. In the same time compound 4 was reacted with a series of aromatic and heterocyclic aldehydes givining chalcones 8a-g (Claisen-Schemidt reaction). Also compound 4 was allowed to react with a series of aromatic and heterocyclic aldehydes, ethyl cyano acetate and/or malononitrile, and ammonium acetate giving pyridine derivatives 9a-d and 10a-e respectively. The biological effects of some of the new synthesized compounds was also investigated.

Predictive clinical and laboratory factors in the diagnosis of temporal arteritis

Surgeons are frequently called upon to perform temporal artery biopsy in patients suspected of having temporal arteritis. In this study, we have attempted to identify clinical and laboratory features that may predict the results of temporal artery biopsy for the diagnosis of temporal arteritis. The medical records of patients undergoing temporal artery biopsy over a 10-year period in one hospital were reviewed. Details of presenting features were recorded and comparisons made between biopsy-positive and biopsy-negative patients. Of 59 patients who underwent temporal artery biopsy, the records of 51 patients were located. Of these, 17 patients had positive biopsy specimens and 33 had negative biopsies. In one patient, no temporal artery was found in the biopsy specimen. In the biopsy-positive patients, 69% had an erythrocyte sedimentation rate of greater than 50 mm/h compared to 31% of biopsy negative patients (P = 0.03). With regard to the other clinical and laboratory parameters that were evaluated, no statistically significant differences were found between biopsy-positive and biopsy-negative patients.

Thrombogenicity of heparin and non-heparin bound arterial prostheses: an in vitro evaluation

The effect on graft thrombogenicity of binding heparin to the luminal surface of prosthetic arterial grafts was investigated. Venous blood was obtained from healthy volunteers and exposed for 30 minutes to tubular segments of standard knitted dacron, polytetrafluoroethylene (PTFE) and a recently introduced heparin-bound knitted dacron graft. After this exposure the fibrinogen level of each sample was measured. The median (range) fibrinogen levels (expressed as a percentage of that in unexposed blood samples) were: standard dacron 3.5% (0-5.4%); PTFE 95.5% (0-121.1%); and heparin-bound dacron 79.8% (3.8-109.6%). Fibrinogen levels in the standard dacron group were significantly less than that of the PTFE and heparin-bound dacron groups (P < 0.05). No significant difference was found between the fibrinogen levels of the PTFE and heparin-bound dacron groups (P = 0.35). These findings suggest that heparin binding significantly reduces fibrinogen consumption and hence may reduce graft thrombogenicity.

Risk factors for bleeding in major abdominal surgery using heparin thromboprophylaxis

BACKGROUND

Patients undergoing major abdominal surgery are at risk of both bleeding and thrombotic complications and usually receive heparin thromboprophylaxis.

PATIENTS AND METHODS

Risk factors for perioperative bleeding were examined in 3,809 patients in a double-blind, randomized trial investigating heparin thromboprophylaxis. The risk factors were modeled by logistic regression, and a risk score was calculated using the significant factors in the model.

RESULTS

Bleeding was associated with the following factors in the model, given as adjusted odds ratios (ORa [95% confidence interval]): male sex (ORa 1.68 [1.21 to 2.34] P = 0.003), malignancy (ORa 1.69 [1.21 to 2.34] P = 0.008), gynecological surgery (ORa 1.62 [1.12 to 2.35] P = 0.011), and complex surgery (ORa 2.7 [2.02 to 3.62] P < 0.001). The risk of excessive bleeding for 0, 1, 2, and 3 risk factors was 2%, 6%, 11%, and 21%, respectively.

CONCLUSIONS

The recognition of patients with these risk factors associated with perioperative bleeding should result in increased vigilance and may lead to modification of surgical and medical therapy.

Patients at risk of venous thromboembolism--clinical results with reviparin

Perioperative thromboembolism can be effectively prevented by low-dose heparin. However, its clinical benefit is limited, due to the risk of bleeding, the need for multiple daily doses, infrequent disorders of platelet function and other potential side effects. Low molecular weight heparin (LMWH) was developed with the aim that the antithrombotic efficacy of heparin could be maintained, while the risk of bleeding and other side effects would be reduced. Prior to recent studies, the anticipated clinical benefit of LMWH remained a controversial issue. We have reviewed the clinical pharmacology and the results of several prospective trials using reviparin a LMWH which has been compared with unfractionated heparin (UFH) and another LMWH. The efficacy and safety of reviparin was examined in the prevention of venous thromboembolism in high risk patients undergoing elective major abdominal and hip surgery. The results of these clinical trials show that reviparin is as effective as UFH in preventing venous thromboembolism whilst having a lower incidence of bleeding complications. Of major significance was the finding that a very low dose of reviparin, namely 1750 anti-Xa IU once daily, was found to be as effective as UFH in preventing deep vein thrombosis whilst having a significantly lower incidence of bleeding complications in patients undergoing major abdominal surgery. Reviparin has also been shown to be effective and safe as enoxaprin in patients undergoing elective hip surgery. Further clinical trials are required to test different dosage regimens as a thromboprophylactic agent in high risk patients. It is possible that reviparin and other LMWHs with similar pharmacological properties may have an important clinical benefit over earlier compounds. However, this needs to be assessed in large scale, double-blind, randomised clinical trials.

An epidemiological study on consanguineous marriage among urban population in Alexandria

The study was carried out using a cross-sectional approach, involving interviews with 500 households randomly selected from three urban areas in Alexandria (Bab Sharki, El Gomrok and Karmouz). A questionnaire interview was conducted with married females in these households to determine prevalence of consanguineous marriages and to study knowledge of married females about causes and effects of consanguineous marriages. Prevalence of consanguineous marriages among 500 married females was 22.8% with the highest frequency among marriage between first cousins (15.8%). Average inbreeding coefficient up to the marriage between second cousins equals to 0.01172. The linear trend of consanguineous marriages throughout the last 50 years was statistically significant. Age at marriage was younger in consanguineous marriages than non consanguineous marriages. Longstanding familiarity and sharing same traditions and customs with male relatives were the main causes of consanguineous marriages. The majority of the studied females (42.2%) reported that consanguineous marriage is harmful while 29.6% reported that it has no effect on offsprings.

Parasitic infections associated with malignancy and leprosy

Results of parasitic infections, as revealed by urine and stool examination was significant (P less than 0.05) in 43.3% of patients suffering from different malignant diseases and non significant (P greater than 0.05) in 29.3% of leprosy patients compared to 22% in control subjects. The most prevalent parasites were E. histolytica and G. lamblia. Cryptosporidium occysts were not detected. By stool examination and culture, S. stercoralis larvae were detected only in the malignancy group. The most common parasites occurring concomitantly were A. duodenale and S. stercoralis. By the IFAT, strongyloidiasis gave significantly higher positive results in the malignancy group than in the leprosy and control groups. IFAT for toxocariasis, showed highly significant positivity in the leprosy group and significantly positivity in the malignancy group. For toxoplasmosis, it showed highly significant positive results in both leprosy and malignancy groups. Eosinophilia was significantly more prominent among malignancy patients and insignificant among those with leprosy. Parasitic infection detected by urine and stool examination among patients with eosinophilia was found in 76% of the malignancy patients and in 66.7% of the leprosy patients.

Parasitic infections associated with mental retardation in Egypt

Examination of 150 mentally retarded patients for parasitic infections by urine and stool analysis revealed that 115 (76.67%) were positive. The most prevalent parasites found were T. trichiura in 56%, A. lumbricoides in 40.6% and A. duodenale in 21.33%. Double infection was present in 30.67%, triple infection in 15.33% and quadriple infection in 6%. Eosinophilia was detected in 91 (64.08%) of 142 examined cases, all were suffering from intestinal parasites. S. stercoralis was present in 11.33% by stool examination and culture and in 24 (60%) out of 40 examined cases by the IFAT. Toxocara antibodies were present in 38 (56.72%) out of 67 examined cases by the IFAT. Toxoplasma antibodies were present in 106 (74.65%) out of 142 examined cases by the IFAT.

Release and rectal absorption of ethosuximide from suppositories in rabbits

Ethosuximide was formulated in different suppository bases. In vitro release experiment demonstrated more rapid and higher release of the drug from water soluble polyethylene glycol (PEG) bases than from Witepsol fatty bases. Rectal administration in PEG 400:4000 and 400:6000 to rabbits gave high plasma levels where Cmax was 45.66 and 42.66 micrograms.ml-1, respectively; while, in the presence of Witepsol E76 and W35 it was 34.00 and 28.33 micrograms.ml-1, respectively. The systemic availability was 89.39%, 82.72%, 58.80% and 47.45% when the bases were PEG 400:4000, PEG 400:6000, Witepsol E76 and Witepsol W35, respectively.

Entomophthoromycosis due to Basidiobolus in Somalia

The clinical picture, histopathology of the lesion, microscopic identification of fungus and treatment of entomophthoromycosis due to Basidiobolus in a seven-year-old boy are described. This is the first case recognized in Somalia and confirms that this condition is common and widely distributed in tropical countries.

Activity of N-methyl-alpha- and -beta-funaltrexamine at opioid receptors

The N-methyl analogues (2a, 2b) of the nonequilibrium mu opioid receptor antagonist beta-funaltrexamine (1b) were synthesized and evaluated in the guinea pig ileum preparation (GPI). These analogues are highly potent, reversible opioid agonists and possess no nonequilibrium antagonist activity. The ineffectiveness of 2b in protecting against irreversible blockage of mu opioid receptors by 1b and the fivefold lower reactivity of 2b with cysteine suggest that N-methyl substitution adversely affects both the first and second recognition steps that are essential for effective covalent blockage of opioid receptors.