Cytotoxicity Activity of Graviola Fruit Extract with Carbamazepine and Valproic Acid Show Antagonistic and Indifferent Effects

OBJECTIVE

Graviola is a tropical fruit with medicinal properties, used for treating various diseases such as inflammation, diabetes, and cancer. Histone deacetylase inhibitors (HDACIs), including carbamazepine (CBZ) and valproic acid (VPA), have been proven strong inhibitors against cancer cell growth. This study investigated the effect of Graviola fruit extract (GFE) on CBZ in healthy rat plasma using high-performance liquid chromatography (HPLC). In addition, the effect of GFE in combination with CBZ and VPA on two human cancer cell lines (PC3 and MCF-7) was explored.

METHODS

The CBZ levels were analyzed using a simple validated HPLC method. The linearity was achieved at a 0.9998 coefficient of determination over a range of 75-5000 ng/mL CBZ. The MTT assay was used to quantify the percentage of viable cells.

RESULT

The maximum plasma concentration (Cmax) and area under the curve (AUC) for CBZ alone were 4,631 ng/mL and 49,225 ng. h/mL, respectively. However, in the presence of GFE, the values reduced significantly to 2,994 ng/mL and 26,587 ng. h/mL, while the p-value was <0.05. The 3-(4,5-dimethylthiazolyl-2)-2, 5-diphenyltetrazolium bromide (MTT) assay results for VPA showed a weak cytotoxicity activity on PC3 and MCF-7 cell lines.

CONCLUSION

A simple and validated HPLC method was used to determine CBZ levels in rats' plasma. The plasma CBZ levels (Cmax) were significantly reduced in the presence of GFE, indicating the importance of drug-herb interactions. For in vitro studies, two human cancer cell lines, MCF-7 (breast cancer cells) and PC3 (prostate cancer cells), were used to screen the cytotoxicity activity of GFE, CBZ, and VPA. We observed an antagonism effect for GFE and CBZ combination in both cell lines with FIC values > 4. On the contrary, the combination of GFE and VPA showed an additive or indifferent effect.

Real-World Effectiveness of Four Types of COVID-19 Vaccines

BACKGROUND

There is a scarcity of evidence regarding the real-world effectiveness of coronavirus disease 2019 (COVID-19) vaccines. This was the first study to evaluate the effectiveness of four types of vaccines against asymptomatic and symptomatic infection, and COVID-19 outcomes among the general population.

METHODS

This was a matched comparison group quasi-experimental study conducted in Jordan between 1 January and 29 August 2021. In the first part of the study, 1200 fully vaccinated individuals were matched with 1200 unvaccinated control participants. In order to measure vaccine effectiveness, the infection rates of both vaccinated and unvaccinated groups were calculated. The second part of the study included measuring specific anti-SARS CoV-2 immune cells and antibodies.

RESULTS

BNT162b2 (Pfizer, New York, NY, USA) showed a significantly higher effectiveness against asymptomatic COVID-19 infection (91.7%) and hospitalization (99.5%) than BBIBP-CorV (Sinopharm, Beijing, China) (88.4% and 98.7%, respectively) and ChAdOx1 nCoV-19 (AstraZeneca, Cambridge, UK) (84.3%, and 98.9%, respectively). The effectiveness rates of the Sputnik V (Gamaleya Research Institute, Moscow, Russia) vaccine against asymptomatic, symptomatic, and hospitalization were 100%, 100%, and 66.7%, respectively. The highest median anti-spike (S) IgG values were seen in individuals who received BNT162b2 (2.9 AU/mL) and ChAdOx1 nCoV-19 (2.8 AU/mL) vaccines. The levels of anti-S IgG were significantly decreased after 7 months of vaccination with BNT162b2 and BBIBP-CorV. There were significant decreases in the median number of neutralizing antibodies one month and seven months after receiving BNT162b2 (from 88.5 to 75.2 4 Bioequivalent Allergen Unit per milliliter/mL), BBIBP-CorV (from 69.5 to 51.5 BAU/mL), and ChAdOx1 nCoV-19 (from 69.2 to 58.BAU/mL) vaccines. The highest percentage of T cells specific to COVID-19 vaccine was found in individuals who received BNT162b2 (88.5%).

CONCLUSION

All four vaccines evaluated in this study showed effectiveness against asymptomatic COVID-19 infection, symptomatic infection, hospitalization, and death. Furthermore, BNT162b2, BBIBP-CorV, and ChAdOx1 nCoV-19 induced high levels of immunology markers within one month of vaccination.

The need to consider the service life of all components of a modern MSW landfill liner system

The long-term performance of a geosynthetic clay liner (GCL) above a drainage layer and a geocomposite drain (GCD) are investigated. Full-scale tests are used to: (i) assess the integrity of GCL and GCD in a double composite liner below a defect in the primary geomembrane with ageing, and (ii) establish the head at which there was internal erosion in GCL without a carrier geotextile (GTX) such that the bentonite is in direct contact with the underlying gravel drainage. Six years after contact with simulated landfill leachate at 85 °C through an intentional defect on the geomembrane, the GCL resting on the GCD had failed due to degradation of the GTX between the bentonite and the core of the GCD and subsequent erosion of the bentonite into the core structure of the GCD was observed. In addition to complete degradation of its GTX at some locations, the GCD had also experienced extensive stress cracking and rib rollover. The second test demonstrates that if a suitable gravel drainage layer had been used instead of the GCD, the GTX component of the GCL would not have been required for acceptable long-term performance under normal design conditions and indeed could withstand a head of up to 15 m before problems became evident. The findings serve as a warning landfill designers and regulators that more attention must be paid to the service life of all components of double liner systems used in Municipal Solid Waste (MSW) landfills.

Fluctuations in loneliness due to changes in frequency of social interactions among older adults: a weekly based diary study

OBJECTIVES

Loneliness functionally varies and is determined by the degree of interaction with others. We examined weekly fluctuations in reported loneliness as a function of frequency of social interactions in old age. We hypothesized that emotional and social components of loneliness would be related to different types of social relationships.

DESIGN

Participants reported their feeling of loneliness and their social interaction quantity (frequency of meetings) via a weekly based diary, over 6 weeks.

SETTING

Diary study.

PARTICIPANTS

The study included 55 older adults with different dwelling arrangements (M = 73.4, SD = 6.97).

MEASUREMENTS

Measures of Loneliness (the De Jong-Gierveld Loneliness Scale), Social Interaction and Contact, and sociodemographic parameters were used.

RESULTS

Social and emotional loneliness fluctuated over the course of the 6-week study. Frequency of meeting friends was related to emotional loneliness and total feelings of loneliness. Frequency of meeting close/trusted figures was related to emotional loneliness which appeared the following week. Other variables were not associated with either changes in loneliness or its dimensions.

CONCLUSIONS

Loneliness in old age is changeable. The emotional component of loneliness seems to be dominant in determining overall feelings of loneliness and is more sensitive to externally chosen social interaction.

Characterization and evaluation of the therapeutic benefits of pure and lanthanides mono- and co-doped zinc oxide nanoparticles

The effect of Lanthanides-doping on the structural, optical, morphological, antibacterial and anticancer properties of zinc oxide (ZnO) nanoparticles was investigated. Pure ZnO, Zn_0.9La_0.1O, Zn_0.9Ce_0.1O, and Zn_0.9La_0.05Ce_0.05O were fabricated through the chemical co-precipitation route. The structural and morphological properties were studied using the X-ray diffraction (XRD) and transmission electron microscopy (TEM), respectively. The optical properties were analyzed by photoluminescence spectroscopy (PL). The inhibitory effect of the synthesized nanoparticles (NPs) was assessed against six bacterial strains using the agar well diffusion and broth micro-dilution methods. The anticancer potential of the synthesized NPs was assessed against two human colon cancer cell lines Caco-2 and HCT-116. The appearance of the La₂O₃ and CeO₂ secondary phases upon doping La³⁺ and Ce³⁺ ions induced structural and morphological changes. The large distorted hexagonal morphology of pure ZnO is transformed into small sized distorted hexagonal form. The photoluminescence spectra revealed the point defects resulting from Lanthanum (La) and cerium (Ce) doping. The prepared NPs significantly inhibited the growth of the six investigated bacteria and induced cytotoxic effects and morphological changes against Caco-2 and HCT-116 cell lines. This study showed that doping ZnO with lanthanide ions such as La³⁺ and Ce³⁺ provide promising biological applications. These NPs showed a potent antibacterial and anticancer effect towards the investigated bacterial strains and colon cancer cell lines. These findings point to the importance of the biological applications of NPs, and the possibility of investigating other biomedical applications for NPs.

580 Vascular Distal Bypass Early Surveillance Audit

Introduction

Due to inconsistency in Duplex surveillance following distal bypass for peripheral arterial disease at our district general hospital. We planned an audit aiming to assess our current early surveillance of distal vascular bypass.

Method

The latest twenty patients who underwent distal bypass were collected retrospectively from the theatre’s records. Their clinical and imaging records were analysed to ascertain the timing of 1st duplex after the procedure. We also examined the discharge medications. We chose the standard advised by Society for Vascular Surgery that every patient following the procedure ideally should have (Clinical examination + ABPI + Duplex) at 1, 3, 6 and 12 months then annually.

Results

8 patients (40%) had a Duplex within 1 month, while 10% did not have a scan at all. Time range between the procedure and first Duplex was 1-11 months with a mean of 4 months. All patients were discharged on at least a single antiplatelet agent while only 70% were prescribed statins. Six patients needed an intervention for blocked graft but eventually failed, only one patient had a Duplex in a timely fashion, the stenosed graft was salvaged by angioplasty.

Conclusions

There was no clear standardized surveillance protocol for vascular team juniors to follow. In addition, discharge of distal bypass patients sometimes is carried by general surgery team during weekends and unlikely that a Duplex is booked. We suggested booking the Duplex in theaters soon after performing the procedure to ensure inclusion in the surveillance protocol, education of junior doctors and re-auditing in 1 year.

Sleeping Duration, Bedtime and BMI and Their Rapport on Academic Performance among Adolescents

Background: Proper development of cognitive skills during childhood is substantially connected with adequate sleeping. Sleeping is drastically undergoing pattern changes during the shifting from childhood to adolescence. The academic acquisition is a multifactorial process with devastating inputs. Academic achievement directly correlates with the behavioral attitudes of students. Shorter sleeping duration erodes the volume of brain gray matter in frontal and precuneus cortex regions. Moreover, the concomitant depletion of neurotransmitters is proportionally connected with inadequate sleeping. Aims: To evaluate the associations between bedtime initiations, sleeping sufficiency and objective academic performance in a large sample of second secondary students. Methods: The study sample consisted of 900 adolescents; 450boysand 450 girls in the second secondary class at Hail city in the Kingdom of Saudi Arabia. Participants filled a questioner about their socioeconomic factors as bedtime, sleeping duration, mental games practicing, and physical activity. Weight and height were measured to assess body mass index (kg/m2). Data extracted from the questioner used to study the contribution of the concomitant factors on academic achievement. Results: The mean weight was 73.57±8.34 kg IQR (44-126) while the mean height was (170.38±6.45) cm IQR (141-192). The mean BMI was 33.57±14.79(IQR 21.0–38.8). The overall prevalence of childhood obesity was 460 (49.6%; 95% CI: 55.3–66.8%) while the prevalence of overweight was 85 (9.04%; 95% CI: 7.3 –11.4%). The mean ministry academic score for the second secondary class was 70±9.99 IQR (44- 99) while the school academic score was 88.07±7.44 IQR (60-99). 51.6% of the students went to bed between 10-12 pm and only 17.6% slept between 8 and 10 hours. Conclusion: We can summarize, the independent variables as bedtime, sleeping duration, and obesity ameliorate academic achievement in a counteractive way; high BMI above 35 and prolonged sleeping duration more than 10 hours significantly curb the total academic score, whereas, healthy bedtime of 8-10 pm concomitantly augment the academic achievement.

Epidemiology and molecular diagnosis of canine coronavirus in Egypt: evaluation of different tests used for its diagnosis

This work aimed to study the epidemiology and molecular detection of existing canine coronavirus (CCoV) strain circulating in Egypt. A total number of 86 dogs with clinical signs suggestive for CCoV infection was subjected to clinical examination and quick immunochromatography (IC) on faecal swabs to detect viral antigen. To identify CCoV viral RNA and S protein gene in blood and faeces, conventional PCR and quantitative RT-PCR were used. All examined dogs showed clinical signs suggestive of CCoV infection. Only 32 out of 86 dogs were positive for IC. Of all samples, 36 showed positive results in PCR and the amplification products from these 36 samples were confirmed as CCoV-S protein partial gene by the analysis of nucleotide sequence. However, the qRT-PCR analysis detected 45 positive samples e.g. more than those of IC or conventional polymerase chain reaction. Statistical evaluation of IC and conventional PCR to the results of qRT-PCR performance showed sensitivity, specificity, accuracy, positive and negative predictive values of 71%, 100%, 84.9%, 100%, 75.9% for IC and 80%, 100%, 89.5%, 100%, 82% for PCR, respectively. Sex and age had no effects on IC and PCR results. The prevalence of CCoV infection among the population of this study was 52.3%. Sequence analysis results proved that CCoV strain 59/08 was the strain, circulating in Egypt among dog populations. PCR products of the CCoV cDNA were closely identical to published CCoV-S partial gene. The NCBI Genbank accession number of sequence of the studied gene (CCoV-S partial gene) in this study was KY655745.

Establishment and Validation of a Sensitive Method for the Detection of Pregabalin in Pharmacological Formulation by GC/MS Spectrometry

Background:

A gas chromatography and mass spectrometry (GC/MS) procedure was developed and validated for the evaluation and quantification of pregabalin (PGN) in pharmaceutical preparations. </P><P> Introduction: Pregabalin is a γ-amino-n-butyric acid derivative used as an antiepileptic drug for the management of fibromyalgia, and has analgesic, anxiolytic, and anticonvulsant activities. Few studies have been reported on the determination of PGN content in pharmaceutical preparations involving gas chromatography - mass spectroscopy.

Methods:

Pregabalin was extracted with MSTFA/NH4F/β- mercapto-ethanol at 60°C for 30 min. The acquired derived molecule of pregabalin was identified by specific ion monitoring mode applying the analytical ions m/z 232 and 331. Propranolol was used as Internal Standard (IS). The following validation parameters were taken into consideration: precision, linearity, accuracy, stability, specificity, robustness, ruggedness, Limit Of Detection (LOD) and Limit Of Quantitation (LOQ).

Results:

The method was selective, precise, sensitive, linear and specific. The linearity of the method was between 3.5 and 300 ng/ml. The precise values were ≤ 3.62% of both intra- and interday validation. The LOD accurate values for Intraday and interday validation were in the range of -0. 25 -2.05%. While LOQ accurate values for intraday and interday were 1.5x10-6 and 3.5 x10-6mg/ml, respectively.

Conclusion:

Therefore, the developed GC-MS method was effectively implemented to identify PGN in a pharmacological preparation.

The influence of Eruca sativa (Arugula) on pharmacokinetics of Sildenafil in rats

OBJECTIVES

A drug like Sildenafil is commonly used for the treatment of erectile dysfunction. Eruca sativa is known as a garden plant used in folk medicine to enhance the sexual desire in males. Nevertheless, the interaction of Sildenafil and Eruca sativa was not studied. In the current study, we aimed to examine the influence of Eruca sativa on Sildenafil pharmacokinetics in rats.

STUDY DESIGN

A crossover experiment with washout period of two weeks was conducted. To one group of animals, Eruca sativa was given as food and a drinking solution to rats for 12 hours before the day of the experiment. On the day of the experiment, the same group received 5 ml (50 mg/ml) orally and a half an hour later animals received 1 ml Sildenafil citrate (2.85 mg/kg) oral administrated to the study group. The other group of rats only received Sildenafil. Two-weeks later a cross-over design on the same animals was conducted. Blood samples were collected from optical vein on different time intervals, samples were analyzed using validated (HPLC-UV) method.

RESULTS AND CONCLUSION

Pre-administration of Eruca sativa has increased Sildenafil Cmax from 226.72 to 345.25 ng/ml, (p<0.05). In addition, the AUC of Sildenafil has significantly increased when it was pre-administered with Eruca sativa (550.59 vs. 916.48 ng/ml*hr). Our findings suggest that co-administration of Eruca sativa with Sildenafil enhances the pharmacokinetics of Sildenafil in rats plasma.

The diagnosis, clinical findings and treatment options for Parkinson's disease patients attending a tertiary referral voice clinic

BACKGROUND

Parkinson's disease is a degenerative disorder of the central nervous system, mainly affecting motor functions including the voice. The aetiology of dysphonia changes throughout the course of disease progression.

OBJECTIVES

This study aimed to determine the laryngeal changes seen in early-, mid- and late-stage Parkinson's disease. Thirteen patients with Parkinson's disease are presented, representing the largest series of voice patients with Parkinson's disease seen in a voice clinic in the literature.

METHOD

Age, gender, severity of handicap caused by voice disorder and possible associated reflux symptoms were examined.

RESULTS

Laryngeal function appeared to change gradually with progression of the disease, and may have been affected by the presence of pre-existing laryngeal pathology.

CONCLUSION

Laryngeal function in Parkinson's disease appears to go through a series of changes that may be helped by both therapeutic and surgical interventions. These patients should be treated within the confines of a voice clinic multidisciplinary model.

Pomegranate and licorice juices modulate metformin pharmacokinetics in rats

OBJECTIVES

Food or drinks may significantly alter the pharmacokinetics and pharmacodynamics of drugs which may lead to adverse events. A drug such as metformin is widely used to regulate plasma glucose level and pomegranate and licorice have been identified to help in type-2 diabetes management. However, the interactions of the latter on metformin pharmacokinetics were not studied. Therefore, we aimed here to study the impact of pomegranate and licorice on metformin pharmacokinetics in rats.

METHODS

Juices were given to rats for two days and half an hour before metformin (20 mg/kg) oral administration. Blood samples, then, were collected at different time intervals, processed and analyzed using validated reliable HPLC method. Plasma profile and pharmacokinetic parameters were calculated for each group.

RESULTS AND CONCLUSION

Pre-administration of pomegranate significantly reduced metformin maximum plasma concentration from 1410 to 1031 ng/ml. On the other hand, pre-administration of licorice significantly delayed metformin reaching its maximum plasma concentration. In conclusion, pre-administration of pomegranate may potentially reduce efficacy of metformin while licorice might delay metformin action. Thus, both juices should be cautiously administrated with metformin, the mainstay drug for type-2 diabetes mellitus management.

Bis(methylsulfonyl)methane

In the title compound, C₃H₈O₄S₂, the two central S—C(H₂) bond lengths are almost identical [1.781 (2) and 1.789 (2) Å]. In the crystal, each mol­ecule utilizes CH₂ and CH₃ bonds to form weak C—H⋯O hydrogen bonds to six other mol­ecules, thus linking mol­ecules into a three-dimensional network.

Effects of traditionally used anxiolytic botanicals on enzymes of the gamma-aminobutyric acid (GABA) system

In Canada, the use of botanical natural health products (NHPs) for anxiety disorders is on the rise, and a critical evaluation of their safety and efficacy is required. The purpose of this study was to determine whether commercially available botanicals directly affect the primary brain enzymes responsible for gamma-aminobutyric acid (GABA) metabolism. Anxiolytic plants may interact with either glutamic acid decarboxylase (GAD) or GABA transaminase (GABA-T) and ultimately influence brain GABA levels and neurotransmission. Two in vitro rat brain homogenate assays were developed to determine the inhibitory concentrations (IC50) of aqueous and ethanolic plant extracts. Approximately 70% of all extracts that were tested showed little or no inhibitory effect (IC50 values greater than 1 mg/mL) and are therefore unlikely to affect GABA metabolism as tested. The aqueous extract of Melissa officinalis (lemon balm) exhibited the greatest inhibition of GABA-T activity (IC50 = 0.35 mg/mL). Extracts from Centella asiatica (gotu kola) and Valeriana officinalis (valerian) stimulated GAD activity by over 40% at a dose of 1 mg/mL. On the other hand, both Matricaria recutita (German chamomile) and Humulus lupulus (hops) showed significant inhibition of GAD activity (0.11-0.65 mg/mL). Several of these species may therefore warrant further pharmacological investigation. The relation between enzyme activity and possible in vivo mode of action is discussed.

Pharmacokinetics and pharmacodynamics profiles of enalapril maleate in healthy volunteers following determination of enalapril and enalaprilat by two specific enzyme immunoassays

BACKGROUND AND OBJECTIVES

Most of the pharmacokinetic (PK) parameters for enalapril and enalaprilat were established following determination of the drug and its metabolite, using angiotensin converting enzyme (ACE) inhibition assays. In these methods, enalapril has to be hydrolysed to enalaprilat first and then assayed. The purpose of this study was to re-estimate the PK parameters of enalapril and enalaprilat in healthy volunteers using two specific enzyme immunoassays for enalapril and enalaprilat.

METHODS

The rate and extent of absorption of enalapril and enalaprilat from a 10-mg dose of two enalapril maleate commercial brands (Renetic and Enalapril) were estimated using a two-way-cross over design with 1-week washout period. Blood pressure was also measured at specified time intervals and correlated to enalaprilat plasma concentrations.

RESULTS

For enalapril, the AUC(o-->infinity) values (Mean+/-SD) were 450.0+/-199.5 and 479.6+/-215.6 ng h/mL, Cmax values were 313.5+/-139.6 and 310.1+/-186.6 ng/mL, Tmax values were 1.06+/-0.30 h and 1.13+/-0.22 h, and t1/2 ranged between 0.3 to 6.1 h (1.6+/-1.5) and 0.40 to 5.05 h (1.3+/-1.0), for the two brands. For enalaprilat, the AUC(o-->infinity) values were 266.9+/-122.7 and 255.9+/-121.8 ng h/ml, Cmax values were 54.8+/-29.5 and 57.2+/-29.0 ng/mL, Tmax values were 4.6+/-1.6 h and 4.3+/-1.45 h, and t1/2 ranged between 1.1 to 10.5 h (4.5+/-2.9) and 0.6 to 9.4 h (3.5+/-2.5) for the two brands.

CONCLUSIONS

Cmax values for enalapril are about 10 times those published in the literature and the rate and extent of absorption of the two brands of enalapril and their deesterification to enalaprilat following the administration of either brand were bioequivalent. Secondly, enalaprilat concentrations at 12-24 h following a single oral dose of enalapril in healthy volunteers were lower than those reported in the literature. The values reported here correlated with the return of blood pressure to predose level. Thirdly, enzyme immunoassays for enalapril and enalaprilat are better than ACE inhibition assays and can be used in bioequivalence assessment of enalapril and enalaprilat and for therapeutic drug monitoring in a clinical laboratory setting.

Phytochemical and biological analysis of skullcap (Scutellaria lateriflora L.): a medicinal plant with anxiolytic properties

The phytochemistry and biological activity of Scutellaria lateriflora L. (American skullcap) which has been traditionally used as a sedative and to treat various nervous disorders such as anxiety was studied. In vivo animal behaviour trials were performed to test anxiolytic effects in rats orally administered S. laterifolia extracts. Significant increases in the number of entries into the center of an "open-field arena"; number of unprotected head dips, number of entries and the length of time spent on the open arms of the Elevated Plus-Maze were found. The identification and quantification of the flavonoid, baicalin in a 50% EtOH extract (40 mg/g) and its aglycone baicalein in a 95% EtOH extract (33 mg/g), as well as the amino acids GABA in H2O and EtOH extracts (approximately 1.6 mg/g) and glutamine in a H2O extract (31 mg/g), was performed using HPLC. These compounds may play a role in anxiolytic activity since baicalin and baicalein are known to bind to the benzodiazepine site of the GABAA receptor and since GABA is the main inhibitory neurotransmitter.

The epidemiology of hepatitis A infection in Palestine: a universal vaccination programme is not yet needed

In Palestine, there has been an increase in the reported incidence of acute hepatitis A virus (HAV) infection since 1995. Since overt clinical disease occurs only among adults, questions were raised whether or not a shift in the epidemiology of HAV has occurred. This is generally characterized by a decrease in the overall incidence rate and a shifting in the mean age of infection towards adolescence and early adulthood. The need for a vaccination programme is being discussed. To resolve this issue, we examined the prevalence of anti-HAV in a representative sample of 396 school children in the Gaza Strip. The prevalence of anti-HAV was 93.7% (95% CI: 91.3, 96.1%). Stratifying the prevalence by age showed that 87.8% (95% CI: 78.6, 97%) were HAV antibody positive by the age of 6. By the age of 14, almost 98% (95% CI: 92.7, 100%) were HAV antibody positive. This means that the majority of HAV infection is still taking place in early childhood, when it is usually asymptomatic and of little clinical significance. The results refuted the shifting epidemiology theory and we recommend that a vaccination programme against HAV infection is not yet needed. Alternative explanations for the increase in reported cases are discussed.

Chronic disseminated intravascular coagulation after surgery for abdominal aortic aneurysm: clinical and haemostatic response to dalteparin

A 77-year-old man developed chronic disseminated intravascular coagulation (DIC) after surgical repair of a large infrarenal aortic aneurysm. Self-administered subcutaneous dalteparin therapy (5000 units o.d.) led to rapid relief of symptoms and sustained improvements in his platelet count and fibrinogen level; activation of coagulation and fibrinolysis appeared to be relatively unaffected. Long-term treatment with low-molecular-weight heparin can provide good symptomatic control of chronic DIC associated with abdominal aortic aneurysm.

A critical review of the infectious diseases surveillance system in the Gaza Strip

The development and strengthening of national surveillance systems is a key part of communicable disease control. This review article describes and evaluates the Palestinian surveillance system and discusses the role of the epidemiology departments and other health providers in Gaza Strip in reporting infectious diseases, considers the use of the data collected, and makes recommendations for strengthening infectious diseases surveillance. Underreporting of infectious diseases remains a major problem in communicable diseases surveillance. Recommendations include the unification of the reporting forms between different health providers, increased involvement of health providers in reporting of infectious diseases, and complete separation of surveillance and clinical activities in epidemiology departments.

BCG vaccine and post-BCG complications among infants in Gaza Strip, 1999

The relationship between post-BCG complications and the practices of administration and/or use of certain batches of BCG vaccine was investigated. A questionnaire were given to nurses administering BCG vaccination. An abstraction sheet was used to analyse cases with BCG complications among infants [n = 552] and schoolchildren [n = 97]. The rate of complications was 14.7/1000 among infants and 2.5/1000 among schoolchildren in 1997. The complications rate was 19.1/1000 at UNRWA and 8.3/1000 at governmental health services. It was found that a single batch of BCG 2611-11 combined with incorrect administering of the vaccine was responsible for this outbreak of complications. Therefore, the establishment of a surveillance system to monitor adverse events following immunization is needed.

A critical review of the infectious diseases surveillance system in the Gaza Strip

The development and strengthening of national surveillance systems is a key part of communicable disease control. This review article describes and evaluates the Palestinian surveillance system and discusses the role of the epidemiology departments and other health providers in Gaza Strip in reporting infectious diseases, considers the use of the data collected, and makes recommendations for strengthening infectious diseases surveillance. Underreporting of infectious diseases remains a major problem in communicable diseases surveillance. Recommendations include the unification of the reporting forms between different health providers, increased involvement of health providers in reporting of infectious diseases, and complete separation of surveillance and clinical activities in epidemiology departments.

BCG vaccine and post-BCG complications among infants in Gaza Strip, 1999

The relationship between post-BCG complications and the practices of administration and/or use of certain batches of BCG vaccine was investigated. A questionnaire were given to nurses administering BCG vaccination. An abstraction sheet was used to analyse cases with BCG complications among infants (n = 552) and schoolchildren (n = 97). The rate of complications was 14.7/1000 among infants and 2.5/1000 among schoolchildren in 1997. The complications rate was 19.1/1000 at UNRWA and 8.3/1000 at governmental health services. It was found that a single batch of BCG 2611-11 combined with incorrect administering of the vaccine was responsible for this outbreak of complications. Therefore, the establishment of a surveillance system to monitor adverse events following immunization is needed.

A pre-steady-state kinetic analysis of substrate binding to human recombinant deoxycytidine kinase: a model for nucleoside kinase action

Deoxycytidine kinase (dCK) is an enzyme with broad substrate specificity which can phosphorylate pyrimidine and purine deoxynucleosides, including important antiviral and cytostatic agents. In this study, stopped-flow experiments were used to monitor intrinsic fluorescence changes induced upon binding of various phosphate donors (ATP, UTP, and the nonhydrolyzable analogue AMP-PNP) and the acceptor dCyd to recombinant dCK. Monophasic kinetics were observed throughout. The nucleotides as well as dCyd bound to the enzyme by a two-step mechanism, involving a rapid initial equilibrium step, followed by a protein conformational change that is responsible for the fluorescence change. The bimolecular association rate constants for nucleotide binding [(4-10) x 10(3) M-1 s-1] were 2-3 orders of magnitude lower than those for dCyd binding [(1.3-1.5 x 10(6) M-1 s-1]. This difference most likely is due predominantly to the large difference in the forward rate constants of the conformational changes (0.04-0.26 s-1 vs 560-710 s-1). Whereas the kinetics of the binding of ATP, UTP, and AMP-PNP to dCK showed some differences, UTP exhibiting the tightest binding, no significant differences were observed for the binding of dCyd to dCK in the presence or absence of phosphate donors. However, the binding of dCyd to dCK in the presence of ATP or UTP was accompanied by a 1.5- or 3-fold higher quenching amplitude as compared with dCyd alone or in the presence of AMP-PNP. We conclude that ATP and UTP induce a conformational change in the enzyme, thereby enabling efficient phosphoryl transfer.

Human brucellosis in Gaza Strip, Palestine

The magnitude of the brucellosis problem in the Gaza Strip and the exposure to risk factors among cases were investigated. The incidence of brucellosis in 1996 was 8/100 000. The age-specific incidence rate was approximately equal in all age groups, with a mean age of infection of 20 years. Cases were reported from all districts, with a particularly high incidence in the Mid-zone district and Gaza City, and most cases had onset of illness in spring and summer. The main reported risk factor was consumption of milk and milk products, especially home-made cheese [70.4%], and 22.2% of cases were among animal breeders. The proportion of chronic and relapsing cases was very high [17%]

Steal syndrome complicating hemodialysis access

The purposes of this study were to examine potential causes for arterial steal syndrome in patients with hemodialysis shunts and to evaluate the results of treatment. A retrospective analysis was performed on all hemodialysis patients who presented with arterial steal syndrome over a 3-year period. Medical records were reviewed to determine demographic data, time to development of symptoms, operative details, and treatment outcome. Results of upper-extremity arteriography in the last five patients were also documented. Eighteen patients presented with steal syndrome at a mean of 7(4) months after shunt placement. Four patients had prior ipsilateral grafts. Fifteen (83%) patients had forearm shunts in loop configuration between the main brachial artery and a superficial vein, and three had straight upper-arm shunts. Graft sizes were 6 mm in five patients and 4- to 7 step grafts in 13. Graft banding was used to treat steal in 11 shunts, one of which remained patent. All five patients who underwent upper-extremity arteriography had arterial stenoses demonstrated in the inflow circulation. In conclusion, arterial steal is an uncommon complication of hemodialysis shunts. Shunt location and choice of graft do not appear to be major factors: steal can develop regardless of access site, configuration, or use of straight versus step graft. Banding is an ineffective method of treatment. Arteriography may be important to detect unsuspected inflow stenoses in patients with steal syndrome.

[Evaluation of Mexican biomedical journals]

We present the evaluation procedures of Biomedical Journals, performed by the Journal Committee of the Centro Nacional de Información y Documentación sobre Salud (CENIDS) for the preparation of CR-ROM ARTEMISA 2 (Edited health information articles in Mexico), which contains a database of the complete text of articles appearing in the journals of the highest quality published in Mexico.

[Biofeedback in the treatment of fecal incontinence]

Four hundred and thirty seven consecutive patients with problems of motility were referred to, and examined at our third-level unit from 1987 to 1993. Forty seven (mean age 36.3 +/- 3.8, range 5-76 years; 25 females) fulfilled the established criteria for fecal incontinence. The mean period of total incontinence was 55.4 +/- 7.6 months (range 6 months to 21 years), with episodes of incontinence of 2.4 +/- 0.2 (range 1-7 a day). All patients were asked to complete a questionnaire in order to validate the incontinence diagnosis. A complete clinical history was obtained from each patient, and they were given laboratory tests, barium enema, recto-sigmoidoscopy, rectal sensitivity tests, recto-anal manometry, and biofeedback without electronic equipment. Twenty one normal subjects were used as a control group. Patients with fecal incontinence showed less rectal sensitivity (P < 0.01). The spontaneous recto-anal inhibitory reflex was not present in all forty seven. All the patients that completed their treatment were completely cured in a period of 4 +/- 0.5 months (range 16 days to 15 months), and follow-up continued for one to eight years. To sum up, this new therapeutic approach is beneficial independent of age, duration and cause of incontinence. The treatment is patient-friendly and economical. Doctors have changed their attitudes, and the quality of life of the patient has improved dramatically, thus providing clinical signification, and proof of the validity and applicability of this treatment: using biofeedback without electronic equipment in the treatment of fecal incontinence.

Chloramine-T in radiolabeling techniques. I. Kinetics and mechanism of the reaction between chloramine-T and amino acids

The determination of the rate and pH dependency of chlorination of amino acids by chloramine-T (CAT) using the model compounds beta-alanine, L-alanine, and L-alanine ethyl ester was investigated. The reactions were studied under pseudo-first-order conditions where the amino acid concentration was in large excess over CAT. The rates of the reactions were determined spectrophotometrically by following the disappearance of CAT. The overall reaction was found to obey second-order kinetics. The effect of pH was studied over the range 6.1 to 12.0. The reaction rate was found to be independent of pH in the range 6.1 to 8.5, and to decrease with increasing pH above 8.5. The pH dependency was rationalized by assuming that un-ionized CAT reacts with the un-ionized amino group of the amino acid. The value of the resulting second-order rate constant (1.9 x 10(7) M-1 min-1) was of the same order of magnitude as rate constants reported for similar N-chlorination reactions. A cyclic transition state involving a water molecule is proposed.

Changing trends in hepatic resection for malignant liver tumours

The records of 57 patients who underwent 65 liver resections for malignant tumours were reviewed. All patients were treated from August 1989 to November 1992 at the Hammersmith Hospital. The type of resections performed were: 13 extended right hepatectomies, 12 right hepatectomies, 12 left hepatectomies, 1 extended left hepatectomy, 7 unisegmentectomies, 10 bisegmentectomies, 3 trisegmentectomies and 3 non-anatomical resections. Operative mortality was 1.5% (1 patient). Repeated liver resections for tumour recurrence were performed in 6 patients with satisfactory early results. The mean postoperative hospital stay was 19.7 +/- 14.2 days. Improvements in operative results have led to relaxation of resectability criteria. A policy of liver resection for "early" tumours for cure has been extended to "advanced" lesions for symptoms palliation. Liver resection still remains a major operation but has become a routine safe surgical procedure.

Estimation of small bowel transit time following colectomy and ileal reservoir construction

A study was carried out to evaluate the breath hydrogen test as a method of estimating small bowel transit in patients with an ileal pouch and to determine whether gut transit time influenced functional outcome. Twelve patients with an ileal reservoir and ten control subjects ingested a test meal of 400 ml chicken soup, 20 g lactulose and 50 ml dilute barium solution. Concurrent breath hydrogen testing and radiological screening was carried out until the head of the test meal reached the ileal pouch or caecum. At the time that the test meal arrived in the pouch, faecal anaerobic bacterial counts were obtained. Pouch compliance, functional capacity and anal sphincter pressures were also measured. While there was an excellent correlation between radiological and breath hydrogen measures of orocaecal transit time in controls (P less than 0.001), no such relationship was found for oropouch transit. Four of the 12 patients with a pouch produced no hydrogen after test meal ingestion, while in two other such patients breath hydrogen peaks occurred when the head of the meal was in the jejunum. The magnitude of the breath hydrogen rise in patients with an ileal pouch correlated well with faecal anaerobic bacterial counts (P less than 0.01). The median (95 per cent confidence interval) radiological small bowel transit time was more rapid in patients with a pouch than in control subjects: 28 (23-33) versus 72 (46-86) min (P less than 0.01). Increased 24-h frequency of defaecation was associated with more rapid small bowel transit after ileal reservoir construction (P less than 0.01) but correlated with neither pouch capacity nor compliance. These data show that small bowel transit time may be a determinant of ileal pouch function but that breath hydrogen estimation of gut transit time in patients with an ileal reservoir is unreliable.

Kinetics and mechanism of decomposition of N-chloroamino acids. II: conformationally restricted models

The kinetics of decomposition of the following conformationally restricted N-chloro-alpha-amino acids were studied: 1-amino-1-cyclopentanecarboxylic acid (2), 1-amino-1-cyclohexanecarboxylic acid (4), 2-amino-2-norbornanecarboxylic acid (6), and 2-amino-2-benzonorbornanecarboxylic acid (8). The first-order rate constants obtained were 0.520, 5.197, 0.198, and 0.078, respectively, which correlated with the ring strain in the structurally related cyclic ketones cyclopentanone, cyclohexanone, norborane-2-one, and benzonorbornane-2-one. The data are supportive of a concerted mechanism for the decomposition reaction involving an imine-like transition state.

A bioequivalence study of two dipyridamole products

Bioequivalence of Antiplate 75 mg was assessed versus Persantine 75 mg in a two-way crossover study. At the 5% confidence level, no significant difference was found between the area under the plasma concentration-time curves of the two products. The Cmax were comparable for both products. Quality control data including assay, content uniformity, disintegration and dissolution indicated that both products passed the pharmacopoeial requirements, USP XXI and BP 1980, Addendum 1983. It is concluded that Antiplate-75 is bioequivalent to Persantine.

Genito-urinary complications of brucellosis

Twelve cases of genito-urinary complications of brucellosis are presented. Ten patients had epididymo-orchitis, 1 presented with right hydronephrosis and 1 with haematuria and dysuria. The 10 cases of epididymo-orchitis were compared with 15 cases of acute non-specific epididymo-orchitis. The former were of longer duration and were not associated with lower urinary tract symptoms; almost all of these patients had ingested unpasteurised milk. Non-specific epididymo-orchitis had a more acute onset, shorter duration and was associated more frequently with pyuria, lower urinary tract symptoms, higher leucocyte counts and insignificant brucella titres. The distinction between these two types of epididymo-orchitis is essential, since the treatments are entirely different.

A benign chondroblastoma with a rare location

The benign chondroblastoma is rarely located at the leg and hand bones. The reported case had a deformation of the first phalanx of the left leg second finger, clinico-radiologically diagnosed as a chondroma, and only the histopathological examination sets the diagnosis of benign chondroblastoma.