Sorption Isotherms and Thermodynamic Characteristics of Gelatin Powder Extracted from Whitefish Skin: Mathematical Modeling Approach

Moisture adsorption and desorption isotherms of gelatin extracted from whitefish skin powder (FSGP) at different temperatures across a wide range of water activity were determined along with their thermodynamic properties. Nine mathematical models were utilized for fitting the experimental data and simulating the adsorption and desorption behavior. The thermodynamic properties were determined and fitted to the experimental data. The results showed that Peleg and GAB models were the best fit for FSGP. The energies involved in the adsorption and desorption process of FSGP indicated a stronger dependence on equilibrium moisture content (Xe). When Xe decreased, there was a consistent trend of increasing thermodynamic properties. Both the moisture adsorption and desorption behaviors of FSGP were, therefore, non-spontaneous processes. Linear correlations between the changes in enthalpy and entropy for adsorption and desorption were observed, indicating the presence of enthalpy-entropy compensation for FSGP. For preserving FSGP quality, it should be stored with Xw ≤ 8 (gw/gdm, d.b.) at temperatures below 53 °C and an RH of 50% to avoid it becoming rubbery. These findings are crucial for providing insight into the optimal drying and storage conditions.

Male Genital Mutilation in the Name of Ritual Circumcision: A Case Report and Literature Review

Unlike female genital mutilation, the alteration of male genitals has not received much attention. Circumcision is the most common and oldest surgical procedure being performed. When performed by surgeons or well-trained personal the procedure is safe, but most of the times it is being performed by untrained people with no or little medical background. This has led to many complications. Total skin loss is an uncommon but serious complication. There is an ongoing debate regarding the management of this complication. Here, we present a case of total penile skin loss which had resulted from penile mutilation in the name of ritual circumcision.

Evaluating Kinetics of Convection Drying and Microstructure Characteristics of Asian Seabass Fish Skin without and with Ultrasound Pretreatment

Convection drying in combination with ultrasound pretreatment has emerged as a promising technology for seafood manufacturing. The primary objective of this research was to model the mass transfer process of Asian seabass (Lates calcarifer) fish skin without and with ultrasound pretreatment during convection drying at different temperatures (45, 55, and 65 °C). Additionally, the study aimed to examine the impact of ultrasound pretreatment and temperatures on the drying characteristics and specific energy consumption for drying of Asian seabass fish skin. Seven semi-theoretical models, namely Lewis, Page, modified Page, Vega-Lemus, Verma, Henderson and Pabis, and two-term models, were employed to characterize the moisture transfer process. The results of the study indicated a decrease in the moisture content as the drying time increased at different drying temperatures. Higher drying temperatures were associated with an increased drying rate. Among the mathematical models tested, the modified Page model provided a satisfactory description of the thin-layer drying characteristics of fish skin. Fick's law of diffusion was utilized to determine the effective moisture diffusivities. Comparing the drying of fish skin without (SS) and with ultrasound pretreatment (US-SS), the drying of the latter generally showed higher Deff values. The temperature dependence of the effective diffusivity coefficient was well described by the Arrhenius-type model. An increase in the drying temperature resulted in an increment of the effective moisture diffusivity. In general, the skin pretreated using ultrasound had a reduced drying time, by up to 28%. Additionally, this approach contributed to an approximate 22% reduction in the specific energy consumption, concurrently enhancing the energy efficiency. The microstructure analysis showed that fresh and dried US-SS samples had a more open structure and higher porosity, in comparison to the corresponding SS samples. These findings contribute to the knowledge on the application of ultrasound as the pretreatment of fish skin before drying and provide valuable insights for the development of potential drying techniques in the seafood industry.

Advanced Red Meat Cooking Technologies and Their Effect on Engineering and Quality Properties: A Review

The aim of this review is to investigate the basic principles of red meat cooking technologies, including traditional and modern methods, and their effects on the physical, thermal, mechanical, sensory, and microbial characteristics of red meat. Cooking methods were categorized into two categories: traditional (cooking in the oven and frying) and modern (ohmic, sous vide, and microwave cooking). When red meat is subjected to high temperatures during food manufacturing, it undergoes changes in its engineering and quality attributes. The quality standards of meat products are associated with several attributes that are determined by food technologists and consumers based on their preferences. Cooking improves the palatability of meat in terms of tenderness, flavor, and juiciness, in addition to eliminating pathogenic microorganisms. The process of meat packaging is one of the important processes that extend the life span of meat and increase its shelf life due to non-exposure to oxygen during cooking and ease of handling without being exposed to microbial contamination. This review highlights the significance of meat cooking mathematical modeling in understanding heat and mass transfer phenomena, reducing costs, and maintaining meat quality. The critical overview considers various production aspects/quality and proposed methods, such as, but not limited to, hurdle technology, for the mass production of meat.

Demographic and clinico-pathological characteristics of colorectal cancer in Kirkuk governorate, Iraq

BACKGROUND

World-wide Colorectal cancer (CRC) is the third most common cancer with one million new cases a year. Historically, a higher incidence of this disease has been recorded among the elderly in the western countries, but it is increasing in developing countries and in younger age groups.

AIM

This study aims to find whether CRC cancer is progressively affecting the younger age groups known as early onset (< 50 years). In addition, it describes the pathological characteristics of CRC in early onset CRC cases.

METHOD

The study is retrospective cross-sectional. It was conducted over a period of five months from October 1st 2019 till 1st March 1st 2020. Data were drawn from patients with CRC from their medical records at Kirkuk Oncology Centre (KOC) and from the IRAQI National CANCER REGISTRY (INCR) over thirteen years period from 2006 to 2018. The basic data we obtained for each patient include sex, age, and stage, grade of the disease at diagnosis and mode of presentation.

RESULTS

The Initial study population included 654 patients of both genders and all ages. CRC occurred in < 5.5/100,000 population per year which accounted for < 8% of total malignancies (2006-2018). The patients were divided into two groups; an early onset (< 50 years) group and a late onset CRC (⩾ 50 years) group. The final study population provided enough data for 238 patients for the years (2014-2018) with an age range of 20-91 and a mean of 54.4 years. The males were ∼54% while ∼46% were females. The age group under 50 years (early onset CRC) was ∼41% (no 98) while those who are 50 years and older (late onset) stood for 59% (no 140). There were no statistical differences between the two age groups regarding stage, grade, or presenting symptom.

CONCLUSION

CRC is common in early onsets or young age groups with similar pathological characteristics to those of the late onset cancer. Accordingly, even mild lower gastrointestinal symptoms should be taken seriously. The study points toward an increasing awareness of the population on the importance of colorectal cancer. Also, conducting more surveillance studies and investigations would be recommended for early detections of the disease in young populations.

The association between salivary zinc levels and dysgeusia in COVID-19 patients

OBJECTIVE

Zinc insufficiency has been proposed to play a role in taste and smell impairment in Coronavirus disease 2019 (COVID-19) patients. Therefore, this study aimed at comparing salivary zinc levels in COVID-19 patients with and without dysgeusia.

PATIENTS AND METHODS

A total of 127 participants were recruited for this study. The patients were divided into three groups based on their COVID-19 test results and taste impairment. Groups I and II were COVID-19 positive with and without taste loss, respectively. Group III included the negative control participants. Salivary zinc levels were measured at baseline in all groups and three months after baseline in groups I and II. Wilcoxon signed-rank test was used to compare the zinc levels between baseline and three months after baseline within each group. Mann-Whitney U test was used to compare zinc levels between groups with different degrees of taste loss.

RESULTS

Salivary zinc levels were significantly lower in the COVID-19 positive group with taste loss compared to levels in the group without taste loss or the negative controls (p<0.005). Three months after baseline, salivary zinc levels were significantly elevated in both COVID-19 positive groups (p<0.001).

CONCLUSIONS

COVID-19 patients with dysgeusia had significantly lower levels of salivary zinc than positive and negative controls. Zinc levels were elevated after recovery, which may indicate that salivary zinc is directly associated with taste abnormalities and COVID-19 outcomes. This study showed that taste impairment is associated with lower salivary zinc levels in COVID-19 patients.

Penetrating scrotal injury due to a bamboo stick in a child: A case report and literature review

The penetrating scrotal trauma is rare in children. Due to low incidence of penetrating scrotal injuries in children, the evaluation and management of this type of injuries has not been well described. To prevent the long term sequalae and complications all such injuries require a prompt surgical exploration and management. We are reporting a five-year-old boy with a penetrating injury in his scrotum due to a bamboo stick. After the stabilization and lab and radiological workup patient was subjected to surgical exploration. Inspite of the severity of the trauma the testis and the spermatic cord were spared of any injury.

Calmodulin mutations and life-threatening cardiac arrhythmias: insights from the International Calmodulinopathy Registry

AIMS

Calmodulinopathies are rare life-threatening arrhythmia syndromes which affect mostly young individuals and are, caused by mutations in any of the three genes (CALM 1-3) that encode identical calmodulin proteins. We established the International Calmodulinopathy Registry (ICalmR) to understand the natural history, clinical features, and response to therapy of patients with a CALM-mediated arrhythmia syndrome.

METHODS AND RESULTS

A dedicated Case Report File was created to collect demographic, clinical, and genetic information. ICalmR has enrolled 74 subjects, with a variant in the CALM1 (n = 36), CALM2 (n = 23), or CALM3 (n = 15) genes. Sixty-four (86.5%) were symptomatic and the 10-year cumulative mortality was 27%. The two prevalent phenotypes are long QT syndrome (LQTS; CALM-LQTS, n = 36, 49%) and catecholaminergic polymorphic ventricular tachycardia (CPVT; CALM-CPVT, n = 21, 28%). CALM-LQTS patients have extremely prolonged QTc intervals (594 ± 73 ms), high prevalence (78%) of life-threatening arrhythmias with median age at onset of 1.5 years [interquartile range (IQR) 0.1-5.5 years] and poor response to therapies. Most electrocardiograms (ECGs) show late onset peaked T waves. All CALM-CPVT patients were symptomatic with median age of onset of 6.0 years (IQR 3.0-8.5 years). Basal ECG frequently shows prominent U waves. Other CALM-related phenotypes are idiopathic ventricular fibrillation (IVF, n = 7), sudden unexplained death (SUD, n = 4), overlapping features of CPVT/LQTS (n = 3), and predominant neurological phenotype (n = 1). Cardiac structural abnormalities and neurological features were present in 18 and 13 patients, respectively.

CONCLUSION

Calmodulinopathies are largely characterized by adrenergically-induced life-threatening arrhythmias. Available therapies are disquietingly insufficient, especially in CALM-LQTS. Combination therapy with drugs, sympathectomy, and devices should be considered.

Stability of vitamin C, color, and garlic aroma of garlic mashed potatoes in polymer packages processed with microwave-assisted thermal sterilization technology

The U.S. Army and NASA need ready-to-eat meals with extended shelf-life for military operations and future manned space missions. For traditional heat sterilization methods, aluminum foil laminated pouches are used to achieve a shelf-life of 3 to 5 years at room temperature. However, those packages are not suited for advanced thermal processing technologies based on microwave energy. This research investigated the effect of polymeric packaging materials on storage stability of garlic flavor, vitamin C, and color of garlic mashed potatoes processed with microwave-assisted thermal sterilization (MATS) technology. Three types of high-barrier metal oxide-coated polymer pouches were used for MATS process, designed to achieve lethality approximately F₀ = 6 min. Aluminum foil-based pouches were used for retort process as control. Results demonstrated that both oxygen and water vapor barrier properties (oxygen transmission rate [OTR] and water vapor transmission rate [WVTR]) of the polymer pouches were affected by MATS processing. OTR increased by three to nine times, while WVTR increased by 5 to 20 times after processing. The MATS process resulted in 13% to 16% vitamin C loss, while retort process resulted in 18% loss in garlic mashed potato. The kinetics of vitamin C indicated that metal oxide-coated high-barrier packages (after processing OTR <0.1 cc/m² .day; WVTR <1.0 g/m² .day) could replace aluminum foil-based pouches for MATS processed shelf-stable ready-to-eat garlic mashed potatoes. PRACTICAL APPLICATION: Garlic mashed potatoes in polymer packages processed in a microwave-assisted thermal sterilization (MATS) system had better retention of vitamin C compared to samples packaged in aluminum laminated pouches and processed in retort. Polymer packages combined with MATS processing could potentially provide safe, better quality, and nutritious shelf-stable food products for military and space missions.

Waterpipe smoking and the risk of myocardial infarction: A hospital-based case-control study

INTRODUCTION

The prevalence of waterpipe smoking is increasing globally. The involvement of waterpipe smoking as an independent risk factor for the development of myocardial infarction is an area in need of further research. Our study examines the possible relationship between waterpipe smoking and myocardial infarction.

METHODS

In this incident case-control study, we enrolled 148 cases with myocardial infarction and 148 participants in the control group. Using logistic regression models, odds ratios and 95% CIs were calculated for the association between waterpipe smoking and myocardial infarction, while adjusting for possible confounders.

RESULTS

Myocardial infarction was associated significantly with current waterpipe smoking (OR=4.08; 95% CI: 1.37–12.10), ever waterpipe smoking (OR=3.6; 95% CI: 1.31–10.19), and exclusive waterpipe smoking (OR=10.26; 95% CI: 2.22–47.29). Exclusive cigarette smoking was also associated significantly with the development of myocardial infarction (OR=4.6; 95% CI: 1.98–11.04).

CONCLUSIONS

Waterpipe smoking is associated with myocardial infarction. Our findings reveal the need for targeted interventions to reduce the prevalence of this globally spreading form of tobacco smoking.

Genetic Mosaicism in Calmodulinopathy

BACKGROUND

CaM (calmodulin) mutations are associated with congenital arrhythmia susceptibility (calmodulinopathy) and are most often de novo. In this report, we sought to broaden the genotype-phenotype spectrum of calmodulinopathies with 2 novel calmodulin mutations and to investigate mosaicism in 2 affected families.

METHODS

CaM mutations were identified in 4 independent cases by DNA sequencing. Biochemical and electrophysiological studies were performed to determine functional consequences of each mutation.

RESULTS

Genetic studies identified 2 novel CaM variants (CALM3-E141K in 2 cases; CALM1-E141V) and one previously reported CaM pathogenic variant (CALM3-D130G) among 4 probands with shared clinical features of prolonged QTc interval (range 505-725 ms) and documented ventricular arrhythmia. A fatal outcome occurred for 2 of the cases. The parents of all probands were asymptomatic with normal QTc duration. However, 2 of the families had multiple affected offspring or multiple occurrences of intrauterine fetal demise. The mother from the family with recurrent intrauterine fetal demise exhibited the CALM3-E141K mutant allele in 25% of next-generation sequencing reads indicating somatic mosaicism, whereas CALM3-D130G was present in 6% of captured molecules of the paternal DNA sample, also indicating mosaicism. Two novel mutations (E141K and E141V) impaired Ca²⁺ binding affinity to the C-domain of CaM. Human-induced pluripotent stem cell-derived cardiomyocytes overexpressing mutant or wild-type CaM showed that both mutants impaired Ca²⁺-dependent inactivation of L-type Ca²⁺ channels and prolonged action potential duration.

CONCLUSIONS

We report 2 families with somatic mosaicism associated with arrhythmogenic calmodulinopathy, and demonstrate dysregulation of L-type Ca²⁺ channels by 2 novel CaM mutations affecting the same residue. Parental mosaicism should be suspected in families with unexplained fetal arrhythmia or fetal demise combined with a documented CaM mutation.

Autosomal recessive long QT syndrome, type 1 in eight families from Saudi Arabia

Background

One of the most common primary cardiac arrhythmia syndromes is autosomal dominant long QT syndrome, type 1 (LQT1), chiefly caused by mono‐allelic mutations in the KCNQ1 gene. Bi‐allelic mutations in the KCNQ1 gene are causal to Jervell and Lange‐Nielsen syndrome (JLNS), characterized by severe and early‐onset arrhythmias with prolonged QTc interval on surface ECG and sensorineural deafness. Occasionally, bi‐allelic mutations in KCNQ1 are also found in patients without any deafness, referred to as autosomal recessive long QT syndrome, type 1 (AR LQT1).

Methods

We used Sanger sequencing to detect the pathogenic mutations in KCNQ1 gene in eight families from Saudi Arabia with autosomal recessive LQT1.

Results

We have detected pathogenic mutations in all eight families, two of the mutations are founder mutations, which are c.387‐5T>A and p.Val172Met/p.Arg293Cys (in cis). QTc and cardiac phenotype was found to be pronounced in all the probands comparable to the cardiac phenotype in JLNS patients. Heterozygous carriers for these mutations did not exhibit any clinical phenotype, but a significant number of them have sinus bradycardia.

Conclusion

To the best of our knowledge, this is the first description of a large series of patients with familial autosomal recessive LQT, type 1. These mutations could be used for targeted screening in cardiac arrhythmia patients in Saudi Arabia and in people of Arabic ancestry.

STAT3 paradoxically stimulates β-catenin expression but inhibits β-catenin function

Wnt signalling and the signal transducer and activator of transcription 3 (STAT3) are oncogenic signalling pathways which are deregulated in colorectal cancer (CRC). Here we investigated the interaction of these two pathways. Firstly, we investigated biochemical interaction by inhibiting STAT3 and β-catenin (through gene knock-down and dominant-negative TCF4 expression) in nine CRC cell lines. β-catenin inhibition did not affect STAT3 levels, whereas STAT3 knock-down resulted in reduced β-catenin mRNA and protein levels. The reduction in β-catenin protein was not prevented by proteasome inhibition, and IL6-induced STAT3 activation resulted in increased β-catenin mRNA. This suggests that STAT3 positively regulates β-catenin (at a transcriptional level) and evaluation of 44 CRCs by immunostaining supported this by showing an association between nuclear STAT3 expression and nuclear β-catenin (P = 0.022). We tested the functional interaction between STAT3 and Wnt signalling by knocking down STAT3 and β-catenin individually and in combination. Knock-down of β-catenin and STAT3 individually inhibited cell proliferation (P < 0. 001 for each) through G1 arrest. However, simultaneous knock-down of STAT3 and β-catenin had a significantly weaker effect than knock-down of β-catenin alone (P < 0.01). Knock-down of STAT3 and β-catenin, individually and together, inhibited cell motility (P < 0.001) without evidence of interaction. We conclude that STAT3 regulates β-catenin but β-catenin does not regulate STAT3. The STAT3/β-catenin interaction is complex but may reduce the proliferative activity of β-catenin possibly by taking β-catenin protein beyond the optimal level. This may indicate biological differences in tumours where both STAT3 and β-catenin are activated compared to those where only one is activated.

The impacts of dental filling materials on RapidArc treatment planning and dose delivery: challenges and solution

PURPOSE

The presence of high-density material in the oral cavity creates dose perturbation in both downstream and upstream directions at the surfaces of dental filling materials (DFM). In this study, the authors have investigated the effect of DFM on head and neck RapidArc treatment plans and delivery. Solutions are proposed to address (1) the issue of downstream dose perturbation, which might cause target under dosage, and (2) to reduce the upstream dose from DFM which may be the primary source of mucositis. In addition, an investigation of the clinical role of a custom-made plastic dental mold∕gutter (PDM) in sparing the oral mucosa and tongue reaction is outlined.

METHODS

The influence of the dental filling artifacts on dose distribution was investigated using a geometrically well-defined head and neck intensity modulated radiation therapy (IMRT) verification phantom (PTW, Freiberg, Germany) with DFM inserts called amalgam, which contained 50% mercury, 25% silver, 14% tin, 8% copper, and 3% other trace metals. Three RapidArc plans were generated in the Varian Eclipse System to treat the oral cavity using the same computer tomography (CT) dataset, including (1) a raw CT image, (2) a streaking artifacts region, which was replaced with a mask of 10 HU, and (3) a 2 cm-thick 6000 HU virtual filter [a volume created in treatment planning system to compensate for beam attenuation, where the thickness of this virtual filter is based on the measured percent depth dose (PDD) data and Eclipse calculation]. The dose delivery for the three plans was verified using Gafchromic-EBT2 film measurements. The custom-made PDM technique to reduce backscatter dose was clinically tested on four head and neck cancer patients (T3, N1, M0) with DFM, two patients with PDM and the other two patients without PDM. The thickness calculation of the PDM toward the mucosa and tongue was purely based on the measured upstream dose. Patients' with oral mucosal reaction was clinically examined initially and weekly during the course of radiotherapy.

RESULTS

For a RapidArc treatment technique, the backscatter dose from the DFM insert was measured to be 9.25±2.17 in the IMRT-verification-phantom. The measured backscatter upstream dose from DFM for a single-field was 22% higher than without the DFM, whereas the downstream dose was lower by 14%. The values of homogeneity index for the plans with and without the application of mask were 0.09 and 0.14, respectively. The calculated mean treatment planning volume (PTV) dose differed from the delivered dose by 13% and was reduced to 2% when using the mask and virtual filter together. A grade 3 mucosa reaction was observed in the control group after 22-24 fractions (44-48 Gy). In contrast, no grade 3 mucositis was observed in the patients wearing the PDM after 25-26 fractions (50-52 Gy).

CONCLUSIONS

The backscatter from the DFM for a single, parallel-opposed fields, and RapidArc treatment technique was found significant. The application of mask in replacing streaking artifacts can be useful in improving dose homogeneity in the PTV. The use of a virtual filter around the teeth during the planning phase reduces the target underdosage issue in the phantom. Furthermore, a reduction in mucositis is observed in the head and neck patients with the use of PDM.

Cten is targeted by Kras signalling to regulate cell motility in the colon and pancreas

CTEN/TNS4 is an oncogene in colorectal cancer (CRC) which enhances cell motility although the mechanism of Cten regulation is unknown. We found an association between high Cten expression and KRAS/BRAF mutation in a series of CRC cell lines (p = 0.03) and hypothesised that Kras may regulate Cten. To test this, Kras was knocked-down (using small interfering (si)RNA) in CRC cell lines SW620 and DLD1 (high Cten expressors and mutant for KRAS). In each cell line, Kras knockdown was mirrored by down-regulation of Cten Since Kras signals through Braf, we tested the effect of Kras knockdown in CRC cell line Colo205 (which shows high Cten expression and is mutant for BRAF but wild type for KRAS). Cten levels were unaffected by Kras knockdown whilst Braf knockdown resulted in reduced Cten expression suggesting that Kras signals via Braf to regulate Cten. Quantification of Cten mRNA and protein analysis following proteasome inhibition suggested that regulation was of Cten transcription. Kras knockdown inhibited cell motility. To test whether this could be mediated through Cten, SW620 cells were co-transfected with Kras specific siRNAs and a Cten expression vector. Restoring Cten expression was able to restore cell motility despite Kras knockdown (transwell migration and wounding assay, p<0.001 for both). Since KRAS is mutated in many cancers, we investigated whether this relationship could be demonstrated in other tumour models. The experiments were repeated in the pancreatic cancer cell lines Colo357 & PSN-1(both high Cten expressors and mutant for KRAS). In both cell lines, Kras was shown to regulate Cten and forced expression of Cten was able to rescue loss of cell motility following Kras knockdown in PSN-1 (transwell migration assay, p<0.001). We conclude that, in the colon and pancreas, Cten is a downstream target of Kras and may be a mechanism through which Kras regulates of cell motility.

Knowledge and attitudes towards AIDS among Saudi and non-Saudi bus drivers

We explored the AIDS knowledge and attitudes of long-distance (non-Saudi) and in-city (Saudi) bus drivers in Saudi Arabia. The 69 non-Saudi drivers tended to score higher on knowledge than the 40 Saudi drivers although there were several gaps in their knowledge. As regards attitude, more Saudis knew that chastity could protect against AIDS and both groups tended to think that they were not the kind of people to get AIDS. Intensive health education and follow up is highly recommended for this sector of workers.

Nosocomial infections and misuse of antibiotics in a provincial community hospital, Saudi Arabia

The incidence of nosocomial infection and prevalence of antibiotic misuse were studied in a 174-bed community hospital in Saudi Arabia over a six-month period. Of 2445 patients admitted, 8.5% developed nosocomial infection, the rates were highest for nursery (35.8%), intensive care (19.8%), gynaecological (16.2%) and surgical (11.7%) patients. Urinary tract (31.3%), wound (27.1%) and blood (14.9%) infections accounted for more than 70% of the infections. Staphylococcus aureus (23%) and Pseudomonas aeruginosa (11%), caused more than 90% of the infections. The majority of the bacterial pathogens (79%) were multi-drug resistant. Over 80% of patients were administered prophylactic and/or therapeutic antibiotics, with 53% receiving multiple antibiotics; 72% of the antibiotics were judged to be misused. Both prophylaxis and treatment were mostly misguided and clinically unwarranted. Host- and hospital-associated infection risk factors were identified. The minimum government cost estimates for the nosocomial infections and misused antibiotics were US $273 180 and $565 603, respectively. The findings emphasize the need for effective measures to reduce both the high infection rates and widespread antibiotic misusage in the hospital. Such measures should include institution of an effective infection control committee and a hospital antibiotic policy.

Endemic nosocomial infections and misuse of antibiotics in a maternity hospital in Saudi Arabia

Patients admitted during a 6-month period to a maternity hospital in Saudi Arabia were studied for nosocomial infections and misuse of antibiotics. Patient history and diagnosis on admission and subsequent clinical and laboratory data were analysed. Infection developing from 72 h after admission was considered nosocomial. Therapeutic and prophylactic data as recorded on the patients' charts were assessed for possible misuse of antibiotics. Of 3439 patients, 136 (4.0%) developed nosocomial infection: 2.0%, 8.9% and 37.7% in obstetric, gynaecologic and nursery patients, respectively. Infections among adults were mostly found in the urinary (44.4%) and lower genital (33.3%) tracts. Among newborns, over 70% of cases were eye and ear (29.8%), skin (26.2%) and blood (19.0%) infections. Gram-negative bacteria caused 65.7% of the infections. Over 90% of the bacterial isolates were multidrug-resistant. About 24% of patients received single or multiple antibiotics; 57.2% were misused. The minimal hospital cost estimate for both nosocomial infections and misused antibiotics was US $318,705. The findings of this study, the first of its type in this region, should prompt improved infection control measures as well as educational and antibiotic restriction interventions.

Therapeutic efficacy of chloroquine against uncomplicated, Plasmodium falciparum malaria in south-western Saudi Arabia

The results of annual random screening indicated that Plasmodium falciparum strains showing chloroquine (CQ) resistance in vitro became increasingly common in the Jazan region of south-western Saudi Arabia between 1986 and 1998 (chi(2) for trend = 50.027; P < 0.001). This worrying trend and the emergence of a micro-epidemic in 1997-1998 prompted an assessment of the therapeutic efficacy of CQ against uncomplicated, P. falciparum malaria in the area. The in-vivo testing of sensitivity to CQ was carried out in 291 clinically manifest, microscopically positive cases of P. falciparum malaria. Most of these patients (88%) were successfully treated with a single standard regimen of CQ therapy. The other 36 patients (12%) showed early treatment failure or a poor response to the CQ, although all of these were then successfully treated with a single standard dose of sulfadoxine-pyrimethamine (Fansidar), as a replacement therapy. Those unsuccessfully treated with CQ were generally younger (t = 2.625; P = 0.01) and tended to have higher body temperatures (t = -2.62; P = 0.012) and higher levels of parasitaemia at initial presentation (P > 0.000) than those who responded well to the drug. Although CQ remains a reasonably effective drug for the treatment of malaria in the Jazan region, and therefore will be kept as the first-line drug for the foreseeable future, failure of CQ efficacy must be carefully monitored in the area.

Is fine needle aspiration of the tonsil superior to a surface swab for isolating its core flora in recurrent tonsillitis?

This prospective study was designed to explore the possible role of fine needle aspiration of recurrently inflamed tonsils in determining their core flora. Seventy-seven patients undergoing tosillectomy for recurrent tonsillitis were included. Colonies grown from fine needle aspirate and surface swab were compared with tonsillar core culture obtained after tosillectomy. The pathogens isolated by fine needle aspiration culture were not greatly different from surface swab results in comparison to core isolates. The results of fine needle aspirate do not appear to confer any advantage over surface swab in representing core flora. These findings would seem to indicate no clinical use for fine needle aspiration in the management of recurrent tonsillitis.