The impact of comorbidities on postoperative outcomes of ventral hernia repair: the patients' perspective

INTRODUCTION

Ventral hernia repair (VHR) outcomes can be adversely affected by modifiable patient co-morbidities, such as diabetes, obesity, and smoking. Although this concept is well accepted among surgeons, the extent to which patients understand the significance of their co-morbidities is unknown, and a few studies have sought to determine patient perspectives regarding the impact of their modifiable co-morbidities on their post-operative outcomes. We attempted to determine how accurately patients predict their surgical outcomes after VHR compared to a surgical risk calculator while considering their modifiable co-morbidities.

METHODS

This is a prospective, single-center, survey-based study evaluating patients' perceptions of how their modifiable risk factors affect outcomes after elective ventral hernia repair. Pre-operatively, after surgeon counseling, patients predicted the percentage of impact that they believed their modifiable co-morbidities (diabetes, obesity, and smoking) had on 30-day surgical site infections (SSI) and hospital readmissions. Their predictions were compared to the Outcomes Reporting App for CLinicians and Patient Engagement (ORACLE) surgical risk calculator. Results were analyzed using demographic information.

RESULTS

222 surveys were administered and 157 were included in the analysis after excluding for incomplete data. 21% had diabetes, 85% were either overweight with body mass index (BMI) 25-29.9 or obese (BMI ≥ 30), and 22% were smokers. The overall mean SSI rate was 10.8%, SSOPI rate was 12.7%, and 30-day readmission rate was 10.2%. ORACLE predictions correlated with observed SSI rates (OR 1.31, 95% CI 1.12-1.54, p < 0.001), but patient predictions did not (OR 1.00, 95% CI 0.98-1.03, p = 0.868). The correlation between patient predictions and ORACLE calculations was weak ([Formula: see text] = 0.17). Patient predictions were on average 10.1 ± 18.0% different than ORACLE, and 65% overestimated their SSI probability. Similarly, ORACLE predictions correlated with observed 30-day readmission rates (OR 1.10, 95% CI 1.00-1.21, p = 0.0459), but patient predictions did not (OR 1.00, 95% CI 0.975-1.03, p = 0.784). The correlation between patient predictions and ORACLE calculations for readmissions was weak ([Formula: see text] = 0.27). Patient predictions were on average 2.4 ± 14.6% different than ORACLE, and 56% underestimated their readmission probability. Additionally, a substantial proportion of the cohort believed that they had a 0% risk of SSI (28%) and a 0% risk of readmission (43%). Education, income and healthcare employment did not affect the accuracy of patient predictions.

CONCLUSIONS

Despite surgeon counseling, patients do not accurately estimate their risks after VHR when compared to ORACLE. Most patients overestimate their SSI risk and underestimate their 30-day readmission risk. Furthermore, several patients believed that they had a 0% risk of SSI and readmission. These findings persisted regardless of level of education, income level, or healthcare employment. Additional attention should be directed toward setting expectations prior to surgery and using applications such as ORACLE to assist in this process.

Discovery of PIM-1 kinase inhibitors based on the 2,5-disubstituted 1,3,4-oxadiazole scaffold against prostate cancer: Design, synthesis, in vitro and in vivo cytotoxicity investigation

PIM-1 kinases play an established role in prostate cancer development and progression. This research work tackles the design and synthesis of new PIM-1 kinase targeting 2,5-disubstituted-1,3,4-oxadiazoles 10a-g&11a-f, and investigation thereof as potential anti-cancer agents through in vitro cytotoxicity assay followed by in vivo studies along with exploration of this chemotype's plausible mechanism of action. In vitro cytotoxicity experiments have disclosed 10f as the most potent derivative against PC-3 cells (IC₅₀ = 16 nM) compared to the reference drug Staurosporine (IC₅₀ = 0.36 μM), also eliciting good cytotoxicity against HepG2 and MCF-7 cells (IC₅₀ = 0.13 and 5.37 μM, respectively). Investigating PIM-1 kinase inhibitory activity of compound 10f revealed an IC₅₀ of 17 nM paralleled to that of Staurosporine (IC₅₀ = 16.7 nM). Furthermore, compound 10f displayed an antioxidant activity eliciting a DPPH inhibition ratio of 94% as compared to Trolox (96%). Further investigation demonstrated that 10f induced apoptosis in treated PC-3 cells by 43.2-fold (19.44%) compared to 0.45% in control. 10f also disrupted the PC-3 cell cycle by increasing the cell population at the PreG1-phase by 19.29-fold while decreasing the G2/M-phase by 0.56-fold compared to control. Moreover, 10f affected a downregulation of JAK2, STAT3 and Bcl-2 and upregulation of caspases 3, 8 and 9 levels that activated the caspase-dependent apoptosis. Finally, in vivo 10f-treatment caused a significant increase in tumor inhibition by 64.2% compared to 44.5% in Staurosporine treatment of the PC-3 xenograft mouse model. Additionally, it improved the hematological, biochemical parameters, and histopathological examinations compared to control untreated animals. Finally, docking of 10f with the ATP-binding site of PIM-1 kinase demonstrated good recognition of and effective binding to the active site. In conclusion, compound 10f represents a promising lead compound that merits further future optimization for controlling prostate cancer.

Short-term surgical missions: joining hands with local providers to ensure sustainability

Short-term surgical missions may appear to fill a void in surgical capacity in the developing world, but may inadvertently also disrupt well-established local healthcare systems. The surgical providers of an East African hospital developed suggestions for improving these missions so that they can benefit visitors, local providers and patients alike.

Radiation dose estimation of sand samples collected from different Egyptian beaches

A high pure germanium detector-based gamma-ray spectroscopy low-background counting system was used to determine the levels of natural radioactivity from beach sand samples on the Egyptian coast along the Mediterranean and Red Seas. The activity concentrations of (226)Ra, (232)Th and (40)K were found to lie in the range of 30±11 to 60±14 Bq kg(-1) with a mean of 39±15 Bq kg(-1), 12±3 to 30±14 Bq kg(-1) with a mean of 21±13 Bq kg(-1) and 392±22 to 413±22 Bq kg(-1) with a mean of 402±23 Bq kg(-1), respectively. Radiation hazard indices and annual effective doses were evaluated and compared with the international data. The results indicate that the values obtained fall below the internationally accepted maximum limits and do not pose any significant radiation hazard to individuals in the study area. From these results, a radiological baseline map of Egyptian beaches can be drawn and used as reference information to assess any future alterations in the radioactivity of beach sands due to any changes in the sea sediments.

Coronary arteriovenous fistulas: collective review and management of six new cases--changing etiology, presentation, and treatment strategy

We considered it worthwhile to review the literature of the last decade (1985-1995) to answer the question whether the etiology and the clinical picture of coronary arteriovenous fistulas (CAVFs) have changed. Furthermore, new therapeutic modalities such as percutaneous transcatheter embolization have been developed. We tried to define the place of these techniques in the therapeutic arena. Clinical presentation and management of six patients with eight congenital CAVFs and 76 subjects with 96 congenital and acquire I CAVFs taken from a review of the recent literature are presented. Sixty-three review subjects (78%) were treated medically with one fatal case. Ligation of the fistula was achieved by surgical techniques in 10% of review subjects, while percutaneous transcatheter embolization (PTE) was performed in nine patients (12%). Percutaneous transcatheter embolization techniques are being increasingly used in the treatment of CAVFs. The etiology of CAVFs has a tendency to show alterations toward the acquired pathogenesis. In 64% of the review subjects the fistula was congenital in origin, and in 36% it had an acquired cause. Among the patients of the current review, the clinical presentations were 55% asymptomatic, 34% chest pain (anginal or atypical), and 13% congestive heart failure. The CAVFs of our six patients are all congenital in origin. In the current review, the clinical presentation showed a trend toward increasing chest complaints (34%) compared with the review (10%) published in the mid 1970s. This may be due to a higher mean age, and hence increased concurrent coronary artery disease due to aging compared with the review population of two decades ago.

Acquired coronary cameral fistulas: are these collaterals losing their destination?

BACKGROUND

The majority of coronary cameral fistulas (CCFs) are congenital in origin. On the other hand, acquired coronary cameral fistulas, having various etiopathogenic origins, are increasingly recognized.

HYPOTHESIS

The aim of this study was to assess the possible involvement of coronary atherosclerosis in the pathogenesis of acquired coronary cameral fistulas.

METHODS

Between 1993 and 1996 coronary cameral fistulas were detected in seven adults patients with coronary atherosclerosis (n = 4) and following myocardial infarction (n = 3) with a mean age of 59.3 years (range 40-77). They were analyzed at our hospital.

RESULTS

Myocardial infarction (MI) was documented in six patients and was localized at the same territory of the fistula-related artery in three of them. All patients remained asymptomatic after the detection of the fistula. Five patients had associated cardiac disorders. Two patients were treated conservatively with medical therapy. Coronary artery bypass grafting (CABG) was performed in three patients. One patient died while awaiting CABG. Thirty-four adult cases with acquired CCFs were collected from the current literature. The right coronary artery was the origin of the fistula in 37% and they terminated into the right heart-side in 72% of cases. They remained asymptomatic in 62% of cases.

CONCLUSIONS

It could be concluded that acquired CCFs may complicate the course of severe atherosclerosis or myocardial infarction in certain adult patients. The symptomatology and treatment strategy is comparable in the congenital and acquired types. The distribution of involvement of the right or left coronary arteries is equally divided in both the acquired and congenital types. Further studies are needed to investigate the precipitating factors for the occurrence of and incidence of acquired CCFs in patients with severe atherosclerosis or post-MI subjects.

Experimental investigation and nuclear model calculations on proton-induced reactions on highly enriched 114Cd at low energies

The excitation functions of both Cd(p,n)(114m)In114 and Cd(p,2n)(113m)In114 reactions were evaluated experimentally by the stacked-foil technique on highly enriched (114)Cd isotope. Two stacks were irradiated by proton beam with energies 14.7 and 18MeV on the MGC-20 cyclotron at Nuclear Research Center, AEA, Egypt. The present results support the previous measurements. The theoretical interpretations of the measured excitation functions were done by EMPIRE-II (v2.18 Mondovi) code. Compatibility with predictions of hybrid Monte Carlo simulation (HMS) pre-equilibrium mechanism was obtained.

Acute nonrheumatic myopericarditis associated with group A hemolytic streptococcal tonsillitis in a male ICU-nurse

We present the case of a 38-year-old man who developed acute myopericarditis, mimicking acute myocardial infarction, as manifested by electrocardiographic, echocardiographic alterations and elevated cardiac enzymes complicating Lancefield group A beta-hemolytic streptococcal tonsillitis. After receiving oral penicillin, the clinical recovery was complete. Fever, tachycardia and chest discomfort resolved within a few days. Furthermore, enzyme levels and C-reactive protein returned to normal within eight days.

A soccer victim: late rupture of the ascending aorta after violent physical trauma

A 56-year-old man without previous medical history or risk factors for coronary artery disease, presented with chest pain 2 weeks after violent blunt chest trauma. He was as a spectator, beaten and kicked almost to death during an amateur soccer match. Because of embarrassment, this was denied till shortly after his death. Shortly before the patient died, thoracic CT-scan showed a dissecting aneurysm of the ascending aorta in association with pericardial and bilateral pleural effusion. He suddenly died in-hospital due to heart tamponade secondary to rupture of the aneurysm into the pericardial space. At autopsy, the intimal layer of the aorta showed no atherosclerotic changes. The intimal rupture was located just above the origin of the right coronary artery.

Role of endogenous endothelin-1 in stress-induced gastric mucosal damage and acid secretion in rats

In rats subjected to 8 h water-immersion stress, gastric and duodenal mucosal hemorrhage and erosions were detected by macroscopic and histopathological examination. Moreover, plasma and gastric mucosal endothelin-1 (ET-1) levels rose appreciably in a time-related manner during water immersion, with a higher concentration detected in gastric mucosa. Thus, the percentage increases in plasma (gastric mucosal) ET-1, relative to basal levels, after 1, 4 and 8 h of water immersion were 86(172), 169(322) and 210(391)%, respectively. Likewise, a marked increase of gastric acid output was demonstrated 30 min after water immersion and lasted for 3 h. Pretreatment with the endothelin ET(A)/ET(B) receptor blocker, bosentan (30 and 100 mg kg(-1)), orally, dose-dependently antagonized gastric and duodenal mucosal damage as indicated by reductions in lesion lengths of 67 and 80%, respectively. Similar protective effects on mucosa were observed when bosentan was given by the intramuscular route. On the other hand, bosentan suppressed the rate of acid output by 30.3+/-2.1% in the stressed rats, but had no such effect in non-stressed animals. Taken together, results from this study implicate the endogenous peptide, ET-1, as a powerful mediator of stress-evoked gastro-duodenal mucosal damage and, moreover, present bosentan as a potential protector against hyperacidity and mucosal erosion that occur as a consequence of stress.

Ventriculo-venous communications in adults: ventriculographic observations in two female patients

Ventriculo-venous communications (VVC) were angiographically demonstrated in two adult female patients clinically presented with effort angina. During oxymetric studies there were minor to moderate left-to-right shunts. Concomitant, mild valvular aortic stenosis (AS) was present in one patient and hypertrophic obstructive cardiomyopathy (HOCM) in the other. It is believed that ventriculo-venous communications have contributed to the symptomatology in both patients. Symptoms were controlled medically in combination with dual (DDD) cardiac pacing with short AV-delay in one patient and only medically in the other patient. From the differential diagnostic point of view, superselective contrast injection into an 'inert' myocardial sinusoid or intramural contrast staining has been considered but could be excluded.

Takayasu's arteritis: a rare cause of cardiac death in a Caucasian teenage female patient

A caucasian teenage Dutch schoolgirl with known chronic low visual acuity and albinism, presented with frank acute pulmonary oedema, died after 1 h of cardio-pulmonary resuscitation for bradyarrhythmia and cardiac arrest. Two weeks prior to presentation, during sport training, she complained of oppressive chest pain on exertion accompanied with vomiting without any other systemic symptoms. Post-mortem examination revealed supravalvular stenosis of the pulmonary trunk and ascending aorta with irregular intimal thickening associated with stenosis of the left coronary artery. Microscopic examination demonstrated cellular infiltration of the wall of the aorta and pulmonary trunk with formation of granulomas with multinucleated giant cells. These features are compatible with Takayasu's arteritis.

Effect of praziquantel on serum glucose and insulin levels in normal and hyperglycemic rats

The effects of praziquantel (CAS 55268-74-1) on serum glucose and insulin levels in normoglycemic and hyperglycemic rats were studied. Also the combined effect of praziquantel and glibenclamide (CAS 10238-21-8) on oral glucose tolerance in rats was investigated. Praziquantel, given orally in a dose of 250 mg/kg, significantly increased serum glucose level in hyperglycemic rats without changing serum insulin level. After oral glucose load, praziquantel produced a significant increase in serum glucose level and antagonized the hypoglycemic action of glibenclamide. These results indicate that praziquantel significantly increased serum glucose level in both hyperglycemic rats and after glucose load. Since insulin levels are not significantly altered by praziquantel, the hyperglycemic effect of this drug may be attributed to inhibition of peripheral glucose utilization. Care should be taken if praziquantel is prescribed to diabetic patients.

Coronary angiographic morphology of congenital coronary arteriovenous fistulas in adults: report of four new cases and review of angiograms of fifteen reported cases

The coronary angiographic features of four new cases of congenital coronary arteriovenous fistulas (CAVFs) are described, and the angiograms of 15 reported cases are reviewed. The morphologic appearance of CAVFs varied from a small discrete single channel to a highly complex plexiform network with a maze of fine vessels. The majority of CAVFs in our series were composed of a single channel. Aneurysmal formation was present in 26% (6/23). Aneurysmal formation involved only the pathway and/or the termination, but never originated from the beginning of the CAVFs.

Flecainide-induced JT prolongation, T wave inversion and ventricular tachycardia during treatment for symptomatic atrial fibrillation

Two hours after taking 100 mg of flecainide, a patient developed gastrointestinal complaints, dizziness and shortness of breath. The ECG demonstrated novel prolonged JT interval with negative T wave in the precordial leads. During admission, several attacks of non-sustained ventricular tachycardia occurred. The plasma drug concentration was 814 mg/l. Although the tachycardia was non-sustained, cardiovascular collapse developed. Serum electrolytes were normal and myocardial infarction was excluded. The patient is now free of symptoms without medications.

Ibopamine-induced reversible leukopenia during treatment for congestive heart failure

Reversible leukopenia was documented in an 81-year-old woman treated with adjunctive ibopamine 100 mg t.i.d. for chronic congestive heart failure. Her antecedent medical history included stable, mild renal function impairment, mitral regurgitation, atrial fibrillation, recurrent transient ischaemic attacks and cholelithiasis. The drugs concomitantly used were digoxin, isosorbide dinitrate, frusemide, urapidil and chlorthalidone in conjunction with oral potassium substitution. Upon withdrawal of ibopamine but continuation of all other drugs, the patient recovered from the blood dyscrasia within 5 days and showed resolution of symptoms. Measurements of protected isolation and selective intestinal decontamination were taken. No complications resulting from secondary infection occurred. After withdrawal of ibopamine and under continuation of all other concomitant medications her body weight continued to decrease during the following few days, her symptoms were alleviated and she was discharge to a nursing home.

Congenital coronary arteriovenous fistula associated with atrioventricular valvular regurgitation in an octogenarian

An arteriovenous fistula originating from halfway down the circumflex coronary artery, draining into the coronary sinus was first diagnosed in a patient of 81. For 10 years, she had had dyspnea on exertion, mild mitral regurgitation and permanent ventricular pacing for symptomatic bradyarrhythmia. She was treated medically and despite her age was offered transcatheter balloon embolization, but she refused to undergo such intervention.

The impact of rural electrification on households a study is indicated by level of living and satisfaction with living conditions

This part of the study is concerned to examine the direct effects of rural electrification on Social and economical conditions of rural households in selected villages in Beheira Governorate. This part aims at achieving many objectives. The main objective of this paper is to examine the impact of electrification on the socio-economic status of household heads which is indicated by many variables. This paper concentrates on the effect of level of living and satisfaction with living conditions. The analysis of the data show that users of electricity are considerably better off than the non-users with regard to their socio-economic status and living conditions. Generally, electricity users expressed higher level of satisfaction with their living conditions when compared with the other two categories. Also, a higher percentage of users felt that their living conditions were better than they were in the past. Mainly, the socio-economic status and living conditions of household heads as measured by different variables appear to be strongly associated with using electricity which resulted in a greater level of satisfaction with their life situation.

Coronary-cameral fistula in association with Klinefelter syndrome: exercise-induced ventricular tachycardia late after surgical ligation

Twenty two years after surgical ligation of a large coronary-cameral fistula originating from the circumflex artery and terminating to the right atrium, non-sustained exercise-induced ventricular tachycardia occurred in a 26-year-old male with known Klinefelter (XXY) syndrome. Cardiac catheterization showed satisfactory closure of the defect, but also revealed occlusion of the circumflex coronary artery, associated with inferolateral infarction.

Stress MIBI scintigraphy in multiple coronary-pulmonary fistula: failure to demonstrate "steal" phenomenon

Stress radionuclide studies were performed in a patient with angiographically proven multiple coronary-pulmonary fistulas, in the presence of atypical chest pain. MIBI scintigraphy showed no myocardial perfusion defects. Multigated ventriculography showed an ejection fraction of 68% and 80% at rest and following exercise, respectively. Three separate fistulas were present between each coronary artery and the pulmonary trunk. The Qp:Qs ratio was 1.3. In the presence of atypical chest pain, stress MIBI scintigraphy and multigated ventriculography both failed to reveal myocardial ischemia in a 49-year-old patient with multiple coronary-pulmonary fistulas. She is using no medication, but advice concerning endocarditis prophylaxis was given.

Failure of subclavian venepuncture: the internal jugular vein as a useful alternative

After several attempts, temporary and permanent pacing for post-infarction symptomatic tachybradyarrhythmias, was finally achieved via the left internal jugular vein. Failure of bilateral subclavian venepuncture was experienced by two different operators. Partial right-sided pneumothorax developed following several attempts of subclavian puncture, and it resolved spontaneously. Upper extremity contrast venography revealed signs compatible with antecedent thrombotic disease of unknown etiology. Antiarrhythmic drug therapy was safely and successfully instituted.

Coronary-cameral fistula in association with intracardiac tumour and aortic stenosis in an adult

We present a patient with the unexpected association of left ventricular tumor, a fistula between the right coronary and the right atrium, and senile valvar aortic stenosis. He had anginal complaints. Doppler echocardiography revealed moderate aortic stenosis with mild aortic and moderate mitral regurgitation. A tumour was detected in the left ventricle. Selective coronary angiography disclosed normal anatomy with a fistula originating from the proximal right coronary artery and draining into the right atrium. He refused operative treatment and is still alive, 1 year after the diagnosis was made, without complications.

Dextrocardia, situs inversus and severe mitral stenosis in a pregnant woman: successful closed commissurotomy

A 16-weeks' pregnant woman with situs inversus and dextrocardia underwent successful closed commissurotomy for severe mitral stenosis. The electrocardiogram revealed sinus rhythm with right axis deviation and progressive diminishing of QRS amplitude towards the left precordial leads. The chest X-ray showed dextrocardia with situs inversus. Doppler echocardiography depicted severe mitral stenosis; the mitral valve area increased from 0.9 cm2 pre-operatively to 1.8 cm2 post-operatively with mild increase of mitral regurgitation from grade I to II post-valvotomy. She also had associated mild functional tricuspid insufficiency and moderate pulmonary hypertension. No thrombo-embolic complications occurred intra- or post-operatively. There was no evidence of either clinical or Doppler restenosis. The course of pregnancy was uneventful. At 39 weeks a healthy baby was vaginally delivered. The patient is still free of cardiac symptoms.

Coronary-pulmonary fistula: long-term follow-up in operated and non-operated patients

Eleven cases with 13, incidentally found coronary-pulmonary fistulous communications were discovered out of about 11,000 diagnostic coronary angiograms performed in different patients, over the period 1968 to 1989. These patients were followed-up for an average period of 4.4 years (range 2-11 years). The majority had a fistulous malformation originating from the proximal part of the left anterior descending artery and terminating in the pulmonary trunk. In three subjects, the right coronary artery participated in formation of the shunt. The fistulas consisted either of a convoluted mass of serpentive vessels, sometimes with aneurysmal formation, or of a solitary single vessel. Angina pectoris, atypical chest pain and fatigue were the most common symptoms. All patients were treated conservatively except one, who underwent ligation of the fistula and coronary arterial bypass grafting. Two subjects are still free of symptoms. No death occurred. None of the patients developed subacute bacterial endocarditis, acute myocardial infarction or left ventricular failure during the period of follow-up of more than four years. Three individuals, prior to the follow-up period, had suffered myocardial infarction contralateral to the shunt. They had no recurrence.

Influence of cimetidine on the pharmacokinetics of piroxicam in rat and man

The influence of cimetidine on piroxicam plasma levels and pharmacokinetic parameters was studied in both rats and healthy volunteers. In male rats, intravenous injection of piroxicam (6 mg/kg) in animals pretreated with cimetidine (50 mg/kg intramuscular) resulted in plasma piroxicam concentrations significantly higher than those of animals which received piroxicam alone. The plasma half-life (1/2) of piroxicam in male rats was about 8.3 h and it was increased to 20.74 h by cimetidine pretreatment. The mean area under piroxicam plasma level-time curves was significantly (p less than 0.01) higher in case of rats pretreated with cimetidine compared with those treated with piroxicam alone. Similar results were obtained in male healthy volunteers, where administration of a single dose of piroxicam (20 mg orally) to subjects who received cimetidine (200 mg 3 times a day orally) resulted in plasma piroxicam concentrations significantly higher than those of subjects treated with piroxicam alone. The t1/2 of piroxicam was increased from 37.36 to 52.86 h with cimetidine administration. Also the mean area under piroxicam plasma level-time curves was significantly (p less than 0.05) increased by cimetidine administration.

Clinical evaluation of two monthly injectable contraceptives and their effects on some metabolic parameters

One-hundred-and-thirty normally menstruating females were subgrouped equally and enrolled from the family planning clinic to study the clinical performance of the monthly injectable contraceptives medroxyprogesterone acetate 25 mg + estradiol cypionate 5 mg (Cycloprovera) and norethisterone enanthate 50 mg + estradiol valerate 5 mg (HRP-102) and their effects on some metabolic parameters. The contraceptive efficacy after 6 months of use for both drugs was 100%. No change in menstrual pattern occurred in 74% of Cycloprovera users and 67.3% of HRP-102 users. A statistically significant decrease (P less than 0.01) occurred in HDL-cholesterol and total serum protein values and a statistically significant increase (P less than 0.01) was observed in hematocrit value of Cycloprovera users only. Body weight and blood pressure values after 6 months of drug use showed no statistically significant changes in both groups. Also, no statistically significant changes were noticed in both groups for hemoglobin, post-prandial blood glucose, cholesterol, A/G ratio, SGPT and SGPT values following 6 months of injectable contraceptive use. None of the injectable users developed cervical dysplastic changes cytologically.

Some metabolic and hormonal changes in women using long acting injectable contraceptives

Some metabolic and hormonal changes in women using longacting injectables as a contraceptive method were examined. The 2 main injectables utilized were depomedroxyprogesterone acetate (DMPA), given every 90 +or- 5 days, and norethisterone enanthate (NET/EN) injected every 60 +or- 5 days. None of the studied cases became pregnant during injectable use, indicating the high contraceptive efficacy of the method. No statistically significant changes were observed in hemoglobin, hematocrit, all protein fractions including albumin, alpha1, alpha2 beta, gamma immunoglobulins IgG, IgA, and IgM after 6 and 12 months in both groups of injectable users as compared with the preinjection values. Statistically significant suppression of the estimated hormones, Follitropin, Luteotropin, and Estradiol-17beta were detected in both groups of NET/EN and DMPA users, after 6 and 12 months, as compared with the preinjection values.

GLC determination of methoxsalen in human serum and urine

A simple, sensitive and specific GLC method for the quantitation of methoxsalen in human serum and urine is described. The procedure involves chloroformic extraction of the active ingredient and the internal standard, trioxsalen, followed by GLC determination, using flame ionization detector and 3% OV on a Gas chromosorb W column. Sensitivity was 0.1 microgram/ml and 0.2 microgram/ml for serum and urine, respectively. Methoxsalen contents of serum of rats treated with this drug are reported.

Effect of antacids on activity of oral hypoglycemics

The effect of some antacids on the dissolution and hypoglycemic activity of acetohexamide, tolazamide, and tolbutamide tablets was investigated, as was the adsorption of the three drugs onto the antacids. The dissolution rates of the three drugs in the presence of magnesium oxide, aluminum hydroxide, magnesium carbonate, and calcium carbonate increased (0.5-1 hr) and then plateaued or decreased (1-3 hr). Magnesium trisilicate directly suppressed the dissolution of the three drugs. The antacids reduced the hypoglycemic activity of tolbutamide in the following order:magnesium trisilicate greater than magnesium oxide greater than aluminum hydroxide greater than magnesium carbonate greater than calcium carbonate. The same order occurred for the first three antacids with acetohexamide and tolazamide. Decreased hypoglycemic activity of the drugs may have been due to their adsorption to the coadministered antacids.

Hypoglycemic activity of oral hypoglycemics with increased hydrophilicity

The effect of increasing the hydrophilicity of acetohexamide and tolbutamide with hydroxypropyl methylcellulose and methylcellulose on drug dissolution and hypoglycemic activity in rats was examined. The dissolution rate of both drugs was increased according to the type and concentration of the polymer. The oral absorption of both drugs was improved, as indicated by potentiation of the reduction in blood glucose in rats. The efficiency of the polymer in increasing the dissolution rates of of the drugs correlated with hydrophilicity of the polymer.

Khellin determination in human serum and urine by high-performance liquid chromatography

A rapid, sensitive, and specific high-performance liquid chromatographic method was developed for the determination of khellin in serum and urine using theophylline as the internal standard. Chromatography was performed on a reversed-phase C18 column with 65% (v/v) methanol as the mobile phase. The assay is capable of measuring khellin concentrations down to 100 ng/ml with a total procedure time of less than 20 min. Oral administration of 60 mg of khellin tablets to two healthy human males was carried out, and the serum samples were analyzed by the described method. Serum concentration-time profiles are presented.

Influence of various agents on adsorption capacity of kaolin for Pseudomonas aeruginosa toxin

The in vitro adsorption of 125I-labeled Pseudomonas aeruginosa toxin (I) onto kaolin (II) at various pH values and in the presence of various agents was studied. The maximal adsorption capacity of I onto II occurred at pH values below 4.1, while minimal values were observed at pH 4.1, 7.4, and 8; average adsorption occurred at pH 5 and 6. The tested agents at specific ratios to II decreased the percent adsorption capacity of II for I to various degrees. The results are explained by reference to the structures of both kaolin and the toxin.