Self-assembling Organogels Loaded with Tenoxicam for Local Intensive Pain and Inflammation Cure: In Vitro and In Vivo Correlation

Due to tenoxicam (TX)'s poor aqueous solubility (0.072 mg/ml), it is poorly absorbable in the GIT, and the long-term oral administration of TX may cause severe GIT disturbances. Topical administration of TX can help in bypassing the GIT adverse effects. Therefore, in the present work, we constructed different pluronic/lecithin organogels (PLOs) for topical delivery of TX. PLO was constructed simply via direct mixing of an aqueous pluronic solution with lecithin solution. The prepared PLO formulations were characterized for their physicochemical properties including pH, drug content, visual inspection, viscosity, and spreadability. Also, the in vitro release and kinetic studies were carried out to investigate the mechanism of drug release. Moreover, the in vivo studies were carried out by investigating the anti-inflammatory and analgesic activities using albino male rats. The results showed that the modified PLOs have good physicochemical properties. The viscosity of the modified gels is a direct proportionality with both lecithin and pluronic concentrations. Also, subsequently, the drug release rate is directly proportional to gel viscosity. Moreover, the in vivo studies showed that the modified PLOs (F19) showed a significant ( < 0.05%) paw edema inhibition and pain analgesia compared with other investigated groups. Also, the results indicated that the increase in dose is accompanied by higher activity and a longer duration of action which extended to 12 h. Hence, the modified PLOs are promising safe candidates or vehicles for effective TX loading with sustained delivery behavior.

Chitosan nanoparticles as a smart nanocarrier for gefitinib for tackling lung cancer: Design of experiment and in vitro cytotoxicity study

Due to its poor solubility and systemic side effects, gefitinib (Gef) has limited application in treatment of lung cancer. In this study, we used design of experiment (DOE) tools to gain the necessary knowledge for the synthesis of high-quality gefitinib loaded chitosan nanoparticles (Gef-CSNPs) capable of delivering and concentrating Gef at A549 cells, thereby increasing therapeutic effectiveness while decreasing adverse effects. The optimized Gef-CSNPs were characterized by SEM, TEM, DSC, XRD, and FTIR analyses. The optimized Gef-CSNPs had a particle size of 158±3.6 nm, an entrapment efficiency of 93±1.2 %, and a release of 97±0.6 % after 8 h. The in vitro cytotoxicity of the optimized Gef-CSNPs was found to be significantly higher than pure Gef (IC50 = 10.08 ± 0.76 μg/mL and IC50 = 21.65 ± 0.32 μg/mL), respectively. In the A549 human cell line, the optimized Gef-CSNPs formula outperformed pure Gef in terms of cellular uptake (3.286 ± 0.12 μg/mL and 1.777 ± 0.1 μg/mL) and apoptotic population (64.82 ± 1.25 % and 29.38 ± 1.11 %), respectively. These findings explain why researchers are so interested in using natural biopolymers to combat lung cancer, and they paint an optimistic picture of their potential as a promising tool in the fight against lung cancer.

Recent Advances in the Pharmaceutical and Biomedical Applications of Cyclodextrin-Capped Gold Nanoparticles

The real problem in pharmaceutical preparation is drugs' poor aqueous solubility, low permeability through biological membranes, and short biological t_1/2. Conventional drug delivery systems are not able to overcome these problems. However, cyclodextrins (CDs) and their derivatives can solve these challenges. This article aims to summarize and review the history, properties, and different applications of cyclodextrins, especially the ability of inclusion complex formation. It also refers to the effects of cyclodextrin on drug solubility, bioavailability, and stability. Moreover, it focuses on preparing and applying gold nanoparticles (AuNPs) as novel drug delivery systems. It also studies the uses and effects of cyclodextrins in this field as novel drug carriers and targeting devices. The system formulated from AuNPs linked with CD molecules combines the advantages of both CD and AuNPs. Cyclodextrins benefit in increasing aqueous drug solubility, loading capacity, stability, and size control of gold NPs. Also, AuNPs are applied as diagnostic and therapeutic agents because of their unique chemical properties. Plus, AuNPs possess several advantages such as ease of detection, targeted and selective drug delivery, greater surface area, high loading efficiency, and higher stability than microparticles. In the present article, we tried to present the potential pharmaceutical applications of CD-derived AuNPs in biomedical applications including antibacterial, anticancer, gene-drug delivery, and various targeted drug delivery applications. Also, the article highlighted the role of CDs in the preparation and improvement of catalytic enzymes, the formation of self-assembling molecular print boards, the fabrication of supramolecular functionalized electrodes, and biosensors formation.

Injectable Hydrogels Based on Cyclodextrin/Cholesterol Inclusion Complexation and Loaded with 5-Fluorouracil/Methotrexate for Breast Cancer Treatment

Breast cancer is the second most common cancer in women worldwide. Long-term treatment with conventional chemotherapy may result in severe systemic side effects. Therefore, the localized delivery of chemotherapy helps to overcome such a problem. In this article, self-assembling hydrogels were constructed via inclusion complexation between host β-cyclodextrin polymers (8armPEG20k-CD and pβ-CD) and the guest polymers 8-armed poly(ethylene glycol) capped either with cholesterol (8armPEG20k-chol) or adamantane (8armPEG20k-Ad) and were loaded with 5-fluorouracil (5-FU) and methotrexate (MTX). The prepared hydrogels were characterized by SEM and rheological behaviors. The in vitro release of 5-FU and MTX was studied. The cytotoxicity of our modified systems was investigated against breast tumor cells (MCF-7) using an MTT assay. Additionally, the histopathological changes in breast tissues were monitored before and after their intratumor injection. The results of rheological characterization indicated the viscoelastic behavior in all cases except for 8armPEG-Ad. In vitro release results showed a variable range of release profiles from 6 to 21 days, depending on the hydrogel composition. MTT findings indicated the inhibition ability of our systems against the viability of cancer cells depending on the kind and concentration of the hydrogel and the incubation period. Moreover, the results of histopathology showed the improvement of cancer manifestation (swelling and inflammation) after intratumor injection of loaded hydrogel systems. In conclusion, the obtained results indicated the applicability of the modified hydrogels as injectable vehicles for both loading and controlled release of anticancer therapies.

Computational Design of Frustrated Lewis Pairs as a Strategy for Catalytic Hydrogen Activation and Hydrogenation Catalyst

Catalytic hydrogenation is one of the most important reaction types commonly used in chemistry and chemical industry. Recently, there has been significant interest in developing a metal-free hydrogenation catalyst to avoid the problems caused by using heavy transition metal catalysts. On the basis of the advances of metal-free hydrogen activation with frustrated Lewis pairs (FLPs, e.g. tBu₃P/B(C₆F₅)₃) which often uses boron as a Lewis acid center, we computationally explored the prospect for phosphorus(V) and sulfur(VI) as Lewis acid centers to construct FLPs for hydrogen activation and hydrogenation. We found out that the proposed FLPs with P(V)- or S(VI)-centered Lewis acid can also activate H₂ with a mechanism similar to that used by the conventional FLPs. A heterolytic cleavage of H-H is achieved when electrons are donated simultaneously from the σ orbital of H₂ to the empty orbital of the Lewis acid center and from the lone-pair orbital of the Lewis base center to the σ* orbital of H₂. The multiple C-H···F hydrogen bonds further aid the association of the pairs for H₂ activation. Some of our designed FLPs possess kinetics and thermodynamics for developing hydrogenation catalysts. This computational exploration could inspire experimental development of a new type of FLPs with P(V) or S(VI) or a Lewis acid partner for FLPs for reversible H₂ activation.

Thermosensitive polymers-based injectable hydrogels: a quantitative validations design utilized for controlled delivery of gefitinib anticancer drug

OBJECTIVE

Gefitinib (GFB) was loaded into different designs of thermos- and pH-responsive polymer-based hydrogels, namely chitosan (CH) and Pluronic F127 (Pl F127) with the aid of a crosslinking β-glycerophosphate (β-GP).

MATERIALS AND METHODS

GFB was loaded in CH and P1 F127 hydrogel. The preparation was characterized and tested for their stability and efficacy as antitumor injectable therapy devices. The antiproliferative effect of the selected CH/β-GP hydrogel formula was investigated against the hepatic cancerous cell, HepG2 using the MTT tetrazolium salt colorimetric assay. Furthermore, the pharmacokinetic was performed for GEF using a developed, reported and validated LC method.

RESULTS

All hydrogel samples showed no changes in color, separation(s), and crystallization in both liquid and gel forms. The CH/β-GP system showed a lower viscosity (110.3 ± 5.2 Cp) compared to CH/β-GP/Pl F127 system (148.4 ± 4.4 Cp) in the sol phase. Also, the results confirmed a continued increase in rats' plasma during the first four days (Tmax) with a plasma peak level (Cmax) of 3.663 μg/mL followed by a decrease below the detection limit after 15 days. Moreover, the results indicated no significant difference (p < 0.05) between the predicted and observed GEF-concentration data and that the proposed CH-based hydrogel facilitated its sustained release as distinguished from the longer value of MRT of 9 days and an AUC0-t of 41.917 μg/L/day.

CONCLUSIONS

The medicated CH/β-GP hydrogel formula had a higher targeting-controlled efficiency against a solid tumor than the free poor water soluble GFB.

Formulation development of lipid polymer hybrid nanoparticles of doxorubicin and its in-vitro, in-vivo and computational evaluation

The purpose of this study was to assess the parameters of doxorubicin (DOX) loaded lipid polymer hybrid nanoparticles (LPHNs) formulation development, and then the bioavailability of DOX were determined in the rabbit model, in order to evaluate the intrinsic outcome of dosage form improvement after the oral administration. LPHNs were prepared by combine approach, using both magnetic stirring and probe sonication followed by its characterization in terms of size-distribution (Zeta Size), entrapment efficiency (EE), loading capacity, and the kinetics of DOX. LPHNPs were further characterized by using scanning electron microscopy (SEM), powder X-Ray diffractometry (P-XRD), Fourier transform infrared spectroscopy (FT-IR), differential scanning calorimetry (DSC), in vitro and in vivo studies. The molecular modeling was determined through the density functional theory (DFT) simulations and interactions. DOX loaded and unloaded LPHNs were administered orally to the rabbits for bioavailability and pharmacokinetic parameters determinations. The plasma concentration of DOX was determined through high performance liquid chromatography (HPLC). The average size of DOX-loaded LPHNs was 121.90 ± 3.0 nm. The drug loading of DOX was 0.391% ± 0.01 of aqueous dispersion, where its encapsulation efficiency was 95.5% ± 1.39. After oral administration of the DOX-LPHNs, the area under the plasma drug concentration-time curve (AUC) improved about 2-folds comparatively (p < 0.05). DFT simulations were used to understand the interactions of polymers with different sites of DOX molecule. The larger negative binding energies (-9.33 to -18.53 kcal/mol) of the different complexes evince that the polymers have stronger affinity to bind with the DOX molecule while the negative values shows that the process is spontaneous, and the synthesis of DOX-LPHNs is energetically favorable. It was concluded that DOX-LPHNs provides a promising new formulation that can enhance the oral bioavailability, which have optimized compatibilities and improve the pharmacokinetic of DOX after oral administration.

A Novel Approach for the Availability and Ocular Delivery of Tenoxicam Potassium: Synthesis, Characterization, and In Vivo Application

Tenoxicam (TX) is a non-steroidal anti-inflammatory agent that can be used to control pain in various ophthalmic lesions like cataracts, refractive surgery, and corneal abrasion. TX has a very slightly aqueous solubility of 0.072 mg/mL resulting in difficulty to be formulated in ophthalmic solutions. This study aims to improve TX solubility by converting it into its potassium salt to achieve a target of 10 mg/mL (1%w/v) concentration of TX in the desired aqueous medium for the formulation of aqueous ophthalmic solutions. The synthesized TX salt was characterized by different evaluation parameters such as solubility studies, ¹H NMR, IR, and elemental analyses. Different TX potassium solutions were formulated at concentrations of 0.5% and 1% w/v using different viscosity-imparting agents. The prepared solutions were characterized for their physicochemical properties including visual inspection, pH, rheological, in vitro release, and kinetic behavior. Also, the formulations were biologically evaluated in vivo using male albino rabbits. The obtained results showed the successful synthesis of TX salt, as indicated by IR and NMR, and elemental analysis. The solubility study showed that the solubility of TX was improved hugely to 18 mg/mL (250-fold). In addition, the results showed that the prepared formulations showed acceptable physicochemical properties. The highest release rate was obtained with formula F1, which contains no viscosity-imparting agents. While as, the lowest release rate was obtained in the case of formula F9, composed of Pluronic F127 (12% w/v). The in vivo results showed that TX optimized ophthalmic solutions F8 and F9 inhibited the redness and edema in an extended or sustained manner.

Cyclodextrin/Adamantane-Grafted Polyethylene Glycol-Based Self-assembling Constructs for Topical Delivery of Ketorolac Tromethamine: Formulation, Characterization, and In Vivo Studies

Topical formulation of non-steroidal anti-inflammatory drugs (NSAIDs) exhibits many advantages over the oral administration route, such as avoiding the direct effect on GIT and avoiding the poor oral bioavailability of such drugs. Our study aims to develop a new self-assembling construct based on the hydrophobic interaction between adamantane terminated poly (ethylene glycol) polymers and polymerized β-cyclodextrin. The viscous constructs were developed from direct mixing of host and guest polymer solutions, indicating spontaneous formation without cross-linkers. The modified system was evaluated by different analyses, including X-ray diffractometry, electron microscopy, isothermal titration calorimetry, and rheological analysis. Moreover, such a system's ability for drug loading and release was investigated via the in vitro release of ketorolac tromethamine (KT) as a model of NSAIDs. Finally, the prepared formulas were applied on a rat paw edema model to prove the enhanced anti-inflammatory activities. The obtained results indicated that the modified constructs have a rubbery porous structure with an amorphous nature. Also, from rheological results, the modified system exhibited a viscous behavior with higher loss modulus (G″) compared with storage (G'). The inclusion complexation between cyclodextrin and adamantane moieties was proved by the recorded high binding constants with a 1:1 stoichiometric ratio. Furthermore, the results showed the successful KT incorporation into the modified system and quantitatively released through a semi-permeable membrane in a sustained fashion (over 24 h). Finally, the in vivo results of the medicated constructs showed a significant inhibition of the induced inflammation and swelling, indicating that the modified construct has a great utility for safe non-irritating topical delivery applications.

Postmastectomy pain syndrome after preoperative stellate ganglion block: a randomized controlled trial

BACKGROUND

This study investigated the effect of preoperative ultrasound (US) guided stellate ganglion block (SGB) with bupivacaine on the frequency of post mastectomy pain syndrome (PMPS).

METHODS

Eighty patients scheduled for mastectomy with axillary dissection for breast cancer were included in this randomized controlled trial. Patients were randomized into two equal groups: Group A received US guided SGB one hour before surgery using five mL of 0.5% bupivacaine and multimodal systemic analgesia, Group B (control) received multimodal systemic analgesia only. Patients were followed up for six months. PMPS was assessed using the grading system for neuropathic pain (GSNP). Postoperative opioid consumption in the first 24 hours and numeric rating scale (NRS) were documented. Patient daily activity and functional capacity were evaluated using the Eastern Cooperative Oncology Group (ECOG) score.

RESULTS

PMPS proportion was significantly lower in group A than group B (30% vs. 62.5%, P=0.004; 52% decrease [95% CI: 18.4%-71.8%]). Postoperative opioid consumption and NRS were significantly lower in group A as compared to group B. ECOG score was significantly higher in Group A than Group B.

CONCLUSIONS

Following mastectomy with axillary dissection, preoperative US guided SGB is associated with less PMPS proportion, postoperative pain and opioid consumption and better patient daily activity and functional capacity.

In Vitro Release of 5-Fluorouracil and Methotrexate from Different Thermosensitive Chitosan Hydrogel Systems

5-Fluorouracil is a member of cytotoxic drugs with poor selectivity to cancer cells. Currently, systemic administration of this anti-cancer drug (oral or injection) exposes normal tissues to the drug-induced toxicity. Nowadays, attention has been greatly directed towards in situ gel-forming systems that can be injected into the affected tissues in its sol form with a minimally invasive technique. More specifically, chitosan hydrogel systems were in focus due to their antibacterial effect as well as their biodegradable, biocompatible, and mucoadhesive properties. In the present work, 5-fluorouracil was loaded on various thermosensitive chitosan hydrogel systems cross linked with different linking agents like β-glycerophosphate, pluronic F127, and hydroxyapatite. Also, methotrexate was added to 5-fluorouracil in order to gain its previously reported synergistic effects. Firstly, a compatibility study was performed using UV-spectrophotometric, infrared spectroscopy (FTIR) and differential scanning calorimetry (DSC) techniques to exclude the possibility of any physical or chemical interactions between the selected drugs and excipients. The prepared hydrogel systems were characterized for their physicochemical properties including organoleptic, pH, syringeability and injectability, viscosity, and gelation temperature (Tgel) by various analysis techniques. Moreover, the in vitro release behavior of 5-fluorouracil and methotrexate was determined with a modified analytical method. The results indicated that chitosan hydrogel system cross-linked with a combination of β- glycerophosphate, and 10 % pluronicF127 (F4) showed the most suitable physicochemical properties and release profile. Accordingly, this formula can be considered as a missionary system for localized sustained delivery of cytotoxic drugs.

Dual fluorescence of (E)-N-(4-(dimethylamino)benzylidene)-2H-1,2,4-triazol-3-amine (DMABA-Amtr): A ground state perspective

We present the absorption and fluorescence spectra of (E)-N-(4-(dimethylamino)benzylidene)-2H-1,2,4-triazol-3-amine (DMABA-Amtr), an electron donor-π-acceptor system. The molecule shows a single fluorescence emission band in non-polar solvents while dual emissions were observed in polar aprotic solvents. Although several researchers over the years provide different explanations for the mechanism of the phenomena, based on solvent assisted excited state geometry changes of such systems, it is still a matter of controversy since such systems are unique as they contradict Kasha's rule. The emission spectrum of the molecule shows strong dependence on solvent polarity and excitation wavelength. This observation together with a single iso-emissive point found in the area normalize emission spectra indicates the presence of two ground state equilibrium structures of the compound which are both fluorescent. Density functional theory (DFT) and time-dependent (TD-DFT) calculations also support the experimental findings.

Self-assembly of precisely defined DNA nanotube superstructures using DNA origami seeds

We demonstrate a versatile process for assembling micron-scale filament architectures by controlling where DNA tile nanotubes nucleate on DNA origami assemblies. "Nunchucks," potential mechanical magnifiers of nanoscale dynamics consisting of two nanotubes connected by a dsDNA linker, form at yields sufficient for application and consistent with models.

Comparison of the problem based learning-driven with the traditional didactic-lecture-based curricula

OBJECTIVE

To compare the Problem-based learning (PBL) with the traditional lecture-based curricula.

METHODS

The single best answer Multiple Choice Questions (MCQ) and the Objective Structured Clinical Examination (OSCE) were used to compare performance of the lecture-based curriculum with the PBL medical student groups. The reliability for the MCQs and OSCE was calculated with Kuder-Richardson formula and Cronbach's alpha, respectively. The content validity of the MCQs and OSCE were tested by the Independent Subject Experts (ISE). The Student's t-test for independent samples was used to compare the item difficulty of the MCQs and OSCE's, and the Chi-square test was used to compare the grades between the two student groups.

RESULTS

The PBL students outperformed the old curriculum students in overall grades, theoretical knowledge base (tested with K2 type MCQs) and OSCE. The number of the PBL students with scores between 80-90% (grade B) was significantly (p=0.035) higher while their number with scores between 60 to 69% (grade C) was significantly p=0.001) lower than the old curriculum students. Similarly, the mean MCQ and the OSCE scores of the new curriculum students were significantly higher (p = 0.001 and p = 0.025, respectively) than the old curriculum students. Lastly, the old curriculum students found the K2-MCQs to be more (p = 0.001) difficult than the single correct answer (K1 type) MCQs while no such difference was found by the new curriculum students.

CONCLUSIONS

Suitably designed MCQs can be used to tap the higher cognitive knowledge base acquired in the PBL setting.

Traumatic Intracranial Aerocele With Progressive Blindness - A case report

BACKGROUND

Traumatic intracranial aerocele, also known as pneumocephalus, is an uncommon condition that may be asymptomatic or may present with progressive neurological deficits and life threatening conditions that demand urgent decompressive craniotomy to reduce the acute rise in intracranial pressure and the sequelae.

AIMS & OBJECTIVES

A high degree of suspicion and continuous neurological monitoring are essential for the early detection and the prompt neurosurgical intervention demanded for the achievement of a good outcome in patients following traumatic acute severe head injury with life threatening neurological complications.

METHOD

Presentation of a young motorcyclist who was not wearing a crash helmet and was involved in a road traffic accident in which he sustained a compound cranio-facial injury with loss of consciousness and symptomatic intracranial aerocele.

RESULTS

The case of a 28-year old motorcyclist without a helmet, following a road traffic accident, sustained compound skull fracture with CSF rhinorrhea, ventricular aerocele and progressive blindness who recovered his vision fully following bitemporal decompressive craniotomy.

CONCLUSION

A high index of suspicion enabled early detection and prompt decompressive craniotomy that stemmed the progressive loss of vision in this patient with an uncommon but symptomatic intracranial aerocele and cranio-facial compound head injury.

Bone mineral density in Kuwaiti patients with end-stage renal disease

OBJECTIVE

This study compared an ethnically uniform group of end-stage renal disease (ESRD) Kuwaiti patients with a control group of healthy Kuwaiti subjects, in terms of their bone mineral density (BMD) and anthropometric measurements.

SUBJECTS AND METHODS

Included in the study were 94 males and 129 females with a mean age of 48 ± 10 years. Forty-five males and 53 females had ESRD. The remaining 49 males and 26 females were the control subjects. BMD was measured at total lumbar spine (L1-L4) and total left hip, using dual energy X-ray absorptiometry (HOLOGIC, QRS series, Europe, Belgium). The data were analyzed using SPSS, version 15 (SPSS Inc., Chicago, Ill., USA). The difference in BMD and the anthropometric measurements between the ESRD patients and the controls was assessed. Multivariate linear regression models were used to examine independent effects of ESRD on BMD while adjusting for relevant covariates.

RESULTS

The ESRD patients had a lower BMD than the controls at the hip (0.81 ± 0.11 vs. 0.92 ± 0.16) and the spine (0.84 ± 0.12 vs. 0.92 ± 0.16), p < 0.001. They also had a lower body mass index (27.80 ± 6.03 vs. 30.85 ± 6.54; p < 0.001) and were taller (162.56 ± 15.31 vs. 156.94 cm ± 10.03; p < 0.01). The reduced BMD persisted after controlling for confounding effects of sex, age and anthropometric measurements (p < 0.001).

CONCLUSION

Kuwaiti patients with ESRD had a lower BMD and, therefore, an increased risk of osteoporosis and bone fractures.

Disseminated cutaneous leishmaniasis in HIV positive patient--a case report

Disseminated cutaneous leishmaniasis and HIV dual-infection is seldom reported. Leishmaniasis and HIV co-infection may intensify the immune defect and is the chief reason for atypical presentation and widespread progression of cutaneous leishmaniasis and its defiance to conventional therapy. Here we report a 38-year-old HIV-positive lady who presented with a 6-month history of a progressive papule and nodular eruptions of leishmaniasis on face, trunk and extremities that was recalcitrant to treatment.

An assessment of functioning and non-functioning distractors in multiple-choice questions: a descriptive analysis

BACKGROUND

Four- or five-option multiple choice questions (MCQs) are the standard in health-science disciplines, both on certification-level examinations and on in-house developed tests. Previous research has shown, however, that few MCQs have three or four functioning distractors. The purpose of this study was to investigate non-functioning distractors in teacher-developed tests in one nursing program in an English-language university in Hong Kong.

METHODS

Using item-analysis data, we assessed the proportion of non-functioning distractors on a sample of seven test papers administered to undergraduate nursing students. A total of 514 items were reviewed, including 2056 options (1542 distractors and 514 correct responses). Non-functioning options were defined as ones that were chosen by fewer than 5% of examinees and those with a positive option discrimination statistic.

RESULTS

The proportion of items containing 0, 1, 2, and 3 functioning distractors was 12.3%, 34.8%, 39.1%, and 13.8% respectively. Overall, items contained an average of 1.54 (SD = 0.88) functioning distractors. Only 52.2% (n = 805) of all distractors were functioning effectively and 10.2% (n = 158) had a choice frequency of 0. Items with more functioning distractors were more difficult and more discriminating.

CONCLUSION

The low frequency of items with three functioning distractors in the four-option items in this study suggests that teachers have difficulty developing plausible distractors for most MCQs. Test items should consist of as many options as is feasible given the item content and the number of plausible distractors; in most cases this would be three. Item analysis results can be used to identify and remove non-functioning distractors from MCQs that have been used in previous tests.

Fracture of the penis. A report of two cases

We present two cases of fracture of the penis in two young men at the extremes of the social strata the first an unemployed tailor while the other a practicing engineer. The first one was a bachelor while the other was married with children. In the first case, the fracture occurred during masturbation while in the second case it occurred during consensual intercourse with his wife on top. In the first case the fracture occurred at the base of the penis with associated rupture of the deep dorsal vein while in the second case it affected the mid-shaft with urethral rupture and blood at the tip of the penis at presentation. Both of them presented within two hours of their injuries with deformed, swollen and tender penis. Laubscher's subcoronal sleeve operation with evacuation of clots and repair of the tear with absorbable sutures to ensure a leak-proof repair was promptly performed with no complications. Both patients experienced spontaneous erection whilst in hospital even with indwelling catheter in place. The wife of the second case became pregnant six months after the repair. Counseling was successful with the engineer but was unsuccessful with the tailor-bachelor who continued with masturbation despite professional help. Though we published the first case of fracture of the penis in this centre almost a decade ago, we still found it necessary to report these new cases managed after we created awareness of this uncommon condition in our environment in order to highlight the presentations and the factors that influenced outcome.

Bone mineral density in premenopausal Arab women with type 2 diabetes mellitus

INTRODUCTION

This study compares an ethnically uniform group of premenopausal type 2 diabetic (T2DM) Arab women with a matched control group of nondiabetic subjects, in terms of their bone mineral density (BMD) and anthropometric measurements.

METHODS

The study included 252 premenopausal Arab women. Their age ranged from 26 to 50 yr with a mean+/-SD of 43.65+/-8.97 yr. One hundred and twenty-two women were T2DM patients and 130 women were nondiabetic controls. The controls matched the subjects in gender, age, and body mass index (BMI). BMD was measured at total lumbar spine (L1-L4) and total left hip, using dual-energy X-ray absorptiometry (DXA; HOLOGIC, QRS SERIES, Europe, Belgium). Difference in BMD and its relationship to the anthropometric measurements in T2DM and control groups were assessed.

RESULTS

Significant difference was found between T2DM patients and nondiabetic patients in their mean hip BMD (0.92+/-0.16 vs. 0.87+/-0.14, p<0.05) and spine BMD (0.93+/-0.15 vs. 0.88+/-0.14, p<0.01). No significant difference was found in age, height, weight, and BMI (p>0.05). The increase in hip BMD in T2DM patients normalized and the increase in spine BMD persisted after controlling for the confounding effect of age and anthropometric measurements.

CONCLUSION

Premenopausal Arab women with T2DM have higher BMD at the spine than women without T2DM. The underlying mechanism causing this increase does not seem to be related to ethnicity, gender, hormonal status, or anthropometric measurements.

Relationship between mammography breast density and bone mineral density

Mammography breast density (MBD) is a well-established and strong predictive risk factor for breast cancer. Bone mineral density (BMD) is another predictor of breast cancer risk in women. Both MBD and BMD are linked to a common pathway, which involves estrogens, and are highly heritable. This study evaluated the relationship between MBD and hip and spine BMD in Kuwaiti women. Mammograms and BMD data of 248 women were studied. BMD was measured at total lumbar spine (L1-L4) and total left hip using dual-energy X-ray absorptiometry. The women were classified into 3 groups: normal, osteopenia, and osteoporosis by their BMD, using the World Health Organization criteria. They were divided into another 4 groups: fatty, fibroglandular, heterogeneously dense, and extremely dense breast according to their MBD and as defined by the Breast Imaging Reporting and Data System. All MBD and BMD data were analyzed statistically. Statistical analysis showed no significant difference or correlation between the MBD and BMD groups even after adjusting for obesity and menopausal status. However, a highly significant difference in body weight was found among the MBD groups (p<0.005). No correlation between MBD and BMD was observed in the group of Kuwaiti women who took part in the present study.

Regional cerebral blood flow in patients with sickle cell disease: study with single photon emission computed tomography

OBJECTIVE

Neurological complications have been reported in patients with sickle-cell disease (SCD) using positron emission tomography (PET), magnetic resonance imaging (MRI), and computed tomography (CT), but not with single photon emission computed tomography (SPECT). The objective of this study was to investigate brain perfusion in the patients with SCD using SPECT after technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO), was administered and compare the findings with those of demography, physical examination, MRI and hematological profile.

METHODS

The study involved 21 patients (12 males, 9 females, age at study 8-45 years) who were known to be having SCD for a duration of at least 5 years. The patients were not in acute crisis and had normal neurological assessments with no known history of stroke or transient ischemic episode or previous abnormal CT or MRI brain scan, and were right-handed. The brain SPECT was performed after intravenous injection of 740 MBq (20 mCi) 99mTc-HMPAO in adults or an appropriate dose in pediatric patients. The scans were visually interpreted by two nuclear medicine physicians and a decision was reached by consensus. An MRI done 3 months later was interpreted by a radiologist. The demographic data and hematological profile were obtained from the medical records of the patients.

RESULTS

Of the 21 patients, 7 (age 11-22 years) had brain perfusion deficit mostly in the frontal lobe either alone or in combination with temporal and/or parietal lobe. The MRI was abnormal in 2 patients. The brain perfusion deficit was not associated with the demographic data of the patients or hematological profiles.

CONCLUSIONS

The findings show that SPECT was useful in detecting brain perfusion deficit in SCD patients, and such an early detection may be clinically useful in the subsequent follow-up of such patients, since it is known that cerebral perfusion deficit can lead to silent infarct and/or overt stroke, and affect cognitive skills.

Water exchange dynamics of manganese(II), cobalt(II), and nickel(II) ions in aqueous solution

The first row transition metal ions Mn(2+), Co(2+), and Ni(2+) have been studied by classical umbrella sampling molecular dynamics simulations. The water exchange mechanisms, estimates of reaction rates, as well as structural changes during the activation process are discussed. Mn(2+) was found to react via an I(A) mechanism, whereas Co(2+) and Ni(2+) both proceed via I(D). Reaction rate constants are generally higher than those obtained by experiment but the simply constructed metal(II) ion-water potential reproduces the relative order quite well.

Sickle cell disease and pregnancy in Bahrain

OBJECTIVE

To determine the morbidity and outcome of pregnancies complicated by homozygous sickle cell disease (SCD) in Bahrain.

METHODS

A controlled study was conducted of all the pregnancies of women with SCD who were delivered at Salmaniya Medical Complex and affiliate hospitals in Bahrain between January 1, 1998, and December 31, 2002.

RESULTS

There were 351 pregnancies with SCD, giving an incidence of 0.67%. The mean+/-S.D. age of women with SCD was 28.8+/-5.7 years. These women, who were mostly from Shia villages, had more spontaneous abortions than the 351 controls (32% and 12%, respectively). Compared with the control group, the mean+/-S.D. number of pregnancies among women with SCD was 5.0+/-1.9 vs. 5.7+/-3.1; birth weight, 2,965+/-540 g vs. 3,457+/-497 g; rate of preterm deliveries, 25.9% vs. 12%; incidence of intrauterine growth restriction, 10% to 13% vs. 4% to 7%; Apgar scores at 1 and 10 min, 8.1+/-0.8 and 8.8+/-0.8; and cesarean section rate, 19.0% vs. 12.7%. There were no differences in the rates of pre-eclampsia, antepartum and postpartum hemorrhage, or stillbirth. There were 4 maternal deaths directly related to SCD complications. Hemoglobin analysis was performed in 86% of the women with SCD. Of these women, 60.6% had homozygous SCD with raised levels of fetal hemoglobin (more than 5% HbF); 9.6% had sickle cell hemoglobin with beta-thalassemia disease; and 1.4% had sickle cell hemoglobin only. Vaso-occlusive crises were the most common cause of hospital admissions during pregnancy (42.2%), while hemolytic and sequestration crises accounted for 28.0% and 0.6% of admissions.

CONCLUSION

Mortality, morbidity, and perinatal loss are still considerable among women with SCD in Bahrain. To reduce mortality and morbidity, there is a need for a multidisciplinary team able to deal with pregnancy complications due to SCD.

Impact of operator on determining functional parameters of nuclear medicine procedures

OBJECTIVE

The study was designed to assess the significance of the interoperator variability in the estimation of functional parameters for four nuclear medicine procedures.

MATERIALS AND METHODS

Three nuclear medicine technologists with varying years of experience processed the following randomly selected 20 cases with diverse functions of each study type: renography, renal cortical scans, myocardial perfusion gated single-photon emission computed tomography (MP-GSPECT) and gated blood pool ventriculography (GBPV). The technologists used the same standard processing routines and were blinded to the results of each other. The means of the values and the means of differences calculated case by case were statistically analyzed by one-way ANOVA. The values were further analyzed using Pearson correlation.

RESULTS

The range of the mean values and standard deviation of relative renal function obtained by the three technologists were 50.65 +/- 3.9 to 50.92 +/- 4.4% for renography, 51.43 +/- 8.4 to 51.55 +/- 8.8% for renal cortical scans, 57.40 +/- 14.3 to 58.30 +/- 14.9% for left ventricular ejection fraction from MP-GSPECT and 54.80 +/- 12.8 to 55.10 +/- 13.1% for GBPV. The difference was not statistically significant, p > 0.9. The values showed a high correlation of more than 0.95. Calculated case by case, the mean of differences +/- SD was found to range from 0.42 +/- 0.36% in renal cortical scans to 1.35 +/- 0.87% in MP-GSPECT with a maximum difference of 4.00%. The difference was not statistically significant, p > 0.19.

CONCLUSION

The estimated functional parameters were reproducible and operator independent as long as the standard processing instructions were followed.

Nonosseous abnormalities on bone scans

Although bone scanning is a test primarily concerned with skeletal abnormalities, important nonosseous findings are occasionally present on the images. To gauge the significance of such nonosseous uptake and, in particular, to determine whether these findings contain useful diagnostic information, the technical and medical staff in nuclear medicine must recognize the various patterns of nonbony uptake and understand their causes. The objectives of this article are to demonstrate the appearances of nonosseous uptake on bone scans, to categorize the forms of soft-tissue uptake, to emphasize technical artifacts leading to soft-tissue uptake, and to highlight the clinical significance of pathologic soft-tissue uptake.

Perineural invasion by carcinoma of the lower lip

Extension of lip cancer to the mental nerve and perineural spread was found in four patients. The main complaint in all cases was sensory disturbance which preceded the diagnosis of recurrence by perineural spread as well as widening of the mandibular canal. In one patient, two cranial nerves, the trigeminal and the facial were involved and one patient had bilateral neural involvement. Three patients died within 1 year of the diagnosis of perineural spread. Prevention includes the separate examination of specimens at the resection line near the mental nerve, and follow-up by examination of the lower vestible, X-ray of the mandible and monitoring of sensory disturbance.

Hemoglobinopathies and glucose-6-phosphate dehydrogenase deficiency in hospital births in Bahrain

In view of the high prevalence of clinical cases of sickle cell anemia, hemoglobin-H-disease and glucose-6-phosphate dehydrogenase deficiency in the archipelago of the State of Bahrain, a cord blood screening study was undertaken over a 15 month period (October 1984 to December 1985) to determine the gene frequency of these diseases. All the state hospitals participated in this study and a total of 10,327 cord blood samples obtained from babies born to Bahraini parents were analyzed. These presented over 80% of all neonates born in the country during the study period. The phenotypes detected included: AF, AF-Barts, SFA and SFA-Barts. Homozygous sickle cell disease was detected in 2.1%, and in 11.2%, the sickle cell trait was present. The incidence of alpha-thalassemia gene based on elevated Bart's hemoglobin was 24.3% in these neonates. The incidence of G6PD-deficiency was as high as 20.9%. Availability of these statistics has enabled the authorities in the Ministry of Health in collaboration with the National Hereditary Anemia Society to plan a comprehensive health care program for patients with hereditary diseases and their families.

The role of ERCP in the management of gallstone-associated acute pancreatitis: A prospective study of 64 patients at Riyadh Central Hospital

In a prospective study, consecutive patients admitted to one of the surgical units at Riyadh Central Hospital with a diagnosis of acute biliary pancreatitis (ABP) underwent, after stabilization, urgent ERCP within 72 hours of admission. A total of 64 patients (35 males, 29 females) were treated over a four-year period (1986-1990). Forty-eight patients were found to have common bile duct stones when endoscopic sphincterotomy (ES) and stone extraction was performed, including four patients with concomitant cholangitis. This was followed by a significant decrease in mean values of the biochemical parameters; serum amylase, SGOT, total bilirubin (P < 0.001) and alkaline phosphatase (P < 0.02), with a corresponding clinical improvement. Urgent ERCP+ES was not associated with any serious complications. There was no hospital mortality in this series. Details of the endoscopic findings and treatment are summarized. Based on the present study and others cited, the role of ERCP in the diagnosis and management of ABP are discussed and recommendations suggested.