Acute Abdomen Is a Rare Presentation of COVID-19 in the Absence of Respiratory Manifestations: A Case Report

Mild gastrointestinal symptoms and mild abdominal pain often occur in association with COVID-19. However, acute abdomen and severe abdominal pain warranting urgent surgical treatment are rare. Here we present the case of a 40-year-old man who presented with the clinical picture of a perforated duodenal ulcer. He was eventually found to have COVID-19 and was treated conservatively. In this report, we discuss his course of treatment and review the relevant literature.

Proficiency of some synthetic alginate derivatives for sequestration of Iodine-131 from radioactive liquid waste

The current effort in environmental remediation is aimed at removing iodine-131 radionuclide from radioactive liquid waste produced by an Egyptian nuclear power plant using some synthesised alginate derivatives. Two different copolymers, namely sodium alginate poly (acrylic acid) (P₁) and sodium alginate poly (acrylic acid-methacrylic acid) (P₂), are prepared using gamma radiation. The ability of these polymers to remove ¹³¹I radionuclide as sorbents has been investigated. The synthesised polymers exhibit excellent adsorption performance for ¹³¹I ions, and the adsorption equilibrium requires only 30 min, which reveals that the sorption process is kinetically faster than most of the other materials reported previously. The removal percents for ¹³¹I radionuclide at a pH of 3.0 at room temperature on P₁ and P₂ are 77.7% and 84.2%, respectively. The sorption capacities of the two polymers demonstrate that P₂ > P₁, with capacities of 67.9 and 58.5 mg/g, respectively. Four linear kinetic models are investigated: pseudo-first order, pseudo-second order, Elovich, and Weber-Morris models. Regarding their calculated parameters, these models indicate that the adsorption process of I-ions on both P1 and P2 is controlled by chemisorption. Four equilibrium isotherm models (Redlich-Peterson, Langmuir, Freundlich, and Harkin-Jura) are investigated, revealing that the adsorption process is a monolayer and multilayer process on a heterogeneous surface.

SP3.1.14 NELA; what happens after discharge?

Aims

NELA has been instrumental at improving perioperative care and 30–day mortality following emergency laparotomy (EmLap); long-term outcomes and follow-up are less well reported. This study aims to establish the unscheduled and scheduled service use of EmLap patients after discharge.

Methods

This is a single-centre service evaluation. Patients were included if they had an EmLap recorded from 2016-2019 at our local institute and were alive on discharge. Outcomes were 30-day readmission rate and outpatient follow-up.

Results

944 patients were included. 11.9% re-presented to the surgical department within 30-days; 58.0% of these needed readmissions. The most common causes for re-presentation (n = 112) were management of a wound issue (15.2%), ongoing pain without evidence of complication (10.7%) and ongoing intra-abdominal sepsis (9.8%).

1-year survival was 81.4%. Of these (n = 856); 74.3% were invited to outpatients; DNA rate was 8.8%, with only 67.8% of patients having a follow-up review. Median time to follow up was 9 weeks. Patients were more likely to be invited for outpatient review if they had a new stoma (OR 2.56, 95% CI 1.81 – 3.56), and less likely if adhesiolysis was the primary procedure (OR 0.55, 95% 0.39-0.76).

Patients who failed to attend an appointment were significantly younger (median age 53 vs. 60 years, p = 0.0033) and from more deprived areas (average WIMD 673.6 vs 977.3, p = 0.002).

Conclusion

This study demonstrates higher levels of unscheduled care and lower levels of scheduled care than expected. Care standards should be extended beyond the 30-day milestone to fully appreciate the morbidity associated from EmLap.

Azolla leaf meal at 5% of the diet improves growth performance, intestinal morphology and p70S6K1 activation, and affects cecal microbiota in broiler chicken

With growing concern about including unconventional dietary protein sources in poultry diets to substitute the protein sources that are essential for human consumption such as soybean meal, Azolla leaf meal (ALM) has grown in popularity. In our prior experiment, ALM was used at inclusion rates of 5 and 10%. Five per cent inclusion of ALM increased broiler chicken growth performance, the concentration of cecal propionic acid, and activation of skeletal muscle p70S6 Kinase1 (p70S6K1) without having detrimental effects on the meat quality. Those results prompted us to further evaluate the effect of the same inclusion rates of ALM on phase feeding and intestine and liver health of the broiler chicks. The current study hypothesis is that dietary ALM positively affects phase feeding, intestinal morphology and p70S6K1 activation, cecal microbial gene expression, and improves the liver energy status. For this, we enrolled 135 one-day-old broiler chicks and collected growth performance data (starter, grower, and finisher stages) and samples of the gastrointestinal tract to analyse the morphology of the villi, immune-related organs, mucin, and abundance of intestinal p70S6K1. Cecal bacterial species were analysed using qPCR and liver samples were collected to analyse adenosine monophosphate (AMP) and ATP content and selected oxidative stress biomarkers. ALM increased BW and feed intake during the starter and grower phases but did not affect the feed conversion ratio. Liver oxidative stress and AMP: ATP ratio increased in chickens fed on a diet containing 10% ALM (AZ10; P < 0.05). Jejunum villi length and abundance of duodenal neutral mucin increased but villi of the ileum decreased in chickens fed on a diet containing 5% ALM (AZ5), while lymphoid follicle areas of the cecal tonsils decreased with both doses of ALM. Activation of p70S6K1 increased with AZ10 in the duodenum and AZ5 in the jejunum. In the gut, the family of Enterobacteriaceae decreased with both ALM doses. In conclusion, our results indicate an overall positive effect of dietary inclusion of ALM in the broiler chicken diet via its positive effect on intestinal morphology and function; however, a negative effect on the liver was observed with 10% ALM.

Concordances and correlations between anthropometric indices of obesity: a systematic review

OBJECTIVES

The pandemic of overweight and obesity has become a major clinical and public health concern worldwide. Anthropometric indices are indirect and quantitative tools used to identify individuals at increased risk of body fat-related morbidity. The aim of this systematic review was to assess the concordances and correlations between anthropometric indices of obesity in adults and whether these indices can be used interchangeably.

STUDY DESIGN

Systematic review.

METHODS

A literature search was conducted in three databases of peer-reviewed publications (PubMed, Scopus, and Embase). Further, the first 10 pages of Google Scholar were also searched for relevant studies.

RESULTS

There were strong correlations between body mass index (BMI) and waist circumference (WC) and between BMI and waist-to-height ratio (WHtR), and a weak correlation between BMI and neck circumference (NC). There was a very strong correlation between WC and WHtR and a moderate correlation between WC and NC. There were moderate concordances between BMI and WC and between BMI and WHtR and good concordance between WC and WHtR.

CONCLUSION

BMI, WC, and WHtR indices can be moderately used interchangeably with caution. More studies in adult populations using statistical tests of concordance and adjusting for differences in ethnicity, age, gender, and weight quantiles are needed.

Distribution, abundance and natural enemies of the invasive tomato leafminer, Tuta absoluta (Meyrick) in Kenya

Tuta absoluta (Meyrick) has become a serious menace to sustainable production of tomato in Kenya. A survey was conducted between April 2015 and June 2016 to determine its distribution, abundance, infestation, and damage levels on tomato, and associated natural enemies. Trap counts of T. absoluta moths were recorded in all surveyed 29 counties, which indicated its nationwide distribution irrespective of altitude. Tuta absoluta was present in both open fields and greenhouses. The highest moth/trap/day was 115.38 ± 15.90. Highest leaf infestation was 92.22% and the highest number of mines and larvae per leaf were 3.71 ± 0.28 and 2.16 ± 0.45, respectively. Trap captures in terms of moth/trap/day were linearly and positively related to leaf infestations in open fields (R2 = 0.81) and greenhouses (R2 = 0.61). Highest fruits' infestation and damage were 60.00 and 59.61%, respectively, while the highest number of mines per fruit was 7.50 ± 0.50. Nesidiocoris tenuis (Reuter) and Macrolophus pygmaeus (Rambur) were identified as predators of T. absoluta larvae. Nine species of larval parasitoids were recovered from infested foliage, with a combined parasitism of 7.26 ± 0.65%. Hockeria species was the most dominant (31.25%) and accounted for 12.88 ± 1.47% parasitism. Two species of larval parasitoids, Hockeria and Necremnus were obtained from sentinel plants with an average parasitism of 1.13 ± 0.25. The overall abundance and parasitism rates of recovered natural enemies were low to effectively control the field populations of T. absoluta. These findings form the basis of researching and developing effective and sustainable management strategies for the pest.

Neglected Foreign Body Aspiration Mimicking Lung Cancer: A Case Report

Tracheobronchial aspiration is relatively rare in adults as compared to children although incidence rates tend to increase with advancing age. The diagnosis of tracheobronchial foreign body aspiration can be challenging and warrants a high index of suspicion as the symptoms are often vague and patients may fail to recall the history of choking. The failure to diagnose the condition promptly may result in serious complications such as recurrent pneumonia, hemoptysis, or atelectasis. We present the case of a 72-year-old female with multiple comorbidities who presented with acute respiratory failure, which required urgent intubation and mechanical ventilation. Eventually, she was found to have aspirated green peas and pomegranate seeds, which were successfully removed by flexible bronchoscopy, leading to a dramatic improvement in both clinical condition and radiological imaging findings.

Massive Gastrointestinal Haemorrhage Unusual Presentation of Gastrointestinal Stromal Tumors of the Jejunum: Case Report and Literature Review

Although gastrointestinal stromal tumors (GISTs) are rare tumors, they are the most common tumors of mesenchymal origin of the gastrointestinal tract. GISTs present with nonspecific clinical manifestation and they are discovered incidentally during endoscopic or radiological investigations. Massive life-threatening bleeding that requires urgent surgery is rare. We present a case of small bowel GIST that presented with massive lower gastrointestinal bleeding that required urgent surgical intervention.

Neurological Manifestations of COVID-19 in Absence of Respiratory Symptoms or Fever

The novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first described in the Hubei region of China and was declared a pandemic by the World Health Organization (WHO) in March 2020.

The clinical presentation of COVID-19 ranges from asymptomatic/mild symptoms to severe illness with associated mortality. The most commonly reported symptoms of COVID-19 are cough, myalgia, and headache. Other well-described features include shortness of breath, fever, sore throat, diarrhea, and smell or taste abnormalities.

Although COVID-19 infection is primarily a disease of the respiratory system affecting lung parenchyma, it can affect multiple organ systems and cause variable extra-pulmonary symptoms. A broad spectrum of neurologic manifestations has been reported in association with SARS-CoV-2 infection, most probably due to different pathogenic pathways. We report a case of a rare presentation of a COVID-19-positive female who presented with slurred speech, dizziness, and left-sided weakness without the other common symptoms of the disease.

African Citrus Greening Disease in East Africa: Incidence, Severity, and Distribution Patterns

African citrus greening disease (ACGD) is considered as one of the major diseases of citrus threatening citrus production in East Africa. Our study aimed for the first time to assess the incidence, severity, and distribution patterns of ACGD in Kenya and Tanzania. In total, 105 citrus orchards were assessed in 13 regions representing low, mid, and high altitude areas. In each backyard and orchard, trees were randomly selected and rated for visual ACGD symptoms; then leaves and insect samples collected for analysis of 'Candidatus Liberibacter africanus' (CLaf), the presumptive causal agent of ACGD. Endpoint PCR, sequencing, and molecular phylogenetic tools were employed to confirm the identity of potential circulating pathogens. Incidence and severity of ACGD varied significantly among the different regions. Both Trioza erytreae (Del Guerico) (Hemiptera: Triozidae) and the invasive Asian citrus psyllid vector Diaphorina citri (Kuwayama) (Hemiptera: Liviidae) were found to co-occur in upper and lower midland regions. Molecular characterization identified 'Candidatus Liberibacter africanus spp. Clausenae' (CLafCl) as the main causal agent of ACGD in most of the citrus plants and insect samples. No instances of Candidatus Liberibacter asiaticus infection were found. These findings provide valuable insights into understanding and management of ACGD by employing stringent and early disease detection tools to curb the spread of the disease.

Infestation Levels and Molecular Identification Based on Mitochondrial COI Barcode Region of Five Invasive Gelechiidae Pest Species in Kenya

Invasive Gelechiidae pest species, namely Tuta absoluta, Phthorimaea operculella, Aproaerema simplixella, Sitotroga cerealella, and Pectinophora gossypiella are among the major constraints hampering agricultural economy in Kenya. Infestation levels were determined on respective host crops sampled from different localities and P. operculella recorded the highest infestation of 68.00 ± 4.92% on stored potato. Aproaerema simplixella and T. absoluta accounted for 61.33 ± 5.35% and 51.56 ± 5.22% maximal infestation on groundnuts and tomato leaves, respectively. Stored maize was significantly infested by S. cerealella (54.33 ± 5.31%) while no infestation was observed on the freshly harvested grains. Infestation on open bolls by P. gossypiella was relatively low (6.11 ± 3.46%) compared to Anatrachyntis simplex (45.67 ± 7.84%) that emerged as the key pest of cotton. The species were discriminated based on sequence similarities, evolutionary divergences, and phylogenetic analyses. A 658-bp fragment of mitochondrial cytochrome c oxidase subunit I (COI) gene was obtained from 302 specimens. Generally, genetic variations were low within and between Gelechiid populations, with an average of 0.02% and all intraspecific divergences were less than 2% except for S. cerealella. The Gelechiids data set generated eight Barcode Index Numbers (BINs), five of which were concordant and three belonging to S. cerealella were singleton. All species were separated into distinct clusters on a maximum likelihood tree. Data on infestation levels will be useful in defining the pest status of these Gelechiids in Kenya. DNA barcoding is also presented as a valuable tool to complement traditional taxonomy for rapid and accurate identification of these species of agronomic interest.

Solid-state fermentation by Trichoderma viride for enhancing phenolic content, antioxidant and antimicrobial activities in ginger

The phenolic content of methanol and water extracts of ginger fermented by Trichoderma spp. using solid-state fermentation (SSF) was evaluated and was compared with unfermented ginger. The total phenolic content in fermented ginger increased several times. The highest phenolic content in ginger was detected after SSF by T. viride. The optimal physiological conditions for the maximum production of phenolic compounds and β-glucosidase activity of fermented ginger by T. viride were detected at day 7 incubation, pH 6·0, 30°C and 30% moisture. The SSF of ginger by T. viride greatly enhanced the antioxidant potency of phenolic compounds and was evaluated using DPPH and ABTS assays. A potent antibacterial activity of the phenolic compounds of fermented ginger was observed against all the tested human-pathogenic bacteria.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first report to investigate the optimal physiological conditions of solid-state fermentation (SSF) of ginger by Trichoderma viride for enhancing its phenolic content and antioxidant capacity. In addition, the phenolic compounds of fermented ginger could be potentially used as a dietary adjunct and an antibacterial agent.

DNA Barcode Reference Library for the African Citrus Triozid, Trioza erytreae (Hemiptera: Triozidae): Vector of African Citrus Greening

Citrus (Citrus spp.) production continues to decline in East Africa, particularly in Kenya and Tanzania, the two major producers in the region. This decline is attributed to pests and diseases including infestation by the African citrus triozid, Trioza erytreae (Del Guercio) (Hemiptera: Triozidae). Besides direct feeding damage by adults and immature stages, T. erytreae is the main vector of 'Candidatus Liberibacter africanus', the causative agent of Greening disease in Africa, closely related to Huanglongbing. This study aimed to generate a novel barcode reference library for T. erytreae in order to use DNA barcoding as a rapid tool for accurate identification of the pest to aid phytosanitary measures. Triozid samples were collected from citrus orchards in Kenya, Tanzania, and South Africa and from alternative host plants. Sequences generated from populations in the study showed very low variability within acceptable ranges of species. All samples analyzed were linked to T. erytreae of GenBank accession number KU517195. Phylogeny of samples in this study and other Trioza reference species was inferred using the Maximum Likelihood method. The phylogenetic tree was paraphyletic with two distinct branches. The first branch had two clusters: 1) cluster of all populations analyzed with GenBank accession of T. erytreae and 2) cluster of all the other GenBank accession of Trioza species analyzed except T. incrustata Percy, 2016 (KT588307.1), T. eugeniae Froggatt (KY294637.1), and T. grallata Percy, 2016 (KT588308.1) that occupied the second branch as outgroups forming sister clade relationships. These results were further substantiated with genetic distance values and principal component analyses.

Can germ cell neoplasia in situ be diagnosed by measuring serum levels of microRNA371a-3p?

Purpose

Diagnosing germ cell neoplasia in situ (GCNis) can detect germ cell tumours (GCTs) at the pre-invasive stage. To date, testicular biopsy with the potential of surgical complications is the only way of safely diagnosing GCNis. Recently, microRNAs (miRs) 371-3, and miR 367 were shown to be valuable serum biomarkers of GCTs. We explored the usefulness of these candidate miRs as a marker for GCNis.

Methods

27 patients with GCNis and no concomitant GCT were enrolled. All patients underwent measuring serum levels of miR-371a-3p and miR-367-3p before treatment, 11 had repeat measurement after treatment, 2 also had testicular vein blood examinations. Serum levels were measured by quantitative PCR. In addition, four orchiectomy specimens of patients with GCT were examined immunohistochemically and by in situ hybridization (ISH) with a probe specific for miR-371a-3p to look for the presence of this miR in GCNis cells.

Results

The median serum level of miR-371a-3p was significantly higher in patients with GCNis than in controls, miR-367 levels were not elevated. Overall, 14 patients (51.9%) had elevated serum levels of miR-371a-3p. The highest levels were found in patients with bilateral GCNis. Levels in testicular vein serum were elevated in both of the cases. After treatment, all elevated levels dropped to normal. In two orchiectomy specimens, miR-371a-3p was detected by ISH in GCNis cells.

Conclusions

Measuring miR-371a-3p serum levels can replace control biopsies after treatment of GCNis. In addition, the test can guide clinical decision making regarding the need of testicular biopsy in cases suspicious of GCNis.

The potential distribution of Bactrocera dorsalis: considering phenology and irrigation patterns

A species in the Bactrocera dorsalis (Hendel) complex was detected in Kenya during 2003 and classified as Bactrocera invadens Drew, Tsuruta & White. Having spread rapidly throughout Africa, it threatens agriculture due to crop damage and loss of market access. In a recent revision of the B. dorsalis complex, B. invadens was incorporated into the species B. dorsalis. The potential distribution of B. dorsalis has been previously modelled. However, previous models were based on presence data and did not incorporate information on the seasonal phenology of B. dorsalis, nor on the possible influence that irrigation may have on its distribution. Methyl eugenol-baited traps were used to collect B. dorsalis in Africa. Seasonal phenology data, measured as fly abundance throughout the year, was related to each location's climate to infer climatic growth response parameters. These functions were used along with African distribution records and development studies to fit the niche model for B. dorsalis, using independent global distribution records outside Africa for model validation. Areas at greatest risk of invasion by B. dorsalis are South and Central America, Mexico, southernmost USA, parts of the Mediterranean coast, parts of Southern and Eastern Australia and New Zealand's North Island. Under irrigation, most of Africa and Australia appear climatically suitable.

Inhibition of Salmonella typhi growth using extremely low frequency electromagnetic (ELF-EM) waves at resonance frequency

AIMS

Typhoid is a serious disease difficult to be treated with conventional drugs. The aim of this study was to demonstrate a new method for the control of Salmonella typhi growth, through the interference with the bioelectric signals generated from the microbe during cell division by extremely low frequency electromagnetic waves (ELF-EMW-ELF-EM) at resonance frequency.

METHODS AND RESULTS

Isolated Salmonella typhi was subjected to square amplitude modulated waves (QAMW) with different modulation frequencies from two generators with constant carrier frequency of 10 MHz, amplitude of 10 Vpp, modulating depth ± 2 Vpp and constant field strength of 200 V m(-1) at 37°C. Both the control and exposed samples were incubated at the same conditions during the experiment. The results showed that there was highly significant inhibition effect for Salm. typhi exposed to 0·8 Hz QAMW for a single exposure for 75 min. Dielectric relaxation, TEM and DNA results indicated highly significant changes in the molecular structure of the DNA and cellular membrane resulting from the exposure to the inhibiting EM waves.

CONCLUSIONS

It was concluded that finding out the inhibiting resonance frequency of ELF-EM waves that deteriorates Salm. typhi growth will be promising method for the treatment of Salm. typhi infection either in vivo or in vitro.

SIGNIFICANCE AND IMPACT OF THE STUDY

This new non-invasive technique for treatment of bacterial infections is of considerable interest for the use in medical and biotechnological applications.

Cold tolerance and disinfestation of Bactrocera invadens (Diptera: Tephritidae) in 'Hass' avocado

Bactrocera invadens (Diptera: Tephritidae) has spread rapidly across Africa and currently poses a phytosanitary threat to the fruit industry of South Africa. In reaction a cold mitigating treatment to provide phytosanitary security to importing countries was developed in Nairobi, Kenya. Using laboratory reared fruit flies, the rate of development in 'Hass' avocado (Persea americana Miller) was determined at 28 degrees C. Fruit ripeness or softness was found to be a factor improving larval fruit fly survival. Using this information the egg and larval developmental stages were subjected to 2 degrees C cold treatment and it was found that the third instars were the most cold tolerant life stage and that it was expected that between 16 and 17 d treatment would provide phytosanitary security. There were no survivors in the treatment of an estimated 153,001 individuals in four replicates at an average fruit pulp temperature of 2 degrees C satisfying the Probit 9 level of efficiency at a confidence of >95%. These data provide evidence that a continuous cold treatment of 1.5 degrees C or lower for 18 d would provide phytosanitary security in that any consignment entering an importing country poses no risk of accidental importation of B. invadens.

Serum levels of visfatin and omentin-1 in patients with psoriasis and their relation to disease severity

BACKGROUND

The association of the novel adipokines visfatin and omentin-1 with psoriasis is still obscure. Data concerning other inflammatory diseases suggest a possible role of these adipokines in the pathophysiology of psoriasis.

OBJECTIVES

To investigate serum levels of visfatin and omentin-1 in patients with psoriasis compared with healthy controls, and to consider their relation to disease duration, disease severity and obesity markers.

METHODS

Visfatin and omentin-1 concentrations were measured in 46 patients with plaque-type psoriasis and 42 healthy controls by using specific enzyme-linked immunosorbent assays.

RESULTS

Patients with psoriasis showed considerably higher serum levels of visfatin than healthy controls with significant positive correlation with disease severity and duration. They also showed lower levels of ominten-1 compared with healthy controls with significant inverse correlation with body mass index and waist circumference.

CONCLUSIONS

Coordinated roles for visfatin and omentin-1 are suggested in the modulation of the inflammatory environment in patients with psoriasis. Given the significant relations of omentin-1 with obesity markers, the health consequences of excessive weight should be better communicated to patients with psoriasis.

Cost-effectiveness of ultrasound use by on-call registrars in an acute gynaecology setting

Ultrasound, and in particular transvaginal sonography (TVS), plays an important role in the management of women with acute gynaecology conditions. This study compared the cost-effectiveness of two models of out-of-hours care for women in an acute gynaecology setting. In the ultrasound-based model, the on-call registrar with ultrasound experience managed such patients after performing pelvic ultrasound as a part of the initial assessment. On the other hand, in the traditional model of care the on-call registrar managed the patients without the use of ultrasound. The conclusion is that the use of ultrasound by the on-call registrars has significant cost implications through reduced hospital admissions. It leads to improved outcomes of such patients through timely diagnosis and treatment.

Cold susceptibility and disinfestation of Bactrocera invadens (Diptera: Tephritidae) in oranges

To develop a cold disinfestation treatment for the fruit fly Bactrocera invadens Drew, Tsuruta & White (Diptera: Tephritidae) that is rapidly spreading across Africa, research was conducted in Nairobi, Kenya, using flies from a laboratory culture and 'Valencia' orange (Citrus sinensis L. Osbeck) as the host. The developmental rate of B. invadens in Valencia oranges was determined at 28 degrees C, and the third instar was found to be the least susceptible of the egg and larval life stages to cold treatment at 1.1 degrees C in oranges. When 22,449 B. invadens third instars were exposed in oranges to a cold treatment with an approximate midpoint of 1.1 +/- 0.5 degrees C, the results suggested that a period of 16 d would be worthwhile verifying on a larger scale in oranges. Results from the first replicate of 16,617 larvae showed no survivors, but the second replicate of 23,536 larvae had three survivors. Because a longer cold treatment based on a mean temperature of 1.1 degrees C would create logistical difficulties for some export markets, further replicates were conducted at an approximate midpoint of 0.5 degrees C and at mean hourly maximum of 0.9 +/- 0.5 degrees C, for 16 d. After three replicates, in which 65,752 B. invadens third instars in total were treated with no survivors, the Japanese requirement of 99.99% mortality at the 95% confidence level was surpassed. The following treatment protocol for B. invadens larvae in oranges can therefore be recommended: fruit pulp to be maintained at temperatures of 0.9 degrees C or lower for 16 consecutive days.

Dural tear post mastoidectomy repaired with Dura Gen

Dural exposure may occur during the course of thinning the tegmen tympani and tegmen mastoideum in mastoid procedure. If large area of dura is exposed or lacerated, cerebrospinal fluid and brain herniation may enter the mastoid cavity. We report a case of a patient with injured dura mater and tegmen mastoideum during mastoidectomy for chronic suppurative otitis media with cholesteatoma managed by using DuraGen. The dura mater and tegmen defect healed totally showing the success of the procedure. A collagen matrix like DuraGen is an option for repairing dural tear in mastoid region.

Repetitive transcranial magnetic stimulation at 1Hz and 5Hz produces sustained improvement in motor function and disability after ischaemic stroke

BACKGROUND

Repetitive transcranial magnetic stimulation (rTMS) is a simple and non-invasive method of augmenting motor recovery after stroke, probably mediated by restoring inter-hemispheric activation balance. This placebo-controlled pilot study examined the possible benefit of stimulating the lesioned hemisphere (5-Hz rTMS) or inhibiting the contra-lesional hemisphere (1-Hz rTMS) on clinical recovery of motor function in patients with ischaemic stroke and assessed the sustainability of the response.

METHODS

Sixty patients with ischaemic stroke (>1 month from onset) with mild-to-moderate hemiparesis were randomized to receive 10 daily sessions of either sham rTMS, 5-Hz ipsi-lesional rTMS or 1-Hz contra-lesional rTMS, in addition to a standard physical therapy protocol. Serial assessments were made over a period of 12 weeks by the thumb-index finger tapping test (FT), Activity Index (AI) score and the modified Rankin Scale (mRS).

RESULTS

In contrast to control patients, those receiving active rTMS as ipsi-lesional 5-Hz stimulation or 1-Hz contra-lesional stimulation showed statistically significant improvement on the FT test, AI scores and mRS score at 2 weeks, and the effect was sustained over the 12-week observation period. No significant adverse events were observed during treatment in either group.

CONCLUSIONS

Repetitive TMS has beneficial effects on motor recovery that can be translated to clinically meaningful improvement in disability in patients with post-stroke hemiparesis, with a well-sustained effect. The similarity of inhibitory and stimulatory rTMS in producing these effects supports the inter-hemispheric balance hypothesis and encourages further research into their use in long-term neurorehabilitation programmes of patients with stroke.

Expectant management of first-trimester miscarriage

Miscarriage is the most common complication of pregnancy, which creates a significant workload for health-care professionals. For decades, surgical evacuation of the uterus has remained the conventional treatment of first-trimester miscarriage. Recently, non surgical treatments have been introduced with increasing popularity. This review explores the evidence in support of expectant management of first-trimester miscarriage. It is safe, effective and well-tolerated by women. It enhances women's choice and control. It generates significant cost savings compared with the traditional surgical management. Accurate diagnosis, counselling, 24/7 telephone advice and follow-up are among the important aspects of expectant management. More studies are needed to develop methods for identifying miscarriages suitable for expectant management.

Potential of some monoterpenoids and their new N-methyl carbamate derivatives against Schistosomiasis snail vector, Biomphalaria alexandrina

Some monoterpenoids and their corresponding new N-methyl carbamate derivatives were used to study their molluscicidal effect on Biomphalaria alexandrina, the snail-vector of Schistosoma mansoni in Egypt. Improving the efficacy of the tested monoterpenoids and/or their corresponding carbamates by either piperonyl butoxide (PBO) or triton X-100 (TX) was also performed. Thymol, β-citronellol, carvacrol, and geraniol exhibited high molluscicidal activity against the snails. Geraniol, β-citronellol, and carvacrol were strongly synergized by PBO but, an opposite trend was found with TX. The molluscicidal activity of geraniol or β-citronellol when mixed with PBO was as potent as copper sulfate. Another attempt to improve the bioactivity of monoterpenoids was through their structure modifications. Thus, conversion of the tested monoterpenoids into their corresponding carbamates led to enhancement in the activity of aliphatic monoterpenoids and reduction in the aromatics.

Early Embryonic Development of the Camel Lumbar Spinal Cord Segment

The lumbar spinal cord segment of the one-humped camel (Camelus dromedarius) embryos at 2.4- to 28-cm crown vertebral rump length (CVRL) was examined. Major changes are occurring in the organization of the lumbar spinal cord segment at this early developmental period. At first, the spinal cord is flattened from side to side but with increase in gestational age it becomes flattened dorsoventrally. The size and shape of the lumen changes in indifferent stage of development. These changes may be in relation to the decrease of ependymal layer and increase of the mantel layer during the developmental stages. The lumen of the spinal cord is a wide spindle in shape at 2.4-cm CVRL, diamond in shape at 5.5-cm CVRL and narrow oval in shape at 28-cm CVRL. It occupies about the whole, half and one-seventh of the total height of the spinal cord at 2.4-, 5.5- and 28-cm CVRL, respectively. At the 2.4-2.7 CVRL, the spinal cord is formed of six plates: roof, floor, two alar and two basal plates. The present investigation indicates that the distribution of the ependymal, mantle and marginal layers differs in the various developmental stages of the camel embryos. The majority of the cross section of the spinal cord consists at first of ependymal and mantle layers, and a thin outer rim of the marginal layer. With the advancement of age, the ependymal layer diminishes in size, while the mantle and marginal layers increase in size forming the future grey and white matters, respectively.

Detection of the 4977 bp deletion of mitochondrial DNA in different human blood cells

As recently reported, it is possible to detect and quantify the amount of the deleted human mitochondrial DNA (mtDNA) in whole blood, platelets and peripheral blood mononuclear cells using real-time PCR. The aim of this study was to identify the cell types in human blood carrying the 4977 bp deleted mtDNA and their accumulation with regard to donor age. Whole blood from 10 healthy donors (five individuals aged from 19 to 22 years, five aged from 57 to 61 years) was separated in various cell populations such as granulocytes, B cells/monocytes and T cells. Purity of the cell isolates was determined by flow cytometry. Total DNA was extracted and 250 ng DNA of each cell type was subjected to PCR using fluorescent-labelled primer pairs. The specific PCR product of the 4977 bp deletion was quantified using an automated detection system. The accumulation of the 4977 bp deletion was more pronounced in T lymphocytes and granulocytes in comparison to B lymphocytes/monocytes. The amount of the 4977 bp deletion in whole blood varied from 0 to 0.00018%, in T lymphocytes from 0.00009 to 0.00160%, in granulocytes from 0 to 0.00162% and in the B lymphocyte/monocyte fraction from 0 to 0.00025%. The higher amount of the deletion in T lymphocytes may be due to a subset of lymphocytes with a longer lifespan thus facilitating the accumulation of mitochondrial damage. The higher amount in granulocytes could have the explanation in the higher release of free radicals for prevention of infectious diseases, because free radicals are supposed to damage the macromolecules of this cell type. The 10 donors displayed differences in the pattern of the accumulation with regard to the different cell types, but no age-dependent accumulation was observed. Differences of the accumulation pattern may be due to actual individual living behaviour or environmental factors.

Mitotic brain cells are just as prone to mitochondrial deletions as neurons: a large-scale single-cell PCR study of the human caudate nucleus

Mitochondria are considered a key element in the process of organismic aging, because of their fundamental role in cellular energy generation. In the course of oxidative phosphorylation, harmful free radicals are continuously produced damaging the mitochondrial (mt) genome. One of the consequences is the occurrence of large-scale deletions in mtDNA molecules. The 4977 bp common deletion accumulates exponentially with age, in a mosaic pattern, especially in postmitotic tissues. In order to investigate whether certain cell characteristics underlie this pattern of distribution, and to look for possible age-related changes, two cell types in the caudate nucleus of the human brain from five young and five senescent subjects were analysed by single-cell PCR.MAP2-positive neurons and GFAP-positive astrocytes were isolated by micromanipulation. For each of the 10 cases, at least 30 cells of each type were collected and subjected to PCR individually. Screening for the presence of the common deletion yielded no significant differences in relative distribution, neither between astrocytes and neurons, nor between healthy young and old humans. Our results imply that the age-dependent increase of the common deletion cannot come about by an increase of independent deletion events in a greater proportion of cells, and that mitotic rate is not a major cellular risk factor for deletion accumulation in the caudate nucleus.

[The mitochondrial genome and aging]

There is a lot of evidence that age-associated alterations of the mitochondrial genome occur, especially in postmitotic tissues such as brain, heart and skeletal muscle. These alterations are supposed to be a result of an attack of free radicals generated as normal byproducts of oxidative phosphorylation and lead to damage of proteins, lipids, and DNA. The alterations of mtDNA include oxidative damage of base pairs, point mutations, large-scale deletions or duplications. The 4977 bp deletion or "common deletion" reveals an age-dependent accumulation in postmitotic tissues, but not in fast-dividing tissues such as blood cells. In addition, it is observed that a tissue-specific accumulation occurs with the highest abundance in the basal ganglia, followed by skeletal muscle, heart, and lowest in cerebellar tissue. Third, pathological alterations of specific tissue, like ischemia/reperfusion events, display a pronounced accumulation of the deletion compared to age-matched controls. Because there are many mtDNA mutations, further analysis of all alterations of mtDNA will elucidate its role in the phenomenon of aging. Despite some criticisms of this free radical theory of aging, there is a lot of experimental evidence to support the important role of mitochondria in organismal aging.

The use of the 'TRAM' flap in some oncological problems

The present study was conducted to evaluate the use of the transverse rectus abdominis myocutaneous (TRAM) flap in immediate autologous soft tissue coverage of the large wound defect that results from some oncological problems and would be impossible to close by direct primary sutures. The study included patients with locally advanced breast cancer (LABC) (n = 24), post-mastectomy local recurrence (n = 10), post-mastectomy irradiation ulcer (n = 4), recurrent fibrosarcoma of the chest wall (n = 1), and a huge ulcerating malignant melanoma of the groin region (n = 1). All patients were female except for the patient with melanoma. Their ages ranged between 39-73 years with an average of 56.2 years. The lower TRAM flap was used in 24 patients and the middle in only six. Mesh re-inforcement of the abdominal wall was adopted in 14 patients (35%). The mean operating time was 2.5 h and the average postoperative hospital stay was 9.7 days (range, 7-12 days). Six patients (15%) had partial flap necrosis which healed after debridement and secondary sutures, and eight patients had wound sepsis (20%). No patient suffered from abdominal herniation, although four patients (10%) had an epigastric bulge postoperatively. During the 48.5 month follow-up period (range 36-56 months), three cases of local recurrence and four cases of distant metastases were encountered in the patients with LABC. Three of the latter died at 7, 11 and 12 months postoperatively. Based on these data, it may be concluded that the results of the TRAM flap for immediate coverage of the large post-extirpation defect in different oncological problems have been encouraging. No flaps were lost, no abdominal herniation was encountered, and overall complications were minimal.

Quantification of mitochondrial DNA in human blood cells using an automated detection system

The 4977 bp deletion of mitochondrial DNA (mtDNA) accumulates in postmitotic tissues with advancing age. The purpose of our study was to detect and quantify these deletion even in blood cells with a high turnover activity. Whole venous blood, isolated human platelets and peripheral blood mononuclear cells (PBMCs) were collected from 10 unrelated donors aged 20-71 years and total DNA was extracted. PCR was performed for total and mutated mtDNA using two different primer pairs and two fluorogenic probes labeled with the fluorescent dyes FAM and VIC. Specific PCR products were generated, detected and quantified in a real-time PCR. The amplification products of total and deleted mtDNA could be detected in each sample and did not exhibit any differences in the amount of the deleted mtDNA in whole blood, human platelets or PBMCs. Our data did not show any accumulation of the 4977 bp deletion with increasing age as it was observed for several other tissues.

alpha-Amylase from developing embryos of the camel tick Hyalomma dromedarii

alpha-Amylase activity in the camel tick Hyalomma dromedarii was followed throughout embryogenesis. During purification of alpha-amylase III to homogeneity, ion exchange chromatography lead to four separate forms (termed I, II, III and IV). alpha-Amylase III with the highest specific activity was pure after chromatography on Sephacryl S-300. The molecular mass of alpha-amylase III was 106 kDa for the native enzyme, composed of two subunits of 43 and 66 kDa, respectively. alpha-Amylase had a value of 10 mg starch/ml. Varying alpha-amylase activity was detected when supplied with various substrates. alpha-Amylase III had a temperature optimum at 40 degrees C with heat stability up to 50 degrees C, and a pH optimum of 7.0. The enzyme activity was activated by CaCl2, MgCl2 and NaNO3, but not activated by NaCl, p-CMB, N-ethylmaleimide and iodoacetamide. EDTA and beta-mercaptoethanol strongly inhibited activity.

A non-stop antisense reading frame in the grp78 gene of Neurospora crassa is homologous to the Achlya klebsiana NAD-gdh gene but is not being transcribed

A long non-stop reading frame exists on the antisense strand of the grp78 gene (cDNA and genomic DNA) of Neurospora crassa. Computer analysis revealed a strong similarity of the putative antisense protein to the 10th exon of the NAD-dependent glutamate dehydrogenase gene (NAD-gdh) of Achlya klebsiana, which is itself located on the complementary strand of a transcribed hsc70 gene homologue. In Neurospora, no grp78 antisense mRNA was detected by Northern blot and reverse transcription-coupled polymerase chain reaction analyses, indicating that this long reading frame is not being transcribed. Hypotheses for the presence of such unexpressed non-stop reading frames are discussed.

Comparison of transvaginal ultrasonography and vaginal sonohysterography in the detection of endometrial polyps

BACKGROUND

The diagnostic accuracy of transvaginal ultrasonography and vaginal sonohysterography in detecting endometrial polyps in women suffering abnormal uterine bleeding are compared.

METHODS

One hundred and six patients suffering from menometrorrhagia were studied. To detect whether there was endometrial polyp or not, these patients were subjected to transvaginal ultrasonographic examination as well as to sonohysterography. The final diagnosis was established by diagnostic hysteroscopy and its guided biopsy.

RESULTS

Transvaginal ultrasonography resulted in false positive and false negative rates of 25% and 36.2% respectively while the figures with sonohysterography were 5.4% and 8% respectively. Combining both techniques further improved such rates to 2.9% and 2.8% respectively but not significantly (p>0.1). The sensitivity and specificity were 64.5%, 75.5% for transvaginal ultrasonography, and 93.1%, 93.9% for sonohysterography (significantly higher: p<0.001).

CONCLUSIONS

Sonohysterography is significantly more accurate than transvaginal ultrasonography in the detection of endometrial polyps in cases with abnormal uterine bleeding. Combining both techniques did not significantly improve the diagnostic accuracy. Sonohysterography is an accurate and cost effective method which requires a little skill.

Upper gastrointestinal endoscopy findings at Riyadh Armed Forces Hospital

Full text is available as a scanned copy of the original print version.

Treatment of chronic hepatitis C genotype 4 with alpha-interferon in Saudi Arabia: a multicenter study

BACKGROUND/AIM

Several studies have indicated that there are certain predictive factors (gender, duration of infection with HCV, cirrhosis and genotype of HCV) of a better response with alpha-interferon treatment in patients with chronic hepatitis C. The aim of this study was to evaluate these factors in Saudis and other Arab nationals with chronic hepatitis C-genotype 4-undergoing alpha-interferon treatment.

METHODOLOGY

A multicenter study was conducted between 1992 and 1994 on 80 consecutive patients who were prospectively recruited and randomized in treatment and control groups.

RESULTS

The results of this multicenter study indicated a low response rate to alpha-interferon with an overall response rate of 43%, of which 28% was complete. The sustained response was only 16%. Among the reasons for this low response in our study are the high percentage of patients with cirrhosis and the long infection interval, as about 80% of our HCV cases were community-acquired.

CONCLUSION

Liver cirrhosis was found to be the main predetermining factor for response to interferon treatment. Genotype 4 was not a contributing factor to the difference in response rate.

Enzymes of delta 1-pyrroline-5-carboxylate metabolism in the camel tick Hyalomma dromedarii during embryogenesis. Purification and characterization of delta 1-pyrroline-5-carboxylate dehydrogenases

The activity of P5C metabolizing enzymes: OAT, P5CR, PO, and P5CD, in the camel tick Hyalomma dromedarii has been followed throughout embryogenesis. The profiles of enzymatic activity showed clear differences in the four enzymes as the embryos grew older. During purification of P5CD to homogeneity the ion exchange chromatography steps lead to two separate forms (termed A and B) with different molecular weights (60,000-59,000 and 50,000-52,000 for the native and denatured enzymes, respectively), amino acid composition, Km for P5C and coenzymes, varying dehydrogenase activities with different substrate specificity when supplied with various aldehyde substrates. Both P5CD A and B exhibited sharp optima at pH 7.5. The effect of different divalent cations and competitive and noncompetitive inhibitors was examined. The changes in P5C metabolizing enzymes during embryogenesis suggest that H. dromedarii has the metabolic potential to convert ornithine into proline and glutamate.

Omeprazole versus histamine H2 receptor antagonists in the treatment of acute upper non-variceal bleeding

BACKGROUND/AIMS

To compare the efficacy of omeprazole, a proton pump inhibitor, with Histamine H2 receptors antagonists in the control and recurrence of non-variceal upper gastrointestinal bleeding.

PATIENTS AND METHODS

Seventy-one patients (Group A, Omeprazole) with definite diagnosis of upper gastrointestinal bleeding of non-variceal origin during January 1993-Dec.1994, compared retrospectively with 119 patients (Group B, Ranitidine) with similar criteria during 1987-1993. Patients in both groups were matched as compared to sex, age and risk factors. Active treatment was omeprazole 40 mg B.D (twice daily) and then orally in group A compared with ranitidine intravenously 50mg TDS (three times daily) and then 150 mg B.D orally in group B. All patients in both groups had endoscopy at the time of presentation or within 24 hours. Endoscopic treatment was applied in some of the patients to arrest acute bleeding. The efficacy of treatment was gauged by the number of blood transfusions needed to maintain Hb., evidence of re-bleeding and need for surgery.

RESULTS

The patients were well matched for endoscopic diagnosis except duodenal ulcers, which were more common in group A (P < 0.05). In group A out of 71 patients, 5 had rebleeding and 2 required surgery. In group B, out of 119 patients 12 rebled and 10 required surgery. Statistically there was no difference between groups (p = 0.52 by using Kendall's Tau B). Nine patients in omeprazole group received 2 units blood transfusion, 6 patients > 4 units and 3 patients > 6 units, while in the H2 blocker group, 16 patients received 2 units, 15 patients received > 4 units, and 3 patients > 6 units of blood transfusion. Statistically there was no difference between groups with regard to number of transfusions, rebleed or the need for surgery.

CONCLUSIONS

In our study we found no difference between omeprazole and histamine H2 receptors antagonists in controlling and recurrence of upper gastrointestinal bleeding.