Causes and effects of road traffic accidents in Saudi Arabia

In Saudi Arabia the motor vehicle is the main means of transportation. Between 1971 and 1997; 564,762 people died or were injured in road traffic accidents, a figure equivalent to 3.5% of the total population in Saudi Arabia. During this period 66,914 people have died on the roads in Saudi Arabia due to road accidents, amounting to one person killed and four injured every hour. Over 65% of accidents occur because of vehicles travelling at excess speed and/or drivers disobeying traffic signals. Of deaths in Ministry of Health hospitals, 81% are due to road traffic accidents and 20% of their beds are occupied by traffic accidents victims. Also, 79.2% of patients admitted to Riyadh Armed Forces Hospital with spinal injuries has sustained their injuries as a result of a motor vehicle accident. We recommend compulsory use of safety seat belts in vehicles and the setting up of a new database to collect, store and analyse information relating to the road traffic accidents.

St. Georg sledge for medial compartment knee replacement. 461 arthroplasties followed for 4 (1-17) years

We evaluated the long-term outcome of 461 medial compartment knee arthroplasties operated at one orthopedic center from 1974 to 1993 through survivorship analysis. Prospective assessment was based on clinical examinations using a modified Bristol knee-scoring system and complete radiographical knee survey. 92% had good or excellent results on objective scoring, and range of motion averaged 112 degrees. 3 criteria were applied to indicate failure: 1) revision or recommended revision, 2) severe-to-moderate pain or revision, 3) lost to follow-up. 20 arthroplasties were revised or recommended to be revised at mean 5.5 years. The incidence of failure due to progression of arthrosis in the unreplaced compartment was low (< 2%). Loosening or wear occurred in 6 cases (1.5%), 2 of which developed fracture of implant. With revisions only as end-point to failure, the survival was 87% at 10 years (95% CI 81%-93%, effective number at risk = 133). In addition to revisions, 19 knees were considered to have failed, as moderate-to-severe pain was noted at follow-up and the survival was reduced to 74% at 10 years with pain or revision as endpoint (95% CI 65%-82%, effective number at risk = 105). We conclude that unicompartmental knee arthroplasty gives long-term pain relief in elderly patients with medial compartment arthrosis.

Incidence of fatal pulmonary embolism after 1,390 knee arthroplasties without routine prophylactic anticoagulation, except in high-risk cases

A consecutive series of 1,390 primary total knee arthroplasty (TKA) procedures (1,201 patients, 1,600 arthroplasties) performed between January 1980 and July 1994 were reviewed to establish the incidence of death from pulmonary embolism (PE). Nine hundred twenty-three bi- or tricompartment TKAs and 467 unicompartment TKAs were performed as one-stage procedures. Chemical thromboprophylaxis was used only in high-risk cases in which there was a history of previous thromboembolism or obesity. There were no deaths from PE after unicompartment arthroplasty procedures. Autopsy confirmed PE as the cause of death in 2 patients following bi- and tricompartment TKAs (0.22%; 95% confidence interval [CI], 0.03-0.8%). The incidence was higher for one-stage bilateral TKA as 1 of the autopsy-confirmed deaths occurred in this group 0.7% (95% CI, 0.02-3.78%). Two other deaths were certified without postmortem examination (pneumonia and myocardial infarction in each case). As PE could not be ruled out as the cause of death in the latter 2 cases, these were considered as possible PE deaths to provide the maximum possible death rate that could result. Thus, the maximum possible incidence of fatal PE after TKA without routine use of chemical anticoagulation was 0.4% (95% CI 0.1-1.1%). It is concluded that the risk of fatal PE after unilateral TKA and unicompartment knee arthroplasty is low. The risk of clinical, nonfatal thromboembolic events, which might themselves warrant prophylaxis, was not quantified in this article.

Phase II clinical trial of a vas deferens injectable contraceptive for the male

Following up on an earlier clinical trial demonstrating the safety of an intra-vas deferens injection of a contraceptive drug named Risug, comprised of styrene maleic anhydride (SMA) in a solvent vehicle of dimethylsulphoxide (DMSO), a study to assess the contraceptive effectiveness of a specific dose (60 mg) of SMA bilaterally was planned and implemented. Male subjects and their wives with normal reproductive profiles were the volunteer subjects. The wives were not using any contraceptives. The results reconfirm the safety and show that for a period of at least 1 year, the treatment leads to azoospermia in the male and gives pregnancy protection.

Phase I clinical trial of an injectable contraceptive for the male

Earlier studies on the rat and the monkey had demonstrated that an injection of styrene maleic anhydride (SMA) in a solvent vehicle of dimethyl sulphoxide (DMSO) into the lumen of the vas deferens is toxicologically safe and has contraceptive action. Phase I clinical trial was therefore undertaken on 38 male volunteers giving varying doses of SMA, ranging between 5 mg and 140 mg, into each vas deferens. A dose of 70 mg is the predicted therapeutic dose based on animal data. That the compound is within the vas deferens lumen during the period of the safety assessment is inferred from the effect on the spermatozoa count in ejaculates which reach azoospermic levels in the higher dose ranges. The treatment is well tolerated with only minimal side effects in a few cases and no long-term adverse effects.

Assessment and management of children aged 1-59 months presenting with wheeze, fast breathing, and/or lower chest indrawing; results of a multicentre descriptive study in Pakistan

BACKGROUND AND AIMS

Using current WHO guidelines, children with wheezing are being over prescribed antibiotics and bronchodilators are underutilised. To improve the WHO case management guidelines, more data is needed about the clinical outcome in children with wheezing/pneumonia overlap.

METHODOLOGY

In a multicentre prospective study, children aged 1-59 months with auscultatory/audible wheeze and fast breathing and/or lower chest indrawing were screened. Response to up to three cycles of inhaled salbutamol was recorded. The responders were enrolled and sent home on inhaled bronchodilators, and followed up on days 3 and 5.

RESULTS

A total of 1622 children with wheeze were screened from May 2001 to April 2002, of which 1004 (61.8%) had WHO defined non-severe and 618 (38.2%) severe pneumonia. Wheeze was audible in only 595 (36.7%) of children. Of 1004 non-severe pneumonia children, 621 (61.8%) responded to up to three cycles of bronchodilator. Of 618 severe pneumonia children, only 166 (26.8%) responded. Among responders, 93 (14.9%) in the non-severe and 63 (37.9%) children in the severe pneumonia group showed subsequent deterioration on follow ups. No family history of wheeze, temperature >100 degrees F, and lower chest indrawing were identified as predictors of subsequent deterioration.

CONCLUSIONS

Two third of children with wheeze are not identified by current WHO ARI (acute respiratory infections) guidelines. Antibiotics are over prescribed and bronchodilators under utilised in children with wheeze. Children with wheeze constitute a special ARI group requiring a separate management algorithm. In countries where wheeze is common it would be worthwhile to train health workers in use of the stethoscope to identify wheeze.

Contraception in male monkeys by intra-vas deferens injection of a pH lowering polymer

A new male method of contraception by injecting a polymer, styrene-maleic anhydride (SMA), into the lumen of the vas deferens has been studied on rhesus monkeys. The polymer has the dual feature that it can occlude the vas deferens lumen and also it can inhibit the fertilising ability of spermatozoa by virtue of the pH lowering effect. Matings with females were carried out when the lumen was completely occluded giving azoospermia as well as with partial block and spermatozoa present in the semen. All matings were infertile. Data up to one year is presented. All indications are that the contraceptive effect will last for a considerably long period.

Polyethylene glycol induces apoptosis in HT-29 cells: potential mechanism for chemoprevention of colon cancer

Recent experimental evidence suggests that polyethylene glycol (PEG) is a highly effective chemopreventive agent against colon cancer; however, the mechanism(s) remain largely unexplored. To further elucidate this issue, we evaluated the effect of PEG on two human colon cancer cell lines. PEG treatment resulted in a dose- and time-dependent reduction in cell number without alteration in markers of cell proliferation. However, there was a dramatic and specific, concentration-dependent induction of apoptosis, with 50 mM PEG rendering approximately half the cells apoptotic. This corresponded with a 17-fold induction in the expression of the pro-apoptotic protein, prostate apoptosis response-4. Our data suggest that induction of apoptosis may be responsible, at least in part, for the ability of PEG to prevent experimental colon cancer.

Management of spontaneous pneumothorax-a Welsh survey

The authors sought to determine to what degree current practice by hospital physicians and accident and emergency (A&E) departments in Wales conformed to the British Thoracic Society's guidelines for the management of spontaneous pneumothorax. Questionnaires were posted to all consultants involved in emergency medical admissions in Wales (149 consultant physicians and 23 A&E consultants) of whom 101 (59%) replied. Only 45% used the classification, "small, moderate, or complete" to describe the size of pneumothorax. Just 44% would do as recommended by the British Thoracic Society and discharge an asymptomatic patient with a primary pneumothorax and 34% would discharge a patient with a primary pneumothorax after successful aspiration. Only 20% were prepared to try aspiration initially for a secondary pneumothorax with a complete lung collapse. Thirty four per cent would follow the recommendation to remove a chest drain without prior clamping of the tube 24 hours after bubbling had stopped. In the event of a persistent air leak 69% would refer patients or seek a specialist opinion. Physicians with an interest in respiratory medicine tolerated persistent air leaks for significantly longer than did non-respiratory physicians (median of 7 v 5 days, p=0.001). The survey indicates that fewer than expected consultant physicians and A&E consultants in Wales manage spontaneous pneumothoraces in the way recommended by the guidelines. Physicians with an interest in respiratory medicine tended to comply with these guidelines more than general physicians with interests other than respiratory medicine or A&E consultants but the trend was not significant at the 5% level. It is felt that the guidelines should be disseminated more widely, ensuring that emergency admissions units and A&E departments have copies on display or easily accessible, and that they could be expanded to cover other aspects such as timing for surgery.

Teratoid Wilms' tumour: a report of two cases

We report two cases of Wilms' tumour in which the degree of heterologous differentiation was sufficient to warrant the diagnosis of teratoid Wilms' tumour. The first description of neural elements in this Wilms' variant and the first cytogenetic analysis of teratoid Wilms' tumour are presented.

Vagus nerve stimulation: indications and limitations

Vagus nerve stimulation (VNS) is an established treatment for selected patients with medically refractory seizures. Recent studies suggest that VNS could be potentially useful in the treatment of resistant depressive disorder. Although a surgical procedure is required in order to implant the VNS device, the possibility of a long-term benefit largely free of severe side effects could give VNS a privileged place in the management of resistant depression. In addition, VNS appears to affect pain perception in depressed adults; a possible role of VNS in the treatment of severe refractory headache, intractable chronic migraine and cluster headache has also been suggested. VNS is currently investigated in clinical studies, as a potential treatment for essential tremor, cognitive deficits in Alzheimer's disease, anxiety disorders, and bulimia. Finally, other studies explore the potential use of VNS in the treatment of resistant obesity, addictions, sleep disorders, narcolepsy, coma and memory and learning deficits.

Characterization of a species-specific repetitive DNA from a highly endangered wild animal, Rhinoceros unicornis, and assessment of genetic polymorphism by microsatellite associated sequence amplification (MASA)

We have cloned and sequenced a 906bp EcoRI repeat DNA fraction from Rhinoceros unicornis genome. The contig pSS(R)2 is AT rich with 340 A (37.53%), 187 C (20.64%), 173 G (19.09%) and 206 T (22.74%). The sequence contains MALT box, NF-E1, Poly-A signal, lariat consensus sequences, TATA box, translational initiation sequences and several stop codons. Translation of the contig showed seven different types of protein motifs, among which, EGF-like domain cysteine pattern signatures and Bowman-Birk serine protease inhibitor family signatures were prominent. The presence of eukaryotic transcriptional elements, protein signatures and analysis of subset sequences in the 5' region from 1 to 165nt indicating coding potential (test code value=0.97) suggest possible regulatory and/or functional role(s) of these sequences in the rhino genome. Translation of the complementary strand from 906 to 706nt and 190 to 2nt showed proteins of more than 7kDa rich in non-polar residues. This suggests that pSS(R)2 is either a part of, or adjacent to, a functional gene. The contig contains mostly non-consecutive simple repeat units from 2 to 17nt with varying frequencies, of which four base motifs were found to be predominant. Zoo-blot hybridization revealed that pSS(R)2 sequences are unique to R. unicornis genome because they do not cross-hybridize, even with the genomic DNA of South African black rhino Diceros bicornis. Southern blot analysis of R. unicornis genomic DNA with pSS(R)2 and other synthetic oligo probes revealed a high level of genetic homogeneity, which was also substantiated by microsatellite associated sequence amplification (MASA). Owing to its uniqueness, the pSS(R)2 probe has a potential application in the area of conservation biology for unequivocal identification of horn or other body tissues of R. unicornis. The evolutionary aspect of this repeat fraction in the context of comparative genome analysis is discussed.

Camel collision as a major cause of low cervical spinal cord injury

One hundred and forty patients with low cervical spinal cord injuries, who were admitted to the Riyadh Armed Forces Hospital over the past 10 years were reviewed. Motor vehicle accidents constituted 119 (85%) of the patients. Camel collisions were a major cause of vehicle accidents 39 (33%), after rollover accidents 70 (59%), and much more than head on collisions 9 (7.5%). Male to female ratio was 14:1 with a mean age of 32 years. Camel collision although a commonly observed cause of motor vehicle accidents in the Middle East has not been mentioned in the literature before. The mechanism of injury is not much different, but the exact description of the accident and sustaining injury is interesting because it leads to localised damage to the neck without major body trauma and mortality.

Successful pregnancy after localized resection of perforated uterus in choriocarcinoma and a literature review

Choriocarcinoma is an aggressive neoplasm arising in the body of the uterus. Rapid growth and myometrial invasion may be followed by uterine perforation. In this study, we present the cases of two young patients (18 and 19 years of age) with acute abdominal pain and shock, while they were under chemotherapy due to persistent trophoblastic disease. During emergent exploratory laparotomy, localized resection of uterus was performed. They had their first successful term pregnancy 5 and 4 years after surgery, respectively. Uterine perforation following choriocarcinoma is a rare event. Hysterectomy is recommended in emergency conditions, but localized resection of uterus should be considered in women who are desirous of future fertility.

Molecular epidemiology of environmental Cryptococcus species isolates based on amplified fragment length polymorphism

OBJECTIVE

Cryptococcosis is a major opportunistic fungal infection caused by members of the genus Cryptococcus, mainly those belonging to the Cryptococcus neoformans/Cryptococcus gattii species complexes. Here, we report a comprehensive molecular epidemiological study of the environmental distribution of Cryptococcus isolates in Shiraz, Iran with review of litreature.

METHOD

A total of 406 samples were obtained from Eucalyptus trees and 139 samples from pigeon droppings. Cryptococcus species identification and genotyping were performed by amplified fragment length polymorphism (AFLP) fingerprinting sequencing and sequencing of the ITS rDNA region.

RESULTS

Majority of the isolates belonged to the Naganishia taxon (n=69) including N. albida (formerly C. albidus, n=62), N. globosa (formerly C. saitoi, n=4), N. adeliensis (formerly C. adeliensis, n=2), N. diffluens (formerly C. diffluens, n=1), and the identified C. neoformans isolates (n=25) belonged to genotype AFLP1/VNI (n=22) and AFLP1B/VNII (n=3).

CONCLUSION

More research efforts should be employed to isolate C. gattii species complex from environmental niches in Iran and provide additional evidence related to novel molecular types.

Analysis of the evolutionarily conserved repeat motifs in the genome of the highly endangered central Indian swamp deer Cervus duvauceli branderi

We have analyzed the genome of central Indian swamp deer Cervus duvauceli branderi, an inhabitant of the Kanha National Park, a wildlife conservatory in Central India, with a view to provide a genetic basis for their extinction. Evolutionarily conserved repeat sequence motifs (GATA)3.75, TA(GATA)4, (GACA)3.75, (TGG)6 and a set of mouse beta-actin primers were used to uncover the sequence variation within and between related species by employing techniques of hybridization and AP-PCR amplification. The oligo probe carrying the GACA and TGG repeat motifs was found to be positive with Cervus genome, whereas (GATA)3.75, TA(GATA)4 and beta-actin probes did not cross-hybridize with the same. AP-PCR amplification with (GACA)3.75, unlike the (TGG)6 primer, generated distinct bands in the range of 0. 37-2.10kb amongst different genomes including Cervus. A comparative genome analysis of other species using the AP-PCR approach with (GACA)3.75 primer revealed the phylogenetic status of Cervus duvauceli branderi. From the analysis of a very limited number of Cervus DNA samples, we observed a high level of genetic homogeneity that may be a prime reason for the extinction of this species. This study has implications in the context of conservation of this endangered Cervus duvauceli branderi species.

Hyperparathyroidism complicating pregnancy: a diagnostic challenge?

Primary hyperparathyroidism (PHPT) is a rare etiology of hypercalcemia-induced pancreatitis, contributing about 0.4% to 1.5% of cases in the general population and up to 13% of cases during pregnancy. PHPT that occurs during pregnancy is a challenging diagnosis as the physiological changes in calcium homeostasis mask the symptoms of hypercalcemia. PHPT during pregnancy often remains undiagnosed and untreated, and may result in serious clinical implications for the mother and fetus. Most clinicians consider surgery within the second trimester of pregnancy as the treatment of choice in this group of patients. This article refers to a case of a 24-year married woman in whom PHPT was diagnosed for the first time in postpartum period. She succumbed to complications on Day 20 postpartum. Pathological findings revealed metastatic calcification in lungs, pancreas and uterine vessels, chronic pancreatitis and renal cortical necrosis.