Recurrent miscarriages as an indication for percutaneous tricuspid valvuloplasty during pregnancy

Isolated balloon tricuspid valvuloplasty was successfully performed in a pregnant woman with a history of recurrent miscarriages. The course of pregnancy was uneventful, and a healthy baby was delivered. This report highlights the unusual indication for the procedure, which was recurrent miscarriage, and outlines some technical aspects of tricuspid valvuloplasty. Cathet. Cardiovasc. Diagn. 40:283–286, 1997. © 1997 Wiley-Liss, Inc.     

Diabetes mellitus in Egypt: glycaemic control and microvascular and neuropathic complications

We performed a cross-sectional, population-based survey of persons 20 years of age and older living in Cairo and surrounding rural villages. The purpose was to describe glycaemic control and the prevalence of microvascular and neuropathic complications among Egyptians with diagnosed diabetes, previously undiagnosed diabetes, impaired glucose tolerance, and normal glucose tolerance. A total of 6052 households were surveyed. The response rate was 76 % for the household survey and 72 % for the medical examination. Among people with previously diagnosed diabetes, mean haemoglobin A_1c was 9.0 %. Forty-two per cent had retinopathy, 21 % albuminuria, and 22 % neuropathy. Legal blindness was prevalent (5 %) but clinical nephropathy (7 %) and foot ulcers (1 %) were uncommon in persons with diagnosed diabetes. Among people with diagnosed diabetes, microvascular and neuropathic complications were associated with hyperglycaemia. Retinopathy was also associated with duration of diabetes; albuminuria with hypertension and hypercholesterolaemia; and neuropathy with age, female sex, and hypercholesterolaemia. Albuminuria was as common in people with previously undiagnosed diabetes (22 %) as those with diagnosed disease (21 %). Mean haemoglobin A_1c was lower (7.8 %) and retinopathy (16 %) and neuropathy (14 %) were less prevalent in people with previously undiagnosed disease. Ocular conditions, blindness, and neuropathy were prevalent in the non-diabetic population. The microvascular and neuropathic complications of diabetes are a major clinical and public health problem in Egypt. Copyright © 1998 John Wiley & Sons, Ltd.     

Challenges that healthcare practitioners experience in the comprehensive assessment of patients with non-communicable diseases: a preliminary investigation

BackgroundResource allocation and access to comprehensive treatment in the public healthcare sector are always under pressure. This pressure takes the form of staff shortages, treatment models and the holistic care of patients, compromising basic healthcare in South Africa.ObjectivesThe study''s aim was to determine the challenges that healthcare practitioners experience while assessing patients with non-communicable diseases, in private and public healthcare sectors in the Gauteng Province of South Africa.MethodsThe research design was exploratory and contextual. Qualitative data were collected through focus groups and semi-structured interviews among healthcare practitioners (n = 12). Data analysis took place using Atlas.ti 8.4 Windows (2020). Inter-rater reliability (r = 93.68%) was calculated to ensure the rigour and validity of the results.ResultsFrom the discussion, four themes emerged: 1) limited consultation time; 2) overwhelming economic impact and healthcare cost for facilities and patients; 3) holistic patient care encompassing physical, mental and socioeconomic components; and 4) lack of patient education due to time constraints experienced by healthcare practitioners.ConclusionConsultation times are reduced due to a shortage of medical staff, patient numbers, equipment, and poor working conditions. By improving these conditions, patients across all socioeconomic groups will be better assisted, treated, and educated, benefiting from equal access and quality healthcare.     

Bartter's syndrome in Arabic children: review of 13 cases

BACKGROUND: Bartter's syndrome (BS) is an inherited disease of renal potassium wasting characterized by hypokalemic alkalosis, normal blood pressure, vascular insensitivity to pressor agents and elevated plasma concentrations of renin and aldosterone. It is caused by generalized hyperplasia of the juxtaglomerular apparatus at the site of renin production caused by mutations in the Na-K-2Cl cotransporter gene, NKCC2. The objective of our study is to establish the prevalence and incidence of BS in Kuwait and to assess treatment modalities for it. METHODS AND RESULTS: Bartter's syndrome was diagnosed in 13 Kuwaiti children over a 14 year period (1981-1995) with the estimated incidence of 1.7/100,000 live births. The mean age at diagnosis was 9.3 months (range 2-32 months). There were five males and eight females (ratio 1:1.6). The mean duration of follow up was 5.6 years (1-14 years). Both consanguinity and familial history among our patients were high (69 and 54%, respectively). All patients had hypokalemia, hypochloremia with metabolic alkalosis, hyperreninemia and were normotensive. Clinical presentation was essentially similar to that in other series. Eleven patients (85%) had growth failure, two had nephrocalcinosis (15%) and one had renal failure. All patients were treated with supplemental potassium, an aldosterone antagonist (spironolactone) and a prostaglandin synthetase inhibitor (indomethacin or aspirin) sequentially. Significant catch-up of growth (four patients) and increases in serum potassium (eight patients) were recorded after administration of indomethacin therapy. One patient died of severe pneumonia with respiratory failure from hypokalemic myopathy. Clinical presentation, inheritance, complications and therapy of BS are briefly discussed. CONCLUSION: Bartter's syndrome is a rare disease, but should be considered in the differential diagnosis of other disorders with growth failure and/or hypokalemia. Early diagnosis, close follow up and compliance with treatment may lead to appropriate growth and development.     

A phase I/II study of hepatic artery infusion with wtp53-CMV-Ad in metastatic malignant liver tumours.

Colorectal cancer (CRC) is the second commonest cause of cancer death in the UK, with greater than 40% of these patients destined to die of the disease despite current medical management. Death is commonly due to liver metastases with sequelae including progressive liver dysfunction. Most patients with liver metastases present with tumours that are unresectable and incurable with existing therapies. The median survival for CRC patients after diagnosis with liver metastases is approximately 6 months or less. The human p53 gene is a tumour suppressor gene involved in the control of cell proliferation. Loss of wild-type p53 function is associated with the uncontrolled growth of many types of human cancers. The reintroduction and expression of wild-type p53 into p53 altered tumour cells has been shown to suppress tumour growth or induce apoptosis in both in vitro and in vivo models. In our experience greater than 50% of CRC tumours have p53 alterations. This study seeks to evaluate the safety, biological efficacy and the effectiveness of wtp53-CMV-Ad treatment which is a recombinant adenoviral vector containing the wild-type human p53 gene. It will be administered by infusion via the hepatic artery, for the regional gene therapy of malignant liver tumours. Study patients will have incurable metastatic (CRC) malignant tumours of the liver with evidence of p53 alteration in their liver tumours. In vitro studies have demonstrated p53-specific antiproliferative effects of wtp53-CMV-Ad on human liver tumour cells and in vivo studies have demonstrated p53-specific antiproliferative effects on human liver tumour cells. The vector Ad-p53 is a recombinant, replication-defective adenovirus based on adenovirus serotype 5. It contains a sequence encoding wild-type p53 whose expression is under the control of the human cytomegalovirus immediate early promoter-enhancer. This construct will be growth in 293 cells which contain the adenoviral E1A and E1B coding sequences which have been removed from the vector to render it replication defective. The study design is an open-label, non-randomised, single-dose, dose escalation Phase I/II clinical trial anticipated to involve a maximum of 19 patients. wtp53-CMV-Ad will be administered by infusion in a reservoir connected to the hepatic artery, for regional gene therapy (surgically implanted pump) in 3 escalating doses to successive cohorts of 3 patients each until the maximum tolerated dose is determined. Subsequently, 10 patients will be treated with this dose. Regional wtp53-CMV-Ad therapy will be administered as a single bolus infusion via hepatic artery catheter. The route of administration of wtp53-CMV-Ad via hepatic artery infusion is designed to maximise gene therapy exposure to the malignant tumours while minimising exposure to normal tissues outside the liver. The clinical protocol is designed to monitor treatment toxicity. Another objective is to evaluate the biological efficacy, including efficiency and stability of gene transfer by analysis of tumour tissues following therapy. As an important part of this objective the pharmacokinetics of wtp53-CMV-Ad will be studied. Clinical evidence of anti-tumour efficacy will also be collected. In addition, the safety and efficacy of different doses levels of wtp53-CMV-Ad will be studied.     

Bioactive brominated metabolites from the Red Sea sponge Pseudoceratina arabica

Chemical investigation of the Red Sea sponge Pseudoceratina arabica has led to the isolation and identification of seven brominated compounds including two new bromotyramine derivatives, hydroxymoloka'iamine (2) and moloka'iakitamide (6), and a new brominated phenolic compound, ceratinophenol A (5), together with the known compounds moloka'iamine (1), ceratinamine (3), 5-bromo-2,3-dihydroxy-6-methoxybenzaldehyde (4), and psammaplysin-A (7). Biological evaluation of these metabolites indicated that moloka'iamine and moloka'iakitamide possess significant parasympatholytic effects on isolated rabbit heart and jejunum. This finding has important implications for further biological investigation of this class of compounds. Moreover, these compounds showed weak antibacterial and antifungal activities.     

Serial distribution of airway diameters from input impedance and computed tomography

Indirect measures of airway diameter such as respiratory system input impedance (Z _in) have been widely used to infer or quantify bronchoconstriction, or bronchodilation. One such measure,Z _in above 100 Hz has been shown to be primarily influenced by airway geometry and airway walls but not by lung and chest wall tissues. We used a recently developed method based on a complex asymmetrically branched network of tubes with nonrigid walls to analyzeZ _in from 100 to 2,000 Hz in control and bronchoconstricted (histamine injection) dogs. The resulting estimates of airway diameters indicated that peripheral airways were constricted far more (≈30% of their control diameters) than central airways (i.e., 0% in the trachea). Separate measurements of changes in airway diameters were made in an excised dog lung using high resolution computed tomography. The observed changes in airway diameter between lung volumes of total lung capacity (TLC) and functional residual capacity (FRC) were quantitatively consistent with those obtained fromZ _indata in our control dogs atFRC. We conclude that this systems identification method can be used to estimate the distribution of airway diameters fromZ _in. An erratum to this article is available at .     

Outpatient cervical ripening with nitric oxide donor isosorbide mononitrate prior to induction of labor.

OBJECTIVE: To examine the effectiveness and safety of outpatient vaginal administration of isosorbide mononitrate (IMN) to induce cervical ripening. METHODS: A prospective, double-blind, placebo-controlled, randomized clinical trial was conducted on 102 singleton term pregnant women with unfavorable cervices who were randomly assigned to receive outpatient intravaginal IMN or placebo before admission for induction of labor. The main outcome variable was time from hospital admission to delivery. Secondary outcomes included fetal and maternal morbidity, labor characteristics, and incidence of cesarean delivery. RESULTS: The admission-delivery interval was 13.45+/-6.63 and 20.12+/-8.19 h (P=0.0001) for the IMN and placebo groups, respectively. Of the IMN patients 62.75% needed prostaglandins for cervical ripening versus 90.2% with placebo (P=0.002). The incidence of tachysystole was significantly lower in the IMN group (P<0.05) but there were no significant differences in cesarean delivery rate, neonatal outcomes, and incidence of hyperstimulation. CONCLUSIONS: Outpatient use of IMN resulted in shorter admission to delivery interval, and was associated with less prostaglandin use and lower incidence of uterine tachysystole.