Does posttransplant anemia at 6 months affect long-term outcome of live-donor kidney transplantation? A single-center experience

Background/Aims  Posttransplantation anemia (PTA) frequently occurs. We aimed to assess the prevalence of anemia at 6 months of transplantation in patients under different protocols of immunosuppression, and to determine the impact of anemia on long-term patient and graft survival. Methods  We included 832 renal transplant recipients who were categorized at 6 months according to hemoglobin (Hb) level into two groups: the first group, with Hb >13 g/dl in males and >12 g/dl in females (group I, 385 cases); and the second group, with Hb <13 g/dl in males and <12 g/dl in females (group II, 447 cases). We compared the two groups regarding posttransplant complications as well as patient and graft survival. Results  Although there was no significant difference between the two groups regarding acute rejection episodes, chronic allograft nephropathy was significantly higher in the anemic group. Other posttransplant medical complications were comparable in both groups. Graft survival was significantly higher in the nonanemic group. However, no difference in patient survival was detected. Conclusion  From this study, we can conclude that prevalence of PTA is high, especially in females and those receiving calcineurine inhibitors (CNI) and mycophenolate mofetil (MMF), and that it was associated with poorer graft outcome but with no effect on patient survival.     

Cardiac hemangioma presenting with neurological manifestations

Primary cardiac tumors are rare. Hemangiomas represent about 5%–10% of benign cardiac tumors. Hemangiomas can be found in any heart chamber, but atria have been more frequently involved. Ventricular involvement is uncommon. Hemangiomas may have various presentations, but there have been few reports about neurological manifestations of such tumors in the English-language literature. We present a patient with a left ventricular hemangioma who presented with leftsided weakness and sudden onset of slurred speech.     

Emergence of VIM-2 and IMP-15 Carbapenemases and Inactivation of oprD Gene in Carbapenem-Resistant Pseudomonas aeruginosa Clinical Isolates from Lebanon

We report here the emergence of VIM-2 and IMP-15 carbapenemases in a series of clinical isolates of carbapenem-resistant Pseudomonas aeruginosa in Lebanon. We also describe the disruption of the oprD gene by either mutations or insertion sequence (IS) elements ISPa1328 and ISPre2 isoform. Our study reemphasizes a rapid dissemination of the VIM-2 carbapenemase-encoding gene in clinical isolates of P. aeruginosa in the Mediterranean basin.     

Anti-Hyperglycemic,Anti-Hyperlipidemic and Antioxidant Potential of Alcoholic-Extract of Sida cordifolia (Areal Part) in Streptozotocin-Induced-Diabetes in Wistar-Rats

Sida cordifolia is a shrub found throughout the tropical and sub-tropical plains. All parts of the plant are used as anti-rheumatic, antipyretic, anti-asthmatic, laxative, diuretic, vasorelaxative, hypotensive, central nervous system depressant, antioxidant, analgesic and hypoglycemic. The present study was aimed to evaluate the hypoglycemic, anti-hyperlipidemic and antioxidant potential of alcoholic-extract obtained from areal part of S. cordifolia in streptozotocin-induced-diabetes in wistar-rats. Diabetes was induced with streptozotocin at the intra-peritoneal dose of 55 mg/kg. Diabetic rats were treated with alcoholic extract of S. cordifolia at dosage of 200, 400 mg/kg and glibenclamide (5 mg/kg) after sub-acute administration for 28 days. Alcoholic extract of S. cordifolia at 400 mg/kg significantly improved the body-weight whereas significantly decreased the blood glucose level in diabetic rats. However at 400 mg/kg, the alcoholic extract of S. cordifolia showed beneficial effect indicating significant decrease in total cholesterol, triglycerides, low density lipids, plasma-creatinine, plasma-urea nitrogen and lipid-peroxidation and a significant increase in high density lipid-level in diabetic rats. Interestingly at 400 mg/kg, a significant increase in antioxidant enzymes such as catalase and superoxide-dismutase-activity was seen in the diabetic rats. The dose 200 mg/kg of alcoholic extract of S. cordifolia showed non-significant change in diabetic rats. The above therapeutic-potential of alcoholic extract of areal parts of plant may be because of the presence of bioactive compounds such as glycosides, resins, alkaloids, sterols, saponins and flavonoids. Thus, the findings of the present study indicate that the alcoholic extract of S. cordifolia at dosage level of 400 mg/kg produces anti-diabetic effect in the streptozotocin-induced diabetes in wistar-rats.     

The effect of light-activation sources on tooth bleaching

Vital bleaching is one of the most requested cosmetic dental procedures asked by patients who seek a more pleasing smile. This procedure consists of carbamide or hydrogen peroxide gel applications that can be applied in-office or by the patient (at-home/overnight bleaching system). Some in-office treatments utilise whitening light with the objective of speeding up the whitening process. The objective of this article is to review and summarise the current literature with regard to the effect of light-activation sources on in-office tooth bleaching. A literature search was conducted using Medline, accessed via the National Library of Medicine Pub Med from 2003 to 2013 searching for articles relating to effectiveness of light activation sources on in-office tooth bleaching. This study found conflicting evidence on whether light truly improve tooth whitening. Other factors such as, type of stain, initial tooth colour and subject age which can influence tooth bleaching outcome were discussed. Conclusions: The use of light activator sources with in-office bleaching treatment of vital teeth did not increase the efficacy of bleaching or accelerate the bleaching.     

Reference values for arterial stiffness indices in an Omani Arab population

Objectives:

To determine the reference values of arterial stiffness indices, particularly augmentation index (AIx) and pulse wave velocity (PWV) using applanation tonometry in a healthy Omani Arab population.

Methods:

This prospective study was carried out in the Department of Clinical Physiology, Sultan Qaboos University Hospital, Muscat, Oman over a 2-year period from June 2011 to June 2013. The central AIx, aortic PWV (AoPWV), and central pulse pressure (CPP) were recorded from 120 healthy subjects recruited randomly from a normal population using a SphygmoCor device. The 2.5th and 97.5th percentiles were used to determine the reference ranges for men and women separately. Analyses were performed using univariate statistics.

Results:

The mean age of the cohort was 38 years for men, and 35 years for women, with the ages ranging from 20-53 years. The overall mean central AIx was 13±11%, and for AoPWV was 6.7±1.6 m/s. The central AIx was higher in women (17 versus 10%; p<0.001), whereas the AoPWV was higher in men (7.1 versus 6.3 m/s; p=0.003). Subjects were categorized according to the gender and age decade, and reference values for CPP, central AIx, and AoPWV were obtained.

Conclusion:

This study reports the reference values for arterial stiffness indices from an Omani Arab population; the results of which should be interpreted in the context of its limitations.Cardiovascular disease is the leading cause of mortality and morbidity worldwide.1 High central pulse pressure (CPP) and increased aortic pulse wave velocity (AoPWV) resulting from stiffness of large arteries have been recognized as an independent risk factor for cardiovascular disease.2-5 The European Hypertension Society guidelines recommended the pulse wave velocity (PWV) to be used for risk assessment stratification of hypertensive patients.6 Several non-invasive techniques have been developed to assess arterial stiffness parameters.7,8 Applanation tonometry developed by O’Rourke and other investigators9-12 is a simple, reproducible, and validated method used to assess arterial stiffness indices in healthy subjects and in subjects with various cardiovascular diseases. In addition to direct analysis of peripheral pulse wave forms to determine peripheral augmentation indices, this method can also be used to calculate central (aortic) augmentation indices and central blood pressure by using validated algorithms.12 A large number of studies from different European populations, African, and Asian nations have assessed reference ranges and correlates of arterial stiffness using applanation tonometry.13-16 However, studies on reference values of arterial stiffness in Arab populations are scant. Considering variations in genetic and environmental factors between populations, differences in arterial stiffness values in health and cardiovascular disease individuals are expected. There is a lack of previous studies on normal arterial stiffness indices in an Omani Arab population. Normal reference values from healthy subjects are particularly pertinent for proper clinical applications. Therefore, this study aimed to determine the reference values of arterial stiffness indices particularly augmentation index (AIx) and PWV using applanation tonometry in a healthy Omani Arab population.