Impact of pulmonary tuberculosis on menstrual pattern and fertility

Introduction and Study Objective: The association between pulmonary tuberculosis (TB) and female reproductive health problems is not well addressed. This study was done at Assiut University and Woman's Health University Hospitals to estimate the effect of pulmonary TB on menstrual patterns and fertility of women in childbearing age. Patients and Methods: This study composed of 429 women with pulmonary TB of childbearing age (study group) and 100 age‐matched healthy women (control group). A detailed medical history was obtained, and a clinical examination, routine investigations of pulmonary TB and transvaginal ultrasonography (TVS) were performed for all cases. Hysterosalpingography, combined laparoscopy and hysteroscopy were done for infertile women whenever indicated. Results: Menstrual abnormalities were reported in 66% of women in the study group. Secondary amenorrhea (112 cases, 26.5%, P < 0.001) and hypomenorrhea (86 cases, 20%, P < 0.001) were significantly higher in the study group than controls (2% and 3%, respectively). TVS diagnosed functional ovarian cysts in 85 patients in the study group (19.8%). After completing anti‐tuberculosis treatment, 76% of women with menstrual abnormalities (162/213) resumed normal menstrual cycles. Among the 68 cases who sought fertility within 1 year after completion of treatment, TB peritubal and fine intrauterine adhesions were confirmed by laparoscopy and hysteroscopy in two and one infertile woman, respectively (0.7% of study group). Conclusions: TB had marked reversible effect on the menstrual cycle but minimal association with genital TB and infertility. Pretreatment counseling of pulmonary TB women should include information on these reversible changes. Persistence of menstrual abnormalities or presence of infertility after completion of treatment should stimulate investigation for the possibility of genital tract involvement. Please cite this paper as: Hassan WA and Darwish AM. Impact of pulmonary tuberculosis on menstrual pattern and fertility. The Clinical Respiratory Journal 2010; 4: 157–161.     

CYP3A4 inhibitors isolated from a marine derived fungus <Emphasis Type="Italic">Penicillium</Emphasis> species

More than 50% of clinically used drugs are thought to be metabolized by cytochrome P450 (CYP) 3A4. Discovery of new, inexpensive, CYP3A4 inhibitors will reduce drug dosages needed to cure patients. In our search for new inhibitors of the enzyme CYP3A4, extracts from 102 marine fungi were screened. Seven of the extracts had potent CYP3A4 inhibitory activity. Four aromatic compounds were isolated from an extract of a culture of one of these, a Penicillium sp., and were identified as 3-methoxyphenol (1), 4-methoxyphenylacetic acid (2), 4-(2-hydroxyethyl)phenol (3), and 4-hydroxy-2-methoxyacetanilide (4) by use of spectroscopic data. Interestingly, compound 3 at 250 μg mL⁻¹did not inhibit CYP3A4 whereas compounds 1, 2 and 4 had CYP inhibitory activity with IC₅₀ values of 2.0, 1.6 and 0.41 μg mL⁻¹, respectively.     

Living-related liver transplantation for Crigler-Najjar syndrome in Saudi Arabia

OBJECTIVE: To analyse the outcome of six children with Crigler-Najjar syndrome type I (CNS-I) and report the first three living-related liver transplants for this syndrome in Saudi Arabia and the Middle East. SETTINGS: To review the medical records of six children suffering from CNS-I, three of whom underwent living-related liver transplantation (LRLT) between 22 November 1998 and January 2001. MAIN RESULTS: Living-related liver transplantation was performed in three children with a pre-transplant unconjugated bilirubin level of 362, 381 and 502 micromol/L, respectively, despite daily phototherapy of >or= 12 h. Two of the transplanted children developed acute hepatocellular rejection, which was successfully treated with methylprednisolone pulse therapy. One tested cytomegalovirus positive (using the PP65 method), but showed no signs of clinical infection and was treated with ganciclovir. One patient had a biliary leak at the cut surface of the graft which was surgically repaired. Post-operative bilirubin levels returned to normal in all three transplanted children and no further phototherapy was required. One patient, who was not transplanted but received phototherapy, developed severe neurological damage prior to the start of our living-related liver transplant programme with a bilirubin level of 450 micromol/L, her sister is still awaiting transplantation. A 14-yr-old child with a bilirubin level of 420 micromol/L is presently undergoing phototherapy whilst awaiting orthotopic liver transplantation because of the lack of a suitable living-related donor. Six siblings of the six children in our series were reported dead by the families. CONCLUSION: Crigler-Najjar syndrome type I is a relatively common disease in Saudi Arabia for which LRLT is a curative treatment when performed at an early age before the development of kernicterus and neurological deficiency. In countries where there is a severe shortage of cadaveric organs, as is the case in Saudi Arabia, LRLT is the optimum treatment modality for this syndrome.     

Guidelines for the management of community-acquired pneumonia in Saudi Arabia: a model for the Middle East region

Worldwide, community-acquired pneumonia (CAP) is a common respiratory tract infection and is now a growing public health concern in Saudi Arabia. In an effort to simplify treatment regimens to aid the practitioner, empirical treatment guidelines for CAP have evolved across the international medical community, reducing the number of antibiotics used and improving outcomes. Saudi Arabia and the surrounding region have no such consensus guidelines and this document aims to redress this lack. The potential impacts of developing and implementing CAP treatment guidelines in Saudi Arabia, which are new to the Kingdom, will be examined. Widespread adoption of these SACAP guidelines could lead to nationwide reductions of antibiotic resistance and improvement of clinical outcomes. Ultimately, Kingdomwide uniformity of treatment algorithms provides a foundation for both database generation and valuable outcomes of research in the future.     

Endovascular repair of abdominal aortic aneurysms: risk stratified outcomes

OBJECTIVE: The impact of co-morbid conditions on early and late clinical outcomes after endovascular treatment of abdominal aortic aneurysm (AAA) was assessed in concurrent cohorts of patients stratified with respect to risk for intervention. SUMMARY BACKGROUND DATA: As a minimally invasive strategy for the treatment of AAA, endovascular repair has been embraced with enthusiasm for all prospective patients who are suitable anatomical candidates because of the promise of achieving a durable result with a reduced risk of perioperative morbidity and mortality. METHODS: From April 1994 to March 2001, endovascular AAA repair was performed in 236 patients using commercially available systems. A subset of patients considered at increased risk for intervention (n = 123) were categorized, as such, based on a preexisting history of ischemic coronary artery disease, with documentation of myocardial infarction (60%) or congestive heart failure (35%), or due to the presence of chronic obstructive disease (21%), liver disease, or malignancy. RESULTS: Perioperative mortality (30-day) was 6.5% in the increased-risk patients as compared to 1.8% among those classified as low risk (P = NS). There was no difference between groups in age (74 +/- 9 years vs. 72 +/- 6 years; mean +/- SD), surgical time (235 +/- 95 minutes vs. 219 +/- 84 minutes), blood loss (457 +/- 432 mL vs. 351 +/- 273 mL), postoperative hospital stay (4.8 +/- 3.4 days vs. 4.0 +/- 3.9 days), or days in the ICU (1.3 +/- 1.8 days vs. 0.5 +/- 1.6 days). Patients at increased risk of intervention had larger aneurysms than low-risk patients (59 +/- 13 mm vs. 51 +/- 14 mm; P <.05). Stent grafts were successfully implanted in 116 (95%) increased-risk versus 107 (95%) low-risk patients (P = NS). Conversion rates to open operative repair were similar in increased-risk and low-risk groups at 3% and 5%, respectively. The initial endoleak rate was 22% versus 20%, based on the first CT performed (either at discharge or 1 month; P = NS). To date, increased-risk patients have been followed for 17.4 +/- 15 months and low-risk patients for 16.3 +/- 14 months. Kaplan-Meier analysis for cumulative patient survival demonstrated a reduced probability of survival among those patients initially classified as at increased risk for intervention (P <.05, Mantel-Cox test). Both cohorts had similar two-year primary and secondary clinical success rates of approximately 75% and 80%, respectively. CONCLUSIONS: Early and late clinical outcomes are comparable after endovascular repair of AAA, regardless of risk-stratification. Notably, 2 years after endovascular repair, at least one in five patients was classified as a clinical failure. Given the need for close life-long surveillance and the continued uncertainty associated with clinical outcome, caution is dictated in advocating endovascular treatment for the patient who is otherwise considered an ideal candidate for standard open surgical repair.     

Quantitative analysis of uvular muscles in cases of simple snoring and obstructive sleep apnea: an image analysis study

Studies on the histopathological changes of the palatine muscles in cases of obstructive sleep apnea (OSA) and simple snoring are controversial, while some authors confirm the presence of muscle hypertrophy and increase in total muscle bulk (obstructive theory), others deny this confirming the presence of muscle atrophy and decrease in the muscle bulk (neurogenic theory), but all these studies depended on subjective observer dependent methods to calculate the muscle bulk. We are carrying a unique study to calculate the muscle bulk in uvular specimens in ten cases of OSA comparing it to ten cases with simple snoring and controls using digital computer dependent software (image analysis). Cases of OSA are associated with definite increase in the total muscle bulk of the palatine muscles when compared to cases of simple snoring and controls. Uvular muscular hypertrophy and the obstructive theory seem to explain the pathophysiology of OSA.     

Intravenous paracetamol is highly effective in pain treatment after tonsillectomy in adults

Tonsillectomy in adults is associated with significant postoperative pain. Intravenous paracetamol injection (Perfalgan) is marketed for the management of acute pain. This prospective placebo-controlled study was performed to evaluate the analgesic efficacy and safety of intravenous paracetamol in 76 adult patients undergoing elective standard bipolar diathermy tonsillectomy. After tonsillectomy was performed under general anesthesia, the patients were randomized to receive either intravenous paracetamol 1 g (Perfalgan) (n = 38) or 0.9% normal saline as a placebo (n = 38) at 6-h intervals. No other analgesic medication was permitted for postoperative pain during the study. Need for rescue analgesic during the first 24 h after surgery as well as all adverse events were recorded. The intravenous paracetamol group differed significantly from the placebo group regarding pain relief and median time to pethidine rescue. Intravenous paracetamol significantly reduced pethidine consumption over the 24-h period. The worst pain after surgery was also more severe in the placebo group than that in the paracetamol group. There was no significant difference between groups in the incidence of adverse events. Intravenous paracetamol administered regularly in adult patients with moderate to severe pain after tonsillectomy provided rapid and effective analgesia and was well tolerated.     

A comparative study between ciliary count and the degree of opacity of paranasal sinus CT scans in chronic sinusitis pre and post FESS

OBJECTIVE: To investigate the relationship between the extent of sinus disease in chronic sinusitis as detected radiologically by computed tomography (CT) scan and the population of cilia (ciliary area) both before and after functional endoscopic sinus surgery (FESS). In a simple way this is a trial to statistically prove that the CT scan could be a valid indicator and a mirror of the histological status of the sinus mucosa. DESIGN: Twenty adult patients were enrolled in this study. Radiological extension of the sinus disease was quantitated using the classification proposed by Kennedy in 1992 and the ciliary population was studied using scanning electron microscopy and image analysis softwares. RESULTS AND CONCLUSION: The more advanced the sinusitis, as evidenced by CT scans, the more the expected reduction in the ciliary area (CA) and in the ciliary count. But after FESS the degree of ciliary regeneration does not depend statistically on the radiological condition of the sinuses and the degree of opacity prior to intervention, i.e. a statistically valid inverse relationship exists between the radiological stage of sinusitis and the ciliary population pre-operatively but the same relation does not extend to the ciliary population post-operatively.