Potentially inappropriate prescribing in a falls clinic using the STOPP and START criteria

International Journal of Clinical Pharmacy - Background Potentially inappropriate prescribing is increasingly common in older patients with falls. However, published indicators to assess...     

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.     

Donor experience and outcome of pediatric living-related liver transplantation in Saudi Arabia

Background/Purpose. The purpose of this article is to present the first series of living donation of liver grafts in Saudi Arabia, as well as in the Arab World, and to report the morbidity and mortality of the living donors after such procedures. Methods. A retrospective review of the medical charts of 37 living donors who were involved in the procedure of living-related liver transplantation (LRLT), that took place in Riyadh Armed forces Hospital in the period between November 1998 and July 2002, is conducted. Results. The age of living donors ranged between 21 and 41 years, and there were 22 women and 15 men. All donors are first-degree relatives, apart from 2 donors who were the cousins of the recipients. There was no mortality among the donors. The morbidity was minimal, including 3 cases of biliary leakage and 1 of incisional hernia. Of 39 pediatric liver transplantations that have been done over the above period, only 2 cases had cadaveric liver transplantation and these were excluded from this study. All donors had left lateral segment donation, apart from one who had right lobe, segments V–VIII donation to a 14-year-old recipient. Conclusion. Living donation of hepatic graft is a safe procedure for the donors with an excellent outcome. Living-related liver transplantation is the optimal treatment for end-stage liver disease and the solution for the scarcity of cadaveric liver grafts. The level of acceptance of living donation of hepatic grafts among the Saudi people is favorable.     

Ocular side effects of systemic steroid therapy in renal transplant patients

Sixty-one renal transplant patients were studied for ocular complications of steroid therapy. Twenty patients (32.8%) were found to have posterior subcapsular cataract. Three patients (4.9%) had ocular hypertension. There was no significant correlation between cataract formation and the total dose of steroids, number of rejection episodes, or the period of hemodialysis. HLA-A9 was present in noncataract patients to a greater extent, a statistically significant (P less than .05) finding not reported before to our knowledge.     

Survival of Sub-optimal Cadaver Renal Grafts With Prolonged Cold Ischaemic Times Using Cyclosporin

Between September 1983 and December 1985, 33 cadaver kidneyswith prolonged ischaemic times (mean 47.3±11.0 h), andfrequently in problematic conditions, were received from Europeand transplanted into adults (16 male, 12 female, mean age 34±11years) and children (2 male, 3 female, mean age 8.8±4.0years), using cyclosporin (CsA) and steroid immunosuppression.Six patients have died (three with functioning grafts) and 12grafts have been lost. Eighteen grafts remain functioning, witha mean survival of 27 months. The 1 year actuarial patient andgraft survivals were 82% and 69% respectively. The mean timeto cessation of haemodialysis was 17±10 days, and tostable graft function was 28±11 days. At 3 months (27patients) mean serum creatinine was 191±88 µmol/l(2.16±1.0 mg/dl), with a mean CsA dose of 6.7±2.2mg/kg per day. There was an association between the immediatepost-transplant renographic perfusion index and the serum creatinineat 3 months (r=0.52, P<0.01). At no stage did the serum creatininecorrelate with CsA dose or length of ischaemic time. These resultsdemonstrate that despite suboptimal conditions, prolonged coldischaemic times, and periods of oliguria, cadaver kidney transplantsmay be managed successfully with CsA and low-dose steroids.     

Structural analysis of Bub3 interactions in the mitotic spindle checkpoint

The Mad3/BubR1, Mad2, Bub1, and Bub3 proteins are gatekeepers for the transition from metaphase to anaphase. Mad3 from Saccharomyces cerevisiae has homology to Bub1 but lacks a corresponding C-terminal kinase domain. Mad3 forms a stable heterodimer with Bub3. Negative-stain electron microscopy shows that Mad3 is an extended molecule (approximately 200 A long), whereas Bub3 is globular. The Gle2-binding-sequence (GLEBS) motifs found in Mad3 and Bub1 are necessary and sufficient for interaction with Bub3. The calorimetrically determined dissociation constants for GLEBS-motif peptides and Bub3 are approximately 5 microM. Crystal structures of these peptides with Bub3 show that the interactions for Mad3 and Bub1 are similar and mutually exclusive. In both structures, the GLEBS peptide snakes along the top surface of the beta-propeller, forming an extensive interface. Mutations in either protein that disrupt the interface cause checkpoint deficiency and chromosome instability. We propose that the structure imposed on the GLEBS segment by its association with Bub3 enables recruitment to unattached kinetochores.     

Bullous pemphigoid and cholestatic hepatitis associated with Castleman's disease.

The case of a 21-yr-old woman admitted with a two-week history of icterus, fever, multiple peripheral lymphadenopathy and pruritic eruption is presented. A full evaluation including computed tomography, endoscopic retrograde cholangiography, liver, skin and lymph node biopsies and biochemical tests confirmed the diagnosis of multicentric Castleman's disease (angiofollicular lymph node hyperplasia). All symptoms improved within four weeks of commencing prednisone therapy. Castleman's disease should be considered in the differental daignosis of cholestatic hepatitis and bullous pemphigoid.     

Accuracy of multi-slice computed tomography for measurement of left ventricular ejection fraction compared with cardiac magnetic resonance imaging and two-dimensional transthoracic echocardiography: a systematic review and meta-analysis

Background

Multi-slice computed tomography (MSCT) allows non-invasive assessment of the coronary arteries and simultaneously can provide measurement of left ventricular ejection fraction (LVEF). The accuracy of newer MSCT generations (64-slice or more) for assessment of LVEF compared with magnetic resonance imaging (MRI) and two-dimensional transthoracic echocardiography (TTE) has not been evaluated in a meta-analysis.

Purpose

To evaluate, via a systematic literature review and meta-analysis, whether MSCT can assess LVEF with high accuracy compared with MRI and TTE.

Methods

Electronic databases and reference lists for relevant published studies were searched. Twenty-seven eligible studies provided mean LVEF% with its standard deviation (SD) measured by MSCT versus MRI and TTE. Meta-analysis of weighted mean difference (WMD) and Bland–Altman method were used to quantify the mean difference and agreement between MSCT compared with MRI and TTE.

Results

The results of combining 12 studies showed no significant difference in LVEF% between MSCT and MRI with a WMD of −0.11 (−1.48, 1.26, 95% CI), p = 0.88. Bland–Altman analysis showed excellent agreement between MSCT and MRI with a bias of 0.0 (−3.7, 3.7 ± 1.96SD) with 95% CI. The results of combining 15 studies showed no significant difference in LVEF between MSCT versus TTE measurements with a WMD of 0.19 (−1.13 to 1.50; 95% CI), p = 0.87. Bland–Altman analysis showed excellent agreement between MSCT and TTE with a bias of 0.3 (−4.7, 5.7 ± 1.96SD) with 95% CI.

Conclusion

The newer MSCT generations can provide accurate LVEF measurement compared to MRI and TTE. MSCT represents a valid technique for the combined evaluation of LVEF and coronary artery disease.     

The Effect of Helicobacter Pylori on Gastroesophageal Reflux Disease

Background and Objectives:

Helicobacter pylori infection represents one of the most common and medically prominent infections worldwide. Gastroesophageal reflux disease (GERD) has a multifactorial etiology. The nature of the relationship between Helicobacter pylori infection (HP) and reflux esophagitis is still not clear. This study is designed to find the influence of HP on GERD.

Patients and Methods:

The study was conducted retrospectively at Sakarya Newcity Hospital between January 2006 and January 2009. Data were collected on patient''s age, sex, weight, the grade of GERD and the severity of HP.

Results:

There were 1,307 women and 1,135 men in this review with a mean age of 39,54 (range, 17 to 70) years. Helicobacter pylori positive (1 to 3 severity) was frequently seen in patients with GERD. A statistically significant relationship was found between HP positivity and the grade of GERD. The Helicobacter pylori infection (1 to 3 severity) was found in 1,437 (82.5%) of patients with GERD in our series.

Conclusions:

Controversy still exists about the association between GERD and HP infection. Based on our findings, significant evidence suggests the potential role of HP infection in the development of GERD. Also, the current data provide sufficient evidence to define the relationship between GERD and HP infection.