Dexamethasone 8 mg in combination with ondansetron 4 mg appears to be the optimal dose for the prevention of nausea and vomiting after laparoscopic cholecystectomy

PURPOSE: The combination of antiemetic drugs could be a solution to prevent severe postoperative nausea and vomiting (PONV). The aim of this randomized double blind, dose-ranging study was to determine the minimum single effective dose of dexamethasone combined with ondansetron for the prevention of PONV in patients undergoing laparoscopic cholecystectomy. METHODS: One hundred eighty patients were allocated randomly to one of six groups to receive saline (P group), ondansetron 4 mg (O group), or ondansetron 4 mg and dexamethasone at doses of 2 mg (OD2 group), 4 mg (OD4 group), 8 mg (OD8 group), and 16 mg (OD16 group). A standardized general anesthetic was used. All episodes of PONV during the intervals of zero to six hours, 6-12 hr and 12-24 hr after surgery were evaluated using a numeric scoring system. Mean visual analogue scale pain scores at rest and on movement, the time to first demand of analgesia, total analgesic consumption in 12 hr epochs, duration of hospital stay, and side effects were recorded. RESULTS: The incidence of PONV in the OD8 (16%) and OD16 (16%) groups was lower than in the 83% (P < 0.001) and O groups (50%) at the 12-24 hr epoch (P < 0.05). There were no differences in antiemetic effect between the O, OD2 and OD4 groups and between the OD8 and OD16 groups. Pain scores, total analgesic consumption, duration of hospital stay and side effects were similar among groups. CONCLUSION: Our results suggest that 8 mg is the minimum dose of dexamethasone that, combined with ondansetron 4 mg will effectively prevent PONV in patients undergoing laparoscopic cholecystectomy.     

Enzyme-linked immunosorbent assay (ELISA) in the diagnosis of active pulmonary tuberculosis.

This study evaluates the sensitivity and specificity of an enzyme-linked immunosorbent assay (ELISA) for the detection of antibodies against Mycobacterium tuberculosis antigen. Twenty seven of the 35 patients with pulmonary tuberculosis had positive serology with an antibody titre of 10 nineteen of them had positive serology with an antibody titre of 100. All the 27 patients with positive serology were either smear or culture positive or both. Twenty six of the 35 control group had negative serology and 9 had positive serology with an antibody titre of 10. The test has a sensitivity of 77.14% and a specificity of 74.29%.     

Knowledge and attitudes of primary health care personnel concerning mental health problems in developing countries: a follow-up study

Within the context of a World Health Organization coordinated collaborative study health workers in six developing countries were assessed 18 months after their training for improvement in their knowledge and attitude towards mental health problems and their management. The approaches to training varied between study areas, but the degree of improvement following the training, was of equal magnitude in all countries. The training process has formalized the recognition by the health workers that treatment of mental health problems is an integral part of their work.     

Genetic markers in coronary heart disease

Coronary heart disease (CHD) was found to aggregate in families. So the present study aimed at studying certain genetic markers (lipoproteins, ABO blood groups and dermatoglyphics), in a group of 60 patients with CHD and a control group to detect any significant association between such genetics markers in this disorder. This can throw light on its genetics. The study revealed significant and marked association of CHD with low alpha-lipoprotein, high pre-beta and beta-lipoproteins. No significant association wa detected with ABO phenotypes. Definite significant association was also detected between CHD and certain dermatoglyphics phenotypes including FTP, T-D count and palm patterns. These significant associations of CHD and these genetic markers "which are genetically determined" denoted strongly genetic etiology or at least genetic predisposition of CHD. Detection of such genetic markers may help in determination of risky individuals in population and families of CHD patients. This can help in prevention by proper genetic counseling.     

Numerical chromosomal aberrations in muscle invasive squamous cell and transitional cell cancer of the urinary bladder: an alternative to classic prognostic indicators?

OBJECTIVES: To evaluate the prognostic value of chromosomal aberrations in muscle invasive bladder cancer, because they are of diagnostic and prognostic significance in superficial bladder cancer. METHODS: One hundred ninety patients, who underwent radical cystectomy because of squamous cell carcinoma (SCC) of the urinary bladder in 94 cases and transitional cell carcinoma (TCC) in 96 cases, were studied retrospectively. Numerical aberrations of chromosomes 7, 9, and 17, p53 positivity, histologic stage and grade, histologic tumor type, lymph node status, and the presence of bilharzial eggs were investigated as possible prognostic factors. RESULTS: Univariate analysis demonstrated the prognostic significance of all parameters analyzed, excluding chromosome 9. Multivariate analysis revealed only T category (P = 0.01095266), lymph node involvement (P = 0.00054877), and p53 positivity (P = 0.0316974) to be independent prognostic factors in muscle invasive SCC and TCC. CONCLUSIONS: Although chromosomal aberrations are associated with progression-free survival, they are not independent prognostic factors and give the clinician no additional information on patients with muscle invasive bladder cancer.     

Reproductive performance, blood testosterone, lipid peroxidation and seminal plasma biochemistry of rabbits as affected by feeding Acacia saligna under subtropical conditions.

Thirty-two New Zealand White growing rabbits (eight-week old) were used to determine the effect of feeding acacia-based diets on semen characteristics, plasma testosterone, free radicals, seminal plasma enzymes and lipids. Rabbits were randomly assigned to four equal groups. The first group (control) was fed a basal diet only, and the other three groups were fed other three diets, as follows: 80% of basal diet+20% of acacia leaves (low), 60% of basal diet+40% of acacia leaves (medium) and 40% of basal diet+60% of acacia leaves (high), respectively for 32 week. Semen samples were collected throughout the last 12 week of the experimental period. Rabbits fed on different levels of Acacia showed no significant changes in libido (reaction time), ejaculate volume, sperm concentration, packed sperm volume and initial hydrogen ion concentration compared to control. However, low and/or medium levels of Acacia caused significant (P<0.05) increase in total sperm output (TSO), sperm motility (%), total motile sperm per ejaculate (TMS), normal sperm, total functional sperm fraction (TFSF), semen initial fructose, live sperm and plasma testosterone. On the other hand, high level of Acacia did not show any significant change in TSO, sperm motility (%), TMS, initial fructose, TFSF or testosterone, while live and normal sperm decreased. All levels of Acacia caused a significant decrease in the concentrations of thiobarbituric acid-reactive substances (TBARS) and an increase in the activity of glutathione S-transferease. The activities of lactate dehydrogenase (LDH), aminotransferases and phosphatases were significantly increased in seminal plasma of animals fed low or medium levels of Acacia. Seminal plasma total lipid, triglyceride, low density lipoprotein and free fatty acids were significantly (P<0.05) decreased in low or medium levels of Acacia. On the other hand, total cholesterol, percentage cholesterol (out of total lipids) and high density lipoprotein were significantly (P<0.05) increased in seminal plasma of rabbits fed on low or medium levels of Acacia. High level of Acacia did not cause any changes in the previous parameters. It can be concluded that up to 40% Acacia leaves could be used successfully and safely in the diet of rabbits without adversely affecting their reproductive performance under subtropical conditions.     

Isoflavone Genistein Induces Fluid Secretion and Morphological Changes in the Uteri of Post-Pubertal Rats

A reported increase in the incidence of infertility following high genistein intake could be related to alteration in the normal fluid volume and morphology of the uterus in adult female. In view of this, we investigated the effect of this compound on fluid secretion, fluid volume and morphology of the uterus in post-pubertal rats. Methods: Ovariectomised SD rats were treated with 17-β oestradiol (E) (0.8 X 10^-4 mg/kg/day) and genistein (0.5, 5, 10, 25, 50 and 100 mg/kg/day) for three days. Following drug treatment, in-vivo uterine perfusion was performed and the rate of fluid secretion and the volume of fluid in the uterus were determined via changes in weight (μl/min) and F-dextran concentration of the perfusate respectively. The animals were then sacrificed and the uteri were removed for weight determination, morphological analyses and proliferative cell nuclear antigen (PCNA) expression analyses by Western blotting. Results: Subcutaneous genistein treatment resulted in a dose-dependent increase in fluid secretion rate, fluid volume and uterine wet weight. Treatment with 100 mg/kg/day genistein resulted in a remarkable increase in the rate of uterine fluid secretion, the volume of the uterine luminal fluid as well as the circumference of the uterine and uterine glandular lumen suggesting an excessive fluid accumulation. Meanwhile, there were evidence of glandular hyperplasia and an increase in the expression of PCNA following treatment with 50 and 100 mg/kg/day genistein. Conclusion: High genistein intake could potentially cause adverse effects on the uterus by inducing excessive fluid secretion and accumulation as well as hyperplasia.