Management of post-tuberculous complex aspergilloma of the lung: role of surgical resection.

Of 14 patients with complex aspergilloma complicating healed tuberculosis, 12 underwent lobectomy or pneumonectomy for recurrent haemoptysis. No deaths occurred, though one patient needed re-exploration for bleeding. There was no postoperative worsening of dyspnoea despite a mean forced vital capacity (FVC) of 60% predicted for the patients undergoing surgery and of 20% predicted for two patients with severe restrictive defects, perhaps owing to the fact that there was little or no function in the resected part of the lung, as shown by preoperative isotope ventilation-perfusion scanning, and that patients were under the age of 50 and generally fit. There has been no recurrence of haemoptysis during follow up, which has been from 12 to 33 months. Surgical resection, provided that cases are carefully selected, offers the best chance of cure with low mortality and morbidity.     

Gelfoam haemostatic agent with or without autologous bone marrow-derived stem cells for the regeneration of critical-size mandibular defects in the rabbit

This study evaluated the effect of Gelfoam sponge with and without autologous bone marrow-derived stem cells (BMSCs) on bone regeneration in critical-size mandibular defects. The study involved 56 New Zealand rabbits assigned to four groups (14 in each). The osseous defects in group I were irrigated with normal saline, those in group II were grafted with autogenous tibial bone, and those in group III were filled with Gelfoam sponge. Group IV defects were treated as for group III, but the interface between the Gelfoam sponge and bone surface was injected with BMSCs. At the end of 4 weeks, seven rabbits in each group were euthanized; the remaining animals were euthanized at the end of the experiment, at 8 weeks postoperative. The percentage area of newly formed bone was significantly higher in group IV at week 4 (0.030 ± 0.01%) and week 8 (0.060 ± 0.03%) than in group I (0.01 ± 0.00% and 0.02 ± 0.00%, respectively) and group III (0.08 ± 0.01% and 0.015 ± 0.02%, respectively), but was lower than that in group II (0.038 ± 0.02% and 0.082 ± 0.01%, respectively). Thus, the combination of Gelfoam and autologous BMSCs promoted the regeneration of mandibular critical-size defects better than the use of Gelfoam alone. However, the amount of newly generated bone was lower than in defects grafted with autogenous bone.     

Determinants of and changes in catastrophic health expenditure in the occupied Palestinian territory: an analysis of ten rounds of the Palestinian Households Expenditure and Consumptions Survey (1996–2011)

Background

Catastrophic health expenditure (CHE) is measured to assess the financial protection from the risk of health-related conditions, which is considered a principle performance goal of any health system. The incidence and intensity of CHE in the occupied Palestinian territory between 1998 and 2007 was assessed in previous research; however, no research has assessed the occurrence of CHE in different population groups in the occupied Palestinian territory. The objective of this study was to examine the changes in the occurrence of CHE in different groups of Palestinians from 1996 to 2011, which was a period of increasing political turmoil, transformation of the national health system, and economic hardship faced by the population.

Assessment of aldehyde dehydrogenase in viable cells

Cytosolic aldehyde dehydrogenase (ALDH), an enzyme responsible for oxidizing intracellular aldehydes, has an important role in ethanol, vitamin A, and cyclophosphamide metabolism. High expression of this enzyme in primitive stem cells from multiple tissues, including bone marrow and intestine, appears to be an important mechanism by which these cells are resistant to cyclophosphamide. However, although hematopoietic stem cells (HSC) express high levels of cytosolic ALDH, isolating viable HSC by their ALDH expression has not been possible because ALDH is an intracellular protein. We found that a fluorescent aldehyde, dansyl aminoacetaldehyde (DAAA), could be used in flow cytometry experiments to isolate viable mouse and human cells based on their ALDH content. The level of dansyl fluorescence exhibited by cells after incubation with DAAA paralleled cytosolic ALDH levels determined by Western blotting and the sensitivity of the cells to cyclophosphamide. Moreover, DAAA appeared to be a more sensitive means of assessing cytosolic ALDH levels than Western blotting. Bone marrow progenitors treated with DAAA proliferated normally. Furthermore, marrow cells expressing high levels of dansyl fluorescence after incubation with DAAA were enriched for hematopoietic progenitors. The ability to isolate viable cells that express high levels of cytosolic ALDH could be an important component of methodology for identifying and purifying HSC and for studying cyclophosphamide-resistant tumor cell populations.     

Gene expression of IQGAPs and Ras families in an experimental mouse model for hepatocellular carcinoma: a mechanistic study of cancer progression

IQGAPs genes play critical role in either induction or suppression of cancer and its progression, however the relationship between Ras genes and these genes are still unclear. In this study, we tried to understand the mechanistic action of IQGAPs genes and its correlation with Ras genes in mouse hepatic cancer model. The genetic expressions of IQGAP1, IQGAP2, IQGAP3, Hras, Kras, Nras, Mras, Caspase3, and BAX were followed in both hepatocellular carcinoma and normal liver cells of Balbc mice. Genotoxic agent diethylnitrosamine (DEN)-induced hepatic cancer model was induced in male mice and recorded the occurrence of hepatocellular carcinoma by morphological and histological changes in the liver. It was observed that mRNA expressions of IQGAP1, Hras, Kras, Nras, Mras, Caspase3, and BAX genes were highly elevated in hepatocellular carcinoma cells when compared with normal liver cells, additionally their expressions increased by concentrating the dose of DEN. While, the expressions of IQGAP2 and IQGAP3 were significantly decreased in hepatocellular carcinoma cells when compared with normal liver cells, as well as their expressions decreased more with increasing the dose of DEN. It was concluded from this study that IQGAP1 has a strong signaling relationship with Ras genes in induction of cancer and it is considered as a key gene for induction or suppression of the hepatocellular carcinoma.     

Value of conventional and tissue Doppler echocardiography in the noninvasive measurement of right atrial pressure

Background: Evaluation of right atrial pressure (RAP) provides useful diagnostic, therapeutic, and prognostic information. Aim: To assess the utility of several conventional and tissue Doppler parameters in the estimation of RAP. Methods: Among 50 consecutive patients (median age: 50 years; all in sinus rhythm), invasively measured RAP was simultaneously correlated with pulsed Doppler of tricuspid inflow (peak E and A velocities, E‐wave deceleration time) and pulsed tissue Doppler of lateral tricuspid annulus (peak E’ and A’ velocities, isovolumic relaxation time [IVRT], acceleration time and rate of E’‐wave, deceleration time and rate of E’‐wave). These ratios were calculated: E/A, E’/A’, E/E’, and E/IVRT. Results: The median RAP was 14 mmHg (range 1–27 mmHg) with 29 patients (58%) having an elevated RAP (>10 mmHg). Among all studied Doppler variables, E/E’ ratio showed the strongest correlation with RAP (r = 0.84, P < 0.001) with the following regression equations: RAP = 1.24 + (1.69 × E/E’). The mean difference between Doppler and invasively measured RAP was 0.21 ± 2.6 mmHg. E/ E’ ratio ≥ 4.5 provides 89% sensitivity and 100% specificity for detection of elevated RAP (receiver operating characteristic area 0.95; P < 0.001). Conclusion: Of all echocardiographic variables investigated, tricuspid annular E/E’ ratio is identified as the best index for noninvasive determination of RAP.     

Synergistic effect of aqueous extract of Telfaria occidentalis on the biological activities of artesunate in Plasmodium berghei infected mice

Background

Resistance to most antimalarial drugs has encouraged the use of herbal preparations along with prescribed orthodox drugs.

Objective

To investigate effect of co-administration of aqueous extract of T. occidentalis leaves; commonly used as antimalarial and haematinic agent in Nigeria and artesunate using P. berghei animal model.

Methods

In vivo curative antiplasmodial effect of T. occidentalis (200mg/kg) alone and combination with artesunate (2mg/kg) were evaluated using albino mice infected with 10⁶ parasitized erythrocytes of P. berghei intraperitoneally. The haematological parameters: haemoglobin level, red blood cells and white blood cells and packed cell volume were monitored using standard methods.

Results

Aqueous extract of T. occidentalis, artesunate and the combination gave 72.17±4.07%, 70.43± 4.27% and 85.43±3.65% reduction in parasitaemia after 48hours respectively. A significant enhancement of the PCV was obtained with the coadministration of artesunate and aqueous extract (p< 0.01). Similar trends were also observed with heamatological parameters at 72hours of administration.

Conclusion

This study revealed a synergistic effect of the co-administration on parasite clearance rate of P. berghei infection in mice, with a significant enhancement of haematological parameters within 48 hours of administration. This indicates a rapid rate of recovery from plasmodial infections with the co-administration.     

Left ventricular function and left atrial volumes in rheumatoid arthritis patients: Subclinical cardiac involvement and relation to seropositivity

BackgroundLeft ventricular (LV) dyfunction with preserved ejection fraction has been associated with increased mortality. Left atrium (LA) modulates LV filling and plays a role in maintaining cardiac function. Cardiovascular disease is a leading cause of death in rheumatoid arthritis (RA).Aim of the workTo study the left atrium modulating the left ventricular filling and to investigate its relation with disease activity to detect subclinical early cardiac affection in RA patients.Patients and methods45 RA patients and 30 control were studied. The disease activity score (DAS28) was calculated. Conventional and tissue Doppler imaging (TDI) and strain (S) and strain rate (SR) analysis by two-dimensional speckle tracking of LA were conducted.ResultsThe 45 female patients mean age was 38.8 ± 8.7 years, disease duration was 7.3 ± 6.2 years and mean DAS28 was 4.1 ± 0.9. Regarding the LA emptying fractions, only the 2 LA passive emptying fraction (PEF) and total emptying fraction (TEF) were significantly lower in patients compared to control (p = 0.01 and p = 0.025 respectively). The LA expansion index (EI) was significantly reduced in patients compared to control (p = 0.009). Regarding TDI-derived mitral annular velocities, lateral e’ and s as well as SRe (l/s) were significantly slower in patients compared to control (p = 0.001, p = 0.02 and p < 0.0001 respectively). Rheumatoid factor (RF) was significantly inversely related to TDI laterale, TDI laterals, and strain rate e, LA-PEF, LA-EI and LA-TEF.ConclusionRA patients had alteration in LV longitudinal myocardial function and more LA stiffness. Cardiac affection is more in seropositive patients.