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   2011| April  | Volume 3 | Issue 4  
    Online since November 9, 2011

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Systemic treatment and targeted therapy in patients with advanced hepatocellular carcinoma
El Mehdi Tazi, Ismail Essadi, Hind M’rabti, Anass Touyar, PR Hassan Errihani
April 2011, 3(4):167-175
Background: Advanced hepatocellular carcinoma (HCC) is a malignancy of global importance: it is the sixth most common cancer and the third most common cause of cancer-related mortality worldwide. Despite decades of efforts by many investigators, systemic chemotherapy or hormone therapy has failed to demonstrate improved survival in patients with HCC.. Ongoing studies are evaluating the efficacy and tolerability of combining Sorafenib with erlotinib and other targeted agents or chemotherapy. Aims: On the basis of placebo-controlled, randomized phase III trials, Sorafenib has shown improved survival benefits in advanced HCC and has set a new standard for future clinical trials. The successful clinical development of Sorafenib in HCC has ushered in the era of molecularly targeted agents in this disease, which is discussed in this educational review. Material and Methods: Many molecularly targeted agents that inhibit angiogenesis, epidermal growth factor receptor, and mammalian target of rapamycin are at different stages of clinical development in advanced HCC. Future research should continue to unravel the mechanism of hepatocarcinogenesis and to identify key relevant molecular targets for therapeutic intervention. Identification and validation of potential surrogate and predictive biomarkers hold promise to individualize patients' treatment to maximize clinical benefit and minimize the toxicity and cost of targeted agents. Results: Systemic therapy with various classes of agents, including hormone and cytotoxic agents, has provided no or marginal benefits. Improved understanding of the mechanism of hepatocarcinogenesis, coupled with the arrival of many newly developed molecularly targeted agents, has provided the unique opportunity to study some of these novel agents in advanced HCC. Conclusions: The demonstration of improved survival benefits by Sorafenib in advanced HCC has ushered in the era of molecular-targeted therapy in this disease, with many agents undergoing active clinical development.
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Dipstick urine analysis screening among asymptomatic school children
Farah Hajar, Mohamad Taleb, Bilal Aoun, Ahmad Shatila
April 2011, 3(4):179-184
Background: Mass urinary screening is a useful tool to identify children with asymptomatic progressive renal diseases. A dipstick urinalysis screening was conducted to detect such prevalence and to set up a more effective screening program for children. Patients and Methods: A cross sectional study was carried out in seven nurseries and primary schools in different regions of Lebanon (Beirut, North Lebanon, and Valley of Bekaa) between February 2010 and March 2010. Eight hundred seventy asymptomatic children were enrolled in this study. First morning mid steam urine samples were obtained from students and were tested by dipstick method. Children with abnormal findings were re-tested after fifteen days. Results: Twenty five (2.9%) children had urinary abnormalities at the first screening; Eighteen (72%) of them still had abnormal results at the second screening. Among all the students, hematuria was the most common abnormality found with a prevalence of 1.5%, followed by nitrituria (0.45%), combined hematuria and nitrituria (0.45%) and proteinuria (0.1%). Urinary abnormalities were more common in females than in males. With respect to age, most positive results were detected at 6 years of age. Hematuria and proteinuria were mainly present in the North of Lebanon. Conclusion: Asymptomatic urinary abnormalities might be detected by urine screening program at school age. Further work-up should be offered to define the exact etiology of any abnormal finding and to determine whether early detection of renal disorders in childhood will lead to effective interventions and reduction in the number of individuals who develop end-stage renal disease.
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Relationship between lactobacilli and opportunistic bacterial pathogens associated with vaginitis
Mohammad Sabri A Razzak, Alaa H Al-Charrakh, Bara Hamid AL-Greitty
April 2011, 3(4):185-192
Background: Vaginitis, is an infectious inflammation of the vaginal mucosa, which sometimes involves the vulva. The balance of the vaginal flora is maintained by the Lactobacilli and its protective and probiotic role in treating and preventing vaginal infection by producing antagonizing compounds which are regarded as safe for humans. Aim: The aim of this study was to evaluate the protective role of Lactobacilli against common bacterial opportunistic pathogens in vaginitis and study the effects of some antibiotics on Lactobacilli isolates. Materials and Methods : In this study (110) vaginal swabs were obtained from women suffering from vaginitis who admitted to Babylon Hospital of Maternity and Paediatrics in Babylon province, Iraq. The study involved the role of intrauterine device among married women with vaginitis and also involved isolation of opportunistic bacterial isolates among pregnant and non pregnant women. This study also involved studying probiotic role of Lactobacilli by production of some defense factors like hydrogen peroxide, bacteriocin, and lactic acid. Results: Results revealed that a total of 130 bacterial isolates were obtained. Intrauterine device was a predisposing factor for vaginitis. The most common opportunistic bacterial isolates were Staphylococcus aureus, Escherichia coli, Streptococcus agalactiae, and Klebsiella pneumoniae. All Lactobacilli were hydrogen peroxide producers while some isolates were bacteriocin producers that inhibited some of opportunistic pathogens (S. aureus, E. coli). Lactobacilli were sensitive to erythromycin while 93.3% of them were resistant to ciprofloxacin and (40%, 53.3%) of them were resistant to amoxicillin and gentamycin respectively. Results revealed that there was an inverse relationship between Lactobacilli presence and organisms causing vaginitis. This may be attributed to the production of defense factors by Lactobacilli. Conclusion: The types of antibiotics used to treat vaginitis must be very selective in order not to kill the beneficial bacteria (Lactobacilli) that help in preservation of vaginal health and ecosystem as being one of the probiotic bacteria.
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Effects of a low level laser on the acceleration of wound healing in rabbits
Adel J Hussein, Abdalbari A Alfars, Mohsin A. J. Falih, Al-Nawar A Hassan
April 2011, 3(4):193-197
Background : Tissue healing is a complex process that involves local and systemic responses. The use of low level laser therapy for wound healing has been shown to be effective in modulating both local and systemic response. Aim: The aim of this study was to accelerate and facilitate wound healing and reduce scar formation and wound contraction of an open wound by a low level laser. Materials & Methods: Twenty adult male rabbits, lepus cuniculus demostica, were brought from a Basrah local market and raised under proper management conditions in Basrah Veterinary Medicine College. The age of these rabbits ranged between 8-10 months and their body weight was 1.5-2 Kg. The rabbits were divided into two groups, group I (Control) and group II (Treated). General anesthesia was provided by a mixture of Xylazine and Ketamine at a ratio of 1:0.5m intramuscularly. Selected sites were shaved, cleaned and disinfected. A wound of 4-cm length and 3-cm depth was made on the gluteal region; six hours later, the wound was treated with gallium aluminum and an arsenide diode laser with a power output of 10m at a wavelength of 890nm in pulsed nods, with a frequency of 20 KLTZ. The wound exposure to the laser was once a day at 890 nm wavelength for 5 minutes over a 7-day period. Histopathological study was obtained regarding the wound depth and edge of the skin on the 3 rd , 7 th and 14 th days. Results : The histopathological finding of group I at three days postoperative showed hemorrhage with inflammatory cell infiltration, mainly neutrophils as well as congested blood vessels in the gap. At seven days, the gap contained necrotized neutrophils together with hemolysis and granulation tissue under the dermis tissue. Hemolysis was seen between the muscle fibers. At 14 days, there was irregular fibrous connective tissue proliferation with congested blood vessels seen in the gap with mononuclear cell infiltration. In group II at three days postoperative, severe inflammatory cell infiltration was observed, mainly neutrophils with proliferation of fibroblasts from a few fibrous connective tissues. On the 7 th day, the main lesion was characterized by severe granulation tissue that consisted of proliferation of fibrous connective tissue and congested blood vessels in the gap of the incision with mononuclear cell infiltration. Conclusions : The study found that low level laser therapy (II) was effective in open wounds, which showed better regeneration and faster restoration of structural and functional integrity as compared to the control group.
  2,309 548 4
Evaluating trial of scar in patients with a history of caesarean section
Aliya Islam, Ambreen Ehsan, Saadia Arif, Javeria Murtaza, Ayesha Hanif
April 2011, 3(4):201-205
Aims: To analyze the outcome of trial of scar in patients with previous caesarean section and to assess the fetal and maternal complications after trial of scar. Patients and Methods : The study was conducted at Military Hospital, Rawalpindi, Pakistan, with 375 pregnant patients who had a previous delivery by caesarean and who had regular antenatal checkup. Data were recorded on special pro-forms designed for the purpose. Results : The results from the 375 patients who had one previous lower segment caesarean section due to non-recurrent causes were analyzed and compared with national and international studies. Indications of previous caesarean section (non-recurrent causes) included malpresentations, fetal distress/cord prolapse, failure to progress, severe pregnancy-induced hypertension/eclampsia and twins with abnormal lie of the first twin. 0 218 patients reported spontaneous labor. Among these patients, 176 delivered vaginally and 42 patients had repeat caesarean sections. There were a total of 157 patients who experienced induction of labor. 97 patients were induced by cervical ripening with mechanical method, followed by artificial rupture of membranes and augmentation (if required) with syntocinon infusion. 60 patients were induced with prostaglandin E 2 vaginal tablet. Conclusion : This study concludes that females with a prior caesarean are at increased risk for subsequent caesareans, regardless of mode of delivery. Eliminating vaginal-birth-after-caesarean will not eliminate the risk. Therefore, vaginal birth after caesarean should be encouraged in selected cases from obstetric units to reduce the risks of repeated caesarean sections. Failed vaginal-birth-after-caesarean can result in increased morbidity than that with elective caesarean section.
  2,001 364 2
Crohn's disease presenting as acute abdomen: Report of two cases
Mahesh Gupta, Subhash Goyal, Rekha Goyal
April 2011, 3(4):209-211
Context : Crohn's Disease may involve any part of GI tract leading to inflammation of all the layers of the affected bowel. The symptoms may mimc other intestinal pathologies and at times diagnosis remains a dilemma. Mostly medical therapy remains the mainstay of treatment. However surgical intervention is warranted in cases presenting with acute abdomen. Case Report : We present two such cases of acute abdomen admitted in our hospital and diagnosed as case of intestinal obstruction. Exploratory laparotomy was performed in both cases and diseased resected segments were confirmed as Crohn's Disease on histopathology. Conclusion : Crohn's Disease should be kept as a differential diagnosis in patients presenting with acute abdomen especially with a long history of vague abdominal complaints.
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Acute pancreatitis and fibromyalgia: Cytokine link
Sadat Muzammil, Helen Catherine Cooper
April 2011, 3(4):206-208
Context: Fibromyalgia is a widespread musculoskeletal pain disorder found in 2% of the general population and with a preponderance of 85% in females, and has both genetic and environmental contribution. Acute pancreatitis is a severe condition and in most cases gallstones disease represents approximately half of the cases of acute pancreatitis, and 20-25% are related to alcohol abuse. Small numbers of cases are caused by a variety of other reasons but a few cases have no obvious cause, referred to as 'idiopathic'. Here we present a case where fibromyalgia might be linked to acute pancreatitis. We believe this has not been reported in this context in literature. Case Report: Fibromyalgia is a widespread musculoskeletal pain disorder found in 2% of the general population and with a preponderance of 85% in females, and has both genetic and environmental contribution. Patient had a cholecystectomy eight years previously. Patient feels tired almost all the time due to her fibromyalgia and requires family support for daily routine. Patient's blood results showed alanine transaminase 527 IU/L, alkaline phosphatase 604 IU/L, bilirubin 34 μmol/L, amylase 2257 IU/L, C-reactive protein 19 mg/L, Gamma-Glutamyl transpeptidase 851 IU/L, renal function and electrolytes were within normal limits. The patient was admitted to the high dependency unit with a diagnosis of acute pancreatitis. Conclusion: There is a known increase in levels of cytokines in patients with fibromyalgia. Part of the pathophysiology of acute pancreatitis is related to raised cytokines and immune deregulations. We hypothesize that elevated levels of cytokines in fibromyalgia has led to acute pancreatitis in our patient. Further epidemiological research on the incidence of pancreatitis in cytokine mediated conditions such as fibromyalgia is required.
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No association between Val158Met of the COMT gene and susceptibility to schizophrenia in the Syrian population
Bassam Lajin, Amal Alachkar, Abdul Rezzak Hamzeh, Roula Michati, Hamid Alhaj
April 2011, 3(4):176-178
Background : The Val158Met single nucleotide polymorphism of the COMT gene has been implicated in the aetiology of schizophrenia, although results from different populations have been conflicting. Aims: The aim of the present study was to investigate possible association between schizophrenia and Val158Met in a novel Arab population from Syria. Methods and Materials: 71 unrelated schizophrenic subjects (45 men) and 102 unrelated healthy controls (62 men) were recruited to take part in this case- control study. The Val158Met of the COMT gene was genotyped for patients and controls, using a new optimized PCR-RFLP method. Results: the results demonstrated that there is no statistically significant difference between the two groups. Conclusion: This study does not support that Val158Met has an influence on susceptibility for schizophrenia in this population.
  1,501 306 -
Prerequsite result of routine human immunodeficiency virus serology among infertile women before assisted reproduction technology
Abieyuwa Patricia Osemwenkha, Kennedy Osegua Ibadin, Egodi Eugenia Akotha, Isaiah Ndubuisi Ibeh
April 2011, 3(4):198-200
Background: Sexually transmitted diseases such as Human Immunodeficiency Virus (HIV) which causes or induces incurable fatal infections have been transmitted through Assisted Reproduction Technology and from infected mothers to the fetus or new born. Aim: The aim of this study is to determine the prevalence of this chronic viral agent among infertile women recruited for Assisted Reproduction Technique programme in Benin City, Nigeria. Materials and Method: Sera (serum) from Five hundred and Ninety infertile women attending Human Reproduction Research Programme/In-vitro fertilization Center at University of Benin Teaching Hospital were screened for the presence of Human Immunodeficiency Virus antibody using three algorithm or techniques of Determine, Unigold and Stat Pack kits. The age range of the infertile women was 20-49 years. Result: 28 (4.7%) out of Five Hundred and fifty infertile women recruited for Assisted Reproduction Technique and screened for Human Immunodeficiency Virus antibody were seropositive with increase in prevalence of 10. 0%, 8.5% and 7.5% among infertile women in age groups of (20 - 24), (25 - 29)yrs and (30 - 34)yrs. Chi-square statistical analysis of data shows insignificance in seroprevalence rate in relation to the number of infertile women screened (P > 0.0001) but the screening of these infertile women for the presence Human Immunodeficiency Virus should continue due to the attendant effects. Conclusion: Infertile women who are Human Immunodeficiency Virus carriers give a new dimension to assisted reproductive techniques. This will no doubt help to prevent further spread and adverse pregnancy outcome.
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Pancreatic endocrine tumors
Ĺke Andrén-Sandberg
April 2011, 3(4):164-166
Pancreatic endocrine tumours are rare tumours, and arise from the types of pancreatic cells that produce hormones. These tumours may or may not secrete hormones themselves and may or may not be cancerous (malignant). Functioning tumours secrete a particular hormones which may cause various syndromes. The present article reviews the latest reports on the pancreatic endocrine tumours
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