International Research Journal of Medicine and Medical Sciences

Number 3, 2015

51-59
Serum markers versus histopathological scoring for discrimination between experimental fatty liver and non-alcoholic steatohepatitis

Authors: Maiiada Hassan Nazmy and Manal Ismail Abdel-Ghany

Abstract

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Number of views: 412

Non-alcoholic fatty liver disease is a multi-factorial health problem which correlates mostly with obesity and metabolic syndrome. Construction of clearer boundaries between simple steatosis and steatohepatitis is a clinical challenge that needs further examination. We aim to offer reliable non-invasive serum markers for discrimination between fatty liver and steatohepatitis thus reduce the urge for invasive histological intervention in some cases. Sixty male albino rats were used in this study, equally divided into 4 groups (15 rats/ group). Group I acted as untreated normal control. Groups II, III, IV were fed high fat diet for 4, 8, 12 weeks respectively. Histological scoring and biochemical analysis including liver enzymes, lipid profile, lipid peroxidation, serum and tissue levels of leptin, vascular endothelial growth factor, tumor necrosis factor-alpha and interleukin-6 were assessed. High fat diet caused sustained hyperglycemia, hyperinsulinemia and insulin resistance. It also induced significant histopathological and biochemical changes in liver enzymes, lipid profile and lipid peroxidation. It significantly increased both serum and tissue levels of leptin, vascular endothelial growth factor, tumor necrosis factor- alpha and interleukin-6. All tested parameters were significantly correlated with histological scoring. Suggested parameters, based on their involvement as key players in disease pathogenesis and their high correlation to histological scoring, may be useful non-invasive diagnostic tools for discrimination between fatty liver and non-alcoholic steatohepatitis. Keywords: Non-alcoholic fatty liver diseases, fatty liver, non-alcoholic steatohepatitis, adipokines, cytokines.

60-63
Role of local anesthesia in pain relief post hemorrhoidectomy

Authors: Sahel Hammouri and Ala al Omari

Abstract

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Number of views: 443

The aim of this study is to evaluate post-operative pain relief on patients who had hemorrhoidectomy. 300 patients who had hemorrhoidectomy were divided in to three groups, according to anesthesia type, group 1 (local anesthesia and sedation), while spinal anesthesia was group 2 and general anesthesia was considered to be group 3, pain relief, post-operative complications, total cost, hospital staying, operating time and post-operative period of time to start ambulation were measured and compared among the three groups. The study was performed during 2010 to 2014 in Jordanian Prince Rashid military hospital. The study showed that patients who had local anesthesia infiltration and sedation had significant influence decrease of post-operative total pain scores at 6/12/18/24 h more than 50%, (200/240/300/320) out of 1000 points compared to (420/500/540/580), (700/680/660/660) in the other 2 groups, the total post-operative analgesia doses in the 3 groups were (120, 140, 180) vials. The total hospital staying time for patients in each group were (130, 210, 260) days, while the total anesthesia and surgical and procedure time were (1500, 3000, 3500) min, total cost (25000, 30000, 35000) JD, post-operative lack of early ambulation time was (100/600/300) h, intra-operative doctor–patients interaction were(100/100/0) patients, headache (0, 8, 1) patients, urine retention (0.6.1) patients, nausea and vomiting (0, 1, 5) patients were reduced by 30%, (P-value < 0.05). In conclusion, post-operative pain, analgesia, total cost, hospital staying and operation time, intra-operative doctor–patients interaction, nausea and vomiting have been significantly reduced by local anesthesia infiltration compared to non-infiltrated groups while spinal anesthesia had a higher rate in post-operative urine retention, headache and hypotension compared to local anesthesia with sedation and general anesthesia. Keywords: Pain, local anesthesia, analgesia, complications, hemorrhoidectomy.

64-69
Eating habits among medical students in a Sudanese medical faculty

Authors: Malak Eisa Abdalla Al-Haj, Hiba A Awooda and Mustafa Khidir Mustafa Elnimeiri

Abstract

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Number of views: 418

Poor nutritional habits and obesity are major public health problems among young adult who experienced transition into university life (18 to 25 years of age) as this time associated with unhealthy lifestyle characteristics. This study aimed to assess the patterns of eating habits among medical students. This is a cross sectional faculty based study was conducted among 180 medical students (66% from the 1st grade and 34% from the 5th grade) at Alneelain University Faculty of Medicine. The questionnaire was composed of close-ended questions on socio-demography, anthropometry, eating habits and knowledge assessment factors as well as their weight, height, percentage body fat and body mass index were measured. Body mass index (BMI) was used to assess students' weight status. More than half of the students had normal body BMI mean was 22.5 ± 3.7, and perform exercise (66 and 60% respectively), while the majority of the students had daily breakfast and vegetable intake of at least three times per week (76 and 71% respectively), and less than half of the students had daily water intake more than 2 L, and snack intake at least three times per week (30 and 42% respectively). There was no significant association between eating habits score (mean was 6.7 ± 0.96) and socio-demographic variables (except for father occupation), or BMI. Lack of time was the most frequently reported as a barrier from healthy eating and physical activity. In conclusion, the majority of the students have healthy eating habit and most of them have normal body weight. In spite of the presence of educational grade deference related to some aspect of eating habits, the students eating habits score is not influencing by educational grade, and by socio-demographic variables (except for father occupation). Keywords: Eating habits, body mass index, medical students.

70-77
Acute kidney injury in patients with cerebrovascular stroke and its relationship to short-term mortality

Authors: Sherifa A. Hamed, Ahmad H. Youssef, Amal M. Tohamy, Refaat F. Abd Elaal, Mahmoud M. Hassan and Eman Nasr Eldin

Abstract

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Number of views: 463

The adverse outcome after cerebrovascular stroke (CVS) is determined not only by the neurological deficits but also by medical comorbidities including kidney dysfunction. We studied the frequency of acute kidney injury (AKI) with CVS and its relationship to short-term mortality. This study included 80 patients with stroke (mean age: 62.5 ± 6.2 years). Stroke severity was determined using Scandinavian Stroke Scale (SSS). Serum creatinine (SCr), creatinine clearance (CrCl) and kidney injury molecule-1 (KIM-1) concentrations were the measured markers of AKI. Follow-up was done for 3-months or till death. Cox proportional hazards model was used to evaluate contributors to mortality. Compared to reference group, patients had higher SCr (p < 0.05) and KIM-1 (p < 0.001) and lower CrCl (p < 0.01). The majority of patients (86.25%) had normal SCr, while 57.5% had lower CrCl (<70 ml/min) and 92.5% had higher KIM-1 (>0.75 ng/ml). Mortality rate was 35%. Compared to survivors, patients who died had lower SSS, higher SCr and KIM-1 and lower CrCl (all p < 0.001). Higher SCr [Hazard ratio (HR), 1.65; 95% CI, 1.41 to 1.93], KIM-1 [HR, 1.63; 95%CI, 1.21 to 2.19] and lower CrCl [HR, 1.34; 95% CI, 1.09 to 1.65] significantly predicted worse short-term survival. We conclude that AKI is a common complication of CVS. Increase in SCr, KIM-1 and decrease in CrCl concentrations are associated with worse short-term outcome with stroke. Keywords: Cerebrovascular stroke, acute kidney injury, kidney injury molecule-1, mortality.

78-87
Randomized clinical trial: Randomized, controlled, single-blind, three-way crossover study to evaluate the efficacy and safety of a new preparation for post-prandial heartburn

Authors: Gordana Bothe, Miquel Sans, Udo Bongartz and Ralf Uebelhack

Abstract

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Number of views: 410

Heartburn is a prevalent symptom related to gastro-oesophageal reflux. Its treatment includes, amongst others, the use of alginates, which combine a rapid onset of action with a longer duration of symptom relief than antacids. The aim of this study was to investigate the time to onset of action of two alginate preparations, Reduflux® liquid sachets (RL) and Reduflux® chewable tablets (RT). This was a randomized, placebo-controlled, single-blind, three-way crossover clinical investigation with subjects prone to suffer from post-prandial heartburn. Heartburn was triggered by a refluxogenic meal and subjects were randomized to receive RL, RT or placebo. Subjects identified the onset of perception of soothing and cooling effects in the throat and oesophagus, by using a previously described dual-stopwatch method. 48 subjects were screened, 42 were randomized and 41 completed the study. Mean time to onset of soothing was 1.71, 1.92, and 29.43 min, for RL, RT and placebo, respectively (p < 0.001). Mean time to onset of cooling was 0.76, 0.78, and 28.83 min, for RL, RT and placebo, respectively (p < 0.001). Only 1 out of 41 subjects experienced reappearance of heartburn in the 4 h after symptoms relief in each of the RL and RT groups. RL and RT were considered highly efficacious and safe by both the investigator and subjects. In conclusion, Reduflux® chewable tablet and liquid sachet were efficacious in the treatment of post-prandial heartburn, providing a quick onset and a long duration of action, with sustained symptoms relief in 97% of the subjects. Keywords: Gastro-oesophageal reflux, heartburn treatment, alginates, Reduflux®.

88-93
The relationship between gene polymorphisms of coagulation factors II, V and XI and risk of recurrent pregnancy loss in Palestine

Authors: Mohammed J. Ashour and Fadel A. Sharif

Abstract

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Number of views: 417

This retrospective case-control study was carried out in order to investigate the association between Factor II (G20210A), Factor V (G1691A, H1299R, Y1702C) and Factor XI (rs3756008 A>T) gene polymorphisms and recurrent pregnancy loss (RPL) in a group of Palestinian women residing in Gaza strip. A total of 400 females, 200 RPL patients and 200 women without previous history of RPL, aged 20 to 35 years were included in the study. Factor V (G1691A) and Factor II (G20210A) polymorphisms were analyzed by allele-specific PCR whereas, Factor V (H1299R, Y1702C) and Factor XI (rs3756008 A>T) gene polymorphisms were screened by PCR-RFLP. No statistically significant difference existed between RPL cases and controls in terms of the allelic and genotypic distribution of Factor II (G20210A), Factor V (Y1702C) or Factor XI (rs3756008 A>T). On the other hand, the minor allele of the two Factor V gene polymorphisms (G1691A and H1299R) independently showed statistically significant association with RPL. Factor V G1691 and H1299R polymorphisms may increase the risk for RPL in Gaza strip women, and should be screened for in cases suspected to have inherited thrombophilia. Keywords: Factor V, Factor II, Factor XI, gene polymorphism, recurrent pregnancy loss.