bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnesium Supplements’ Effect on Magnesium Balance in Athletes during Prolonged Restriction of Muscular Activity
Authors: Zorbas Yan G. , Kakurin Vassil J. , Afonin Victor B. , Charapakhin Kirill P. , Denogradov Sergei D.
Published: April 2003

Electrolyte supplements may be used to prevent negative electrolyte balance during hypokinesia (HK) (decreased number of kilometres per day). The aim of this study was to evaluate the effect of daily intakes of magnesium (Mg) supplements on Mg balance during prolonged HK. Studies were done during a 30–day period of pre–HK and during a 364–day period of HK. Forty male athletes aged 22–26 years were chosen as subjects. They were equally divided into four groups: unsupplemented ambulatory control (UACS), unsupplemented hypokinetic subjects (UHKS), supplemented hypokinetic subjects (SHKS) and supplemented ambulatory control subjects (SACS). The SHKS and UHKS groups were maintained under an average running distance of 1.7 km/day, while the SACS and UACS groups experienced no changes in their professional training and routine daily activities. The SHKS and SACS groups took daily 23 mg Mg as Mg lactate per kilogram body weight. Mg balance, urinary and faecal Mg excretion and serum Mg concentration, anthropometric characteristics and peak oxygen uptake were measured. Negative Mg balance, faecal and urinary Mg excretion and serum Mg concentration increased significantly (p≤0.01) in the SHKS and UHKS groups when compared with the SACS and UACS groups. Serum, urinary and faecal Mg changes and negative Mg balance were much greater and appeared much faster in the SHKS group than in the UHKS group. Body weight and peak oxygen uptake decreased significantly (p≤0.01) in the SHKS and UHKS when compared with the SACS and UACS groups. By contrast, the corresponding parameters did not change significantly in the SACS and UACS groups when compared with the baseline control values. It was concluded that prolonged HK induces a significant negative Mg balance accompanied by significant Mg changes in urine, faeces and serum. Thus, using Mg supplements was not effective to prevent negative Mg balance in athletes during prolonged HK.
Enalapril Inhibits Growth and Proliferation of Various Tissues in Rat Normotensive Four–Sixths Kidney Ablation Nephropathy
Authors: Gajdoš Martin , Krivošíková Zora , Šebeková Katarína , Lajdová Ingrid , Spustová Viera , Dzúrik Rastislav
Published: April 2003

Most experimental studies on kidney proliferation and its attenuation by angiotensin–converting enzyme inhibitors were performed in the rat hypertensive remnant–kidney model with a five–sixths kidney ablation. The developing hypertension rose the objections on the hypertension and its treatment in control rats. A normotensive four–sixths remnant–kidney model (Nx) was elaborated, compared with sham–operated (S) animals, and a subantihypertensive dosage of enalapril (E) was administered for 4 weeks of intensive kidney tissue proliferation (NxE). The pair–fed groups increased their body weight and blood pressure comparably. Moderately increased plasma creatinine and urea concentrations were found in the Nx group; markedly increased levels in the NxE group. Nx increased proteinuria, and E attenuated its increase. The remnant–kidney weight (Nx 912±31 vs. S 1,111±36 mg, p<0.001) was still lower, but collagen (Col; Nx 164±2 vs. S 148±5 mg/100 g, p<0.05) and tubular protein/DNA ratio (Nx 26.2±10.8 vs. S 9.8±1.0, p<0.05) increased markedly in the Nx group; E attenuated the kidney growth (NxE 719±31 vs. Nx 912±31 mg, p<0.01) and decreased the tubular protein/DNA ratio remarkably (NxE 15.3±10.5 vs. Nx 26.2 ±10.8), but E did not inhibit the Col accumulation. Nx decreased the heart (Nx 1,002±28 vs. S 1,130±41 mg, p<0.05), but not liver weights and did not influence Col concentrations or protein/DNA ratios either in heart or liver. E potentiated the weight decrease of heart (NxE 862±20 vs. Nx 1,002±28 mg, p<0.01) and liver (NxE 8.3±0.44 vs. Nx 10.3±0.51 g, p<0.001) and Col accumulation (heart: NxE 113±6 vs. Nx 92±5 mg/100 g, p<0.01; liver: NxE 134±8 vs. Nx 101±9 mg/100 g, p<0.01). Nx did not influence either the soleus muscle weight or its Col accumulation, but it increased its protein/DNA ratio (Nx 66.3±4.7 vs. S 35.5±2.8 mg/100 g, p<0.01). E increased the Col concentration in muscle (NxE 141±3 vs. Nx 110±5 mg/100 g, p<0.01), while it attenuated the increase in protein/DNA ratio (NxE 36.6±2.1 vs. Nx 66.3±4.7, p<0.01). In conclusion, kidney ablation nephropathy stimulating kidney proliferation evokes only minor changes in heart, liver and striated muscle. E inhibits markedly the kidney proliferation and functional recovery, but does not prevent the Col accumulation. E evokes antiproliferative changes also in the heart and surprisingly even in the liver. Alterations in soleus muscle are only borderline.
Towards Defining Socioeconomic and Demographic Inequalities That May Affect Health in Kuwait
Authors: Shah Nasra M. , Shah Makhdoom A. , Radovanovic Zoran
Published: April 2003

The experience of several developed Western countries shows that mortality and health differences between socioeconomic groups continue to persist, and may even be increasing. However, there is no agreed upon, or ‘standard’ way of measuring socioeconomic status (SES). In Kuwait questions pertaining to social inequalities in health, and accurate measurement of SES remain to be answered. This paper presents several ideas about the variables that should be examined to define SES. Characteristics of women residing in the most developed and least developed areas are compared to assess the range of inequality in the country. Except for literacy levels, large differences exist for most variables. Previous research and data do not provide a clear idea of any systematic difference in health by social class. This may be partially a result of weaknesses in measurement. The need for reliable data on outcome measures of health as well as indicators of social class is emphasized.
Down’s Syndrome with Coexistent Gout in 2 Patients:Is the Association Underreported or Is the Prevalence Actually Increasing?
Authors: Malaviya A.N. , Abdella N.A. , Mukhtar M.M.
Published: April 2003

This report describes 2 patients diagnosed with Down’s syndrome and who developed acute gouty arthritis. While hyperuricemia in gout is a well-known abnormality, association of gout with Down’s syndrome has not been widely discussed. With increasing life expectancy in this syndrome, it is likely that more such cases will occur. For early diagnosis and proper management clinicians must be aware of this association.
Influence of Arterial Baroreceptors on Heart Rate Variability
Authors: Piepoli Massimo , Bernardi Luciano
Published: April 2003

Objective: Fluctuations in heart rate, blood pressure and other circulatory parameters have been described since the last century, but only recently the observation that changes in these fluctuations are associated with changes in the sympathovagal balance and with the activity of the arterial baroreflexes has led to the practical use of analysis of cardiovascular variability as a marker of autonomic function. The present review reports the various hypotheses on the origin of fluctuations in cardiovascular variability and the possibility to apply these observations to the clinical field. Method: Two main oscillatory components have been described in the cardiovascular system: one is related to the respiratory activity; a second component whose period is ∼10 s is independent of respiration. These can be accurately quantified by computerized methods based on spectral analysis. These fluctuations might not only be used as a marker of vagal and sympathetic activity, but also provide information on the activity of the arterial baroreflex. A practical approach to obtain this data is discussed. Results: Practical implications of this methodology involve the non-invasive assessment of baroreflex activity and sympathovagal balance under a large number of physiologic and pathologic conditions. In this article the application to the autonomic assessment during physical exercise and after cardiac transplantation is reviewed in depth. Conclusions: The arterial baroreceptors exert a strong, though not exclusive influence on the cardiovascular fluctuations, through both sympathetic and vagal activity. These might be conveniently evaluated by non-invasive techniques involving spectral analysis of cardiovascular variability.
Comparison of the Anthropometry of Saudi Arabian Male Children Aged 6–11 Years with the NCHS/CDC Reference Population
Authors: Al-Nuaim Abdul Rahman , Bamgboye Elijah A.
Published: April 2003

Objective: To assess the nutritional status of children based on anthropometric indicators and to develop a standard growth chart for schoolchildren in Saudi Arabia. Methods: A total of 4,154 male Saudi primary schoolchildren aged 6–11 years were randomly selected, using a three-stage stratified cluster sampling procedure that covered all regions of Saudi Arabia. Weight and height were measured and used to calculate the anthropometric indicators: weight for height, height for age and weight for age. These indicators were compared with the American National Center for Health Statistics Center for Disease Control (NCHS/CDC) reference population. Results: There was an indicator of past malnutrition of children whose height for age fell in the lower centile range of the NCHS/CDC reference population. Weight for height, an indicator of current nutritional status, was comparable with the reference population with only 5% below –2 standard deviations of the reference population. There was a statistically significant trend in the prevalence of indicators of past and current malnutrition with age. While the indicator of past malnutrition increased with age, the prevalence of the indicator of current malnutrition decreased with age. The level of obesity increased from 3.8% at age 6 years to 8.3% at 11 years, with the overall level of obesity of 6.6%. Conclusion: These findings showed high reliability of the interpretation of the anthropometric indicators, and that the Saudi male primary schoolchildren appear to enjoy a comparable nutritional status with their American counterparts. The generated growth charts are more applicable to the Saudis and probably to the Gulf communities as they are derived from local rather than European or American measurements.
Factors for Job Satisfaction among Primary Care Physicians in Kuwait
Authors: Al-Zaid Bader M. , Buhamra Sana S. , Al-Ibrahim A.H.
Published: April 2003

Objective: To explore factors affecting job satisfaction among primary care physicians in Kuwait amidst the various challenges in the aftermath of the Gulf war. These challenges are in terms of lower number of physicians and lesser number of reopened primary care centres post liberation. Methods: A self-administered questionnaire covering various aspects of job satisfaction was prepared and distributed to a random sample of 185 primary care physician across the five governorates of Kuwait. Factor analysis was employed to ascertain factors underlying job satisfaction. Results: Nine common factors underlying job satisfaction explained 66.9% of the variance in the data. Generally, the physicians were dissatisfied with three factors: salary and promotion, relationship with superiors, and availability of resources. They were satisfied with the remaining six factors: intrinsic work factors, work surroundings, job enthusiasm, relationship with hospital doctors, relationship with colleagues, and finally comfort at work. These nine factors were related to certain demographic variables that were indicative of social structure. Kuwaiti non-family physicians were least dissatisfied with salary and promotion and non-Kuwaiti family physicians were most dissatisfied with this factor. Conclusion: Nationality and specialty proved to be powerful predictors of satisfaction as well as other variables. This is expected because of the advantages Kuwaities have over non-Kuwaities in terms of salary and promotion, and the disadvantages facing family practitioners being, in general, better qualified to do the job, though not appreciated.
Recurrent Seizures and Prolonged Post-Ictal Aphasia in a Patient with Multiple Sclerosis
Authors: Al-Shubaili A.F. , Farah S. , Khuraibet A.J. , Khaffagi S.
Published: April 2003

Objective: To evaluate the duration and underlying pathology of post-ictal aphasia in a patient with multiple sclerosis. Clinical Presentation: A 36-year-old female patient with chronic multiple sclerosis developed recurrent seizures followed by prolonged stereotyped post-ictal aphasia that lasted for 4–6 days. There was no response to a therapeutic trial of steroids. Investigations: A brain MRI did not reveal new demyelinative plaques. EEG showed persistent abnormalities from the left temporal lobe, which had no temporal relationship to the aphasic episodes. Conclusion: We believe that these aphasic episodes represent a post-ictal phenomenon of unusually long duration that has not been reported before.
Giant Prostatic Calculus Associated with Giant Urethral Calculus
Authors: Dahniya M.H. , Emechete B.I. , Asegbu S.
Published: April 2003

We report 2 cases of giant prostatic calculi associated with giant renal calculi. Both patients were advanced in age and had a long history of urethral strictures and urinary tract infection. They were anemic and their serum creatinine levels were also raised. Diagnosis in both cases was made by rectal examination, and confirmed by plain radiography. Treatment was by suprapubic cystolithotomy preceded by retrograde manipulation of the urethral calculi after control of their urinary tract infection. Both patients made an uneventful recovery, and required regular dilatations of their urethral strictures.
Non-Immune Hydrops Associated with Urogenital Sinus
Authors: Al-Essa Mazen , Kazi Ahmed , Al-Hunayan Adel , Deverajan L.V.
Published: April 2003

Objective and Importance: To report an unknown association between nonimmune hydrops and a case of urogenital sinus. Clinical Presentation: A newborn girl presented with gross fetal and neonatal hydrops and was managed successfully. She was then extensively investigated for the cause of hydrops, and was only found to have a urogenital anomaly that was managed by temporary external drainage. Conclusion: Urogenital sinus anomalies may be added to the list of causes and associations of nonimmune hydrops fetalis.
Primary Drug Resistance of Mycobacterium tuberculosis to First Line Antitubercular Agents at Kuwait Chest Diseases Hospital during 1992–1995
Authors: Abul A.T. , Abul H.T. , Syabbalo N.C.
Published: April 2003

Objective: Primary drug resistance to Mycobacterium tuberculosis has not been studied previously in Kuwait. The aim of the present study was to investigate factors associated with primary drug resistance at the Chest Diseases Hospital in Kuwait. Methods: We evaluated the clinical data, radiological features and results of susceptibility tests to five antitubercular drugs between 1992 and 1995. Results: Of the 582 patients admitted for newly diagnosed, previously untreated tuberculosis, 465 (79.9%) were non-Kuwaitis. Among the Kuwaitis, primary drug resistance to a single antitubercular agent was noted in isolates from 12 patients (10.3%), 7 (6.0%) for pyrazinamide and 5 (4.3%) for isoniazid. None of the Kuwaiti patients had multiple drug resistance. Regarding non-Kuwaitis, primary resistance was noted in isolates from 71 patients (15.3%). Thirty-nine patients (8.4%) were resistant to isoniazid, 29 (6.2%) to pyrazinamide, 24 (5.2%) to streptomycin, 8 (1.7%) to rifampicin, and 7 (1.5%) to ethambutol. Two drug resistance was detected in 26 patients (5.6%), and three drug resistance was noted in 5 patients (1.1%). One non-Kuwaiti patient was resistant to four antitubercular agents. Conclusion: We conclude that single and multiple drug resistance is more common among non-Kuwaiti patients when compared to Kuwaitis. This is related to the fact that most of the non-Kuwaiti patients originate from countries with high incidence of tuberculosis and high drug resistance.
Results of Subtrochanteric Fractures Treated with Dynamic Hip Screw and Dynamic Condylar Screw
Authors: Khallaf F.G.M. , Al-Rowaih A. , Abdul-Hamid H.F.
Published: April 2003

Objective: To study the results of 48 patients with subtrochanteric fractures of the femur, treated surgically with fixation by dynamic hip screw (DHS) in 25 patients (52%), and by dynamic condylar screw (DCS) in 23 patients (48%), at Al-Razi Orthopaedic Hospital in the period between January 1990 and June 1995. Methods: The patients were reviewed with the mean follow-up of 16 months (range 6–30 months). Results: The mean duration of union was 4 months in 46 patients (95.8%). Non-union was evident in 2 patients (4.2%). Two patients (4.2%) developed delayed union, which was successfully united after re-operation by autogenous bone graft. One patient (2.1%) had wound infection. Metal failure occurred in the 2 non-union patients (4.2%). Excellent and good clinical and radiological scoring was achieved in 41 patients (85.4%), fair in 5 (10.4%), and failure in 2 patients (4.2%). Conclusions: We concluded that DHS and DCS are among the best fixation devices in the armamentarium for subtrochanteric fracture management. Although all the complications in our series occurred in the DCS group, with better clinical and radiological scoring in the DHS group, we could not conclude that DHS is better than DCS because more complex and unstable subtrochanteric fracture types were treated by DCS (8 patients with type B and 8 patients with type C, 69.6%), comparable to 19 patients with type A (76%) and only 6 patients (24%) in type B in the DHS group. The small number of patients in each group makes also the difference between them statistically insignificant.
The Role of Ultrasound in the Management of Inflammatory Disorders of the Breast
Authors: Gupta Renu , Behbehani AbdullaI. , Chisti FayazA. , Al-Saleh MervatS.M.
Published: April 2003

Objectives: To evaluate the role of ultrasound in the diagnosis and follow-up of suspected inflammatory lesions of the breast and its role in monitoring the response to appropriate therapy. Methods: Twenty-six patients with clinically suspected inflammatory mass in the breast were subjected to ultrasonography using a 7.5-MHz transducer. Mammographic examination was performed on 11 of these patients to rule out underlying malignancy. Repeated follow-up ultrasonography was performed on all patients to assess the response to therapy. Results: Twenty-six patients aged between 18 and 60 years, clinically suspected to have inflammation of the breast, underwent ultrasonography which demonstrated inflammatory mass in 12, abscess cavity in 8, and ductal ectasia in 6 cases. Of the 11 breasts examined mammographically, only 6 showed abnormality with irregular mass in 4, and asymmetric density in 2. One patient showed a dense spiculated mass on mammography mimicking carcinoma, but ultrasound showed an abscess cavity, which resolved completely after drainage of abscess and antibiotic treatment. Conclusion: We conclude that ultrasound should be the first imaging modality in the diagnosis of acute inflammatory conditions of the breast. Follow-up ultrasound after therapy is valuable in monitoring response to therapy.
Alcaptonuria with Myelopathy and Neuropathy
Authors: Mavra Milica , Chadha Geeti , Henein MohebM. , Bhargava Sneha
Published: April 2003

Objective and Importance: Myelopathy secondary to alcaptonuria or ochronosis has been reported in only a few patients, but no reports on alcaptonuria and neuropathy have been available. Clinical Presentation: We report a case of alcaptonuria in a 55-year-old patient who presented with neuropathy and myelopathy after sustaining injuries in a traffic accident. Alcaptonuria, which is a rare autosomal recessive disorder characterized by the inability to metabolize homogentisic acid, was confirmed by the presence of homogentisic acid in the urine of the patient and by typical radiological changes in the spine, hips and knees. Conclusion: The association of alcaptonuria and peripheral neuropathy in this patient may remain accidental; nevertheless, the possibility exists that it is a further disorder of amino acid metabolism associated with neuropathy.
Duracon Total Knee Replacement in Kuwait: A Clinical and Radiographic Analysis of52 Knees Followed for 2–5 Years
Authors: Al-Rowaih Ahmad , Pospula Wieslaw , Abdul-Moez Osama , Lindstrand Anders
Published: April 2003

Objective: In this prospective clinical and radiological study results of 52 consecutive Duracon bicompartmental total knee arthroplasties in 37 patients with femorotibial arthrosis and rheumatoid arthritis with the average observation time of 3 (2–5) years were analyzed. Methods: The study includes 32 women (44 knees) and 5 men (8 knees) with a mean age of 60 years. Details of implant design and surgical technique were given. Two surgeons performed all the operations. The patients were evaluated by an unbiased observer. The Hospital for Special Surgery (HSS) score for both pre- and postoperative assessment was used. Results: The average initial HSS score of 44 (20–65) improved to 85 (60–99) after operation. By subjective assessment, 41 knees were excellent, 10 good and 1 knee had a fair result. There were no revisions. The mean postoperative flexion was 101° (80–120). The mean anteroposterior angle of the tibial component was 4° of the varus and the mean lateral angle was 3° of the posterior slope. The mean postoperative hip-knee-ankle deviation was 4° of the varus. Conclusion: In Kuwait, the cemented Duracon total knee arthroplasty without patellar resurfacing gave satisfactory clinical results after an intermediate follow-up period of 3 years.
Apolipoprotein E Polymorphism in a Healthy Lebanese Population
Authors: Almawi WassimY. , Hassan GhadaS. , Habbal M.Zouhair
Published: April 2003

Objective: The gene for apolipoprotein (apo) E, which modulates serum lipoprotein metabolism and concentration, is polymorphic with three major alleles, E2, E3, and E4, and a corresponding six apo E genotypes, E2/E2, E3/E2, E3/E3, E4/E2, E4/E3, and E4/E4. Due to its clinical importance in regulating lipid transport and redistribution, and coupled with the association of certain apo E alleles with metabolic disorders, we investigated apo E genotype in 155 healthy Lebanese individuals of both sexes, aged 5–77, by PCR/Cfo I restriction analysis. Methods: Total genomic DNA was extracted from the peripheral blood of study subjects, and apo E genomic sequence was amplified by PCR using one set of primers defining a conserved region of apo E gene. Apo E genotype was determined by the digestion of the PCR products with Cfo I, followed by agarose gel electrophoresis. Results: Among the genotypes obtained the most prevalent were: E3/E3 (120/155; 77.42%), E2/E3 (20/155; 12.90%), E3/E4 (13/155; 8.39%), and E2/E4 (2/155; 1.29%). None of the homozygous E2/E2 or E4/E4 genotypes were detected. Furthermore, there was no difference in apo E genotype distribution with regard to age or sex, which is in accordance with the reports for other study populations. Conclusions: The finding that apo E3/E3 is the most significant genotype in healthy Lebanese is similar to what was described for Caucasian populations. Further studies are required to establish the prevalence of homozygous E2/E2 and E4/E4.
Normal Values of Lower Limb Nerve Conduction in Kuwait
Authors: Shehab Dia , Moussa MohamedA.A.
Published: April 2003

Objectives: To establish the normal electrophysiological values of the common lower limb nerves and to study the relationship of conduction velocity (CV) of the lower limb nerves to height and age in healthy adult subjects. Methods: Nerve conduction investigations were performed on the lower limbs of 51 screened healthy volunteers using standard electrophysiological techniques. Results: Fifty-one subjects (21 males and 30 females) participated in the study. The mean (± SD) ages of the subjects were 38 (±8.82) and 36 (±8.58) years for males and females, respectively. The tibial motor nerve showed a mean (± SD) CV of 46.1 (±3.3) m/s, distal latency (DL) 4.4 (±0.8) ms, and amplitude 8.8 (±3.4) mV for males. For females, the results were CV 47.8 (±3.4) m/s, DL 3.9 (±0.85) ms and amplitude 12.0 (±3.4) mV. Peroneal motor parameters were CV 47.1 (±3.3) m/s, DL 3.9 (±0.53) ms, amplitude 5.6 (±2.2) mV for males and 49.3 (±2.3) m/s, 4.0 (±0.56) ms, 6.0 (±2.2) mV for females, respectively. The sural sensory nerve parameters were CV 48.7 ± 6.0 m/s, DL 2.9 (±0.3) ms, amplitude 18.9 (±3.3) μV for males and 51.5 (±4.9) m/s, 2.7 (±0.24) ms and 21.6 (±6.3) μV for females. Most CV values were significantly correlated with height, and there was a significant difference between males and females. However, after adjustment for height by the linear regression method, all significant gender differences disappeared. Conclusion: This study established the normative conduction parameters of the commonly tested nerves of the lower limbs for our electromyography laboratory in Kuwait. Gender differences disappeared when the data were adjusted for age and height.
Profile of Chromosomal Abnormalities in the Al Jahra Region of Kuwait
Authors: Al-Naggar R.L. , Mady S.A. , Tayel S.M. , Farag T.I. , Al-Awadi S.A. , Al-Ghanim M.M. , Abulhasan S.J. , Sabry M.A. , Bastaki L.
Published: April 2003

Objective: One hundred and seventy-seven newborn babies with chromosomal abnormalities were studied at the Al-Jahra satellite clinic of the Kuwait Medical Genetics Centre (KMGC), Kuwait, over a 7-year period from January 1983 to December 1989 to make a reanalysis and recomputation of the statistical results of the previous short-term studies. Methods: The data were collected from the registry of chromosomal abnormalities and from the clinical records of the patients in KMGC retrospectively. Controls were selected from the newborn babies delivered in the same period of study. The logistic regression analysis was computed using dependent/independent variables. Results: Ninety-five percent of the cases had numerical chromosomal abnormalities, and 5% had structural chromosomal abnormalities. One hundred and forty-five cases had classic trisomy 21, with an incidence of 2.9/1,000 live births (LB), 16 cases had trisomy 18 (0.3/1,000 LB), 5 cases had trisomy 13 (0.1/1,000 LB), 1 case had triploidy 69, XXY (0.02/1,000 LB) and 1 had Turner’s syndrome (0.05/1,000 female LB). Nine cases with structural chromosomal abnormalities were enumerated, dir dup(1) (p21–p32), del(1)(q32–q42), del(13)(q22–q34) and inversion Y chromosome, the incidence was 0.02/1,000 LB for each. Two cases of translocation trisomy 21 (0.04/1,000 LB) and 3 cases of cri-du-chat (0.06/1,000 LB) were enumerated too. Bedouins had a double-fold increased risk of trisomy 21 (odds ratio = 1.819, p = 0.032), and advanced maternal age was also a risk factor while paternal age showed inconsistent pattern of risk. Conclusion: This study confirmed the high incidence of the common trisomies and the role of advanced maternal age and the Bedouin ethnicity as a risk factor.
Serum Immunoglobulins and IgG Subclasses in SS Patients with Saudi Arabia/India Haplotype
Authors: Adekile A.D. , Haider M.Z. , Serebour F. , Al-Zaabi K. , Tuli M.
Published: April 2003

Objectives: This study investigates serum immunoglobulin fractions (IgG, IgA and IgM) and IgG subclasses (IgGScs; IgG1–4) in SS patients with the Saudi Arabia/India (SAI) haplotype. The influence of gender, Hb F levels, spleen function and coexistent α-thal trait were studied. Methods: Immunoglobulins and IgGScs were assayed using nephelometry. βs-globin gene cluster haplotyping and α-globin genotyping were done using a combination of PCR and allele-specific oligonucleotide hybridization techniques. Results: Twenty-nine steady-state (i.e. not acutely ill) SS patients (23 SAI homozygotes and 6 SAI/Benin compound heterozygotes) and 34 healthy age- and sex-matched Hb AA and AS controls were studied. Mean serum IgG and IgA values were significantly higher in the patient group, while there were no significant differences in the mean IgGScs. The patient group was further subdivided depending on whether the spleen was normally visualized (group 1), partially visualized (group 2) or not visualized (group 3) on 99mTc-labeled tin colloid scintigraphy. There was a significant sequential increase in mean IgG values from group 1 to group 3 but the reverse was true for IgM, while IgA showed no consistent trend. The mean levels of IgG1 and IgG3 were significantly higher in group 3 (p < 0.01). Hb F level did not influence immunoglobulins or IgGScs, but SS patients with coexistent α-thal trait tended to have lower IgG and IgG1 levels. Conclusions: Increased serum IgG is associated with poor splenic function and recurrent infections among SAI patients, while increased IgM is seen mainly in those with relatively normal splenic function.
Tuberculoma of the Spermatic Cord
Authors: Al-Meshaan M.K. , Afif H.A.R.
Published: April 2003

Objective and importance: Tuberculoma of the intrascrotal cord is rare. There were only 8 other cases reported in the English literature. Clinical presentation: A 40-year-old man presented with a painless mass in the left scrotal region. Preoperated frozen section showed it to be a tuberculous lesion. Intervention or technique: The mass was excised in toto and the final histopathology confirmed the frozen section and antituberculous drugs were administered. Conclusion: An awareness of this condition would prevent an orchidectomy on the patient for a benign lesion.
The Effect of Forskolin on Isoproterenol-Induced Relaxation in Rat and Guinea-Pig Tracheal Preparations
Authors: Yousif Mariam H. , Thulesius Olav
Published: April 2003

Objective: In this study, we have examined the relaxant effects of forskolin and isoproterenol on isolated rings of the rat and guinea-pig trachea. The objective of the study was to compare the potency and efficacy of both agents on the tracheal preparations from different species and to assess any possible synergistic bronchodilator effect of forskolin and isoproterenol. Method: The preparations were mounted in organ baths containing Krebs-Henseleit solution and changes in isometric tension were recorded. Results: Forskolin, an activator of adenylate cyclase, and the β-adrenergic stimulator isoproterenol produced concentration-dependent (10–9 to 3 × 10–5 M) relaxations in rat and guinea-pig tracheal rings pre-contracted by carbachol (10–6 and 3 × 10–7 M, respectively). Forskolin was less potent than isoproterenol but is had a higher relaxing efficacy. It increased isoproterenol-elicited maximal relaxation in rat tracheal preparations. Forskolin significantly potentiated the bronchorelaxant response to isoproterenol in guinea-pig preparations (lower IC50 values). Moreover, relaxation to standard concentrations of isoproterenol (10–8 and 3 × 10–8 M) were significantly enhanced in the presence of forskolin (10–6 and 3 × 10–6 M) in both rat and guinea-pig tracheal rings. Conclusion: These results suggest that in guinea-pig tracheal ring preparations, forskolin produces an apparent potentiation of isoproterenol-induced relaxation, while in rat tracheal preparations, forskolin increases the efficacy of isoproterenol. This response could provide an alternative to increasing the dosage of β-adrenergic bronchodilator drugs in patients with asthma. Therefore, a combined therapy with forskolin may be considered.
Reissner’s Fibre in Rat: A Scanning Electron Microscope Study
Authors: Mathew T.C. , Al-Bader A. , Abul H. , Dashti H.M.
Published: April 2003

Objective: To study the detailed morphology of Reissner’s fibre (RF) that lies on the floor of the fourth ventricle in an adult rat by scanning electron microscopy. Method: For these studies 7 Wistar rats weighing about 200 g were used. The animals were anaesthetised and perfused with 0.9% oxygenated saline followed by 3% glutaraldehyde. The brain stems were dissected out and processed for scanning electron microscopy. Observations: Scanning electron microscopic studies showed that the RF is longitudinally grooved and covered with fine granular material. At certain regions, cellular debris and large amounts of amorphous material are found attached to the RF. Interestingly, we have observed the presence of a knot-like swelling or convolution in the RF, in the fourth ventricle, prior to its entry into the central canal of the spinal cord, that has not been previously described. Furthermore, a dense network of supra-ependymal nerve fibres is found on the surface of the fourth ventricle, in the near vicinity of the RF. Conclusion: Although the functional significance of the knot-like structure is not understood, it is reasonable to believe that these structures may represent one of the regions of RF disintegration.
Prokinetic Effect of Duodenal Extract on Ovine Gallbladders
Authors: Al-Hussaini M. , Oriowo M.A. , Philip E. , Thulesius O.
Published: April 2003

Objective: It is known that the macrolide antibiotic erythromycin stimulates gastrointestinal and gallbladder motility by an as yet unidentified mechanism. It was the objective of this study to investigate the mechanism of the gallbladder motility-stimulating effect of erythromycin. Methods: In our experiments we used strips of sheep gallbladders measuring isometric tension in organ baths. Since erythromycin itself did not induce contraction we examined the prokinetic effects of sheep duodenal extract, incubated with (DEX) or without (blank) erythromycin (10–5 M). Results: Both DEX and blank elicited gallbladder contraction associated with heat-stable, water-soluble but not with lipid-soluble duodenal prokinetic factor. The factor is unrelated to motilin or cholecystokinin and is only partially (<20%) blocked by atropine (10–6 M) and not affected by the pretreatment with dexamethasone or somatostatin. Conclusion: It was concluded that erythromycin indirectly stimulates contraction of ovine gallbladders through the endogenous release of a duodenal prokinetic factor.
Bacterial Endotoxin Induces Changes in the Organization and Expression of Actin and Modulation of the Cell Membrane of Microglia
Authors: Abd-El-Basset Ebtesam
Published: April 2003

Background and Objectives: In situ there are at least three morphologically and functionally different forms of microglia: the resting, the activated, and the phagocytic microglia. The signals promoting the morphological changes which adapt microglia to specific functions are still unknown. In this study the effect of bacterial wall lipopolysaccharide (LPS) on the morphology and organization and expression of actin in microglia was investigated. In addition, the changes in the appearance of the cell membrane were investigated. Methods: Microglia cultures were prepared from neopallia of newborn mice and treated with LPS. Scanning electron microscopy, labeling with phalloidin, and immunoblotting were used. Results: The majority of nontreated microglia were ameboid in shape with many short processes that extended into lamellipodia. When microglia were treated with LPS most of the microglia acquired a large, round, and flat shape. The rest of the ameboid microglia became larger in size. Fluorescent labeling with phalloidin showed that the F-actin network appeared diffusely arranged throughout the cytoplasm of nontreated microglia. In LPS-treated microglia the F-actin network was reorganized into filamentous bundles extending into microspike-like projections. Using scanning electron microscopy, the nontreated microglia had large membrane folds and few large blebs. In LPS-treated microglia most of the membrane folds and blebs at the cell periphery disappeared with the appearance of many microspike-like projections. Immunoblotting showed that LPS-treated microglia upregulated their actin protein. Conclusions: These changes in the organization of F-actin and the cell membrane may reflect adaptation of activated microglia to specific functional activity, such as increases in their phagocytic activity.
Rupture of the Gravid Uterus: Experience of the Maternity Hospital, Kuwait
Authors: Al Salem M.H. , Makhseed M. , Ahmed M.A. , Gupta M.
Published: April 2003

Objective: To review the cases of ruptured uteri at the Maternity Hospital, Kuwait, over a period of 11 years, and to analyze the predisposing factors, maternal and fetal outcome and modes of management. Method: This is a retrospective study of 91 cases of uterine rupture out of 168,486 deliveries at the Maternity Hospital, Kuwait, between January 1981 and December 1993. Result: The incidence of uterine rupture was 1 in 1,851. A previous uterine scar was present in 51 (56%) cases. The percentage of cases with instrumental delivery, malpresentation, history of previous cesarean section, use of oxytocics, higher age of the mother and parity of 5 or more was significantly higher in mothers with uterine rupture than mothers without uterine rupture. The percentage of cases with parity of 5 or more and those using oxytocics was significantly higher in the unscarred uterus group than scarred uterus group. Anterior lower segment was the most common site of rupture. The percentage of cases with simple repair of the uterus was higher in patients with the unscarred uterus than scarred uterus. Total hysterectomy was more common in patients with previously unscarred uterus. The perinatal and maternal mortality was 25.5 and 3.3%, respectively. Conclusion: The incidence of uterine rupture in this study is comparable to that in developed countries. Previous uterine scar, use of oxytocics, grand multiparity, instrumental delivery and malpresentation are associated with the rupture of the gravid uterus.
Video-Assisted Thoracoscopy versus Thoracotomy for Primary Spontaneous Pneumothorax: A Randomized Controlled Trial
Authors: Ayed Adel K. , Jamal Al-Din Hassan
Published: April 2003

Objective: Video-assisted thoracic surgery has been evaluated to replace thoracotomy for recurrent or persistent spontaneous pneumothorax. This study aimed to compare the clinical results and long-term follow-up of both procedures in treating primary spontaneous pneumothorax. Methods: In a prospective comparison, all 60 patients aged 14–57 years with recurrent or persistent primary spontaneous pneumothorax seen at the Chest Diseases Hospital in Kuwait were randomly allocated to treatment by video-assisted surgery or thoracotomy. Subsequently various factors were analysed and compared in both groups, and the follow-up of both procedures was 3 years. Results: The mean and standard deviation (SD) operating time was longer in the thoracotomy group (95.3 ± 16.4 min) than in those undergoing video-assisted thoracoscopy (77.5 ± 13.7 min; p < 0.0001). The mean ± SD amount of analgesics (Demerol) used in the first 12 h postoperatively was 67.16 ± 27.1 mg in the video-assisted thoracoscopy group and 148.3 ± 24.5 mg in the thoracotomy group (p < 0.0001). The mean 24-hour chest tube drainage was less in the video-assisted thoracoscopy group than in the thoracotomy group (82 vs. 347.1 ml; p < 0.0001). The mean duration of intercostal chest tube was 4.1 days in the thoracoscopy group and 5 days in the thoracotomy group (p = 0.18). The length of hospital stay was shorter in the thoracoscopy group than in the thoracotomy group (6.5 vs. 10.7 days; p < 0.0001). After a follow-up of 3 years, the number of recurrences was 3 in the thoracoscopy group and none in the thoracotomy group. Conclusion: Video-assisted thoracoscopy has many clinical advantages over thoracotomy for recurrent or persistent primary spontaneous pneumothorax; but it results in a higher recurrence rate. The future role of video-assisted thoracoscopic surgery in this disease remains to be determined by a larger study.
Status of Treatment of Vascular Dementia
Authors: Lechner H.
Published: April 2003

The therapeutic goal in treating vascular dementia has been based on its presumed association with cerebral arteriosclerosis. Therefore, it is necessary to control risk factors for arteriosclerosis. In this connection, application of platelet-aggregating substances has been used extensively. Promising results have also been observed by altering the hemorheologic profile because hemorheologically active substances may be able to ameliorate the course of vascular dementia. Further improvement could be achieved by application of the HELP system to enhance the effect of hemorheologically active drugs. Using the HELP system, LDL, cholesterol, triglycerides and fibrinogen can be lowered considerably and may result in clinical improvement or slowing of the progression of vascular dementia.
Incidence of Transient Ischemic Attacks in Dijon, France
Authors: Lemesle M. , Madinier G. , Menassa M. , Billiar T. , Becker F. , Giroud M.
Published: April 2003

The aim of this study was to determine the incidence of first-ever TIA and the distribution of risk factors in those patients with TIA in Dijon. We performed a prospective population-based study in Dijon City with 135,000 inhabitants, from 1990 to 1994, using several case-collection sources. Over a 5-year period, we recorded 258 cases of first-ever TIA, giving a crude annual incidence rate of 38.68/100,000 for men and 32.70/100,000 for women. The mean age of first-ever TIA was higher in women (71.75 years) than in men (70.35 years). A CT scan was performed in 97% of the cases and silent lacunes were discovered in 17% of cases. In our 5-year study in Dijon of first-ever TIA, we found incidence rates similar to those of previous population-based studies. Our results also support the hypothesis that risk factors for TIA are similar to those for stroke.
Multiple Sclerosis and Infectious Childhood Diseases
Authors: Bachmann Stefan , Kesselring Jürg
Published: April 2003

To examine a possible relationship between infectious diseases and multiple sclerosis (MS) an enquiry was carried out among 606 MS patients in Switzerland. The data concerning their infectious childhood diseases were compared with epidemiological data for the normal Swiss population obtained from the Swiss Federal Health Office and from the Institute of Medical Statistics. The mean age of the MS patients was 50.7 years and the mean age at onset of multiple sclerosis was 33.8 years, significantly earlier in women (33.2 years) than in men (35.4 years, p < 0.05). In 18.8% multiple members of the family were affected. In comparison with persons of the control population, MS patients had measles infection at a later age (6.4 vs. 7.5 years). The curve of the age at which several infectious childhood diseases occurred was shifted to higher ages for MS patients (p < 0.005) compared to normal controls for mumps (80.2% for MS vs. 64.1% for controls in the age group 5–14 years), rubella (64.3% for MS vs. 48.4% for controls in the age group 5–14 years) and varicella (81.9% for MS vs. 39.0% for controls in the age group 5–19 years). For pertussis, however, there were more cases among those who later developed MS in the age group 1–9 years, which was earlier than in controls (86.0 vs. 56.7%). These results are compatible with the hypothesis that the risk of developing multiple sclerosis may be associated with acquiring certain infectious childhood diseases at a later stage in comparison to normal controls.
Curative and Population Medicine: Bridging the Great Divide
Authors: Ferguson John H.
Published: April 2003

There are gaps in understanding between practicing physicians (curative medicine) and those trained in public health and epidemiology (population medicine). In the last century, these groups were closer, as physicians played a role in public health, sanitation and in the prevention of the spreading of infection. However, with the recent extraordinary successes of the biomedical model in explaining disease, and the ensuing explosion of remarkable – and expensive – medical procedures and treatments, public health, preventive medicine and the population approach in general have been overshadowed. In this essay, I try to explain how the training of physicians and the daily care of patients may hinder their appreciation of the population model. For instance, for many of the myriad decisions involved in patient care in daily practice, there is little evidence, population derived or otherwise. What little evidence there is may be dominated by personal experiences, opinions and values. Additionally, the statistical and epidemiologic approach necessary for the maintenance of health and prevention of illness may not be valued by practitioners whose training and focus is on treating sick people one by one. To illustrate these disparities in understanding, examples are given from the NIH Consensus Conference on mammography screening for women aged 40–49, and from the use of science in the courtroom in adjudicating toxic tort cases. Understanding population medicine requires an appreciation of the concepts of chance, probability and statistics and of epidemiologic principles, difficult areas for many – including the general public. These topics play a small to nonexistent role in the formal training of most physicians. Some closing of the gap in understanding may be occurring. It is hoped this essay will help.
Association of Nonsteroidal Anti-Inflammatory Drugs and Aspirinwith Cognitive Performance inMiddle-Aged Adults
Authors: Peacock James M. , Folsom Aaron R. , Knopman David S. , Mosley Thomas H. , Goff Jr. David C. , Szklo Moyses
Published: April 2003

Objectives: To assess the cross-sectional association of regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin with cognitive function in 13,153 individuals, aged 48–67 years, participating in the Atherosclerosis Risk in Communities (ARIC) Study. Methods: Regular use of NSAIDs or aspirin was analyzed in relation to the results of three cognitive tests, the Delayed Word Recall Test, the WAIS-R Digit Symbol Subtest, and the Word Fluency Test. Results: After adjustment for covariates previously found to be associated with cognition in this sample, we found a weak negative association between current use of aspirin and poor Word Recall [OR = 0.84 (95% confidence interval: 0.68–1.04)] and poor Word Fluency [OR = 0.85 (0.70–1.03)]. We found no association between current use of aspirin and Digit Symbol score, nor did we find current NSAID use to be significantly associated with any of the cognitive tests. Conclusions: This study suggests a modest association, at best, between NSAIDs or aspirin and better cognitive function.
What Are Surrogate Outcome Measures and Why Do They Fail in Clinical Research?
Authors: Johnston Karen C.
Published: April 2003

Surrogate outcome measures have been of interest in clinical research for a long time because of their potential ability to save time and cost. The literature, however, has numerous examples of failed surrogate measures. The definition of a surrogate outcome measure, its consideration in clinical stroke research and some of the potential mechanisms for failure of surrogate measures will be discussed.