Fetal chromosome abnormalities and congenital malformations: an Egyptian study

Objective: Our objective were to determine and evaluate the role of genetic counseling and amniocentesis in early detection of chromosomal abnormalities or congenital malformations among women at risk. Patients and Methods: The study was performed on 784 pregnant women. Results: The cause for seeking genetic counseling in 22.8% of the study cases was positive family history of CNS malformations, and in 17.9% was chromosomal abnormalities in previous child. Also, the results showed that the indications for amniocentesis in 60.8% were history of having previous child with Down syndrome, and in 15.3% were advanced maternal age. The results of chromosomal analysis of amniotic fluid samples; 21 cases (19.3%) had chromosomal abnormalities, where trisomy 21 (Down syndrome) was detected in 10 cases (9.2%), unbalanced translocation Down syndrome was detected in 9 cases (8.3%) and one had 46 XX, del (13-q), one had 45, XX, t (13;14) and 2.8% was 46, XX, +21, der (14;21) (q10;q10). The risk of complications of amniocentesis was associated with performing amniocentesis early in pregnancy, and with increased number of attempts. The results also showed that Multiple congenital anomalies (MCA) represented among 42.2%, congenital malformation of CNS represents 26.6%, congenital malformation of the skeletal system 20%, congenital polycystic kidney 8.8% and pyloric stenosis in 2.2%. Among the 21 women with abnormal karyotype of amniotic fluid, the decision to terminate the pregnancy was made in 3 (14.3%). Among the 45 cases with abnormal findings suggesting fetal congenital malformation, 16 (35.6%) chose termination of their pregnancy. In conclusion: Public awareness of the risks and difficulties facing a child with chromosomal anomalies or congenital malformations and the effect on their future health and living is of great importance for acceptance of prenatal screening. Prenatal diagnosis may affect the reproductive decision after genetic counseling. It is essential that genetic counseling is noncoercive and nonjudjemental. The couples decision (Even if it is different from the counselor's views) should be respected. Keywords: Genetic counselling, antenatal screening, amniocentesis. Egypt. J. Hum. Genet Vol. 8 (2) 2007: pp. 131-14

Prevention of Radiocontrast-Induced Nephropathy after Coronary Angiography: N-Acetylcysteine plus Saline Hydration versus Saline Hydration

Purpose: To compare the incidence of radiocontrast-induced nephropathy (RCIN) in patients undergoing coronary angiography pretreated with N-acetylcysteine NAC plus saline hydration or saline hydration alone and to determine the association between various risk factors and RCIN.Methods: Patients were retrospectively evaluated over a one-year period. RCIN was defined as an acute rise in serum creatinine of at least 0.5 mg/dl or more than 25 % from baseline value. SPSS software, version 13 was used for data analysis.Results: Overall, 299 patients were studied. Thirteen patients (4.3%) developed RCIN. RCIN was 3.3 % in patients treated with hydration, and 8.3 % in patients treated with NAC plus hydration (p = 0.09). Inpatients with RCIN, the changes in creatinine and % change in creatinine after 24 h were significantly lower in the NAC plus hydration group (p = 0.039 and p = 0.042, respectively). RCIN was significantly associated with male gender (p = 0.017), history of renal failure (p = 0.006), ischemic heart disease (p =0.003), and diuretic treatment (p = 0.013).Conclusion: NAC plus saline hydration may not be more effective than saline hydration alone in decreasing RCIN after coronary angiography. Additional efforts to find an ideal preventive treatment are needed

Computation of melting dissipative magnetohydrodynamic nanofluid bioconvection with second order slip and variable thermophysical properties

This paper studies the combined effects of viscous dissipation, first and second order slip and variable transport properties on phase-change hydromagnetic bio-nanofluid convection flow from a stretching sheet. Nanoscale materials possess a much larger surface to volume ratio than bulk materials which significantly modifies their thermodynamic and thermal properties and lowers substantially the melting point. Gyrotactic non-magnetic micro-organisms are present in the nanofluid. The transport properties are assumed to be dependent on the concentration and temperature. Via appropriate similarity variables, the governing equation with boundary conditions are converted to nonlinear ordinary differential equations and are solved using the BVP4C subroutine in the symbolic software Matlab. The non-dimensional boundary value features a melting (phase change) parameter, temperature-dependent thermal conductive parameter, first as well as second order slip parameters, mass diffusivity parameter, Schmidt number, microorganism diffusivity parameter, bioconvection Schmidt number, magnetic body force parameter, Brownian motion and thermophoresis parameter. Extensive computations are visualized for the influence of these parameters. The present simulation is of relevance in the fabrication of bio-nanomaterials for bio-inspired fuel cells

Diagnosing pediatric intussusception through bedside ultrasound by novice emergency department sonographers: a case report

Intussusception is a common cause of gastrointestinal emergency in the paediatric population and it is usually diagnosed through Barium enema radiography or ultrasound. The skill of using an ultrasound by a minimally trained medical officer in diagnosing this cases in the Emergency Department are very helpful and expedite the management. We present the case of a 7-month-old girl who presented to Emergency Department (ED) with the chief complaint of passing blood in stool. Clinically she was dehydrated, irritable and in compensated shock. There was generalised tenderness per abdomen but it was soft and not distended. There was no palpable mass and bowel sound normal. Immmediate fluid resuscitated commenced. Bedside abdominal ultrasound performed by ED medical officer showed a 1.8 cm x 2.5 cm mass of alternating hypo-echoic and hyper-echoic rings at the right lower quadrant, consistent with the ‘target’ sign of intussusception. Supine plain abdominal X-ray did not reveal any abnormality. The ultrasound finding of intussusception was later confirmed by the radiologist. She underwent immediate hydrostatic reduction and was discharged well

Epicatechin content and antioxidant capacity of cocoa beans from four different countries

Natural antioxidant has received more attention to be part of daily diet. Cocoa beans is one of the main sources of polyphenols especially epicatechin. This study was conducted to investigate the relationship between antioxidant potential and epicatechin content of raw cocoa beans from different countries, namely Malaysia, Ghana, Cote d’Ivoire and Sulawesi (Indonesia). Antioxidant potential was determined using trolox-equivalent antioxidant capacity (TEAC) and ferric reducing antioxidant power (FRAP) assays. Reversed-phase high performance liquid chromatography (HPLC) was used to quantify the amount of epicatechin. The epicatechin content of raw cocoa beans was in the range of 270 - 1235mg/100 g cocoa beans. Based on the two assays, Sulawesian beans exhibited the highest antioxidant capacity followed by Malaysian, Ghanaian and Cote d’Ivoirian beans for both extracts. Both ethanolic (r= 0.92) and water (r = 0.90) extracts of cocoa beans showed a significant positive and high correlation between epicatechin and TEAC value. Similarly, FRAP assay also showed a positive and high correlation with epicatechin for both ethanolic (r = 0.84) and water (r = 0.79) extracts. Results indicatedthat antioxidant capacity using two different antioxidant assays exhibited a positive and high correlation with epicatechin content in cocoa beans. Thus, epicatechin content in cocoa beans could be responsible for the antioxidant capacity

Efficient Photoelectrochemical Performance of Gamma Irradiated gC3N4 and its g-C3N4@BiVO4 Heterojunction for Solar Water Splitting

This is the author accepted manuscript. The final version is available from the American Chemical Society via the DOI in this recordComprehensive experimental and density functional theory simulations have been performed for the enhanced photoelectrochemical performance of gamma irradiated g-C3N4 and its heterojunction with BiVO4. The structure and morphology of g-C3N4@BiVO4 as a heterojunction were analyzed and verified from the correlation of experimental and theoretical data. It is found that gamma radiations have changed the bonding structure of g-C3N4 which ultimately reduces the optical bandgap energy. Moreover, the performance of gamma-irradiated g-C3N4 is two-fold, compared to that of non-irradiated one; increases from 3.59 to 5.86 µAcm-2 at 1.23 V versus Ag/AgCl in 0.5 M Na2SO4 electrolyte solution (pH 7). Finally, it is observed that the performance of gamma irradiated g-C3N4 in g-C3N4@BiVO4 heterojunction increased from 0.53 mA cm-2 to 1.38 mA cm-2, compared to that of the non–irradiated one. In summary, it has been concluded that gamma-irradiated g-C3N4 and its heterojunction is potentially be applied in PEC solar water splitting.National University of Malaysi

Doing less is better : challenges in complex polytrauma management - case report

Damage control resuscitation, characterized by hemostatic resuscitation with blood products, rapid arrest of bleeding and when possible, permissive hypotension with restricted fluid load form a structured approach in managing a polytrauma patient. When complicated with traumatic rhabdomyolysis however, permissive hypotension strategy may cause more harm resulting in subsequent ischaemicreperfusion injury and acute kidney injury. We present a case involving a 20-yearold man who was rolled over by a lorry and sustained an open unstable pelvic fracture with vascular injury and left lower limb ischaemia. Permissive hypotension strategy was pursued for 4 hours prior to bleeding control in OT. This was followed by protracted surgery of 6 hours. Coagulopathy, acute kidney injury and rhabdomyolysis ensued in the post-operative period and patient succumbed to his injury on Day 3 post-trauma. Challenges and pitfalls in managing a complex polytrauma patient and recent evidences on damage control resuscitation is discussed

Cost analysis of psoriasis treatment modalities in Malaysian public hospitals

Psoriasis imposes a great economic burden as a result of higher expenditures for different interventions, diagnostic procedures, pharmaceuticals and loss of productivity. Less is known about the economic impact of psoriasis treatment in Asean region. The aim of this research was to calculate the costs associated with four psoriasis treatment modalities. A prospective cohort study was conducted in five hospitals involving 91 moderate to severe psoriasis patients. Costs were calculated from the societal perspective using the principle of Step Down and Activity Based Costing (ABC) within a six (6) months follow-up duration. The components of the costs borne by the provider were inpatient cost, cost of medication, laboratory investigation and radiology. Patient’s cost included out of pocket expenses, travelling cost and loss of productivity. Cost per patient per day was RM1,105.24 (inpatient) (US$315.94) and RM298.02 (outpatient) (US$85.19). Medication accounted for almost 90% (RM457,014.00) (US$130 638.45) of the total provider cost. Meanwhile, loss of productivity represented 84$47,862.80) of the total patient’s cost. Biologic treatment exhibited the highest cost which was RM342,377.00 (US$97,869.21), followed by systemic treatment (RM105,607.00) (US$30,187.99), topical treatment (RM38,280.00) (US$10,942.42) and topical phototherapy treatment (RM21,824.00) (US$6,238.44). Understanding the relationship between direct and indirect costs from both perspectives is important to accurately identify and evaluate effective treatment for psoriasis

Outcome of early cardiopulmonary resuscitation in out-of-hospital cardiac arrest managed in Universiti Kebangsaan Malaysia Medical Centre

Out-of-hospital cardiac arrest (OHCA) patients require immediate cardiopulmonary resuscitation (CPR). Early initiation of CPR and defibrillation before arrival at Emergency Department (ED) increases the chance of survival from sudden cardiac arrest. The main objective of this study was to identify the factors that influenced the outcome of early cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) patients managed at the ED of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). The second objective was to determine the incidence of CPR initiated by the public prior to ambulance arrival. The present study was a one-year cross-sectional study. The OHCA patients were identified from the ED resuscitation logbook. Patients’ medical records were used to obtain details of the resuscitation. Factors recorded included: aetiology of arrest, initiation of on-scene CPR, use of automated external defibrillators (AEDs), mode of transportation and the incidence of return of spontaneous circulation (ROSC) in the ED. Categorical data was analysed using chi-square and Fisher exact tests. Nine patients out of 98 had early CPR. Three patients achieved ROSC. Gender was significantly associated with ROSC (p-value=0.015). More patients who received early CPR achieved ROSC compared to those who received late CPR. The provision of early CPR and usage of AEDs by the public is still low. Female gender had a positive influence on ROSC. Efforts are required to increase the awareness and involvement of the public in initiating early CPR prior to the arrival of ambulance service

Prior Pulmonary Tuberculosis Is a Risk Factor for Asymptomatic Cryptococcal Antigenemia in a Cohort of Adults With Advanced Human Immunodeficiency Virus Disease.

The greater mortality risk among people with advanced human immunodeficiency virus disease and cryptococcal antigenemia, despite treatment, indicates an increased susceptibility to other infections. We found that prior tuberculosis was an independent risk factor for cryptococcal antigenemia (adjusted odds ratio, 2.72; 95% confidence interval, 1.13-6.52; P = .03) among patients with CD4 counts <100 cells/µL