Twisted ovarian cyst in pregnancy: a case report

Ovarian cysts are frequently encountered during pregnancy due to the use of routine prenatal ultrasound. Most of them are benign but in some cases, complications can occur such as torsion, rupture and malignant change. In pregnancy risk of torsion increases 5-fold. It carries significant risk to a pregnant woman and her intrauterine foetus. Here we are reporting a 30-year-old female G3 P1+1L2 with 15 weeks of gestation who presented to antenatal OPD with complain of dull aching abdominal pain for 1 month and nausea and vomiting for 5 days. On ultrasound bilateral ovarian cysts were found, with one of the cyst with multiple septations. She underwent laparotomy, a right sided twisted ovarian cyst was found for which salpingoophrectomy was done. Left sided cyst was simple where cystectomy was done. Her histopathology report showed a bilateral benign serous cystadenoma. Her pregnancy was followed up. She delivered a healthy male baby at term. Ovarian cyst diagnosed in pregnancy can be followed up with serial ultrasound but if associated with complication such as torsion then urgent surgical intervention has to be done

Recurrent spontaneous multiple pregnancy: a case report

Multiple gestations are usually iatrogenic like use of assisted reproductive techniques (ART), infertility treatment but it is rare in spontaneous conception. High order multiple pregnancies (HOMPs) are major cause of maternal, fetal and neonatal morbidity. Multiple gestations carries 2 complications either abortion in early gestation or a preterm delivery in late pregnancy (more common). Preterm delivery is common (50%) and patient usually delivers by 30-32 weeks. Discordance of fetal growth is very common and even more than in twins. Perinatal loss is inversely related to birth weight. The mothers should be counseled about regular ante natal care (ANC) check-ups for early identification of multiple pregnancies so that proper care can be given to prolong the gestational age and reduce the complications associated with multiple pregnancies

Leiomyosarcoma: a rare complication of uterine fibroid

Uterine sarcomas are rare tumours of mesodermal origin. Malignant change occurring in uterine fibroid is termed as leiomyosarcoma. They constitute around 2-6 % uterine malignancies and 25-36% of uterine sarcomas. The tumour is common in women between the age group 40-50 years. It has an aggressive course & usually metastasis goes to the lungs. The prognosis for women with uterine sarcoma primarily depends on the extent of disease at the time of diagnosis and mitotic index. Women with tumor size >5 cm in maximum diameter have poor prognosis. These tumours should be diagnosed and managed with no delay and must be followed vigilantly as the rate of recurrence & metastasis is very high

Vinpocetine and Ischemic Stroke

Vinpocetine (VPN) is a synthetic ethyl-ester derivative of the alkaloid apovincamine from Vinca minor leaves. VPN is a selective inhibitor of phosphodiesterase type 1 (PDE1) has potential neurological effects through inhibition of voltage gated sodium channel and reduction of neuronal calcium influx. VPN have noteworthy antioxidant, anti-inflammatory and anti-apoptotic effects with inhibitory effect on glial and astrocyte cells during and following ischemic stroke (IS). VPN is effective as an adjuvant therapy in the management of epilepsy; it reduces seizure frequency by 50% in a dose of 2 mg/kg/day. VPN improves psychomotor performances through modulation of brain monoamine pathway mainly on dopamine and serotonin, which play an integral role in attenuation of depressive symptoms. VPN recover cognitive functions and spatial memory through inhibition of hippocampal and cortical PDE-1with augmentation of cAMP/cGMP ratio, enhancement of cholinergic neurotransmission and inhibition of neuronal inflammatory mediators. Therefore, VPN is an effective agent in the management of ischemic stroke and plays an integral role in the prevention and attenuation of post-stroke epilepsy, depression and cognitive deficit through direct cAMP/cGMP-dependent pathway or indirectly through anti-inflammatory and anti-oxidant effects

Experimental antibacterial activity of selective cyclooxygenase antagonist

Background: From the history of the development of pharmaceutical compounds it is evident that any drug may have the possibility of possessing diverse functions and thus may have useful activity in completely different fields of medicine and different studies showed that newer antimicrobials have revealed antimicrobial action involved in the management of diseases of non-infectious etiology. This study was done to determine in vitro antibacterial activity of selected selective cyclooxygenase-2 inhibitor.Methods: Twenty two strains of gram positive and gram negative bacteria, which were isolated from skin and urinary tract infected patient. These bacteria were being cultured on specific optimal growth media. The antibacterial activity of selective COX-2 (meloxicam, celecoxib, valdecoxib and nimesulide). Inhibitors determined by measuring zone of inhibition and minimal inhibitory concentration (MIC).Results: Results showed that MIC of celecoxib and meloxicam in µg/ml was ranged from 5-80µg/ml on selected bacteria compared with negative control distilled water (D.W) ,valdecoxib was 80-160µg/ml, while and nimesulide was ranged from 5-40 µg/ml .All the selected bacteria were showed sensitivity for all coxib used in this experimental study except Pseudomonas aeruginosa which showed resistant to meloxicam and valdecoxib, Klebsiella pneumoniae resist to nimesulide while Staphylococcus aureus was resist to valdecoxib. The smaller zone of inhibition showed by valdecoxib and celecoxib which was 3mm against Klebsiella pneumoniae, while the larger zone of inhibition showed by nimesulide which was 26mm against Escherichia coli.Conclusions: In conclusion selective cyclooxygenase (cox-2) inhibitor possesses antibacterial activity this is especially for nimesulide and little by valdecoxib. Escherichia coli are sensitive bacteria to all coxib. Consequently; coxib may be regarded as anti-inflammatory and antibacterial agent especially for urinary tract infection where Escherichia coli are the major causative organism

FEBUXOSTAT MODULATES OXIDATIVE AND APOPTOTIC PATHWAYS IN ACUTE DOXORUBICIN‑INDUCED CARDIOTOXICITY: AN EXPERIMENTAL ANIMAL MODEL STUDY

Objectives: Doxorubicin is one of the most important and powerful anticancer drugs, the most pronounced limitation for its use is toxicity on normal cells. Mechanism of doxorubicin-induced cardiotoxicity (DIC) is multifactorial and complex, including direct DNA damage, formation of free radicals, interference with DNA repair, and activation of immune reactions. Febuxostat is a non-purine-selective xanthine oxidase inhibitor decrease the production of uric acid. The aim of the present study was to evaluate the influence of febuxostat on doxorubicin-induced acute cardiotoxicity in rats regarding oxidative stress and antiapoptotic effects. Methods: A total of 30 Sprague Dawley male rats were used which subdivided into three groups: Group I (negative control group) received normal saline for 10 days, Group II (positive control group) received normal saline plus single dose of doxorubicin (15 mg/kg, IP), and Group III (treated group) received febuxostat (10 mg/kg, po), for 10 successive days plus single dose of doxorubicin (15 mg/kg, I.P.). Serum brain natriuretic peptide (BNP), cardiac troponin I (cTn-I), caspase-3, glutathione peroxidase (GSH-Px), lipid peroxidase (LPO), malondialdehyde (MDA), and tumor necrosis factor alpha were estimated by ELISA kit method. Results: Febuxostat administration before doxorubicin led to significant decrease on cardiac troponin, caspase-3, and elevation in GSH-Px levels significantly p<0.05. While the effects of febuxostat on BNP, LPO, MDA, tumor necrosis-alpha were insignificant p>0.05 compare to doxorubicin. Conclusion: Febuxostat attenuates DIC through modulation of antioxidant, anti-inflammatory, and antiapoptotic biomarkers

ANTIOXIDANT AND ANTI-INFLAMMATORY EFFECTS OF CURCUMIN CONTRIBUTE INTO ATTENUATION OF ACUTE GENTAMICIN-INDUCED NEPHROTOXICITY IN RATS

Objectives: Nephrotoxicity is a renal-specific situation in which the excretion of toxic metabolites is reduced due to toxic agents and drugs. Gentamicin is an antibiotic belongs to aminoglycoside group which may induce nephrotoxicity due to induction of oxidative stress. Curcumin is a component of traditional medicine with significant nephroprotective effect. Therefore, the objective of the present study was to evaluate the nephroprotective effect of curcumin on gentamicin-induced nephrotoxicity. Methods: A total of 30 male Sprague-Dawley rats were used which divided into Group 1 (n=10): Rats treated with distilled water 5 ml/kg plus normal saline 5 ml/kg for 12 days, Group 2 (n=10): Rats treated with distilled water 5 ml/kg plus gentamicin 100 mg/kg for 12 days, and Group 3 (n=10): Rats treated with curcumin 100 mg/kg plus gentamicin 100 mg/kg for 12 days. Blood urea, serum creatinine, malondialdehyde (MDA), kidney injury molecule (KIM-1), and cystatin-C were measured in both control and experimental groups. Results: Rats treated with gentamicin showed nephrotoxicity as evident by significant elevation in blood urea, serum creatinine, KIM-1, MDA, and cystatin-C sera levels. Curcumin leads to significant reduction of blood urea and serum creatinine compared to gentamicin group, p<0.05. Curcumin also reduced MDA, KIM-1, and cystatin-C sera levels significantly compared to gentamicin group, p<0.01. Conclusion: Curcumin produced significant nephroprotective effect on gentamicin-induced nephrotoxicity through modulation of oxidative stress and inflammatory biomarkers

COVID-19 and Risk of Acute Ischemic Stroke and Acute Lung Injury in Patients With Type II Diabetes Mellitus: The Anti-inflammatory Role of Metformin

Background: Coronavirus disease 19 (COVID-19) is regarded as an independent risk factor for acute ischemic stroke (AIS) due to the induction of endothelial dysfunction, coagulopathy, cytokine storm, and plaque instability. Method: In this retrospective cohort study, a total of 42 COVID-19 patients with type 2 diabetes mellitus (T2DM) who presented with AIS within 1 week of displaying COVID-19 symptoms were recruited. According to the current anti-DM pharmacotherapy, patients were divided into two groups: a Metformin group of T2DM patients with COVID-19 and AIS on metformin therapy (850 mg, 3 times daily (n = 22), and a Non-metformin group of T2DM patients with COVID-19 and AIS under another anti-DM pharmacotherapy like glibenclamide and pioglitazone (n = 20). Anthropometric, biochemical, and radiological data were evaluated. Results: Ferritin serum level was lower in metformin-treated patients compared to non-metformin treated patients (365.93 ± 17.41 vs. 475.92 ± 22.78 ng/mL, p = 0.0001). CRP, LDH, and D-dimer serum levels were also lowered in metformin-treated patients compared to non-metformin treated patients (p = 0.0001). In addition, lung CT scan scores of COVID-19 patients was 30.62 ± 10.64 for metformin and 36.31 ± 5.03 for non-metformin treated patients. Conclusion: Metformin therapy in T2DM patients was linked to a lower risk of AIS during COVID-19. Further studies are needed to observe the link between AIS in COVID-19 diabetic patients and metformin therapy.NC-M acknowledges the Portuguese Foundation for Science and Technology under the Horizon 2020 Program (PTDC/PSI-GER/28076/2017). This work was supported by Taif University Researchers Supporting Program (project number: TURSP-2020/93), Taif University, Saudi Arabia

BETTERMENT OF DICLOFENAC-INDUCED NEPHROTOXICITY BY PENTOXIFYLLINE THROUGH MODULATION OF INFLAMMATORY BIOMARKERS

Objectives: Diclofenac-induced nephrotoxicity is caused by oxidative stress which leads to lipid peroxidation and formation of free radicals. Pentoxifylline can ameliorates renal tissue injury by its anti-inflammatory, antifibrotic, and antioxidant effects, so it mitigates the progression of renal diseases. Therefore, the aim of this study was to evaluate the nephroprotective effects of pentoxifylline on diclofenac-induced nephrotoxicity in rats. Methods: A total of 30 male Sprague-Dawley rats were allocated into three groups, Group 1 (n=10): Rats treated with distilled water 5 ml/kg plus normal saline 5 ml/kg for 12 days, Group 2 (n=10): Rats treated with distilled water 5 ml/kg plus diclofenac 15 mg/kg for 12 days, and Group 3 (n=10): Rats treated with pentoxifylline 100 mg/kg plus diclofenac 15 mg/kg for 12 days. Blood urea, creatinine, malondialdehyde (MDA), superoxide dismutase (SOD-1), glutathione reductase (GSH), neutrophil gelatinase associated lipocalin (NGAL), kidney injury molecules (KIM-1) vitronectin (VTN), integrin (ITG) , interleukin-18 (IL-18) and cystatin-C were used to measure the severity of nephrotoxicity. Results: Diclofenac-induced nephrotoxicity led to significant elevation in blood urea, serum creatinine, MDA, IL-18, KIM-1, NGAL, serum ITG, and VTN with decrease of SOD-1 and GSH sera levels p<0.05. Treatment with pentoxifylline showed no significant effect on all biomarker levels compared to diclofenac group except on serum level KIM-1 and serum VTN, p<0.05. Conclusion: Pentoxifylline produced significant nephroprotective effect on diclofenac-induced nephrotoxicity through modulation of inflammatory biomarkers

Evaluation of the efficacy of adrenergic neurons inhibition through various surgical and therapeutic regimens on controlling blood pressure and circadian rhythm in patients with uncontrolled hypertension

Objective: Resistant hypertension treatment is one of the most challenging medical issues that are difficult to treat, even nowadays with advanced medical techniques and advances, even combination therapy is not effective for resistant hypertension treatment or uncontrolled hypertension surgeons may give the resolving for this issue. Such a treatment is also Renal denervation – the technique developed ten years earlier that includes interrupting the renal adrenergic fibers efferent and afferent with radiofrequency energy. Using this technique, we wanted to know the effectiveness of blocking the adrenal activity by various therapeutic regimens in decreasing the variability of blood pressure and circadian diurnal profile in patients with resistant hypertension. Materials and methods: A total of 80 patients with resistant HTN without comorbidities were enrolled in the study, these patients undergo surgical treatment of hypertension. Results: The pathological profile "non-dipper" for NOCTURNAL blood pressure was documented in most patients at the initial stage: in group I -20 (80%), in group II -17 (68%), and in group III -19 (76%). After 3 months of evaluation, the number of subjects with this pathological profile increases in the treatment groups with Clonidine (21 (84%) patients) and Bisoprolol (19 (76% patients)) due to their rebound from the more aggressive profiles "night-picker" and "over-dipper", in the group treated by Renal denervation there was a reduction in this number (18 (72%) patients). Conclusions: The data obtained have illustrated the antihypertensive efficacy of both medical and surgical treatment; however, renal denervation has a clearly superior effect