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2015| September-December | Volume 21 | Issue 3
Online since
March 1, 2016
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ORIGINAL ARTICLES
Efficacy of antenatal exercises on maternal and neonatal outcomes in elderly primigravida
Ali A Gehan, SA Khadiga, GA Amir, A Eman
September-December 2015, 21(3):109-114
DOI
:10.4103/1687-4625.177813
Background and purpose
Elderly primigravida and their offspring have traditionally been considered to be at increased risk of adverse maternal and neonatal outcomes because of associated pregnancy and labor complications. This study was designed to examine the efficacy of antenatal exercises on maternal and neonatal outcomes in elderly primigravida.
Participants and methods
Sixty elderly primigravida women (age range: 35-40 years) at 14 weeks' gestation were divided randomly into two equal groups (A and B). Group A performed antenatal exercises for 6 months, whereas group B continued their lifestyle after receiving specific advice for each trimester. The exercise program parameters were based on the American College of Obstetricians and Gynecologists guidelines for exercise during pregnancy. Assessment of labor pain was performed using the Present Pain Intensity scale.
Results
Participants in group A showed a statistically significant difference in the intensity of labor pain when cervical dilatation was between 7 and 8 cm (
P
= 0.000), duration of first stage of labor (
P
= 0.026), and neonates' APGAR scores at the first and the fifth minute of life (
P
= 0.000) compared with participants in group B. There was no statistically significant difference between groups in the intensity of labor pain when cervical dilatation was between 3 and 5 cm (
P
= 0.775) and mode of delivery (
P
= 0.630).
Conclusion
Antenatal exercises are very effective in decreasing adverse effects and labor complications in elderly primigravida and their neonates.
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Study of diurnal variation in peak expiratory flow rates in healthy men in South India
Jenny Jayapal
September-December 2015, 21(3):73-75
DOI
:10.4103/1687-4625.177804
Background
Peak expiratory flow rate (PEFR) reflects the strength and condition of respiratory muscles and the degree of airflow limitation in large airways. PEFR shows hour-to-hour variation that follows a specific pattern in asthmatics and in healthy individuals. Adequate data are not available on the diurnal variation in normal individuals who are students in professional courses and living a sedentary lifestyle. Hence, this study was undertaken to study the diurnal variation in PEFRs in healthy men in South India.
Participants and methods
PEFR was recorded in 50 adult healthy male students who were nonsmokers, between 18 and 23 years of age and studying in professional courses (MBBS, BDS, Nursing and MSc). Mini Wright's peak flow meter was used to measure the PEFR. PEFRs were recorded at 7-8 a.m., 10-11 a.m., 1-2 p.m., 4-5 p.m. and 7-8 p.m. for 2 consecutive days.
Results
On analysis of PEFR records of each individual, it was seen that there was an overall dip in the morning at 7-8 h PEFR, which increased during the daytime, peaking in the afternoon at 4-5 p.m. and eventually decreased in the night. Participants did not show the peak PEFR values at the same time point: 16% of participants had a rise in PEFR in the early morning hours; afternoon (1-2 p.m.) peak was observed in 22% of participants; and evening (4-5 p.m.) peak was observed in 36% of participants. Only 2% of participants showed a peak in the night time (7-8 p.m.) PEFR values.
Conclusion
This study provided the preliminary reference data of diurnal variation of PEFR in healthy adults. As there is a variation in the PEFR recorded during different time points of the day, it is advisable to record the PEFR at the same time point to compare the PEFR between individuals.
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Effect of obesity on lung function tests in South Indian population
Ajith Pakkala, Amrith Pakkala
September-December 2015, 21(3):76-79
DOI
:10.4103/1687-4625.177805
Background
Obesity is a modern-day epidemic. Pulmonary function tests are likely to be compromised to varying degrees in these individuals, thus affecting their artificial ventilation under general anesthesia. It is thus important to study the pattern of pulmonary function in these individuals in a group likely to undergo surgery for varying reasons.
Participants and methods
A total of 30 male participants between 45 and 60 years of age attending the surgical outpatient clinic with a BMI of more than 25 kg/m
2
who qualified as obese were included in the study, and a similar number of participants with BMI less than 25 kg/m
2
were randomly selected as controls. Flow-volume loop, forced expiratory volume in the first second (FEV
1
), forced vital capacity (FVC), and FEV
1
/FVC were recorded using a computerized spirometer.
Results
FEV
1
, FVC, and FEV
1
/FVC ratio measured in obese patients were significantly reduced (
P
< 0.05) compared with normal BMI individuals.
Conclusion
The incidence of restrictive tendency is higher in obese individuals compared with controls. As the changes in respiratory mechanics due to obesity are almost completely reversible, early intervention in such patients will ensure lesser chance of complications on the operation table and postoperatively. With the advent of computerized spirometry, analysis of flow-volume loops is indeed of great help to the obese.
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Vitamin D protects diabetic rats from neuropathic changes by improving insulin sensitivity and upregulating vitamin D receptors
Laila A El-Sayed, Ola M Tork, Hanan Seddiek, Radwa M Taha, Noha I Gomaa
September-December 2015, 21(3):115-124
DOI
:10.4103/1687-4625.177819
Background
There is emerging evidence of neuroprotective roles for vitamin D. However, its role in the pathogenesis of type 2 diabetes mellitus (T2DM) and its exact mechanism of action in neuroprotection are still unclear. The present work was designed to examine the effect of vitamin D supplementation on insulin sensitivity and nerve conduction velocity with and without insulin treatment in a diabetic model.
Materials and methods
This study was carried out on 50 male adult rats. They were divided into five groups: a control group, a diabetic group, in which T2DM was induced; a diabetic insulin-treated group, in which diabetic rats were treated with insulin alone; a diabetic vitamin D-treated group, in which diabetic rats were treated with vitamin D alone; and finally, a diabetic with combined insulin and vitamin D treatment group. At the end of the experimental period, blood samples were obtained from all animals for measurement of serum glucose and insulin, together with the oxidative stress marker malondialdehyde (MDA) and inflammatory markers interleukins 1β and 10 (IL1β and IL10). Nerve conduction velocity was performed on a dissected sciatic nerve. In addition, vitamin D receptor (VDR) gene expressions in pancreatic (
VDR-P
) and sciatic nerve (
VDR-N
) tissues were estimated and the homeostasis model assessment for insulin resistance index was calculated for each group.
Results
Data showed a significant reduction in nerve conduction velocity of the sciatic nerve, together with increased insulin resistance in diabetic rats that paralleled increased MDA and IL1β and decreased IL10. Administration of insulin alone, vitamin D alone, or both combined after induction of diabetes improved the nerve conduction velocity. This improvement was accompanied by significant enhancement of
VDR-P
and
VDR-N
gene expression, together with reduction in oxidative stress and inflammatory state.
Conclusion
The improvement of insulin sensitivity and neuroprotection with vitamin D supplementation in T2DM is related to restoration of
VDR-P
and
VDR-N
expression. Thus, vitamin D could be a novel approach to lower neuropathic risk in diabetes.
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2
A study of biofilm on endotracheal tubes in pediatric intensive care unit
Bassant Meligy, Sahar Khairat, Amal Sayed, Magda Azmy, Dalia K Ismail, Shaimaa Yahia
September-December 2015, 21(3):87-93
DOI
:10.4103/1687-4625.177808
Aim
This study was performed to evaluate the existence of biofilm in the endotracheal tube (ETT) of mechanically ventilated children, and to study a microbial link between biofilm flora and bacteria causing ventilator-associated pneumonia (VAP).
Patients and methods
This was a prospective study conducted on 20 children with ETT who were evaluated for biofilm existence using scanning electron microscopy.
Results
A total of 20 children were enrolled in the study. Of them, 17 (85%) children showed biofilm formation on the luminal surface of ETT. A significant relationship was observed between duration of intubation and biofilm stage. Of the 17 positive cases with biofilm formation, colonization of the inner ETT surface occurred in 14 (70%) cases and 17 isolates were recovered. Five isolates were Gram positive, whereas the majority of isolates were Gram-negative bacilli. Seventeen patients developed pneumonia. All patients who developed biofilm also developed VAP. The occurrence of multidrug resistance among detected microorganisms was high.
Conclusion
We concluded that the density of ETT biofilm increased with increased duration of intubation. We also concluded that ETT colonization with biofilm-producing organisms increased the risk of developing VAP with highly resistant microbes.
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1
The association between serum levels of 25-hydroxyvitamin D and nonalcoholic fatty liver disease in the Egyptian population
Nadia A Elshamy, Heba Sedrak, Ahmed M Hashem, Mohammed S Abd Allah, Aml E Abdou, Ibrahim A Abd Algawad
September-December 2015, 21(3):80-86
DOI
:10.4103/1687-4625.177807
Background and aim
Nonalcoholic fatty liver disease (NAFLD) and vitamin D deficiency are associated with insulin resistance, type 2 diabetes, and dyslipidemia. Many studies have examined the association between vitamin D and NAFLD, but the results have been contradictory. Our aim was to investigate the association of serum vitamin D assessed by 25-hydroxyvitamin D [25 (OH) vitamin D] with NAFLD and to analyze the role of insulin resistance and dyslipidemia.
Patients and methods
A total of 60 patients with NAFLD, chosen from the gastroenterology outpatient clinic of Internal Medicine, Kasr Al-Ainy Hospital, Cairo University, were included in the study. They were classified into three groups (group 1: 20 diabetic patients; group 2: 20 dyslipidemic patients; and group 3: 20 nondiabetic nondyslipidemic patients). In addition, 20 healthy control individuals were also included. For all participants, clinical and biochemical data were obtained, liver ultrasonography for the diagnosis of fatty liver disease was performed, and serum 25 (OH) vitamin D was measured.
Results
Our data showed that NAFLD patients had lower levels of 25 (OH) vitamin D (15.7 ± 10 nmol/l) compared with controls (43.4 ± 14 nmol/l), with a statistically significant difference between the two groups. There was a statistically significant inverse correlation between 25 (OH) vitamin D and low-density lipoprotein and triglyceride among the studied groups, whereas no significant correlation was detected with other variables. The receiver operating characteristic curve showed that 25 (OH) vitamin D was better positive than negative in discriminating between NAFLD patients and controls at a cutoff of 18. The sensitivity was 99% and specificity was 77%, with an excellent area under the curve of 0.94.
Conclusion
Low 25 (OH) vitamin D levels were associated with the presence of NAFLD independently of age, sex, type 2 diabetes mellitus, and insulin resistance.
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Protective effects of remote ischemic preconditioning against cisplatin-induced hepatotoxicity in rats
Ola M Tork, Amal F Dawood, Nermeen B Sadek, Laila A Rashed
September-December 2015, 21(3):94-100
DOI
:10.4103/1687-4625.177811
Background
As cisplatin (CP) remains one of the most effective antineoplastics used in chemotherapy, strategies to protect tissues against CP toxicity are of clinical interest. A major dose-limiting side effect in CP-based chemotherapy is hepatotoxicity. Remote ischemic preconditioning (rIP) represents a noninvasive model for organ protection. The present study was designed to examine,
in vivo
, the CP-induced hepatic injury and to find the protective probability of rIP in this model in relation to an inflammatory mechanism and the hepatic energetic activity.
Materials and methods
Twenty-four adult male albino rats were divided equally into three groups that were treated as follows: (i) control group, (ii) CP group (single intraperitoneal injection of CP 7 mg/kg body weight), and (iii) preconditioned group. rIP was induced with three 10-min ischemia/10-min reperfusion cycles of the right hind limbs just before CP injection. The animals were killed 14 days after the treatment. Among all groups, the gene expression of
nuclear factor 0κB (NF-κB)
,
coenzyme Q10 (Mito.Q10)
, an autophagy marker
LC3
and fatty acid-binding protein
L-FABP
was assessed by real-time reverse transcription-PCR in the rat liver tissue, in addition, the serum levels of liver enzymes alanine aminotransferase and aspartate transaminase were measured.
Results
CP induced an increase in hepatic NF-κB and mitochondrial dysfunction as reflected by the decrease in
Mito.Q10
and a significant reduction in the mitochondrial clearance mechanism: mitochondrial autophagy, which is known as mitophagy. Further, CP significantly decreased the expression of the main protein involved in fatty acid transport,
L-FABP
, which is also considered an effective endogenous antioxidant. However, these alterations were ameliorated in preconditioned rats.
Conclusion
We can assume that the alleviative outcome of rIP in CP-induced hepatotoxicity could be because of induction of anti-inflammatory and antioxidant responses associated with the upregulation of mitochondrial function.
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Impact of cyclic nucleotides on the antiseizure activity of acute and chronic diazepam administration in isoniazid-induced seizures and pentylenetetrazole kindling in rats
Sherine Abdelmissih, Fatma A Elhalim, Ebtissam A.M. Darweesh, Olfat G Shaker, Magdy Ishak
September-December 2015, 21(3):101-108
DOI
:10.4103/1687-4625.177812
Background
It is estimated that ~10% of the population suffers a single convulsive episode during their lifetime. Epilepsy is the second most common chronic neurological disorder after stroke, affecting ~0.5% of the population in developed countries and 1.5-2% in developing countries. Diazepam (DZ) is among the benzodiazepines used most widely in status epilepticus as well as resistant and refractory seizures. However, tolerance to its antiseizure activity is among the obstacles facing it use on a wider basis. Exploration of the role of cyclic nucleotides in seizures might enable finding ways to combat tolerance as well as discover new treatment modalities.
Materials and methods
Seizure severity, electroencephalography, and levels of γ-aminobutyric acid (GABA), glutamate, cyclic adenosine monophosphate (cAMP), and cyclic guanosine monophosphate (cGMP) in brain homogenate were assessed upon single administration of isoniazid and repeated pentylenetetrazole injections, whether untreated or treated with DZ, either acutely or on a chronic basis, respectively.
Results
A single DZ injection, 10 min after single isoniazid, could significantly improve seizure severity, associated with increased power of the fast β wave, implying ameliorated cognitive functions, together with an equal GABA/glutamate ratio versus significant reduction in the cAMP/cGMP ratio. Repeated DZ injections, 10 min after each pentylenetetrazole injection, on alternate days for 1 month and every 2 days for another month produced a significant improvement in seizure severity, accompanied by reduced power of the fast β and the slow δ waves, associated with an increased GABA/glutamate ratio and an unchanged cAMP/cGMP ratio.
Conclusion
The current study assumes that a certain interplay exists between GABA/glutamate on the one hand and cAMP/cGMP on the other so that DZ could exert an anticonvulsant effect on an acute basis despite an unchanged GABA/glutamate ratio as well as upon chronic administration in the presence of an unchanged cAMP/cGMP ratio. In addition, the unchanged cAMP/cGMP ratio associated with chronic DZ administration suggests that cyclic nucleotides might lead to loss of some of the effects of DZ, as shown by reduced β wave power, indicating a reduction in cognitive abilities, concentration, and learning abilities, in contrast to higher β power after single use.
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© Kasr Al Ainy Medical Journal | Published by Wolters Kluwer -
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Online since 28
th
April, 2015