Fear of a new pandemic: perception and prediction of monkeypox among the middle east general population

Background

Monkeypox is a zoonotic disease caused by the monkeypox virus, an Orthopox virus. The 2022 monkeypox outbreak provoked fear among the public. Public awareness about the disease could be an important factor in its control. The authors conducted this study to assess the perception and prediction of monkeypox among the Middle East public.

Methods

This cross-sectional study was conducted in August 2022. Data were conveniently collected from eight Middle Eastern countries using an online self-administered questionnaire distributed through educational and social media platforms. Statistical analysis was conducted using R software.

Results

Approximately 11 016 individuals participated in this study. The participants' overall knowledge score indicated poor knowledge about monkeypox. Most of the participants knew the causative organism (66.7%). However, numerous participants were not aware of the disease mode of transmission, symptoms, complications, and vaccination. Participants' awareness was mostly gained from social media (61.8%). The majority predicted acquiring monkeypox when protective measures are not taken (72.7%), progression to a pandemic with economic consequences (50.8 and 52%, respectively), and the ability of the Ministry of Health to control the epidemic (51.5%).

Conclusion

In the Middle East, public knowledge about monkeypox is poor. Raising awareness about monkeypox would be of benefit in controlling the epidemic. This study constitutes evidence upon which health education programs could be designed.

Knowledge, attitude, and ethical concepts of Sudanese medical students regarding stem cells and its application

One of the major challenges that stem cell transplantation faces is a lack of donors due to a lack of knowledge and awareness of the importance of stem cell transplantation, this implies that health care providers should arm themselves with sufficient knowledge to contribute positively to raising awareness. This is an analytical cross-sectional study of 1040 medical students from 10 universities from various Sudanese states, through an online self-administered pre-tested and structured questionnaire formulated by the authors with a particular focus and/or reflection on the knowledge and attitudes of medical students. The median knowledge score among all students was 8.0 (6-9) with the majority of students confirming that stem cells are capable of dividing and can self-renew for a long period (88.6%). Regarding attitude, the median score among the participants was 23 (17-27) with (47.9%) agreeing that competency in stem cell knowledge is important for them as future health care providers. In terms of ethical attitude; the majority of the students (59, 2%) think there's a need to obtain ethical approval before conducting research. Moreover, (45.9%) of students believe that health practitioners have the right to use stem cells in treatments if those treatments have been scientifically proven to be effective on animals and on human cells in the laboratory. It is important to promote educational programs that inform medical students about the full range of possibilities offered by stem cell research. Furthermore, more studies is required to determine how society and religion affect medical students' attitudes toward stem cells.

Augmenting Prediction of Intracranial Aneurysms' Risk Status Using Velocity-Informatics: Initial Experience

Our primary goal here is to demonstrate that innovative analytics of aneurismal velocities, named velocity-informatics, enhances intracranial aneurysm (IA) rupture status prediction. 3D computer models were generated using imaging data from 112 subjects harboring anterior IAs (4-25 mm; 44 ruptured and 68 unruptured). Computational fluid dynamics simulations and geometrical analyses were performed. Then, computed 3D velocity vector fields within the IA dome were processed for velocity-informatics. Four machine learning methods (support vector machine, random forest, generalized linear model, and GLM with Lasso or elastic net regularization) were employed to assess the merits of the proposed velocity-informatics. All 4 ML methods consistently showed that, with velocity-informatics metrics, the area under the curve and prediction accuracy both improved by approximately 0.03. Overall, with velocity-informatics, the support vector machine's prediction was most promising: an AUC of 0.86 and total accuracy of 77%, with 60% and 88% of ruptured and unruptured IAs being correctly identified, respectively.

Alanda (Ephedra foeminea) nanoparticles as a modulator of genomic DNA degradation in mice: new inspiration for treating Ehrlich solid tumour-induced kidney and liver toxicity

OBJECTIVE

The limitations faced by conventional drug delivery systems are being overcome through the use of rapidly evolving cancer nanotherapeutics. Determining the manner in which the Ehrlich solid tumor (EST) is impacted by the new bioactive Alanda-loaded flax seed gum nanoparticles (Alanda NPs) functioning as an anti-carcinogenic agent represents the research objective of this paper.

MATERIALS AND METHODS

Identification of the functional groups, surface morphology, particle size, and zeta potential were among the characterizations and preparations made for the prepared nanoparticles. A Control group, a Flax Seed Gum group, a raw Alanda group, an Alanda NPs group, an EST group, and an induced EST treated with Alanda NPs group comprised the six groups respectively which the 60 female mice were separated into in this in vivo study.

RESULTS

Toxicity assessments for kidneys and liver were performed alongside the detection of total genomic DNA degradation. The zeta potential and the particle sizes for Alanda NPs were -25.60±0.38 mv and 40±0.28 nm, respectively, where the latter demonstrated a monodisperse spherical shape, per the findings. The use of Alanda NPs to treat EST was found to alle te the DNA damage, apoptosis, and renal and hepatic toxicity that EST induces. Additionally, the activation of oxidative stress and apoptosis causing the renal and hepatic toxicity induced by EST is counteracted by the scavenging of free radicals by the Alanda NPs.

CONCLUSIONS

A high degree of safety for effective cancer treatment was displayed by the newly developed oral nanoparticles while also demonstrating strong potential in vivo.

Sudan's armed rivalry: A comment on the vulnerable healthcare system catastrophe

The Sudan War 2023 is a military conflict that erupted in the heart of a paralyzed state system. A total of 68% of hospitals are presently closed, with the remainder operating just partially owing to a lack of staff, medical supplies, and pharmaceuticals. Furthermore, due to power outages, Sudan's vaccination and insulin stocks are under jeopardy. Additionally, patients with chronic conditions have difficulty receiving their prescriptions. This unaccounted-for conflict is expected to degrade Sudan's already-weak healthcare sector by the recent COVID-19 pandemic and 2018 revolution. Humanitarian emergency care is being offered by numerous non-for-profit organizations and civilians initiatives; but, more measures, notably aimed at preventing political upheaval, are required to save the country's future.

Virtual reality-based exercises' effects on pulmonary functions, cardiopulmonary capacity, functional performance, and quality of life in children with repaired congenital diaphragmatic hernia

OBJECTIVE

The long-term consequences of congenital diaphragmatic hernia (CDH), which include altered lung functions and compromised cardiopulmonary capacity, impact functional performance and quality of life. This study investigates the effects of virtual reality-based exercise programs on pulmonary functions, cardiopulmonary capacity, functional performance, and quality of life in children with repaired CDH.

PATIENTS AND METHODS

A randomized controlled clinical trial was performed. Fifty-two children with repaired CDH (aged 6-10 years) were enrolled and randomly allocated to virtual reality-based exercises plus traditional physical therapy (VR-EX group, n = 26) or traditional physical therapy alone (control group, n = 26). Interventions were conducted three times a week for 12 weeks. Pulmonary functions, cardiopulmonary capacity, functional performance, and quality of life were assessed before and after the intervention.

RESULTS

The VR-EX group demonstrated significantly enhanced post-treatment pulmonary functions and cardiopulmonary capacity compared to the control group after accounting for the pre-treatment values (p < 0.05). In addition, the values in functional performance and quality of life measures showed significantly larger improvements in the VR-EX group (p < 0.05).

CONCLUSIONS

Children with repaired CDH may benefit more from VR-based exercises when combined with traditional physical therapy than from traditional physical therapy alone regarding their pulmonary functions, cardiopulmonary capacity, functional performance, and quality of life.

Evaluation of Early Renal Involvement in Essential Hypertension by Measuring Urinary Biomarkers

Hypertensive kidney damage results in glomerular as well as tubular dysfunction. Albuminuria is a well-known marker of glomerular damage. On the other hand, urinary uromodulin is increasingly considered as a potential biomarker of early tubular dysfunction. The aim of the study was to assess glomerular and tubular function of the kidney by measuring urinary albumin and uromodulin excretion in hypertensive subjects. This cross-sectional study was conducted from July 2018 to June 2019 in Hypertension Clinic of Dhaka Medical College Hospital, Dhaka and Kidney Care and Research Centre, Sonargaon, Narayanganj, Bangladesh. In this study 122 hypertensive subjects with age >30 years, duration of hypertension <5 years, without accelerated or malignant BP, absence of dipstick proteinuria and eGFR >60ml/min were included. There were also 33 normotensive individuals included as healthy controls. Albumin-creatinine ratio (uACR mg/g), urine uromodulin-creatinine ratio (uUMODμg/g), urinary sodium-creatinine ratio (mEq/g) and potassium-creatinine ratio (mEq/g) were measured from single morning spot urine sample. Urinary uromodulin levels were measured by ELISA method. The hypertensive and normotensive subjects were age matched 49.0±12.0 vs. 48.0±11.0, years (p=NS). The mean uACR was 29.0±65.0 versus 5.6±2.7mg/g, (p<0.001) respectively. The median uUMOD in hypertensive subjects was 3.38 (1.73-9.06) and in normotensives 3.85(2.28-5.69) μg/g (p=non significant). Multivariate analysis showed significant inverse association between diastolic blood pressure and urinary uromodulin excretion. A uUMOD cut-off of 2.9 (25th percentile) showed eGFR, urinary sodium and potassium excretions were significantly lower at low uromodulin group. The glomerular involvement was found in 21.0% of hypertensive subjects as evidenced by albuminuria. No difference was observed in urinary uromodulin level between hypertensive and normotensive subjects. Low urinary uromodulin level was associated with lower eGFR, Na+ and K+ excretion which indicate simultaneous tubular and glomerular involvement.

Evaluation of hepatoprotective effect of Nebivolol and sodium copper Chlorophyllin on CCL4-induced hepatotoxicity in mice

OBJECTIVE

In this study, the protective effect of sodium copper chlorophyllin and nebivolol was evaluated in a mice model of CCL4 induced hepatotoxicity. Silymarin was used as a traditional hepatoprotective drug.

MATERIALS AND METHODS

Thirty (30) mice were used as they were divided into five groups: the first group was the control group which received distilled water + olive oil, the second group which received 1.5 ml/kg of CCl4 diluted in olive oil three times a week, the third group which received CCl4 + Silymarin 50 mg/kg/day, the fourth group which received CCl4 + nebivolol 4 mg/kg/day, and the fifth group which received 1.5 ml/kg of CCl4+ Cu-chlorophyllin 50 mg/kg/day. The drugs were given by intraperitoneal route for 5 weeks. The detection, quantification of CCl4 induced hepatotoxicity and possible protective effect of either silymarin, nebivolol, or sodium copper chlorophyllin were assessed using biochemical analysis of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total protein, lipid profile, an assay of oxidants and antioxidants, assay of interleukin 6 (IL6) and tumor necrosis factor-alpha (TNF-α), and histopathological examination.

RESULTS

The administration of carbon tetrachloride (CCl4) produced pronounced liver impairment. It significantly increased ALT, AST, ALP, malondialdehyde, and serum nitric oxide levels compared to normal control group besides a decrease in total protein, serum catalase, tissue SOD, and GSH levels. IL-6 and TNF-α levels were significantly higher while total cholesterol was significantly lower in mice receiving CCL4 compared to the normal control group. CCL4 induced severe hyperemia and congestion inside the portal area with leukocytic infiltration, hepatic degeneration, and bridge fibrosis.

CONCLUSIONS

Co-administration of either silymarin, nebivolol, or sodium copper chlorophyllin with CCl4 was able to ameliorate up to almost contradict CCl4 induced hepatic injury through their anti-inflammatory and antioxidant activities.

Transcriptional Analysis of Nuclear-Encoded Mitochondrial Genes in Eight Neurodegenerative Disorders: The Analysis of Seven Diseases in Reference to Friedreich’s Ataxia

Neurodegenerative diseases (NDDs) are challenging to understand, diagnose, and treat. Revealing the genomic and transcriptomic changes in NDDs contributes greatly to the understanding of the diseases, their causes, and development. Moreover, it enables more precise genetic diagnosis and novel drug target identification that could potentially treat the diseases or at least ease the symptoms. In this study, we analyzed the transcriptional changes of nuclear-encoded mitochondrial (NEM) genes in eight NDDs to specifically address the association of these genes with the diseases. Previous studies show strong links between defects in NEM genes and neurodegeneration, yet connecting specific genes with NDDs is not well studied. Friedreich’s ataxia (FRDA) is an NDD that cannot be treated effectively; therefore, we focused first on FRDA and compared the outcome with seven other NDDs, including Alzheimer’s disease, amyotrophic lateral sclerosis, Creutzfeldt–Jakob disease, frontotemporal dementia, Huntington’s disease, multiple sclerosis, and Parkinson’s disease. First, weighted correlation network analysis was performed on an FRDA RNA-Seq data set, focusing only on NEM genes. We then carried out differential gene expression analysis and pathway enrichment analysis to pinpoint differentially expressed genes that are potentially associated with one or more of the analyzed NDDs. Our findings propose a strong link between NEM genes and NDDs and suggest that our identified candidate genes can be potentially used as diagnostic markers and therapeutic targets.

The overexpression of DNA repair genes in invasive ductal and lobular breast carcinomas: Insights on individual variations and precision medicine

In the era of precision medicine, analyzing the transcriptomic profile of patients is essential to tailor the appropriate therapy. In this study, we explored transcriptional differences between two invasive breast cancer subtypes; infiltrating ductal carcinoma (IDC) and lobular carcinoma (LC) using RNA-Seq data deposited in the TCGA-BRCA project. We revealed 3854 differentially expressed genes between normal ductal tissues and IDC. In addition, IDC to LC comparison resulted in 663 differentially expressed genes. We then focused on DNA repair genes because of their known effects on patients' response to therapy and resistance. We here report that 36 DNA repair genes are overexpressed in a significant number of both IDC and LC patients' samples. Despite the upregulation in a significant number of samples, we observed a noticeable variation in the expression levels of the repair genes across patients of the same cancer subtype. The same trend is valid for the expression of miRNAs, where remarkable variations between patients' samples of the same cancer subtype are also observed. These individual variations could lie behind the differential response of patients to treatment. The future of cancer diagnostics and therapy will inevitably depend on high-throughput genomic and transcriptomic data analysis. However, we propose that performing analysis on individual patients rather than a big set of patients' samples will be necessary to ensure that the best treatment is determined, and therapy resistance is reduced.

A novel source of the cardiac glycoside digoxin from the endophytic fungus Epicoccum nigrum: isolation, characterization, production enhancement by gamma irradiation mutagenesis and anticancer activity evaluation

AIMS

Different endophytic fungi were isolated and screened for their digoxin-producing ability. Strain improvement and different culture conditions were studied for more effective production of digoxin.

METHODS AND RESULTS

Among the isolated fungi, an isolate produced digoxin in a concentration of 2·07 mg l^-1 . The digoxin-producing fungal isolate was identified as Epicoccum nigrum Link according to the morphological features and phylogenetic analyses. The potentiality of the fungal strain for production enhancement of digoxin was performed by gamma radiation mutagenesis. Gamma irradiation dose of 1000 Gy intensified the digoxin yield by five-fold. Using this dose, a stable mutant strain with improved digoxin productivity was isolated and the stability for digoxin production was followed up across four successive generations. In the effort to increase digoxin magnitude, selection of the proper cultivation medium, addition of some elicitors to the most proper medium and several physical fermentation conditions were tested. Fermentation process carried out in malt extract autolysate medium (pH 6·5) supplemented by methyl jasmonate and inoculated with 2 ml of 6-day-old culture and incubated at 25°C for 10 days stimulated the highest production of digoxin to attain 50·14 mg l^-1 . Moreover, cytotoxicity of digoxin separated from the fungal culture was tested against five different cancer cell lines. Based on the MTT assay, digoxin inhibited the proliferation of the five different cancer cell lines and the recorded 50% inhibitory concentration ranged from 10·76 to 35·14 μg ml^-1 .

CONCLUSIONS

This is the first report on the production and enhancement of digoxin using fungal fermentation as a new and alternate source with high productivity.

SIGNIFICANCE AND IMPACT OF THE STUDY

These findings offer new and alternate sources with excellent biotechnological potential for digoxin production by fungal fermentation. Moreover, digoxin proved to be a promising anticancer agent whose anticancer potential should be assessed in prospective cancer therapy.

A novel source of the cardiac glycoside digoxin from the endophytic fungus Epicoccum nigrum: isolation, characterization, production enhancement by gamma irradiation mutagenesis and anticancer activity evaluation

AIMS

Different endophytic fungi were isolated and screened for their digoxin-producing ability. Strain improvement and different culture conditions were studied for more effective production of digoxin.

METHODS AND RESULTS

Among the isolated fungi, an isolate produced digoxin in a concentration of 2·07 mg l^-1 . The digoxin-producing fungal isolate was identified as Epicoccum nigrum Link according to the morphological features and phylogenetic analyses. The potentiality of the fungal strain for production enhancement of digoxin was performed by gamma radiation mutagenesis. Gamma irradiation dose of 1000 Gy intensified the digoxin yield by five-fold. Using this dose, a stable mutant strain with improved digoxin productivity was isolated and the stability for digoxin production was followed up across four successive generations. In the effort to increase digoxin magnitude, selection of the proper cultivation medium, addition of some elicitors to the most proper medium and several physical fermentation conditions were tested. Fermentation process carried out in malt extract autolysate medium (pH 6·5) supplemented by methyl jasmonate and inoculated with 2 ml of 6-day-old culture and incubated at 25°C for 10 days stimulated the highest production of digoxin to attain 50·14 mg l^-1 . Moreover, cytotoxicity of digoxin separated from the fungal culture was tested against five different cancer cell lines. Based on the MTT assay, digoxin inhibited the proliferation of the five different cancer cell lines and the recorded 50% inhibitory concentration ranged from 10·76 to 35·14 μg ml^-1 .

CONCLUSIONS

This is the first report on the production and enhancement of digoxin using fungal fermentation as a new and alternate source with high productivity.

SIGNIFICANCE AND IMPACT OF THE STUDY

These findings offer new and alternate sources with excellent biotechnological potential for digoxin production by fungal fermentation. Moreover, digoxin proved to be a promising anticancer agent whose anticancer potential should be assessed in prospective cancer therapy.

Ultrastructure changes induced by the phloroglucinol derivative agrimol G isolated from Leucosidea sericea in Haemonchus contortus

Plant extracts used for the treatment of helminth infections in sheep are an alternative to chemical anthelmintic drugs. Previous studies have reported the anthelmintic activity of acetone leaf extracts of Leucosidea sericea. For this study, we evaluate the ultrastructure changes induced by the acetone leaf extract of L. sericea and the component agrimol G (AG) that was isolated for the first time on adult haemonchus parasites. Adult haemonchus parasites harvested from sheep were incubated with the plant extract and AG for 3 h and evaluated by both scanning and transmission electron microscopy in comparison and in combination with albendazole or ivermectin. In all cases the method of evaluation shows ultrastructural changes, with albendazole inducing mitochondrial damage and ivermectin inducing muscle degeneration, both as previously described. Incubation with the plant extract and AG resulted in the formation of numerous non-membrane bound multi-vesicular like bodies and evenly spread disruptions/erosion in the epicuticle. Combining AG with ivermectin or albendazole resulted in an absence of effect of AG. Based on the structural changes induced by AG, together with the absence of an effect in combination with ivermectin and albendazole would suggest a disrupted microtubular network. The latter does however require biochemical confirmation.

Ultrasound as a Diagnostic Tool in Paediatric Distal Forearm Fractures

Aims To evaluate the accuracy of ultrasound in pediatric distal forearm fractures as well as the effect on the ED waiting time for these patients. Methods Convenience sample of 42 pediatric patients presented with wrist injury. All patients underwent US examination followed by 2-views radiographs of the wrist with recording the time to US. In addition, the time to X-ray were calculated, retrospectively, on 95 pediatric patients for comparison. Results Forty-two patients were examined, 25 males (60%) and 17 females (40%), mean age 7.2 years. On X-Ray, 30 patients (71%) were confirmed to have a distal forearm fractures, of which, 28 (93%) were diagnosed by US. The sensitivity of ultrasound diagnosis was 93.3% (95% CI, 83%-100%), and the specificity was 92% (95% CI, 76%-100%). The positive and negative likelihood ratios were 11.6 and 0.07, respectively. Conclusions Ultrasound is a reliable diagnostic tool in the diagnosis of distal forearm fractures in children. Ultrasound has radiation free and decreases the length of stay in ED.

Immune and vascular dysfunction in diabetic wound healing

The diminished capacity for wound healing in patients with diabetes contributes to morbidity through ulceration and recurrent infections, loss of function and decreased workplace productivity, increased hospitalisation rates, and rising health-care costs. These are due to diabetes' effects on signalling molecules, cellular cascades, different cell populations, and the vasculature. The function of multiple immune system components including cellular response, blood factors, and vascular tone are all negatively impacted by diabetes. The purpose of this paper is to review the current understanding of immune and vascular dysfunction contributing to impaired wound healing mechanisms in the diabetic population. Normal wound healing mechanisms are reviewed followed by diabetic aberrations to immune and inflammatory function and atherogenesis and angiopathy.

DECLARATION OF INTEREST

The authors have no financial or personal relationships to people or organisations that could potentially and inappropriately influence their work and conclusions.

ALUMINA PHASE TRANSFORMATION FROM THERMAL DECOMPOSITION OF AMMONIUM ALUM SYNTHESIZED FROM KANKARA KAOLIN

Thermal stability of transitional alumina phases produced from ammonium alum using Kankara kaolin as starting material was studied. Wet beneficiation method was employed to purify the starting material, after which it was calcined and dealuminated with sulphuric acid. The elemental composition, mineralogical, and physiological analyses were carried out using X-ray fluorescence (XRF), X-ray diffraction (XRD) and Brunauer-Emmett-Teller (BET) techniques respectively. The ammonium alum was thermally treated by varying the calcination temperature from 700 to 1200°C and varying the time of calcination from 1 to 4 h. The formation of gamma alumina began at calcination temperature of 825°C for calcination time of 3 h, which was found to be lower than reported works of 900°C. It was found to be stable at higher temperature of 1125°C, above which phase transformation to alpha alumina was observed. The observed wide range of thermal stability of the gamma alumina phase gives it good advantage to be used for high temperature applications, such as support for catalyst promoters. Alpha alumina phase formation began at 1150°C and was fully formed at 1200°C. BET specific surface area of 166 m2/g was obtained for the gamma alumina phase which was high enough for it application as support for catalyst, catalyst and adsorbent. http://dx.doi.org/10.4314/njt.v36i3.23

DEVELOPMEMT OF PILOT SCALE DEALUMINATION UNIT OF 2.5 kg METAKAOLIN PER BATCH CAPACITY

A pilot-size dealumination unit to handle 2.5kg of metakaolin per batch was designed and fabricated and test run. The metakaolin was prepared from Kankara kaolin. The metakaolin was completely split into silica and alumina. The silica component which was inert to the sulphuric acid used during the reaction and was obtained as a solid product. While the alumina which reacted with the sulphuric acid was obtained in liquid form as aluminum sulphate, known as alum. The dealumination unit comprises of the dealumination reactor, known as dealuminator, acid holding tank and metakaolin slurry mixing tank. The material of construction selected for the dealumination reactor was stainless steel type 304 lined internally with glass to withstand the corrosive environment of the concentrated sulphuric acid at the reaction temperature > 140°C. The capacity of the componentsare; acid holding tank 5 liters;metakaolin slurry mixing tank 20 liters, with 70 W capacity motor and the dealuminator 50 liters, which had pressure relief valve, pressure gauge (0-10 bars) and temperature gauge (0 - 300°C) on the cover. Woven glass fiber cloth was used as lagging material to minimize heat lossto the surrounding. The purity level of the silica obtained from the reaction was above 95%.The endothermic nature of the dealumination process was void of external heating. http://dx.doi.org/10.4314/njt.v36i3.24

Implementation of enhanced recovery after surgery (ERAS) in gynaecological oncology

OBJECTIVES

To evaluate the outcomes of enhanced recovery after surgery (ERAS) implementation in a gynaecological oncology centre.

METHOD

Non-randomised control trial, evaluating morbidity outcomes, before and after implementation of ERAS programme. All consecutive major gynaecological oncology operations performed during two specified periods were included. Data were collected prospectively for a study group in the initial 7.5 months of ERAS implementation and compared with a consecutive historic control group from the exact same period, the year before. Patients' characteristics and perioperative outcomes were compared. Further analysis stratified abdominal and laparoscopic surgery.

RESULTS

In total, 265 cases identified; 99 patients followed ERAS and 99 historic controls, managed with a traditional peri-operative approach, the exact same period the year before (vulval surgery excluded, 67 cases). Groups were comparable in demographics and co-morbidities (age, BMI, ASA, WHO), level of surgery and 30 days post-operative complication (grading Clavien-Dindo classification) and readmission rates (p > 0.05). Overall, the post-operative length of hospital stay (LOS) was significantly reduced for patients who followed ERAS (4.29 ± 2.78 days versus 7.23 ± 5.68 days, p < 0.001). Stratification to subgroups was based on the type of surgery, abdominal versus laparoscopic. Those who underwent abdominal surgery and followed ERAS benefited the maximum (LOS: 5.09 ± 2.74 days versus 8.70 ± 5.75, p < 0.001) CONCLUSIONS: ERAS programme is feasible and safe in Gynae-oncology. In this study, there was a reduction of 3.61 (SE: 0.78, CI 95 %) days in the total LOS, in major abdominal Gynae-oncology surgery (level 3 and 4) without affecting complication or readmission rates.

Verbal and physical abuse against Jordanian nurses in the work environment

This descriptive cross-sectional study determined the prevalence and sources of verbal and physical workplace abuse in the last 6 months, the nurses' reactions to abuse, and their opinions about it. Datawere collected by questionnaire from 447 nurses working in various departments in 3 hospitals in Amman. The prevalence of verbal and physical abuse was 37.1% and 18.3% respectively. Younger, less experienced nurses and those in emergency and intensive care departments experienced more abuse. Patients and their relatives were the usual abusers. Only 35.1% of the abused nurses reported it; of those that did not, 57.1% thought it was useless to do so, while 34.2% thought they could handle the incident without help. Over half of the abused nurses considered leaving nursing and felt their quality of work decreased because of the abuse. Negative societal image of nurses (64%) and poor support from hospital authorities (60%) were the factors the nurses believed most contributed to abuse.

Effect of short-term water restriction in hot season on some blood parameters and immune response to Newcastle disease vaccine of local and commercial layers in the late phase of production

Forty-five Hisex commercial layers and forty-five local Saudi breed layers were used to compare and assess the effect of water restriction under hot conditions on blood constituents and immune response to Newcastle disease (ND) vaccine. The trial was divided into three periods: control (7 day), water restriction (14 day) and rehydration (7 day). During water restriction, layers from each breed were divided into three groups that received 0%, 20% and 40% restriction of drinking water relative to the control period. The immune response against ND was affected by breed; it also declined significantly with 40% water restriction 10 days post-restriction. Water restriction did not affect haematocrit value, plasma total protein, albumin, glucose or osmolality, which may not suggest a reduction in plasma volume. However, plasma creatinine increased in both breeds because of water restriction that remained elevated during rehydration. Water restriction increased plasma urea in the local group, while it decreased in the commercial group. Irrespective of rate of water restriction, it can be concluded that the two breeds can withstand up to 40% water restriction during high environmental temperature. However, the local breed may be superior in water conservation in relation to the commercial layers.

Size-dependent oriented attachment in the growth of pure and defect-free hexagonal boron nitride nanocrystals

Pure and defect-free hexagonal boron nitride (hBN) nanocrystals with deep-ultraviolet light emissions at around 215 nm were prepared via a solid state reaction. This involved preparing a precursor from potassium borohydride and ammonium chloride powders, and then heating the precursor and additional ammonium chloride to 1000 °C within a nitrogen atmosphere. The hBN nanocrystals were studied using a variety of characterization techniques (e.g., TEM, AFM, N(2) absorption/desorption). A growth mechanism based on size-dependent oriented attachment was proposed for the nanocrystals.

Hepatocyte growth factor in Egyptian females with breast benign lumps and cancers

BACKGROUND

Hepatocyte growth factor (HGF) also known as scatter factor (SF) and its receptor c-met play important roles in mammary differentiation and have been implicated in mammary carcinogenesis.

OBJECTIVE

Estimation of the plasma level of HGF in females with benign breast lumps or breast carcinomas and correlating levels with important prognostic parameters.

SUBJECTS

Sixty eight adult premenopausal females were divided into control group of fifteen healthy volunteers and fifty-three patients subdivided into fifteen with benign breast lumps and thirty-eight with breast carcinomas.

METHODS

A thorough clinical examination, plain chest x-rays, ultrasonography of the abdomen and pelvis, pre- operative fine needle aspiration cytology, estimation of fasting serum glucose, urea, creatinine and uric acid levels, alanine aminotransferase activities, C-reactive protein, HGF level and histopathological examination of the breast masses were performed.

RESULTS

Significant increase in HGF levels was found in patients with benign breast lumps and in breast cancer patients when each was compared to controls and when cancer patients were compared to the benign breast lumps group.

CONCLUSION

The serum level of HGF is an independent prognostic indicator for breast cancer.

Impact of intra-arterial injection parameters on arterial, capillary, and venous time-concentration curves in a canine model

BACKGROUND AND PURPOSE

Recent advances in flat panel detector angiographic equipment have provided the opportunity to obtain physiologic and anatomic information from angiographic examinations. To exploit this possibility, one must understand the factors that affect the bolus geometry of an intra-arterial injection of contrast medium. It was our purpose to examine these factors in a canine model.

MATERIALS AND METHODS

Under an institutionally approved protocol conforming to Guide for the Care and Use of Laboratory Animals of the National Institutes of Health, 7 canines were placed under general anesthesia with isoflurane and propofol. Through a 5F catheter placed into the right common carotid artery, a series of biplane angiographic acquisitions was obtained to examine the effects caused by variation in the volume of injection, the rate of injection, the duration of injection, the concentration of contrast medium, and the catheter position on arterial, capillary, and venous opacification. The results of each injection protocol were determined from analysis of a time-contrast concentration curve derived from locations over an artery, in brain parenchyma, and over a vein. The curve was generated from 2D digital subtraction angiography acquisitions by using prototype software. The area under the curve, the amplitude of the curve, and the time to peak (TTP) were analyzed separately for each injection parameter.

RESULTS

Changes in the injection protocols resulted in predictable changes in the time-concentration curves. The injection parameter that contributed most to maximum opacification was the volume of contrast medium injected. When the injection rate was fixed and the volume was varied, there was an increase in opacification (maximal) proportional to the injected volume. The injected volume also had an indirect (secondary) impact on the temporal characteristics of the opacification. The time-concentration curve became wider, and the peak was shifted to the right as the injection duration increased. The impact of injected volume on maximal opacification was significant (P < .0001), regardless of the site of measurement (artery, tissue, and vein); however, the impact on the temporal characteristics of the time-concentration curve reached statistical significance only in measurements made in the artery and the vein (P < .05), but not in the tissue (P > .1). The impact of injected volume on maximal opacification became nonproportional in the tissue and vein when the volume was very large (>12 mL). Increasing the concentration of contrast medium resulted in a nonproportional increase in the height of the time-concentration curves (P < .05). Injection rate had an impact on both maximal opacification and TTP. The impact on TTP occurred only when the injection rate was very slow (1 mL/s). Changes of concentration had a similar impact on the time-concentration curve. Catheter position did not cause significant alterations in the shape of the curves.

CONCLUSIONS

There were predictable effects from modification of injection parameters on the contrast bolus geometry and on time-concentration curves as measured in an artery, brain parenchyma, or a vein. The amplitude, TTP, and area under the time-concentration curve depend mainly and proportionally on the amount of iodine traversing the vasculature per second. Other injection parameters were of less importance in defining bolus geometry. These findings mimic those observed in studies of parameters affecting bolus geometry following an intravenous injection.

C-arm CT measurement of cerebral blood volume: an experimental study in canines

BACKGROUND AND PURPOSE

Cerebral blood volume (CBV) is an important parameter in estimating the viability of brain tissue following an ischemic event. We tested the hypothesis that C-arm CT measurements of CBV would correlate well with those made with perfusion CT (PCT).

MATERIALS AND METHODS

CBV was measured in 12 canines by using PCT and C-arm CT. Two measurements with each technique were made on each animal; a different injection protocol was used for each of these techniques. PCT was performed by using a 64-section V-scanner. C-arm CT was performed by using a biplane Artis dBA system. PCT images were transferred to a commercially available workstation for postprocessing and analysis; C-arm CT images were transferred to a commercially available workstation for postprocessing and analysis by using prototype software. From each animal, 2 sections from each technique were selected for analysis.

RESULTS

There was good agreement of both the color maps and absolute numbers between the 2 techniques. The maximum and mean deviations of values between the 2 techniques for the first 5 animals were 30.20% and 7.82%; for the second 7 animals, these values were 26.79% and 7.40%. The maximum and mean deviations between the 2 C-arm CT studies performed on the first 5 animals were 33.15% and 12.24%; for the second 7 animals, these values were 41.15% and 10.89%.

CONCLUSIONS

In these healthy animals, measurement of CBV with C-arm CT compared well with measurements made with PCT.

Apronectomy in combination with major gynaecological procedures

Removal of excess abdominal fat may be necessary to facilitate major gynaecological surgery for oncology patients. The aim of the study was to assess the feasibility, associated morbidity of such operation when combined with other major gynaecological procedures. This was a retrospective review of cases performed in a tertiary gynaecological oncology centre. All of the patients were diagnosed with gynaecological cancers. The results show a modest increase in operative time; however the procedure was feasible and safe with no other increased risk. This represents time saving for the patients and hospital in having two operations in one session.

Outcome analysis of 4 years' follow-up of patients referred for colposcopy with one smear showing mild dyskaryosis

OBJECTIVE

To assess the 4-year outcome of patients after one smear showing mild dyskaryosis with respect to smear regression rate, prevalence of cervical intraepithelial neoplasia (CIN) and the effect of age.

METHODS

Retrospective analysis of patients diagnosed with initial mildly dyskaryotic smear during the year 2000 with a follow-up period of 48 months. These women had not had any previous abnormal smears.

SETTINGS

Cytopathology Department and Colposcopy Unit, King's College Hospital, London, UK.

RESULTS

We identified 524 patients of whom 375 patients with complete follow-up data are included. The age range was 19-67 years with a median of 29 years. There were 207 patients aged 35 years or less (55%). At 6 months, 258 smears were performed and 47.8% of them were negative (95% CI: 41.6-54.0%). The total number of negative follow-up smears in the first year was 198 out of a total of 397 smears performed (50%). This proportion has significantly increased between 1 and 4 years' follow-up to 67.5% (RR: 1.24; 95% CI: 1.14-1.35). Over the 4-year period, 791 smears were performed and 477 were negative (60.3%; 95% CI: 56.9-63.7%). Of the 477 negative smears there were only 61 smears (12.8%; 95% CI: 10-16%), in 54 patients (14%; 95% CI: 11-18%) that reverted back to low-grade cytological abnormality. In only one case the repeat smear showed high-grade abnormality after initial negative follow-up; however, on biopsy, histology showed CIN I. Out of the 375 patients, 70 required treatment with excisional biopsy (19%; 95% CI: 15.0-22.9%). Histology confirmed high-grade CIN in only 41 cases giving a prevalence of 11% (95% CI: 8.1-14.5%). There were no cases of microinvasive or invasive cancer detected. Age (< or =35 years versus >35 years) did not significantly affect either cytological or histological outcome.

CONCLUSION

Sixty per cent of follow-up smears after initial mild dyskaryosis subsequently became negative; of them 87.2% remained negative over the 4 year follow-up. Treatment was only required in 19% of patients, with 11% prevalence of high-grade CIN. Age did not affect the outcome. These results are reassuring and indicate that colposcopic referral may not be necessary after only one mildly dyskaryotic smear.

Tumour M2-PK as a predictor of surgical outcome in ovarian cancer, a prospective cohort study

BACKGROUND

Optimal cytoreduction is a major prognostic factor in ovarian cancer; several clinical, radiological and biochemical predictors have been studied. Tumour M2-PK (TU M2-PK) is over-expressed in tumour cells and can be detected in plasma samples but its role in ovarian cancer has not yet been evaluated.

OBJECTIVES

To assess the potential clinical applications of TU M2-PK in ovarian cancer particularly in relation to surgical cytoreduction.

SETTINGS

The Gynaecological Cancer Centre at both King's College and St Thomas' Hospitals; London; UK.

METHODS

Patients with suspected ovarian cancer were recruited prospectively during the years 2004-2005. Blood samples were collected before surgery for plasma TU M2-PK assays. Data were analysed in relation to cancer diagnosis and outcome. Statistical analysis was performed using Analyse-It' and SPSS' V13.

RESULTS

100 patients were recruited; 52 diagnosed with invasive ovarian cancer, 13 with borderline tumours and 35 patients had benign conditions. The mean M2-PK concentration in cancer patients was 52 U/ml vs 31 U/ml in patients with borderline tumours and 22 U/ml in those with benign conditions (p < 0.001); it was significantly raised in association with late stage disease and higher grade (p < 0.05). Taking 35 U/ml as a reference point, TU M2-PK predicted sub-optimal cytoreduction in advanced stage disease with a sensitivity of 69%, specificity of 60% and overall efficacy of 61% (95% CI: 44-75%).

CONCLUSION

TU M2-PK was significantly raised in ovarian cancer patients, particularly those with higher stage disease. The potential clinical application as a predictor of surgical outcome in ovarian cancer needs further evaluation.

M2-PK as a novel marker in ovarian cancer. A prospective cohort study

BACKGROUND

Pyruvate kinase isoenzyme M2-PK is instrumental to tumour metabolism and hence over-expressed in tumour cells leading to detectable plasma concentrations.

OBJECTIVES

To assess the degree of association between M2-PK plasma concentrations and ovarian cancer and to determine the cut-off values for its sensitivity and specificity for differentiating between benign and malignant ovarian disease.

SETTINGS

The Gynaecological Cancer Centre at both King's College and St. Thomas' Hospitals, London, UK.

METHODS

Patients with suspected ovarian cancer referred to the above centre were recruited prospectively during the years 2004-2005. Blood samples were collected before surgery for plasma M2-PK assays. Results were assessed with respect to cancer diagnosis, patient and tumour characteristics. Statistical analysis including the receiver operator characteristic (ROC) curve was performed using Analyse-It and SPSS V 13.

RESULTS

100 patients with age range 14-88 years and a median of 57 years were recruited in the study. Of whom 52 were diagnosed with invasive ovarian cancer. Of these 35 (67%) were Stage III and above with two secondary tumours. M2-PK was not related to patient age (p = 0.43). There was a significant correlation between CA125 and M2-PK (p < 0.001). The mean M2-PK concentration in cancer patients was 52 U/ml versus 27 U/ml in patients with benign conditions (p < 0.001). At a cut-off value of 22 U/ml the sensitivity of M2-PK for detecting cancer was 70% with a specificity of 65%.

CONCLUSION

M2-PK was significantly raised in ovarian cancer patients, however its role in clinical practice needs further evaluation.

Anaemia among schoolchildren in Qena Governorate, Upper Egypt

A study was carried out during January/February 2001 in Deshna and Armant Districts of Qena Governorate, Upper Egypt, to establish the prevalence of anaemia among schoolchildren aged 6 to 11 years and define appropriate control interventions in the area. Haemoglobin levels were measured directly in schools using a portable spectrophotometer. The mean (SD) level of haemoglobin in 1844 schoolchildren in 37 schools was 12.79 (1.15) g/dL. Only 12% of children were below the WHO cut-off for anaemia for this age group (< 11.5 g/dL) and no cases of severe anaemia (< 7.0 g/dL) were detected. The low prevalence of mild to moderate anaemia indicates that mass iron supplementation is not justifiable, but routine monitoring of haemoglobin levels should be part of the public health activities in the schools.

Localisation of members of the vascular endothelial growth factor (VEGF) family and their receptors in human atherosclerotic arteries

BACKGROUND

Vascular endothelial growth factor (VEGF) mediates endothelial cell mitogenesis and enhances vascular permeability. The existence of single or multiple VEGF isoforms and receptors suggests that these proteins may have overlapping but distinct functions, which may be reflected in their cell expression and distribution.

METHODS

The localisation of VEGFs A-C and their receptors (VEGFRs 1-3, respectively) in 30 fresh human atherosclerotic arteries, 15 normal uterine arteries, and 15 saphenous veins using immunohistochemistry and western blotting.

RESULTS

Saphenous veins showed no staining for VEGF-B or VEGFR-2. Smooth muscle cells (SMCs) showed the strongest staining for VEGF-A, VEGF-B, VEGFR-1, and VEGFR-2 in all specimens. Conversely, VEGFR-3 and VEGF-C were predominantly localised to the endothelial vasa vasorum in normal arteries, whereas medial SMCs showed the strongest staining in atherosclerotic arteries. Western blotting showed variations in VEGF protein localisation, with lower amounts of VEGF-B and VEGF-C in saphenous veins, compared with arterial tissue. Amounts of VEGF-C were lower than those of VEGF-A and VEGF-B in all specimens.

CONCLUSION

This study provides direct evidence of the presence of VEGF proteins and receptors in human physiology and pathology, with variations in both the amounts of VEGF proteins expressed and their cellular distribution in normal arteries compared with atherosclerotic arteries. The presence of VEGFs A-C and their receptors in normal arterial tissue implies that VEGF functions may extend beyond endothelial cell proliferation. Reduced VEGFR-2 staining in atherosclerotic arteries may have implications for the atherosclerosis process and the development of vascular disease and its complications.

Critical appraisal of the application of carotid duplex scanning

AIMS

To evaluate the indications for carotid arterial imaging in an open access vascular laboratory. To identify those symptoms predictive of > 50% stenosis of the carotid artery in order to reduce unnecessary imaging. To test the hypothesis that duplex scanning would not be of significant benefit in the management of those patients with ill defined symptoms.

METHODS

We compared the outcome of carotid duplex scanning performed on 816 consecutive patients referred for a variety of clinical indications. The medical records of 816 patients were retrospectively analysed to identify the clinical indication for carotid duplex imaging over a three-year period (1997-9).

RESULTS

The indications for duplex imaging were divided into two groups: definite carotid symptoms, n=350 (transient ischaemic attack n=205, cerebrovascular accident n=66, amaurosis fugax n=49, dysphasia n=30); and non-carotid symptoms, n=466 (dizziness n=63, syncope n=63, confusion n=20, vertigo n=10 and others n=310). Less than 5% of those with definite carotid symptoms and 2% of those with ill-defined symptoms had a stenosis > 80%.

CONCLUSION

Regardless of symptoms, 14% and 2.9% of patients referred for carotid duplex imaging have a stenosis of > or = 50% and > or = 80%, respectively. Patients without definite carotid symptoms are of low priority for duplex imaging.

White matter extracellular matrix chondroitin sulfate/dermatan sulfate proteoglycans in multiple sclerosis

Extracellular matrix (ECM) alterations in the central nervous system (CNS) of multiple sclerosis (MS) patients result from blood-brain barrier breakdown, release and activation of proteases, and synthesis of ECM components. To elucidate their potential pathophysiologic roles, we analyzed expression of major CNS ECM proteoglycans (PGs) in MS and control CNS tissues. In active MS plaque edges, 3 CNS lecticans (versican, aggrecan, and neurocan) and dermatan sulfate PG were increased in association with astrocytosis; in active plaque centers they were decreased in the ECM and accumulated in foamy macrophages, suggesting that these ECM PGs are injured and phagocytosed along with myelin. In inactive lesions they were diminished and in normal-appearing white matter they showed heretofore-unappreciated abnormal heterogeneous aggregation. Phosphacan, an ECM PG abundant in both gray and white matter, was less markedly altered. Since in development the spaciotemporal expression of ECM PGs influences neurite outgrowth, cell migration, axon guidance, and myelination, these data suggest that 1) enhanced white matter lectican and dermatan sulfate PG expression in the pro-inflammatory milieu of expanding lesion edges contributes to their sharp boundaries and the failure of neuronal ingrowth; 2) decreases in plaque centers may preclude regeneration and repair; and 3) diffuse ECM PG damage relates to axon degeneration outside of overt lesions. Thus, ECM PG alterations are specific, temporally dynamic, and widespread in MS patients and may play critical roles in lesion pathogenesis and CNS dysfunction.

The effect of ischemic re-perfusion injury plus particle infusion embolism on the apoptosis of rats with pancreatic cancer

OBJECTIVES

In an attempt to develop new method of treating the end- or mid-stage pancreatic cancer, we examined the effect of ischemic re-perfusion injury plus particle embolism on the pathology and cell apoptosis of pancreatic cancer in Sprague Dawely rats.

METHODS

9 mg dimethylbeneanthracine (DMBA) were implanted directly into the parenchyma of pancreatic tail of Sprague-Dawely rats. After establishment of tumor, the inferior splenic artery, a main supplying vessel to pancreatic tail was subjected to blockade and re-opening for 30 min separately, then embolism particles were infused via the artery. Afterwards, artery was ligated. Pathological changes and cell apoptosis indicators (AI) of pancreatic cancer were observed by light microscopy and ISEL respectively 14 days after the operation.

RESULTS

The prevalence of pancreatic cancer among DMBA-implanted rats evaluated 3 months to 4 months after implantation was 59%. The volumes of the tumor in positive control group (B), pancreatic ischemic group (C), pancreatic ischemic re-perfusion injury group (D) were significantly larger than pancreatic ischemic re-perfusion injury plus particle thrombus group (E) ( P < 0.01). The volumes of the tumor in groups D, E were significantly smaller than that in group C (P < 0.01). There was a significant difference in tumor size between group B and group C ( P < 0. 01), but the difference was not significant between group D and group E ( P > 0.05). There was a significant infiltration of tumor tissue in group B rats, but strong inflammatory reaction was not noted. In groups C, D, E, a localized tumor growth was observed; infiltration of inflammatory cells and proliferation of fibroblasts and connective fiber were obvious, and some of these fibers grew into cancer nests and separate the tumor. The above findings were most conspicuous in group E. There was a significant difference in AI between group E (13.7 +/- 1.5) and other groups ( P < 0.01), with the difference being also significant between group C (4.3 +/- 2.4), D (8.5 +/- 1.1) and group B (1.2 +/- 0.8) (P < 0.01), and between group C and group D (P < 0.01) or between group D and group E ( P < 0.01). In the samples of group A, the apoptotic cells were not found.

CONCLUSIONS

Pancreatic ischemic re-perfusion injury plus particle thrombus can cause significant infiltration of inflammatory cells in tumor tissues thereby limiting its growth, and inducing cell apoptosis of pancreatic cancer. This effect is superior to either pancreatic ischemia alone or pancreatic ischemia plus re-perfusion injury.

Isoflavonoid glycosides from Dalbergia sissoo

Two isoflavone glycosides, biochanin A 7-O-[beta-D-apiofuranosyl-(1-->5)-beta-D-apiofuranosyl-(1-->6)-beta-D-glucopyranoside] and tectorigenin 7-O-[beta-D-apiofuranosyl-(1-->6)-beta-D-glucopyranoside], were isolated from Dalbergia sissoo. Their structures were elucidated on the basis of spectral and chemical evidence.

Lessons to be learned: a case study approach: ascites and elevated serum CA 125 due to a pancreatic carcinoma. A diagnostic dilemma

A 72 year-old lady with unrecognised cancer of the body of the pancreas presented with a 4-month history of progressive loss of weight and ascites. The results of laboratory investigations were either negative or within normal limits--apart from a raised serum CA 125 level; no tumour mass was detected on diagnostic imaging. She underwent exploratory laparotomy for a suspected ovarian tumour, but this proved not to be the correct diagnosis. A serum CA 19-9 level was subsequently requested and found to be significantly raised; a second contrast CT scan then showed the presence of ill-defined peri-aortic tissue. A further exploratory laparotomy was carried out in order to establish the true nature of the problem; a large pancreatic carcinoma was revealed.

Phenolic constituents from Grevillea robusta

Seven phenolic compounds were isolated from a MeOH extract of the leaves of Grevillea robusta. Their structures were determined by various spectral methods including 2D NMR spectroscopy.

Effects of steroid anaesthesia on some liver function tests in goats

The effect of Saffan, a steroid anaesthetic, on the liver function of goats has been studied. Forty healthy animals were divided into 4 equal groups. The first 2 groups were given 2 and 4 mg Saffan/kg b. wt respectively. A mixture of Saffan (1 mg) and Xylazine (0.1 mg)/kg b. wt was given to the third group and Xylazine alone to the fourth group (0.1 mg/kg b. wt). Serum samples from all groups were analysed for glucose, total protein, total and direct bilirubin and the level of activity of transaminases. Administration of Saffan evoked more hyperglycemia than a mixture with Xylazine, or Xylazine alone. The hyperglycemic effect of both doses of Saffan (2 and 4 mg) was equivocal beyond 2 h. The effect then differed and glucose was increased 4-fold by 2 mg and 3-fold by 4 mg Saffan. Serum total protein, conjugated and total bilirubin, and GPT and GOT were not changed in the four experimental groups. This was good evidence of a normally functioning liver during the course of steroid anaesthesia administration in goats.

Influence of dietary mineral imbalance on the incidence of urolithiasis in Egyptian calves

The influence of certain dietary elements on the urolithiasis syndrome in cattle calves was elucidated. Calcium, phosphorus, and magnesium measurements were conducted on feed rations as well as on serum and urine samples collected from affected and normal calves. Analysis of the rations given to the animals showed phosphorus at higher levels than calcium, indicating mineral imbalance. Serum and urine of urolithic calves were characterised by high phosphorus, calcium, magnesium, urea, and creatinine levels. Physical examination of urine of affected animals showed a high degree of turbidity, a large amount of calcium carbonate, and triple phosphate as well as abundant amount of pus cells and red blood cells. The characteristic clinical symptoms of urine retention were observed. Moreover, some animals were found to urinate through an opening in front of the scrotal region.

Dietary magnesium and urolithiasis in growing calves

The effect of high levels of dietary magnesium (1.4%) alone or in combination with elevated calcium (1.8%) or phosphorus (1.6%) on growth and health of male calves was evaluated during a nine week feeding trial after weaning. Twenty calves were randomly divided into 4 feeding groups consisting of controls, high magnesium, high magnesium and calcium or high magnesium and phosphorus. Elevated dietary minerals caused decreased feed intake and growth rate. Blood urea nitrogen and serum creatinine levels were greatly elevated in calves fed high magnesium or magnesium and phosphorus and serum urea nitrogen was moderately elevated in calves fed high magnesium and calcium. These elevations suggested the occurrence of renal damage as a result of microcrystalline obstruction of renal tubules. Serum magnesium levels were three times normal in calves fed high magnesium or magnesium and phosphorus, but only twice normal in calves fed high magnesium and calcium. High dietary magnesium resulted in a significant depression in blood calcium level. This effect was somewhat overcome by additional dietary calcium Three calves fed the high magnesium diet and two calves fed the high magnesium and phosphorus diet developed urinary tract obstruction. The chemical composition of uroliths recovered from these calves was calcium apatite. Elevated dietary magnesium has been shown to be a cause of urolithiasis in growing male calves. Additional dietary calcium, but not phosphorus, appears to protect calves against urolithiasis induced by elevated dietary magnesium.