Floor plants’ leaf shape and Phyllagathis rotundifolia’s soil organic matter in Kuala Keniam Trail, Pahang National Park

Kuala Keniam forest in the Pahang National Park is a part of the oldest and most complex ecosystem in the world with multispecies of plants and structures. Unfortunately, near to none information was documented on the geometrical aspects of leaves. Thus, this study aims to pre-document on the variety of shapes of leaves along the trail and classify them. Photographs of the plants and all site activities were taken and documented by using the digital single-lens reflex (DSLR) and smartphone-digital cameras. Secondly, this study also aims at understanding this one particular herbaceous plant, known as Phyllagathis rotundifolia (tapak sulaiman) which is commonly found along the trail, and traditionally used to relieve gastrointestinal problems and fever. The composition of the soil organic matter of the plant were collected for better understanding of the type of soil needed for mass-cultivation and medical purposes. The Walkley-Black (WB) titration method was used to analyse the soil, where the oxidation of organic matter by potassium dichromate (K2Cr2O7)-sulfuric acid mixture followed by back titration of the excessive dichromate by ferrous ammonium sulphate (Fe (NH4)2(SO4)2.6H2O) were monitored. Findings from the Kuala Keniam trails were documented and analysed. Thirty distinct-leaves have been identified and classified into 10-distinct leaf shape categories. Rich soil contents such as iron, carbon and phosphorous were also detected, thus creating Kuala Keniam as an excellent environment for the growth of beneficial shrubs and herbs

Artificial intelligence to evaluate postoperative pain based on facial expression recognition

BACKGROUND

Pain intensity evaluation by self-report is difficult and biased in non-communicating people, which may contribute to inappropriate pain management. The use of artificial intelligence (AI) to evaluate pain intensity based on automated facial expression analysis has not been evaluated in clinical conditions.

METHODS

We trained and externally validated a deep-learning system (ResNet-18 convolutional neural network) to identify and classify 2810 facial expressions of 1189 patients, captured before and after surgery, according to their self-reported pain intensity using numeric rating scale (NRS, 0-10). AI performances were evaluated by accuracy (concordance between AI prediction and patient-reported pain intensity), sensitivity and specificity to diagnose pain ≥4/10 and ≥7/10. We then confronted AI performances with those of 33 nurses to evaluate pain intensity from facial expression in the same situation.

RESULTS

In the external testing set (120 face images), the deep learning system was able to predict exactly the pain intensity among the 11 possible scores (0-10) in 53% of the cases with a mean error of 2.4 points. Its sensitivities to detect pain ≥4/10 and ≥7/10 were 89.7% and 77.5%, respectively. Nurses estimated the right NRS pain intensity with a mean accuracy of 14.9% and identified pain ≥4/10 and ≥7/10 with sensitivities of 44.9% and 17.0%.

CONCLUSIONS

Subject to further improvement of AI performances through further training, these results suggest that AI using facial expression analysis could be used to assist physicians to evaluate pain and detect severe pain, especially in people not able to report appropriately their pain by themselves.

SIGNIFICANCE

These original findings represent a major step in the development of a fully automated, rapid, standardized and objective method based on facial expression analysis to measure pain and detect severe pain.

A Review on Impedimetric and Voltammetric Analysis Based on Polypyrrole Conducting Polymers for Electrochemical Sensing Applications

Conducting polymers have been widely used in electrochemical sensors as receptors of the sensing signal's analytes and transducers. Polypyrrole (PPy) conducting polymers are highlighted due to their good electrical conductive properties, ease in preparation, and flexibility of surface characteristics. The objective of this review paper is to discuss the theoretical background of the two main types of electrochemical detection: impedimetric and voltammetric analysis. It also reviews the application and results obtained from these two electrochemical detections when utilizing PPy as a based sensing material in electrochemical sensor. Finally, related aspects in electrochemical sensor construction using PPy will also be discussed. It is anticipated that this review will provide researchers, especially those without an electrochemical analysis background, with an easy-to-understand summary of the concepts and technologies used in electrochemical sensor research, particularly those interested in utilizing PPy as a based sensing material.

Study of Gene Expression of Programmed Cell Death Ligand 1 (PD-L1) in Breast Cancer Patients

Introduction:

Breast cancer is the most frequently occurring cancer among females and the second most common cancer overall. Programmed Cell Death Ligand 1 (PD-L1) plays an important role in blocking ‘cancer-immunity cycle’ and is considered as a major inhibitory pathway. The aim of the present study was to clarify the alterations of expression of PD-L1 in peripheral blood mononuclear cytes (PBMCs) of female breast cancer patients and analyze its association with clinico-pathological criteria as well as therapeutic response.

Materials and Methods:

The study was conducted on 45 female breast cancer patients and 45 female controls. Blood samples were collected followed by PBMCs isolation, total RNA extraction, reverse transcription and finally, quantitative polymerase chain reaction (qPCR) using SYBR Green DNA binding dye. Expression levels of PD-L1 were calculated and then compared with clinicopathological parameters of the patients in addition to initial therapeutic response.

Results:

A significant difference was detected for PD-L1 expression levels in breast cancer patients compared to controls. A significant association with age, metastatic breast cancer, estrogen receptor (ER) negative status as well as high concentrations of cancer antigen 15-3 (CA15-3) was detected. On the other hand, no significant association was recognized with tumor size, lymph nodal status, histopathological type, grade, progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER-2) status, triple negative, among de novo and recurrent metastatic patients and for the number of metastatic sites as well as the therapeutic response.

Conclusions:

This study paves the way of the use of PD-L1 as a noninvasive prognostic and diagnostic biomarker for poor prognosis of breast cancer.

Chitosan Decorated Copper Nanoparticles as Efficient Catalyst for Synthesis of Novel Quinoline Derivatives

Chitosan decorated copper nanoparticles (CS/CuNPs) catalysts were synthesized via reduction methods utilizing green protocol. The CS/CuNPs hybrid catalysts were tested for the synthesis of quinoline derivatives utilizing one-pot multicomponent reaction (MCR) under ultrasonic irradiation. The optimized CS/CuNPs catalyst that provided good conversion reaction yield and high turnover frequency (TOF) was characterized using Fourier transform infrared (FTIR), thermogravimetric analyses (TGA), X-ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscope (TEM) and X-ray photoelectron spectroscopy (XPS) techniques. Generalization of the scope of the proposed catalytic process was studied using different aldehydes. Excellent products yield and high TOF in even shorter reaction time (~5 min) was attained. Recyclability performance of the catalyst over five times re-use without detectable loss in product yield was recorded. The current method is green process utilizing environmentally benign catalyst and considered to be promising sustainable protocol for the synthesis of fine chemicals.

Influence of the Reaction Temperature on the Nature of the Active and Deactivating Species During Methanol-to-Olefins Conversion over H-SAPO-34

The selectivity toward lower olefins during the methanol-to-olefins conversion over H-SAPO-34 at reaction temperatures between 573 and 773 K has been studied with a combination of operando UV-vis diffuse reflectance spectroscopy and online gas chromatography. It was found that the selectivity toward propylene increases in the temperature range of 573-623 K, while it decreases in the temperature range of 623-773 K. The high degree of incorporation of olefins, mainly propylene, into the hydrocarbon pool affects the product selectivity at lower reaction temperatures. The nature and dynamics of the active and deactivating hydrocarbon species with increasing reaction temperature were revealed by a non-negative matrix factorization of the time-resolved operando UV-vis diffuse reflectance spectra. The active hydrocarbon pool species consist of mainly highly methylated benzene carbocations at temperatures between 573 and 598 K, of both highly methylated benzene carbocations and methylated naphthalene carbocations at 623 K, and of only methylated naphthalene carbocations at temperatures between 673 and 773 K. The operando spectroscopy results suggest that the nature of the active species also influences the olefin selectivity. In fact, monoenylic and highly methylated benzene carbocations are more selective to the formation of propylene, whereas the formation of the group of low methylated benzene carbocations and methylated naphthalene carbocations at higher reaction temperatures (i.e., 673 and 773 K) favors the formation of ethylene. At reaction temperatures between 573 and 623 K, catalyst deactivation is caused by the gradual filling of the micropores with methylated naphthalene carbocations, while between 623 and 773 K the formation of neutral poly aromatics and phenanthrene/anthracene carbocations are mainly responsible for catalyst deactivation, their respective contribution increasing with increasing reaction temperature. Methanol pulse experiments at different temperatures demonstrate the dynamics between methylated benzene and methylated naphthalene carbocations. It was found that methylated naphthalene carbocations species are deactivating and block the micropores at low reaction temperatures, while acting as the active species at higher reaction temperatures, although they give rise to the formation of extended hydrocarbon deposits.

Physicochemical Surface and Catalytic Properties of the Na2O-doped CuO–ZnO/Al2O3 System

In order to investigate the effect of Na2O doping (0.75–4.5 mol%) on metal oxide-support interactions, the surface and catalytic properties of the CuO–ZnO/Al2O3 system have been studied using XRD, nitrogen adsorption at -196°C and the catalytic oxidation of CO by O2 at 150–200°C. Pure and doped mixed oxide solid samples were prepared via the wet impregnation method using Al(OH)3, NaNO3. Zn(NO3)2 and Cu(NO3)2 solutions, followed by drying and calcination at 600°C and 700°C.The nominal composition of the solids thus prepared was 0.25CuO:0.06ZnO: Al2O3.

The results obtained showed that Na2O doping followed by heating in air at 600°C leads to enhanced crystallization of the CuO crystallites to an extent proportional to the amount of dopant present, while doping followed by heating in air at 700°C hinders the solid–solid interactions between CuO andA12O3, and leads to the production of CuAl2O4. The specific surface area was found to increase progressively as a function of the dopant concentration for the solid calcined at 700°C. The catalytic activity was also found to increase progressively on increasing the amount of dopant added. The maximum increase in the catalytic activity measured at 150, 175 and 200°C over solids calcined at 700°C was 114, 102 and 82%. respectively. The doping process did not modify the mechanism of the catalyzed reaction but rather increased the concentration of catalytically active constituents (surface CuO crystallites) involved in the chemisorption and catalysis of the CO oxidation reaction without affecting their energetic nature.

Lapatinib-based therapy for women with advanced/metastatic HER2 positive breast cancer

BACKGROUND

Lapatinib alone or in combination with other agents, mostly capecitabine is used for patients with advanced/metastatic HER2 positive breast cancer (HER2(+)BC) after progression on trastuzumab based therapy. Here we report our experience with lapatinib based therapy in this setting.

MATERIAL AND METHODS

67 consecutive patients received lapatinib based therapy. 58 (86.6%) received lapatinib + capecitabine (LC), 7 (10.4%) with other agents and 2 (3.0%) as single agent lapatinib. Data was collected from patients' records retrospectively.

RESULTS

Objective response to lapatinib based therapy in 64 evaluable patients was 64.0% in all patients and 64.0% in patients who received LC. Median progression free survival and overall survival were 10 and 27 months in all patients and 10 and 17 months in patients who received LC, respectively. 16 (24.0%) patients had dose delay > 1 week and/or dose reduction.

CONCLUSION

Lapatinib based therapy is an effective treatment for women with advanced/metastatic HER2(+)BC after prior exposure to trastuzumab. It yields meaningful response rates, progression free and overall survival. Some patients require dose adjustments.

Multi-wavelength Brillouin-Raman fiber laser utilizing enhanced nonlinear amplifying loop mirror design

We demonstrate a single-spacing, multi-wavelength Brillouin-Raman fiber laser utilizing an enhanced cavity of nonlinear amplifying loop mirror. In this structure, the optimization of multi-wavelength lasing is done with proper adjustments of coupling ratio and Brillouin pump power. When setting the Raman pump power to 300 mW, up to 28 channels with an average 17 dB optical signal-to-noise ratio are achieved. In this case, the Brillouin pump power is maintained at -2.6 dBm when the splitting ratio and Brillouin pump wavelength are fixed at 99/1 and 1555 nm, correspondingly. Our achievements present high numbers of Stokes channels with an acceptable optical signal-to-noise ratio at low pump power operation.

20 GHz spacing multi-wavelength generation of Brillouin-Raman fiber laser in a hybrid linear cavity

We demonstrate a tunable multi-wavelength Brillouin-Raman fiber laser with 20 GHz wavelength spacing. The setup is arranged in a linear cavity by employing 7.2 and 11 km dispersion compensating fibers (DCF) in addition to a 30 cm Bismuth-oxide erbium doped fiber. In this experiment, for the purpose of increasing the Stokes lines, it is necessary to optimize Raman pump power and Brillouin pump power together with its corresponding wavelengths. At the specific Brillouin pump wavelength, it is found that the longer length of 11 km DCF with optimized parameters results in larger number of Stokes combs and optical signal to noise ratios (OSNRs). In this case, a total of 195 Brillouin Stokes combs are produced across 28 nm bandwidth at Brillouin pump power of -2 dBm and Raman pump power of 1000 mW. In addition, all Brillouin Stokes signals exhibit an average OSNR of 26 dB.

Drug-loaded nanocarriers: passive targeting and crossing of biological barriers

Poor bioavailability and poor pharmacokinetic characteristics are some of the leading causes of drug development failure. Therefore, poorly-soluble drugs, fragile proteins or nucleic acid products may benefit from their encapsulation in nanosized vehicles, providing enhanced solubilization, protection against degradation, and increased access to pathological compartments. A key element for the success of drug-loaded nanocarriers is their ability to either cross biological barriers themselves, or allow loaded drugs to traverse them to achieve optimal pharmacological action at pathological sites. Depending on the mode of administration, nanocarriers may have to cross different physiological barriers in their journey towards their target. In this review, the crossing of biological barriers by passive targeting strategies will be presented for intravenous delivery (vascular endothelial lining, particularly for tumor vasculature and blood brain barrier targeting), oral administration (gastrointestinal lining), and upper airway administration (pulmonary epithelium). For each specific barrier, background information will be provided on the structure and biology of the tissues involved as well as available pathways for nano-objects or loaded drugs (diffusion and convection through fenestration, transcytosis, tight junction crossing, etc.). The determinants of passive targeting - size, shape, surface chemistry, surface patterning of nanovectors - will be discussed in light of current results. Perspectives on each mode of administration will be presented. The focus will be on polymeric nanoparticles and dendrimers, although advances in liposome technology will be also reported as they represent the largest body in the drug delivery literature.

An eco-friendly N-sulfonylation of amines using stable and reusable Zn-Al-hydrotalcite solid base catalyst under ultrasound irradiation

Synthetic nanosized Zn-Al-hydrotalcite (Zn-Al-HT) with 20 nm crystallite size and 61 m(2)/g BET-surface area is found to be a mild and efficient catalyst for N-sulfonylation of amines in quantitative yields under ultrasound irradiation. Exclusive synthesis of sulfonamides, using Zn-Al-HT, under ultrasound irradiation, was realized by compatible basic sites of catalyst used. The products were isolated after simple work-up in high yields and purity.

Seamless tuning range based-on available gain bandwidth in multiwavelength Brillouin fiber laser

We experimentally demonstrate a simple widely tunable multiwavelength Brillouin/Erbium fiber laser that can be tuned over the entire C-band, thereby greatly improving the tuning range limitation faced by the previous Brillouin-erbium fiber laser architectures. Tuning range of 39 nm from 1527 nm to 1566 nm, which is only limited by the amplification bandwidth of the erbium gain was successfully achieved. At Brillouin pump wavelength of 1550 nm and 1480 nm laser pump and Brillouin pump powers of 130 mW and 2 mW respectively, all the generated output channels have peak power above 0 dBm, with the first output channel having a peak power of 8.52 dBm. The experimental set up that consists of only 4 optical components, is simple, devoid of the complex structure employed previously to enhance the tunability and feedback mechanism normally associated with multiwavelength Brillouin-erbium fiber laser sources. The generated output channels are stable, rigidly separated by 10 GHz (0.08 nm).

[Columella defects: yet a challenge!]

The repair of nasal defects is thought to be the most ancient of facial reconstructive procedures, dating back to at least 3000 BC in India. In spite of the development of nasal reconstruction concepts, leading to remarkable esthetic and functional improvements, columella reconstruction is yet a contemporary challenge. Columella defects may result from trauma, infections, carcinoma resection, syphilis, bilateral cleft lip, etc. Maintaining symmetry, contour and function are essential for a successful columella reconstruction. Multiple factors help to determine the optimal repair method, including the size of the defect, its depth and location, and the strength of the underlying nasal framework. This article presents a range of techniques and discusses the application of these methods to specific columella defects. A chronological review of columellar reconstruction procedures used for this partial rhinoplasty is exposed.

[Amniotic band syndrome and facial malformations]

Amniotic band syndrome (ABS) is a collection of fetal congenital malformations affecting mainly the limbs, but also the craniofacial area. The pathogenic mechanism is still unclear. The facial malformations in ABS are multiple, polymorphous, and asymmetric. The type and extent of facial defects depend on band location and time of onset. Defects may include a combination of facial cleft, cleft palate and lip, ocular lesions, and cranial malformations. The management of this disease must be multidisciplinary and the outcome depends on the gravity of malformations.

[Mandibular aggressive fibromatosis]

INTRODUCTION

Aggressive fibromatosis is a rare histologically benign fibrous tumor with a potential for locoregional aggression. Treatment is not well defined and several therapeutic approaches have been proposed. Surgical treatment is the reference, chemotherapy, radiotherapy and homonotherapy being proposed as complementary treatment or for inoperable tumors.

CASE REPORT

A three-year-old patient underwent surgery for removal of a mandibular tumor. Pathology reported aggressive fibromatosis. The patient was given conservative treatment and was free of recurrence nine years after resection.

DISCUSSION

Conservative surgery for aggressive mandibular fibromatosis appears to be preferable to radical mutilating surgery which would have a major impact on facial growth in children.

Surface and Catalytic Properties of the CuO/Al2O3 System as Influenced by Treating with Trace Amounts of MoO3

A CuO/Al2O3 solid containing 0.2 mol% CuO (0.2CuO/Al2O3) and three MoO3-doped variants of this material were all prepared via the wet impregnation method, the amount of dopant added to the CuO/Al2O3 solid being 0.25, 1.0 or 2.0 mol% MoO3, respectively. All the samples prepared were heated in air to 350, 450 or 600°C, respectively, before being cooled to room temperature and stored.

X-Ray studies of these materials showed that the undoped (pure) solid calcined at 350°C exhibited all the diffractions lines associated with the AlO(OH) and CuO phases with an excellent degree of crystallinity. Doping the pure solid resulted in the effective progressive decrease in the degree of crystallinity of both the above-mentioned phases to an extent proportional to the amount of dopant added. Increasing the calcination temperature of the pure and doped solids to 650°C led to a significant decrease in the degree of ordering of CuO due to the formation of poorly crystalline γ-Al2O3 having a much better dispersion power relative to AlO(OH).

The specific surface areas of the various samples were found to decrease progressively as the amount of dopant added was increased, especially for samples calcined at 650°C. Increasing the calcination temperature of the pure sample within the range 350–650°C led to a small increase in their catalytic activities in H2O2 decomposition. In contrast, MoO3 treatment followed by calcination of the resulting materials in the range 350–650°C resulted in a significant increase in their catalytic activities in the same catalytic reaction. The maximum increase in the catalytic activity at 30°C attained values of 720%, 735% and 976% for the doped solids calcined at 350, 450 and 650°C, respectively. In contrast, however, such doping brought about a progressive measurable decrease in the catalytic activity of the treated solids towards CO oxidation by O2 when this latter reaction was conducted over the temperature range 150–250°C.

Neonatal screening for sickle cell disease, glucose-6-phosphate dehydrogenase deficiency and a-thalassemia in Qatif and Al Hasa

BACKGROUND

Screening programs to determine the frequency of sickle cell, glucose-6-phosphate dehydrogenase deficiency and alpha-thalassemia gene are available in Saudi Arabia, although not used frequently. Greater use of these programs will decrease the morbidity and mortality of Saudi children affected by these disorders.

PATIENTS AND METHODS

Neonatal hemoglobin electrophoresis and glucose-6-dehydrogenase fluorescent spot tests were performed on newborn babies delivered between December 1992 and December 1993 at the Qatif Central Hospital and at the King Fahad Hospital in Al Hasa. Cord blood samples were collected from babies born in these two hospitals. Babies born in other hospitals had blood collected in their first visit to Qatif primary care centers at the time of vaccination. All specimens were sent to Dammam Central Laboratory. The diagnosis of sickle cell and alpha-thalassemia was based on cellulose acetate electrophoresis and confirmed by agar gel electrophoresis, and glucose-6-phosphate dehydrogenase was confirmed by fluorescent spot test.

RESULTS

A total of 12,220 infants, including 11,313 Saudis (92.6%), were screened over a 12-month period. The common phenotypes detected in these infants included AF, AF Bartâs, SFA, SFA Bartâs, FS and FS Bartâs. In the Saudi infants, homozygous sickle cell disease was detected in 2.35% and 1.08% in Qatif and Al Hasa, respectively. The frequencies of sickle cell gene were 0.1545% and 0.1109% in Qatif and Al Hasa. alphathalassemia gene based on an elevated level of Hb Bartâs were 28% and 16.3% in Qatif and Al Hasa. The screening for G6PD deficiency revealed a high prevalence of 30.6% and 14.7% in Qatif and Al Hasa. In the non-Saudi infants, the frequencies were low.

CONCLUSION

The outcome of this study indicates that the Saudi populations in Qatif and Al Hasa are at risk for hemoglobinopathies and G6PD. Neonatal screening programs are essential and cost effective and should be maintained as a routine practice.

Emergence of multidrug-resistant Salmonella enterica serotype typhimurium DT104 infections in the United States

BACKGROUND

Strains of salmonella that are resistant to antimicrobial agents have become a worldwide health problem. A distinct strain of Salmonella enterica serotype typhimurium, known as definitive type 104 (DT104), is resistant to ampicillin, chloramphenicol, streptomycin, sulfonamides, and tetracycline and has become a major cause of illness in humans and animals in Europe, especially the United Kingdom.

METHODS

To characterize typhimurium DT104 infections in the United States, we analyzed data collected by local and state health departments and public health laboratories between 1979 and 1996 in national surveys of the antimicrobial-drug resistance of salmonella. Selected typhimurium isolates with the five-drug pattern of resistance were phage typed.

RESULTS

The prevalence of typhimurium isolates with the five-drug pattern of resistance increased from 0.6 percent in 1979-1980 to 34 percent in 1996. In 1994-1995, such isolates were identified in samples from 36 of the 46 surveillance sites (78 percent). Thirty-nine of 43 typhimurium isolates with the five-drug pattern of resistance identified in 1994-1995 and 1996 were phage type DT104 or a closely related phage type.

CONCLUSIONS

Multidrug-resistant typhimurium DT104 has become a widespread pathogen in the United States. More prudent use of antimicrobial agents in farm animals and more effective disease prevention on farms are necessary to reduce the dissemination of multidrug-resistant typhimurium DT104 and to slow the emergence of resistance to additional agents in this and other strains of salmonella.

Emerging quinolone-resistant Salmonella in the United States

We conducted a national survey of antimicrobial resistance in human clinical isolates of Salmonella between July 1, 1994, and June 30, 1995. Every tenth nontyphoidal Salmonella isolate received at state public health laboratories in the United States during this period was tested for resistance to 12 antimicrobial agents, including two quinolones, nalidixic acid, and ciprofloxacin. Emerging quinolone resistance was detected; of 4,008 isolates tested, 21 (0.5%) were resistant to nalidixic acid, and one (0.02%) was resistant to ciprofloxacin. Continued surveillance for quinolone-resistant Salmonella is necessary, particularly after the recent approval of a fluoroquinolone for use in animals intended for food in the United States.

Hughes syndrome: a common problem in Kuwait hospitals

The objective was to study antiphospholipid antibody syndrome (APS or Hughes syndrome) in two major teaching hospitals in Kuwait. patients with suspected Hughes syndrome were investigated with tests for anticardiolipin antibodies (aCL) and lupus anticoagulants (LAC) over 1 yr. Diagnosis was considered confirmed if significant levels of either or both antibodies with no obvious cause (primary), or with systemic lupus erythematosus (SLE) or SLE-like illness (including SLE serology) (secondary) were present. Twelve (37.5%; seven females, 58%) primary and 20 (62.5%; 18 females, 90%) secondary Hughes syndrome patients were seen during this period. patients were Kuwaiti, Middle-Eastern and North-African Arabs (29). Filipinos (2) and White (1). None were from the Indian subcontinent. The main presentation was thrombosis in 75% (arterial in 25% and venous in 50%), and recurrent abortions in 50% of married women. Haematological and dermatological manifestations were limited entirely to the secondary variety, seen in 25% and 19%, respectively. Clinical manifestations were severe, leading to death in one, intensive-care management in 31% and with partial or complete warfarin resistance or brittleness in 25%. Neurological/eye and cardiac manifestations were not seen, as these patients may be attending separate speciality hospitals for these diseases in Kuwait. The approximate prevalence of this syndrome was 2.66/1000 admissions in medical wards. Projected to the total referral areas of the two hospitals, an approximate figure of 52 patients/million population/year was obtained. Hughes syndrome was a common problem among Arabs, Filipinos and possibly Whites in Kuwait. Its manifestations were severe, often requiring intensive-care management, and in one case it was fatal. Patients from the Indian subcontinent were conspicuous by their absence, despite the fact that they were well represented in all other rheumatic disease groups. Ethnic and/or geographical factors could be important in this syndrome. To the best of our knowledge, this is the first report of Hughes syndrome from the Middle East.

The effect of pravastatin in patients with primary hyperlipidaemia

Thirty-four (34) subjects with primary hyperlipidaemia were enrolled for this study. After low fat dietary therapy for 6 weeks, subjects' whose serum total cholesterol fell to below 6.2 mmol/l (11 subjects) were excluded from the study and those whose serum total cholesterol were 6.2 mmol/l or more (23 subjects) were started on pravastatin 10 mg nocte. After 8 weeks of treatment, there was a significant decrease in the mean total cholesterol and LDL-cholesterol. However 13 of the subjects still had serum total cholesterol 6.2 mmol/l or more and their pravastatin dose was increased to 20 mg nocte. After 12 weeks, there was a significant reduction in triglyceride, total cholesterol and LDL-cholesterol. There was also a significant increase in HDL-cholesterol. The triglyceride fell by a mean of 15.7%, total cholesterol by a mean of 18.1% and LDL-cholesterol by a mean of 26.3%. HDL-cholesterol on the other hand, increased by 19.4%. The subjects whose total cholesterol fell below 6.2 mmol/l at week 8 had significantly lower total cholesterol to begin with than those whose total cholesterol failed to do so and hence were commenced on 20 mg pravastatin. This suggests that the optimum dose of the drug is dependent on the initial level of total cholesterol. We conclude that pravastatin is effective as a lipid lowering agent.

Light and electron microscopic studies of pityriasis rosea

Light and electron microscopic studies of biopsy specimens taken from five patients with pityriasis rosea revealed the most conspicuous finding to be the presence of dyskeratotic cells within the epidermis. Ultrastructurally, these cells contained an aggregation of tonofilaments, intracytoplasmic desmosomes, many vacuoles, and viral-like particles. It is assumed that pityriasis rosea is caused by a virus to which these changes are related.