Antibacterial activity of silver nanoparticles against field and reference strains of Mycobacterium tuberculosis, Mycobacterium bovis and multiple-drug-resistant tuberculosis strains

Tuberculosis (TB) is an endemic disease in animals and humans in Egypt. This study aims to investigate the antimycobacterial activity of silver nanoparticles(AgNPs) by determining the minimal inhibitory concentration (MIC) of AgNPs, using the microplate Alamar blue assay. The AgNPs were chemically synthesised and their form and size were characterised by ultraviolet-visible absorption spectrophotometry, transmission electron microscopy and X-ray diffraction.The reference strains of Mycobacterium bovis and Mycobacterium tuberculosisH37Rv, and one multiple-drug-resistant (MDR) strain of M. tuberculosis were tested, as well as clinical isolates of M. bovis and M. tuberculosis. The AgNPs were tetrahydral with a few spherical particles and an average particle size of 50 nm. The mycobacterial strains were varied with MICs of AgNPs. Both reference strains of M. tuberculosis and M. bovis, in addition to the MDR strain of M. tuberculosis, were successfully inhibited by AgNPs at MICs of 1 ?g/ml, 4 ?g/ml and 16 ?g/ml, respectively, whereas clinical isolates of M. bovis and M. tuberculosis were inhibited at MIC values of 4-32 ?g/ml and 1-16 ?g/ml, respectively. The AgNPs showed an in vitro chemotherapeutic effect against Mycobacterium spp.Thus, they can be used to treat TB not only in humans but also in animals, and maybe useful in TB prevention and control strategies worldwide.

Mu opioid receptor antagonism in the nucleus accumbens shell blocks consumption of a preferred sucrose solution in an anticipatory contrast paradigm

Binge eating, a central feature of multiple eating disorders, is characterized by excessive consumption occurring during discrete, often brief, intervals. Highly palatable foods play an important role in these binge episodes - foods chosen during bingeing are typically higher in fat or sugar than those normally consumed. Multiple lines of evidence suggest a central role for signaling by endogenous opioids in promoting palatability-driven eating. This role extends to binge-like feeding studied in animal models, which is reduced by administration of opioid antagonists. However, the neural circuits and specific opioid receptors mediating these effects are not fully understood. In the present experiments, we tested the hypothesis that endogenous opioid signaling in the nucleus accumbens promotes consumption in a model of binge eating. We used an anticipatory contrast paradigm in which separate groups of rats were presented sequentially with 4% sucrose and then either 20% or 0% sucrose solutions. In rats presented with 4% and then 20% sucrose, daily training in this paradigm produced robust intake of 20% sucrose, preceded by learned hypophagia during access to 4% sucrose. We tested the effects of site-specific infusions of naltrexone (a nonspecific opioid receptor antagonist: 0, 1, 10, and 50μg/side in the nucleus accumbens core and shell), naltrindole (a delta opioid receptor antagonist: 0, 0.5, 5, and 10μg/side in the nucleus accumbens shell) and beta-funaltrexamine (a mu opioid receptor antagonist: 0 and 2.5μg/side in the nucleus accumbens shell) on consumption in this contrast paradigm. Our results show that signaling through the mu opioid receptor in the nucleus accumbens shell is dynamically modulated during formation of learned food preferences, and promotes binge-like consumption of palatable foods based on these learned preferences.

Convergent, not serial, striatal and pallidal circuits regulate opioid-induced food intake

Mu opioid receptor (MOR) signaling in the nucleus accumbens (NAcc) elicits marked increases in the consumption of palatable tastants. However, the mechanism and circuitry underlying this effect are not fully understood. Multiple downstream target regions have been implicated in mediating this effect but the role of the ventral pallidum (VP), a primary target of NAcc efferents, has not been well defined. To probe the mechanisms underlying increased consumption, we identified behavioral changes in rats' licking patterns following NAcc MOR stimulation. Because the temporal structure of licking reflects the physiological substrates modulating consumption, these measures provide a useful tool in dissecting the cause of increased consumption following NAcc MOR stimulation. Next, we used a combination of pharmacological inactivation and lesions to define the role of the VP in hyperphagia following infusion of the MOR-specific agonist [D-Ala2, N-MePhe4, Gly-ol]-enkephalin (DAMGO) into the NAcc. In agreement with previous studies, results from lick microstructure analysis suggest that NAcc MOR stimulation augments intake through a palatability-driven mechanism. Our results also demonstrate an important role for the VP in normal feeding behavior: pharmacological inactivation of the VP suppresses baseline and NAcc DAMGO-induced consumption. However, this interaction does not occur through a serial circuit requiring direct projections from the NAcc to the VP. Rather, our results indicate that NAcc and VP circuits converge on a common downstream target that regulates food intake.

Nucleus accumbens opioid signaling conditions short-term flavor preferences

Opioid signaling in the nucleus accumbens (NAcc) strongly modulates flavor-based food choice. To further investigate the role of opioid signaling in taste reward, we used a sensory specific satiety (SSS) paradigm to devalue specific flavors of nutritionally identical food pellets in rats. In the NAcc, infusion of a mu opioid (MOP) receptor selective agonist selectively increased consumption of a pre-fed flavor, thus reversing the SSS effect. Conversely, blockade of endogenous opioid signaling with the opioid antagonist naltrexone selectively decreased consumption of a recently consumed flavor, potentiating the SSS effect. No enhancement of consumption was observed if a delay of 3 h was imposed following the intra-NAcc MOP agonist indicating that there were no long-term changes in flavor preference. If a delay was introduced between the initial flavor exposure and the intra-NAcc MOP agonist infusion, pellet consumption was increased non-selectively (irrespective of flavor) suggesting that close temporal contiguity between flavor experience and NAcc opioid action is critical for the opioid effect on flavor preference. In contrast to opioid effects, inactivating NAcc neurons by local microinjection of muscimol (a GABAA agonist) increased consumption of both the pre-fed and non-pre-fed flavors equally. These results demonstrate that opioids released in the NAcc during consumption of palatable foods produce a selective and transient increase in preference for a recently sampled flavor.

Nucleus accumbens dopamine release is necessary and sufficient to promote the behavioral response to reward-predictive cues

The nucleus accumbens is part of the neural circuit that controls reward-seeking in response to reward-predictive cues. Dopamine release in the accumbens is essential for the normal functioning of this circuit. Previous studies have shown that injection of dopamine receptor antagonists into the accumbens severely impairs an animal's ability to perform operant behaviors specified by predictive cues. Furthermore, excitations and inhibitions of accumbens neurons evoked by such cues are abolished by inactivation of the ventral tegmental area, the major dopaminergic input to the accumbens. These results indicate that dopamine is necessary to elicit neural activity in the accumbens that drives the behavioral response to cues. Here we show that accumbens dopamine release is causal to the rats' reward-seeking behavioral response by demonstrating that dopamine in this structure is both necessary and sufficient to promote the appropriate behavioral response to reward-predictive cues.

Physicians’ knowledge, attitude and practice towards erectile dysfunction in Saudi Arabia

We aimed to test the knowledge, attitude and practice [KAP] of physicians towards erectile dysfunction in the Eastern province of Saudi Arabia. At a scientific meeting about erectile dysfunction, 159 physicians from both government and private sectors answered a 34-item questionnaire in private. The mean total KAP score for the group was below the expected st and ard of 60%. Male physicians scored significantly higher than females. Urologists scored the highest, followed by and rologists. Surprisingly, physicians with higher qualifications scored lower than those with intermediate qualifications and even less than general practitioners. Those who had practised for >/= 10 years scored better than those with < 10 years practice. The role of cardiologists in the diagnosis and management of erectile dysfunction is discussed

Physicians' knowledge, attitude and practice towards erectile dysfunction in Saudi Arabia

We aimed to test the knowledge, attitude and practice (KAP) of physicians towards erectile dysfunction in the Eastern province of Saudi Arabia. At a scientific meeting about erectile dysfunction, 159 physicians from both government and private sectors answered a 34-item questionnaire in private. The mean total KAP score for the group was below the expected standard of 60%. Male physicians scored significantly higher than females. Urologists scored the highest, followed by andrologists. Surprisingly, physicians with higher qualifications scored lower than those with intermediate qualifications and even less than general practitioners. Those who had practised for > or = 10 years scored better than those with < 10 years practice. The role of cardiologists in the diagnosis and management of erectile dysfunction is discussed.

Urethral calculi: presentation and management

OBJECTIVE

To determine the occurrence, symptoms, treatment and outcome in patients with urethral stones.

PATIENTS AND METHODS

Fifty-one consecutive patients with urethral calculi were assessed prospectively; all were male and one was an infant.

RESULTS

Acute retention of urine occurred in 78% of patients, urethral anatomical pathology in 6% and posterior urethral calculi in 88%. The urethral stones, solitary in each patient, consisted of calcium oxalate in 86%, struvite in 6%, mixed stones in 4%, calcium phosphate in 2% and uric acid in 2%. A methodical approach to therapy was used which aimed to clearly define the circumstances in which a given procedure was used, and the resulting success rate.

CONCLUSION

The common belief that most urethral calculi in patients in developing countries originate from the bladder does not seem to be generally applicable. Urethral anatomical pathology does not seem to be a necessary condition for most of these calculi.

The Efficiency of Duodenal Aspirate in the Diagnosis of Parasitosis and Candidiasis

A hundred patients presenting with dyspepsia and/or symptoms suggesting parasitosis/candidiasis were subjected to oesophago-gastroduodenoscopy (OGD) in the Endoscopy Unit of Basrah Teaching Hospital Duodenal ulcers were found in 23% of them. Duodenal aspirate and stool samples were taken and examined microscopically for parasitosis and candidiasis. Examination of duodenal aspirates revealed the presence of Giardia lamblia in 15% of the cases, B. hominis in 5%, C. parvum in 4% and Candida spp. in 16%; the respective figures for those microorganisms in stool samples were 8%, 12%y 2% and 7%. There was no characteristic pH level of the duodenal aspirate in relation to parasitosis, candidiasis or endoscopic findings.

Ecological factors underlying protein-calorie malnutrition in an irrigated area of the Sudan

A community survey was undertaken in 14 villages in the Gezira farming region of the Sudan to determine the causes of malnutrition which is prevalent in the area. Low expenditure on food, poor housing conditions, and poor hygiene were found to result from low income. While the ultimate goal should be improvement of income, quicker results will accrue from tackling the equally important dietary causes which result from ignorance about child feeding. In the Sudan, the decline of breastfeeding, the rise in bottlefeeding, the lack of supplementary feeding, and inequitable intrafamily distribution of food are particularly important causative factors. The low levels of immunization against communicable diseases is a contributory factor which could be corrected immediately. Family size and birth rank were not important in the etiology of malnutrition.

Anterior hypospadias. Is repair necessary with urination in a sitting or squatting position?

OBJECTIVE

To determine the chronic complication rate of anterior hypospadias repair and to explore whether the practice of placing the neomeatus at the tip of the penis should be applicable to all cases in our community where urination is in a sitting/squatting position.

METHODS

Over a 10-year period commencing 1st September 1987, 312 patients had hypospadias repair of whom 72% had anterior hypospadias. The meatus was advanced to the tip of the penis in all repairs. The location of the meatus was also determined in 281 non-complaining men with a straight penis and normal sexual and reproductive functions. Following prior information that anterior hypospadias was not associated with sexual and reproductive dysfunction, 51 patients were given a choice between repair or no repair.

RESULTS

Urethrocutaneous fistula occurred in 5% of patients, urethral stricture in 3% and meatal retraction in 3%, with 92% of patients having no complications. Forty six percent of non-complaining men had the meatus in locations other than the tip of the penis. Of 51 patients with the benefit of informed consent, 73% opted for no repair.

CONCLUSION

Our results of anterior hypospadias repair compare favourably with those of other centers. Placement of the meatus at the tip of the penis for anterior hypospadias should not be applicable to all patients in this community where urination is in a sitting/squatting position. Before such repairs, an informed consent is warranted by making the patients and their parents aware of the non-association of sexual and reproductive disorders with these anomalies.

Unusual high presentation of torsion of testicular appendages

Full text is available as a scanned copy of the original print version.

Effect of ambrein on smooth muscle responses to various agonists

The pharmacological effects of ambrein (isolated from ambergris) on the contractile responses induced by some agonists in smooth muscle preparations were investigated. Ambrein in the concentration range of 10, 50 and 250 microg/ml decreased the spontaneous contraction of the isolated rabbit jejunum, rat uterus and guinea-pig vas deferens. Ambrein-induced antagonism to acetylcholine (Ach) in the guinea-pig ileum was abolished when the concentration of calcium chloride in the Tyrode's solution was increased to 5 mM/l. Furthermore, ambrein did not antagonise nicotine-induced contractions in the isolated rabbit jejunum or serotonin-induced contractions in the isolated guinea-pig ileum and vas deferens or the rat uterus. However, ambrein in the concentration range of 10, 50 and 250 microg/ml antagonised prostaglandins (PGs) E2, D2, F2alpha, and oxytocin-induced contractions in the rat uterus in vitro. Ambrein also antagonised (+/-) noradrenaline and (-) adrenaline-induced contractions in the isolated guinea-pig vas deferens. It is concluded that ambrein-induced non-selective dose-dependent antagonism to the effects of some agonists (Ach, adrenaline, noradrenaline, PGs and oxytocin) in some smooth muscles may be due to the ability of this compound to interfere with the mobilisation of extracellular Ca2+ required for muscular contractions induced by these agonists.

Hypoglycemic effect and protein nutritive quality of soy and methionine-supplemented whole durum pasta products

New low cost, high-protein and high-fiber pasta products processed from whole durum meal (WD) solely, WD supplemented with 7% or 12% defatted soy flour (SF), or 12% SF plus 0.3% methionine were evaluated in comparison with the regular pasta made of pure durum semolina (DS). Their protein nutritive quality was biologically evaluated by rat growth studies using diets containing 9% protein, through the parameters: food efficiency ratio (FER), protein efficiency ratio (PER), net protein utilization (NPU), digestibility coefficient (DC) and biological value (BV). The original products were administered to diabetic hypercholesterolemic albino rats, (injected with alloxane) to study their effects on the levels of blood glucose and plasma lipid fractions. The results indicate that diets based on pasta made of WD supplemented with SE or SF plus methionine had superior protein quality and succeeded in supporting normal growth of rats in contrast to the diets based on pasta made of unsupplemented WD or DS. These assays demonstrated that the values of FER, PER, NPU and BV of WD-pasta increased with increasing SF supplementation. However, high-fiber pasta made of unrefined WD solely or with SF had lower DC values compared to that of the regular DS-pasta. DC values decreased as the added SF increased. Adding methionine evidently affected FER, PER, BV and NPU values. Administration of high-protein and high-fiber pasta samples made of WD solely, supplemented with SF or SF plus methionine significantly reduced the elevated blood glucose as well as plasma cholesterol and plasma lipid fractions in hypercholesterolemic diabetic rats. Overall, considering nutritional evaluation, protein cost as well as hypoglycemic and hypocholesterolemic effects the pasta composed of 12% SF-WD and supplemented with 0.3% methionine represented the best high-fiber; high-protein and high-quality product.

Protection by epicoprostanol against hyperglycemia and insulitis in normal and diabetic rats

Epicoprostanol (3-alpha-hydroxy-5 beta-cholestanol) has been studied for its effects on blood glucose and plasma insulin levels in rodents. Epicoprostanol significantly induced hypoglycemia and increased insulin levels in rat blood plasma by 88% and 66% compared to that of control after 2 h and 4 h of acute treatment at 100 mg/kg dose. It also highly significantly lowered blood glucose levels in a dose dependent manner at 50, 100 and 200 mg/kg doses when administered to alloxan-rendered moderately diabetic rats after 120 and 240 min of treatment. Similarly, epicoprostanol, with the same dosage regimen, caused hypoglycemia in streptozotocin-induced severe diabetic rats, to a similar extent at the same time-points. However, the lowest dose (10 mg/kg) failed to produce a striking effect in either of the diabetic groups. In normoglycemic rats, plasma insulin levels were affected significantly after a single dose (100 mg/kg) of epicoprostanol. In contrast, diabetic animals suffering from insulitis showed a significant decline in hyperglycemia, strongly suggesting an insulin-like action of epicoprostanol. It seems likely that epicoprostanol acts through a mechanism other than hyperinsulinemia.

Effect of (-)-cathinone, a psychoactive alkaloid from khat (Catha edulis Forsk.) and caffeine on sexual behaviour in rats

The effect of (-)-cathinone, caffeine and their combinations was studied on the sexual behaviour of male rats. Male sexual activities were assessed by recording the erectile responses (grooming of genitalis, yawning/stretching and homosexual mounting), in the absence of females. The copulatory behaviour was observed by caging males with receptive females brought into oestrus with s.c. injection of oestradiol benzoate and progesterone. The copulatory pattern of male rats (mounting, intromissions, ejaculations and refractory period) was recorded. The oral treatment of cathinone (5 mg kg-1 day-1), caffeine (50 mg kg-1 day-1) and their combinations for 15 days increased arousal (motivation) in male rats as evidenced by increased mounting performance and anogenital investigatory behaviour. However, erectile and ejaculatory responses, measured in the present study, showed no stimulant effect. It is conceivable from the present results that cathinone, the psychostimulant constituent of khat modified masculine pattern behaviour and caffeine also changed the effect of cathinone when administered concomitantly. However, our data provide no evidence that cathinone could be considered as an aphrodisiac.

A study of ambrein treatment for the evaluation of change in plasma biochemical parameters in rats

Biochemical effects of acute and subacute treatments with ambrein were investigated in rats by measuring the total proteins, cholesterol, triglycerides, GOT, GPT and alkaline phosphatase in the blood plasma. Also, determinations of prothrombin time (PT), partial thrombin time (PTT), thrombin time (TT) and fibrinogen level were performed. Furthermore, changes in plasma electrolyte concentration were studied. Ambrein administered i.p. did not cause any toxic symptoms in the liver as revealed by the histology of the liver tissue both in acute and subacute treatments. Ambrein itself did not significantly affect the plasma protein, cholesterol, GOT and GPT profiles, but lowered alkaline phosphatase at high doses (50 and 250 mg/kg) after subacute treatment. Thus far, no specific pattern of action of ambrein in electrolyte control has been found. However, it increased PT, PTT and TT and decreased fibrinogen levels in both the acute and subacute studies, pointing towards its potential as an anticoagulant and antifibrinogenic agent.

Effect of ambrein, a major constituent of ambergris, on masculine sexual behavior in rats

The effect of ambrein, a major constituent of ambergris, was studied on the sexual behavior of male rats. The rats were administered ambrein in doses of 100 and 300 mg/kg body weight. Male sexual activities were assessed by recording the erectile responses (penile erection) and homosexual mountings in the absence of female. The copulatory studies were carried out by caging males with receptive females brought into estrus with subcutaneous injections of estradiol benzoate and progesterone. The copulatory pattern of treated male rats (mountings, intromissions, ejaculations and refractory period), the pendiculations (yawns/stretches) and orientation activities towards females, the environment and themselves, were recorded. Ambrein produced recurrent episodes of penile erection, a dose-dependent, vigorous and repetitive increase in intromissions and an increased anogenital investigatory behavior, identifying the drug used in the present study as a sexual stimulant. It is conceivable from the present results that the ambrein-modified masculine sexual behavior in male rats supports the folk use of this drug as an aphrodisiac.

Laboratory induced resistance to praziquantel in experimental schistosomiasis

To study the effect of praziquantel (PZQ) on successive generations of S. mansoni worms, infected mice were treated 6 weeks after infection with different doses of PZQ (300, 500 mg/kg.), the schistosome strain was originally obtained from an infected Egyptian patient. The eggs subsequently produced by worms that had survived the PZQ treatment were used to infect snails and mice of the following generations. The results were expressed as average number of worms and cure rates in comparison with control groups. It was found that the use of PZQ., especially in low subcurative dose may lead to the development of resistance to therapeutic dose of the drug in following generations.

Male pseudohermaphroditism: factors determining the gender of rearing in Saudi Arabia

OBJECTIVE

Experience with male pseudohermaphrodites at King Fahd Hospital of King Faisal University, Al-Khobar, Saudi Arabia from 1981 to 1991 was reviewed to ascertain the factors determining the gender of rearing.

METHODS

The records of 14 patients consisting of 6 prepubertal and 8 postpubertal patients were studied. None of the patients had any prior evaluation or treatment, since their gender assignment at birth was carried out by midwives in rural communities. The males presented to our hospital with ambiguous genitalia: small phallus, bifid scrotum, perineoscrotal hypospadias, and undescended testes (UDT). Most of those raised as females presented in the postpubertal period seeking remedy for deep voice, excessive musculature, facial hair, erection of the phallus, ejaculation, inappropriate attraction to the female sex, and primary amenorrhea. As their male genotype became determined, all the patients and/or their parents, with the exception of one, insisted on appropriate reconstructive surgery to the male gender. This report focuses primarily on 11 patients assigned a female gender at birth, 10 of whom insisted on a gender change.

RESULTS

Most adolescents and adults still complained of small penises after reconstructive surgery, but cherished their male role.

CONCLUSIONS

The male genotype is a more important factor than phallic adequacy in determining the gender of rearing in the Kingdom of Saudi Arabia, an observation attributable to the financial, social, and cultural benefits that the male gender confers in Saudi society.

Experimental schistomiasis: the effect of chemotherapy on concomitant immunity and resistance to reinfection

To study the effect of chemotherapy on concomitant immunity, mice infected with Schistosoma mansoni were treated after either 8 or 16 weeks of primary infection and challnged at different periods after treatment. Results were compared with infected un-treated groups of mice. It was found that in mice treated 8 weeks after infection the degree of protection decreased gradually with time and 16 weeks after treatment no significant degree of protection was obtained. On the other hand, mice infected for 16 weeks prior to treatment showed higher degrees of protection and there was still significant degree of resistance to challenge infection after 16 weeks of treatment. It was concluded that in schistosomiasis mansoni there is a certain degree of resistance to reinfection after successful treatment of primary infection prior to treatment.

Studies on the mode of action of ambrein as a new antinociceptive compound

The compound ambrein was isolated from ambergris, which is commonly used as an analgesic in the Saudi folklore medicine. The LD50 of ambrein, given intraperitoneally (i.p.) in mice, was found to be high (7.5 g/kg), and ambrein proved to be a safe compound in this species. In the hotplate test, ambrein was found to possess antinociceptive activity in mice at doses which did not sedate or incapacitate the animals. By the i.p. administration route, ambrein produced antinociception in mice at a dose as low as 10 mg/kg. The antinociceptive activity of ambrein (250 mg/kg i.p.) was inhibited by a noradrenergic neurotoxin (DSP-4) and by naloxone, methysergide or prazosin. It was not influenced by a serotonin depletor, p-chlorophenylalanine. The possible mechanism of ambrein antinociception is discussed.

Rectus andominis myocutaneous flap: Analysis of 40 cases

We present a series of 40 cases who underwent reconstructive procedures using rectus abdominis myocutaneous units. The transplanted tissue comprised superior pedicle (26 cases), inferior pedicle (11 cases), and as free muscle flap (3 cases). The application fell into three groups i.e.; 1. breast and chest wall reconstruction; 2. groin, genital, and trochanteric area; and 3. leg and heel ulcer. The results show that surgical dissection of flaps is relatively easy and has a wide range of applications that can be used for different surgical reconstructive problems. Surgical dissection has a low incidence of complication for flap viability as well as for donor site.

Risk factors in wound infection following urologic operations: a prospective study

A total of 134 urologic operations were studied prospectively for postoperative wound infection, the methodology involving direct intraoperative swab taking. Patients' variables were (mean +/- SD): age 32.4 +/- 20.7 years, Quetelet index 27.4 +/- 8, duration of operation 98 +/- 34 minutes, and male:female ratio 9.3:1. Of the 131 intraoperative swabs 28 (21%) were positive, 97% of the organisms being aerobic; 16% of the patients were nasal carriers of S. aureus. The overall wound infection rate was 9%, and it prolonged hospital stay by six days average. Significant risk factors (and their magnitude) were: age over 60 years (x 2.2), prolonged preoperative hospital stay (x 15), and wound contamination (x 4.3 and x 14.3 for classes 3 and 4 wounds respectively). Neither diabetes mellitus, obesity, nor surgeon's rank was contributory. We conclude that, although the 9% rate of postoperative wound infection was acceptable, appropriate prophylactic antibiotics may reduce it further, and, from our data, we would recommend an aminoglycoside (e.g. Amikacin) and Ampicillin combined.

Management of an unusually high postpubertal presentation of cryptorchidism

A high proportion (43%) of postpubertal presentation of cryptorchid testes was found in 114 patients with undescended testes (UDT). Bilateral presentation of UDT was observed in 25% of patients. Orchiopexy was performed on 75% of postpubertal cases, the determinant factor for choice of operation being cosmetic and psychological. Follow-up results appear to be promising in this environment with very low incidence of testicular cancer.

Chemical investigation of the internal secretion of the sperm blue whale

Ambergris, which is an internal secretion of the sperm blue whale, was extracted with 96% ethanol. The saponified and unsapondied portions have been studied in detail. The number of fractions and components of the unsaponified matter as separated by column and thin layer Chromatography confirm the presence of ambrein (triterpenoid) as well as same other steroid. The saponified portion is reported to contain stearic, oleic, linoleic, archidic and betenic acids. More than one compound have been found in each fraction.

Prognosis of radiologically non-functioning obstructed kidneys

Twenty patients found to have unilateral radiologically non-functioning obstructed kidneys on excretory urography (IVU), and who had normal contralateral kidneys, were further evaluated. Ultrasonography, radionuclide imaging and CT scan were carried out pre-operatively to try to predict which of the kidneys were potentially recoverable after relief of obstruction. Percutaneous nephrostomy was also performed on the last consecutive 7 patients 4 weeks before definitive treatment and the function of the kidneys determined daily. The patients were re-evaluated 2 months after the relief of obstruction. Ultrasonography, radionuclide imaging and CT scan were not found to be reliable in predicting whether these kidneys were potentially recoverable. We consider percutaneous nephrostomy a good procedure for obtaining prognostic information prior to definitive surgery.

Psychological aspects of intersex in Saudi patients

Four cases of male pseudo-hermaphrodism were seen post pubertal. All had been reared as females unambiguously since birth. Two cases developed male gender identity post pubertal, but failed to declare themselves to their families and society until a similar case had been publicized in the local newspaper. The third case did not reveal her problem to her family even after being informed by a doctor at the age of 15, and was discovered accidentally at the age of 22 on routine medical examination. The fourth was discovered accidentally at age 40 after having been married and divorced. The families of the four cases shared a strong desire for their children to be reassigned to the male sex including the third case, irrespective of being assured of her female gender identity by physicians. Psychiatric and social problems encountered pre- and post-operatively are discussed with particular emphasis on the role of culture and traditions.

Fracture of the penis: surgical management

Fracture of the penis is a rare injury, only 135 patients having been reported by 1985. Our recent experience with six patients who underwent emergency surgery, has been documented. The results of treatment were excellent with complete recovery of function. The study recommends operative management as the treatment of choice.

Homozygous sickle cell disease and priapism in the eastern province of Saudi Arabia

Two adult sickle cell homozygotes from the eastern oases of the Kingdom of Saudi Arabia presented with severe persistent priapism. Each patient had a high Hb F of 24%, and their red cells were neither hypochromic nor microcytic. Priapism probably occurs more frequently in homozygous sickle cell disease than reported previously from this region. It would appear that a high fetal haemoglobin alone without hypochromia and microcytosis--features suggestive of co-existing alpha-thalassaemia--does not protect against this agonizing vaso-occlusive event.

Reliability of present-day glucose test strips in the neonatal settings of a developing country

To estimate the accuracy of glucose test strips in measuring glucose concentrations estimations were done in 100 full-term neonates, using Reflotest Hypoglycemie, Dextrostix, and BM-test-Glycemie. Results were compared with those obtained by laboratory methods. None of the glucose test strips was found to be completely reliable but the Reflomat system was found to be the least inaccurate.

Priapism in association with sickle cell anemia in Saudi Arabia

A questionnaire study of 42 Saudi patients with sickle cell anemia revealed that none of them had ever suffered from priapism. A comparison of hematological parameters between Jamaican priapism patients and Saudi non-priapism patients suggested that high Hb F levels and hypochromic microcytosis in Saudi patients might play an important role in preventing this complication.

Meningitis in children of Riyadh

One hundred and forty cases of meningitis admitted to the Children's Hospital in Riyadh from June 1980 to the end of May 1982 were included in a prospective study. Sixty-seven percent were under 1 year of age and 90% were under 5 years old. One hundred and twenty-four (88.6%) had purulent CSF, 12 (8.6%) had viral and four (2.9%) had tuberculous meningitis. E. coli was the commonest causative organism in the neonates. After that age S. pneumoniae was the predominant isolate. The implication of increasing resistance of H. influenzae to ampicillin therapy were discussed and a further rare case of meningitis caused by Flavobacterium meningosepticum was described. Seventy-three (52%) were cured completely, 39 (28%) survived with immediate neurological deficits and 28 (20%) died. Mortality and neurological sequelae were found to be high in four categories of patients: neonates, patients who were stuporose or comatose on admission, those who were partially treated before admission and those who presented late after the onset of their symptoms.

Size at birth of live-born Saudi infants

Anthropometric measurements were done on 967 singleton live-born Saudi infants of gestational age 33 to 42 weeks who belonged to the high and middle social classes and who were born consecutively in Riyadh University Hospital. The 914 infants born at term (greater than or equal to 37 weeks) had a mean birthweight of 3.31 kg (SD 0.45), a mean length of 49.74 cm (SD 2.5) and a mean head circumference of 34.4 cm (SD 1.4). Values were significantly higher in males than females. Effect of sex in this study was not apparent until 40 weeks and later. Difference in body size was significant between the first-born and second infants but the trend was unimpressive with greater parity. Fifty-three (5.5%) of the infants were born preterm. Twenty-one of the preterm babies and 18 of the term infants weighed less than 2500 g, an overall incidence of low birthweight of 4%. Results were compared with studies from Saudi Arabia and other countries. It is concluded that there was no significant difference between birthweights of upper-class Saudis and Europeans.

Transcutaneous bilirubin measurement in evaluating neonatal jaundice among Saudi newborns

Transcutaneous bilirubin measurements, using the Minolta transcutaneous bilirubinometer (TcB), were performed in 68 full-term, healthy Saudi infants. Infants who had exchange transfusion and those under phototherapy were excluded. One hundred and twenty measurements were obtained and compared with serum bilirubin levels measured by the American Optics (A.O.) bilirubinometer. The serum bilirubin range was 3.8-18.4 mg/dl. The results showed that the TcB index correlates well with the serum bilirubin measurement: the regression analysis was: r = 0.878, y = 10.78 + 0.909 x, P less than 0.001. However, the regression line showed that at a serum bilirubin level above 12.9 mg/dl the sensitivity of the TcB was 69% and the specificity 92%, while its positive and negative predictive values were 58% and 95% respectively. There was a fair amount of variability around the regression line which may lead to significant errors in clinical decision-making. Thus, the TcB at present has grave limitations which restrict its usefulness in the newborn.

Seroepidemiology of rubella in Saudi Arabia: an adapted vaccination policy

Rubella haemagglutination antibodies were tested for in sera of 1793 unvaccinated subjects with age ranging from birth to 40 years. This was to assess the immune status of the population and to see the feasibility of introduction and the proper age for rubella vaccination in a Saudi community. Those with titres of greater than or equal to 1:8 were considered as seropositive. The lowest level of antibodies was seen among the 10-18 month age group. All children aged 2-5 years were seropositive as were 75% of the elementary school girls. Only 90-95% of the women of childbearing age were seropositive, however, leaving an immune gap of 5-10%. Unnecessary mass vaccination of young children is discouraged. Rubella vaccine should be given to all final elementary school girls and all women of childbearing age after screening, whenever possible. Special catchment zones are suggested for the latter group. Further nationwide seroepidemiological surveys are recommended for the other parts of the Saudi Kingdom.

Cerebral palsy in Saudi Arabia: a clinical study of 102 cases

One hundred and two children with severe cerebral palsy (CP), referred to us during the period 1980 to 1983, were analysed for aetiology and clinical features. Ninety-one children were under the age of two years. Male to female ratio was 3:2. The causes of CP were prenatal in 23.5%, perinatal in 48%, and postnatal in 28.4% of cases. All the clinical types were represented and the study revealed the well-established high frequency of associated neurological deficits. Cerebral palsy was considered medically preventable in at least 30% of the cases, through improvements in obstetric and neonatal care services and control of infection. There is need, also, to establish integrated interdisciplinary teams for the effective diagnosis and complete habilitation of CP patients.

25-Hydroxyvitamin D and total calcium: extraordinarily low plasma concentrations in Saudi mothers and their neonates

Venous blood was obtained from 100 consecutive and unselected Saudi Arabian mothers and their neonates within 48 h after delivery. Plasma levels of 25-hydroxyvitamin D (25-OHD) and total calcium were measured in paired samples. Fifty-nine mothers and 70 neonates had subnormal (less than 10 ng/ml) 25-OHD levels. Plasma Ca concentrations were low in 61% of the mothers and 59% of the newborns consisting of 10 preterm and 38 full term babies. There were significant correlation between the plasma levels of maternal and neonatal 25-OHD (r = 0.54; P = 0.0001), maternal 25-OHD and Ca (r = -0.22; P = 0.03), neonatal 25-OHD and Ca (r = -0.28; P = 0.0009), and maternal and neonatal calcium levels (r = 0.46; P = 0.0001). Nevertheless, maternal 25-OHD was not invariably higher than that in the infant. Normocalcemia was observed in 29 neonates and 26 mothers (20 mother/baby pairs) in the presence of subnormal maternal 25-OHD. Twenty babies and 16 mothers including nine mother/baby pairs had hypocalcemia in the presence of normal levels of 25-OHD. This indicates that vitamin D plays a crucial, but not exclusive, role in calcium homeostasis during pregnancy. This study revealed that vitamin D deficiency is very prevalent during pregnancy in Saudi Arabia. It also showed that asymptomatic hypocalcemia in full term babies is far commoner than is generally appreciated. It is considered that vitamin D deficiency is primarily due to lack of exposure to sunlight. Encouragement to obtain sunlight exposure and fortification of food are the only alternative measures.

Datura intoxication in Riyadh

Cases of stramonium poisoning due to deliberate abuse by young adults have been widely reported. There are also a few reports of accidental poisoning in children from contaminated food. The taste and shape of Datura stramonium makes it unattractive to both man and animals and, therefore, ingestion by children in ignorance of its toxicity is rare. Three such cases are described in this paper. In Saudi Arabia stramonium abuse is unheard of and poisoning of children as a result of food contamination is very unlikely. Cases of ingestion in ignorance are, however, likely to occur frequently since D. stramonium grows in many parts of the country. The doses taken under the circumstances, though toxic, were small. The patients, therefore, suffered mainly the peripheral signs of the anti-cholinergic action of atropine, the principal D. stramonium alkaloid. Central nervous system manifestations and toxic psychosis were minimal in contrast to intentional misuse or accidental poisoning. Due to the special susceptibility of children to atropine toxicity and the relatively small lethal dose (less than or equal to 10 mg), treatment with the specific antidote, physostigmine salicylate, is emphasized for all but the mildest cases, in addition to any symptomatic treatment that might be needed.

Epidemiology of accidental home poisoning in Riyadh (Saudi Arabia)

In a prospective study on 178 cases of accidental home poisoning admitted to the main children's hospital in Riyadh poisoning was found to account for 5.6% of the total annual admissions--greater than any other developing country and approaching Western proportions. The commonest ages were between 1 and 5 years. Drugs accounted for 52% of cases and household products for 46%. This picture also differs from the pattern of poisoning in developing countries and is more akin to that of industrialised countries. The most important factors in aetiology, besides the age of the patient and the underprivileged social class, were the abundance of drugs and household chemicals in the Saudi home, none of them in child proof containers; inappropriate storage; and lack of supervision of children. Cultural factors also contributed. The frequency of poisoning in childhood may be decreased in the long run by improved housing, socioeconomic status, and education. The place and methods of health education, also a long term objective, is discussed. For immediate primary prevention two important legislative measures are proposed: (1) provision of childproof containers of drugs and other chemicals used in the home and (2) banning of over the counter sales of drugs. For more accurate epidemiological data collection, and thereby better preventative planning, a national register of accidental poisoning and other accidents is recommended. Poison information centres are also deemed necessary.

The first febrile convulsion: an analysis of 108 children in Saudi Arabia

In 108 children admitted to the Maternity and Children's Hospital, Riyadh with their first febrile convulsion, clinical course, management and underlying causes were analysed. There was a preponderance of boys (69%) and a mean age of 18.6 months with a peak incidence (82%) between six months and three years. The commonest precipitating conditions were upper respiratory infection and gastroenteritis. Physical findings were confined to those of the primary disease. Routine investigations, including CSF analysis were not helpful. Convulsions were mainly of the simple type, single and symmetrical, and did not last for more than 30 minutes. Two thirds of the children reached hospital within two hours of the onset of their first convulsion, and the remainder up to ten hours after the convulsion had ceased. In only 18 patients did the parents take measures to lower the temperature or revive the child. Management of febrile convulsions is discussed. Since the condition is common and, if repeated, may have serious effects, methods of educating parents are suggested.

The pattern of severe protein-calorie malnutrition in Sudanese children attending a large hospital in The Sudan

One hundred fifty patients suffering from severe protein-calorie malnutrition, admitted in 1 month to the Pediatric wards of Wad Medani Hospital, Sudan, were classified according to the Wellcome classification. Marasmus was the prevailing type. It was common in the 2nd year of life, while kwashiorkor occurred mainly under the age of 12 months. Anthropometric measurements showed that kwashiorkor was an acute disease while marasmus and marasmic kwashiorkor were more chronic. The triceps skinfold was unexpectedly low in kwashiorkor. Of the simple measurements and ratios used for assessing the nutritional status, the head/chest ratio applied ot children over 1 year was not found to be reliable and the weight for head circumference correlated poorly with deficits in other variables. Non of the major clinical features was found to be pathognomonic of any type of severe protein-calorie malnutrition. Megaloblastic anemia was common.

The comprehensive child health care centres in the Sudan

In 1963, Morley initiated the concept of clinics for children under five years old. This paper describes our experience in applying that concept in Omdurman town (Sudan) where existing maternity and child health centres and hospitals in the area were involved in the scheme. It was found necessary to establish a main centre to develop methodology and to provide a specialized training of staff. The medical problems were similar to those described by Morley. The approach to their solution was essentially the same except that we used more professional staff and placed more emphasis on nutrition education than hitherto advocated. It is concluded that, in theory, Morley's concept provides a system of comprehensive child health care which suits the needs of developing countries. But our adaptation of Morley's ideas to existing health structures, even on the small scale we achieved in Omdurman, was difficult because of the high initial and running costs and in view of the long established dichotomy between curative and preventive medicine.