Clinical and microbiological efficacy of MDT in the treatment of diabetic foot ulcers

OBJECTIVE

To assess the clinical and microbiological efficacy of maggot debridement therapy (MDT) in the management of diabetic foot ulcers unresponsive to conventional treatment and surgical intervention.

METHOD

Consecutive diabetic patients with foot wounds presenting at the vascular surgery unit and the diabetic foot unit of Alexandria Main University Hospital were selected for MDT. Lucilia sericata medicinal maggots were applied to the ulcers for three days per week. Changes in the percentage of necrotic tissue and ulcer surface area were recorded each week over the 12-week follow-up period. Semiquantitative swab technique was used to determine the bacterial load before and after MDT.

RESULTS

The sample comprised 10 patients with 13 diabetic foot ulcers. The mean baseline ulcer surface area was 23.5cm2 (range 1.3-63.1), and the mean percentage of necrotic tissue was 74.9% (range 29.9-100). Complete debridement was achieved in all ulcers in a mean of 1.9 weeks (range 1-4). Five ulcers (38.5%) were completely debrided with one three-day MDT cycle. The mean reduction in ulcer size was significant at 90.2%, and this occurred in a mean of 8.1 weeks (range 2-12). The mean weekly reduction in ulcer size was 16.1% (range 8.3-50). Full wound healing occurred in 11 ulcers (84.6%) within a mean of 7.3 weeks (range 2-10). The bacterial load of all ulcers reduced sharply after the first MDT cycle to below the 10(5) threshold, which facilitates healing.

CONCLUSION

The results highlight the potential benefits of MDT in diabetic wound care in developing countries. MDT was proved to be a rapid, simple and efficient method of treating these ulcers.

Ultrastructural observations on the elusive subtegumental cells of the viviparous gill monogenean, Macrogyrodactylus clarii

The ultrastructure of the tegument, including putative subtegumental cells, of the monogenean gill parasite Macrogyrodactylus clarii is described for the first time. The lateral cells are secretory in nature and can be classified into four types: T1 producing elongated, electron-dense, bodies (t1); T2 manufacturing electron-lucent vesicles (t2); T3 producing thin, dump-bell shaped, electron-dense bodies (t3); and T4 containing lyzosome-like inclusions. Morphologically, the T2 cells resemble those described as presumptive vitelline cells in other gyrodactylids whereas the T1, T3 and T4 cells are reported for the first time in gyrodactylids. The close similarity between the secretory inclusions of the outer syncytial layer of the tegument and those found in the T1, T2 and T3 cells suggests that these cells represent the enigmatic tegumental cell bodies rather than vitelline cells. The possible functions of the distinctive features of the tegument of M. clarii are discussed.

Developing an integrated organ/system curriculum with community-orientation for a new medical college in jazan, saudi arabia

BACKGROUND

Jazan province is located in the south-west of the Kingdom of Saudi Arabia. The province is offlicted with a wide spectrum of diseases and therefore have a special need for more health services. The Faculty of Medicine at Jazan has been following the traditional curriculum since its inception in 2001. The traditional curriculum has been criticized because of the students inability to relate what they learned in the basic sciences to medicine, thus stifling their motivation. It was felt that much of what was presented in preclinical courses was irrelevant to what the doctor really needed to know for his practice. The College therefore, decided to change to an integrated curriculum.

DESIGN

The study was conducted in 2004-2005 in the Faculty of Medicine, Jazan University. It began with a literature survey/search for relevant information and a series of meetings with experts from various institutions. A Curriculum Committee was formed and a set of guiding principles was prepared to help develop the new curriculum. A standard curriculum writing format was adopted for each module. It was decided that an independent evaluation of the new curriculum was to be done by experts in medical education before submission for official approval. There were several difficulties in the course of designing the curriculum, such as: provision of vertical integration, the lack of preparedness of faculty to teach an integrated curriculum, and difficulties inherent in setting a truly integrated examination.

CURRICULUM

The program designed is for 6 years and in 3 phases; pre-med (year 1), organ/system (years 2 and 3), and clinical clerkship (years 4, 5, and 6). This is to be followed by a year of Internship. The pre-med phase aims at improving the students' English language and prepare them for the succeeding phases. The organ/ system phase includes the integrated systems and the introductory modules. The curriculum includes elective modules, early clinical training, behavioral sciences, medical ethics, biostatistics, computer practice, and research methods. The curriculum provides active methods of instruction that include: small group discussion/ tutorials, problem-based learning (PBL), case-study/ clinical presentations, seminars, skills practice (clinical skill lab), practical, demonstration, and student independent learning. Methods of evaluating students include continuous and summative assessment.

CONCLUSION

The new curriculum adopted by the Jazan Faculty of Medicine is an integrated, organ/ system based, community-oriented, with early clinical skills, elective modules, and innovative methods of instructions.

Functional and morphological study of cultured pancreatic islets treated with cyclosporine

Cyclosporine A (CsA), a potent immunosuppressive drug, has been found to induce glucose intolerance through its toxic effect on the endocrine pancreas. It is not exactly known whether CsA has a direct effect on the endocrine pancreas or induces its effect indirectly. The present study was therefore undertaken to examine the function and morphology of isolated pancreatic islets when they are directly exposed in vitro to CsA. Pancreatic islets were isolated from adult male Lewis rats using collagenase ductal perfusion technique. The islets were separated with the discontinuous Ficoll gradient technique and further purified by hand picking of the non-islet tissue. The islets were cultured in RPMI-1640, pH 7.4 and maintained at 37 degrees C in a humid atmosphere of 5% (v/v) carbon dioxide in air. Cyclosporine was added to the culture medium to give a final concentration of 1 microg/ml (therapeutic dose), 5 microg/ml (toxic dose), or vehicle (control). Islets were harvested at 1, 4 and 10 days of culture and processed for functional or histological study. The functional study of the islets cultured with 1 microg/ml CsA showed insulin and C-peptide contents similar to those of the control islets. The islets cultured with 5 microg/ml CsA showed a marked decrease in insulin and C-peptide contents. Glucose-dependent insulin release was variable. C-peptide release was lower than that of the control following both the therapeutic and toxic doses of CsA. Phase contrast microscopy showed that the islets cultured with 1 microg/ml CsA were mostly normal looking with a well-defined regular periphery; a few islets had ill-defined or irregular peripheries. The islets cultured with 5 microg/ml CsA had ill-defined irregular peripheries at 1 day, and were dense and forming clumps at 4 and 10 days following culture. There was a decrease in the islet number following the therapeutic dose; the decrease was more following the toxic dose of CsA. The islet diameters increased after the therapeutic dose, but slightly decreased following the toxic dose of CsA. Islets showed a weakly positive immunoperoxidase reaction for insulin that was weaker following the toxic dose of CsA. It is concluded that CsA has a direct effect on B-cells that was proved by the functional and morphological changes seen in the pancreatic islets cultured in vitro.

Neuromusculature of Macrogyrodactylus congolensis, a monogenean skin parasite of the Nile catfish Clarias gariepinus

Phalloidin fluorescence technique, enzyme cytochemistry and immunocytochemistry, in conjunction with confocal scanning laser microscopy, were used to describe the neuromusculature of the monogenean skin parasite Macrogyrodactylus congolensis from the Nile catfish Clarias gariepinus. The body wall muscles are composed of an outer layer of compactly arranged circular fibres, an intermediate layer of paired longitudinal fibres and an inner layer of well-spaced bands of diagonal fibres arranged in two crossed directions. The central nervous system consists of paired cerebral ganglia from which three pairs of longitudinal ventral, lateral and dorsal nerve cords arise. The nerve cords are connected at intervals by many transverse connectives. Both central and peripheral nervous systems are bilaterally symmetrical and better developed ventrally than laterally and dorsally. Structural and functional correlates of the neuromusculature of the pharynx, haptor and reproductive tracts were examined. Results implicate acetylcholine, FMRFamide-related peptides and serotonin in sensory and motor function. The results were compared with those of Macrogyrodactylus clarii, a gill parasite of the same host fish C. gariepinus.

Effect of thawing rate and post-thaw culture on the cryopreserved fetal rat islets: Functional and morphological correlation

The ability of the fetal pancreatic islet cells to multiply rendered them a potential tissue for transplantation studies to cure diabetes. A bank of fetal islets could be created with proper storage in liquid nitrogen. The aim of this study is to evaluate the effect of thawing rate and post-thaw culture on the structural and functional integrity of isolated cryopreserved islets of rat fetuses. Fetal rat islets were isolated by the collagenase digestion, cultured for three days, and then cryopreserved using dimethylsulphoxide as cryoprotectant and the step-rate cooling to -40 degrees C before immersing them in liquid nitrogen. The islets were thawed by the slow or fast warming rates using hyperosmolar sucrose solution and then cultured for 1 or 2 days. Insulin and C-peptide contents of the slow thawed islets were higher than those of the control. In the fast thawed islets the contents were similar to those of the control. Insulin and C-peptide release in response to glucose for the slow thawed islets were lower than those of the control and in the fast thawed islets they were similar to that of the control. Histological examination showed irregular periphery and fragmented central part of the large slowly thawed islets, which showed also variable immunohistochemical reaction to anti-insulin serum, ranging from strongly positive reaction to markedly weak reaction. Fast thawed islets showed mostly regular periphery and their reaction to the anti-insulin serum was slightly weaker than that of the control islets. It was concluded that fast thawing and post-thaw culture is much better than slow thawing, as indicated by nearly normal insulin and C-peptide content and release and intact structural integrity.

Structural study on cultured isolated fetal rat pancreatic islets

OBJECTIVE

To perform a morphometric and structural study of the cultured isolated fetal rat pancreatic islets.

METHODS

Islets of the fetal rat pancreas, aged 22 days were isolated by the standard procedure of collagenase digestion and culture technique. The islets were cultured for 1, 2, 3, 4 and 5 days. The islets were counted under a dissecting microscope and islet diameter and purity were measured under a phase contrast microscope fitted with a calibrated grid. The islet specimens were fixed in buffered neutral formalin, dehydrated in alcohol and embedded in parablast. Sections were stained with hematoxylin and eosin. This study was conducted in King Fahd Medical Research Center, Faculty of Medicine, King Abdul-Aziz University, Kingdom of Saudi Arabia, during 2003 and 2004.

RESULTS

The purity of the cultured islets gradually increased with time and was significantly different between the cultured groups. The number of the cultured islets gradually decreased with time. The islet diameter gradually increased with culture period. The islet purity and diameter were significantly different between the cultured groups. Parablast sections stained with hematoxylin and eosin showed that the shape and histological structure of the cultured islets were intact.

CONCLUSION

The results of the present work represent an extensive morphometric structural study of isolated cultured fetal islets. The culture islet diameter and purity showed gradual increase with culture period, while the islet number showed gradual decrease.

Neuromusculature of Macrogyrodactylus clarii, a monogenean gill parasite of the Nile catfish Clarias gariepinus in Egypt

Phalloidin fluorescence technique, enzyme cytochemistry and immunocytochemistry in conjunction with confocal scanning laser microscopy have been used for the first time to describe the nervous and muscle systems of the viviparous monogenean gill parasite, Macrogyrodactylus clarii. The gross spatial arrangement of muscle and associated cholinergic, peptidergic and aminergic innervations has been examined. The central nervous system (CNS) consists of paired cerebral ganglia from which emanate three pairs of longitudinal ventral, lateral and dorsal nerve cords, connected at intervals by transverse connectives. The CNS is better developed ventrally than dorsally or laterally, and has the strongest reactivity for all neuroactive substances examined. Structural and functional correlates of the neuromusculature of the pharynx, haptor and reproductive tracts have been examined. Results implicate acetylcholine, FMRFamide-related peptides (FaRPs) and serotonin in sensory and motor function in this monogenean, although confirmatory physiological data are obviously required.

Variant of the coracobrachialis muscle with a tunnel for the median nerve and brachial artery

This case report documents a variation in the insertion of the coracobrachialis muscle of the right arm of an adult male cadaver of unknown age. In addition to the normal insertion of the coracobrachialis muscle into the middle of the medial border of the humerus, an additional slender tendon passed inferiorly, crossing anterior to the median nerve and brachial artery before attaching to the medial epicondyle of the humerus. Most of the proximal part of the tendon gave rise to an aponeurotic expansion that inserted into the distal medial border of the humerus. The tendinous insertion and aponeurotic expansion may represent a variant of the coracobrachialis longus (Wood's) muscle and the internal brachial ligament, respectively. The median nerve and brachial artery traversed a tunnel bounded by the additional tendon and aponeurotic expansion as well as the usual humeral insertion of the coracobrachialis muscle. The clinical implication of this variation is that it may be a cause of median nerve entrapment and brachial artery compression.

Identification of 100 KDa protein in sera of mice-treated with Cu(II) complex with superoxide dismutase-mimetic activity

The protein profile of sera isolated from mice pre-treated with Cu(II) complex of Girard T with superoxide dismutase (SOD)-mimetic activity was analyzed using SDS-PAGE. This complex was intraperitoneally administered (10 mg/Kg body weight) to Swiss albino mice. The resolved polypeptides showed a new sharp band at 100 KDa against which a polyclonal antibody was raised in rabbit. Sera of rabbit anti-100 KDa protein was used as a powerful probe for the detection of 100 KDa protein isolated from sera of treated mice. Western blot assays revealed a strong reactive polypeptide band at 100 KDa in sera of the mice, but no cross reaction was observed with sera of normal mice. The identification of purified polypeptide was confirmed by different characterization experiments.

Chaetotaxy of the monogeneans Macrogyrodactylus clarii and m. congolensis from the gills and skin of the catfish clarias gariepinus in Egypt, with a note on argentophilic elements in the nervous system

A comparison has been made between the chaetotaxy of the gyrodactylid monogeneans Macrogyrodactylus clarii Gussev, 1961 and M. congolensis (Prudhoe, 1957) Yamaguti, 1963 from the gills and skin, respectively, of the catfish Clarias gariepinus (Burchell) from the river Nile in Egypt. Bilaterally arranged argentophilic structures on the surface of these parasites are presumed to be sensilla and are more abundant in M. clarii than in M. congolensis especially on the ventral surface (124 vs. 66). In both species these sensilla are concentrated on the head lobes and in the pharyngeal region, but there are features of the sensilla patterns that can be used to distinguish the two species. Comparison is made with sensilla patterns of other gyrodactylids. A system of cells and dendritic processes, most probably part of the nervous system, also has an affinity for silver in the two species. There are no previous records of extensive argentophilic elements in the nervous systems of monogeneans.

Two bellies of the coracobrachialis muscle associated with a third head of the biceps brachii muscle

Reports that describe the abnormalities and complexities of the anatomy of the arm are important with regard to surgical approaches. This case study reports a combined abnormal form of the coracobrachialis and biceps brachii muscles of the left arm of an adult male cadaver that was detected during the educational gross anatomy dissections of embalmed cadavers. The coracobrachialis muscle demonstrated two bellies which formed shortly inferior to its origin from the coracoid process of the scapula. One belly inserted into the middle of the antero-medial surface of the humerus, whereas the other belly inserted into the medial head of the triceps brachii muscle. The musculocutaneous nerve passed between the two bellies, giving a separate branch to each. We suggest that the two bellies of the coracobrachialis muscle may represent the incompletely fused short heads of the ancestral muscle. The biceps brachii muscle showed a third head, which originated mainly from the antero-medial surface of the humerus and partially from an aponeurosis belonging to the medial head of the triceps brachii muscle. These observations were confined to the left upper limb and were not accompanied by any other abnormality.

Effect of allergen-specific immunotherapy on interleukin-4, interleukin-5 and interferon-gamma mRNA expression in the nasal mucosa of rats with allergic rhinitis

To elucidate the mechanism of immunotherapy, we tested the effect of ovalbumin and ovalbumin-pullulan conjugate immunotherapy on the expression of interleukin (IL)-4, IL-5 and interferon-gamma (IFN-gamma) mRNA in the nasal mucosa of sensitized rats. Forty-five rats were injected with ovalbumin intraperitoneally on three consecutive days and later were exposed to ovalbumin aerosol. The rats were injected intradermally, on six consecutive days, with saline, ovalbumin or ovalbumin-pullulan conjugate. Later, nasal mucosa was obtained and reverse transcription-polymerase chain reaction (RT-PCR) was performed. Nasal responses and specific immunoglobulin E (IgE) were measured. Although the immunotherapy significantly decreased nasal airway resistance, dye leakage and histamine content in nasal irrigation after allergen challenge, no significant difference was found in IL-4 and IL-5 mRNA expression or in specific IgE level among the three groups. We conclude that in this allergic model, the improvement of nasal responses after immunotherapy was the result of a mechanism other than decrease of T-helper 2 (Th2) cytokines.

Antitumor activities of vanadium(IV), manganese(IV), iron(III), cobalt(II) and copper(II) complexes of 2-methylaminopyridine

The effect of Cu(II), Mn(IV), Fe(III), V(IV) and Co(II) complexes of 2-methylaminopyridine (L) having superoxide dismutase (SOD)-like activities on Ehrlich ascites carcinoma (EAC) cells was studied. Each of these complexes was intraperitoneally administered (10 mg/kg body weight for 9 days) to Swiss albino mice implanted intraperitoneally with 1 x 10(6) EAC cells. Six days after the last treatment the EAC cells were harvested using a heparinized syringe. The volume of EAC cells and EAC cell viability as well as changes in the levels of tumor cell enzyme activities of SOD, catalase, glutathione peroxidase (GSH-Px), glutathione reductase (GSH-R) and glucose-6-phosphate dehydrogenase (G6PD) were tested to examine the antitumor effects of these complexes. Both tumor volume and tumor cell viability were significantly lowered in complex-treated mice. After tumor transplantation and treatment with the complexes, the activities of GSH-Px and GSH-R were significantly lowered while SOD and G6PD activities were increased in EAC cells compared to their levels in EAC cells harvested from saline-treated mice.

Expression of interferon-gamma, interleukin-4 and interleukin-5 mRNA in the nasal mucosal membrane of rats with allergic rhinitis

The production of immunoglobulin E (IgE) antibody is largely dependent on the ratio between interleukin-4 (IL-4) (a T helper 2 (Th2)-type cytokine) and interferon-gamma (IFN-gamma) (a T helper 1 (Th1)-type cytokine). Interleukin-5 (IL-5) (also a Th2-type cytokine) is an important eosinophil differentiation factor and also co-stimulates B-cell growth and differentiation. The present study was designed to evaluate and compare the expression of IFN-gamma, IL-4 and IL-5 mRNA in the nasal mucosal membrane of sensitized Brown-Norway (BN) rats. Fourteen BN rats were divided into two groups: non-sensitized (control) and sensitized. The sensitized group was injected with ovalbumin (OA) intraperitoneally on three consecutive days. Twenty-one days later, rats were exposed to 1% OA aerosol. Twenty-four hours after exposure to aerosol, nasal mucosa was extracted from both groups and reverse transcriptase-polymerase chain reaction (RT-PCR) was performed. The densities of the bands of IL-4, IL-5 and IFN-gamma mRNA were expressed as percentages against beta-actin mRNA. Our results showed that the mean values for IL-4 and IL-5 mRNA were increased significantly in sensitized rats compared with control rats. In contrast, the mean value for IFN-gamma mRNA was significantly lower in sensitized rats compared with those of the control group. Our data therefore suggest that sensitization of rat nasal mucous membranes results in the predominant expression of Th2-type cytokines.

Superoxide dismutase activities in serum and white blood cells of patients with some malignancies

Superoxide dismutase (SOD) activity has been estimated in serum and leukocytes isolated from adults and children with acute lymphoblastic leukemia (ALL), non-Hodgkin lymphoma (NHL), Hodgkin's disease (HD) and neuroblastoma. Superoxide dismutase levels in leukocytes isolated from adult patients with HD, ALL and NHL were significantly higher than the corresponding control values. Serum SOD activity of adult patients with ALL and NHL was significantly decreased compared to the normal value, while its activity was not significantly changed in patients with HD. Marked deficiencies of leukocyte SOD levels in children with ALL, NHL, HD and neuroblastoma were found. There were no apparent differences in serum SOD activity in children suffering from ALL, NHL, HD and neuroblastoma. It is concluded that the assay of leukocyte SOD can be used to differentiate between HD and NHL in both adults and children.

The development of the human phreno-oesophageal membrane

23 human fetal diaphragms were used to study the structural changes of the phreno-oesophageal membrane at the different prenatal ages. 2 human adult diaphragms were used for comparison. This membrane was found to be formed by both the superior and inferior diaphragmatic fasciae. The phreno-oesophageal membrane was mainly formed by the superior fascia at early stages of development and by the inferior at later ages. The collagenous and elastic components of this membrane increased gradually with age. The crural muscle fibres forming the boundary of the oesophageal hiatus at 10 weeks showed gradual regression and was replaced by tendinous fibres. The latter formed secondary insertion in addition to the primary one in the central tendon. The strip of striated muscle, which was occasionally present at the lower end of the oesophagus, could be attributed to failure of recession of the crural muscle bordering the hiatus. The functional significance of the phreno-oesophageal membrane in the process of deglutition and vomiting and for prevention of hiatus hernia is discussed.

Ultrastructural observations on the anterior adhesive apparatus in the monogeneans Dactylogyrus amphibothrium Wagener, 1857 and D. hemiamphibothrium Ergens, 1956

The light microscope and the transmission electron microscope have revealed that the anterior adhesive apparatus of Dactylogyrus amphibothrium and that of D. hemiamphibothrium are similar and composed of three kinds of gland cell, one producing rod-shaped bodies (secretion S1), one producing spherical bodies (S2), and the third producing electronlucent vesicles (S3). In the cytoplasm of G1 gland cells each rod-shaped body is enclosed by a single layer of microtubules but no microtubules are associated with S2 and S3 bodies. The possible functions of these microtubules are discussed. The ducts which extend anteriorly from all three kinds of gland cell converge on and open into six adhesive sacs, situated ventrally on the distal extremities of the head lobes. Each adhesive sac is supplied with at least one gland duct from each type of gland cell and is lined by a special tegument bearing dense microvilli and a few cilia which may have a sensory function. It has been shown that during the attachment of the head region, these sacs are everted to expose the enclosed microvilli and duct openings and secretions S1 and S2 are extruded.