ISSN 1301 - 0883 / E-ISSN 1309 - 3886

  Eastern J Med: 12 (1)
Volume: 12  Issue: 1 - 2007
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1.Metabotropic glutamate receptor 5 antagonist, MPEP, lacks anticonvulsant activity in acute models of epilepsy
Cihan Meral, Atilla Ersen, Mustafa Kul, Bülent Ünay, Rıdvan Akın, Erdal Gölçay
Pages 1 - 5
Evaluation of the effects of different doses of 2-methyl-6-phenylethynyl-pyridine (MPEP), a selective antagonist of mGluR5, in acute models of epilepsy [pentylenetetrazole (PTZ) and maximal electroconvulsive shock (MES)], dosage relations and also whether if this effect is enhanced by conventional antiepileptic drugs. The anticonvulsant properties of MPEP were examined in mice who received MPEP by intracerebroventricular infusion prior to a subcutaneous injection of pentylenetetrazole and maximal electroshock. Evaluations of convulsive seizures caused by PTZ were performed by the loss of righting reflex while convulsive seizures caused by MES were performed by the occurence of tonic hind limb extension in adult mice. There was no significant difference in both groups (PTZ, MES) when compared with the control group. The present results do not support a significant anticonvulsant potential of MPEP on adult mice as a selective antagonist of mGluR5 in convulsive seizures.

2.Antimicrobials utilization and outcomes of neonatal sepsis among patients admitted to a University Teaching Hospital in Malaysia
Ahmed Awaisu, Syed Azhar Syed Sulaiman, Abdulmumin Saad
Pages 6 - 14
Neonatal sepsis is one of the most common reasons for admission to neonatal units in developing countries and it remains a significant cause of neonatal morbidity and mortality. Antimicrobial treatment of patients with sepsis is often predicated on the general principles of appropriate drug use and information extrapolated from other populations, rather than on evidence-based recommendations specific to these patients. Limited information is available about antibiotics use among neonates with suspected or confirmed sepsis in Malaysia and many regions of the world. This study aimed to explore and describe the clinical characteristics of neonatal sepsis; current pattern of antimicrobial use; the clinical outcomes of neonatal sepsis management; and to estimate the acquisition costs of the most commonly used antimicrobial regimens in the management of the condition. We retrospectively reviewed all cases of neonates admitted with sepsis to the Neonatal Intensive Care Unit (NICU) of Hospital Universiti Sains Malaysia; a university-based teaching hospital for one year. Both descriptive and inferential statistics were used for data analysis where appropriate. Of the 121 neonates included in the study, 89 (73.6%) presented with various risk factors for sepsis prior to or at the time of diagnosis and maternal risk factor was the highest reported (37.2%). About 26% of the neonates had positive culture and sensitivity tests. Of these, methicillin-resistant Staphylococcus aureus (MRSA) constituted the most prevalent microbial isolate (22.5%). All the patients received some form of empiric antibiotic therapy and crystalline penicillin G plus gentamicin regimen was the most commonly prescribed empiric therapy (69.4%). There was about 9-fold difference between the acquisition costs of the most widely and the second most widely used regimen (RM 29.32 per patient vs. RM 264.74 per patient). Four patients (3.3%) died during hospitalization in the NICU and 107 (88.4 %) were discharged clinically stable. Early treatment of neonatal sepsis with broad-spectrum antibiotics based on presenting signs and symptoms and clinical history had produced good clinical outcomes. This study has an important implication on guiding policy for developing comprehensive, evidence-based practice guidelines, adherence to which may lead to improved rational antibiotics use, costs reduction and improvement of overall care of patients with neonatal sepsis.

3.Randomised clinical trial of effect of oral nifedipine on pain and healing after hemorrhoidectomy
Yousef Thwayeb
Pages 15 - 20
Hemorrhoidectomy has the best long-term results and is the only effective treatment for symptomatic third and fourth degree hemorrhoids. Patients and doctors consider it a painful operation. Nifedipine reduces the activity of the internal anal sphincter and relieves symptoms in patients with haemorrhoids or anal fissure. The aim of this study was to evaluate the effect of oral nifedipine after haemorrhoidectomy.We randomly assigned 40 consecutive patients admitted for hemorrhoidectomy by Milligan Morgan technique. Group 1 (n=20) is the control group, group 2 (n=20) is the study group. All received habitual treatment; lactulose as stool softener, metronidazole 500 mg three times daily for seven postoperative days, and ketorolac tromethamine as analgesic. Group 2 additionally received oral nifedipine 20 mg twice daily from 2 days before surgery until wound healing. Linear analog scales were used to assess pain. Time to first bowel movement, return to normal activity, complications, and use of additional analgesics were recorded. Patients were reviewed and assessed postoperatively every week for measurement of blood pressure, pulse rate, wound healing and adverse effects until return to work. Patients in the oral nifedipine group had significantly less pain, less analgesics consumption [median 18 (12 - 38) vs 33 (25 - 48)] (P=0,021). Median time to healing the wounds was 28 days (range 14 - 40) in the oral nifedipine group and 40 days (21 - 60) in the control group (P=0,023). Median time to return to work or normal activity was 37.5 days (range 20 - 80) in the oral nifedipine group and 47.5 days (20 - 115) in the control group (P=0,445). There was no significant change in baseline pulse rate or systolic and diastolic blood pressure. Headache occurred in 4 patients who responded to paracetamol. The use of oral nifedipine reduced postoperative pain, analgesic consumption, and promoted earlier wounds healing and return to work. And we suggest its inclusion in routine posthemorrhoidectomy treatment.

4.Study of level of stress and burden in the caregivers of children with mental retardation
Sujata Sethi, Subhash C. Bhargava, Vishal Dhiman
Pages 21 - 24
Mental retardation is one of the most prevalent developmental disabilities. Family is the main source of support for the persons with disabilities in any society. Families experience a great deal of physical and emotional burden whilst caring for such relatives. This study tries to look into the issues such as the impact of severity of mental retardation on the level of stress and burden perceived by the caregivers.

5.Cognitive function and event related potentials in children with type I diabetes mellitus
Ghaydaa A. Shehata, Azza A. Eltayeb
Pages 25 - 31
Type 1 diabetes mellitus is associated with cognitive changes, but the extent of cognition decline depends on age at onset, duration of diabetes and occurrence of attacks of hypoglycemia or ketoacidosis.This study was designed to assess cognitive function in a group of children with type I diabetes mellitus. Forty diabetic children, with mean age at onset of 8.59±2.71 year, were recruited from the Pediatric Department of Assuit University Hospital, Egypt. Forty healthy children matched for age, sex, socioeconomic states were chosen as controls for comparison. Cognition was assessed using the psychometric (Stanford Binet test) and electrophysiologic (Event Related Potentials) tests. Compared to control group, patients reported significant reduction in intelligent quotient, comprehension, abstract visual reasoning, quantitative reasoning, bead memory and total short memory testing for cognitive functions. Prolonged N1, P200, N2 and P300 latencies and reduced P300-N2 amplitude of event related potentials were also reported. Significant negative correlations were identified between in most studied cognitive functions and ketoacidosis or family history of diabetes mellitus. Type I diabetes mellitus and diabetes-related factors are important risks for cognitive deficits in children group of population.

6.Large chondrosarcoma of skull base: an unusual intracranial tumor in a young male
Serhat Avcu, Arzu Turan, Özkan Ünal, Aydın Bora
Pages 32 - 35
A 25-year-old male presented with headache. He was noted to be neurologically intact on physical examination. He had normal laboratory findings. CT and MR imaging showed a large right temporal mass. Radiological diagnosis was cartilaginous tumor arising from the skull base. The patient underwent surgery at another hospital. The histopathologic features were supporting the radiologic diagnosis being evaluated as mixoid type chondrosarcoma. Although intracranial cartillaginous tumors are rare, the diagnosis can be possible with careful radiological analysis.

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