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Background: Between food and medicine, nutraceuticals are widely used in human health for the prevention and treatment of various diseases. This study aims to determine the cytoprotective effects of Anethum gravelons fruit extract (AGFAE) on castor oil-induced diarrhea in rats due to its phytochemical and antioxidant properties., Methods: Male rats were divided into six groups of six animals each: Control (C), Castor oil (CO), CO + different doses of AGFAE (50, 100, and 200 mg/kg, b.w., p.o.), and the CO + loperamide group (LOP, 10 mg/kg, b.w., p.o.)., Key Results: In vitro, the chemical composition of aqueous Dill fruit extract showed strong antioxidant activity, with a high content of total polyphenols, flavonoids, and tannins. In our in vivo studies, pre-treatment with AGFAE reduced malondialdehyde and hydrogen peroxide levels and maintained normal activity of enzymatic and non-enzymatic antioxidants in the gastric and intestinal mucosa. In addition, we found that AGFAE prophylaxis improved the stability of many plasma biochemical parameters altered by castor oil intoxication, such as C-reactive protein concentrations and alkaline phosphatase activities., Conclusions & Inferences: We suggest that AGFAE phenolic compounds had significant protection against diarrhea involving several mechanisms such as reducing hypersecretion, peristaltic, inflammation, and preserving the endogenous antioxidant levels., (© 2024 The Author(s). Neurogastroenterology & Motility published by John Wiley & Sons Ltd.)

Lipidomics is focusing on the screening of lipid species in complex mixtures using mass spectrometry-based approaches. In this work, we aim to enhance the intestinal lipidome coverage within the Oligo-Mouse-Microbiota (OMM 12 ) colonized mouse model by testing eight mobile phase conditions on five reversed-phase columns. Our selected mobile phase modifiers included two ammonium salts, two concentrations, and the addition of respective acids at 0.1 %. We compared two columns with hybrid surface technology, two with ethylene bridged hybrid technology and one with core-shell particles. Best performance was attained for standards and intestinal lipidome, using either ammonium formate or acetate in ESI(+) or ammonium acetate in ESI(-) for all column technologies. Notably, a concentration of 5 mM ammonium salt showed optimal results for both modes, while the addition of acids had a negligible effect on lipid ionization efficiency. The HST BEH C18 column improved peak width and tailing factor parameters compared to other technologies. We achieved the highest lipid count in colon and ileum content, including ceramides, phosphatidylethanolamines and phosphatidylcholines, when using 5 mM ammonium acetate in ESI(-). Conversely, in ESI(+) 5 mM ammonium formate demonstrated superior coverage for diacylglycerols and triacylglycerols., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Purpose: The optimal timing of surgery after traumatic rotator cuff tears (RCT) is unclear, with its impact on functional outcomes under debate. This study aimed to review functional outcomes after RCT repair in patients who underwent early vs delayed surgery at our unit., Methods: This was single-centre retrospective evaluation. Patients with an acute traumatic RCT that underwent repair between 2017 and 2019 and had local follow-up were included and placed into two groups: early surgery (within 6 months from injury) and delayed surgery (more than 6 months from injury). Patient demographics, RCT data and pre- and post-operative (after 12 months) Oxford Shoulder Score (OSS) were extracted from medical records. Data was analysed to compare OSS scores between groups, as well as the effect of cuff tear sizes on OSS scores., Results: Forty-nine patients were included in the analysis (15 early, 34 delayed). There were no significant differences in age, sex or cuff tear sizes between groups. No difference was identified in the mean post-operative OSS between early vs delayed groups (40.9 ± 6.34 vs 40.5 ± 7.65, p = 0.86). The mean improvement in OSS after surgery was also similar between groups (22.5 ± 7.81 vs 20.97 ± 7.19, p = 0.498). Having a large or massive RCT did not worsen OSS compared to small or medium RCT (p = 0.44), even when stratified by early or delayed surgery., Conclusion: Delayed surgery for traumatic RCT greater than 6 months from injury did not negatively impact long-term functional outcomes at our unit. Patients should be reassured as applicable before surgery in the event of prolonged or unavoidable delays., (© 2024. The Author(s) under exclusive licence to SICOT aisbl.)

The present study aims to evaluate the protective effect of Crataegus azarolus berries decoction extract (CAB-DE) against acetic acid-induced ulcerative colitis as well as the mechanisms implicated in such protection. Adult male Wistar rats were separated into seven groups: Control (H 2 O), acetic acid (AA), AA + various doses of CAB-DE (100, 200, and 400 mg/kg, b.w.,p.o. ), and AA + sulfasalazine (100 mg/kg, b.w.,p.o. ) or gallic acid (50 mg/kg, b.w.,p.o. ) during 10 days. All rats were kept fasting overnight and ulcerative colitis was induced by rectal infusion of AA (300 mg kg -1 , b.w. ) (3%, v/v, 5 mL kg -1 b.w ), for 30 s. The colon was rapidly excised and macroscopically examined to measure ulcerated surfaces and the ulcer index. In vitro, we found that CAB-DE exhibited a high antioxidant activity against DPPH radical (IC 50 pretreatment with CAB-DE significantly protected the colonic mucosa against AA-induced damage by stimulating mucus secretion, reducing ulcer index as well as histopathological changes. Also, CAB-DE limited the oxidative status induced by AA in the colonic mucosa, as assessed by MDA and H , pretreatment with CAB-DE significantly protected the colonic mucosa against AA-induced damage by stimulating mucus secretion, reducing ulcer index as well as histopathological changes. Also, CAB-DE limited the oxidative status induced by AA in the colonic mucosa, as assessed by MDA and H 2 O 2 increased levels and the depletion of both enzymatic activities and non-enzymatic levels. In addition, AA intoxication increased iron and calcium levels in colonic mucosa and plasma, while CAB-DE pretreatment regulated all intracellular mediators deregulation and significantly reduced inflammatory markers such as CRP (1.175 ± .04 ─ .734 ± .06 μg/dl) and ALP (161.53 ± 5.02 ─ 98.60 ± 4.21 UI/L) levels. We suggest that CAB-DE protected against AA-induced ulcerative colitis due in part to its antioxidant and anti-inflammatory properties., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

The current study investigated the possible mechanisms of aqueous extract Salvia officinalis flowers (SF-AE) and its protective effects against hepatorenal toxicities produced by simultaneous acute administration of ethanol (EtOH)/castor oil (CO). Healthy male rats (N = 50) were separated into five equal groups: control, Ethanol (EtOH) + Castor oil (CO), doses of increasing orders of SF-AE (50, 100, and 200 mg/kg, b.w., p.o.) during 15 days. Liver and kidney injuries were induced by EtOH (4 g/kg, b.w., p.o.) combined with CO (5 mL/kg, b.w., p.o.). Compared to the control group, SF-AE pretreatment protected against simultaneous administration of EtOH and CO-caused serious histological alterations in liver and kidney tissues. SF-AE also reversed liver and kidney biochemical parameters and lipid profile alterations. More importantly, SF-AE significantly reduced the malondialdehyde (MDA) level and counteracted the depletion of both enzymatic and non-enzymatic antioxidants. SF-AE also prevents against inflammation induced by EtOH combined with CO, expressed by the rise of inflammation biomarkers (C-reactive protein: CRP and alkaline phosphatase: ALP). Additionally, combined EtOH intoxication and CO poisoning exerted an increase in H 2 O 2 , free iron and calcium levels. Impressively, SF-AE treatment regulated levels of these studied intracellular mediators in a dose-dependent manner. In conclusion, SF-AE can potentially improve liver and kidney injuries associated with biochemical parameter deregulations, possibly by controlling oxidative stress and inflammation., (© 2023 The Authors. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.)

Paracetamol/acetaminophen (N-acetyl-p-aminophenol, APAP) is a top selling analgesic used in more than 600 prescription and non-prescription pharmaceuticals. To study efficiently some of the potential undesirable effects associated with increasing APAP consumption (e.g., developmental disorders, drug-induced liver injury), there is a need to improve current APAP biomonitoring methods that are limited by APAP short half-life. Here, we demonstrate using high-resolution mass spectrometry (HRMS) in several human studies that APAP thiomethyl metabolite conjugates (S-methyl-3-thioacetaminophen sulfate and S-methyl-3-thioacetaminophen sulphoxide sulfate) are stable biomarkers with delayed excretion rates compared to conventional APAP metabolites, that could provide a more reliable history of APAP ingestion in epidemiological studies. We also show that these biomarkers could serve as relevant clinical markers to diagnose APAP acute intoxication in overdosed patients, when free APAP have nearly disappeared from blood. Using in vitro liver models (HepaRG cells and primary human hepatocytes), we then confirm that these thiomethyl metabolites are directly linked to the toxic N-acetyl-p-benzoquinone imine (NAPQI) elimination, and produced via an overlooked pathway called the thiomethyl shunt pathway. Further studies will be needed to determine whether the production of the reactive hepatotoxic NAPQI metabolites is currently underestimated in human. Nevertheless, these biomarkers could already serve to improve APAP human biomonitoring, and investigate, for instance, inter-individual variability in NAPQI production to study underlying causes involved in APAP-induced hepatotoxicity. Overall, our findings demonstrate the potential of exposomics-based HRMS approach to advance towards a better precision for human biomonitoring., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The continued exploration of the diversity of lactic acid bacteria in little-studied ecological niches represents a fundamental activity to understand the diffusion and biotechnological significance of this heterogeneous class of prokaryotes. In this study, Lactiplantibacillus plantarum ( Lpb. plantarum ) strains were isolated from Tunisian vegetable sources, including fermented olive and fermented pepper, and from dead locust intestines, which were subsequently evaluated for their antimicrobial activity against foodborne pathogenic bacteria, including Escherichia coli O157:H7 CECT 4267 and Listeria monocytogenes CECT 4031, as well as against some fungi, including Penicillium expansum , Aspergilus niger , and Botrytis cinerea . In addition, their resistance to oro-gastro-intestinal transit, aggregation capabilities, biofilm production capacity, adhesion to human enterocyte-like cells, and cytotoxicity to colorectal adenocarcinoma cell line were determined. Further, adhesion to tomatoes and the biocontrol potential of this model food matrix were analyzed. It was found that all the strains were able to inhibit the indicator growth, mostly through organic acid production. Furthermore, these strains showed promising probiotic traits, including in vitro tolerance to oro-gastrointestinal conditions, and adhesion to abiotic surfaces and Caco-2 cells. Moreover, all tested Lpb. plantarum strains were able to adhere to tomatoes with similar rates (4.0-6.0 LogCFU/g tomato). The co-culture of LAB strains with pathogens on tomatoes showed that Lpb. plantarum could be a good candidate to control pathogen growth. Nonetheless, further studies are needed to guarantee their use as probiotic strains for biocontrol on food matrices.

Inflammatory bowel disease is associated with multiple extraintestinal disorders, including hepato-nephrological disruptions. The aim of this study was to evaluate the hepato-nephroprotective effect of Salvia officinalis leaf decoction extract (SLDE) on acetic acid (AA)-induced colitis accompanied with liver and kidney injuries. Wistar albinos rats were pretreated with SLDE (50, 100, and 200 mg kg -1 , b.w., p.o.) during 10 days and intoxicated for 24 h by acute rectal administration of AA (3%, v/v, 5 mL kg -1 , b.w.). Our results showed that S. officinalis treatment protected against AA-induced liver and kidney injuries by plasma transaminase activities and preservation of the hepatic and renal tissue structures. The level of high-density lipoprotein-cholesterol was also reverted back to near normalcy by treatment. Lipid peroxidation was decreased significantly by officinal sage supplementation. Treatment with SLDE increased enzymatic (superoxide dismutase, catalase, and glutathione peroxidase) and nonenzymatic (-SH groups and reduced glutathione) antioxidants in liver and kidney tissues. Also, SLDE treatment significantly protected against inflammation markers and reversed all intracellular mediator perturbations. This study suggests that the S. officinalis has a beneficial effect in controlling kidney and liver injuries by reducing lipid peroxidation and increasing antioxidant enzyme activities and nonenzymatic contents, which reduce the risk of developing extraintestinal complications.

The spread of pathogenic and food spoilage microorganisms through the food chain still faces major mitigation challenges, despite modern advances. Although multiple cleaning and disinfection procedures are available for microbial load reduction in food-related settings, microbes can still remain on surfaces, equipment, or machinery, especially if they have the ability to form biofilms. The present study assessed the biofilm-forming properties of pure and mixed cultures of foodborne and spoilage bacteria ( Listeria monocytogenes , Enterococcus faecalis , Aeromonas hydrophila , Brochothrix thermosphacta ), using polystyrene and stainless steel contact surfaces. Subsequently, the antimicrobial and antibiofilm properties of Thymus vulgaris and Cymbopogon flexuosus essential oils-EOs-were evaluated against these bacteria. Moreover, in silico prediction of the absorption and toxicity values of the EOs' major constituents was also performed, perceiving the putative application in food-related settings. Overall, biofilm formation was observed for all microbes under study, at different temperatures and both contact surfaces. In polystyrene, at 25 °C, when comparing pure with mixed cultures, the combination Listeria-Aeromonas achieved the highest biofilm biomass. Moreover, at 4 °C, increased biofilm formation was detected in stainless steel. Regarding thyme, this EO showed promising antimicrobial features (especially against A. hydrophila, with a MIC of 0.60 µg/µL) and antibiofilm abilities (MBEC of 110.79 µg/µL against L. monocytogenes, a major concern in food settings). As for lemongrass EO, the highest antimicrobial activity, with a MIC of 0.49 µg/µL, was also observed against L. monocytogenes . Overall, despite promising results, the in situ effectiveness of these essential oils, alone or in combination with other antimicrobial compounds, should be further explored.

Background: In high-energy femoral shaft fractures (FSFs), ipsilateral femoral neck fractures (FNFs) can be missed by conventional trauma computed topography (CT) imaging, resulting in increased treatment costs and patient complications. Preliminary evidence suggests that a rapid, limited-sequence pelvis and hip magnetic resonance imaging (MRI) protocol can identify these occult fractures and be feasibly implemented in the trauma setting. This study aims to establish the economic break-even point for implementing such an MRI protocol in all high-energy FSFs., Methods: We used an adapted break-even economic tool to determine whether the costs of a targeted MRI protocol can be offset by cost-savings achieved through prevention of missed fractures (thus avoiding prolonged admission and re-operation). Sensitivity analyses were performed to demonstrate reliability of the economic modelling across a range of assumptions., Results: Assuming a baseline of FNFs missed on CT of 12%, an MRI cost of £129 and cost of treating each missed FNF of £2457.5, the equation yielded a break-even rate of 7% and absolute risk reduction (ARR) of 5%, indicating that for every 100 FSFs, MRI would need to diagnose 5 of the 12 missed FNF to be economically viable (number needed to treat (NNT)=20). Economic viability was maintained even at double the cost of MRI, while increasing the cost of treating each complication served to reduce the ARR further, increasing cost-savings., Conclusion: A rapid, limited-sequence MRI protocol to exclude occult ipsilateral FNFs in all high-energy FSFs appears to be economically justified measure. Further research exploring the feasibility of such a protocol, as well as the role of intra-operative fluoroscopy in this context, is required., (Copyright © 2022. Published by Elsevier Ltd.)

Introduction: The COVID-19 pandemic has brought a series of new challenges to the management of surgical patients. The consent process relies on a foundation of open and non-coerced discussion between clinician and patient, which includes all the potential risks of surgery. This must be updated to incorporate the additional risks of surgery during the pandemic including infection with the SARS-CoV-2 and increased risks of complications with the potential requirement for intensive care support., Aim: The aim of this multi-cycle quality improvement project was to ensure all patients were fully informed of the risks of developing COVID-19 and the possible need for intensive care unit (ICU) support., Methods: We investigated the quality of the consent process for patients undergoing surgery for trauma at our major trauma centre. Our baseline data collection included a review of all orthopaedic trauma consent forms over a 4-week period in March 2020. We subsequently undertook three further Plan-Do-Study-Act (PDSA) cycles over separate 4-week periods. First, in June 2020, after education measures and presentation of baseline data, second in July 2020 after further education and regular digital reminders were sent to staff, and third in September 2021 after the implementation of an electronic consent form., Results: At baseline, only 2.6% of consent forms mentioned the risk of COVID-19 and none mentioned the risk of requiring ITU support. Through three PDSA cycles this increased to 97% of cases where consent forms displayed the additional risks of COVID-19 and the potential need for ITU admission., Conclusion: Our quality improvement project improved the informed consent procedure at our trust. By incorporating these additional risks into the template of an electronic consent form, we hope to achieve sustained improvement in practice., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The present study was conducted to investigate the protective action of Salvia officinalis flowers aqueous extract (SOFAE) against combined gastro-intestinal (GI) disorders-induced by ethanol and castor oil administration in rats. Adult male Wistar rats were divided into seven groups of ten each and various doses of SOFAE (50, 100, and 200 mg kg -1 , b.w ., p.o .) and sulfasalazine (100 mg kg -1 , b.w. , p.o .) were daily administrated during 15 days. After, animals were intoxicated with a single oral administration of ethanol (4 g kg -1 , b.w. , p . o. ) and castor oil (5 mL kg -1 , b.w. , p.o .). We found that SOFAE contains several phytoactive compounds with a strong ABTS scavenging ability. In vivo , we showed that SOFAE protected against EtOH/CO-induced macroscopic and histological alterations in GI tract accompanied by intestinal fluid accumulation and gastric juice decrease. SOFAE significantly counteracted lipoperoxydation increase and reversed the depletion of both enzymatic and non-enzymatic antioxidants. More importantly, SOFAE significantly reduced the levels of inflammatory markers (CRP and ALP) in plasma and mucosal GI tract. In conclusion, our data clearly indicate that the SOFAE exerted a potential protective effect against EtOH-induced peptic ulcer combined with CO-induced diarrhea in rats. These effects could be associated with its antioxidant and anti-inflammatory properties., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

This study assessed the hepato- and nephroprotective effects of Salvia officinalis flowers decoction extract (SODE) against ethanol (EtOH)-induced oxidative stress in rats as well as the possible mechanism implicated in such protection. Animals were divided into four groups: control, EtOH, and EtOH+SODE. Wistar rats were pretreated with SODE (50, 100, and 200 mg/kg, body weight [b.w.], p.o.) for 15 days and intoxicated during 2 h by acute oral administration of EtOH (4 g/kg, b.w.) 60 min after the last dose of SODE. We found that SODE pretreatment, in vivo , protected against EtOH-induced liver and kidney injuries evident by plasma transaminases activity and preservation of the hepatic tissue structure. Compared with the control group, the animals treated with the SODE showed a significant decrease (68.81 ± 6.89-50.65 ± 3.97 UI/L) of alanine aminotransferase (ALT) and aspartate aminotransferase (AST; 144.38 ± 6.58-113.64 ± 8.03 UI/L) in a dose-dependent manner. By contrast, the plant extract significantly and dose dependently increased (0.175 ± 0.077-0.302 ± 0.011 mmol/L) the uric acid. The SODE counteracted EtOH-induced liver and kidney lipoperoxidation, preserved sulfhydryl groups (-SH) and glutathione reduced (GSH) contents. Our extract prevented the depletion of antioxidant enzyme activities such as superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx). We also showed that acute alcohol administration increased tissue and plasma hydrogen peroxide (H 2 O 2 ), calcium and free iron levels. Of interest, SODE pretreatment reversed all EtOH-induced disturbances in intracellular mediators. More importantly, SODE treatment significantly protected against alcohol-induced inflammation by reducing C-reactive protein (CRP) and alkaline phosphatase (ALP) activities in plasma. It was concluded that the SODE exerted a potential protective effect against EtOH-induced inflammation and oxidative stress in the rat organs. This study recommends that the consumption of sage flowers is useful for patients who suffer from hepato- and nephrotoxicity.

The number of shoulder replacements performed each year continues to increase, and the need for revision replacements has grown accordingly. The outcome of a revision replacement may influence which primary implant is selected and the timing of primary surgery, particularly in younger patients. The aim of this study was to establish the expected improvement in shoulder function and implant survival following revision of a hemiarthroplasty and revision of an anatomical total shoulder arthroplasty (TSA). A systematic review and meta-analysis were performed of all studies reporting shoulder scores or implant survival following revision hemiarthroplasty or revision TSA. MEDLINE, EMBASE, CENTRAL, The Cochrane Database of Systematic Reviews and National Joint Registry reports were searched. 15 studies were included, reporting on 593 revision anatomical shoulder replacements. There was large variation in the magnitude of improvement in shoulder scores following revision surgery. Over 80% of revision replacements last 5 years and over 70% last 10 years. There was no significant difference in shoulder scores or implant survival according to the type of primary implant. The belief that revision of a shoulder hemiarthroplasty may lead to improved outcomes compared to revision of a TSA is not supported by the current literature., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Background: Diarrhea is a multifactorial gastrointestinal disorder responsible for about 5 million deaths annually. The chemical composition, the antioxidant activity of Crataegus azarolus berries aqueous extract (CABAE) as well as its protective effects against castor oil-induced diarrhea, oxidative stress, and inflammation in rat were studied., Methods: Sixty male rats were used and divided into six groups of ten animals in each: Control (C), castor oil (CO), CO+various doses of CABAE (100, 200, and 400 mg/kg b.w., p.o.), and CO+loperamide (LOP, 10 mg/kg b.w., p.o.)., Key Results: The CABAE showed relatively high levels of total polyphenols, flavonoids, and tannins. The LC-HRESIMS technique allowed the identification of 5 phenolic compounds and the major component is quinic acid. In vivo studies showed that CABAE protected against castor oil-induced diarrhea and intestinal fluid accumulation. The CABAE counteracted castor oil-induced lipoperoxidation, preserved GSH and thiol groups levels, and prevented the depletion of antioxidant enzyme activities, such as superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx). The CABAE administration also protected against castor oil-induced inflammatory markers (ALP and CRP) increase. More importantly, castor oil induced an increase of intracellular mediators, such as hydrogen peroxide, free iron, and calcium, while CABAE pretreatment significantly reversed them to near control levels., Conclusion: The Crataegus azarolus berries aqueous extract significantly protected against diarrhea due in part to its antioxidant and anti-inflammatory properties., (© 2020 John Wiley & Sons Ltd.)

The present study was carried out to determine the phytochemical composition of Salvia officinalis flowers decoction extract (SOFDE) as well as its individual and/or synergistic actions with sulfasalazine against ethanol (EtOH)-induced peptic ulcer in Wistar rats. In this respect, rats were divided into six groups of eight animals each: control, EtOH, EtOH + sulfasalazine (SULF, 100 mg kg -1 , b.w., p.o.), mixture: MIX (SOFDE, 50 mg kg -1 b.w., p.o. + SULF, 50 mg kg -1 , b.w., p.o.) and EtOH + two doses of SOFDE (100 and 200 mg kg -1 b.w., p.o.). In vitro , the phytochemical and the antioxidant properties were determined using colorimetric analysis. HPLC-PDA/ESI-MS assay was used to identify the distinctive qualitative profile of phenolic compounds. Our results firstly indicated that SOFDE is rich in total tannins, flavonols, anthocyanins and a moderate concentration of total carotenoids. Chromatographic techniques allowed the identification of 13 phenolic compounds and the major ones are quinic acid, protocatechuic acid, gallic acid and salviolinic acid. SOFDE also exhibited an important in vitro antioxidant activity using the β-carotene bleaching method. In vivo , SOFDE and the mixture provide significant protection against ethanol-induced gastric and duodenal macroscopic and histological alterations. Also, SOFDE alone or in combination with SULF, showed a significant protection against the secretory profile disturbances, lipid peroxidation, antioxidant enzyme activities and non-enzymatic antioxidant level depletion induced by alcohol administration. Importantly, we showed that EtOH acute intoxication increased gastric and intestinal calcium, free iron, magnesium and hydrogen peroxide (H 2 O 2 ) levels, while SOFDE/MIX treatment protected against all these intracellular mediators' deregulation. We also showed that alcohol treatment significantly increased the C-reactive protein (CRP) and alkaline phosphatase (ALP) activities in plasma. The SOFDE and MIX treatment significantly protected against alcohol-induced inflammation. More importantly, we showed in the present work that the mixture exerted a more important effect than SOFDE and SULF each alone indicating a possible synergism between these two molecules. In conclusion, our data suggests that SOFDE and SULF exerted a potential synergistic protective effect against all the macroscopic, histological and biochemical disturbances induced by EtOH intoxication. This protection might be related in part to its antioxidant and anti-inflammatory properties as well as by negatively regulating Fenton reaction components such as H 2 O 2 and free iron., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Introduction: Axillary nerve injury is a major complication of shoulder surgery during glenoid exposure. The aim of this study was to measure the mean distance between the inferior glenoid and the axillary nerve in healthy shoulders and then to compare this distance between osteoarthritic and rotator cuff deficient glenohumeral joints., Methods: The magnetic resonance images of 50 patients with normal glenohumeral joints were reviewed. The infra-glenoid tubercle was determined as a fixed point and the distance to the axillary nerve was measured. Two separate assessors measured on the same sagittal sections. With a study power of 80%, the sample needed in each comparison group was 28 patients. Measurements were then performed on scans in patients with osteoarthritis and cuff tear arthropathy. The mean distance was compared between groups., Results: The mean distance between the infra-glenoid tubercle and axillary nerve was 12mm (standard deviation, SD, 5.6mm) in normal shoulders, 10.6mm (SD 5.4mm) in shoulders with osteoarthritis and 9.7mm (SD 3.7mm) in those with cuff tear arthropathy. For this sample size of 50 patients with a confidence interval of 95%, the mean range is 12mm (95% CI 10.4-13.6). A comparison between normal shoulder and osteoarthritis showed a p -value of 0.3, and between normal and cuff tear arthropathy a p -value of 0.06. This was not statistically significant., Conclusions: The axillary nerve lies on average 12mm from the infra-glenoid tubercle. The presence of inferior osteophytes in glenohumeral osteoarthritis and the proximal migration of humeral head in cuff tear arthropathy does not seem to alter the course of the nerve significantly in relation to the inferior glenoid tubercle.

Background: The current international context considers birth experiences as a focal point for women's health. However, this subject is rarely discussed in Tunisian literature., Aim: Analyze birth experience of a sample of Tunisian women., Methods: Transverse descriptive study. All women who gave birth in the study unit during August 2018 were included. A direct interview was conducted during the first postpartum day. The questionnaire used was developed by a multidisciplinary team and included 55 questions, divided into 4 items. We compared the group of women who described their delivery as physically or psychologically traumatic to the group of women who reported a serene birth experience.    A multivariate analysis of variance was used to identify the variables that can influence childbirth experience., Results: During the study period, 170 women were included with a response rate of 81%. Severe anxiety about delivery was reported by 74.5% (n = 127) of women. Delivery was experienced as a trauma in 48.2% (n = 82) of cases. In the group of women who expressed a negative experience, we found a significant association with the use of media and internet as a source of information (p=0.001) and repeated vaginal examinations (p=0.001). Pain significantly impacted women's experience (p = 0.02). Finally, main risk factors of a negative childbirth experience were: uterine revision: OR=7.04 95%CI [0.27-177.68]; Emergency caesarean section: OR=3.04 95%CI [0.94-9.85] and vaginal delivery: OR=2.13 95%CI [0.45-10.14]., Conclusion: We can intervene on modifiable factors with the introduction of a specific program preparing women for their childbirth and the improvement of the professional practices. However, the issue will benefit from being discussed and addressed at the national, cultural and societal levels.

We aimed in the present study to investigate the chemical composition, the antioxidant capacities as well as the in vitro fermentation properties of Salvia officinalis leaves aqueous extract (SOLAE) grown in four regions of northwestern Tunisia. Our data firstly indicated a spatial variation (P<0.05) in condensed tannins, total lipids, polyphenols and flavonoids contents. The HPLC-PDA-ESI-MS/MS-LC/HR-ESI-MS technique allowed to the identification of 13 phenolic compounds and showed that protocatechuic acid is the major constituent of the plant leaves grown in Tabarka, Ain Draham and Testour. The SOLAE of the plant grown in Tabarka presents the most potent scavenging activity against DPPH radical and had the highest percentage of inhibition. More importantly, we found in the present study that the digestibility of dry matter and in vitro fermentation showed a significant variation between the regions and the animal species. Also, we showed a very positive correlation between antioxidant properties and phenolic compounds contents. In conclusion, we suggest that SOLAE had potential beneficial effects owing in part to its antioxidant and ROS scavenging activities. Therefore, S. officinalis can be proposed as an additive food for animals' nutrition and health., (© 2019 Wiley-VHCA AG, Zurich, Switzerland.)

Medicinal plants are known by pharmacological relevance and were used for long time to prevent/treat numerous gastrointestinal (GI) disorders. The current study focuses on the phytochemical/antioxidant characteristics of sage aqueous extract (SAE), as well as its pharmacological actions on altering motor function in the intestine and related disruptions. In vitro phytochemical/antioxidant properties were investigated by colorimetric/biochemical methods. Male rats were divided into seven groups of six animals in each: control (C), castor oil (CO), CO + loperamide (LOP, 10 mg/kg, b.w., p.o.), CO + various doses of SAE (50, 100, and 200 mg/kg, b.w., p.o.), and the mixture (MIX: SAE, 50 mg/kg, b.w., p.o. + LOP, 5 mg/kg, b.w., i.p.) group. In vivo GI/physiological/pharmacological actions of SAE were explored based on the watery/frequent stools, enteropooling, and GI transit time, as well as their associated disturbances. The aqueous extract of S. officinalis contains high tannins/flavonols/anthocyanin contents and a strong, free radical scavenging activity (EC 50  = 48.56 ± 0.34  μ g/mL). SAE/MIX significantly reduced CO-induced diarrhea in a dose-dependent manner. SAE/MIX decreased also the gastric and intestinal mucosal malondialdehyde/hydrogen peroxide levels and preserved the normal activities/levels of enzymatic/nonenzymatic antioxidants. Added to that, we showed that SAE/MIX pretreatment provided stability of lipid profile (cholesterol and triglycerides), hepatic transaminases, renal injury indicators, and C-reactive protein/alkaline phosphatase levels changed by CO intoxication. These findings suggested that SAE/MIX exerted benefic individual/synergistic effects confirming their use as a strategy in the treatment of GI physiological disorders.

The supply of oxygen and nutrients and the disposal of metabolic waste in the organs depend strongly on how blood, especially red blood cells, flow through the microvascular network. Macromolecular plasma proteins such as fibrinogen cause red blood cells to form large aggregates, called rouleaux, which are usually assumed to be disaggregated in the circulation due to the shear forces present in bulk flow. This leads to the assumption that rouleaux formation is only relevant in the venule network and in arterioles at low shear rates or stasis. Thanks to an excellent agreement between combined experimental and numerical approaches, we show that despite the large shear rates present in microcapillaries, the presence of either fibrinogen or the synthetic polymer dextran leads to an enhanced formation of robust clusters of red blood cells, even at haematocrits as low as 1%. Robust aggregates are shown to exist in microcapillaries even for fibrinogen concentrations within the healthy physiological range. These persistent aggregates should strongly affect cell distribution and blood perfusion in the microvasculature, with putative implications for blood disorders even within apparently asymptomatic subjects.

The genetic polymorphism of the goat Kappa casein was investigated in Tunisian goats. Blood samples were collected from local goat breeds. Samples of genomic DNA were obtained from leukocytes of 175 dairy goats and regions of interest in the gene were amplified by Polymerase Chain Reaction (PCR) and then evaluated in agarose gel. For a better characterization of the single nucleotide polymorphism, a PCR-Restriction Fragment Length Polymorphism was performed employing the endonuclease DNA amplification using 459 bp primers. The PCR products of primers (459 bp) digested by restriction enzyme Alw44I produced two fragments of 459 and 381 bp. The Kappa casein allelic variants in tested animals revealed different genotypes, two of them were homozygous: AA or BB, AC or BC and CC. Genotypic frequencies were 12.5, 60.5 and 27% for AA or BB, CC and AC or BC, respectively. Identification of different variants of the Kappa casein can be used for the improvement and conservation of Tunisian local goats.

Background: In spite of its rarity in the paediatric age, Graves' disease constitutes the principal aetiology of hyperthyroidism in child., Aim: Our goal is to analyze the clinical and evolutive particularities of Graves's disease in children., Methods: We studied retrospectively seven cases of Graves' disease in children enrolled in the pediatrics department of Sousse during ten years period (1993-2002)., Results: There were six girls and one boy (sex - ratio = 0.16) aged 4.5 to 16 years (mean age: nine years and one month). The diagnosis has been established clinically on the presence of classic symptoms of the illness associated to the biological and radiological findings. As part of research of possible associations with this illness, we observed solely in a case, in addition of Graves's disease, the coexistence of Down syndrome and coeliac disease, rarely described. Among the HLA antigens predisposing the Graves's disease, we only found HLA B8 antigen in a patient. The evolution under antithyroid drug treatment (ATD) has been marked by fast disappearance of functional signs in all patients. However, biological and clinical euthyroidism was more difficult to achieve. The treatment has been stopped in only one patient after 40 months period., Conclusion: Graves' disease is usually easy to recognize but difficult to treat. Radical treatments (thyroidectomy or radioactive iodine therapy) are indicated in second intention after having tempted ATD beforehand.

Aim: Analyze the clinical and evolutive particularities of complete primary distal renal tubular acidosis in children,, Methods: We studied retrospectively 11 cases enrolled in the pediatrics department of Sousse during 10 years period (1993-2002)., Results: It is about 9 boys and 2 girls (sex-ratio = 45) aged 3 month to 5 years (mean age: 18 months). Diagnosis was suspected on clinical and biological data of presumption and confirmed by acidification test. Radiological investigation objectified a nephrocalcinosis in eight patients and urinary lithiasis in two other cases. Auditive exploration showed sensorineural deafness in three patients. The illness appears sporadic in two cases and autosomal recessive in nine other cases. After alkali treatment (sodium bicarbonate), evolution was globally favorable.

High consumption of olive oil in the Mediterranean diet has been suggested to protect DNA against oxidative damage and to reduce cancer incidence. We investigated the impact of the phenolic compounds in olive oil, and the oil proper, on DNA and RNA oxidation in North, Central, and South European populations. In a multicenter, double-blind, randomized, controlled crossover intervention trial, the effect of olive oil phenolic content on urinary oxidation products of guanine (8-oxo-guanine, 8-oxo-guanosine and 8-oxo-deoxyguanosine) was investigated. Twenty-five milliliters of three olive oils with low, medium, and high phenolic content were administered to healthy males (n=182) daily for 3 wk. At study baseline the urinary excretion of 8-oxo-guanosine (RNA oxidation) and 8-oxo-deoxyguanosine (DNA oxidation) was higher in the Northern regions of Europe compared with Central and Southern European regions (P=0.035). Urinary excretion of the 8 hydroxylated forms of guanine, guanosine, deoxyguanosine and their nonoxidized forms were not different when comparing olive oils with low, medium, and high phenolic content given for 2 wk. Testing the effect of oil from urinary 8-oxo-deoxyguanosine changes from baseline to post-treatment showed a reduction of DNA oxidation by 13% (P=0.008). These findings support the idea that ingestion of olive oil is beneficial and can reduce the rate of oxidation of DNA. This effect is not due to the phenolic content in the olive oil. The higher DNA and RNA oxidation in Northern European regions compared with that in Central and Southern regions supports the contention that olive oil consumption may explain some of the North-South differences in cancer incidences in Europe.

Aim: Analyze the clinical and evolutive particularities of Henoch Schonlein purpura in children, Methods: We studied retrospectively 122 cases enrolled in the pediatrics department of Sousse during 10 years period (1992-2001)., Results: It is about 66 boys and 56 girls (sex - ratio= 1.18) aged 3 to 13 years (mean age: 7 years and half). The diagnosis has been established clinically on the presence of cutaneous syndrome with symmetrical declivitous region purpura in all patients with articular syndrome (91cases) and/or digestive syndrome (65cases). Complications were variable: digestive hemorrhage (19 cases), occlusive syndrome (2cases), renal involvement at variable severity (56 cases), scrotal and testicular complications (11 cases), cardiac complications (tamponade in a case). Henoch Schonlein purpura was associated with a primary antiphospholipid syndrome in a case, renal tuberculosis in a case and cholestatic hepatitis A in another case. All patient receeved symptomatic treatment (rest in bed + / - antalgic treatment). Digestive rest was prescribed for 20 patients presenting severe abdominal pains with corticosteroid during 2 at 4 weeks (1-2mg/kg/d) in eight cases. Corticosteroid-cyclophosphamid association was prescribed for 2 patients with severe renal involvement; one of them benefitted of extra-renal purification. One or several relapses of Henoch Schonlein purpura were noted in 13 patients. All sick evolved favorably same those presenting renal or cardiac involvement (middle receding of 5 years).

Genetic factors could be implicated in the pathogenesis of severe diabetic retinopathy (DR). Recently, we reported a strong association between the eNOS4b/a endothelial nitric oxide synthase (eNOS) polymorphism and severe DR. To examine whether T-786C and C774T eNOS polymorphisms are involved in severe DR, 254 Caucasians with longstanding C-peptide-negative type 1 diabetes, 128 patients with absent/mild DR (control group), and 126 patients with preproliferative/proliferative DR (study group) were genotyped. The distribution of T-786C and C774T eNOS polymorphisms was in Hardy-Weinberg equilibrium and did not differ between the study and control groups. However, in case patients (n=126), T-786C and C774T polymorphisms influenced the onset pattern of severe DR (P=0.0169 and P=0.0257, respectively). The C-786C genotype was associated with early-onset severe DR (duration of diabetes: 15.2+/-5.9 vs. 19.4+/-6.3 years, P=0.0105), and the homozygous T774T genotype was associated with late-onset severe DR (24.3+/-7.0 vs. 18.4+/-6.2 years, P=0.0067). In the case of patients with high glycosylated hemoglobin levels (HbA1c >8%, n=88), the association between the T-786C polymorphism and early-onset severe DR was stronger (P=0.0068). Case patients carrying the C-786C genotype had higher HbA1c values (9.61+/-1.89%) than those carrying the T-786T genotype (8.93+/-1.47%, P=0.0173). Multivariate analysis showed that T-786C polymorphism was the best independent factor for onset pattern of severe DR (P<0.001). These findings, supported by previous associations between eNOS4b/a polymorphism and DR, suggest that T-786C and C774T eNOS polymorphisms affect the onset pattern of severe DR.

A 1-year prospective study in 2 paediatric outpatient clinics in Sousse, Tunisia, aimed to determine the presence of group A streptococci in acute pharyngitis cases and carriers, and the distribution of the serotypes and biotypes. Group A streptococci were found in 9.0% of throat swabs from 155 controls and 17.7% from 474 patients (P < 0.05). Of 43 strains isolated from patients and submitted for typing, 15 different types were identified, the most common being M75 (14 strains; 32.5%), M9 (6 strains; 14.0%), M76 (5 strains; 11.6%) and M12 (4 strains; 9.3%). Three strains were non-typeable (7.0%). Biotyping of the strains showed 3 predominant biotypes: biotype 3 (n = 14), biotype 2 (n = 11), and biotype 1 (n = 7).

Unlabelled: Gastrointestinal manifestations of Kawasaki disease are usually limited to stomatitis, paralytic ileus, and hydrops of the gallbladder. We report a case of Kawasaki disease complicated with hemophagocytosis and ischemic colitis., Case Report: A 5-year-old girl with Kawasaki disease presented with hemophagocytosis that responded to gamma-globulin therapy. On day 4 she had abdominal pain and diarrhea. CT scan showed features suggesting ischemic colitis. Symptoms resolved on total parenteral nutrition., Conclusion: Ischemic colitis and hemophagocytosis are potential severe complications of Kawasaki disease.

Background: In beta-thalassemia major impaired biosynthesis of beta globin leads to accumulation of unpaired alpha globin chain. An iron overload, usually observed, generates oxygen-free radicals and peroxidative tissue injury., Aim: To investigate hematological parameters, oxidative stress and the antioxidant capacity in beta-thalassemia patients compared to control subjects in order to determine their impact in several organs functions., Methods: This study was conducted on 56 beta-thalassemia major patients compared to 51 healthy subjects. We determined metabolic parameters (glycaemia, lipid parameters, electrolytes, iron indices, hepatic, renal and heart functions tests), plasmatic thiobarbituric acid reactive substances (TBARS), plasmatic peroxyl radical trapping potential (TRAP), plasmatic superoxide dismutase (SOD), erythrocyte gluthathione peroxidase (GPX), plasmatic vitamin E, vitamin A and trace elements., Results: Except triglycerides, lipid fractions were significantly decreased in beta-thalassemia compared to controls. Serum ferritin, iron, TBARS concentrations, SOD and GPX activities were significantly increased. But TRAP, vitamin E and zinc concentrations were significantly decreased., Conclusion: Our findings confirm the peroxidative status generated by iron overload in beta-thalassemia major patients and highlight the rapid formation of marked amounts of TBARS and the increase of SOD and GPX activity. Our study suggested that in beta-thalassemia the first organ impaired is the liver.

Background: Aicardi syndrome is usually associated with a very poor outcome., Case Report: We report a particular case of Aicardi syndrome characterised by a partial agenesis of the corpus callosum associated with an arachnoidal interhemispheric cystic formation, and by a complete control of epilepsy and a favorable outcome regarding visual and psychomotor performances., Conclusion: A better prognosis could be expected in Aicardi syndrome when spasms occur lately and are not preceded by partial seizures, when agenesis of corpus callosum is partial and especially when chorioretinal lacunae are small, isolated, few and spare the macula.

Unlabelled: Symptoms of the late infantile form of type II glycogen storage disease are mainly due to functional impairment of skeletal muscle. Cardiac muscle can be involved in the late stage of the disease., Case Report: We report the cases of two siblings seven and 12 years old with type II glycogen storage disease. The initial symptoms were hypertrophic cardiomyopathy with Wolf-Parkinson-White syndrome., Conclusion: Hypertrophic cardiomyopathy may be the form of presentation of the late infantile form of type II glycogen storage disease. The risk of sudden death is high.

A child showing signs of Henoch-Schönlein purpura developed a right tibiofibular vascular thrombosis. Antiphospholipid antibody tests were positive for both lupus anticoagulant and anticardiolipin antibodies. This suggests that an antiphospholipid syndrome should be considered in cases of Henoch-Schönlein purpura and antiphospholipid antibodies should be measured to determine whether prophylactic antithrombotic measures are needed to prevent thrombotic manifestations.

There is no data available on the cardiovascular risk of children under 18 years of age in Tunisia, although it is well known that these risk factors present themselves in childhood. The authors performed an epidemiological study based on a representative sample of 793 schoolchildren in the rural region of Sousse, in Tunisia, to determine the incidence of the following risk factors: hypertension, hypercholesterolaemia and other lipid disorders, obesity and smoking. The main results show that the prevalence of hypertension is 11.2% with no statistically significant difference between the sexes. The prevalence of hypercholesterolaemia (2.9%), of hyper-LDL cholesterolaemia (0.6%) and hypertriglyceridaemia (1%) were comparable in boys and girls. Obesity (BMI > 30) was observed in 1.8% of the study population and was as common in girls (1.7%) as in boys (1.9%). Smoking was recorded in 4% of the study population and was commoner in boys (7.3%) than in girls (1.2%). This cardiovascular risk profile is encouraging and efforts should be made to maintain these levels until adulthood. This data will form the basis of a regional programme for the promotion of cardiovascular health in schools.

A 4-year-old female was hospitalized with clinical and electroencephalographic evidence of acute encephalopathy. Five days later the classic signs of Kawasaki disease appeared. The neurologic outcome in this female was poor despite early treatment with immunoglobulin. Like many other vasculitidies, Kawasaki disease can have predominant neurologic symptoms as the initial presentation and during the subsequent evolution of the condition.

This retrospective study includes 139 infants (74 girls and 65 boys) treated for status epilepticus at two University hospitals in Tunisia between 1990 and 1997. Their mean age was 11 months. The majority of seizures were generalized (74%) and lasted between 30 minutes and 1 hour (70%). The cause of status epilepticus was classified as acute symptomatic in 56, febrile in 57, remote symptomatic in nine, progressive neurologic in 10 and idiopathic in seven. Overall mortality was 15.8% and neurological sequelae were identified in 36% of the cases during the mean follow-up time of 3.5 years. The incidence of significant sequelae was a function of aetiology (especially acute symptomatic causes) and age (under 1 year of age). We conclude that the most frequent causes of infantile status epilepticus in Tunisia were fever and acute symptomatic causes. Status epilepticus among infants is an important public health problem, with significant associated mortality and morbidity. Management of status epilepticus can be improved by more rapid access to appropriate medical care., (Copyright 2001 BEA Trading Ltd.)

Background: Congenital self healing histiocytosis, described for the first time in 1973 by Hashimoto and Pritzker, is characterized by multiple violaceous brown cutaneous papulonodules present at birth and disappearing spontaneously in 2 to 4 months. There are classically no systemic manifestations and the prognosis is always good. We present a case, particular by the intensity of hemosiderinic deposits., Case-Report: The patient was a 2-month-old female infant. Physical examination at birth revealed a healthy-appearing full-term newborn, with five skin lesions: firm violaceous-reddish pigmented papules and nodules distributed over the head (scalp and forehead), right ear, right forearm and the flexural aspect of the left thigh. There was no hepatosplenomegaly or lymphadenopathy, and the patient's general condition was excellent. Histologic examination confirm the diagnosis by showing a dense polymorphous infiltrate composed of histiocytes associated with giant cells and erythrocytes extravasation. Perls stain was strongly positive. Staining with S100 Protein was positive. Outcome was good with involution of all lesions with atrophic and pigmented scars., Discussion: The patient's excellent general condition, the absence of visceral locations and the spontaneous self healing allows us to classify this form as a benign self healing congenital histiocytosis. This patient presented intensely hemosiderinic deposits giving the lesions a strongly pigmented aspect.

The authors report a retrospective study of 39 cases of Guillain-Barré syndrome in children. Including 23 boys and 16 girls. The mean age was 4 years (14 months to 10 years). A history of infection preceded the polyradiculoneuritis in 75% of cases. The mean duration of extensive phase and of the maximum paralysis was 10 days. A severe respiratory involvement was observed in 9 children and cranial nerve paralysis in 8 children. An early raised cerebrospinal fluid protein concentration was found in 95%. Electrodiagnostic studies, performed in 37 patients, showed nerve conduction velocity slowing in all cases. 28 children (73%) recovered clinically, 8 patients (20%) had residual deficits and 3 patients (7%) died.

Fifteen patients (9 girls and 6 boys) with different forms of cerebromeningeal tuberculosis (meningitis: 13 cases, tuberculoma: 2 cases) was reported. Their mean age was 6 years (4 months to 14 years). The initial diagnosis was difficult. Half patients had meningism, abnormal mental state and defects signs. The cerebrospinal fluid (CSF) leukocyte count was > 20/mm3, protein > 1 g/l (66%) and glucose < 2.2 mmol/l (80%). BK was isolated in 7 patients. Five patients (33%) died. Major neurological sequelae developed in 5 patients and 5 patients completely recovered. Factors predicting fatal outcome and permanent sequelae were: diagnosis delay, altered level of consciousness, hypotrophy and low glucose level in CSF.

Unlabelled: Traumatic and non-traumatic rhabdomyolysis have been mostly reported in adults. Polymyositis rarely leads to rhabdomyolysis., Case Report: We report the case of a 13-year-old girl with rhabdomyolysis. Full recovery was observed after symptomatic treatment. Nine months later she developed polymyositis., Conclusion: Long-term follow-up is necessary for rhabdomyolysis, even in those cases with an isolated occurrence caused by viral infection.

Hemophagocytosis has already been in cases of visceral leishmaniasis and thus may complicate search for diagnosis. We report a case of hemophagocytosis in a 20 month-old boy presenting with fever, hepatosplenomegaly, pancytopenia and coagulopathy. An initial diagnosis of kala-azar was refuted because of absence of biological inflammatory syndrome and negativity of bone-marrow aspiration. Specific serology for visceral leishmaniasis become positive. The boy was given stibogluconate for 21 days; he improves gradually with complete remission.

The authors have reviewed the notes of 103 pregnant women who contracted hepatitis during pregnancy and compared it with a controlled series of hepatitis occurring in 100 women who were not pregnant but were of reproductive age. The mortality rate in the pregnant group was considerably higher than in those who were not pregnant--27 deaths out of 103 cases as against 4 deaths in the control series of 100 cases. The fetal prognosis was very bad in the group of women who died. 3 out of 4 pregnancies resulted in loss of the fetus. It was less bad in those who had mild hepatitis--39.3% lost the fetus and one out of two pregnancies had a premature labour. Loss of consciousness was a very bad prognostic sign. The prognostic value of marked drop in prothrombin and raised white blood counts is emphasized in the cases who died. When the series of women who were pregnant and who survived is compared with those who survived in the control group, the authors found that judgment had to be used carefully in evaluating the prodromal signs in the pregnant women. They found in the two groups that the haemoglobin level and the serial levels of protein and albumen are comparable to those found in developed countries. They conclude that their maternal mortality due to hepatitis was comparable to that reported in underprivileged countries but that "malnutrition" in the broader sense of the term does not explain the serious state of affairs.

We present the case of a multiparous woman of 32 years of age who, at term after a more or less normal pregnancy, went into severe shock in labour. The patient in this case was very difficult to diagnose. Her life was only saved after massive blood transfusions and after delivering a fresh stillborn infant. It was not a case of uterine rupture nor of retro-placental haemorrhage. The site of origin of the hypovolaemic shock was intestinal. The patient had an ulcer of the pylorus which was diagnosed after fibroscopy. Some authors state that it appears that the few ulcers that have been diagnosed before pregnancy go into remission during pregnancy. All the same it would appear that sometimes very serious complicated ulcers which have to be treated with great respect do occur, especially in toxaemic patients at the end of pregnancy, and these carry with them a significant mortality both for the mother and the fetus. Although medical treatment (resuscitation) is essential, surgery should be resorted to if necessary because it may save the mother and sometimes the infant and so improve the prognosis of complicated ulcers occurring in pregnancy.