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Epilepsy is a chronic and the fourth most common neurological disorder which affects people of all age groups. Recently research and awareness on epilepsy-related deaths have rapidly grown over the past two decades. Many previous studies are attributed to the guidelines that apprise health care professionals in handling these deaths, but there is a relative scarcity of information accessible for clinicians and pharmacists who are responsible for manufacturing or preparing the extemporaneous anti-epileptic suspensions in the hospitals. Mostly in partial seizures, phenytoin is one of the first-choice drugs. In Saudi Arabian hospitals, the extemporaneous preparation of phenytoin suspension is common, but the hot climatic weather in Saudi Arabia possesses stability problems that should be tackled as the prepared suspension should pass all the stability tests to ensure uniform dosage of the extemporaneous formulation. In the current study, the commercial capsules were used to prepare the oral phenytoin sodium extemporaneous suspension. The physical, chemical and microbiological stability of phenytoin sodium suspension is analyzed at various temperatures.

Objective: The aim of this work is to compare the clinical, functional, and ultrasonographic outcomes of focused, radial, and combined extracorporeal shock-wave therapy (ESWT) in the treatment of c...

Background: There is a lack of data in discrimination of different aspects of quality of life impairment in Egyptian patients with painful diabetic neuropathy (PDN). Objective: To assess the influence of PDN on different aspects of life quality in patients with type 2 diabetes mellitus (T2D). Patients and methods: A cross-sectional study that included 125 patients with T2D (100 with PDN and 25 without) during the period from December 2018 to May 2019. All patients were subjected to history, examination with modified Neuropathy Disability Score (NDS), neuropathy symptom score (NSS), visual analogue pain score (VAS), nerve conduction study for (peroneal, sural and ulnar nerves) bilaterally and Norfolk Quality of Life QuestionnaireDiabetic Neuropathy (Norfolk QOL-DN) and lab. Other neuropathy causes were excluded. Results: PDN patients have longer duration of T2D. Norfolk QOL-DN showed a significant deterioration of the activity of daily life (ADL) and general health status in PDN patients. We found a significant positive correlation between the NSS, VAS, NDS, superficial pain sensation, and the duration of T2D with the effects on ADL and health status in the case group. In addition, there was a significant positive correlation between insulin therapy, HbA1c, electrical sensation, NSS, VAS, NDS and the duration of T2D with axonal neuropathy. The NDS was the only independent predictor of ADL and health status impairment. Axonal neuropathy was independently determined by NDS, electrical sensation and insulin therapy. Conclusion: PDN impaired the activity of daily life and health status of patients with T2D. The NDS independently could predict axonal neuropathy, ADL and health status impairment.

Background Septic shock remains the leading cause of death in the intensive care unit (ICU), with an increasing incidence and a current mortality rate of approximately 30 %. Sepsis was defined by the presence of at least two criteria of systemic inflammatory response syndrome associated with a clinically or microbiologically documented, or a highly suspected infection. Severe sepsis was defined as a sepsis associated with at least one organ failure different from that responsible for the infection. Septic shock was defined as a severe sepsis associated with low blood pressure despite adequate vascular filling which required a vasopressor support. Cardiac dysfunction in sepsis is driven primarily by release of cytokines, mitochondrial dysfunction, and tissue hypoxia that leads to cardiac myocyte injury and death. Aim of the Work The aim of this study was to evaluate the effect of diastolic function on prognosis of septic shock in patients admitted to an intensive care unit (ICU). Patient and Methods This study was conducted on (50) patients with septic shock admitted to an intensive care unit (ICU) from November 2017 to November 2018. Results These patients was divided according to cardiac echocardiography findings into two groups:-Group 1:- 25 patients with preserved diastolic function and diastolic dysfunction grade I; 12 Male and 13 Female were included in the study, the average age was 43.44±13.69.Group 2:- Another 25 patients with diastolic dysfunction grade II and grade III; 11 Males and 14 Females were included in the study, the average age was 47.28±15.7. Conclusion We recommend assessment of patients admitted to the ICU with septic shock via echocardiography to determine the grade of diastolic dysfunction and using diastolic dysfunction as a predictive risk factor in various score assessment of ICU patients. Our study was limited by decreased sample size and we recommend further studies with increased sample size..

Introduction Fundamental of regional anesthesia is pharmacologically interrupting transmission of sensation in the specific nerve fiber. The sensory signals generated by tissue damage triggers a state of increased excitability, leading to prolonged post-operative pain or sensitization to such pain. The optimal pain treatment pre-empts the establishment of pain hypersensitivity during and after surgery by minimizing the patient discomfort while leaving physiologic nociceptive mechanisms intact so as to function as an early warning symptom. Aim To measure the effect of intravenous magnesium infusion during spinal anesthesia on post operative analgesia in patients undergoing total hip replacement. Patients and Methods Patients were randomly assigned to two groups using closed envelopes chosen by patients before the study. Patients in the magnesium group (Group M, n = 15) received magnesium sulphate 50 mg per Kg over 15 min after spinal anesthesia and then 15 mg per Kg per hr by continuous i.v. infusion until the end of surgery. Patients in the saline group (Group S, n = 15) received the same volume of isotonic saline over the same period. Infusions were prepared in pharmacy and they were administered using the infusion machines. Study data were recorded by an observer unaware of group assignments. Results the study showed that intravenous magnesium infusion during spinal anesthesia decreased VAS results in magnesium group specifically in the first 24 hours and hence decreasing need for post operative rescue analgesic consumption .Also post operative nausea,vomiting and shivering were lower in magnesium group. Conclusion We concluded that intravenous magnesium infusion during spinal anesthesia improves post operative analgesia and reduces incidence of nausea, vomiting and shivering in patients undergoing total hip replacement.

Hussein M Ismail,1,2 Abeer S Algrafi,2 Osama Amoudi,3 Sameh Ahmed,4 Sultan S Al-Thagfan,5 Hassan Shora,6 Mohammed Aljohani,7 Mohammed Almutairi,7 Fahad Alharbi,7 Abdullah Alhejaili,7 Majed Alamri,7 Abdullah Muhawish,7 Ayat Abdallah8,9 1Department of cardiology, College of Medicine, Suez Canal University, Ismailia, Egypt; 2Department of medicine, College of Medicine, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia; 3Madinah Cardiac Center, Adult cardiology, Al-Madinah Al-Munawara, Saudi Arabia; 4Department of Pharmacognosy and Pharmaceutical Chemistry, College of Pharmacy, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia; 5Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia; 6Department of molecular biology/biochemistry, Port Said University, Port Said, Egypt; 7Medical intern, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia; 8Epidemiology and Preventive Medicine Department, National Liver Institute, Shebin El-Kom, Egypt; 9Department of Family and Community Medicine, Taibah University, Al-Madinah Al-Munawara, Saudi ArabiaCorrespondence: Hussein M IsmailDepartment of Cardiology, College of Medicine, Suez Canal University, Ismailia, EgyptEmail husseinismail@med.suez.edu.eg; drhussein72@gmail.comBackground: Vitamin D deficiency is considered an emerging health problem that affects at least one billion patients worldwide. Calcitriol 1,25(OH)2D3 has several systemic effects, including anti-inflammatory, anti-thrombotic and anti-atherosclerotic impacts that explain its cardioprotective effects. The precise association between vitamin D and its metabolites and the value of supplements in acute coronary syndrome (ACS) is still controversial. This study aims to search the association between vitamin D2, D3, and metabolites and ACS in patients undergoing coronary angiography.Materials and Methods: This was a case–control study on 73 consecutive adult patients with ACS undergoing coronary angiography compared to 50 controls without coronary artery disease and matched for age and sex from June 2019 till July 2019. Echocardiography and coronary angiography were done for all cases. Plasma vitamin D and its metabolites were measured at admission for all participants along with chemistry profiles.Results: Vitamin D and its metabolites were statistically significantly lower in ACS patients than the controls. Multivariate regression analysis revealed that low levels of 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D) significantly predicted ACS occurrence; the other significant predictors were high systolic blood pressure (BP), high total cholesterol, and low high-density lipoprotein-cholesterol. Interestingly, vitamin D2 and D3 did not significantly predict ACS (p> 0.05). We did not find a statistically significant association between the number of affected coronary vessels and vitamin D metabolites. Moreover, there was no statistically significant correlation between vitamin D and its metabolites and left ventricular ejection fraction measured by echocardiography.Conclusion: There was a strong association between vitamin D and all its metabolites with ACS. Significantly, low 25(OH)D and 1,25(OH)2D predicted ACS, but vitamin D2 and D3 did not. Large randomized controlled trials are needed to verify the beneficial values of vitamin D supplementation in ACS patients.Keywords: vitamin D3, vitamin D2, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D3, acute coronary syndrome, coronary artery disease

Background: Type 1 diabetes is an autoimmune disease with a strong genetic component. It can occur at any age Aim: To evaluate the effect of lifestyle promotion on outcomes of patients with insulin dependent diabetes mellitus. Research design: Pre/posttest research design was utilized. Setting: The study was conducted in the internal medical department & outpatient clinic at Assuit University Hospital. Samples included 50 adult patients selected according to the following criteria: Conscious patient, age range between 18-65 years, from both sexes and insulin dependent diabetes mellitus. Tools: Patient interview questionnaire. It includes: demographic data and health promotion lifestyle. Based on the analysis of the assessment tools health promotion lifestyle booklet was developed. Results: More than have of the studied sample were female and there mean age were 49.220±14.226. Patients' level of knowledge was increased after the implementation of the booklet; particularly in the areas of the health responsibility, physical activity, interpersonal relations, and nutrition. Conclusion: There are statistical significance differences for studied samples as regard to life style subscale. Recommendation: It is important to educate patients about how to modify life style to healthy life, prevent and manage diabetic complications

The phase stability and microstructure of ZrO2–5CaO and ZrO2–24MgO mixed coating (wt%) by air plasma spraying on 304 stainless steel substrates were investigated. A Ni–5Al (wt%) metallic bond coating was firstly sprayed between the substrate and the ceramic top layer. The results were compared with the individual coatings of ZrO2–5CaO and ZrO2–24MgO for a better understanding of the correlation between their microstructures and mechanical properties. Mixed zirconia coating was found to have a mixture of cubic and tetragonal phases that stabilized under different plasma spray conditions. Microscopic observations and elemental composition analysis of as-sprayed mixed coating showed that modified ceramic-matrix grains had been formed. Microsized ZrO2–5CaO particles were embedded in the matrix grain creating an intragranular microstructure. Results indicated that ceramic-matrix grains provided a diffusion barrier for the growth of oxides induced stress near and onto the bond layer that reduced cracks, thereby overcoming the top delamination of the ceramic coating. Moreover, disparity in wear resistance and microhardness behavior of the coatings was influenced by initial feedstock powder and matrix microstructures. Improvement in the wear resistance of the mixed zirconia coating was attributed to a decrease in oxide content, which resulted in an increase in intersplat cohesive strength.

Resveratrol (RSV), a naturally occurring polyphenol, has been found to have potent antioxidant, anti-inflammatory, and anticancer effects. Recently, RSV was reported as a new potential agent to suppress inflammation of collagen-induced arthritis in a mouse model. Nevertheless, the clinical benefits of RSV in the management of rheumatoid arthritis (RA) were not studied. This randomized controlled clinical trial aims to shed some light on the therapeutic benefits of RSV in the treatment of RA in patients with different stages of the disease activity. In this randomized controlled clinical trial, 100 RA patients (68 female, 32 male) were enrolled randomly and divided into two groups, each of 50 patients: an RSV-treated group that received a daily RSV capsule of 1 g with the conventional treatment for 3 months and a control group that just received the regular treatment. The clinical and biochemical markers of RA in both groups were assessed. It was found that the clinical markers (i.e., the 28-joint count for swelling and tenderness) and the disease activity score assessment for 28 joints were significantly lowered in the RSV-treated group. Moreover, serum levels of certain biochemical markers (i.e., C-reactive protein, erythrocyte sedimentation rate, undercarboxylated osteocalcin, matrix metalloproteinase-3, tumor necrosis factor alpha, and interleukin-6) were also significantly decreased in RSV-treated patients. The current study suggests the addition of RSV as an adjuvant to the conventional antirheumatic drugs.

Vitamin D affects innate and adaptive immunity processes that impact treatment, severity, and morbidity of acute asthma episodes. Several vitamin D forms may help modulate immunity, including vitamin D2 (D2), vitamin D3 (D3), 25-hydroxyvitamin D3 (25(OH)D3), and 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3). This study assessed serum levels of vitamin D derivatives in bronchial asthma patients and their correlation with disease markers. One hundred thirteen subjects, divided into two groups, were enrolled. The first group included 73 asthmatic patients (57 males and 16 females), and the second included 40 healthy adults (31 males and 9 females) as a control group. All subjects were evaluated with a careful history and clinical examination, a chest X-ray with a posteroanterior view, routine laboratory examination, spirometry , and asthma control tests (ACT). Vitamin D serum levels were assessed using ultra-performance liquid chromatography (UPLC) with tandem mass spectrometry . Disease markers were assessed and correlated with serum levels of vitamin D forms. Markers included forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC%, peak expiratory flow (PEF), forced expiratory flow25–75% (FEF 25–75% ), eosinophilic blood count, and total immunoglobulin E (IgE). Asthmatic patients had significantly lower serum levels of vitamin D than healthy controls (p ≤ 0.001). Further, serum vitamin D levels decreased significantly in uncontrolled asthmatic patients than partially controlled and controlled patients. Correlations for 25(OH)D3 and 1,25-(OH) 2D3 were stronger than for D2 and D3. There were negative correlations for eosinophilic blood count, total IgE, and ACT. Serum levels of all vitamin D forms were reduced in asthmatic patients with moderate to strong correlations with disease severity. Vitamin D deficiency or even insufficiency may thus play a role in disease severity.

Selective and fast chromatographic method was essential for the determination of triptans, selective serotonin receptor (5-HT1) agonists, in biological specimens. However, selective chromatographic separation of these highly basic drugs is a challenging problem on silica-based stationary phases. Zirconia-based stationary phases have been introduced as an efficient alternative for silica-based columns offering unique stability, selectivity, and retention ability for various classes of drugs. Herein, a new selective, fast and reproducible high performance liquid chromatographic method (HPLC) was developed and validated for the determination of four triptans in plasma samples namely; Sumatriptan (SMT), Zolmitriptan (ZLT), Eletriptan (ELT) and Rizatriptan (RZT). Zirconia-based polybutadiene (PBD) column was used for the separation and quantitation of the studied triptans in rat plasma based on mixed mode ion exchange and reversed phase chromatography. Zirconia-PBD column (ZirChrom-PBD) has enhanced chemical and thermal stability, selectivity and provides high resolution for the investigated triptans in short analysis time compared with the commonly used C 18 columns. A simple isocratic separation mode was used with a mobile phase consisted of acetonitrile and 10 mM phosphate buffer adjusted to pH 3.0 (20:80; v/v) at flow rate 1.0 mL min −1 . The column was maintained at 50 °C and effluent was monitored by photodiode array detector (PDA). The developed method was validated in agreement with US-FDA guidelines and was appropriate for analysis of triptans in plasma samples. The linearity range obtained for the developed HPLC method was 15–2000 ng mL −1 with detection limits of 4.8- 6.2 ng mL −1 for all the studied triptans. The developed zirchonia-PBD-HPLC method was applied successfully to study the pharmacokinetics of ZLT in rats after a single oral dose. The method was proved to be valuable for therapeutic drug monitoring and bioavailability studies of the studied triptans.

Newcastle disease (ND) is a very contagious disease in chickens and turkeys and one of the most important diseases of poultry in the world. The infection causes sudden death with high mortality. ND in recent years showed symptoms more severe than previous symptoms of this disease. NDV infection of genotype VII has been reported to cause this outbreak in several commercial poultry farms. In this study the isolated viruses were molecularly characterized by RT-PCR targeting the partial F-gene of NDV. Partial F gene sequence analysis showed that the isolated NDV strains belong to genotype VII with the characteristic amino acid sequences of the F0 protein proteolytic cleavage site motifs (112RRQKRF117) for the velogenic NDV (vNDV) strains. From the isolated and molecular identified NDV Genotype VII four selected isolates (NDV/Chicken/EG-MN/NRC/2015, NDV/Chicken/EG-QU/NRC/2015, NDV/Chicken/EG-SH/NRC/2015 and NDV/Chicken/EG -SH2/NR/2015) were sequenced for NDV F gene and nucleotide sequences were submitted to GenBank and given accession numbers (MF418017), (MF418018), (MF418019) and (MF418020); respectively. Though no significant genetic changes observed, the multiple vNDV outbreaks in vaccinated chicken require continuous monitoring of the evolution and the epidemiology characteristics of the vNDV as well as evaluation of the used vaccines.

ObjectiveCigarette smoking generates free radicals, such as reactive oxygen and nitrogen species (RONS) that contribute to many diseases. The aim of this study was to compare the levels of individual RONS in serum from smokers and non-smokers, and to examine their impact on lipid profiles and the endogenous antioxidant status, which is represented by vitamins C and E.MethodsNinety-four healthy Egyptian volunteers (48 smokers and 46 non-smokers) were enrolled. Blood samples were collected and analysed for common haematological tests, lipid profiles, and serum antioxidants. Six reactive oxygen species and three reactive nitrogen species were measured.ResultsA significant increase in radical levels was observed, as well as significant increases in haemoglobin (Hb), haematocrit, platelet count, total cholesterol, triglycerides, low-density lipoprotein cholesterol, and very low-density lipoprotein cholesterol in smokers compared with non-smokers. In contrast, high-density lipoprotein cholesterol was significantly reduced in smokers compared with non-smokers. A moderate negative correlation was found between serum levels of vitamins C and E and O2–•, HO•, H2O2, NO•, and ONO•, reflecting a negative impact of elevated RONS levels on the endogenous antioxidant status.ConclusionThese results may increase our understanding of the pathological role of smoking in several diseases.

Background/Aims: The psoas major muscle acts not only as a spine flexor, but also as a spine stabiliser. This study was conducted to investigate correlations between pain level and functional disability with morphological changes of the psoas major muscle in chronic low back pain patients with disc herniation. Method: Chronic low back pain patients with disc herniation were examined with routine lumbar MRI. An observational study was carried out using a convenience sample of 30 patients (mean age of 43.6 ± 6.8 years) of chronic low back pain with lumbar posterolateral disc herniation at L4–L5. Outcome measures included pain level, functional disability (ODI score), cross-sectional area, and fatty infiltration of psoas major muscle ipsilateral to the side of disc herniation. Results: There were significant correlations between functional disability with the cross-sectional areas and fatty infiltration of the psoas major muscle (r=-0.42, P=0.02) and (r=0.55, P=0.002) respectively. There was a significant correlation between pain level and fatty infiltration but not in the cross-sectional area of the psoas major muscle (r=0.44, P=0.015) and (r=-0.288, P=0.123) respectively. Linear regression analysis indicated that increasing the fatty infiltration grade by one unit leads to increasing functional disabilities and pain score by 7.3 and 0.8, respectively. Conclusions: Functional disability was correlated with the cross-sectional areas and fatty infiltration of the psoas major muscle, however pain showed a positive relationship with fatty infiltration only. The fatty infiltration of the psoas major muscle might be used as a good predictor for functional performance and pain level in chronic low back pain patients with disc herniation.

Reactive oxygen species (ROS) and reactive nitrogen species (RNS) have distinct contribution to the destructive, proliferative synovitis of rheumatoid arthritis (RA) and play a prominent role in cell-signaling events. However, few studies had clarified the role of individual ROS and RNS in the etiopathogenesis of RA. To date, most of the studies were concerned with the measurement of the total oxidative and nitrative stress levels in RA. The aim of this study was to monitor the levels of individual ROS and RNS to emphasize the role that each plays in the pathogenesis of RA and their usefulness as possible biomarkers for the disease activity. In addition, the effect of an antioxidant (ascorbic acid), added to the treatment regimen, on the levels of ROS, RNS and disease activity has been evaluated. Forty-two Saudi RA patients and 40 healthy controls of both genders were included in this study. Serum levels of six different ROS and three different RNS were measured using specific fluorescent probes. The ROS included the hydroxyl radical ((•)OH), the superoxide anion (O2(•-)), hydrogen peroxide (H2O2), the singlet oxygen ((1)O2), the hypochlorite radical (OHCl(•)), and the peroxyl radical (ROO(•)). The RNS included nitric oxide (NO(•)), nitrogen dioxide (ONO-) and peroxynitrite (ONOO-). The main clinical and biochemical markers for disease activity were assessed and correlated with ROS and RNS levels. The clinical markers included the 28 swollen joint count (SJC-28), the 28-tender joint count (TJC-28), morning stiffness and symmetric arthritis, in addition to the disease activity score assessing 28 joints with erythrocyte sedimentation rate (DAS28-ESR). The biochemical markers included undercarboxylated osteocalcin (ucOC), matrix metalloproteinase (MMP-3), ESR, C-reactive protein (CRP), rheumatoid factor (RF) and anticyclic citrullinated polypeptide (Anti-CCP). Ascorbic acid (1mg/day) was added as an antioxidant to the regular treatment regimen of RA patients for two months, and the levels of ROS and RNS, as well as disease activity were re-evaluated. The results have shown significant higher serum levels of individual ROS and RNS in RA patients compared with healthy subjects. Moreover, this study might be the first to report strong positive correlations between most of the reactive species and the clinical and biochemical markers of RA. Interestingly, the addition of ascorbic acid had significantly reduced the levels of all ROS and RNS in RA patients. In conclusion, the role of oxidative and nitrative stress in the pathogenesis of RA has been confirmed by this study. Serum levels of ROS and RNS may effectively serve as biomarkers for monitoring disease progression. Finally, the addition of an antioxidant, such as ascorbic acid, in the management of RA may be of a great value.

A sensitive, reliable and reproducible ion-pair chromatographic (IPC) method with enhanced fluorescent detection suitable for therapeutic drug monitoring was developed and validated for the determination of α1-blockers. The chromatographic and fluorescence enhancement conditions were optimized for maximum sensitivity and selectivity. Sodium dodecyl sulfate (SDS) has a dual role in the newly developed IPC method as an ion pair reagent as well as enhancement of the native fluorescence of the studied drugs. Additionally, a simple isocratic separation mode with mobile phase containing acetonitrile and 20 mM phosphate buffer (pH 6.3) (60:40, v/v) containing 25 mM SDS was the best for separation. The flow rate was set at 0.8 mL min− 1 and the effluent was monitored by a fluorescence detector and the wavelengths at emission wavelength of 389 nm after excitation at = 250 nm. The developed IPC method provided rapid separation of α1-blockers with good peak resolution compared with conventional reversed phase (RP-C18) methods. The method was validated in accordance with the requirements of USP-FDA guidelines and shown to be suitable for intended applications. The linearity range for the developed IPC method in rabbit plasma obtained was 0.5–20 ng mL− 1 with correlation coefficients of more than 0.9985. The limits of detection (S/N = 3) and quantification (S/N = 10) were 0.16–0.71 ng mL− 1 and 0.53–2.14 ng mL− 1, respectively. The inter-day and intra-day precision % RSD was 1.14–3.91 and accuracy of 9.06–102.3%. The proposed IPC–FL method was successfully applied for the bioequivalence study of two formulations for terazosin from different brands in rabbits by a randomized, two-way, single-dose, crossover study and proved to be bioequivalent.

A simple, selective salting out and stability-indicating thin layer chromatographic (SOTLC) technique was developed for determination of two antidiabetic drugs; glimepiride and metformin HCl in pure and in tablets as a binary mixture. Separation was performed on silica gel 60 F254 plates using aqueous ammonium sulfate and acetonitrile (7:3, v/v) as a mobile phase. The Rf values were 0.26 ± 0.02 and 0.73 ± 0.02 for glimepiride and metformin HCl, respectively. The separated bands were scanned at λ 237 nm using CAMAG TLC scanner III. The proposed method focusing on study of all the factors that play important role in the mechanism of salting out process. The proposed method was validated according to ICH guidelines and complied with USP31-NF26 validation guidelines. The correlation coefficients of calibration curves were 0.996 and 0.997 for glimepiride and metformin HCl, respectively, in the concentration range of 60-1,400 ng/band for both drugs. The investigated drugs were also subjected to acidic, basic, oxidative and photo-degradation and kinetic study was carried out.

Background: Hyperdynamic circulatory state in liver cirrhosis is characterized by increased splanchnic blood flow and renal vasoconstriction. Aim: To evaluate the relationship between renal resistive indices (RI) and HCV liver cirrhosis severity and RI value in predicting 6 month survival of those patients. Also we aimed to assess the effect of midodrine on RI. Patients and methods: 120 patients with HCV liver cirrhosis and 40 healthy controls were enrolled in the study. INR, total bilirubin, albumin, creatinine and sodium were measured in all patients. Both patients and controls underwent abdominal ultrasound with duplex Doppler examination of the kidneys with RI calculated. Patients were followed for 6 months. Surviving patients with highest risk underwent renal duplex with RI calculation (RI2). They then received oral midodrine at a dose of 7.5 mg three times daily for 3 months with revaluation of RI (RI3). Results: 57 (47.5%) patients had high RI (RI > 0.7) while 63 (52.5%) patients had normal RI. Patients had significantly higher RI than healthy controls (P 0.73 are at higher risk of death within 6 months (P 0.73 (P = 0.1605). Conclusion: RI is strongly correlated with liver cirrhosis severity and had comparable prognostic value with MELD score. Midodrine had no significant effect on RI in high risk patients.

New sensitive and selective HPTLC-densitometric method has been developed for the determination of pioglitazone hydrochloride. The proposed method depends on the interaction of the drug with ophthaldehyde (as spray reagent) and densitometric measurement (using UVP scanner) of the intensity of the produced pink color. Separation was achieved on HPTLC silica gel 60 aluminum sheets with chloroform-methanol (10:1 v/v) as mobile phase, and the R F value was 0.51 ± 0.01. The linearity of the method was studied in the range of 200–3000 ng per spot. Agood correlation coefficient (0.998) was obtained between the drug concentration and the corresponding optical intensities of the produced color. Limits of detection and quantification were found 65.06 and 197.16 ng per spot, respectively. The proposed method was applied successfully for the determination of pioglitazone HCl in pure form and in pharmaceutical dosage forms.

Felodipine (FLD), a calcium channel antagonist, is commonly prescribed for the treatment of hypertension either with Metoprolol (MET) or Ramipril (RAM) in two different drug combinations. FLD has high plasma protein binding ability affecting its extraction recoveries from plasma samples. Hence, a specific ultrasound assisted dispersive liquid-liquid microextraction (UA-DLLME) method coupled with HPLC using photodiode array detector was developed and validated for the simultaneous determination of FLD, MET and RAM in rat plasma after oral administration of these combinations. The factors affecting UA-DLLME were carefully optimized. In this study, UA-DLLME method could provide simple and efficient plasma extraction procedures with superior recovery results. Under optimum condition, all target drugs were separated within 13min. The validation procedures was carried out in agreement with US-FDA guidelines and shown to be suitable for anticipated purposes. Linear calibration ranges were obtained in the range 0.05-2.0μgmL-1 for FLD and MET and 0.1-2.0μgmL-1 for RAM with detection limits of 0.013-0.031μgmL-1 for all the studied drug combinations. The%RSD for inter-day and intra-day precisions was in range of 0.63-3.85% and the accuracy results were in the range of 92.13-100.5%. The validated UA-DLLME-HPLC method was successfully applied for the bioavailability studies of FLD, MET and RAM. The pharmacokinetic parameters were calculated for all the investigated drugs in rats after single-dose administrations of two different drug combinations. Although FLD was bioequivalent in the two formulations, a small increase in plasma levels of MET and RAM was found in the presence of FLD.

The aim of this study was to evaluate the possible role of vitamin K homologs as potential biomarkers for disease activity in patients with rheumatoid arthritis (RA). In this study, 42 patients with RA and 40 healthy controls were enrolled. Serum levels of vitamin K homologs were measured using a high-performance liquid chromatography-fluorescence method. Different biochemical and clinical markers for disease activity were measured and correlated with serum levels of vitamin K homologs. There were no significant differences between RA patients and healthy subjects in demographic data. Patients with RA showed significantly higher levels of biochemical markers compared with healthy subjects (p

Several methods are available for detecting Helicobacter pylori infection: (1) invasive methods based on gastric biopsies, (2) non invasive methods like Urea Breath Test (UBT), serology and stool antigen tests. Importance of salivary PCR in detection of H. pylori is still questionable. To evaluate the role of salivary PCR technique in detecting H. pylori gastric affection in Egyptian patients with dyspepsia and in differentiating between functional dyspepsia and acid-ulcer syndrome. This study included 60 patients with dyspepsia classified into three groups: (Group 1) patients with gastric H. pylori and ulcers or erosions (n= 20), (Group 2) patients with gastric H. pylori and no ulcers or erosions and had functional dyspepsia (n= 20), (Group 3) patients without H. pylori and had functional dyspepsia (n= 20). All underwent upper gastrointestinal endoscopy with biopsies, rapid urease test and salivary samples for H. pylori PCR. Significant difference between the three groups regarding salivary PCR values. No significant difference between Group 1 and Group 2 but both had significant difference with Group 3, significant difference between gastric H. pylori positive patients (n= 40) and negative ones (n= 20). Salivary PCR test had sensitivity of 85%, specificity of 70% in diagnosing H. pylori. PCR value of 534000 Iu/ml had best sensitivity (75%) and specificity (100%) for diagnosing H. pylori, highly significant positive correlation between H. pylori gastric affection and salivary PCR values. No significant difference between patients with acid ulcer syndrome (n=20) and those with functional dyspepsia (n= 40) as regard salivary PCR mean values. Salivary PCR test showed sensitivity of 100%, specificity of 50% in differentiating between patients with acid ulcer syndrome and those with functional dyspepsia. PCR value of 440000 Iu/ml had best sensitivity (100%) and specificity (55%) in differentiating acid ulcer syndrome from functional dyspepsia with non significant. H. pylori salivary PCR may be of value in diagnosing H. pylori gastric affection and is strongly correlated with it but it is of limited value in differentiating between acid ulcer syndrome and functional dyspepsia.Keywords: Salivary PCR; Helicobacter pylori; Functional dyspepsia; Acid ulcer syndrome

"Re-feeding syndrome" is a potentially fatal, but entirely avoidable condition. It was first reported in severely malnourished prisoners in World War II. Recently interest in the topic has seen a resurgence with the increased use of artificial nutrition and improved monitoring. In 2007, the National Institute for Clinical Excellence (NICE) has produced guidelines for the prevention and management of re-feeding syndrome. These have some important differences to the previous guidelines of the Parenteral and Enteral Nutrition Group of the British Dietetic Association (PENG). The aim of this article is to review the literature on re-feeding syndrome, and present the most recent guidelines for its diagnosis, prevention and treatment.

Vitamin K is a fat-soluble vitamin involved in blood coagulation and bone metabolism. The detection and monitoring of vitamin K homologues in rheumatoid arthritis (RA) patients is a challenging problem due to the smaller concentrations of vitamin K and the presence of several interfering medications. Therefore, this study aimed to develop a new highly sensitive and selective chemiluminescence (CL) method designated to quantify vitamin K homologues in plasma of RA patients including phylloquinone (PK, vitamin K(1)), menaquinone-4 (MK-4, vitamin K(2)) and menaquinone-7 (MK-7, vitamin K(2)). The method was based on the unique photochemical properties of vitamin K homologues that were exploited for selective luminol CL reaction. The correlation coefficients of 0.998 or more were obtained in the concentration ranges of 0.1-100 ng mL(-1) vitamin K homologues. The detection limits were 0.03-0.1 ng mL(-1) in human plasma for vitamin K homologues. The developed HPLC-CL system was successfully applied for selective determination of vitamin K homologues in plasma of RA patients. The developed method may provide a useful tool for monitoring vitamin K homologues in different clinical studies such as RA, osteoporosis and hepatocellular carcinoma in which vitamin K is intervented., Talanta, 85(1), pp.230-236; 2011

A simple, reproducible and efficient dual separation mode high performance liquid chromatographic (HPLC) method was developed for simultaneous determination of antihypertensive drug combinations including; hydrochlorothiazide (HCTZ), valsartan (VAL), amiloride (AML) and captopril (CAP). The newly developed Platinum™ column, which provides a dual-mode separation with its polar and non-polar sites, was used for rapid separation of these co-administered drugs. Good resolution was obtained when Platinum™ column was used compared with C(18) column. Additionally, simple isocratic mode with mobile phase containing methanol and 0.02 mole L(-1) phosphate buffer adjusted to pH 3.0 (45:55, v/v) was used for separation. The flow rate was 0.5 mL min(-1) and effluent was monitored at 270 nm. All the investigated drugs were completely separated within less than 6 min. The linearity range obtained for the developed HPLC method was 0.5-100 μg mL(-1) with detection limits of 0.13-1.2 μg mL(-1) for all the studied drugs. The method was validated in accordance with the requirements of ICH guidelines and shown to be suitable for intended applications. The method was successfully used for determination of the studied drugs in pure form and pharmaceutical dosage forms without prior need for separation. The method is valuable for quality control laboratories for simultaneous determination of these co-administered antihypertensive drugs in binary, ternary and quaternary mixtures.

Background Recently, platelet-rich fibrin (PRF) was described as a second-generation platelet concentrate. PRF is known as a rich source of autologous cytokines and growth factors and is universally used for tissue regeneration in clinical medicine. Objective The aim of the current study was to evaluate the effect of PRF on the quality and quantity of bone formation in unilateral maxillary alveolar cleft reconstruction. Patients and Methods Twenty-four patients with unilateral alveolar cleft underwent bone reconstruction. Patients were randomly divided into two groups. Group A consisted of patients grafted with PRF combined with autogenous anterior iliac crest bone graft. Group B patients were grafted using autogenous bone graft alone (control group). Computed tomography was performed 6 months postoperatively to assess the quality and quantity of the newly formed bone. Results The percentage of newly formed bone (quantity) in group A ranged from 79.74% to 88.4%, with a mean percentage of 82.6% ± 3.9%. In group B, the percentage of bone formation ranged from 60.3% to 76.4%, with a mean percentage of 68.38% ± 6.67%. There was a statistically significant increase in the percentage of newly formed bone in group A. The mean bone density (quality) of the newly formed bone was lower in group A than group B, but the difference was not statistically significant ( P < .05). Conclusions PRF in combination with autogenous bone was beneficial in improving the volume of newly formed bone in alveolar cleft reconstruction and does not enhance bone density.

A high-throughput 96-microwell plate fluorometric method was developed and validated to determine omeprazole (OMZ) in its dosage forms. The method was based on the charge-transfer (CT) sensitized fluorescence reaction of OMZ with 2, 3-dichloro-5, 6-dicyano-1, 4-benzoquinone (DDQ). This fluorescence reaction provided a new approach for simple, sensitive and selective determinations of OMZ in pharmaceutical preparations. In the present method, the fluorescence reaction was carried out in 96-microwell plates as reaction vessels in order to increase the automation of the methodology and the efficiency of its use in quality control laboratories. All factors affecting the fluorescence reaction were carefully studied and the conditions were optimized. The stoichiometry of the fluorescence reaction between OMZ and DDQ was determined and the reaction mechanism was suggested. Under the optimum conditions, the linear range was 100-6000 ng/ml with the lowest LOD of 33 ng/ml. Analytical performance of the proposed assay, in terms of accuracy and precision, was statistically validated and the results were satisfactory; RSD was

The infection of gastric mucosa by Helicobacter pylori (HP) is an essential cofactor in the aetiology of gastroduodenal ulcer and gastric carcinoma. Because of the bacterial resistance, combination therapy containing omeprazole (OME), tinidazole (TNZ) and clarithromycin (CLA) is commonly used for eradication of HP. However, the simultaneous determination of the triple therapy in human plasma was not reported. A simple, reproducible, and selective HPLC method was developed for the simultaneous determination of the triple therapy mixture used for management of HP infections in human plasma. An HPLC procedure based on a liquid-liquid extraction, enrichment of the analytes and subsequent reversed-phase chromatography with UV detection was used. To enable sensitive and selective detection, the method involved the use of online wavelength switching detection, with two different detection wavelengths; 280nm for detection of OME and TNZ and 210nm for detection of CLA. Separations were performed on C18 analytical column with acetonitrile-10mM phosphate buffer of pH=3.0 at flow rate of 1.0mLmin(-1). The linear ranges in human plasma were 0.05-10μgmL(-1) with correlation coefficients >0.9990. The detection limits in human plasma were 0.02-0.07μgmL(-1). Validation parameters were assessed in compliance with US-FDA guidelines. The method proved to be valuable for the therapeutic drug monitoring after oral administration of triple therapy tablets.

Cefpodoxime proxetil (CFP), a broad-spectrum third-generation cephalosporin, has been used most widely in the treatment of respiratory and urinary tract infections. For bioequivalence study of CFP in rabbit plasma, it was necessary to develop a highly sensitive and selective high-performance liquid chromatographic (HPLC) method with fluorescence (FL) detection. The pre-column labeling of cefpodoxime acid (CFA) (active metabolite) with an efficient benzofurazan type fluorogenic reagent, 4-N,N-dimethyl aminosulfonyl-7-fluoro-2,1,3-benzoxadiazole (DBD-F) was carried out in the present study in 100mM borate buffer (pH=8.5) at 50°C for 15min. The obtained fluorescent products were separated on C18 column with an isocratic elution of the mobile phase, which consists of 10mM phosphate buffer (pH=3.5)/CH3CN (70:30, v/v). The fluorescent product (DBD-CFA) was detected fluorimetrically at 556nm with an excitation wavelength of 430nm. Cefotaxime sodium was used as internal standard. The method was validated according to the requirements of US-FDA guidelines. The correlation coefficient of 0.999 was obtained in the concentration ranges of 10-1000ngmL(-1). The limits of detection and quantification (S/N=3) were 3 and 10ngmL(-1), respectively. Plasma CFA levels were successfully determined in rabbit with satisfactory precision and accuracy. The proposed HPLC-FL method was successfully applied to study bioequivalence in rabbits for two formulations of different brands contained CFP (prodrug) in a randomized, two-way, single-dose, crossover study and all pharmacokinetic parameters for the two formulations were assessed.

Montelukast (MKST) is a leukotriene receptor antagonist that has been concomitantly used with inhaled corticosteroids (ICS) for its steroid-sparing effect in the long-term management of asthma. However, the simultaneous determination of MKST, when used as ICS tapering therapy, with ICS in human plasma has not yet been reported. A fast and efficient reversed phase monolith HPLC method was developed for simultaneous determination of MKST with some ICS in plasma of asthmatic patients. The separation was achieved on monolith reversed phase column by isocratic mode at a flow rate of 1.0 ml min−1 using a mobile phase consisted of a mixture of acetonitrile and 10 mM phosphate buffer adjusted to pH 3.5 (40:60, v/v) and detected at 240 nm. Betamethasone dipropionate (BDP) was used as the internal standard. All the studied ICS and MKST were efficiently separated within less than 6 min. The obtained linearity range for the developed HPLC method was 0.03–10 μg ml−1 with correlation coefficients > 0.9995 and the detection limits were 0.009–0.016 μg ml−1 in plasma for all the studied drugs. The method was validated in agreement with the requirements of US-FDA guideline and was recommended for the target applications. The method is valuable for investigations concerned with the effective tapering of ICS therapy with MKST in patients with chronic asthma in clinical practice without loss of asthma control.

A sensitive and highly selective high-performance liquid chromatography (HPLC) method was developed for the determination of vitamin K homologues including phylloquinone (PK), menaquinone-4 (MK-4) and menaquinone-7 (MK-7) in human plasma using post-column peroxyoxalate chemiluminescence (PO-CL) detection following on-line ultraviolet (UV) irradiation. The method was based on ultraviolet irradiation (254 nm, 15 W) of vitamin K to produce hydrogen peroxide and a fluorescent product at the same time, which can be determined with PO-CL detection. The separation of vitamin K by HPLC was accomplished isocratically on an ODS column within 35 min. The method involves the use of 2-methyl-3-pentadecyl-1,4-naphthoquinone as an internal standard. The detection limits (signal-to-noise ratio = 3) were 32, 38 and 85 fmol for PK, MK-4 and MK-7, respectively. The recoveries of PK, MK-4 and MK-7 were greater than 82% and the inter- and intra-assay R.S.D. values were 1.9-5.4%. The sensitivity and selectivity of this method were sufficient for clinical and nutritional applications.

A simple, efficient and reliable ion-pair chromatography (IPC) method was developed and validated for the determination of some H2 receptor antagonists including ranitidine (RAN), nizatidine (NIZ) and famotidine (FAM). The use of IPC separations provided improved peak resolution with good peak shape in short analysis time and augmented method selectivity compared with the frequently used RP-C18 methods. A simple isocratic mode with mobile phase containing acetonitrile and 20 mM acetate buffer (50 : 50, v/v) containing 20 mM sodium dodecyl sulfate was used for separation. The flow rate was set at 1.0 mL min(-1), and the effluent was monitored by UV detector at 280 nm FAM and 320 nm for NIZ and RAN. The method was validated in accordance with International Conference on Harmonization guidelines and shown to be suitable for intended applications. The limits of detections and quantitations were 0.008-0.011 and 0.025-0.033 µg mL(-1), respectively. The proposed IPC method was successfully applied for the determination of pharmaceutical dosage forms without prior need for separation. Additionally, the developed method was applied for the determination of RAN in rabbit plasma using NIZ as the internal standard. The method entailed direct injection of the plasma samples after deproteination using methanol. Finally, the proposed IPC method was applied successfully in a pharmacokinetic study for RAN in rabbits after a single oral dose of RAN.

Objective: to evaluate the role of US C 29 patients had adequate PRB (29/30) (96.7%) for histopatholgical diagnosis. Out of those 29 patients; 23 showed increase in renal cortical echogenicity (13 with GI, 8 with GII, &2 with GIII) & 6 cases showed normal echogenicity (G0). The lupus nephritis was the most accounted diagnosis (16/29) (55.2%)(7 with GI, 5 with GII, 4 with G0 cortical echogenicity). The glomerular changes were depicted in 25 cases (13 with GI, 7 with GII, 2 with GIII, 3 with G0), tubular changes in 21 cases (10 with GI, 7 with GII, 2 with GI, 2 with G0), and interstitial changes in 24 cases (12 with GI, 8 with GII, 2 with GIII, 2 with G0). Post biopsy complications (minor) were accounted only in 2 cases (2/30) (6.7%). Conclusions: Ultrasound PRB is the standard method for most non-focal renal biopsies as it has the advantage of real-time needle placement without radiation & fundamental procedure for diagnosis, monitoring &treatment of RPD. US and CT guided PRB is generally considered safe with minimal risk.

Background: Respiratory muscle strength, occurrence of chronic dyspnea and hypoxemia are still subjects of debate in liver cirrhosis. The loss of muscle mass in cirrhotic patients may affect respiratory muscles thus contributing to chronic dyspnea in those patients. Objective: To evaluate respiratory muscle strength, occurrence of hypoxemia and chronic dyspnea and their interrelationships in cirrhotic patients. Patients and methods: One hundred HCV liver cirrhosis patients were recruited. Liver profile, serum creatinine, arterial blood gases (ABG), spirometry, maximal inspiratory (PiMAX) and expiratory (PeMAX) pressures were measured. Grading of dyspnea was done using the modified medical research council (mMRC) scale. The model for end-stage liver disease (MELD) score was calculated for every patient. Results: Patients’ mean MELD score was 16.9 ± 5.23. Mean mMRC score was 2.18 ± 0.81. Hypoxemia was found in 81 (81%) patients. 39 (39%) and 35 (35%) patients had low PiMAX and PeMAX, respectively, and 37 (37%) patients had low respiratory muscle strength (RMS). mMRC score correlated negatively with RMS (r = −0.767, p