Abstract Background There are many surgical approaches which described extent of resection of the colon for adequate surgicalmanagement of splenic flexure cancer, but up till now there is no established surgical procedure, this is because the presence of double lymphatic drainage of themesenteric vessels. Segmental resection of the colon for the management of splenic flexure cancer was a recently accepted surgical procedure. Objective In the present study, we aimed to compare three surgical management techniques to clarify the best management approach of Egyptian patients with splenic flexure cancer regarding operative, clinical, and oncological outcomes: segmental resection, and extended left or right hemicolectomy,. Materials and Methods In the present study, we included 90 patients with splenic flexure cancer. Cases were divided into 3 groups. Each group included 30 patients in order to compare three surgical techniques: segmental resection, extended left hemicolectomy, and extended right hemicolectomy. Results We have found no statistically significant differences between the three included groups regarding operative findings, postoperative complications, local recurrence, distant recurrence, disease progression, recurrence-free survival rate, progression-free survival rate, and overall survival rate. The operative time was longer, and the number of lymph nodes was higher in the extended right hemicolectomy group (p<0.001). Conclusion We have shown that segmental resection of the splenic flexure is surgically and clinically suitable for the adequate management of operable cases of carcinoma of the splenic flexure.

Abstract Investigating the etiological causes of acute myeloid leukemia (AML) at the molecular level should help in identifying targets and strategies that would increase the efficacy of the current management regimens. Some genes may act as molecular diagnostics, of these ASXL1 and PHF6 are involved in regulation of gene expression, and BAX , and ARC, are pro- and anti-apoptotic molecules, respectively. In this study, peripheral blood samples were collected from 54 recently diagnosed AML patients in addition to 20 healthy individuals (the control group). Cellular RNA was extracted from all the samples and were subjected to quantitative analysis of the transcript levels of the four selected markers. Our data showed a significant elevation in the expression levels of PHF6 and ARC in AML patients, when compared to the controls (77.8% and 83.3%, respectively). On the other hand, ASXL1 and BAX exhibited increase, to a lesser extent, in the expression levels of the AML patients (52% and 55.6%, respectively). Our study also showed that the expression levels of ARC and PHF6 exhibited a concomitant increase and this could be correlated with poor prognosis of the cases. Thus, we can suggest these markers as reliable prognostic markers for prediction of AML outcomes.

ABSTRACT FitoMas-E is a bionutrient produced in Cuba through a rational management and appropriate technologies. Therefore, the research was to assess the effects of the application of different FitoMas-E doses on the sunflower growth in the dry season by adding 1 L ha-1 and 2 L ha-1. Sunflowers were grown in Cambisol soil with row spacing 0.90 m and plant spacing 0.25 m. Twenty-one plants were analyzed for the height of the plants (HP), stem diameter (SD), foliar area (FA), leaf area index (LAI), net assimilation rate (NAR), photosynthetic potential (PP). The dry matter accumulation was determined at random of each one of the plant organs such as the root dry weight (RDW), stem dry weight (SDW) and leaf dry weight (LDW). This procedure was carried out at 41 and 62 days after the emergency phase of plants (VE). The results indicate that FitoMas-E most helped sunflowers to develop. Results show that FitoMas-E positively influenced sunflower growth. Differences were observed regarding the behavior of the phenology and dry matter accumulation in roots, stems and leaves. The plants that were grown without FitoMas-E added were the shortest (163.6 cm) and less robust. Sunflowers with added FitoMas-E showed the best results for the most plant growth parameters assessed.

RESUMEN El producto FitoMas-E es un bionutriente que se produce en Cuba a través de la gestión racional y del uso de tecnologías apropiadas. El objetivo de la investigación fue evaluar los efectos de la aplicación de diferentes dosis de FitoMas-E sobre el crecimiento del girasol (Helianthus annuus L. cv. CIAP JE- 94) en el periodo poco lluvioso mediante la adición de dosis de 1 L ha-1 y 2 L ha-1. Las plantas se cultivaron en suelo Pardo mullido carbonatado con un espaciamiento de 0,90 m entre hileras y de 0,25 m entre plantas. En total 21 plantas fueron analizadas para las variables altura de las plantas (AP), diámetro del tallo (DT), área foliar (AF), índice de área foliar (IAF), tasa de asimilación neta (TAN) y potencial fotosintético (PF). Además, se determinó la acumulación de materia seca de cada uno de los órganos de la planta y se obtuvo el peso seco del sistema radicular (PSR), el peso seco del tallo (PST) y el peso seco de las hojas (PSH). Este procedimiento se realizó a los 41 y 62 días después de la fase fenológica de emergencia (VE). Los resultados mostraron que el FitoMas-E influyó positivamente sobre el crecimiento del girasol. Se observaron diferencias significativas con respecto a la fenología y a la acumulación de materia seca en raíces, tallos y hojas. Las plantas que se cultivaron sin FitoMas-E fueron de menor altura (163,6 cm) y menos robustas. Las plantas con aplicación de FitoMas-E mostraron los mejores resultados para la mayoría de los parámetros de crecimiento evaluados.

ABSTRACT Fadogia agrestis Schweinf. ex Hiern (Vangueria agrestis (Schweinf. ex Hiern) Lantz), Rubiaceae, is an African traditional medicinal plant also used as a dietary supplement in the US. The present paper is the first report of the pharmacognostic study of the leaf, stem and root of F. agrestis by microscopy, HPTLC and total phenolic/flavonoid content analyses. Noteworthy microscopic features that can help in identification and quality control are septate and lignified non-glandular trichomes on leaf and stem epidermises, paracytic stomata on leaf abaxial epidermis, numerous cells containing yellow substances of presumably phenolic compounds in leaf and stem, calcium oxalate druses and prismatic crystals in leaf and styloids in stem, primary phloem fibers in stem, brachysclereids in stem and root, spherical starch grains in root, and vessels with vestured pits and simple perforated end walls. In addition to microscopy, a total phenolic/flavonoid content determination and an HPTLC method were also developed for rapid chemical fingerprint analyses of Fadogia samples and dietary supplements.

ABSTRACT Introduction: Acute kidney injury (AKI) after major surgeries is associated with significant morbidity and mortality. We aim to report incidence, predictors and associated comorbidities of AKI after radical cystectomy in a large cohort of patients. Materials and Methods: We conducted a retrospective analysis of 1000 patients who underwent open radical cystectomy in a tertiary referral center. Perioperative serum creatinine measurements were used to define AKI according to the RIFLE criteria (as Risk, Injury and Failure). The predictors of AKI after surgery were determined using univariate and multivariate analyses. Results: Out of 988 evaluable patients, AKI developed in 46 (4.7%). According to RIFLE criteria; AKI-Risk, AKI-Injury and AKI-Failure occurred in 26 (2.6%), 9 (0.9%) and 11 (1.1%) patients, respectively. Multivariate analysis showed that performing nephroureterectomy with cystectomy (Odds ratio [OR]: 4.3; 95% Confidence interval [CI]: 1.3-13.6; p=0.01) and the development of high grade complications (OR: 3.8; 95% CI 1.9-7.2; p<0.0001) were independently associated with AKI. Conclusions: AKI is a significant morbidity after radical cystectomy and the term should be included during routine cystectomy morbidity assessment.

Resumo Objetivos: Realizamos este estudo para avaliar a segurança e eficácia da analgesia com a adição de cetamina à bupivacaína em bloqueio do nervo infraorbitário, bilateral e extraoral, em crianças submetidas à cirurgia de lábio leporino. Métodos: Foram randomicamente alocados 60 pacientes em dois grupos (n = 30): o Grupo B recebeu bloqueio do nervo infraorbitário com bupivacaína a 0,25% (2 mL) e o Grupo BC recebeu bloqueio com cetamina (0,5 mg.kg-1) em cada lado, mais a adição de 1 mL de solução de bupivacaína a 0,5% diluída até 2 mL da concentração a 0,25%. Os parâmetros de avaliação incluíram: hemodinâmica, tempo de recuperação, tempo até a primeira ingestão oral, escores da escala FLACC (que avalia a expressão facial [Face], os movimentos das pernas [Legs], a atividade [Activity], o choro [Cry] e a consolabilidade [Consolability]), escores de agitação em escala de quatro pontos, consumo de analgésicos e efeitos adversos no pós-operatório. Resultados: Os pacientes do Grupo BC apresentaram escores FLACC mais baixos em todos os momentos mensurados no pós-operatório (p < 0,0001). Dois pacientes do Grupo BC versus 12 do Grupo B solicitaram analgesia de resgate no pós-operatório (p < 0,001). Não houve diferenças entre os grupos em relação ao tempo até a primeira solicitação de analgesia de resgate. Os pacientes do Grupo BC relataram consumo menor de analgésicos (366,67 ± 45,67 vs. 240,0 ± 0,0 mg, p < 0,04). O tempo em minutos (min) até a primeira ingestão oral foi significativamente reduzido no Grupo BC (87,67 ± 15,41 vs. 27,33 ± 8,68 min, p < 0,001). Escores mais baixos de agitação no pós-operatório foram registrados para os pacientes do Grupo BC, com significância estatística no tempo de 45 min (0,86 ± 0,11 vs. 0,46 ± 0,16; p < 0,04) e na primeira hora de pós-operatório (1,40 ± 0,17 vs. 0,67 ± 0,14; p < 0,003). Índices mais altos de satisfação dos pais foram registrados no Grupo BC (p < 0,04), sem efeitos adversos significativos. Conclusões: A adição de cetamina à bupivacaína acentuou a eficácia analgésica do bloqueio do nervo infraorbitário em crianças submetidas à cirurgia de correção de lábio leporino.

Abstract Objectives: We conducted this study to investigate the safety and analgesic efficacy of the addition of Ketamine to Bupivacaine in bilateral extra-oral infra-orbital nerve block in children undergoing cleft lip surgeries. Methods: Sixty patients were randomly allocated into two groups (n = 30), Group B received infra-orbital nerve block with 2 mL of 0.25% Bupivacaine and Group BK received 0.5 mg.kg-1 Ketamine for each side added to 1 mL of 0.5% Bupivacaine solution diluted up to 2 mL solution to 0.25% Bupivacaine concentration. Assessment parameters included; hemodynamics, recovery time, time to first oral intake, postoperative Faces Legs Activity Cry Consolability (FLACC) scores, Four-point Agitation scores, analgesic consumption and adverse effects. Results: Patients in Group BK showed lower postoperative FLACC scores during all recorded time points (p < 0.0001). Two patients in Group BK versus 12 in Group B requested for postoperative rescue analgesia (p < 0.001). There were no differences between groups in time, minutes (min), to first request for rescue analgesia. Patients in Group BK reported lower analgesic consumption (366.67 ± 45.67 vs. 240.0 ± 0.0 mg, p < 0.04). The time to first oral intake was significantly reduced in Group BK (87.67 ± 15.41 vs. 27.33 ± 8.68 min, p < 0.001). Lower postoperative Agitation scores were recorded in Group BK patients that reached a statistical significance at 45 min (0.86 ± 0.11 vs. 0.46 ± 0.16, p < 0.04) and in the first hour (h) postoperatively (1.40 ± 0.17 vs. 0.67 ± 0.14, p < 0.003). Higher parent satisfaction scores were recorded in Group BK (p < 0.04) without significant adverse effects. Conclusions: The addition of Ketamine to Bupivacaine has accentuated the analgesic efficacy of infra-orbital nerve block in children undergoing cleft lip repair surgeries.

The damage that world biodiversity is facing this days and their negative impact in the obtainment of new molecule of therapeutic interest is a sad reality, because there are species that have been disappear from this planet. The aim of this review is to analyze the great potential and endangered problems of some medicinal plants in three countries as a representation of three continents of our planet. Analysis of flora of some herbaceous plants in Kazakhstan has shown that about 40 % of sorts presented in its composition have economic importance. In Egypt up to 95 % of its lands are deserts. One of the most valuable treasures that can be found in those deserts are Medicinal and Aromatic plants where is possible to find 30 economically cultivated species. In Cuba medicinal plant species amount to 1 241 (97 are endemic ones), which belong to 725 genera from 172 families. Among them, 17 species, which have the same quantity of genera and families, are in the endangered categories and from them 4 are critically endangered. Medicinal herbs are taking their place alongside the likes of bioenergy crops, sources of renewable industrial feed stocks and bioremedials as potential beneficiaries of technological solutions. For this reasons scientific community most pay attention to this important source of plants especially to those that are endangered

Los daños que la biodiversidad mundial sufre actualmente y su impacto negativo en la obtención de nuevas moléculas de interés terapéutico es una triste realidad, porque hay especies que han desaparecido del planeta. El objetivo de esta revisión es analizar el gran potencial y problemas de extinción de algunas plantas medicinales en tres países diferentes como una representación de tres continentes de nuestro planeta. El análisis de la flora de algunas plantas herbáceas en Kazajstán mostró que alrededor del 40 % de las especies presentes tienen importancia económica. En Egipto el 95 % de sus tierras son desiertos. Uno de los tesoros más valiosos que puede encontrarse en esos desiertos son las plantas Medicinales y Aromáticas donde es posible hallar 30 especies económicamente cultivadas. En Cuba la cantidad de plantas medicinales es de 1 241 (97 son endémicas), las que pertenecen a 725 géneros de 172 familias. Entre estas plantas, 17 especies, las cuales tienen la misma cantidad de género y familia, están en la categoría de amenazadas, y de estas 4 están críticamente en peligro. Las plantas medicinales están tomando su lugar junto a los cultivos bioenergéticos, fuente de energía renovable para las industrias y bioremediales como beneficiarios potenciales de soluciones tecnológicas. Por estas razones la comunidad científica debe prestar atención a esta importante fuente de plantas especialmente a aquellas que se encuentran amenazadas

Although community pharmacists have become more involved in the care of asthma patients, several studies have assessed pharmacists' ability to illustrate appropriately inhalation technique of different asthma devices. Many studies addressed inappropriate use of asthma devices by patients and pharmacists, in addition to its clinical, humanistic and economic burden. Objective: To evaluate community pharmacists´ practical knowledge and skills of demonstrating proper inhalation technique of asthma inhaler devices available in Sudan. Method: Three hundred community pharmacies located around the three major hospitals in the capital city (Khartoum) and four other provinces were approached, and four asthma devices were assessed: Metered-dose inhaler (MDI) (n=105), MDI with Spacer (n=83), Turbuhaler (n=61), and Diskus (n=51). Investigator (a pharmacist) acted as a mystery patient. He selected one device and asked the serving pharmacist to demonstrate how to use the device. Investigator completed a checklist of 9 steps of inhaler device use immediately after leaving the pharmacy. Essential steps derived from published literature were pre-specified for each device. Five evaluation categories were accordingly formulated as follows: optimal technique, adequate technique, poor technique, totally unfamiliar with the device, and does not know. Results: More than half of the pharmacists approached with metered dose inhaler did not know how to use optimal technique (ie all steps correct) all through. A third poorly demonstrated the technique, and only one pharmacist was categorized as being able to demonstrate an "optimal technique". The majority of pharmacists approached with spacing chamber and dry powder inhalers (Turbuhaler and Diskus) either did not know proper technique or were totally unfamiliar with the devices. Conclusion: The majority of community pharmacists, who were expected to educate asthma patients on their dispensed inhalers, lack the basic knowledge of proper use of commonly dispensed asthma inhaler devices.

Aunque los farmacéuticos comunitarios se han involucrado en el cuidado de los pacientes con asma, varios estudios han evaluado las capacidades de los farmacéuticos para ilustrar apropiadamente la técnica de inhalación de los diferentes dispositivos. Muchos estudios encararon el uso inapropiado de los inhaladores por pacientes y farmacéuticos, además de su daño clínico, humanístico y económico. Objetivo: Evaluar en los farmacéuticos comunitarios el conocimiento práctico y las habilidades para demostrar la técnica de inhalación apropiada de los dispositivos para asma disponibles en Sudan. Métodos: Se abordó a 300 farmacéuticos comunitarios situados alrededor de 3 hospitales principales de la ciudad de Kartum y de otras 4 provincias, y se evaluaron 4 dispositivos para el asma: Inhaladores dosificadores (MDI) (n=105), MDI con cámara espaciadora (n=83), Turbuhaler (n=61), y Diskus (n=51). Un investigador (farmacéutico) actuó como un paciente simulado. Seleccionaba un dispositivo y pedía al farmacéutico que le demostrase como utilizarlo. El investigador rellenaba un check-list de 9 pasos sobre el uso del inhalador inmediatamente después de abandonar la farmacia. Los pasos esenciales extraídos de la literatura fueron previamente especificados para cada dispositivo. Se crearon 5 categorías de evaluación: técnica óptima; técnica adecuada; técnica pobre; dispositivo totalmente extraño; y no sabía. Resultados: Más de la mitad de los farmacéuticos abordaos con el dispositivo no conocían la técnica óptima de uso (i.e. todos los pasos correctos). Un tercio demostraba pobremente la técnica y solo un farmacéutico fue calificado como capaz de demostrar la "técnica óptima". La mayoría de los farmacéuticos abordados con cámara espaciadora o con inhaladores de polvo seco (Turbuhaler y Diskus) o no sabían la técnica apropiada o desconocían totalmente los dispositivos. Concusión: La mayoría de los farmacéuticos comunitarios, de los que se esperaba que educasen a los pacientes con asma sobre los inhaladores dispensados, carecían de conocimientos básicos sobre el uso apropiado de los inhaladores para asma comúnmente dispensados.

Visceral leishmaniasis (VL) has been known to occur since the 1980s on the western bank of the White Nile River (Central Sudan), 150 km south of Khartoum, and has resulted in high mortality. The most recent outbreak of the disease in this area began in 2006. Entomological surveys were carried out during May 2008, June 2010 and May and July 2011 in the White Nile area. Sandflies were collected using Centers for Disease Control light traps and sticky oil traps in the village of Kadaba and the nearby woodland. Phlebotomus females were dissected for the presence of Leishmania promastigotes. A total of 17,387 sandflies, including six species of Phlebotomus and 10 species of Sergentomyia, were identified. The Phlebotomus species recorded were Phlebotomus orientalis, Phlebotomus papatasi, Phlebotomus bergeroti, Phlebotomus duboscqi, Phlebotomus rodhaini and Phlebotomus saevus. P. orientalis was collected in both habitats. The relative abundance of P. orientalis in the woodland habitat was higher than that recorded in the village habitat. In the woodland habitat, there was a notable increase in the relative abundance of P. orientalis during the surveys conducted in 2008 and 2010 compared to 2011. None of the 311 P. orientalis females dissected were infected with Leishmania promastigotes, although relatively high parous rates were recorded in both habitats. Based on the distribution of P. orientalis recorded in this study, this species is the most likely vector of VL in the endemic focus in the White Nile area. Further investigation is required to elucidate the seasonal abundance and distribution of the vector, as well as the transmission season of VL in both habitats so that appropriate control strategies for the vector can be designed.

The thermal properties of a number of Schiff base metal complexes in nitrogen atmosphere have been investigated by thermogravimetry (TG) and differential thermogravimetry (DTG). The kinetic analyses of the thermal decomposition were studied using the Coats-Redfern and Horowitz-Metzger equations. The obtained kinetic parameters show the kinetic compensation effect.

We report on a 29-year-old Pakistani man who presented to the clinic with epigastric pain, of one-month duration. He did not report fever, cough, vomiting blood, passing black stools, loss of appetite or diarrhea. However, he had lost 7 kg since his symptoms had begun. Clinical examination was unremarkable. Laboratory results were within normal limits. An abdominal CT scan showed a mass with enhancement in the stomach. Gastric endoscopy revealed an ulcerative mass in the fundus. An endoscopic-biopsy specimen revealed caseating granulomas with acid-fast bacilli. The patient was diagnosed to have primary gastric tuberculosis, and antituberculous medications were initiated. Cultures of the gastric mass subsequently grew Mycobacterium tuberculosis sensitive to isoniazid and rifampcin. Follow-up after six months showed a good response to treatment; an upper gastrointestinal tract endoscopy after six months was normal.