Background: The treatment of unstable intertrochanteric fracture in the elderly patient is still controversial. Traditionally, internal fixation using a dynamic hip screw was of choice. Recently, some authors advocated the use of cemented bipolar arthroplasty or hemiarthroplasty which results in better functional outcome. Aim: The aim of this study is to find out which of these treatment options can lead to the best clinical and functional outcomes. Patients and Methods: One hundred and two patients admitted to Makassed General Hospital between 2002 and 2007 with a diagnosis of unstable intertrochanteric fracture of femur were selected. Preoperative and operative data was retrieved from inpatient hospital files. Postoperative radio clinical data at follow up visits was collected from outpatient department files. Functional outcomes were assessed with use of Harris hip score. The main clinical measures were early postoperative full weight bearing, postoperative complications and functional outcome. Results: The time to full weight bearing, the rate of postoperative complications, and the functional outcomes was significantly better in the cemented bipolar arthroplasty group. Conclusion: According to our results, we believe that cemented bipolar hemiarthroplasty is of choice in freely mobile elderly patients above seventy years of age with an intertrochanteric femoral fracture.

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Lentiviruses have been adapted as gene delivery vehicles. This article summarized shRNA lentiviral vector methods generally used in research laboratories. The main procedures of shRNA lentiviral vector include that (1) Target sequences screening and shRNA oligonucleotides designing, (2) insert designed oligonucleotides into lentiviral vectors, (3) using packaging cells to produce shRNA lentivirus, and (4) transducing target cells with shRNA lentivirus.

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Background : Probiotics are live microorganisms which are mainly strains of Lactobacillus spp., Bifidobacterium spp. When administered in adequate amounts, these microorganisms offer a health benefit for the host. Probiotic organisms are also available commercially in milk, sour milk, ice cream and other foods. Aims : To identify bacterial species isolated from burn wounds, and also to evaluate (In-vitro) the therapeutic efficacy of Lacto. acidophilus against these bacterial isolates. To compare this activity to other antibacterial agents which are used medically in the treatment of burn wound cases. Materials and Methods : Burn wound swabs were obtained from 50 patients who had been admitted to hospitals in Baghdad during August to November 2009. These swabs were inoculated onto enriched and differential culture media. Subcultures were performed on selective media. The necessary biochemical tests were conducted and the organisms identified using standard procedures. Susceptibility of isolated pathogens to local isolates Lacto. Acidophilus (with 1υ10⁸ cells/mL) and 10 commonly used burn wounds antibiotics was examined using standard susceptibility testing. Results : Ninety different organisms were isolated. Gram-positive cocci accounted for 16 (17.7%) and gram-negative bacilli for 74 (82.2%) bacterial isolates. Pseudomonas aeruginosa 30(33.3%) were the most commonly isolated organisms, followed by Escherichia coli, Enterobacter spp., Klebsiella spp., Proteus spp.(22.2,20,4.4,2.2%), respectively. Staphylococcus aureus isolates were performed in 8(8.8%). However, the incidence of Staphylococcus epidermidis was 2 (2.2%), while ί-haemolytic Streptococci was 4(4.4%). In susceptibility testing, Lacto. acidophilus had coverage against 90 (100%) of 74 gram-negative and 16 of gram-positive bacteria tested. The coverage of the remaining 10 antibacterial agents used was different in their activity (resistance or sensitivity), which ranged between 50-100%. Conclusion : The results of the study concluded that lactobacillus acidophilus concentration of 1X10 ⁸ cells/mL had a high activity to inhibit the growth in-vitro of all pathogenic gram-positive and gram-negative bacteria, which cause burn wound infections. This indicated the therapeutic efficacy of lactobacillus acidophilus bacteria.

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Background : Since the advent of the Industrial Revolution in the late 19th century, we have all been unfortunately exposed to an increasingly toxic and polluted world. Among the most dangerous of these pollutants is mercury, which is considered to be the most toxic non-radioactive heavy metal. Fermented foods may help cleanse the body of heavy metals. Fermentation breaks down the nutrients in foods by the action of beneficial microorganisms and creates natural chelators that are available to bind toxins and remove them from the body. Aims: The current study was designed to determine the impact of feeding a high fiber probiotic fermented mare's milk on the biological effects of mercury toxicity in rat model. Methods and Materials: The high fiber fermented mare's milk containing probiotics was prepared and its sensory properties, chemical composition, and antioxidant activity were determined. A rat model of mercury toxicity was used. The effect of feeding the high fiber probiotic fermented mare's milk to rats, along with mercury ingestion, was determined by the analysis of several biochemical markers in serum and histopathological examinations of brain and kidney. Results: The high fiber fermented mare's milk containing probiotics was found to be acceptable by all test panels and volunteers. Mercury ingestion was found to cause biochemical and histopathological alterations in rat serum and tissues. The mercury-treated rats showed a decrease in body weight and an increase in kidney weight. Sera of the mercury treated rats showed alterations in biochemical parameters, and histopathological changes in brain and kidney. However, the rats fed high fiber fermented mare`s milk along with mercury ingestion showed improved histopathology of kidney and brain, and there was restoration of the biochemical parameters in serum to almost normal values. Conclusions: Feeding high fiber fermented mare`s milk may reduce the toxic effects of mercury.

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Background: Diabetes is one of the most common chronic diseases, affecting almost 3 million in Canada alone and is characterized by increased blood glucose levels. Treatment varies from lifestyle changes to oral anti-diabetics and/or insulin. Sodium glucose co-transport inhibitors may offer promising treatment for patients suffering from diabetes. The inhibitors act by increasing the loss of glucose in urine by decreasing the reabsorption of glucose from the proximal tubules of nephrons. Aims: The aim of this review was to assess the efficacy of sodium glucose co-transport inhibitors in the treatment of diabetes as well as any adverse effects. Materials and Methods : Databases such as MEDLINE, COCHRANE and EMBASE were systematically searched for literature on the efficacy of sodium glucose co-transport inhibitors in improving the glycemic control of patients with diabetes. Results: Research showed that sodium glucose co-transport inhibitors significantly decreased blood glucose levels by increasing glucosuria. Due to the diuretic effects of these inhibitors, diabetic patients who were suffering from hypertension showed a decrease in blood pressure. The caloric loss associated with these inhibitors resulted in weight loss as well. The most common adverse effect seen in patients on these medications was mycotic infection of the urinary or genital tract. Conclusion: Sodium glucose co-transport inhibitors may be an effective line of treatment for diabetes. Although short-term research has shown these drugs to be safe and well-tolerated, studies should be conducted to assess the long-term effects of these drugs.

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Context: Spontaneous perforation of rectum is a rare event; however evisceration of the small bowel through the perforated site without predisposing factors is extremely rare, complex and worth reporting. Case report: A 14 years old presented to us apparently as a case of intussception. The operative findings revealed it to be a case of spontaneous perforation of rectum with evisceration of the small bowel through the perforation. Conclusion: Sudden increase in the intra-abdominal pressure leads to the perforation in the chronically deranged rectal wall and pushes the small bowel loops into the pelvis and through the perforated rectum to appear transanally.

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Background : Rauwolfia vomitoria, a tropical shrub, is a medicinal plant used in the treatment of a variety of ailments. It is popular to the locals because of its anti-hypertensive and sedative properties. Aim : This is to find the probable teratogenic effects of ethanolic leaf and root bark extracts of Rauwolfia vomitoria on the morphological and histological features of the fetal heart. Material and Methods: Twenty five female rats weighing between 170-200g were used for this study. The rats were divided into five groups labeled A, B, C, D and E, with each group consisting of five rats. Pregnancy was induced by caging the female rats with sexually matured males. The presence of vaginal plug and tail structures in the vaginal smear the following morning confirmed coition, and it was regarded as day 0 of pregnancy. Group A was given sham treatment of distilled water. Group B and C received respectively 150mg/kg and 250mg/kg body weight doses of ethanolic leaf extract of Rauwolfia vomitoria, and those in groups D and E received respectively 150mg/kg and 250mg/kg body weight doses of ethanolic root bark extract of Rauwolfia vomitoria. These treatments were on days 7-11 of gestation (5 days) with the aid of an orogastric tube. On the day 20 of gestation, the rats were sacrificed and the fetuses examined for gross anomalies, preserved and latter process for histological studies. Results : There were no mortality in this study, and no obvious gross malformations in the fetuses. Histological observations of the fetal heart showed marked distortion of the cardiac muscle nuclei and myocardial fibers in the treated groups particularly those whose mothers received 250mg/kg of the extracts. These effects were more pronounced in the groups whose mothers received the root extract when compared with the control and the groups whose mothers received the leaf extract. Conclusion : This result suggests that high doses of ethanolic leaf and root extracts of Rauwolfia vomitoria may be cardiotoxic to the developing rat's heart.

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Background : Blood hyperviscosity has been acknowledged to be a complicating factor in polycythaemia and hyperproteinaemia. Hyperleucocytosis has also been implicated in hyperviscosity and may be a basis for therapeutic leukapheresis. Aims : This issue in the series seeks to determine the association and correlation between whole blood viscosity and white blood cell count (WBCC), with a view to advance the cause of a neglected clinical pathology index. Materials & Methods : Based on archived clinical pathology data, 10,857 cases that were concomitantly tested for full blood count and total proteins in the 2008 calendar year were audited for hyperleucocytosis. Whole blood viscosity level was determined and compared in the group with leucocytosis relative to the group with leucopenia and normal WBCC. The confounding effects of age, gender and red blood cell indices were evaluated. The correlation between whole blood viscosity and WBCC was also determined. Results : As a generalization, hypoviscosity is observed among individuals who presented hyperleucocytosis. There is no correlation (r = 0.20) between leucocytosis and blood viscosity. Conclusion : It is known that anaemia and thromboembolism, which can be associated with leucocytosis, predispose to hypoviscosity. The finding from this study provides evidence of association between hypoviscosity and leucocytosis. The absence of association and insignificant correlation between leucocytosis and hyperviscosity may be one explanation for ineffectiveness of therapeutic leukapheresis. Further, the non-correlation lends credence to specificity of blood viscosity, for which critical leucocytosis is not a substitute.

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Background: Because of the appalling health indices in West Africa, Physicians there need to be at the forefront of the organizational challenge in managing and improving health systems. Aim: To collate the views of West African surgeons on how well their educational and professional backgrounds may have prepared them for leadership and managerial roles in health care, and draw appropriate policy implications. Material and Methods: Filled structured questionnaires from 110 surgeons that were attending an annual conference were analyzed. The respondents' bio data, professional, educational, health administrative backgrounds were probed. Their views on justifications for physicians' involvement in health managerial roles, probable influence of some physicians' characteristic traits and professional attributes on health leadership roles, and suggestions for improvement were also collated. Results: 71.8% of the respondents had held or were then holding health-related administrative posts; 90% had attended different varieties of management courses; 95.4% identified physicians as the inherent leaders of the health care team; but only 28.4% adjudged their health management role "strongly important" (28.4%) among their multi-faceted roles; and they largely agreed that some stated professional and characteristic traits of physicians tend to make them poor leaders and managers. Conclusions: Our findings suggest that the preparations that the respondents got from their formal and professional education for leadership and managerial roles in health care were not optimal. We recommend for a paradigm shift for physicians on health leadership issue which is to be facilitated by a well-focused short time duration health management course for all physicians, particularly specialists.

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A number of methods are available for the drainage of pancreatic pseudocysts, including percutaneous, endoscopic and open approaches. The author reviewed the most rently reports, and and summarized the latest advances in the pancreatic pseudocysts .

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