احسان صلاح محمدرضا ربيع

rastuzumab, a monoclonal antibody, is effective in HER2 positive breast cancer patients but cardiotoxicity is problem. The aim of this study was to clarify the possible effects of Valsartan on echocardiographic ejection fraction and cardiac biomarkers (serum brain natriuretic peptide and malondialdehyde) in trastuzumab treated females with breast cancer over expressing HER2 receptor. Twenty six female patients with new diagnosis of HER2 positive breast cancer were randomly assigned to 8 cycles trastuzumab treatment (group I, no= 13) or trastuzumab plus Valsartan 40 mg (group II, no= 13). Echocardiography ejection fraction was analyzed at base line, 4th and 8th cycles in both groups. Serum malondialdehyde and brain natriuretic peptide were analyzed at base line, 2nd, 4th, 6th and 8th cycles in both groups. Treatment with trastuzumab caused significant decrease in echocardiographic ejection fraction at 8th cycle treatment in comparison to baseline readings (P < 0.05). A significant increase in echocardiographic ejection fraction was obtained by group II (trastuzumab plus Valsartan group) in comparison with that of trastuzumab therapy group (P < 0.05). Regarding serum brain natriuretic peptide and Malondialdehyde, trastuzumab therapy caused significant increase in both these markers compared with the baseline readings (P < 0.05).Combined trastuzumab plus Valsartan caused significant decrease in serum brain natriuretic peptide and Malondialdehyde compared with that of trastuzumab therapy group (P < 0.05). In trastuzumab treated patients, Valsartan causes significant increase in ejection fraction with significant decrease in both serum brain natriuretic peptide and malondialdehyde

Objectives: The aim of this study is to assess the general health of diabetic type 2 patients by using SF-36 and also to find if there was an association between the scores of eight domains of this tool with disease-specific and demographic variables. Methods: A cross-sectional study was conducted to evaluate the general health of patients with diabetes mellitus type 2. The participants of the present study were randomly selected from rural and urban areas. The diabetic patients visiting community pharmacies in these areas were invited to participate in this study after explaining the goal of the study. A self-reported questionnaire in the Arabic version of the medical outcome survey, the Short-Form (36-item), was conducted. However, uneducated patients were interviewed by trained pharmacists in the community pharmacies. Results and Discussion: Two hundred confirmed DM patients were enrolled in this study with a mean age of (50.65 ± 8.914 years). 142 (71%) were male and the remaining 58 (29%) were female. The scores of all domains of SF-36 were significantly lower (p < 0.05) in female patients in comparison to that recorded in men. In addition, diabetic patients aged more than 50 years showed significantly lower scores of most domains of SF-36 (p < 0.05) except for emotional well-being (p > 0.05). The multivariate linear regression analysis demonstrated that gender, age, and treatment type were independent of health status based on the SF-36 survey, while emotional well-being, social functioning, and pain were exceptional. Conclusion: The outcomes of this study showed a negative correlation between diabetes mellitus and the health status as measured by SF-36. Furthermore, excluding emotional well-being, social functioning, and pain domains, the other parameters of gender, age, and treatment type showed a significant correlation with health status.

Abstract Acute renal failure also known as acute kidney injury (AKI) is a complex health condition related to significant morbidity and mortality. In hospitalized patients, around 19-33 percent of AKI episodes are linked to drug induced nephrotoxicity. Although considered safe, NSAIDs such as diclofenac have gained special attention over the past few years due to the potential risk of renal injury. The direct effect of diclofenac-induced renal injury depends on targeting the mitochondria in kidney tissue, and formation of reactive oxygen species (ROS) resulting in oxidative stress. Secondly, diclofenac inhibit renal prostaglandin production, limiting renal afferent arteriole vasodilation, increasing afferent resistance; thus decreasing the glomerular capillary pressure below normal values and glomerular filtration rate will decrease resulting in AKI. Alpha-Lipoic acid (ALA) has beneficial effects in prevention or relief of symptoms of oxidative stress- related diseases, as it acts as antioxidant and anti-inflammatory micronutrient. Bosentan is a competitive antagonist with dual endothelin-1 receptors, as renal vascular ET-1 system is upregulated under many pathophysiological situations. In present study, we investigated the effect of lipoic acid and bosentan in diclofenac induced acute renal failure in male rats. We observed that diclofenac increased serum levels of urea, creatinine, malondialdehyde, KIM-1, TGFβ1 and fibronectin significantly (p>0.05) in the induction group compared to control group. While, SOD significantly (p>0.05) reduced in the induction group compared to control group. Both of lipoic acid and bosentan alone didn’t significantly protect against diclofenac induced AKI. However, the combination group showed a significant protection against AKI. Pearson correlation analysis showed a significant positive correlation between (urea and KIM-1) and between (creatinine and KIM-1) (r2=0.792 and r2=0.677 respectively). Furthermore, there was a significant positive correlation between fibronectin and urea (r2= 0.498, p>0.01) and fibronectin and creatinine (r2=0.356, p>0.05). Interestingly, KIM-1 showed a significant positive correlation with fibronectin (r2=0.536, p>0.01). ROC curve test was performed for KIM-1 and fibronectin biomarkers. The AUC for KIM-1 was 0.986 and for fibronectin was 0.829. We concluded that combination therapy of lipoic acid and bosentan showed a significant protective effect against diclofenac-induced AKI. In addition, fibronectin could be a promising biomarker for detection and diagnosis of acute kidney injury. Key words: Diclofenac, oxidative stress, alpha- lipoic acid, endothelin-1, bosentan

ABSTRACT Trastuzumab therapy represents the standard of care for HER2 positive breast cancer patients, which is highly complicated by cardiotoxicity. The aim of the study was to elucidate the possible effects of carvedilol on echocardiographic ejection fraction, serum brain natriuretic peptide and serum C- reactive protein in trastuzumab treated females with HER2 positive breast cancer. A total of 26 females with HER2 positive breast cancer were included in this study. The patients were randomized into two groups, 13 patients in each group. Group I included patients were treated with trastuzumab therapy for 8 cycles with 21 day apart. Group II included patients were received trastuzumab therapy with carvedilol 3.125 mg, orally, twice daily dose for 8 cycles. Echocardiography was used to measure ejection fraction at zero time, 4 th and 8th cycles in both groups. Serum brain natriuretic peptide and C- reactive protein were measured at zero time, 2nd, 4th, 6th and 8th cycles in both groups. Treatment with trastuzumab therapy caused significant decrement in echocardiographic ejection fraction at only 8th cycle in comparison to baseline readings (P < 0.05). Combined trastuzumab plus carvedilol caused significant increase in echocardiographic ejection fraction compared with that of trastuzumab therapy group (P < 0.05). Regarding serum brain natriuretic peptide and C- reactive protein, trastuzumab therapy caused significant increment in both these markers in comparison to baseline readings (P < 0.05). Combined trastuzumab plus carvedilol caused significant decrement in serum brain natriuretic peptide and C- reactive protein compared with that of trastuzumab therapy group (P < 0.05). Carvedilol causes significant increment in echocardiographic ejection fraction and significant decrease in serum brain natriuretic peptide and C- reactive protein in trastuzumab treated patients. Keywords: Carvedilol, Trastuzumab, Cardiotoxicity, Ejection fraction, BNP, C-RP

tract infections in AL-Kadhumia and AL-Yarmook teaching hospitals in Baghdad for a period between 22/11/2009 to 15/3/2010, from these samples twenty five isolates were selected according to their pattern of the highest resistance as these showing multi-drug resistances and tested to specify their minimum inhibitory concentration for (meropenem, nitrofurantoin, and ciprofloxacin), meropenem was found having the lowest MIC comparing with others.This study also includes in vitro effects of various combinations of three types of antimicrobials (meropenem, nitrofurantoin, and ciprofloxacin) against twenty five E. coli isolates. Among combinations the combination of meropenem with the other types of antimicrobials showed high synergistic effect when 1/4+1/4 MIC for each antimicrobial were used. While combinations of nitrfurantoin with ciprofloxacin in some isolates showed additive effect when 1/2+1/2 MIC for each antimicrobial were used. The plasmid profile for the (25) E. coli isolates were studied using Pure Yeild ™ plasmid Miniprep system- Cat.# A1220 – Promega- USA. In order to determined the presence of plasmid for antimicrobials resistance. جمعت خمسة وسبعون عزلة من الاشيريشيا القولونية من ادرار مرضى المجاري البولية الذين راجعوا مستشفى الكاظمية واليرموك التعليمي في بغداد للفتره من ٢٢⁄۱۱⁄٢۰۰۹ الى ۱۵⁄۳⁄٢۰۱۰ ومنهم تم اختيار خمسة وعشرين عزلة اعتماداً على ما اٴبدته من مقاومة عالية و متعددة للمضادات الجرثومية ثم حددت التراكيز المثبطة الدنيا (MIC) للمضادات ( الميروبنيم النايتروفيورانتوين ٬ و السبروفلوكساسين( وقد اٴظهرت النتائج بان مضاد الميروبنيم هو الاٴكثر فعالية و ذلك بتثبيطه نمو البكتريا باٴقل تركيز مقارنة بالمضادات الاٴخرى.تضمنت هذه الدراسة استقصاء تاٴثير اتحاد المضادات الحيوية ضد (25( عزلة من E. coli ((in vitro وقد اٴظهرت النتائج اٴن مزج الميروبنيم مع بقية المضادات الحيوية (السبروفلوكساسين ٬ النايتروفيورانتوين ( يشير الى تاثير تازري عالي عند استعمال ربع التركيز المثبط الادنى ((MIC لكل مضاد حيوي. بينما اتحاد النايتروفيورانتوين مع السبروفلوكساسين في بعض العزلات يشير الى تأثير اضافي فقط عند استعمال نصف التركيز المثبط الادنى ((MIC لكل مضاد حيوي.شملت اٴلدراسة ايضاً دراسة اٴلنمط البلازميدي ل ((25 عزلة من ال E. coli باٴستخدام عدة لعزل البلازميد بواسطة نظام ال Miniprep وقد اٴظهرت النتائج باٴن العزلات (۳٢٬۳۷٬۵۷٬٦) حاملة لبلازميد مقاومة اٴلمضادات الحيوية.

Despite recent advances in antimicrobial chemotherapy and burns management, infection continues to be an important problem in the burns. Treatment of multi-drug resistant Pseudomonas aeruginosa, which causes burn infection, is a big challenge in clinics and needs novel strategies. Failure of the current treatment strategies to control many cases of burns infections, the local and systemic adverse effects that are produced by many topical antibiotics (especially in infants, children, pregnant ladies, and elderly people), and the delay of healing caused by many antiseptics, make a strong motive to find out a new, safe and effective products. Many recent studies were done to find out natural products that have antimicrobial properties, and enhance the healing process. This study aimed to investigate the in vitro activity of different types of honey against P. aeruginosa in comparison to the ciprofloxacin one of the antibiotics used in treatment of burns infection by using disk diffusion method and agar dilution MICs assay. The mean±SE inhibition zone in mm were (12.1± 0.41, 11.25 ± 0.27, 11.05 ± 0.29) and MICs {(20% - 10%), 20%, 20%} for Sider, Acacia, Eucalyptus respectively. So the conclusion was that all tested types of honey exerted a good in vitro antimicrobial activity against all tested isolates.