Seham Mustafa

Hyperthermia alters kidney function and renal scintigraphy.

Background/Aim: Fever can be caused by different reasons such as environmental conditions, acute rejection after kidney transplantation and bacterial diseases including kidney and urinary tract infections. The present study represents a novel idea of investigating the direct effect of body temperature elevation on kidney function to determine whether hyperthermia alters the kidney function transiently leading to inaccurate findings and possible misinterpretation of the radionuclide (99mTc-MAG-3) renography studies. Methods: Renography studies were performed on New Zealand White rabbits weighing approximately 3–3.5 kg. Each rabbit was inject with 48.1 MBq (1.3 mCi) technetium-99m-mercaptoacetyltriglycine (99mTc-MAG-3). Studies were acquired using a gamma camera equipped with a low-energy, high-resolution collimator interfaced with a computer. Dynamic images were acquired as 2-s frames for the first 1 min and every 30 s for the next 30 min on a matrix of 64 × 64. Regions of interest were drawn over the whole kidneys. Radioactivity time curves were generated from the regions of interest. Time to peak activity (Tmax), time from peak to 50% activity (T½), and the uptake slope of each kidney were calculated from the renograms. Three days later the same protocol was repeated for the same rabbit but with a higher body temperature by 2°C. Then it was repeated with a higher body temperature by 3°C, then 4°C with the same interval period. Blood pressure was measured using a catheter inserted into the femoral artery connected to a Lectromid recorder at normal temperature and during increasing the temperature by 2, 3 and 4°C. Renal blood flow was also measured via the renal artery using an electromagnetic blood flow sensor connected to a flowmeter. Creatinine and blood urea nitrogen (BUN) in blood were measured in control and hyperthermic rabbits. Results: During hyperthermia the experimental curves shifted to the right of the control curves indicating that there was a delayed renal uptake of 99mTc-MAG-3 and clearance of radioactivity. This delay was proportional to body temperature. Calculated averages were: Tmax 1.6 ± 0.1, 2.8 ± 0.3, 8.8 ± 1, 15 ± 4 min; T½ 2.77 ± 0.2, 3 ± 0.4, 8.9 ± 1.1, 20 ± 3.4 min, and perfusion index 190 ± 5, 201 ± 4, 218 ± 7, 224 ± 9 of control and hyperthermic (elevation of temperature 2, 3, and 4°C) rabbits, respectively (n = 6; p < 0.05). Mean arterial pressure and renal blood flow did not significantly change during hyperthermia. Creatinine and BUN were proportionally elevated to high temperature. Conclusions: Our results indicate that hyperthermia causes a transient alteration in the function of the kidney and scintigraphic pattern on radionuclide renography. Radionuclide renography studies may be performed at normothermic temperature since interpretation at higher body temperature could lead to misleading results, and temperature should be checked and recorded for single and follow-up radionuclide renography studies.

Effect of Diabetes on Cooling-induced Detrusor Muscle Contraction: Mediation Via Rho-kinase Activation

OBJECTIVES To investigate the possible involvement of Rho-kinase in cooling-induced contraction of the detrusor muscle. The etiology of diabetic cystopathy is not clear. It may be due to various changes in bladder innervation and/or detrusor muscle dysfunction. Because cooling of urinary bladder smooth muscle normally is a potent stimulus to micturition due to increase in muscle tone, we studied the effects of cooling on normal and diabetic bladder specimens. METHODS Urinary detrusor muscle strips isolated from rats were suspended in organ baths containing Krebs solution for isometric tension recording. Tissue responses to stepwise cooling were examined from normal and 12-week streptozocin-induced diabetic rats. We examined the effects of calcium-free, ethylene glycol bis (beta-aminoethylether)-N,N,N,N,-tetraacetic acid (1 mm)-containing Krebs solution, and the Rho-kinase inhibitor Y-27632 on the cooling responses. RESULTS Stepwise cooling from 37 degrees C to 5 degrees C induced a rapid and reproducible increase in basal tone, proportional to cooling temperature. This response was more pronounced in diabetic specimens. Cooling-induced contractions were significantly inhibited in calcium-free solutions in both control and diabetic bladders. Our investigation showed that the influx of extracellular calcium is important in inducing the cooling response. The Rho-kinase inhibitor Y-27632 (1 microm) inhibited cooling (20 degrees C)-induced contraction. It reduced the response by 52.1% +/- 10.0% in control and by 70.0% +/- 12.0% in diabetic rats. CONCLUSIONS Cooling-induced contractions in control and diabetic detrusor muscle preparations are highly calcium dependant. It also involves activation of Rho-kinase, which might be upregulated in the diabetic detrusor muscle. These results may help in the management of diabetes-induced incontinence due to involuntary detrusor muscle activity.

Effect of Diabetes on the Ion Pumps of the Bladder

OBJECTIVE To establish whether the activities of Na+/K+-adenosine triphosphatase (ATPase) and Ca2+-ATPases ion pumps in bladder smooth muscle are altered as a consequence of diabetes and, if so, how this might contribute to bladder cystopathy. Urinary bladder dysfunction is a common occurrence in patients with diabetes. Pressure generation requires calcium and cytosolic ATP. Activities of these pumps are responsible for calcium homeostasis. METHODS Rat urinary detrusor muscle strips were suspended in organ baths containing Krebs solution for isometric tension recording. Tissue responses to the Na+/K+-ATPase pump inhibitor, ouabain, the plasma membrane Ca2+ ATPase inhibitor, vanadate, and the sarcoplasmic reticulum Ca2+ ATPase inhibitor, cyclopiazonic acid (CPA), were examined from normal and streptozocin-induced diabetic rats for 2, 4, and 12 weeks. RESULTS Ouabain, vanadate, and CPA caused concentration-dependent contractions of bladder strips from diabetic and normal rats. The degree of contraction of diabetic bladder muscle was lower than that of controls. This reduction was a function of duration of diabetes. For ouabain, the reduction peaked at 2 weeks, with partial restoration to normal after diabetes induction. For vanadate and CPA, the reduction increased with the duration of diabetes. CONCLUSION The ion pumps are important modulators of bladder smooth muscle tone, and in a rat model of streptozotocin-induced diabetes, the activity of these pumps is impaired. Although this is only a single model of diabetes, these findings suggest that a defect in these pumps may be an important component of the development of diabetic bladder cystopathy.

Self-medication among undergraduate medical students in Kuwait with reference to the role of the pharmacist.

Objective: The practice of self-medication is growing world-wide. It is associated with problems that may lead to potentially life-threatening complications represent a priority to be investigated. The aim of this study was to estimate the prevalence of self-medication among undergraduate medical students and to evaluate the possible role of the pharmacist in self-medication in Kuwait. Methods: A descriptive cross-sectional study was performed, using the questionnaire on a sample of 900 male and female students randomly selected from three health faculties in Kuwait. The prevalence of self-medication, as well as the contribution of pharmacist in self-medication was assessed. In addition, the role of the pharmacist as drug consultant for the students after getting the medication was evaluated. Findings: The overall prevalence of self-medication was 97.8%. The age was significantly inversely proportional to self-medication. There was a significant difference between male and female students in self-medication practice. Headache was the highest health conditions that most frequently motivated self-medication with 90.1% prevalence, followed by 84.7% for dysmenorrhea and 60.3% for constipation. Contribution of the pharmacist as a part of self-medication care was low totally, with the highest rate for cough conditions 40.1%. However, the role of the pharmacist as a drug consultant was more noticeable after obtaining the drug, not before. Around 80.1% of the students request information from the pharmacist about doses, duration of treatments and side-effects. Conclusion: The prevalence of self-medication among undergraduate students in Kuwait is high and there were significant differences for age and gender. The contribution of the pharmacist was low in self-medication, while it was high after getting the drugs for obtaining drug related information. The practice of self-medication is alarming. Improved awareness about the role of pharmacist as a drug consultant for careful and cautious use of medicines available for self-medication would be strongly recommended.

Synergistic effects of ethanol and hyperthermia on carotid artery vasoconstriction

Background:  Heatstroke is a serious condition and clinical studies indicate that vascular stroke increases with excessive consumption of alcohol (ethanol). It was our objective to test the influence of ethanol on cerebral perfusion at normal and higher temperatures.

Effect of the NSAID Diclofenac on 99mTc-MAG3 and 99mTc-DTPA Renography

Renal function and disease are commonly evaluated by radionuclide studies. The choice of radiopharmaceutical agent for various studies is crucial for proper interpretation. 99mTc-mercaptoacetyltriglycine (99mTc-MAG3) is excreted almost exclusively by the renal tubules, whereas 99mTc-diethylenetriamine pentaacetic acid (99mTc-DTPA) is predominantly excreted by glomerular filtration. The present study compared the effect of the nonsteroidal antiinflammatory drug (NSAID) diclofenac, which is the most commonly used drug to relieve kidney pain, on the kinetic behavior of administered 99mTc-MAG3 and 99mTc-DTPA in experimental animals. Methods: Two groups of 12 New Zealand White rabbits (99mTc-MAG3 and 99mTc-DTPA) were used for the renography. Each rabbit served as its own control. The animals were given 60 mL of saline intravenously 30 min before each renographic study. A baseline study (control) was done by injecting 48 MBq (1.3 mCi) of 99mTc-MAG3, and renography was performed. Two days later, a single intravenous dose of diclofenac (2 mg/kg) (treated animals) was given, and after 20 min, 99mTc-MAG3 renography was performed. This procedure was repeated for the 99mTc-DTPA group after administration of 96 MBq (2.6 mCi) of the tracer. Dynamic images (as 2-s frames for the first minute and 30-s frames for the next 30 min on a 64 × 64 matrix) were acquired using a γ-camera equipped with a low-energy high-resolution collimator interfaced with a computer. Regions of interest were drawn over the whole kidneys. Time–activity curves were generated from the region of interest. Time to peak activity (Tmax), time from peak to 50% activity (T1/2), and the uptake slope of each kidney were calculated from the renograms for control and treated rabbits. Results: Administration of diclofenac shifted the experimental renogram curves to the right, compared with the control curves, indicating that there was a delayed renal uptake of the 2 tracers and clearance of the radioactivity. The calculated average values of Tmax for control and treated rabbits using 99mTc-MAG3 were 1.8 ± 0.5 and 6.35 ± 0.4 min, respectively, whereas those of 99mTc-DTPA were 3.4 ± 0.4 and 18.2 ± 2 min, respectively. The T1/2 for control and treated rabbits for 99mTc-MAG3 were 3.2 ± 0.07 and 6.6 ± 0.07 min, respectively, whereas those for 99mTc-DTPA were 10.1 ± 1 and 35 ± 4 min, respectively. The differences were statistically significant (P < 0.05). Conclusion: This study showed that diclofenac delayed both Tmax and T1/2. The NSAID-induced kinetic changes were considerably greater for 99mTc-DTPA than for 99mTc-MAG3. On the basis of these findings, it is suggested that 99mTc-MAG3 be used to perform renography for studies involving the use of NSAID administration to decrease any change that may occur due to the type of tracer and not to the condition of the kidney.

Effect of ethnicity on erythropoietin therapy response for hemodialysis patients: a retrospective study.

Anemia is a common feature in chronic kidney disease patients due to deficiency of erythropoietin (EPO). Diseased kidneys are unable to produce EPO, which enhances red blood cell production from the bone marrow. Recombinant human EPO in hemodialysis patients was introduced with perfect outcomes as a hormonal substitutive treatment. Some ethnic minority groups have high prevalence of anemia associated with chronic kidney diseases. The aim of this study is to evaluate the differences between African Caribbeans and Caucasians’ EPO therapy response with regard to hemoglobin (Hb), some factors affecting it and some comorbid conditions. A retrospective study for 6 months of 100 patients on hemodialysis was conducted on two ethnic minorities groups; 46 patients were African Caribbean and 54 patients were Caucasian, who received EPO therapy at once or three times weekly dose at the Hanbury Dialysis Unit of Royal London Hospital. There were three types of EPO therapy used: Aranesp, Mircera and Neorecormon. Forty‐six patients were African Caribbean and 54 patients were Caucasian. There were 63.4% of patients treated by Aranesp while 13% were given Mircera; 22.8% of the sample used Neorecorman. It was shown that the chosen comorbid conditions had higher percentage in the African Caribbeans than in Caucasians. Diabetic and/or hypertensive patients are almost double the patient numbers. In addition, sickle cell anemia is only present in African Caribbeans. There were 43.5% of African Caribbeans and 81.1% of Caucasians who met the standards of Hb level. There was no significant difference between African Caribbeans and Caucasians regarding parathyroid hormone, c‐reactive protein, B12, mean corpuscular volume, ferritin, and folate. In this study, there was a significant difference in the Hb levels between African Caribbean and Caucasian groups. Sixty percent of African Caribbeans had mean Hb less than normal levels. However, they received lower EPO dose than Caucasians. As a result, this may affect the whole treatment and therapy which may lead to anemic complications.

Ethanol potentiates heat response in the carotid artery via TRPV1

AIM Ethanol is one of the most widely used recreational drugs in the world. At high concentrations, it can induce carotid artery vasoconstriction. Hyperthermia potentiates its effects resulting in carotid artery vasoconstriction at any concentration. The aim of this study is to investigate the interaction between ethanol and heating and to understand the underlying mechanisms leading to their synergistic effect. MATERIALS AND METHODS Isometric tension of rabbit carotid artery ring segments suspended in organ baths filled with Krebs solution was recorded. Different concentrations of ethanol were examined at 37°C and during temperature elevation to39-43°C. Capsaicin and capsazepine were used to examine the mechanism of action of ethanol. KEY FINDINGS Ethanol induced contraction at 37°C when the concentration reached 100mM. Contraction was observed at any concentration at higher temperatures. Ethanol potentiated heat-induced contraction. Capsaicin, the vanilloid receptor subtype1 (TRPV1) agonist, potentiated the vasoconstriction due to heating. While capsazepine, TRPV1 antagonist, abolished the effect of ethanol and its potentiation of heating-induced contraction, but it did not abolish the heating effect. SIGNIFICANCE Ethanols mechanism of action and its effect on heating induced-vasoconstriction of the carotid artery is being mediated by TRPV1. The combination of ethanol and hyperthermia can lead to a synergistic effect on carotid vasoconstriction. This effect may induce brain damage and heat stroke. Development of new drugs act as TRPV1 antagonist can be used to prevent these fatal effects.

Adolescents’ knowledge and awareness of diabetes mellitus in Kuwait

Abstract Background and aim Diabetes mellitus is a major public health problem in Kuwait. This study aimed to evaluate the awareness and the knowledge of diabetes in adolescent about the disease which, will be of a great help to reduce the risk of developing diabetes and its complications. Methodology A cross-sectional survey was done to evaluate the general knowledge of diabetes. The survey was introduced randomly to the students of 30 secondary public and private schools in Kuwait. The questionnaire was divided into eight main sections, with each section focusing on different aspects of diabetes mellitus, namely General knowledge about diabetes, Knowledge of risk factors of diabetes, Knowledge of symptoms, Knowledge on complications, Knowledge about treatment and available medications, Knowledge about lifestyle and non-medical measures, Things diabetics should not do, and Knowledge of management of diabetes. Results A total of 4333 students contributed. The main score obtained by the students was 63.2% of the maximum total score. For “General knowledge about diabetes” section’s scores were 71.0%, “Knowledge of risk factors of diabetes” 63%, “Knowledge of symptoms and complications” 55.8%, “Knowledge about treatment and management” 62.7%, and “Knowledge of monitoring diabetes” 72.3%. Conclusion The students contributed in this study have good general information about diabetes except for a few areas. Our study will clarify these areas to help in designing educational programs to treat these deficiencies of knowledge about the disease and increase the awareness.

Evaluation of different anti-asthmatic drugs on cooling-induced bronchoconstriction.

Inhalation of cold air is a well‐recognized cause of bronchoconstriction in asthmatics. Sudden changes in weather temperature outdoors and indoors due to the extensive use of air conditioning in Kuwait is an important existing problem.