Tear function abnormalities in down syndrome

Down syndrome is a common chromosomal anomaly, characterized by specific facial features, eye anomalies with repeated ophthalmic infections. The integrity of the ocular surface is maintained by the tear film. To determine the presence of tear function changes in children with Down syndrome and their relation with the development of ophthalmic diseases. Tear film was evaluated by the ferning test and breakup time [BUT] measurement in 23 patients [46 eyes] confirmed as having Down syndrome by cylogenetic analysis and 20 normal control children [40 eyes] with matched age and sex. There was an alteration in both ferning and BUT tests in children with Down syndrome compared to controls. Abnormal ferning test was found in 28 out of 46 tear samples from the patient's eyes compared to 2 out of 40 normal control eyes. BUT test results showed that the preocular tear film stability was poor in 65.2% of patients' eyes, average in 26.1% and good in only 8.7% of their eyes; while controls had good and average tear film stability each representing 50% of eye's number. These tear function abnormalities may have a role in the frequent infectious pathologies found in the anterior eye segment in patients with Down syndrome which necessitates applying new stringent strategies for ophthalmologic care and management of these patients

Limited versus complete superficial parotidectomy for benign parotid tumors

Benign tumors of the parotid gland accounts for the majority of salivary gland rumors. Surgical treatment of benign parotid tumors requires complete removal of the mass with preservation of the facial nerve, but is a traditional conservative superficial parotidectomy with complete facial nerve exposure required for success? The aim of this study is to evaluate the results of benign parotid rumors treated by limited superficial parotidectomy versus the traditional conservative superficial parotidectomy with complete facial nerve exposure. All patients with benign tumors treated by the author were included. Fourteen cases were identified and treated with a median follow up period of 2 years [average 1-3 years]. Limited superficial parotidectomy was done on 6 patients. None developed facial weakness. Traditional superficial parotidectomy were performed on 8 patients. Temporary facial weakness developed in 2 patients and one developed permanent weakness in one branch of cervicofacial division of the facial nerve. Recurrence was not reported in any of both groups. Complete superficial parotidectomy is unnecessary in the treatment of localized parotid tumors. Limited parotidectomy is associated with low morbidity and revealed significant clinical advantage in term of decreasing operative time, blood loss, and significantly reducing the volume of normal parotid tissues excised .There was no reported recurrence among either group. Preoperative investigation [including fine needle aspiration cytology] should be used selectively

Reduced bone mineral density in polytransfused patients with beta thalassemia, poorly defined role of hypoparathyroidism in pathogenesis

Patients with beta thalassemia frequently develop bone disease of multi-factorial etiology. We studied the prevalence of hypoparathyroidism in addition to other laboratory indices of bone and calcium metabolism [serum calcium, phosphorus and alkaline phosphatase], in fifty patients with beta thalassemia major and ten patients with beta thalassemia intermedia. These biochemical indices were correlated to bone mineral density assessed by dual x-ray absorptiometry [DEXA]. Hypoparathyroidism was found in 8% of the studied thalassemic patients with significantly lower serum parathormone and calcium and significantly higher serum phosphate compared to control subjects. Results of DEXA scan revealed decreased bone mineral density in 90% of the studied thalassemic patients. Serum parathyroid hormone showed no significant correlation with any of the studied DEXA parameters. In conclusion, bone disease is present in the majority of thalassemic patients with no significant correlation with parathyroid hormone, denoting that bone disease in beta thalassemia is likely to be multi-factorial

In Vitro Biliary Lithotripsy By Q-switched Versus Continuous Wave Nd/YAG Laser

In this work, the role of the Q-switched and continuous wave [CW] Nd:YAG laser biliary lithotripsy was studied. A total of 120 biliary stones was randomly divided into two groups [A and B], which were conducted to CW and Q-switched Nd:YAG laser, respectively. A radiological and spectroscopic examination was done. Gall bladder wall exposure to both laser techniques was done, then was subjected to gross and microscopic examination. During Q-switched technique at the same volume of cholesterol stones, the fragmenting pulse number was inversely proportionate to the spectroscopic calcium [Ca%] content of the stones. Moreover, the thermal effect of both techniques on the gall bladder wall was evaluated. It can be concluded that CW has a hazardous thermal effect on the soft tissue surroundings which limits its use in biliary lithotripsy. The Q-switched Nd:YAG laser is an effective and safe method for biliary lithotripsy. The fragmenting pulse number depends on the pigment content of the stones. In cholesterol stones, the fragmentation pulse number is inversely proportionate to the Ca content of the stone

Hafnia alvei infection in broiler breeder chickens

The significance of Hafnia alvei [H.alvei] as a new potent poultry pathogen primarly investigated in broiler breeder chickens. H.alvei has been isolated from 3 naturally infected broiler breeder chickens suffering from sudden mortalities drop in egg production with necrotizing hepatitis and splenitis. Bacteriological examination of cloacal swabs of other apparently healthy 10 broiler breeder flocks revealed H.alvei with an isolation rate of 8%. Egg transmission of H.alvei could be proved both in naturally and experimentally infected broiler breeders. The antibiogramme of the isolated strains was investigated. Serological screening of the 13 investigated flocks for infections commonly encounted in broiler parent flocks was carried out. Histopathological examination for both naturally and experimentally infected chickens were studied. The pathogenicity of the isolated H.alvei was investigated

Electronystagmography profile in unilateral profound sensorineural hearing loss

Forty two patients with profound sensorineural hearing loss for more than 5 years were examined by electronystagmography [ENG] to evaluate their vestibular function. Their age range was 20 - 45 years. They had no complaint of imbalance and on examination there was no spontaneous nystagmus, no nystagmus on gaze or positional tests and they showed normal saccadic, smooth pursuit and optokinetic test results. Bithermal caloric test showed weaker response recorded from either ear of the study group when referenced to the normal subjects; however, fixation suppression index was normal. There was no significant unilateral weakness of the ear with hearing loss compared to the normal ear of the same subjects. These findings could be attributed to one of the compensation mechanisms, which suppress the normal ear and stimulate the affected ear

Perinatal mortality in Mansoura University Hospital

This study was conducted at Mansoura University Hospital, Mansoura, Egypt, through the period from April 1[st] 1998 to March 30[th] 1999, to evaluate the crude perinatal mortality rate at that center as an index for obstetric and neonatal care in our locality. Also, the study aimed to identify the major risk factors operative in perinatal losses. Also, we aim to reduce these losses by proper prediction, prevention and management of the underlying factors. Perinatal morality is still high in developing countries. Low birth weight, lethal anomalies, asphyxia, pregnancy complicated cases, grand multiparity and undermined general condition are the essential causes. The vast majority of the causes of perinatal mortality are preventable, and are within the scope of management by obstetricians. Prediction and prevention of preterm labour, is of great value for immediate reduction of perinatal mortality. Prediction and prevention of pre-eclampsia and eclampsia, urgent hospitalization and proper management of established cases are life saving. Obstetric management of multifoetal pregnancies represents a major obstetric challenge as regards good perinatal outcome. Grand multiparity should be considered as a disease and should be prevented by contraception. Strict control of diabetes mellitus and thorough evaluation of foetal well being can lead to favourable perinatal outcome. Proper conduct of the hospital deliveries, early referral of complicated cases, proper selection of cases for vaginal breech delivery, leads to noticeable and immediate reduction in perinatal mortality. Ultrasonographic screening for lethal congenital anomalies during early pregnancy and throughout gestation, and termination of pregnancy when justified. In addition to that: perinatal mortality rate will be reduced following improvement of socioeconomic and educational standards on long term. Proper data collection and efficient statistical records

Middle ear pressure changes during different inhalation anesthesia comparative study by tympanometry between modern and old inhalational anesthetic agents

This investigation examined the effect of modern inhalant anesthesia [isoflurane and sevoflurane] in comparison with older inhalational agent [halothane] with or without nitrous oxide on middle ear pressure [MEP]. Tympanometry was used to measure MEP variations. Seventy-six subjects were examined with tympanometry prior to inhalant anesthesia and baseline tympanometry was performed. This study found that the changes of MEP are significantly greater when nitrous oxide added to any of modern or older inhalational agents. The results have shown that administration of nitrous oxide with these agents should be used with great care during tympanic membrane grafting, ossiculoplasty or ossicular replacement prosthesis

Relation between tinnitus and temporomandibular disorder therapy

Twenty-eight adult patients with temporomandibular joint disease [TMD] associated with tinnitus were prospectively studied before and after conservative treatment of TMD. The aim of the study was to determine the effect of treatment of TMD on tinnitus. Treatment of TMD resulted in an improvement of tinnitus in 67.9% of the cases. The patients who showed an improvement of their tinnitus were usually young and their tinnitus was not severe and had a positive relation to TMD

Study of the prognostic value of early echocardiographic assessment of left ventricular function in acute variceal bleeding

To determine the prognostic value of early echocardiographic assessment in patients with acute variceal bleeding. The study was conducted on 80 patients with portal hypertension, admitted to the emergency hematemesis and tropical medicine units at the Alexandria University main Hospital. They were divided into two groups; group I: included 40 patients with acute variceal hemorrhage and group II: included 40 patients without active bleeding. Transthoracic echocardiography was used to measure and calculate left ventricular fractional shorting, left ventricular ejection fraction, stroke volume, cardiac output, total peripheral vascular resistance and the left venticular stoke work. According to the inhospital course; the bleeders [group I] were further subdivided into two subgroups: group la included 16 [40%] patients who had a poor evolution [inhospital mortality or early variceal rebleeding], and group Ib included 24 [60%] patients were discharged uneventfully. Using standard univariate analysis, the poorly evoluted patients had lower stroke volume [64.44 +/- 13.25vs. 82.33 +/- 15.88ml/beat, p=0.017], lesser cardiac index [3.10 +/- 0.66vs. 4.48 +/- 0.69L/min/[m]2, p=0.007], higher systemic vascular resistance [1387 +/- 379vs. 990 +/- 239dynes/sec/[cm]-5,p=0.010] and lower left ventricular stroke work [77.94 +/- 13.34vs. 104.18 +/- 23gram-m; p=0.007]. The prognostic value of such four variables was tested by running a stepwise logistic regression analysis. The cardiac index was the only significant predictor factor for poor evolution among our patients [chi square = 13.78, P=0.002]. The resting cardiac index is a useful predictor for inhospital mortality among patients with portal hypertension and acute variceal bleeding. Echocardiographic measurement of the cardiac index and the systemic vascular resistance may help to identify the high risk bleeders to optimise their management

Effects of noise on peripheral hearing of bus drivers [a conventional and extended high frequency audiometry study]

Hearing threshold evaluation was assessed by pure tone audiometry for 100 subjects working as bus drivers, they were constantly exposed to buses noise for at least five years. Other causes for hearing impairment, either conductive or sensorineural, were excluded. The study group was compared with a control group of 30 normal hearing subjects. Elevation in hearing threshold was noticed in the study group, especially at high frequencies and the differences were statistically significant. Normal hearing was found in 43%, high frequency SNHL above 4 KHz in 14%, mild SNHL in 33%, moderate SNHL in 4% and moderately severe to severe SNHL in 6%. The degree of hearing loss was directly proportional to duration of noise exposure. The subjects with normal hearing sensitivity in the ordinary frequency range [0.25-8 KHz] showed statistically significant elevation in the extended high frequency range [9-IS KHz]. This signified the value of extended high frequency audiometry in the early detection of susceptibility of hearing to noise insult

Studies on recent outbreaks of infectious laryngotracheitis

Recently, increased incidence of outbreaks of infectious laryngotracheitis [ILT] was observed among chicken flocks in Egypt. These were associated with variable high mortalities. Investigation of 8 such outbreaks revealed that three nonvaccinated replacement layer pullets of 6-8 weeks of age were severely affected with mortality rates of 11-12% up to 40%, while in a 4[th] pullet flock of 24 weeks of age, which was comparatively milder and resulted in only 2% mortality. On the other hand, in four commercial broiler flocks of 5-7 weeks of age with no history of previous vaccination, the disease varied in severity and mortalities [7.6 - 18.0%]. Eight isolates were recovered from these outbreaks and were identified as those of ILTV. Pathogenicity tests for two representative isolates from pullets and broilers were carried out by inoculation of each intratracheally into susceptible chickens of the respective types [egg and meat-type], morbidity and mortality rates were used to calculate an intratracheal pathogenicity index used the same as that described for Newcastle disease virus, in addition to microscopic tracheal lesion scoring as criteria for judging their pathogenicity. Results indicated that both isolates were pathogenic like wild ILT field viruses. Reversed virulence of modified live vaccine viruses was speculated under prevailing conditions of suboptimal management practices, hygiene and biosecurity measures which help spread of infection between flocks, beside the role of latently infected carrier birds and other factors in the epizootiology of the disease, especially in nonvaccinated flocks, were discussed

Studies on pyocin typing, dermoneurosis and pathogenicity of E. Coil recovered from septicemic broiler chickens

E. coli was recovered from 59.00% of septicemic broiler chickens suffering enteritis, perihepatitis and airsacculitis. Pyocin typing of chosen E. coli isolates revealed two types. The first type was able to grow in the presence of pyocin [PREC]. The second type was unable to grow in the presence of pyocin [PSEC]. There is no correlation between pyocin typing and dermonecrotic test or pyocin typing and pathogenicity for day-old chicken. But there is a correlation between dermonecrotic test and pathogenicity for day-old chicks. Thus, virulent types of E. coli can be detected through the dermonecrosis of their whole cell lysates [WCL] in the skin of guinea- pigs

Occurrence and public health importance of enterobacteriacea in giblets at consumer level

A total of 30 samples of giblets [10 of each gizzards, hearts and livers] were collected from general markets at Alexandria Province and examined bacteriologically for detection of enteric organisms. Respectively, the mean values for total coliform/g of the gizzard, heart and liver were 8.30 x 10 4 +/- 2.06 x 10 4, 3.64 x 10 2 +/- 0.67 x 10 2 and 2.79 x 10 4 +/- 0.55 x 10 4 and 7.06 x 10 4 +/- 2.23 x 10 4, 4.72 x 10 2 +/- 0.85 x 10 2 and 3.6 x 10 4 +/- 0.67 x 10 4 for total Enterobacteriaceae count. E. coli were the highest isolates from gizzards, hearts and livers [11.90%, 23.80% and 4.76%], followed by Enterobacter cloacae [2.38%, 9.52% and 4.76%] and Enterobacter aerogenes [2.38%, 9.52% and 2.38%]. Citrobacter frequndii, Hafnia alvei, Proteus rettgeri, Proteus morganii, Salmonella spp., Salmonella typhi and Shigella flexneri type 6, could be isolated in a different percentages from examined samples. Spoilage effect as well as the public health significance of isolated species have been discussed

Toxoplasma antibodies in pregnant and aborting women in Suez

The prevalence of toxoplasma antibodies in obstetric patients is not well studied in Egypt and the role of T. gondii as a cause of abortion is unsettled. The objective of this study was to assess the contribution of T. gondii as a cause of abortion in Egyptian women. Women below the age of 35 years consecutively presenting with abortion of no apparent anatomical cause, were eligible after exclusion of those who were Rh -ve or VDRL +ve or had any chronic illness. Controls were pregnant women of same age group, social class and residence, from the general hospital. All sera were tested by IHA test and IFA test for IgG antibodies of T. gondii, and by micro-ELISA for IgM antibodies. The overall prevalence of toxoplasma IgG antibodies was 27.5% IHA and 25.7% IFA and that of toxoplasma IgM was 2.8%. IgG antibodies were more prevalent among aborting women [30%] compared with normal pregnant control [20%]. Also, IgM antibodies were higher among aborting women [4%] compared with normal pregnant controls [1.5%]. However, the differences were not statistically significant. Although, there is considerable association between toxoplasma antibodies and abortion. A cause relation could not be settled, further studies are recommended

Ultrasound and infertility

The method used for the assessment of ovarian function, is noninvasive with a high degree of acceptability by the patients and supplying the clinician with readily accessible information. In this study 42 infertile women were studied by ultrasound and hormonal assays for luteinizing hormone, progesterone and estradiol. Ovulation was detected in 71% by ultrasound in all women studied which was comparable to hormonal evidence of ovulation. However, ultrasound was superior to any of the hormones used for the diagnosis of ovulation. In addition to diagnosis and prediction of ovulation, ultrasound was capable of diagnosing other pathological conditions, like polycystic ovary syndrome, luteinized unruptured follicles, small fibroids and hydrosalpinx

Study of the fibrinolytic activity of gastric secretion in schistosomal hepatic fibrosis and its relation to hematemesis

Hematemesis due to rupture of gastro-esophageal varices is a common and serious problem in patients with schistosomal hepatic fibrosis. Factors that may lead to or augment this are still controversial. This work aimed at studying the fibrinolytic activity of gastric juice as a guide to its possible role in initiating or perpetuation bleeding in these patients. Thirty male patients with pure schistosomal hepatic fibrosis and gastro-esophageal varices were studied divided into two equal groups. One group had a history of repeated bleeding from these varices while the other had not such a history. Another 10 healthy male subjects were included as a control group. Gastric secretion of all subjects was examined for the presence of fibrin degradation products [FDPs] and is capability to shorten euglobulin clot lysis time [ECLT] of plasma of the same subject. FDPs were detected only in the two groups of patients with higher degree of positivity in the bleeding group. With gastric secretion ECLT was significantly shortened in bleeding group and ECLT in both groups of patients was significantly shorter than that of the control group. These results confirmed the presence of fibrinolytic activity in gastric secretion that is more evident in patients with tendency to bleeding from gastro-esophageal varices

Acute appendicitis in childhood: the role of controlled observation in imposing diagnosis

One hundred and forty-two patients with abdominal pain were suspected of having acute appendicitis, 72 of whom were operated upon after a period of observation varying between 6 and 72 hours. Only 3 patients had histologically normal appendix. The non-operated group were discharged home after a period of observation of between 12 and 36 hours. Of the operated group, 3 had wound infection of which only one was a deep infection. We believe that the benefits of a controlled period of observation far outweigh the possible complications of delayed surgery and include the improvement and accuracy of the diagnosis rate