Screening of developmental dysplasia of the hip in neonates with breech presentation

Background: Developmental dysplasia of the hip [DDH] is one of the most common congenital malformations and it is an important cause of childhood disability

Aim of this study: Selective screening for DDH in neonates with breech presentation and evaluating the effectiveness of ultrasound use in diagnosis of DDH

Patient and Methods: A cross-sectional study in phase I and a prospective study in its phase II, was conducted on 268 full term and near term breech neonates born in Obstetrics and Gynecology Hospital of Ain Shams University, in the period from March 2013 to February 2014. All included subjects were subjected to: Full history taking, thorough clinical examination and ultrasonographic assessment of the hip joint using the static and dynamic method

Results: The overall final incidence of the disease was 3%. The frequency of the disease was highest in female gender [male: female was 1: 3]. Twenty one cases [7.8%] were defined as pathological according to the clinical examination, 15 of them [71%] were defined as pathological according to ultrasonography [USG] and 6 cases [29%] had normal findings. 247 newborns [92.2%] had normal clinical examination, of these clinically normal neonates sonographic abnormalities were found in 36 [14.5%]. Considering ultrasonography as a gold standard method in evaluating DDH, the sensitivity and specificity of clinical examination were determined 25.6% and 96.8%, respectively. Among the possible risk factors significantly associated with DDH, oligohydrammos was the only risk factor significantly associated with DDH

Conclusion: The incidence of DDH in breech presented neonates is variable and clinical examination does not reliably detect ultrasonographically defined DDH in infants being screened for this disease, so routine screening should be done with clinical examination and with US to all of them because early intervention is better and cheaper with less complication

Study of prevalence and effects of insulin resistance in patients with chronic hepatitis C genotype 4

There is strong epidemiological evidence linking hepatitis C virus [HCV] infection and diabetes. Our aim was to evaluate the prevalence of insulin resistance in Egyptian patients with chronic HCV genotype 4 infection, to assess factors associated with insulin resistance and to test the impact of insulin resistance on outcomes of treatment with pegylated interferon/ribavirin. Insulin resistance [homeostasis model assessmentinsulin resistance [HOMA-IR] score > 3.0] was detected in 31 of 100 nondiabetic patients. The relationship between elevated HOMA-IR and baseline viral load and degree of fibrosis was statistically significant [r = 0.218 and r = 0.223]. Follow-up of patients with complete early virological response until the end of treatment showed a statistically significant decrease in HOMA-IR score. Out of 29 liver tissue sections examined, 14 had a low level of expression of insulin receptor type 1 by immunohistochemical studies. This study confirms that insulin resistance affects treatment outcome, and thus HOMA-IR testing before initiation of therapy may be a cost-effective tool

Role of fibulin-3 in the diagnosis of malignant mesothelioma

Early detection of malignant pleural mesothelioma [MPM] is critical to survival, the use of pleural or blood fibuin-3 might allow this early detection. Studying the validity of measuring serum and pleural fibulin-3 in the diagnosis of MPM. Fibulin-3 levels were measured in serum and pleural fluid by enzyme-linked immunosorbant assay [ELISA] in 45 patients with exudative pleural effusion. Patients with non-conclusive cytology or microbiological examination had undergone medical thoracosope for histopathological examination. Twenty five was diagnosed as MPM, 11 cases as pleural metastasis of carcinoma [Mets] and nine cases with benign pleural effusions. Patients with MPM had significantly higher pleural effusion and serum fibulin-3 levels than those with metastatic effusion of carcinoma or benign pleural effusion [p-value < 0.001]. Using a cut-off point of pleural fluid fibulin-3 [150 ng/ml] with AUC of 0.878 [sensitivity 72.3%, specificity 80] and at a cut-off point of serum fibulin-3 [66.5 ng/ml], with AUC of 0.776 [sensitivity 88%, specificity 81.8%], discrimination between MPM and Mets occurred. Also, using a cut-off point of pleural fluid fibulin-3 [127.5 ng/ml] with AUC of 0.909 [sensitivity 88%, specificity 77.8%], and at a cut-off point of serum fibulin-3 [18 ng/ml], with AUC of 0.931 [sensitivity 100%, specificity 77.8%], discrimination between MPM and benign pleural effusion could occur. Fibulin-3 in the serum and pleural fluid is a good biomarker in the diagnosis of MPM and in differentiation between MPM from malignant pleural metastasis other than mesothelioma and also from benign pleural effusions

Prevalence of chronic kidney diseases in rural areas in Assiut district

Chronic kidney disease [CKD] is increasingly recognized as a global public health problem. Currently, CKD is the 12[th] highest cause of death and 17[th] highest cause of disability worldwide. To determine the prevalence of chronic kidney diseases in rural areas in Assiut District, prevalence of most common risk factors for CKD and the relation between these risk factors and CKD in the studied group Two villages out of 15 villages from Assiut district were randomly selected; El Bora and Awlad Rayek. Sample size was calculated using EPI info 2000 statistical calculation version 6 which revealed that we should have sample size not less than 235 participants. All candidates were interviewed in a previously prepared questionnaire. Blood pressure measured, morning urine samples were obtained, and blood samples were withdrawn for kidney function and blood glucose level. Prevalence of chronic kidney diseases [stage 1-4] in rural areas of Assiut District is high 27.6%, prevalence of hypertension, diabetes, recurrent urinary tract infection, past history of bilharziasis and renal stones in the studied sample as follow: 15.5%, 13.2%, 12.6%, 8.9%, 6.9%; respectively. Hypertension and diabetes had high association with cases of CKD in the studied sample. It seems that there is a high prevalence of chronic kidney disease in our locality; but unfortunately little awareness about chronic kidney diseases. Hypertension and diabetes had high association with cases of CKD in the studied group

Measles and rubella vaccine antibody levels in children with acute lymphoblastic leukemia following chemotherapy

Children in remission from acute lymphoblastic leukemia [ALL] have a high prevalence of immune system defects; one of them is the decrease of vaccine-induced antibody seropositivity rates. This antibody deficiency may place children with ALL at risk for the development of vaccine- preventable diseases, even after completion of chemotherapy, and they could function as a reservoir for additional spread of these diseases in the population. The aim of the present study was the assessment of the levels of vaccine- induced antibodies against measles and rubella viruses n ALL children following chemotherapy. Antibody levels against measles and rubella vaccine viruses were evaluated by ELISA technique in 96 children with ALL after completion of chemotherapy, in addition to 30 healthy children [non cancer controls of matched age and sex]. All healthy children were seropositive for measles and rubella antibodies. On the other hand, out of 96 children who received chemotherapy, only 19 [19.8%] were seropositive for measles antibodies, while 70 [72.9%] were seropositive for rubella antibodies. Most of measles seropositive cases [57.9%] had low levels of measles antibodies while among control group most children [56.7%] had high levels of measles antibodies, Similarly among children who received chemotherapy, most of the seropositive cases [45.7%] had low levels of rubella antibodies, while among control group, most of children [36.6%] had high levels of rubella antibodies. Seropositivity rate of measles was found to be related to the age at diagnosis and disease duration, while that of rubella was found to be related to the disease duration only. Most of children who have been treated with chemotherapy for ALL had lost measles antibodies and to less extent rubella antibodies. Among seropositive cases, levels of measles and rubella antibodies are low following treatment with chemotherapy compared to levels among normal controls. Therefore, revaccination of children with ALL following completion of chemotherapeutic treatment against measles and rubella is recommended

Clinical, parasitological and social studies on Wuchereria bancrofti in Egypt

This study was conducted on patients attending AlHussein University Hospital and Mansura University Hospitals. Sheets were filled out on each patient [age, residence, occupation, family similar condition, travelling, disease duration, symptoms suggesting acute dermatolymphangitis attacks, frequency and duration. They were 25 lymphoedema patients and 8 controls [17 males and 16 females] and subjected to clinical and parasitological examinations. According to residence, five patients were from Giza Governorate [18.18%], four from Dakahlia G. [12.12%], four from Gharbia G. [12.12%], five from Menoufia G. [15.15%], four from Sharkia G. [12.12%], two cases from Kafr Elsheikh G. [6.06%] and one patient from Assiut G. [3.03%]. In controls, 6 were from Al Hussein Cairo G. [15.15%], and two cases [6.06] from Al Abbassia. They were 48% farmers [10 male and 2 female]; 4% grocers [1 male]; 8% carpenters [2 male]; and 40% house wife [10 female]. According to lymphedema site: 3 cases [12%] were bilateral lower limbs lymphedema [2 female and 1 male], 13 cases [52%] had right lower limb lymphedema [6 female and 7 male], and 9 cases [36%] had left lower limb lymphedema [4 female and 5 male]. They were 18 [72%] with below knee extension of lymphedema [10 male and 8 female] and 7 [28%] above knee extension of lymphedema [3 male and 4 female]. Grade of lymphedema was one case [male] with grade II lymphedema [4%], 13 cases [52%] with grade III [7 male and 6 female] and 11 cases [44%] with grade IV [5 male and 6 female]. Duration of lymphedema was one case with grade II lymphedema in a period of 3 years, 13 cases with grade III lymphedema and the durations of lymphedema for these cases were [one case with 5 years duration, 3 cases were>6-9 years, 6 cases were>9-12 years and 3 cases were>12 years] and 11 cases with grade IV lymphedema and duration of lymphedema for these cases were [one case with 6 years duration, 2 cases were>6-9 years, 3 cases were>9-12 years and 5 cases were>12 years]

Lipoprotein lbpase mRNA expression in different tissues of farm animals

Lipoprotein lipase [LPL] controls triacylglycerol partitioning between adipose tissues and muscles, so it is important enzyme for fattening of animals.The present work was planned to clarify the use of polymerase chain reaction [PCR] for detection of LPL mRNA expression in different tissues representing internal organs of male Friesian cows. The obtained results revealed that, LPL mRNA was expressed in all tested tissues, and the highest expression was encountered in testis [1.03]. The expression in heart, liver, kidney, adrenal gland, spleen were 0.92, 0.77, 0.76, 0.73, and 0.70 respectively.The lowest expression was found in adipose tissue [0.64] It could be concluded from the present study that, expression of LPL mRNA differs according to the type of tissue. The highest expression was found in testis which may confirm the role of LPL in the process of spermatogenesis

Biological, serological and molecular studies on prunus necrotic ring spot virus infecting Rosa hybrida L. in Egypt

Prunus necrotic ring spot virus [PNRSV] was isolated for the first time in Egypt from naturally infected rose plants collected from the experimental farm of the Faculty of Agriculture, Cairo University. Observed symptoms circumvented necrotic ring spots on leaves, bud failure, and color breaking of petals. The virus was transmitted mechanically. The purified virus had Amax and A min at 260 and 240 nm respectively. The 260/280 ratio was 1.56. Yield of purified virus from infected Gompherina globosa was 0.182 mg/g tissue. Electron micrograph of the purified virus showed spherical [23-nm] as well as bacilliform virus particles [42x23 nm]. The induced antiserum from the purified virus was successfully used to detect PNRSV in rose plants in several locations in Egypt. The full length of the replicase gene of PNRSV was successfully amplified by reverse transcription-polymerase chain reaction [RT-PCR] using different sets of specific primers. A sensitive and specific IC-RT-PCR protocol was used for the detection of PNRSV from rose tissues. Sequence analysis of PNRSV/rep gene of the rose isolate indicated 60% similarity to that of PNRSV-AF278534 and NC-004362

Transnasal endoscopic repair of anterior skull base fistulas

CSF rhinorrhea is the leakage of CSF from the subarachnoid space through the nose. CSF rhinorrhea or liquorrhea commonly occurs following head trauma [frontobasal skull fractures], as a result of intracranial surgery, or destructive lesions, however, CSF rhinorrhea may be spontaneous. The incidence of CSF fistula after ESS is less than 1% yet it represents since recently a common cause of iatrogenic CSF fistula. A spinal fluid leak from the intracranial space to the nasal respiratory tract is potentially very serious because of the risk of an ascending infection which could produce fulminant meningitis, hence the importance of the prompt diagnosis and treatment of such condition. Since the introduction of transnasal endoscopic techniques the morbidity of surgical repair has been significantly reduced when compared with previous intracranial techniques. Is to evaluate the endoscopic endonasal approach in terms of morbidity and efficacy to control CSF fistulas. 43 cases of CSF rhinorrhea operated in the period between 1999 to 2006 are included in this retrospective study. Patients' data preoperatively as regarding history, examination and investigations, as well as operative details and postoperative care and outcome are carefully reviewed, analyzed and compared to the literature. Endoscopic transnasal repair of CSF fistulas in our study had an excellent outcome with a success rate of 95% in the first attempt and reaching up to 100% in the second attempt without any significant postoperative complication. Our leak sites were mainly found in the ethmoidal region [in 67.4%]. The endoscopic repair of CSF Rhinorrhea provides a safe and efficient technique for closure of the anterior and middle skull base sinonasal defects with minimal morbidity and hospital stay

Endoscopic trans-sphenoid approach to pituitary tumors Kasr El-Eini Cairo University hospitals experience

Over the last decades pituitary surgery has been one of the models of the minimally invasive surgeries. Horsley performed the first reported pituitary operation in 1889 through a trans-cranial approach. Schloffer was the first to introduce the trans-sphenoid approach in 1907. Gushing popularized the sublabial trans-septal approach in 1910 and with the introduction of the operating microscope and intra-operative fluoroscopy in the 1950s and 1960s, the trans-septal approach became the gold standard for pituitary surgery. In the 1980s and 1990s, the nasal endoscope became the standard of care in surgery of the nose and PNS. Trans-sphenoidal hypophysectomy is becoming progressively less invasive. Recent endoscopic techniques avoid nasal or intraoral incisions, use of nasal specula and nasal packing for some operators. To present the endoscopic trans-sphenoidal approach for surgical treatment of pituitary adenomas and to evaluate its results and complications. From 1996 to 2006 in the Departments of Otorhinohryngology and Neurosurgery in Cairo University Hospital, 310 patients with pituitary adenomas were operated using the trans-sphenoidal endoscopic approach, among which 197 patients had giant adenomas with supra or para sellar extensions. Complete tumor removal was accomplished in 284 patients [91.6%]. Mortality rate was 3 patients [0.97%]. Morbidity rate was 68 patients [21.9%] in the form of transient diabetes insipidus in 64 patients [20.6%], intraoperative CSF leak in 2 patients [0.6%], bilateral visual loss in 1 patient [0.3%] and tension pneumocephalus in 1 patient [0.3%]. The endoscopic trans-sphenoid approach is the management of choice for pituitary adenomas including invasive type. The surgery can be done with minimal morbidity and more radically than classic transsphenoidal surgery. Invasion of the cavernous sinus is no longer a taboo and could he attempted in 68.2% of the cases with a parasellar extension

Impact of some bio-insecticides on certain biological aspects of pulvinaria tenuivalvata [newstead] [fam.: Coccidae, order: Homoptera] infesting sugar-cane

The red-striped soft scale insect, [R.S.S.S] Pulvinaria tenuivalvata attacking sugar-cane at Attfieh region, Giza Governorate is recently considered an important economic insect pest of sugar-cane in Egypt. Laboratory evaluation of different extracts of the spicked centaury, Centaurium spicatum on the biological aspects of P. tenuivalvata was studied. Petroleum ether extract proved the most effective extract on all insect stages. The impact of the most effective extract, mineral oil, and biocide on the biological aspects of P. tenuivalvata under laboratory and field conditions was studied. The tested compounds are effective against soft scale insect, P. tenuivalvata on sugar-cane leaves and they increased sugar-cane yield significantly, at Attfieh region

Risk factors contributing to fascioliasis endemicity in a focus in Dakahlia governorate 1- human host

Zoonotic fascioliasis is a problem not only in Dakahlia Governorate, but also in other Egyptian Governorates. Two hundreds and twenty patients randomly selected with suggesting manifestations were examined for fascioliasis. A total of 23 [10.4%] were positive by Kato thick smears, of which 21 were from Kafr El-Hessah and two from Oweish El-Hager. The proven human fascioliasis was examined for anti -Fasciola antibodies by IHAT and ELISA [Fhes], haemoglobin level, eosinophils percent, serum bilirubin and liver function tests. IHAT gave 82.61% positive results [19/23], and ELISA gave 100% positive results [23/23]. The clinical signs ranged between splenomegaly and ascitis in 4.34% for each up to hepatomegaly in 73.91% and mild fever in 78.26% but 2 cases were asymptomatic. Mild eosinophilia and moderate anaemia were recorded with means of 11 +/- 5.8 and 10 +/- 1.3 respectively. Mean serum bilirubin was not elevated [0.91 +/- 0.51 gm/dl]. Liver function tests [AST within normal range in all cases; <40 unit /ml but one patient had ALT above normal; >45 unit/ml]

Bacteriological monitoring of dialysis fluid in two haemodialysis centres in a Alexandria

Patients undergoing haemodialysis [HD] are exposed to large volumes of dialysis fluid and the bacteriological contamination of treated water and dialyste is therefore attracting increasing interest and concern. The present study aimed to assess the bacteriological quality of dialysis fluid in two HD units in Alexandria, Egypt. A total of 321 samples from water treatment system [WTS], treated water, concentrates and final dialysate were analyzed for the count of the total viable heterotrophic bacteria using the standard pour plate method, and for the determination of the total coliforms [TC] using the presence /absence method. Fifty random samples were also examined for endotoxin detection by the Limulus Amoebocyte Lysate assay, [LAL]. employing the gel clot method. The percentages of acceptable samples of WTS were 67% and 66.7% from unit A and B respectively while the dialysate samples showed higher acceptability at unit B [86.1%] than unit A [51.7%]. Eleven samples [4.9%] were detected having TC. LAL assay showed a range of 57% to 100% of samples exceeded 0.25 EU/ml The results demonstrate that haemodialysis centres need monitoring and preventive maintenance in order to ensure renal replacement therapy of good quality

Serum leptin, insulin and parathyroid hormone levels in chronic renal failure patients

Chronic renal failure patients whether they are treated with hemodialysis or on conservative treatment frequently suffer uremic anorexia and malnutrition, which is associated with increased morbidity and mortality. In this study we have measured serum leptin, serum insulin and parathyroid hormone in addition to routine kidney function tests, serum glucose, total protein, albumin, lipogram, total serum calcium and inorganic phosphorus. This study was conducted on forty five male patients with chronic renal failure and ten healthy male subjects as control group [Group I.]. According to management of chronic renal failure the patients were divided into two groups: 22 patients on conservative treatment [Group II] and 23 patients on hemodialysis [Group III]. Serum levels of both leptin and insulin revealed significant elevation in patient groups [either on conservative or on hemodialysis,] compared to controls, also in hemodialysis group compared to group on conservative treatment. Serum level of intact parathyroid hormone, also showed significant elevation in groups II and III compared to controls with no difference in comparing group Ill versus group II. Correlation study in whole patients group revealed significant negative correlations between creatinine clearance with both leptin and insulin. Also significant positive correlations were found between leptin and insulin and between leptin and intact parathyroid hormone [iPTH]. Anorexia was found in both patient groups II and III [90.9% and 91.3% respectively,]. Chronic renal failure patients have hyperleptinemia and hyperinsulinemia and there are important interactions between leptin and insulin in which each hormone may be involved in regulating the function of the other. Excess parathyroid hormone may play a role in the pathogenesis of both hyperleptinemia and hyperinsulinemia. Hyperleptinemia may be an important contributing factor for uremic anorexia

Effect of functional electrical stimulation on hand function in hemiplegic cerebral palsy

The purpose of this study was to investigate the effect of functional electrical stimulation on hand functions in children with hemiplegic cerebral palsy. This study included 20 children with hemiplegic cerebral palsy, their ages ranges from three to seven years. All children had no visual, cognitive or behavioral impairments, the children had not undergone previous surgery on their impaired upper limb. All children were divided randomly into two groups of equal number [treatment and control groups]. The treatment group was treated by functional electrical stimulation in addition to the usual physiotherapy, while the control group was treated by the usual physiotherapy program, only. The treatment program for both groups extends up to 12 weeks. All children of both groups were assessed before and after treatment, their assessment included hand function through Jebson test and active wrist extension. The results showed that significant improvement in hand function was recorded in the treatment group manifested by significant decrease in time taken to complete the components of the hand function test and significant increase in active range of motion in wrist joint. In conclusion, the present study revealed that functional electrical stimulation is effective in improvement of hand function in hemiplegic cerebral palsy, which may partially result from the increased movement and strength around the wrist joint of the impaired limb

Host-plant preference of the red-striped soft scale insect, Pulvinaria tenuivalvata [Newstead]

Effect of five host plants on different biological aspects of the red striped-soft scale, Pulvinaria tenuivalvata [Newstead] was studied. The percentage of nymphs that succeeded to reach the adult stage differed on the different host plants. This percentage was maximum on sugar-cane and sweet sorghum followed by cogon grass, while the minimum was on maize. The shortest pre-oviposition period of the insects was recorded on sugar-cane and elephant grass plants, while the oviposition period was about twice greater on sugar-cane than on sweet sorghum. No significant difference existed between the oviposition period on sweet sorghum and maize. The maximum number of eggs was found on sugar-cane, but the minimum number was found on maize and sweet sorghum. Adult longevity on sugar-cane was about twice greater than that on maize, while it was one and half that on elephant grass. Thus, sugar-cane plant was more preferable to the insect than all other tested host plants

Erectile dysfunction in chronic renal failure patients undergoing haemodialysis

In this study, 75 patients were subjected to clinical and laboratory investigations. Age, presence of hypertension, smoking history of ischemic heart disease and duration of dialysis were detected. Hemoglobin level, creatinine level, blood urea, albumin and glucose were evaluated. A control group of 148 healthy males, representing the general Egyptian population, was also included in the study. In view of the observed high prevalence of erectile dysfunction [ED] among hemodialysis [HD] patients, it was suggested that a complete health evaluation of male HD patients should include a discussion about erectile function in the standard clinical care program of patients with renal disease

Survey study of microalbuminuria in diabetic patients attending out-patient clinic of diabetes in Assiut University Hospital

Micro albuminuria is the earliest sign of diabetic nephropathy [DNP] and it is an indicator for the presence of the characteristic glomerular lesion. This study was conducted on the adult diabetic patients of both types I and II of diabetes mellitus [DM] attending the out -patient clinic of Assiut University Hospital throughout the year 2002. Patients with hypertension, congestive heart failure or those with urinary tract infection albuminuria were excluded. Five hundred patients were subjected to full history taking and clinical examination as well as the following investigations; [I] complete urine analysis [2] screening for micro albuminuria [3] fasting serum glucose [FSG]] and glycosylated hemoglobin [HbAlc] [4] serum urea and creatinine and creatinine clearance. Out of 500 patients 213 [42.6%] were positive for micro albuminuria which was more prevalent among type I DM, male sex, extreems of age, urbans, over-weight and obese patients and those with low physical activities as well as patients with non renal complications. Significant direct proportions were found between level of micro albuminuria, on one hand, and level of FSG and HbAlc and serum urea and creatinine on the other hand, while inverse proportion was found with creatinine clearance. We have concluded that, micro albuminuria is a simple detectable marker for screening incipient DNP. Micralbuminuria was prevalent among considerable percentage [42.6%] of our diabetic patients. It was found to be more prevalent among different studied categories of patients which could be considered as possible risk factors for developing DNP in our locality. Apart from hypertension, these factors are [1] type I DM [2] male sex [3] extreems of age [4] urbans [5] low physical activities [6] obesity [7] long duration of DM [8] bad control of hyperglycaemia [9] presence of non renal complications [10] renal insufficiency

superadded value of magnetic resonance angiography in evaluation of renal artery stenosis

The aim of this work was to study the optimal techniques, applications, limitations and value of magnetic resonance angiography [MRA] in the diagnosis of renovascular hypertension, using digital subtraction angiography [DSA] as the standard procedure in most of the cases. Fifty-five patients were included in this study; all referred from Nephrology Unit for the clinical suspicion of renovascular hypertension. Ultrasonography [US] including Doppler [CDUS] examination was done to exclude renal parenchymal disease. Breath hold gadolinium enhanced MRA for renal arteries, followed by three dimensional phase contrast angiography [3D PCA] maximum intensity projection [MIP] reformatting images were done in axial and oblique directions. The study concluded that MRA is a sensitive procedure [100%] in the diagnosis of main renal artery stenosis, particularly those with significant stenosis near 50% stenosis. MRA is also a sensitive procedure in the following up patients with previous intravascular procedure and for the vascular assessment of transplanted kidneys