Cryptosporidium and giardia in water in Alexandria: detection and evaluation of viability by flow cytometry and different stains

Cryptosporidium oocysts and Giardia cysts have become ubiquitous in surface waters worldwide. The number and extent of outbreaks of waterborne diseases indicate a significant risk for their possible transmission by drinking-water. Since many Egyptian cities depend on surface water as their main source of drinking water, knowledge of the prevalence of waterborne protozoa in water resources is important. The present study was designed to use flow cytometry to detect Cryptosporidium oocysts and Giardia cysts in water samples in Alexandria city in comparison with the standard staining techniques. Testing the viability of the encountered parasites was also carried out comparing flow cytometry and trypan blue vital stain. Thirty water samples were collected from water tanks from different districts of Alexandria city. Samples were subjected to staining techniques and flow cytometry. Stains used were modified Zeihl-Neelsen [MZN], safranin methylene blue [SMeB], modified trichrome, fluorescent stains [phenol auramine and acridine orange]. Viability was evaluated comparing trypan blue stain and flow cytometry using 4'-6-Diamidino-2-phenylindole immunostain [DAPI]. Flow cytometry proved to be much more sensitive than staining techniques with a sensitivity of 100% for both Cryptosporidium oocysts [30 samples] and Giardia cysts [11 samples]. Following flow cytometry, the fluorescent phenol auramine stain had the greatest sensitivity of 94.74% and 80% [18 and 4 samples, respectively]. The percent of live parasites present in each sample was always significantly higher by DAPI than trypan blue stain. The results of the present study clearly demonstrate that incorporation of flow cytometry can improve sensitivity of detection of Giardia cysts and Cryptosporidium oocysts in water samples. Although it is more expensive than the other staining methods, it is rapid, simple and accurate in estimating the quantity and viability of the parasites in each sample. Thus, flow cytometry can be recommended for detection of protozoa in water

Management of civilian colon injuries

Over the past three decades, primary repair of colonic injuries has become more accepted and there has been a trend toward using this procedure for repairing civilian colonic injures. However, the best procedure remains controversial. Forty patients with colonic injuries alone or associated with other organ injuries were included in the present study over a 44 months period Benha University Hospital. After resuscitation, exploratory laparotomy was done and other organ injuries were appropriately managed. Colonic injuries were dealt with either by primary repair, age, blood transfusion, mechanism and site of injury and injury severity indices. The mechanism of injury was stab injury in 37.5% gunshout in 32.5% iatrogenic in 17% and blunt trauma in 13%. Isolated colon injuries were found in 27.5% and associated with small intestinal injury in 47%. The left colon injuries were found in 40% followed by transverse colon in 37.5%. Primary repair, either by debridement and simple closure in 2 layers or by segmental resection and primary anastomosis was done in 65% of patients while diversion procedures were carried out for 35% of patients. There were 3 mortalities and complications occurred in 30% of the studied patients. From this study we can conclude that there is no single policy for management of colon injuries either by diversion or primary repair. Good results can be obtained by proper decision of an experienced surgeon according to the individual circumstances of each case rather than following solid scheme by less experienced surge Primary suture should be limited to early cases induced by sharp agents or iatrogenic injury. For most severely traumatized patients diversion remains the most dependable method of treatment as it is followed by the least morbidity and mortality

Improvement of some cases of impotence from the medicolegal point of view

A detailed study on a new treatment of male impotence by using a smooth muscle relaxant drugs which is papaverine by local intracavernous injection. This treatment found to be successful in all cases of psychogenic impotence and almost all cases of organic impotence giving hope to many patients who were until recently beyond any hope of ever achieving an erection again. In light of this study a new evaluation diagnosis and judgment in many cases of impotence will emerge on the medicolegal surface and we must consider these cases with a different perspective