Molecular typing of hospital acquired klebsiella isolates from Mansoura university children hospital [MUCH]

Nosocomial isolates of Klebsiella species collected from Mansoura University Children Hospital during the period of the study were analysed in order to determine their epidemiological relatedness and genetic characteristics. Klebsiella isolates were characterized by biotyping, antibiotyping, plasmid profile and multiplex PCR. Klebsiella pneumoniae was the most frequent isolated nosocomial pathogen [17.0% of the total isolates], while Klebsiella oxytoca represented only 1.57%. The majority of the clinical isolates were resistant to multiple antibiotics, in particular to beta-lactams, and 51.3% were found to be extendedspectrum beta-lactamase [ESBL] producers. ESBL-phenotype by double disk synergy [DDS] test was associated with multiplex PCR [mPCR] pattern B; [contain wzc and bla[CTX-M] genes], with the exception of two isolates which were ESBL-positive by DDS, and found belonging to mPCR pattern A; [contain wzc gene only]. Plasmid analysis was efficient to differentiate K. pneumoniae strains; it delineated 8 distinct plasmid profiles. However, mPCR appeared less discriminatory, since it stated only 3 genotypic groups. We also investigated an outbreak caused by a multiresistant K. pneumoniae involved 7 patients admitted to the pediatric ICU of MUCH. We assumed that the outbreak was related to a healthcare worker with onychomycosis colonized in her hands with the same ESBL-producing Klebsiella pneumoniae [ESBL-Kp] strain. Molecular typing of the isolates revealed clonal similarity between the recovered strain and the isolates of the 7 cases. Plasmid analysis and mPCR proved to be effective techniques in discriminating unrelated Klebsiella pneumoniae isolates. We concluded that K. pneumoniae infections in MUCH have been caused by a variety of strain genotypes. So, tracing of the sources and revising our infection control policies were strictly implemented

Tuberculosis vaccine

Tuberculosis [TB] is still one of the leading causes of death from a single infectious agent, killing 1.6 million people each year, mostly in developing countries. The existing vaccines, Bacille Calmette and Guerin [BCG], are efficient in preventing the most severe disseminated forms of disease in children and newborns, but its efficacy against active TB in adults has been challenged by several clinical studies. It is a common opinion that only the development of a new and more effective vaccine against TB would significantly ease the deadly disease. In recent years, looking for a new vaccine or an improved TB vaccine is urgently needed. Such vaccines include new live and attenuated strains of Mycobacterium tuberculosis, improved recombinant BCG strains, subunit and DNA vaccines

Distribution of ABO blood groups and Rhesus factor in Southwest Saudi Arabia

To document the distribution of the ABO and rhesus Rh blood groups in a random sample of Saudi students from the King Khalid University, Abha, Kingdom of Saudi Arabia, and to compare our results from that of other studies in the Kingdom and elsewhere. The subjects included in this study were 944 males from thesouthwest region of Saudi Arabia including Aseer, Jizan, and Najran regions. The ABO blood groups and Rh factor from 944 Saudi males were determined. The frequency of ABO blood groups and Rh status were calculated separately. This study was carried out at King Khalid University, Abha, Kingdom of Saudi Arabia, from January to March 2008, and the ethical approval was obtained from the Research Ethical Committee, College of Science, King Khalid University. The frequencies of ABO groups showed 56.8% for group O, 33.4% group A, 6% group B and 3.8% group AB trend. Only 7.2% of them were found to be Rh-negative. The frequencies of ABO and Rh phenotypes in the southwest population of Saudi Arabia are similar to those reported in most areas of the Arabian Gulf region

Controllbd-release prednisolone poly [DL-lactide] microspheres: impact of formulation parameters, characterization and release mechanism

The steroidal drug prednisolone was encapsulated into microspheres using the biodegradable polymer poly [DL-lactide] using emulsion-solvent evaporation method. The produced microspheres were characterized using scanning electron microscopy, X-ray diffractometery, FT-IR spectroscopy, DSC, and laser light diffraction. The morphology, particle size distribution, encapsulation efficiency [EE%], and drug release showed marked dependence upon formulation parameters viz. initial polymer concentration, surfactant concentration, drug-to-polymer ratio, and volume of the external aqueous phase. The effect of the addition of hydrophilic additives such as PVP or PEG 8000 was also investigated. The encapsulation efficiency percent and the mean particle size were increased by increasing the initial polymer concentration and drug polymer ratio. On the other hand, increasing the surfactant concentration resulted in decreasing the mean particle size and increasing the drug release from the microspheres. The probable mechanism of drug release was estimated and found to be via diffusion through channels and/or pores present within the polymeric matrix. Release data of almost all formulae fitted Higuchi's planar model better than spherical model. This finding could be due to the small extent of drug release [- 40%], or the presence of a large fraction of the encapsulated drug nearby the surface of the microspheres

Assessment of the nutritional status for visually handicapped children and adolescents in Egypt

Visually handicapped children are one of the most vulnerable groups who are sensitive to various factors. Therefore, it is important to assess their nutritional as well as health environment status. This work was carried out to evaluate the nutritional status of visual disabled children [239 males and 313 females] who were chosen randomly from visual handicapped school children from five governorate representing Egypt. A sub sample of 115 males and 168 females was subjected to dietary and laboratory analysis. Information about nutritional habits, dietary intake and biochemical analysis were collected during the interview. All this data has been given by family members of the handicapped children with the help of schools social workers. Anthropometric measurements were taken for all targeted handicapped children. Results indicated that, the majority of children [70% of total sample] consumed their full amount of protein while only 11.7% of them had their full daily energy requirements. The study also revealed that most of the surveyed children consumed <75% RDA of macronutrients and vitamins. Regarding anthropometric indices, the results proved that male children suffered more under weight and stunting than females. In conclusion, these results highlight the need for establishing accurate statistics regarding the type and degree of disability as well as age and sex distribution of disabled population. Also nutrition education to the families and teachers of these disabled group about healthy diet to overcome micronutrients deficiencies

Formulation and characterization of biodegradable chitosan films for topical application of terbinafine Hcl

Chitosan biodegradable films containing terbinafine HCI [Tr.HCl] were evaluated for their potential drug delivery at a controlled rate. Terbinafine HCI could be loaded at 1.8% w/w of polymer in films, which were translucent and flexible. The effect of drug loading and nature of plasticizers on the in-vitro release of Tr.HCl have been examined, Physicochemical characterization of Tr.HCl via thermal, spectroscopic, X-ray diffraction, and scanning electron microscopy techniques revealed information on the solid-state properties of Tr.HCl as well as chitosan in films. While chitosan was in an amorphous form, Tr.HCl seemed to be present in crystalline form in the films. It was found that the release rate of the drug was directly proportional to drug concentraton. Also medicated chitosan films plasticized with water- soluble plasticizers as glycerol triacetate [GTA], propylene glycol [PG], and polyethylene glycol 400 [PEG 400], produced fast release in comparison with water insoluble plasticizers as glycerol tributyrate [GTB], dimethylphthalate [DMPH], and diethyl phthalate [DEPH]. The characterizations of chitosan films conducted by IR, X-ray, and DSC, showed that no interaction occurred between Tr.HCl and chitosan polymer. The minimum inhibitory concentration [MIC] of the drug against Candida albicans was investigated. Results showed that MIC of Tr.HCl was 1.4 micro g/ml. The inhibition zone diameter of Tr.HCl chitosan films was higher than that of Tr.HCl normal dressing. Also antifungal activity of Tr.HCl was enhanced in plasticized chitosan films. The results were promising for topical formulation of Tr.HCl in biodegradable chitosan films and have the potential to be used as a novel drug delivery

Bone Mineral Density and nutrient intake among stunted Egyptian adolescents

In this study, bone mineral density, dietary and nutritional status were assessed among 159 stunted adolescents and the results were compared with 159 age, sex and socioeconomic matching controls. The results showed that the mean level of bone mass density [BMD] was significantly lower among the stunted compared with the control group; both groups had values much below the reported figures among adolescents of different countries. Dietary intake analysis showed that the mean intake of calcium and copper was not different among stunted and control groups; while the intake of animal fat, zinc and vitamin A was significantly lower among the stunted cases compared with the control group

effect of intrauterine levonorgestrel on blood glucose, serum lipid profiles and sex Hormones binding globulin

Metabolic changes with hormonal contraception had been known several decades ago. The concentration of sex hormone binding globulin [SHBG] has been shown to decrease during the use of levonorgestrel [LNG] containing contraception. This decrease has been thought to be due to the andro genie action of LNG. Also, serum lipidse are known to be affected by hormonal treatment. To examine whether SHBG, blood sugar and serum lipids are affected by LNG intrauterine medicated device [LNG-IUS]. Forty women were divided into two groups. A copper releasing intrauterine device [IUD] was used in the control group [n = 20] and LNG-IUS in the study group [n = 20]. Fasting blood sugar [FBS], SHBG and serum lipids levels at base line and after 6 months use of contraception were measured. SHBG concentration decreased slightly with LNG-IUS. There was no change in the blood glucose level. Also, there were slight decrease in serum total cholesterol [TC], triglycerides [TG], low-density lipoprotein [LDL-C] and high-density lipoprotein [HDL-C] but LDL-C/HDL-C Ratio slightly increased. The data in this study showed that alterations in the levels of SHBG, FBS, TC, TG, HDL-C, LDL-C and LDL-C/HDL-C ratio are minimal 6 month after insertion of LNG-IUS

Prediction of preterm labor; a prospective study of the role of cervico-vaginal fibronectin and transvaginal sonography and their possible impact on the results of cervical cerclage

To determine the value of cervico-vaginal fetal fibronectin detection and transvaginal sonographic measurement of endocervical canal length as predictors of preterm labor in asymptomatic patients. Also, to evaluate the results of cervical cerclage in a group of patients with short cervix with and without positive fibronectin results in the cervicovaginal fluid. Longitudinal prospective study in which samples from cervico-vaginal secretions for fetal fibronectin were obtained biweekly from 24 to 34 weeks gestation. The length of endocervical canal was measured by an endo-vaginal sonography at 24 weeks. McDoneld cervical cerclage was done for some cases with short cervix. The study included 3 groups of patients; a group with high risk for preterm labor, another group with low risk and the third group included patients who undenvent cervical cerclage. Thirty four patients delivered before 37 weeks out of 273 patients [12.5%], 21 patients were positive for fibronectin in cervico-vaginal fluid and 23 patients had cervical shortening. The sensitivity, specificity, positive predictive value [PPV] and negative predictive value [NPV] were in the low risk group 40%, 87%, 22.2%, 44% respectively and in the high risk group 70.8%, 86.3%, 48.5%, 94.2% respectively. The positive predictive value of 2 positive fibronectin samples was 89.5% while PPV of any one positive sample was 11.8%. Most positive predictive tests were between 24-28 weeks [71.4%]. Trans-vaginal sonography of endocervical canal length with the chosen cut-off limit as a predictive test for preterm labor achieved sensitivity, specificity, PPV and NPV of 60%, 96.3%, 60% and 96.3% respectively in the low risk group and 70.8%, 90.1%, 56.7% and 94.4% in the high risk group. Examination at 24 weeks, detected 65.2% of the cases predicted by ultrasound. Eighteen patients underwent cervical cerclage, delivered prematurely. Fibronectin was positive in 4 cases that delivered prematurely and in 6 patients who delivered at term and the comparison was not significant. The incidence of preterm labor in cases that had cervical cerclage was 38.9% while in 14 cases with short cervix that had not cervical cerclage was 57.5%. Fibronectin is a predictor of preterm labor. As a negative test, it is reliable and the reliability as a positive test increases if two positive samples are obtained. The most important period for screening is between 24 and 28 weeks biweekly. Endocervical canal measurement by ultrasound is also, a predictor of preterm labor as good as fibronectin even more effective in low risk population or primigravidae. Positive fibronectin results had no impact on the outcome of cervical cerclage. Cervical cerclage decrease incidence of preterm delivery in cases with short cervix but not to a significant degree

comparative study of step-down dose, low-dose step-up and sequential step-up and step down regimens of human menopausal gonadotrophin for patients with polycystic ovary syndrome

To compare the efficacy and safety of the step-down dose, low-dose step up and sequential step-up and step-down regimens of human menopausal gonadotrophins [hMG] for women with poly cystic ovary syndrome [PCOS]. A prospective randomized study involved 68 stimulation cycles in 61 patients with PCOS divided as 24 cycles with step-down dose regimen, 25 cycles with low-dose step-up regimen and 19 cycles with sequential step-up and step-down protocol. The step-down regimen consisted of 225 IU/day of the hMG for the first 2 days, followed by 150 IU/day until the follicular diameter reached 9 mm after which the dose was decreased to 75 IU/day for the next 7 days. The low-dose step-up protocol consisted of 75 IU/dayof hMG for the first 7 days and if the follicular diameter did not increase to 9 mm. The dose was increased by 37.5 IU every 7 days. The sequential regimen was the same as the step up protocol but when follicular diameter reached 14 mm the daily dose was halved. Main outcome measures included the number of growing follicles and serum hormone levels. The number of intermediate sized follicles was significantly lower in the sequential regimen group and the low dose step up protocol compared with step-down dose regimen. Also, the maximum diameter of the ovaries was smaller in the same two groups. The luteal phase progesterone was significantly lower in the low dose step-up protocol and the sequential regimen. A pregnancy rate per cycle of 20%-21% was achieved in the 3 groups. The sequential step-up and step down regimen of hMG and low-dose step-up regimen may be the safest to avoid ovarian hyper stimulation syndrome and to ensure more rate of monofollicidar growth. However, they may be associated with higher risk of miscarriage

Measurements of facial points during growth utilizing centroids

The aim of the present study was to Investigate the movement of facial cephalometric points during growth In a vertical and horizontal direction. A sample of 36 lateral skull radiographs were selected from a bigger sample. Half of the radiographs were taken at aged 9 years +/- 2 months and the other 18 radiographs were taken at 16 years +/- 2 months. The sample was traced and digitized. The computer was able to produce a line joining the centres of the skull, cranium and face CFC [Cranio Facial Centroid line]. Fifteen [15] cephalometric points were located for each subject and measured to a horizontal and a vertical line, based on the centre of the cranium and oriented 450 to the CFC. Millimetric measurements were used to calculate ratios. The data were subjected to descriptive statistics and student t-test. The greatest percentage change for the pooled sample was 11.75% upward movement for Nasion [SD +/- 17.90] and 11.46% downward movement for Gonion [SD +/- 3.25]. Horizontally, the greatest forward movement was for point A, maxillary and mandibular central Incisors, point B, pogonion, Menton, Gnathion and Gonion. There was significant difference between girls and boys in the vertical direction for point B, pogonion, Gnathion and Menton. While in the horizontal direction, significant differences were found for ANS, point A, Apex and tip upper and lower incisor, point B, pogonion, Gnathion Menton, and condylion

Comparison between fallopian tube sperm perfusion and intrauterine insemination in the management of couples with male subfertility, cervical hostility and unexplained infertility

To compare fallopian tube sperm perfusion and standard intrauterine insemination in the management of couples with male subfertility, cervical hostility and unexplained infertility. 78 couples with primary and secondary infertility due to male subfertility, cervical hostility and unexplained infertility with duration of infertility of two years. The couples were randomly assigned into two groups. Group I [Ntube = 37] underwent 96 completed cycles of induction of ovulation followed by intrauterine insemination using a volume of inseminate of 0.5 ml and group 2 [N=41] had 108 cycles where fallopian tube sperm perfusion was done using a volume of 4 ml. Out of 204 cycles in 78 couples, 21 pregnancies were achieved with pregnancy rate [PR] of 10.3% per cycle and 26.9% per couple. The highest PR was achieved in couples with unexplained infertility. There were more pregnancies in the fallopian tube sperm perfusion [FSP] group [13] compared to the intrauterine insemination [IUI] group [8]. Both PR per cycle and PR per couple were significantly higher in FSP [12% and 31.7%] than in IUI group [8.3% and 21.6%]. The two groups were similar regarding the age of the females, duration of infertility and induction of ovulation. The number of follicles 18 mm, endometrial thickness at the time of HCG administration and the mean number of motile spermatozoa inseminated were similar in the two groups. The technique of fallopian tube sperm perfusion with a larger volume of processed semen appears to give better results than intrauterine insemination with a small volt/me. The best results are achieved in the two techniques in couples with unexplained infertility

Arginine vasopressin plasma level in children with nocturnal enuresis

Serial measurements of arginine vasopressin plasma level at 8 PM, 12 midnight, 4 AM and AM were done by radioimmunoassay in 18 children with nocturnal enuresis and 8 children of matched age and sex acting as a control group. Also, urine osmolality was measured at 8 PM and 8 AM in both groups. The results demonstrated that the normal circadian rhythm of AVP plasma level, being high at night found in the control group, was partially lost in enuretic children. This change could be responsible for a high urine output at night and subsequent nocturnal enuresis. So, abnormality in the rhythmicity of AVP production may be a factor in the pathogenesis of uncomplicated nocturnal enuresis

DRB1 alleles in Egyptian children with idiopathic Nephrotic Syndrome

Idiopathic nephrotic syndrome [INS] of children has been reported to be associated with serologically detected HLA-DR antigens. To investigate the association of INS and genes, 22 patients with INS and 20 control subjects were typed for HLA DRB1 during reverse hybridization technique. The study have found that the frequency of children positive for DRB1*03 alleles was significantly increased among patients with INS. The frequency of DRB1 01* alleles was also increased; however it was not significant. The frequency of DRB1*11 alleles was low in INS patients, but it was not significant when corrected to the number of antigens tested. These findings suggested that DRB1*03 genes, or closely associated unknown genes confer susceptibility to INS. The DEB1*03 genes are not involved in the response of INS patients to steroid therapy. The protective effect of DRB1*11 genes remains to be elucidated due small number of patients

genetic susceptibility and value of lipoprotein screening in offsprings of parents with premature coronary artery disease

In a study to uncover any genetic susceptibility to develop premature coronary artery disease [PCAD], serum total cholesterol [TC], triglycerides [TG], high density lipoprotein cholesterol [HDLc], low density lipoprotein cholesterol [LDLc], lipoprotein [a] [LP [a]] and apo [B], were determined in 106 members of 20 families of parents with PCAD, and 40 individuals of 10 normal families. The aim is to identify children at increased risk of developing PCAD. The results revealed highly significant increase of LP [a] among diseased parents and their offsprings, tendency of change in the other types of lipoproteins and significant only in TC and LDLc among offsprings, and autosomal mode of inheritance in LP[a] and recessive in TC and LDLc

Lipid abnormalities, atherogenicity and lipid peroxidation in nephrotic syndrome patients

Serum lipid abnormalities are common in nephrotic syndrome. Disturbance in lipid enzymatic activities and lipoprotein catabolism may account for uremic hyperlipidemia. Therefore, serum lipids from 25 patients with nephrotic syndrome and from 12 healthy control subjects were examined. Free cholesterol level demonstrated significant increase while lecithin showed significant decrease, in turn, higher F/L ratio [atherogenic index]. Lipase activities revealed significant decrease, while lipid peroxidation was insignificantly increased. F/L ratio was positively correlated [insignificant] with peroxide value and lipase activity [r = 0.14, 0.16, respectively]. In the control group, F/L was negatively correlated with lipase, but was significantly positive versus peroxide value

utility of screening instrument for behavioral problems of children in clinical and community samples

A total of 1563 children were surveyed using the Connors Parent Teacher Rating Scale [C P T R S] in different clinical [N=307] and community [N=1256] samples. Although the CPTRS was found to be limited in its capacity to search for behavioral problems in school-aged children, this instrument was more effective in discriminating higher rates of behavioral problems in clinical and high risk samples [66%] in comparison to lower rates [22%] in community nonreferred children, particularly for preschoolers and younger children. Our results are suggestive of a good discriminate validity of this instrument. The implications of further use of CPTRS in epidemiological research on Egyptian children are discussed

Effect of soybean flour and improvers on bread quality

Sedimentation value, fermentation time, height, volume and relative volume of bread decreased with the increase in soybean flour percentage added in flour mixtures. Addition of potassium bromate up to 18ppm to flour mixtures containing 3% Soy bean flour enhanced Quality of both flour and bread. The im proving effect of Lascorbic acid was better than that of potassium bromate. No improving effect was noticed with flour mixtures containing 6% soy bean flour