use of microencapsulated hepatocytes transplantation reduces mortality and liver alterations in schistosoma mansoni infected hamsters

Hepatocyte transplantation is an attractive therapeutic modality for liver disease as an alternative for orthotropic liver transplantation. The goal of this work was to study the adequacy of intrasplenic hepatocyte transplantation [HCTx] in fresh and microencapsulated forms, in a hamster model of liver fibrosis by Schistosoma mansoni infected hamsters were divided into 6 groups; untreated for 11 weeks [GI] and for 15 weeks [GII] treated with praziquantel [PZQ] 7 weeks PI, and killed 4 weeks [GUI] and 8 weeks [GIV] post-treatment. Treated with PZQ 7 weeks PI, and then treated orally with immunosuppressive drug "cyclosporine [4 weeks post PZQ treatment], 24 hr. before interasplenic injection with fresh hepatocytes [V]. Treated with PZQ 7 weeks PI, and then injected interasplenically [4 weeks post-treatment] with microencapsulated hepatocytes [GVI]. GI and GUI were killed 11 weeks PI for assessment the anti-schistosomal efficacy of PZQ. The other four groups were killed 15 weeks PI for investigation of liver and spleen histology, serum liver enzymes and hepatic oxidative markers before and after HCTx. Freshly isolated hepatocytes with a mean viability 92.9711.2% were used for microencapsulation and transplantation. Histological study showed the presence of transplanted hepatocytes in spleen of recipient. PZQ accelerated healing of hepatic granulomatous lesions as evidenced parasitologically by the increase in the percentage of dead eggs and histologically showing more gfanuloma circumscription with more ova degeneration and less inflammatory cells. The 25-day survival rates in Gil, GIV, GVand GVI were 5/15 [33.3%], 8/15 [53.3%], 10/15 [66.7%] and 9/15 [60%] respecttively. In addition, there were significantly better outcomes in serum biochemical indexes such as ALT, AST, y-GT, ALP, and hepatic SOD and MDA in the fresh and microencapsulated groups than in PZQ-treated group, without great differences between the microencapsulated and the fresh transplanted groups. Liver pathological staining supported these findings

Assessment of patient satisfaction towards primary health care facilities - a survey study in Sharkia Governorate

Patient satisfaction is an important tool that measure performance of health care providers. To assess patient satisfaction towards Primary Care in Sharkia Governorate in 2009, and to detect causes of patient dissatisfaction. This study was carried out on 893 patients from 18 Primary Health Care Facilities in Sharkia. Data were collected through interview sheet including seven domains of patient satisfaction: reception service, doctors' and nurses' performance, accessibility in time and place, health environment and patients' rights. Responses were put in Likert Scale from excellent to poor, then satisfaction level was classified into: unsatisfied, partially satisfied and strongly satisfied. Pareto analysis for causes of dissatisfaction was done. The majority of patients were satisfied with accessibility of facilities in time 96.98% and place [98.54%], short waiting time [97.98%]. 73.46% of patients were satisfied with doctors' performance and 60.36% with nurses' performance. 33.26% of patients reported drugs unavailability, 25.87% were dissatisfied with the inadequacy of laboratory capabilities. Pareto analysis revealed that causes of dissatisfaction were deficiency in: information given to patients, bio-psychosocial approach, co-ordination between drugs, shared management, examination, follow-up, health education, referral, drugs, cleanliness, nurses' skills, and investigations. Most of patients were satisfied with accessibility of PHC facilities in time and place, short waiting time, cost of tickets, preventive services and staff performance. Most of patient dissatisfaction [80%] resulted from only 8 of studied causes regarding doctors' performance and only 7 of studied causes of nurses' performance, and health care environment

pulmonary immune effects of different ventilatory settings in patients undergoing thoracic surgery

Abstract: Mechanical ventilation using tidal volume [Vt] around 10 ml/kg and zero positive end-expiratory pressure [ZEEP] is still commonly used in anesthesia. Experimental data suggest that mechanical ventilation with high Vt and ZEEP induces not only cytokine release but also translocation of cytokines from the lungs to the systemic circulation. In addition, inflammatory responses to mechanical stress caused by mechanical ventilation may aggravated by inflammatory co-stimulation. One-lung ventilation is an established procedure during thoracic surgery. Commonly, Vt used during two-lung ventilation [TLV] are recommended during OLV to maintain arterial oxygenation and carbon dioxide elimination. Previous experimental and clinical studies on TLV showed a progressive alteration of pulmonary immune function during anesthesia and surgery. Accordingly, in surgical patients undergoing OLV with high and low Vt, a time-dependent increase of proinflammatory variables may be found. In this prospective, randomized, clinical study, we therefore examined whether a standard ventilation setting [V[T] = 10 mL/kg] may result in a time-dependent alteration of pulmonary immune function in patients undergoing open thoracic surgery and OLV. Furthermore, we tested whether ventilation with different Vt and positive end expiratory pressure [PEEP] modifies pulmonary immune function, hemodynamics, and gas exchange during OLV

Methods: Forty five patients undergoing open thoracic surgery were randomized to receive mechanical ventilation with either [1] Vt = 10 ml/kg on ZEEP, [2] Vt = 6 ml/kg on ZEEP, or [3] Vt = 6 ml/kg on PEEP of 10 cm H2O. Because interleukin-6 and macrophage inflammatory protein-2 are more sensitive markers of ventilation-induced cytokine release, serum and bronchoalveolar lavage samples were examined for these mediators. Cells, protein, tumor necrosis factor [TNF]-[alpha], interleukin [IL]-8, soluble intercellular adhesion molecule [sICAM]-1, IL-10, and elastase were determined in the bronchoalveolar lavage. Data were analyzed by parametric or nonparametric tests, as indicated. In all patients, an increase of proinflammatory variables was found. Concentrations were significantly smaller after OLV with Vt = 6 mL/kg on PEEP of 10 cm H2O

Conclusion: Mechanical ventilation can induce a cytokine response that may be attenuated by a strategy to minimize overdistention and recruitment/derecruitment of the lung. Whether these physiological improvements are associated with improvements in clinical end points should be determined in future studies

Influence of hydroxyethyl starch 130/0.4 versus ringer lactate on renal function during acute normovolemic haemodilution in combination with controlled hypotension

The risks associated with banked homologous blood products are well known. Several techniques for management of surgical patients without homologous blood transfusion are available. Controlled hypotension and acute normovolemic haemodilution [ANH] have been proven effective in decreasing operative blood loss and the need for transfusion of allogenic blood. The combined reduction of oxygen carrying capacity and perfusion pressure during combination of ANH and controlled hypotension raises the concerns of hypoperfusion and ischaemic injury to the kidney. Forty patients undergoing major abdominal surgery were allocated to receive controlled hypotension induced by Na nitroprusside [mean arterial pressure 50 mm Hg] and acute normovolemic haemodilution [post ANH haematocrite 29%]. ANH was established by withdrawing venous blood into standard blood bags and replacing it by HES 130/0.4 [Group I] or RL [group II]. The shed blood was reinfused at the end of surgery. Subclinical alteration in renal integrity detected by sensitive markers of tubular damage has been reported in the absence of overt change in creatinine serum concentration and creatinine clearance in both groups. These markers have returned to normal values after 24 hours. Sensitive markers of kidney dysfunction have increased in both groups indicating moderate alterations in renal integrity during combination of ANH and controlled hypotension. Both volume replacement regimens did not differ with regard to kidney integrity

Enteral nutrition in critically ill patients

Critical illness, stress, and surgery place increased demands on the body's nutritional requirements. These conditions promote a catabolic state and negative nitrogen balance. Nutritional problems are common in critically ill patients. Nutritional supplementation affords the opportunity of slowing down or stopping the catabolic process, restoring nitrogen balance, and preventing malnutrition. Enteral nutrition preserve the integrity of the gastrointestinal mucosa and enhance immune function. Early enteral nutrition administration to critically ill patients can decrease the number of infectious complications, length of stay and mortality. However, early enteral nutrition in the critically ill is often limited by gastroparesis, which impairs gastric emptying, thereby promoting gastroesophageal reflux and aspiration pneumonia. However, Early enteral nutrition is the treatment of choice with an A level of recommendation for some authors. A total of two hundred critically ill adult patients were enrolled in the study. Daily 18-hrs enteral nutrition via a 14F gastric tube was initiated either immediately after stabilization in group I, or later than 48hrs after admition in group II. Residual gastric volume was measured every 6hrs, and enteral nutrition was discontinued if exceed 300ml or vomiting occurred. Nutritional outcome measures included the percentage of the goal rate achieved during the study period, volume ratio, and gastrointestinal complications rate. Clinical outcomes included the incidence of ventilator associated pneumonia, multiple organ failure score, the duration of mechanical ventilation, and the length of ICU stay. Overall, the evidence suggests that early enteral feeding is beneficial to critically ill patients. In our study early intervention was associated with shorter duration of mechanical ventilation and ICU stay. Patients in the early feeding group had less sever form of MOF, and decreased infectious complications and mortality. The early institution of nutritional support and the use of enteral nutrition optimize nutritional status of the patient and reduce complications associated with bowel rest resulting in improved clinical outcomes in critically ill patients

Detection of cotinine in neonate meconium as a marker for nicotine exposure in utero

Neonate meconium cotinine level was evaluated as a marker of prenatal exposure to nicotine from tobacco smoking by mothers. Mothers admitted to a maternity hospital in Alexandria, Egypt, were divided into 3 groups: 10 active smokers, 10 passive smokers and 10 with no tobacco exposure during pregnancy. Urine and saliva samples were collected from mothers and first-day meconium samples from their neonates. Mean maternal urinary cotinine levels, measured using radioimmunoassay, differed significantly between the 3 groups, as did mean salivary cotinine and mean cotinine levels in meconium.There was a significant positive correlation between cotinine levels in meconium and both maternal urinary and salivary cotinine levels. Meconium is an ideal biological marker for testing direct fetal exposure to tobacco smoke in the neonatal period

Estimation of tuberculosis incidence and mortality in Egypt using epidemiological models

To estimate tuberculosis incidence in Egypt, data were collected from national tuberculosis case notification records, vital registration statistics, tuberculin surveys and treatment outcomes. An important source of information was the national comprehensive tuberculin survey results, which estimated a 55.2% case detection rate and a 65.6% case notification rate. The data suggest that only two-thirds of actual cases are being identified and treated by the national programme. The figures for expected versus reported deaths from tuberculosis in Egypt in 1996 suggest underreporting to be almost 80%

Polysomnography, a new modality in evaluating sleep disorders in children

Relatively, little is known about sleep disturbances among children, this descriptive study, examined a variety of common sleep behaviors in a group of 500 elementary school children aged from 4 to 10 years [median 7 years], using a battery of sleep questionnaires. The prevalence of parent-defined sleep problems ranged from head banging [3.2%] to teeth grinding [19.2%] and bed wetting [21.2%] with 94 children [/8.8%] of over all sample described as having significant sleep problems. Polysomnographic recordings were obtained from 21 children with severe sleep disturbances : rhythmic movement disorders [4 children], obstructive sleep apnea syndrome [OSAS] 5 children, nocturnal enuresis [5 children] and other parasomnias constitute 7 children. One of the four children with rhythmic movement disorders proved by polysomnographic records [EEG] to had nocturnal frontal lobe epilepsy, while 3 children out of the five children with clinically suspected OSAS met its polysomnographic criteria. We concluded from this study that sleep disturbances are common in school aged children and polysomnography is of great value in diagnosis of OSAS and violent nocturnal movements

Personality traits, intelligence quotient and dactylography in juvenile delinquents

Sixty boys [30 delinquents and 30 control] were studied. All subjects underwent the following tests: Eysenck personality inventory to evaluate neuroticism [N] and extraversion [E], Minnesota Multiphasic Personality Inventory to evaluate psychopathic deviation [PD], modification of draw a person test [DAP] to measure IQ, h and test to measure degree of aggression, acting out and violence, and dermatoglyphics of fingers of both h and s. Results showed that the 3 personality dimensions tested were significantly higher in juvenile delinquents than in the control group. Similarly, a significant difference existed for aggression and acting out at p <0.01 IQ was significantly lower among juvenile delinquents than among the control group [t = 3.77, p = 0.01]. As for the dermatoglyphics, radial loops were nearly absent in both h and s of juvenile delinquents. The only significant relationship elicited was in the right index for the drug abuse offense

Prevalence of rheumatic heart diseases among school students in Sharkia governorate, Egypt

The prevalence of rheumatic heart diseases [RHD] in school students in Sharkia Gorernorate [about 500.000 students] was studied in contribution with the current screening program of school Health Insurance System in Sharkia Governorate. Target population [6- I 5 years, old] was followed during the period from January 1994 to November 1996. Students were medically examined in collaboration with school physicians, positive screened cases were further submitted to investigations by serial echocardiography and Doppler ultrasongoraphy and other diagnostic tools at Health Insurance Hospital at Zagazig City. The prevalence of RHD among school student was 5.2%. The highest prevalence rate of RHD was observed among females aged 15 years or more. Double mitral valve disease was the commonest lesion while combined mitral and tricuspid valve diseases were the least one. The use of echocardiography during this work removed any bias and attached more accuracy to our data. Authors recommended comprehensive field studies for early detection of cases, also more efforts must be paid for the prevention and control of rheumatic fever and RHD especially among adolescent females

Evaluation of the health service performance in outpatient clinics in Zagazig University

Many illnessess now can be treated on an ambulatory base [outpatient care] due to the shortage of hospital beds and escalation in operating expenses for inpatient care. The objective of this study is to evaluate the health service performance in Outpatient Clinics in Zagazig, University Hospitals for the sake of promotion of health services in these clinics. This work was done at the Pediatric and Gynecologic Outpatient Clinics, Zagazig University Hospitals. The health care - providers [physician number 37] and a random sample of 800 consumers of both studied clinics, were included in the present study The performance of the health service was evaluated by assessment of structure, care process, and outcome of care of the studied clinics.The work conditions of the studied outpatient clinics were satisfactory in general, but that for site, area and artificial ventilation of the Gynecologic clinic were inadequate. Lavatones and booklets were not adequate in both clinics while posters were not available in Gynecologic clinic The required medical equipments were available in Pediatric [35%] and Gynecologic clinics [73.9%], while non medical ones represented 62.5% and 68.7% of the required items respectively. Drugs availability was not satisfactory [at both studied clinics] according to both providors and consumers oponion. One record was present at each clinic in which recorded data were inaccurate and incomplete. Functional analysis of physicians showed that their performance was generally satisfactory except for completing ticket data and supervising subordinates. About case management, there was deficiency in communication skills [e.g. welcoming of the patient] versus manual skills [e, g.local examination] Consumer study revealed that rural residence and lower levels of education were significantly associated with higher degree of satisfaction. But consumers of both studied clinics were generally satisfied with service offered except for waiting time at Pediatric clinic. Institution of a quality assurance program to monitor the health service performance at the outpatient clinics on a regular basis is highly recommended

Epidemiological and sociocultural study of burn patients in Alexandria, Egypt

All burn cases admitted to the burns unit of Alexandria Main University Hospital over a period of one year were investigated. Burns were found to occur in younger age groups. There was an almost equal distribution of cases by sex, but when stratified by age, more females were found in most age groups. Most burns were domestic, with cooking being the most prevalent activity. Flame was the most common agent. Death occurred in about one-third of cases; when using logistic regression analysis, the outcome of the burn injury was significantly associated with age, sex, total surface area burnt and degree and depth of the burn

Comparative study to evaluate the antibacterial effect of 3 different forms of calcium hydroxide used in root canal treatment.

The antimicrobial effectiveness of three different forms of calcium hydroxide in root canals of extracted human teeth was compared. Canals were enlarged and inoculated with S. aureus, Str. faecalis. E. coli and Ps. aeruginosa in pure forms as well as in different combinations. After treatment with the tested forms of calcium hydroxide [powder, paste and points] and sealing, the roots were incubated at 37 C. At intervals, 0 hour, 24 hour, 48 hour, 72 hour and 7 days, a set of root canals was analyzed for the viability of bacterial strains. All tested forms of calcium hydroxide exhibited similar antibacterial activity against all bacteria and bacterial mixtures included in the study. Str. faecalis was the most sensitive one [after 24 hour] followed by E. coli [after 48 hour], while S. aureus and Ps. aeruginosa as well as the mixtures used were inactivated after 72 hour exposure. A similar comparative study was done on thirty patients having single rooted teeth with necrotic pulps and indicated for root canal treatment. Intracanal culture samples were taken before canal preparation for bacterial count. Patients were divided into three groups, each group received an interappointment dressing of one form of calcium hydroxide. Cultures were repeated at 3, 7 and 10 days and the antibacterial effect of different forms was expressed as percentage reduction of the viable bacterial count compared to the baseline cultures

Management of cholelithiasis during pregnancy

Twenty-seven pregnant women, with symptomatic gallstone disease, were admitted to this prospective study. All patients received initial medical therapy, and surgical intervention was performed in cases with frequent relapses or no response to medical treatment. Twelve patients underwent surgery during pregnancy, 2 in the first and 10 in the second trimester. Eight patients underwent laparoscopic cholecystectomy, while 4 had open cholecystectomy [one had exploration of the common bile duct]. While no maternal or fetal deaths occurred secondary to medical treatment, one spontaneous abortion occurred following open cholecystectomy in the first trimester. Patients, after receiving primary medical treatment, had 74.1% rate of relapse and additional days in hospital, compared to no relapse and less hospital stays after surgery. Patients acute cholecystitis had increased incidence of medical treatment failure and need of surgery. It is concluded that management of biliary tract disease during pregnancy should follow a protocol, with clear indications for the role of surgical intervention during the second trimester of pregnancy does not increase maternal or fetal morbidity. It may in fact reduce the number of relapses during pregnancy, hence reduces the consequent complications and additional hospital stay. Laparoscopic cholecystectomy is feasible in the great majority of patients, except those with large uteri in the late second trimester and the presence of common bile duct stones

Vaccine effect on the trend of measles morbidity and mortality in Egypt [1960-1985]

Since the measles vaccination program began in 1976, measles reported data for Egypt, 1960 - 1985, were analyzed to reveal trends in measles occurrence, age pattern, seasonal variation and mortality pattern. Data analysis revealed a reduction in the annual average reported cases in Egypt by about 57% after introduction of compulsory vaccination. The impact of vaccination was more evident in the urban than rural areas as the reduction was 64% in urban compared with only 3.5% in the rural Egypt. The mean age of notified measles cases has risen from 3.5 years to approximately 5 years of age over the 9 years since the program began. The mean seasonal index of measles calculated in the pre- and post-vaccination period revealed 8 weeks shift for the maximum seasonal index of measles morbidity. Data analysis showed marked reduction in the reported measles deaths and the case fatality rate after introduction of compulsory vaccination in 1976

Evaluation of a direct agglutination test and methylene blue test in diagnosis of cutaneous leishmaniasis

The usefulness and sensitivity of a direct agglutination test [DAT] in the diagnosis of cutaneous leishmaniasis infection has been investigated. Trypsin treated, formalin fixed and coomassie blue stained Leishmania promastigotes were used as antigens: L. infantum, L. donovani, L. aethiopica. Although the titers of sera from patients with localized cutaneous leishmaniasis were low, sera from lepromatous, tuberculous and toxoplasmic patients gave high titers indicating cross reactivity. Comparable results were obtained when the same sera were tested using freshly prepared antigen or antigens stored for 5 months at 4C, and with addition of 0.78% 2-meracaptoethanol to the diluents

Immunosuppressive effect in oral and maxillofacial surgery

Using tissue culture techniques, peripheral blood lymphocytes [PBL], obtained from patients undergoing various types of oral and maxillofacial surgical operations, have been found to develop depressed immunological competence as reflected by their diminished ability, under maximal stimulation with phytohaemagglutinin, to incorporate 14 C thymidine and synthesise D.N.A. More important, however, was the observation that this biosynthetic defect was most severe in lymphocytes harvested from individuals of maxillofacial trauma with associated injuries and oral cancer. The clinical significance of this abnormality measured in vitro may be reflected by postoperative infection in case of multiple trauma, and the acceleration of metastasis which often takes place postoperatively in patients with carcinoma

Hepatitis B surface antigen [HBs Ag] among addicts in Alexandria: a seroepidemiologic study

The prevalence of HBs Ag among 107 male addicts was 23.4% compared to 5.3% among their controls. Calculating the crude odds ratio it was found that addicts have 5 times the risk to be HBs Ag positive compared to non addicts. Studying the risk of hepatitis in association with injection data of the present work revealed that addicts with past history of injection have 4 times the risk of HBs Ag compared to non addicts. A significant relationship was found between the elevation of transaminases [SGOT and SGPT] and the addiction of drugs irrespective of presence of HBs Ag