Effect of Clomiphene Citrate on the Ultrastructure of Testis in Albino Rats

SUMMARY: The aim of the present work was to study the closer effect of clomiphene citrate on the ultrastructure of the testis of adult albino rats to provide a basis for optimizing this drug in the treatment of male infertility. The testes were removed from both groups under anesthesia and then prepared for examination by light using hematoxylin and eosin stains and a transmission electron microscope. Semithin sections were cut into 1 µm thick sections, stained with toluidine blue, and examined by light microscopy for a survey. The desired areas were placed in the center, and other areas were trimmed. Primary spermatocytes showed marked nuclear changes (pyknosis), and their nuclear membranes were ill-defined and disrupted. The cytoplasm showed widespread degeneration of mitochondria and lysosomes and focal degeneration of the rough endoplasmic reticulum compared with the control group. The spermatids were pale, and the two phases of spermatogenesis were distinctly identifiable in the control group but were confused in the treated group. Some spermatids had interrupted nuclear membranes, also containing degenerated mitochondria, focal fragmentation of rough endoplasmic reticulum, and free ribosomes. Spermatozoa in the treated group appeared deformed compared to the control, where they had deformed head caps. Leydig cells of the treated group have an irregularly shaped nucleus, with focal chromatin aggregation and peripheral chromatin condensation on the inner surface of the nuclear membrane. The observations of the present work indicate a possible causal relationship between testicular affection and ingestion of clomiphene citrate, which can be avoided by close medical observations using ultrasonography, semen analysis, or testicular biopsy to detect early malignant changes. Furthermore, the drug should not be used for more than three to six cycles and should be stopped for at least three cycles before reuse. When clomiphene citrate is ineffective in the treatment of male infertility, human menopausal gonadotropin (hMG) administration is typically selected. However, high-dose hMG therapy is associated with a variety of adverse effects. In this work, we report the success of a modified clomiphene citrate regimen in increasing sperm count without any hazards to the testicular tissue.

El objetivo del trabajo fue estudiar el efecto del citrato de clomifeno sobre la estructura de los testículos de la rata albina adulta, con la finalidad de determinar la mejor manera de utilizar este fármaco en el tratamiento de la infertilidad masculina. Los testículos se extrajeron bajo anestesia y para su análisis a través de microscopio de luz se tiñeron con HE. Además, las muestras fueron preparadas para su examen con microscopía electrónica de transmisión. Por otra parte, se cortaron secciones semifinas de 1 µm de espesor, se tiñeron con azul de toluidina y se examinaron mediante microscopía óptica. Los espermatocitos primarios mostraron cambios nucleares marcados (picnosis) y sus membranas nucleares estaban mal definidas y alteradas. En el grupo experimental las células presentaban el citoplasma con degeneración generalizada de las mitocondrias y de los lisosomas y una degeneración focal del retículo endoplásmico rugoso en comparación con el grupo control. Las espermátidas estaban pálidas y las dos fases de la espermatogénesis eran claramente identificables en el grupo control, pero se confundían en el grupo tratado. Algunas espermátidas tenían membranas nucleares interrumpidas, y también contenían mitocondrias degeneradas, fragmentación focal del retículo endoplásmico rugoso y ribosomas libres. Los espermatozoides del grupo tratado se presentaban deformados en comparación con el control. Las células de Leydig del grupo tratado presentaban un núcleo de forma irregular, con agregación focal de cromatina y condensación de cromatina periférica en la superficie interna de la membrana nuclear. Las observaciones del presente trabajo indican una posible relación causal entre la afección testicular y la ingestión de citrato de clomifeno, que puede evitarse mediante observaciones médicas minuciosas a través de ecografía, análisis de semen o biopsia testicular para detectar cambios malignos tempranos. Además, el medicamento no debiera ser usado durante más de tres a seis ciclos y debe suspenderse durante al menos tres ciclos antes de volver a usarlo. Cuando el citrato de clomifeno es ineficaz en el tratamiento de la infertilidad masculina, normalmente se selecciona la administración de gonadotropina menopáusica humana (hMG). Sin embargo, la terapia con hMG en dosis altas se asocia con una variedad de efectos adversos. En este trabajo, informamos el éxito de un régimen modificado con citrato de clomifeno para aumentar el recuento de espermatozoides sin riesgo para el tejido testicular.

Use of abdominal compression device in colonoscopy: a systematic review and meta-analysis

Background/Aims@#Colonoscopy for screening is associated with unpleasant experiences for patients, and abdominal compression devices have been developed to minimize these problems. However, there is a paucity of data supporting the therapeutic benefits of this strategy. This study examined the effects of using an abdominal compression device during colonoscopy on the cecal intubation time (CIT), abdominal compression, patient comfort, and postural changes. @*Methods@#We searched PubMed and Scopus (from inception to November 2021) for randomized controlled trials that assessed the effects of an abdominal compression device during colonoscopy on CIT, abdominal compression, patient comfort, and postural change. A random-effects meta-analysis was performed. Weighted mean differences (WMDs) and Mantel-Haenszel odds ratios (ORs) were calculated. @*Results@#Our pooled analysis of seven randomized controlled trials revealed that abdominal compression devices significantly reduced CIT (WMD, –0.76 [–1.49 to –0.03] minutes; p=0.04), abdominal compression (OR, 0.52; 95% confidence interval [CI], 0.28–0.94; p=0.03), and postural changes (OR, 0.46; 95% CI, 0.27–0.78; p=0.004) during colonoscopy. However, our results did not show a significant change in patient comfort (WMD, –0.48; 95% CI, –1.05 to 0.08; p=0.09) when using an abdominal compression device. @*Conclusions@#Our findings demonstrate that employing an abdominal compression device may reduce CIT, abdominal compression, and postural change but have no impact on patient comfort.

Significance of tumor-associated neutrophils, lymphocytes, and neutrophil-to-lymphocyte ratio in non-invasive and invasive bladder urothelial carcinoma

Background@#Tumor-infiltrating neutrophils and lymphocytes play essential roles in promoting or combating various neoplasms. This study aimed to investigate the association between tumor-infiltrating neutrophils and lymphocytes and the neutrophil-to-lymphocyte ratio in the progression of urothelial carcinoma. @*Methods@#A total of 106 patients diagnosed with urothelial carcinoma were was. Pathological examination for tumor grade and stage and for tumor-infiltrating neutrophils, both CD4 and CD8+ T lymphocytes, as well as the neutrophil- to-lymphocyte ratio were evaluated. @*Results@#The presence of neutrophils and the neutrophil-to-lymphocyte ratio correlated with high-grade urothelial neoplasms. In both low- and high-grade tumors, the lymphocytes increased during progression from a non-invasive neoplasm to an early-invasive neoplasm. CD8+ T lymphocytes increased in low-grade non–muscle-invasive tumors compared to non-invasive tumors. Additionally, there was a significant decrease in CD8+ T lymphocytes during progression to muscle-invasive tumors. @*Conclusions@#Our results suggest that tumor-infiltrating neutrophils and CD8+ T lymphocytes have a significant effect on tumor grade and progression.

Assessment of anterior positioning splint in conjunction with lateral pterygoid BTX injection to treat TMJ disc displacement with reduction — a preliminary report / 대한악안면성형재건외과학회지

Objective@#Treatment of temporomandibular disc displacement with reduction is controversial. This study assesses the use of an anterior positioning splint with botulinum toxin in the lateral pterygoid muscle (BTX) for such cases. @*Methods@#Twelve joints were included; groups I and II received BTX injection while group II also received an anterior positioning splint. Pain scores and clicking status were recorded at regular intervals then a postoperative MRI was done after 4 months. @*Results@#Clinical improvement was noted in both groups. Mean pain scores dropped significantly and clicks in the twelve joints disappeared in 83% of group I and 33% of group II. MRIs showed significant disc position improvement with the higher mean change (1.33 ± 0.76) in group I. Group I showed better improvement of discal position and only one joint regained a click. Patients of group II reported discomfort from the splint which may have caused psychological distress and so worst pain scores. @*Conclusions@#Group I showed slightly better results but the cost of BTX injections and the complications of the splint should be kept in mind and the decision of treatment selection made according to each condition.

Evaluation of Antidiabetic Potentiality of Truffles and Balanites Aegyptiaca among Streptozotocin Induced Diabetic Rats

The potential application of Truffle (Terfeziaceae) and Desert Date tree (Balanites aegyptiaca) for modulating the diabetesmellitus related symptoms has gained much interest. However, less firm evidence has come from data to increase theunderstanding of the mechanism by which Truffle and Balanites protect pancreatic β-cells. The present study aimed toevaluate the effect of methanolic extract of Truffle and Balanites aegyptiaca on the fasting blood glucose (FBG) level; thechanges in pancreatic histology as well as the changes in iNOS and IL-1β genes expression level among STZ induceddiabetic rats which might help in better clarification of possible mechanisms beside the beneficial effects of the studiedplants on diabetes. The elevation of the FBG level, pathological pancreatic changes and the level of both IL-1β and iNOSgene expressions in diabetic rats were observed in comparison with negative control rats. This increase was declinedsignificantly due to the administration of Truffle and Balanites extracts. All of the studied parameters did not completelyreverse to the normal levels as compared with negative control rats. The obtained results concluded that the beneficial effectof Truffle and Balanites aegyptiaca on STZ-induced diabetes was at least partly due to the reduction of IL-1β and iNOS geneover the expression which can have a protective effect on β cell.

Ketamine as an adjunct to bupivacaine in infra-orbital nerve block analgesia after cleft lip repair / Cetamina como adjuvante de bupivacaína em bloqueio do nervo infraorbitário para analgesia após correção de lábio leporino

Abstract Objectives: We conducted this study to investigate the safety and analgesic efficacy of the addition of Ketamine to Bupivacaine in bilateral extra-oral infra-orbital nerve block in children undergoing cleft lip surgeries. Methods: Sixty patients were randomly allocated into two groups (n = 30), Group B received infra-orbital nerve block with 2 mL of 0.25% Bupivacaine and Group BK received 0.5 mg.kg-1 Ketamine for each side added to 1 mL of 0.5% Bupivacaine solution diluted up to 2 mL solution to 0.25% Bupivacaine concentration. Assessment parameters included; hemodynamics, recovery time, time to first oral intake, postoperative Faces Legs Activity Cry Consolability (FLACC) scores, Four-point Agitation scores, analgesic consumption and adverse effects. Results: Patients in Group BK showed lower postoperative FLACC scores during all recorded time points (p < 0.0001). Two patients in Group BK versus 12 in Group B requested for postoperative rescue analgesia (p < 0.001). There were no differences between groups in time, minutes (min), to first request for rescue analgesia. Patients in Group BK reported lower analgesic consumption (366.67 ± 45.67 vs. 240.0 ± 0.0 mg, p < 0.04). The time to first oral intake was significantly reduced in Group BK (87.67 ± 15.41 vs. 27.33 ± 8.68 min, p < 0.001). Lower postoperative Agitation scores were recorded in Group BK patients that reached a statistical significance at 45 min (0.86 ± 0.11 vs. 0.46 ± 0.16, p < 0.04) and in the first hour (h) postoperatively (1.40 ± 0.17 vs. 0.67 ± 0.14, p < 0.003). Higher parent satisfaction scores were recorded in Group BK (p < 0.04) without significant adverse effects. Conclusions: The addition of Ketamine to Bupivacaine has accentuated the analgesic efficacy of infra-orbital nerve block in children undergoing cleft lip repair surgeries.

Resumo Objetivos: Realizamos este estudo para avaliar a segurança e eficácia da analgesia com a adição de cetamina à bupivacaína em bloqueio do nervo infraorbitário, bilateral e extraoral, em crianças submetidas à cirurgia de lábio leporino. Métodos: Foram randomicamente alocados 60 pacientes em dois grupos (n = 30): o Grupo B recebeu bloqueio do nervo infraorbitário com bupivacaína a 0,25% (2 mL) e o Grupo BC recebeu bloqueio com cetamina (0,5 mg.kg-1) em cada lado, mais a adição de 1 mL de solução de bupivacaína a 0,5% diluída até 2 mL da concentração a 0,25%. Os parâmetros de avaliação incluíram: hemodinâmica, tempo de recuperação, tempo até a primeira ingestão oral, escores da escala FLACC (que avalia a expressão facial [Face], os movimentos das pernas [Legs], a atividade [Activity], o choro [Cry] e a consolabilidade [Consolability]), escores de agitação em escala de quatro pontos, consumo de analgésicos e efeitos adversos no pós-operatório. Resultados: Os pacientes do Grupo BC apresentaram escores FLACC mais baixos em todos os momentos mensurados no pós-operatório (p < 0,0001). Dois pacientes do Grupo BC versus 12 do Grupo B solicitaram analgesia de resgate no pós-operatório (p < 0,001). Não houve diferenças entre os grupos em relação ao tempo até a primeira solicitação de analgesia de resgate. Os pacientes do Grupo BC relataram consumo menor de analgésicos (366,67 ± 45,67 vs. 240,0 ± 0,0 mg, p < 0,04). O tempo em minutos (min) até a primeira ingestão oral foi significativamente reduzido no Grupo BC (87,67 ± 15,41 vs. 27,33 ± 8,68 min, p < 0,001). Escores mais baixos de agitação no pós-operatório foram registrados para os pacientes do Grupo BC, com significância estatística no tempo de 45 min (0,86 ± 0,11 vs. 0,46 ± 0,16; p < 0,04) e na primeira hora de pós-operatório (1,40 ± 0,17 vs. 0,67 ± 0,14; p < 0,003). Índices mais altos de satisfação dos pais foram registrados no Grupo BC (p < 0,04), sem efeitos adversos significativos. Conclusões: A adição de cetamina à bupivacaína acentuou a eficácia analgésica do bloqueio do nervo infraorbitário em crianças submetidas à cirurgia de correção de lábio leporino.

Prediction of post total thyroidectomy hypocalcemia using perioperative parathyroid hormone

Background: hypocalcaemia, which is a major contributing factor for delayed hospital discharge, occurs in many patients following total thyroidectomy. Parathyroid hormone [PTH] measurement has been proposed as a marker of this condition

Aim: the aim of this study was to evaluate the reliability of perioperative parathyroid hormone measurement to predict post-total thyroidectomy hypocalcaemia

Patients and methods: a prospective randomized study was conducted in the period between July 2015 and September 2017 in Ain Shams University, General Surgery Department, Endocrine Surgery Unit, Cairo, Egypt. The study was conducted on sixty patients for whom total thyroidectomy was done. Parathyroid hormone was measured pre-operative and 6 hours postoperative, and serum Ca was measured daily to predict hypocalcaemia. Patients were evaluated for symptoms of hypocalcaemia and treated with calcium and vitamin D supplementation as necessary

Results: the study included 60 patients, 12 males and 48 females with mean age 39.1+ 16.52 [20-65]. Co morbid conditions included HTN, DM, ISHD and COPD. Most patients had nodular goiter [48 patients] whether unilateral or bilateral. 63.3% of patients had follicular lesion by FNABC. All patients underwent total thyroidectomy. Hypocalcemia developed in 16.7% [10 of 60] of the patients. Best cut off was 66% reduction giving 77% Sensitivity and 91.4% Specificity. Positive predictive value was 85% and negative predictive value was 94%

Conclusion: the evaluation of PTH and corrected calcium levels 6 hours after thyroidectomy allows for an accurate prediction of the trend of hypocalcemia. This study enables us to discharge most patients safely within 24 hours after total thyroidectomy

prevalence of biofilm formation, antimicrobial resistance and adhesive pap gene (pyelonephritis associated pili) among Escherichia coli strains isolated from outpatients and inpatients with urinary tract infection

Background: E.coli is the most common cause of urinary tract infection [UTI] both in the community and hospital settings. UropathogenicE.coli [UPEC] possesses a number of virulence factors that allow it to colonize and persist in the urinary tract. Of particular interest are the P pili and biofilm formation. The emergence of drug resistant E.coli is a global threat to the public health

Objectives: To determine the biofilm producing ability, antimicrobial susceptibility pattern, ESBL production and the presence of the adhesive pap gene [pyelonephritis associated pili] in E-coli strains isolated from Outpatients and Inpatients diagnosed with UTI

Methodology:The study was conducted on 40 Inpatients and 40 Outpatients diagnosed with UTI attending Ain Shams University Hospitals. E. coli Isolates were tested for antimicrobial susceptibility using disk diffusion method, ESBL production by ESBL detection discs, in vitro formation of biofilm on Congo red media, and detection of Pap gene using conventional PCR technique

Results: The prevalence of antibiotic resistance was significantly higher in E.coli isolates from inpatients group than those from the outpatients group. The prevalence of ESBL production, biofilm formation and pap gene among E. coli isolates was 55%, 82.5% and 40% respectively. ESBL production and biofilm formation were significantly higher in the inpatients with upper UTI than in patients with lower UTI [90-38.5%] and [100-61.5%] respectively. There was no statistically significant difference between the 2 groups as regards the prevalence of pap gene

Conclusion: The prevalence of biofilm producing, ESBL producing and antibiotic resistant E.coli strains is more in the inpatients population particularly those with upper UTI. Special concern should be addressed to the spread of ESBL producing E.coli in the community. Pap gene is expressed equally in the outpatients and inpatients groups which highlights its importance in the establishment of UTI

Experience with wide and narrow caliber percutaneous radiologically guided gastrostomy tubes

Objective: To compare the percutaneous radiologically guided gastrostomy [PeRG] tubes of wide caliber with narrow caliber tubes

Methodology: This retrospective study was performed on 36 patients who were referred to Radiology department for PeRG tube placement between 2008 till 2012. Comparison of wide caliber gastrostomy tubes [18-24 Fr] was done with narrow caliber tubes [14 Fr] considering procedure success rate, procedure related complications and catheter related minor and major complications

Results: Out of 36 patients, 18 patients were present in each group. Mean age of patients was 53.944 +/- 19.380. Procedure success rate was 100% in both groups and procedure related immediate complications were none in either groups. Peri-catheter leakage was observed in 1 patient in each group. Tube occlusion was present in 2 patients in narrow caliber group. Two patients had severe pain in wide caliber group and also 3 patients had wound infection in this group

Conclusion: Regardless of the type of radiologic catheter placed, PeRG can be considered as safe and highly successful procedure. Use of a 24 Fr gastrostomy tubes may show promising results if placed under radiological guidance with comparable technical success and complication rates to other caliber tubes

role of 320 slice CT angiography in predicting vascular trauma

Objective: To determine the accuracy of multidetector CT angiography [MDCT angiography] as initial diagnostic technique in depicting and characterizing post traumatic vascular injuries, looking for additional injuries and confirming the findings with intervention and follow-up

Study Design: Descriptive analytical study

Place and Duration of Study: Department of Radiology, Shifa International Hospital, Islamabad, from June 2010 to October 2013 Methodology: Patients who underwent MDCT angiography for clinically suspected post traumatic vascular injury were included. All MDCT angiographies were performed on 320 slice CT [Aquilion One[TM]] and were reviewed by two independent consultant radiologists. The sites of injury were intracranial, neck and maxillofacial, chest, abdomen and extremities. The presence and characteristics of vascular injuries were confirmed by post-operative findings or digital subtraction angiography [DSA]. Sensitivity and specificity was calculated

Results: The age of the patients ranged from 7 to 90 years with 94% [48] males and 6% [3] females. Blunt trauma was commoner than penetrating trauma. The site of injury in majority was extremities. Majority of patients had post-traumatic pseudoaneurysm formation followed by arterial occlusion, thrombosis, active extravasation, spasm, arteriovenous malformation and combination injuries. Twenty-one [41%] patients were reported as having vascular injury and confirmed by surgery or DSA. Fifteen [29.5%] patients were reported as normal and had no intervention on follow-up. The sensitivity and specificity of MDCT angiography was found as 100% and 88%, NPV of 100%, PPV of 94% and accuracy of 96%

Conclusion: MDCT angiography can be reliably used as an initial diagnostic technique for the evaluation and characterization of post-traumatic vascular injuries

Patterns of self-medication with over-the-counter pain relievers [acetaminophen, ibuprofen, and aspirin] among the Kuwaiti population

To estimate the prevalence of self-medication with over-the-counter pain relievers [OTCPR,like acetaminophen, ibuprofen, and aspirin] among Kuwaiti citizens above the age of 16 years and describe their patterns of use, perceived awareness of, and concerns about the drugs potential side effects. A descriptive cross-sectional questionnaire-based survey. Selected population from the six Kuwaiti governorates. The data were collected over a four-month period in 2012, from 850 subjects identified as Kuwaiti citizens. These subjects were recruited using stratified random sampling. Overall, a 67% response rate was obtained. In total, 68% [573] of the respondents reported use of OTCPR. Women, middle-aged or singles, and those with higher education used these drugs more than other subgroups [p < 0.05]. We found evidence of inappropriate use of these drugs, with 15% [88] of consumers using them almost daily. Not only were 81% of the consumers unaware of the potential side effects, but also more than 61% were not concerned about them. Women were more knowledgeable than men regarding the maximum dose [p = 0.036, OR = 1.49, CI = 1.03-2.17]. Consumers with higher levels of education did not show distinct knowledge regarding the maximum allowed dose of the drugs [p = 0.252, OR = 1.71, CI = 0.68-4.25]. The results showed a high prevalence of self-medication with OTCPR among Kuwaiti citizens. The subjects showed unawareness and unconcern regarding potential complications. This demonstrates the need for educational interventions

Does gauge of needle effects causation of pneumothorax following ultrasound guided thoracentesis?

Objective: to determine the frequency of pneumothorax following ultrasound guided thoracentesis in our department and its association with gauge of needle in causation of pneumothorax

Methadology: this is descriptive cross sectional study conducted at the Department of Diagnostic and Interventional Radiology, Shifa International Hospital [SIH], Islamabad from January 2010 to April, 2012. A total of 359 ultrasound guided thoracentesis were performed followed by a chest radiograph between January 2010 and April, 2012 fulfilling the inclusion criteria. All procedures were performed by radiology consultants and residents. Generally 18 and 16 G cannulas were used. A few were done with 16 and 18 G spinal needle and 21G syringe needle. Relevant data was collected from hospital data base system on the performa and was analyzed for demographic variables, frequency of pneumothorax, and its association with operator's experience [residents or consultants] and gauge of needle by applying chi square test. P value of < 0.05 was considered significant

Results: 309 patients had thoracocentesis while performed by residents and 50 by consultants. Pneumothorax occurred in 22 of these 359 cases with an overall frequency of 6%. In 219 patients 18 G cannula was used and 8 of these developed pneumothorax [3.6%]. In 94 patients 16 G cannula was used. Pneumothorax occurred in 11 [11.6%]. Statistical analysis confirmed that the frequency of pneumothorax was significantly increased following use of 16G as compared to 18G [p=0.02]

Conclusion: the frequency of pneumothorax following ultrasound guided thoracentesis increases significantly with use of 16G as compared to 18G [p=0.02]

Xenomonitoring of Different Filarial Nematodes Using Single and Multiplex PCR in Mosquitoes from Assiut Governorate, Egypt

Wuchereria bancrofti, Dirofilaria immitis, and Dirofilaria repens are filarial nematodes transmitted by mosquitoes belonging to Culex, Aedes, and Anopheles genera. Screening by vector dissection is a tiresome technique. We aimed to screen filarial parasites in their vectors by single and multiplex PCR and evaluate the usefulness of multiplex PCR as a rapid xenomonitoring and simultaneous differentiation tool, in area where 3 filarial parasites are coexisting. Female mosquitoes were collected from 7 localities in Assiut Governorate, were microscopically identified and divided into pools according to their species and collection site. Detection of W. bancrofti, D. immitis, and D. repens using single PCR was reached followed by multiplex PCR. Usefulness of multiplex PCR was evaluated by testing mosquito pools to know which genera and species are used by filarial parasites as a vector. An overall estimated rate of infection (ERI) in mosquitoes was 0.6%; the highest was Culex spp. (0.47%). W. bancrofti, D. immitis, and D. repens could be simultaneously and differentially detected in infected vectors by using multiplex PCR. Out of 100 mosquito pools, 8 were positive for W. bancrofti (ERI of 0.33%) and 3 pools each were positive for D. immitis and D. repens (ERI 0.12%). The technique showed 100% sensitivity and 98% specificity. El-Nikhila, El-Matiaa villages, and Sahel Seleem district in Assiut Governorate, Egypt are still endemic foci for filarial parasites. Multiplex PCR offers a reliable procedure for molecular xenomonitoring of filariasis within their respective vectors in endemic areas. Therefore, it is recommended for evaluation of mosquito infection after lymphatic filariasis eradication programs.

Xenomonitoring of Different Filarial Nematodes Using Single and Multiplex PCR in Mosquitoes from Assiut Governorate, Egypt

Wuchereria bancrofti, Dirofilaria immitis, and Dirofilaria repens are filarial nematodes transmitted by mosquitoes belonging to Culex, Aedes, and Anopheles genera. Screening by vector dissection is a tiresome technique. We aimed to screen filarial parasites in their vectors by single and multiplex PCR and evaluate the usefulness of multiplex PCR as a rapid xenomonitoring and simultaneous differentiation tool, in area where 3 filarial parasites are coexisting. Female mosquitoes were collected from 7 localities in Assiut Governorate, were microscopically identified and divided into pools according to their species and collection site. Detection of W. bancrofti, D. immitis, and D. repens using single PCR was reached followed by multiplex PCR. Usefulness of multiplex PCR was evaluated by testing mosquito pools to know which genera and species are used by filarial parasites as a vector. An overall estimated rate of infection (ERI) in mosquitoes was 0.6%; the highest was Culex spp. (0.47%). W. bancrofti, D. immitis, and D. repens could be simultaneously and differentially detected in infected vectors by using multiplex PCR. Out of 100 mosquito pools, 8 were positive for W. bancrofti (ERI of 0.33%) and 3 pools each were positive for D. immitis and D. repens (ERI 0.12%). The technique showed 100% sensitivity and 98% specificity. El-Nikhila, El-Matiaa villages, and Sahel Seleem district in Assiut Governorate, Egypt are still endemic foci for filarial parasites. Multiplex PCR offers a reliable procedure for molecular xenomonitoring of filariasis within their respective vectors in endemic areas. Therefore, it is recommended for evaluation of mosquito infection after lymphatic filariasis eradication programs.

Device- associated infections and antimicrobial resistance patterns of isolated pathogens in surgical intensive care unit at Ain Sham University Hospital

Device associated infections [DAIs] are considered the principal threat to patient safety in the ICU, and among the main causes of patient morbidity and mortality. To determine the DAI rates, as well as to identify the infectious agents isolated and their antimicrobial resistance patterns in the surgical ICU of Ain Sham University Hospital. The numbers of total patient days, ventilator days, urinary catheter days, and central catheter days in the ICUs were recorded during the period from June to November 2013. DAI rates and device utilization ratios were calculated. Clinical specimens were obtained from infected patients, cultured onto suitable media and isolates were identified using conventional methods. Antimicrobial susceptibilities of the isolates were investigated according to the standards of the Clinical and Laboratory Standards Institute. Totally 152DAIs were determined with a rate of 24.43/1, 000device days. The device utilization ratios were as follows: [0.75] for urinary catheter, [0.54] for mechanical ventilator, and [0.41] for central line. Ventilator associated pneumonia rate was 26.07/1, 000 ventilator days and most common microorganism was K.pneumoniae. Catheter associated urinary infection rate was 25.3/1, 000 urinary catheter days and the most common pathogen was E.coli. Central catheter associated blood stream infection rate was 19.84/1, 000 central catheter days and the most common infecting organism was S.aureus. Among Staphylococcus spp., 60.52% of S.aureus isolates and 50% of coagulase negative Staphylococci were methicillin resistant. ESBL production rates were 27.77% in E.coli, 27.6% in P.aeuroginosa, and 20.83% in K.pneumoniae isolates. The high rates of DAIs, device utilization ratios, and levels of antimicrobial resistance of pathogens identified in this study, highlight the importance of establishing antimicrobial stewardship and an active surveillance program, developing a comprehensive education program on evidence-based approaches for all health care workers, decreasing device utilization and the implementation of care bundles

Screening for neonatal hypothyroidism in Port-Sudan, Red Sea State

The objective of this study was to investigate the prevalence of neonatal hypothyroidism in Port Sudan, Red Sea State, using serum TSH and TT[4] levels. In this study 60 neonatal born at Port Sudan region were screened by the measuring the TSH, TT[4] [total thyroxin] values. Sample was taken and TSH, TT[4] levels were analyzed using RIA and IRMA methods. The [mean +/- SD] TSH and TT[4] levels I neonatal born respectively were 41.91 +/- 97.96 mU/L, 72.03 +/- 26.27 nmol/L, incidence of hypothyroidism in this study [16.7%] was much lower than in a similar study done in Darfur States [77%] by Mhammedni and Omaima [2002]. Incidence of hypothyroidism was not correlated with mother age, sex of the neonates, mother and father tribes, residence of the families and the prevalence of goiter

Role of liposuction in treatment of gynecomastia

Numerous techniques have been described for the correction of gynaecomastia. Surgical excision has been an effective treatment for gynaecomastia. Recently, there has been a shift from the open approach to liposuction. The purpose of this study to illustrate the advantages of using liposuction in treatment of gynecomastia. A total of 12 gynaecomastia patients were treated in this study, 11 patients were treated by liposuction only and one case was treated by liposuction and open excision of breast disc. Their ages ranged from 22 to 38 years. A vacuum assisted liposuction removing the fatty tissue was performed through a small incision. The amount of aspirated fat ranged from 200 to 850 cc. The mean infiltration volume per breast in vaccum-assisted liposuction was 500 ml [200-1000 ml]. The mean follow-up time was 4 months [range: 3-12 months]. All patients were satisfied with the improvements in their chest shapes. Use of liposuction in treatment of gynecomastia reduces the conspicuous scars, down-time morbidity and postoperative complications compared to subcutaneous mastectomy and leads to uniformly good esthetic results

A case of melanoma in xeroderma pigmentosum.

Xeroderma pigmentosum (XP) was first described in 1874 by Hebra and Kaposi. [1] It is a rare autosomal recessive disorder characterized by photosensitivity, pigmentary changes, premature skin aging, and malignant tumor development due to cellular hypersensitivity to ultraviolet radiation resulting from a defect in DNA repair. The basic defect in XP is in nucleotide excision repair (NER), leading to deficient repair of damaged DNA. A 12-year-old boy presented with a large growth over the right side of the forehead. The lesion was first noticed before two years as a 2 x 2 cm 2 mass. It was slowly growing and attained the present size of 10 x 8 x 7 cm 3 . The surface showed ulceration with areas of hemorrhage and blackish pigmentation. Also, the patient had hyperpigmented macules over the skin since early childhood. The macules appeared initially over the face and later developed over the other areas of the body. The macules were more over the sun exposed areas. He also had photophobia and both eyes showed corneal opacities. Histopathological examination of the excised growth showed features consistent with melanoma. This case is being presented because of its rare association with xeroderma pigmentosum patients in India.