burden of ischemic heart disease at a major cardiac center in central Saudi Arabia

To estimate the direct medical costs associated with ischemic heart disease [IHD] at Prince Sultan Cardiac Center [PSCC] in Riyadh, Saudi Arabia. This is a prevalence-based prospective observational cost of illness study conducted in PSCC, Riyadh, Kingdom of Saudi Arabia between April and June 2009. All patients diagnosed or suspected of having IHD at admission were included. They were followed up until discharge, or performing coronary artery bypass graft [CABG], or changing diagnosis. Clinical data were extracted from the patients' computerized database, and combined with the unit cost of services to calculate costs. A total of 205 patients were recruited and diagnosed with stable angina [SA, 47.8%], unstable angina [USA, 24.4%], ST-segment elevation myocardial infarction [STEMI, 19.5%], and non-ST-segment elevation myocardial infarction [NSTEMI, 8.3%]. Most of the patients were Saudi males, aged between 40-75 years. Eighty-seven percent of patients had 2 or more co-morbidities, and 32% of the patients were obese. The average cost was 40,164 Saudi Riyals [SAR]/patient [US$10,710]. Medication contributed the lowest in the costs [3.2%]. A cost associated with SA was SAR33,991, USA was SAR35,107, NSTEMI was SAR46,585, and STEMI was SAR58,877 per patient. The lowest mean hospital length of stay was 6.5 days with SA. The average length of stay increased with the number of co-morbidities from 5.67 days [no co-morbidity] to 11.25 days [6 co-morbidities]. The IHD is of high economic burden in the country. Among IHD types studied, the resource consumption associated to STEMI was the highest in terms of costs, and hospital length of stay

Biomphalaria Alexandrina: cellular responses of susceptible and resistant snails to Schistosma manson infection

The distribution pattern of Schistosoma mansoni miracidia among exposed Biomphalaria alexandrina determined by the level of host susceptibility/resistance and the basic cellular responses observed during the parasite development were studied. Several snail stocks showed a wide spectrum of host reaction to the parasite. From the present study, a vigorous "resistant-type" cellular response to invade miracidia was observed in the histological sections of the non- susceptible snails. In this respect, they were classified in this study as "resistant snails". B. alexandrina experimentally infected with S. Mansoni exhibited a wide range of histopathological and immunological changes. The rate of phagocytosis as well as the actual number of hemocytes were determined in different groups of snails during the infection cycle. The significant fluctuation [increase and/or decrease] in circulating hemocyte number was only correlated with a shift in the hemocyte populations in the first two days after the exposure to the infective stage. The in vitro phagocytic activity of the resistant snail hemocytes was found to be higher than that observed in the susceptible snails

possible rolefor an enkephalinergic system in the internal defense mechanism of Biomphalaria alexandrina exposed to Schistosoma mansoni

The present study revealed that in Biomphalaria alexandrina, the coordinated responses to Schistosoma mansoni infection are modulated by receptor-mediated opioid signals. The comprehensive tests in susceptible and resistant snails demonstrated the presence of endogenous opioids in the snail hemolymph [in particular, Leu- enkephalin-like material]. The in vitro treatment of snail hemocytes with synthetic Leu-enkephalin analogue [DADLE] resulted in the modulation of cellular adherence and phagocytic activity. The addition of naloxone, either alone or in combination with DADLE, generally reduced the hemocyte activity indicating opioid-receptor- mediated mechanism. The presence of DADLE or naloxone modulated the level of IL-2-, TNF-gamma- and FNF-alpha-like molecules in S. Mansoni resistant and susceptible snails. Specifically, DADLE and DADLE in combination with naloxone, generally, were found to be capable of modulating the resistant snail hemocytes at concentrations of 10-6 and 10-8 M. Similar actions after incubation with the same concentrations were not detected in the susceptible snails

Application of schistosome microsomal antigens in immunodiagnostic assays

The target of this study is to assess and evaluate the use of S. mansoni and S. haematobium microsomal antigens [MAMA and HAMA] in FAST-ELISA and EITB for immunodiagnosis of schistosomiasis and to compare their findings with those of the dipstick [DS] assay as a practical screening test for field sites. Screening of the S.mansoni-infected sera [Kafr El-Sheikh site] with FAST-MAMA and EITB-MAMA, showed sensitivity levels of 98.3% and 100%, respectively. Meanwhile, screening of these sera with DS assay, resulted in the same sensitivity as the EITB assay. Screening of S. haematobium-infected sera [Giza site] with FAS-TMAMA showed a low sensitivity [80.5%] as compared to the FAST-HAMA where the sensitivity was much better, reaching 95%. About 97% of sera from parasitologically S. haematobium positive subjects sera, which were FAST-HAMA positive, recognized Gp23 in both EITB and DS assays. All participants from Giza site were parasitologically negative for S. mansoni. Sixty one percent of them were positive in FAST-MAMA and 45%-23% of them recognized Gp30 in EITB and DS assays, respectively. This lower percentage in DS assay could be a much more accurate estimation of S.mansoni antibodies in such S. haematobium endemic site. On comparing the EITB findings with that of the DS assay, the results showed that all negative sera in MAMA and HAMA blots were also negative in the DS assay. Ninety six percent of the positive HAMA blots were also positive in DS assay indicating nearly the same sensitivities of the two assays for Gp23 reactivity. About fifty two percent of the mixed infection sera, which weakly recognized Gp30 in MAMA blots, were totally negative in DS assay thus indicating the purity and specificity of the DS-assay antigen is much higher than that used in EITB. DS assay is sensitive, specific, reproducible and highly effective in screening patients with either schistosome infections. Also, DS assay is economic, rapid and lends itself for use under field conditions

Immunoaffinity isolation of Schistosoma mansoni species specific molecules using monoclonal antibodies

Traditional diagnosis of schistosomiasis by stool and urine examination techniques is both insensitive and labor intensive; many efforts are directed towards the development of alternate sensitive and specific assays for diagnosis of schistosomiasis. With the development of hybridoma technology, monoclonal antibodies [MoAb] with high specificity to diagnostic antigens could be produced. In the present study, a species-specific fraction namely, Gp30 prepared from S. mansoni microsomal antigen [MAMA] was purified by a simple, easy and cheap apparatus [491-prep cell] [Bio-Rad]. Balb/c mice were immunized with the isolated glycoprotein [Gp] to produce a panel of MoAbs, which can be used to immunoaffinity purify target antigen. Among the produced panel, 6B3-1B432 MoAb of IgG2a isotope was able to detect 10-20 ng of Gp30 antigen in ELISA [O.D[650] = 1.985] and dot blot. In immunoblotting, 6B3-1B432 recognized only one band in the MAMA antigens, namely Gp30. This MoAb was purified with protein G Suprose using FPLC and PD-10 column and consequently used to immunoaffinity purify target antigen. The specificity and sensitivity of the immunoaffinity purified Gp30 [IP Gp30] was determined before using it in the dipstick assay. Our results indicated the absolute specificity of IP Gp30 and sensitivity results, 98%, was comparable to that obtained by the electroeluted GP30. The simplicity of the purification and the efficacy of the dipstick assay may render this diagnostic method for widespread use in the field of schistosomiasis

Epidemiology and immunodiagnosis of schistosomiasis haematobium in low endemic area in Egypt

A survey was performed in Behbeet Village in Giza Governorate including 370 individuals [172 males and 198 females] representing 10% of the house holds. Clinical, stool, urine and serological tests accompanied by a questionnaire were applied to all participants to find out the prevalence, intensity of infection of S. Hematobium, underlying sociodemographic factors, morbidity indicators and the awareness and treatment status among the infected population. It was revealed that the overall prevalence of S. Hematobium based on the detection of eggs in urine was 18.1%, while the prevalence of antibodies to S. Hematobium species specific microsomal antigen was 57.6% detected by enzyme-linked immuno-transfer blot [EITB]. The highest age specific prevalence and intensity of infection were detected among school children in the early teenage. Males were at a higher risk of contracting infection than females with a sex ratio of 2.5: 1. Occupational and recreational water contact were significantly more frequent among the egg positives than the negative ones. Present history of hematuria and microhematuria detected by reagent strips had the strongest association with S. Hematobium infection followed by leucocyturia and dysuria