Impact of Atrial Fibrillation on in-Hospital and Short-Term Outcomes of Patients with Acute Coronary Syndrome

Background: Atrial fibrillation (AF) is an irregular and often rapid heart rate that can increase the risk of stroke, heart failure and other heart-related complications. The acute coronary syndrome is a potential risk factor for atrial fibrillation. The aim of this work was to evaluate the impact of atrial fibrillation on in-hospital and short-term outcomes of patients with acute coronary syndrome. Methods: This prospective cohort study was carried out on 80 patients with acute coronary syndrome with or without AF. Patients were classified into 3 groups: group I (50 patients) with acute coronary syndrome without AF, group II (15 patients) with acute coronary syndrome with new onset AF and group III (15 patients) with acute coronary syndrome with pre-existing AF. All patients were subjected to laboratory investigations (CBC, kidney functions and liver function tests) and twelve-lead surface ECG. Results: ACEI, warfarin, amiodarone and PCI were significantly different among studied groups. ACEI was significantly lower in group 3 when compared to group 1. Warfarin, amiodarone, HF and AKI were significantly higher in group 2 and group 3 compared to group 1. PCI was significantly higher in group 1 and group 2 compared to group 3. Conclusions: New-onset and pre-existing AF remained associated with an increased risk of in-hospital complications as heart failure and acute renal failure compared to patients presented with acute coronary syndrome without AF. Anticoagulation as warfarin and antiarrhythmic drugs as amiodarone were largely used in patients with AF during hospitalization.

Assessment of Variation in Clinical Presentation of Visceral Leishmaniasis Among Patients Attending the Tropical Diseases Teaching Hospital in Sudan

Background: Visceral leishmaniasis (also known as Kala-azar) is a systemic parasitic infection with many clinical presentations. The present study assesses the variation in presentations among patients who attended the Tropical Diseases Teaching Hospital (TDTH) in Khartoum, Sudan. Methods: This analytical cross-sectional, hospital-based study was conducted at the TDTH between November 2019 and September 2020. Medical records of patients who presented at the TDTH were reviewed using a structured data extraction checklist. The Chi-square test was used to determine the associations between sociodemographic and clinical presentations of patients. P-value < 0.05 was considered as statistically significant. Results: Out of 195 patients, 79.5% were male and 48.2% were <31 years old. Fever was the main clinical presentation (90.2%) while 53.3% presented with weight loss and 72.3% and 39% presented, respectively, with splenomegaly and hepatomegaly. HIV was detected in 4.6% of the patients. RK39 was the main diagnostic test. We found a significant association between the abdominal distention and the age of the patients (P < 0.05) ­ age groups 11­20 and 41­50 years were more likely to present with abdominal distention than other age groups. Conclusion: There is no exact clinical presentation or routine laboratory findings that are pathognomonic for visceral leishmaniasis; therefore, it should be considered in the differential diagnosis of any patient with fever, weight loss, and abdominal distention, and among patients with HIV.

How Difficult is it for Patients Having Oral Ulcers to Get Diagnosed?

ABSTRACT: Oral ulcers cause high levels of impairment of the patients' quality of life. Therefore, patients having oral ulcers visit clinicians while seeking treatment. This study aims to investigate the extent of patients' suffering till reaching the correct clinician specialty, and therefore, proper diagnosis and treatment. The study included 62 diagnosed oral ulcer patients. They filled a questionnaire about previously visited clinicians and their specialties, causes of their referral and Oral Health Impact Profile-14 indicating their quality of life. The study revealed that participants visit a mean number of 2.93 clinicians before reaching a specialist. Furthermore, the number of the visited clinicians was positively correlated to the impact of the oral ulcer on quality of life. The study reflects the degree of unnecessary suffering of patients having oral ulcers due to unnecessary delay of diagnosis. It, thereby, highlights the necessity for higher awareness about Oral Medicine specialty among medical practitioners and among general population as well.

RESUMEN: Las úlceras orales y su diagnóstico tardío causan un nivel de deterioro significativo en la calidad de vida de los pacientes. Este estudio tuvo como objetivo investigar el nivel de sufrimiento de los pacientes hasta llegar a la especialidad clínica y lograr un diagnóstico y tratamiento adecuado. El estudio incluyó a 62 pacientes diagnosticados con úlcera oral. Los pacientes completaron un cuestionario sobre los médicos consultados previamente, las especialidades, las causas de su derivación y el Perfil de Impacto en la Salud Oral-14, que refleja su calidad de vida. El estudio reveló que los participantes visitaron una media de 2,93 médicos antes de consultar con un especialista. Además, el número de médicos visitados se correlacionó positivamente con el impacto que tiene la úlcera oral en la calidad de vida. El estudio refleja el grado de sufrimiento innecesario de los pacientes que presentan úlceras orales debido a un diagnóstico tardío. Por lo tanto, se destaca la necesidad de una mayor conciencia sobre la especialidad de medicina oral entre los médicos y también de la población en general.

Assessment of the anti-diabetic effect of Bauhinia variegata gold nano-extract against streptozotocin induced diabetes mellitus in rats

Diabetes mellitus (DM) is the most common type of the metabolic endocrine disorders. It is categorized as the thirdcause of death after heart and cancer diseases. Due to the undesirable side effects of the synthetic anti-diabetic drugs,the medicinal plants were selected for DM treatment. The recent studies directed to use nanotechnology in medicine toovercome restrictions of the drugs that were represented by weak bioavailability, insolubility in water, low absorptionby the intestine, and inability to reach to the appropriate site of action. The study aimed to investigate the antioxidant,antidiabetic, and hypolipidemic effect of Bauhinia variegata (B. variegata) extract before and after incorporating goldnanoparticles (Au-NPs) against DM induced by streptozotocin (STZ) in rats. The present study conducted on 36 malealbino Western rats divided into six groups {control, B. variegata extract treated group, B. variegata gold nano-extracttreated group, diabetic group [injected by STZ intrapretinoally (i.p.) at a dose of 60 mg/kg], diabetic rats treatedwith B. variegata extract, and B. variegata gold nano-extract groups}. The DM related biochemical functions (liverand kidney functions, glucose, insulin, and lipid profile) were assayed. Moreover, the enzymatic and non-enzymaticantioxidants were assayed in addition to lipid peroxidation products in liver and pancreas. Furthermore, the nativeprotein, lipoprotein patterns, and isoenzymes were electrophoretically studied. It was found that the administrationof both B. variegata extract and nano-extract to diabetic rats ameliorated the deleterious effects that occurred asa result of STZ injection and restored the biochemical functions in addition to levels of hepatic and pancreaticantioxidants to normalcy. These findings were supported by the histopathological examination. It was concluded thatB. variegata nano-extract exhibited more antidiabetic effect through restoring the normal architecture of pancreaticβ-cells in addition to the antioxidant and hypolipidemic effect than extract alone, which indicated that the efficacy ofB. variegata extract was increased after the incorporation of Au-NPs.

Radioprotective role of α-tocotrienol against oxidative damage in γ-irradiated human blood cultures / Papel radioprotectivo do α-tocotrienol contra danos oxidantes nas culturas de sangue humano γ-irradiadas

Tocotrienols are members of the natural vitamin E family which is considered one of important fat soluble vitamins. The tocotrienols react with free radicals, which are the main cause of oxidation damage to cell membranes, without formation of other free radicals in the process. All natural forms of tocotrienols have the ability to regulate peroxidation reactions and to control free radicals production within the body. This study aimed to assess the antimutagenic and antioxidant ability of y-tocotrienol at a working dose (0.04 mg/ ml) through cytogenetic (Micronucleus test) study and biochemical analysis including Caspase -3, Superoxide dismutase (SOD), Catalase (CAT) activities and Nitric Oxide (NO) concentration in y-irradiated human blood cultures. The treatment time was 72 hrs post-irradiation with gamma rays at dose of 3 Gy. Triple blood cultures for each blood sample were set up. Ionizing irradiation induces a significant increase in micronuclei (MNi) frequencies, and nucleuplasmic bridge (N bridge) accompanied by a significant rise in Caspase-3 activity and NO concentration. Furthermore, SOD and CAT activities showed significant decrease. y- tocotrienol treatment results into a decrease of MNi and N bridges numbers, enhancement of SOD and CAT activities and improvement of both NO and Caspase-3 levels, compared to irradiated cells which not treated with -tocotrienol. The present results reveal the antimutagenic and the anti-oxidant effects of y-tocotrienol against y- irradiation.

Os tocotrienóis são membros da família natural de vitamina E, que é considerada uma das vitaminas importantes solúveis em gordura. Os tocotrienóis reagem com os radicais livres, que são a principal causa do dano de oxidação das membranas celulares, sem formação de outros radicais livres no processo. Todas as formas naturais de tocotrienóis têm a capacidade de regular as reações de peroxidação e controlar a produção de radicais livres dentro do corpo. Este estudo teve como objetivo avaliar a capacidade antimutagênica e antioxidante do y-tocotrienol em uma dose de trabalho (0,04 mg/ml) através de estudo citogenético (Teste dos Micronúcleos) e análise bioquímica incluindo atividades de Caspase 3, Superóxido Dismutase (SOD), Catalase (CAT) e concentração de óxido nítrico (NO) em culturas sanguíneas humanas irradiadas com y-. O tempo de tratamento foi de 72 horas pós-irradiação com raios gama na dose de 3 Gy. Foram estabelecidas culturas de sangue triplas para cada amostra de sangue. A irradiação ionizante induz um aumento significativo nas freqüências de micronúcleos (MNi) e ponte nucleoplasmática (ponte N), acompanhada por um aumento significativo da atividade da Caspase 3 e da concentração de NO. Além disso, as atividades de SOD e CAT mostraram queda significativa. O tratamento com -tocotrienol resulta em uma diminuição do número de pontes MNi e N, aumento das atividades de SOD e CAT e melhora dos níveis de NO e Caspase 3, em comparação com células irradiadas que não foram tratadas com -tocotrienol. Os presentes resultados revelam os efeitos antimutagênicos e antioxidantes do y- tocotrienol contra a irradiação y-.

The impact of caudally administrated tramadol on immune response and analgesic efficacy for pediatric patients: a comparative randomized clinical trial

BACKGROUND: Immune responses appear to be affected by anesthetics and analgesics. We investigated the effects of caudal tramadol on the postoperative immune response and pain management in pediatric patients. METHODS: Sixty ASA-I pediatric patients aged 3–10 years undergoing lower abdominal surgery. Patients were randomly assigned either to a caudal bupivacaine (0.25%) group (group B), or a group that received caudal tramadol (1 mg/kg) added to the bupivacaine (0.25%) (group T). Both were diluted in a 0.9% NaCl solution to a total volume of 1ml/kg. The systemic immune response was measured by collecting blood samples preoperatively, at the end of anesthesia, and at 24 and 72 hours postoperatively, and studied for interleukin IL-6, C-reactive proteins (CRP) cortisol levels, and leucocytes with its differential count. Postoperative pain was assessed along with sedation scales. RESULTS: Postoperative production of IL-6 was significantly higher in group B at the end of anesthesia, than at the 24th hour, and at the 72nd hour in group B and group T, respectively. The immune response showed leukocytosis with increased percentages of neutrophil and monocytes, and a decreased lymphocyte response rate within both groups with no significant differences between the groups. Cortisol and CRP were significantly higher in group B. CONCLUSIONS: Adding tramadol to a caudal bupivacaine block can attenuate the pro-inflammatory cytokine response, Cortisol, and CRP in children undergoing lower abdominal surgery.

Effect of Stem Cells and Gene Transfected Stem Cells Therapy on the Pancreas of Experimentally Induced Type 1 Diabetes

BACKGROUND AND OBJECTIVES: Insulin secretion entirely depends on Ca²⁺ influx and sequestration into endoplasmic reticulum (ER) of β-cells, performed by Sarco-ER Ca²⁺-ATPase 2b (SERCA2b). In diabetes, SERCA2b is decreased in the β-cells leading to impaired intracellular Ca²⁺ homeostasis and insulin secretion. Adipose mesenchymal stem cells (AMSCs) play a potential role in transplantation in animal models. The present study aimed at investigating and comparing the therapeutic effect of non-transfected AMSCs and SERCA2b gene transfected AMSCs on the pancreas of induced diabetes type 1 in rat. METHODS AND RESULTS: 58 adult male albino rats were divided into: Donor group: 22 rats, 2 for isolation, propagation and characterization of AMSCs and SERCA2b transfected AMSCs, in addition 20 for isolated islet calcium level assessment. Group I (Control Group): 6 rats, Group II (Diabetic Group): 10 rats, 50 mg streptozotocin (STZ) were injected intraperitoneal (IP), Group III (AMSCs Group): 10 rats, 1×10⁶ AMSCs were injected intravenous and Group IV (SERCA2b transfected AMSCs Group): 10 rats, 1×10⁶SERCA2b transfected AMSCs were injected as in group III. Groups I, II, III and IV were sacrified 3 weeks following confirmation of diabetes. Serological, histological, morphometric studies and quantitative polymerase chain reaction (qPCR) were performed. Nuclear, cytoplasmic degenerative and extensive fibrotic changes were detected in the islets of group II that regressed in groups III and IV. Isolated islet calcium, blood glucose, plasma insulin and qPCR were confirmative. CONCLUSIONS: AMSCs and SERCA2b gene transfected AMSCs therapy proved definite therapeutic effect, more obvious in response to SERCA2b gene transfected AMSCs.

Audiological profile in children with autism spectrum disorders

Background: Autism spectrum disorder is defined by the Diagnostic Statistical Manual of Mental Disorders V [DSM V] as a neurobehavioral disorder manifested by persistent deficits in social and communication interaction, deficits in developing, understanding and maintaining relationships, as well as abnormal and fixed interests and repetitive behavior. Symptoms must be present at early childhood and interfere with daily function. The majority of individuals with ASD demonstrate some degree of auditory dysfunction. The level and expression of this dysfunction ranges from deafness and increased thresholds to hyperacusis and difficulty listening with background noise

Objective: The purpose of this study was to characterize the findings of audiological and electrophysiological hearing assessment in individuals with autism and to compare these findings to those obtained in typically developing individuals

Subjects, Materials and Method: Forty one Autistic children are divided into two groups:- group [1] Mild to moderate autism were seventeen children and group [2] Severe autism were twenty four children] were enrolled in this study [Whose ages were 2-6.5 years old] compared with ten typically developing matching peers. All Autistic children in the study had a definite medical diagnosis of Autism according to DSM-5 and based on the severity of symptomatology, ASD children were assessed and divided using CARS score [Childhood autism rating scale]. Audiologic evaluation consisted of a case history, otoscopic examinatioin, behavioral free field evaluation, acoustic immittance measures [Tympanogram and Acoustic reflexes], speech audiometry, measurement of distortion product otoacoustic emissions and auditory brain stem response

Results: Our results support an association between ASD and higher DPOAEs S/N ratios at only 500 and 750 Hz. Moreover, ABR in ASD children showed a significant increase in waves III and V absolute latencies and IIII and I-V inert peak latencies [In both groups of ASD], with inter aural asymmetry as shortened right ear III-V and I-V inter peak latencies reflecting a more right ear advantage [mild to moderate group], in addition to a significant decrease in waves V/I amplitude ratio [Both ASD groups]

Conclusion: The OAE responses of children with ASD were highly significantly only at 500 Hz [Both groups] 750 Hz [Mild to moderate group]. ASD children [either mild to moderate or severe] had a significant increase in ABR waves III and V peak absolute latencies and I-III and I-V inter peak latencies. Asymmetrical ABR findings also noted in children with ASD [mild to moderate group] as shortened right ear III-V and I-V inter peak latencies [more prominent right ear advantage]. In ABR also the amplitude of peak I in response to 90 dB nHL click stimulation was greater than the amplitude of peak V significantly in both groups of ASD children than controls

Comparative study between flexible ureteroscopy and semirigid ureteroscopy in management of upper ureteric stones using laser lithotripsy

Background: There are various options in the management of proximal ureteral stones, which includes medical expulsive therapy, extracorporeal shock wave lithotripsy [ESWL], ureteroscopy [URS; retrograde], percutaneous nephrolithotomy [PCNL], laparoscopy [LAP], and open surgery

Objective: The aim of this study was to evaluate the efficacy and safety of both semirigid and flexible ureteroscopy in management of upper ureteric stones using laser lithotripsy

Patients and Methods: To achieve this goal, this prospective study was done at the urology department, Ain Shams University Hospitals on 60 patients with upper ureteric stones less than 2 cm in size. They were divided into groups of 30 patients in each group. Patients in group A were treated by semirigid ureteroscopy. While patients in group B were treated by flexible ureteroscopy using laser lithotripsy in both procedures

Results: Stone free rate was 90.0% in group A while it was 93.3% in group B. Mean operative time was 55.07 +/- 13.24 min in Group A while it was 64.63 +/- 17.33 min in Group B. Success rate was 76.7% in group A, while it was 90.0% in group B. 20% of patients in group A had intra or postoperative complications in the form of: 6.7% of cases had failure to access to the stone, in 3.3% of cases there was upward migration of stone toward kidneys, 3.3% of cases had ureteral submucosal injury, 3.3% of patients had postoperative fever and 3.3% of patients developed haematuria

Conclusion: Flexible ureteroscopy is a favorable option for patients having proximal ureteral stones with higher stone free rate and success rate. On the other hand, semirigid ureteroscopy is an acceptable alternative for treatment of proximal ureteral stones. Flexible ureteroscopy costs is much higher compared to semirigid ureteroscopy

Different detection methods of virulent Helicobacter pylori in gastric biopsies

Background: The global allocation and high level of frequency with the consequence of related pathologies make the eradication of Helicobacter pylori is a very useful advance to test and treat. In addition, the determination of the genotype of H. pylori isolates helps us to comprehend the correlation between assumed virulence genes and clinical disease out come

Objectives: To determine the prevalence of H. pylori infections in patientscomplaining of gastric disorders, the best phenotypic method for detection of H. pylori and the antimicrobial susceptibility patterns among the isolated strains. To compare between phenotypic and genotypic detection methods and to evaluate the frequency of vacA, cagA and iceA genotypes with their clinical outcomes

Methodology:This study was carried out by collecting gastric biopsy endoscopic specimens from 92 participants admitted to Internal Medicine Endoscopy Unit, Faculty of medicine, Menoufia University. Direct detection of H. pylori in gastric biopsy specimens was done by polymerase chain reaction[ureA gene], microaeroplillic culturing, histological examination and Campylobacter like organism [CLO] rapid urease test. Antimicrobial susceptibility patterns among the isolated strains were determined by disc diffusion method. Some virulence genes [cytotoxin-associated gene [cagA], vaculatingcytotoxin [vacA] alleles; vacAs1, vacAs2 and vacAm, also induced by contact epithelium [iceA]] were determined using multiplex PCR

Results:H.pylori genome [UreA] detection by conventional PCR was used as the confirmatory diagnostic tool with 70 PCR positive isolates from 92 participants totally by 76.1%. Histo-pathological examination by both H and E and Giemsa stain detected H. pylori in 68 cases [73.9%]. CLO rapid urease test detected H.pylori urease activity in 64 cases [69.6%]. Microaerophilic culturing detected H. pylori growth in only 32 cases [34.8%].About 100%, 68.8%, 81.3%, 68.8% and 12.5% of isolates were resistant to metronidazole, amoxicillin, tetracycline, clarithromycin and ciprofloxacin respectively.CagA was identified in 58 isolates [82.9%], iceA in 38 [54.3%], vacAs1 in 22 [31.4%], vacAs2 in 10 [14.3%], vacAm in 32 [45.7%]. CagA and cagA+vacAs1m1+IceA were the most prevalent genotypes

Conclusion: Egypt is among the countries that reported high prevalence rate of H.pyloriinfections mainly with antibiotic resistant virulent strains

Review of Heterotopic Thyroid Autotransplantation

Total thyroidectomy is increasingly accepted for the management of bilateral benign thyroid disorders. Postoperatively, patients require lifelong levothyroxine replacement therapy to avoid postoperative hypothyroidism, which besides the burden of compliance, has been proven to be associated with several long-term side effects. Heterotopic thyroid autotransplantation was proposed several decades ago to avoid the need for life-long postoperative replacement therapy with maintaining the autoregulatory mechanism of thyroxin production inside the body according to its needs. Available data regarding this topic in literature is relatively poor. Before applying thyroid autotransplantation on humans, several studies have been done on animals, where the autologous transplantations were found to be successful in almost all the cases, proved by follow up postoperative 8-week measurements of thyroid hormones and histopathological examination of the removed autografts. Regarding the clinical application, few trials have been done using cryopreserved in vivo, in vitro or immediately autotransplanted thyroid autografts. Satisfactory results were obtained, however, the number of these studies and the number of patients per each study was very low. Besides the study methodologies were not so consistent.

Molecular mechanisms of the anti-obesity potential effect of Moringa oleifera in the experimental model

Objective To elucidate the molecular mechanisms of the potent anti-obesity effect of Moringa oleifera Lam. (M. oleifera) ethanolic extract and to clarify the link between these mechanisms and the associated metabolic and vascular risks in the experimental model of visceral obesity. Methods M. oleifera ethanolic extract was orally administered at 600 mg/kg body weight in obese female rats daily for 12 weeks. At the end of treatment, body weight was determined, and the atherogenic index, coronary artery index, glucose level, insulin resistance status, liver and kidney functions were assessed. Also, the mRNA of leptin, adiponectin and resistin in visceral adipose tissue was determined by quantitative real time-PCR. Results The results showed that M. oleifera extract down-regulated mRNA expression of leptin and resistin, while it up-regulated adiponectin gene expression in obese rats relative to untreated obese control counterparts. This amelioration of genes expression was paralleled by a reduction in body weight and improvement of the atherogenic index and coronary artery index, as well as glucose level and insulin resistance value without adverse effects on liver or kidney functions, versus the untreated obese control ones. Conclusions It is reasonable to assume that the anti-obesity, anti-atherogenic and anti-diabetic properties of M. oleifera are mechanistically achieved via working directly on the adipokines of the visceral adipose tissue. Therefore, M. oleifera may be a good therapeutic candidate for the symptoms of metabolic syndrome.

Efficacy and In Vitro Cytotoxicity of Nanostructured Lipid Carriers for Paclitaxel Delivery

Paclitaxel (PTX) is an anticancer drug having poor aqueous solubility and low bioavailability. Formulation of PTX into Nanostructure lipid carriers (NLC) could be a potential way to enhance PTX aqueous solubility and bioavailability hence increases efficacy and decreases side effects. Eight PTX-NLC formulae were prepared using homogenization-ultrasonication technique. Characterization of the nanoparticles was done by transmission electron microscopy and by measurement of particle size, poly dispersibility index and zeta potential. Encapsulation efficiency, drug loading, and In Vitro release were measured. Particle size ranged between 172.8 ± 0.8 to 378.2 ± 1.8 nm and zeta potential between -18.6 ± 0.4 to -28.1 ± 1.2 mV. High EE and DL were obtained due to incorporation of liquid lipid and the In Vitro release showed prolonged time dependent release compared to Taxol®. NLC-3 had the best results among the eight prepared formulae. In Vitro cytotoxicity of NLC-3 was evaluated on MCF-7 cell line and compared to pure PTX powder and Taxol®. These findings show that NLC is a potential carrier to improve efficacy and enhance PTX delivery.

Molecular characterization of Cysticercus tenuicollis of slaughtered livestock in Upper Egypt governorates

Objective To present the molecular characterization of Cysticercus tenuicollis (C. tenuicollis) of Taenia hydatigena (T. hydatigena) from livestock isolates in Egypt, and to introduce a detailed image of C. tenuicollis infection in ruminant animals in Upper Egypt. Methods The prevalence rates of C. tenuicollis infections among the slaughtered animals from different organs were determined using the amplification of sequencing of the MT-CO1 gene. Results In the present study the infection rates of C. tenuicollis were found to be 16% and 19% in sheep and goat samples respectively. Firstly we report one larval stage of T. hydatigena detected in the camel liver in Egypt. C. tenuicollis infection manifested a higher prevalence in females than in males. Those above two years of age manifested a higher infection rate than younger animals. The preferred site for the infection was the omentum: a 70% preference in sheep and a 68% preference in goats. The molecular characterization using the MT-CO1 gene of isolates from sheep, goats and camels corresponded to T. hydatigena. For this study, molecular characterizations of T. hydatigena were done for the first time in Egypt. Molecular tools are of great assistance in characterizing the C. tenuicollis parasite especially when the morphological character cannot be detected, because the metacestodes are frequently confused with infection by the hydatid cyst, especially when these occur in the visceral organs. In the present study, C. tenuicollis manifested high identity in the goat and sheep samples, while differences were found more frequently in the camel samples (10 base pair). Conclusions Clearly molecular diagnosis for C. tenuicollis infection significantly helps to differentiate it from such other metacestodes as hydatidosis, which manifests a completely different pathogenicity and requires different control programs.

Expression of survivin in squamous cell carcinoma and transitional cell carcinoma of the urinary bladder: A comparative immunohistochemical study

PURPOSE: To compare the expression of survivin and its association with clinicopathological criteria in major types of urinary bladder carcinoma, specifically, transitional cell carcinoma with and without squamous differentiation and squamous cell carcinoma. MATERIALS AND METHODS: Immunohistochemical staining for survivin and Ki67 was performed on paraffin-embedded sections of 104 carcinomas: 52 transitional cell carcinoma, 20 transitional cell carcinoma with squamous differentiation, and 32 squamous cell carcinoma. Expression of survivin in >10% of tumor cells was described as altered survivin status. Ki67 staining in >20% of tumor cells was described as a high proliferation index. RESULTS: Altered survivin expression was detected in 60/104 specimens (58%) and was significantly more frequent in transitional cell carcinoma (78%) than in squamous cell carcinoma (38%) or transitional cell carcinoma with squamous differentiation (40%) (p<0.0001). In transitional cell carcinoma but not in squamous cell carcinoma, altered survivin status was associated with higher tumor grade, higher proliferation index, and recurrence. In the whole specimens, altered survivin expression was significantly associated with advanced stage (p<0.001), recurrence (p=0.005), distant metastasis (p<0.001), and death (p=0.001). In the multivariate analysis, altered survivin was an independent poor prognostic factor for recurrence. CONCLUSIONS: Unlike in transitional cell carcinoma, alteration of survivin expression in squamous cell carcinoma occurs less frequently and is not associated with features of tumor aggression or patient outcome. These findings raise a question: are urinary bladder carcinoma patients with squamous cell carcinoma type suitable candidates for survivin vaccine? This is an important question to be answered before approving the vaccine in management.

Molecular study on methicillin-resistant Staphylococcus aureus strains isolated from dogs and associated personnel in Jordan

Objective: To determine the prevalence, genetic relatedness, and pattern of antimicrobial susceptibility in methicillin-resistant Staphylococcus aureus ( S. aureus) (MRSA) isolated from household dogs, farm dogs, and stray dogs, compared to isolates from their associated personnel. Methods: MRSA was isolated from 250 nasal swabs (150 swabs from dogs and 100 swabs from humans). PCR assays were used to detect the presence of both the nuc and mecA genes, which confirmed the identity of S. aureus isolates and the presence of methicillin resistance, respectively. Disk diffusion was used to determine the antibiotic susceptibility against 15 antimicrobial agents along with an E-test that determined the minimum inhibitory concentration for oxacillin. Pulsed field gel electrophoresis was conducted to determine the genetic relatedness of MRSA isolates from dogs to those from associated and unassociated personnel. Results: The prevalence of S. aureus in dogs and humans was 12.7% and 10.0% respectively, while the prevalence of MRSA isolates in dogs and humans was 5.3% and 5.0%, respectively. The prevalence of MRSA isolates in household dogs, farm dogs, and stray dogs was 7.8%, 4.7%, and 0.0%, respectively. MRSA isolates demonstrated a significantly higher rate of multi-resistance against three or more antimicrobial agents than methicillin-susceptible S. aureus (MSSA). Trimethoprim-sulphamethoxazole and chloramphenicol were the most effective antibiotics against all MRSA isolates. Pulsed field gel electrophoresis revealed a strong association between dog MRSA isolates and MRSA isolates from strongly associated personnel. Conclusions: MRSA is prevalent in house dogs, as well as in dog rearing centers and among their strongly associated personnel. A strong association was found between the MRSA isolates from dogs and those from humans who are in close contact. In addition, MRSA isolates showed a high rate of multi-resistance compared to MSSA isolates.

Nonopioid versus opioid based general anesthesia technique for bariatric surgery: a randomized double-blind study

The objective of this study was to evaluate the efficacy and safety of giving general anesthesia without the use of any opioids either systemic or intraperitoneal in bariatric surgery. Prospective randomized controlled trial. Obese patients [body mass index >50 Kg/m[2]] undergoing laparoscopic sleeve gastrectomies were recruited and provided an informed signed consent. Patients were randomized using a computer generated randomization table to receive either opioid or non-opioid based anesthesia. The patient and the investigator scoring patient outcome after surgery were blinded to the anesthetic protocol. Primary outcomes were hemodynamics in the form of "heart rate, systolic, diastolic, and mean arterial blood pressure" on induction and 1/2 hourly thereafter. Pain monitoring through visual analog scale [VAS] 30 min after recovery, hourly for 2 h and every 4 h for 24 h was also recorded. Pain monitoring through VAS and post-operative nausea and vomiting 30 min after recovery were also recorded and finally patient satisfaction and acute pain nurse satisfaction. There was no difference in background characteristics in both groups. There were no statistically significant differences in different outcomes as heart rate, mean blood pressure, O[2] saturation in different timings between groups at any of the determined eight time points but pain score and nurse satisfaction showed a trend to better performance with non-opioid treatment. Nonopioid based general anesthesia for Bariatric surgery is as effective as opioid one. There is no need to use opioids for such surgery especially that there was a trend to less pain in non-opioid anesthesia

Pediatric poisoning in egypt.

Poisoning exposures are a widespread public health problem for children and represents one of the most common medical emergencies encountered in young children, and accounts for a significant proportion of emergency room visits for the adolescent population. The aim of this work is to collect data for management of the most common pediatric poisoning in Egypt as a guideline for physicians and toxicologists. Most common childhood ingestions involve nontoxic substances or nontoxic doses of potentially toxic drugs or products, although a few ingestions can be very dangerous and require treatment. There are three things that typically put children at risk for toxic ingestion: improper storage of substances in the home, children spending more time in other people's homes, and caregiver distraction. The majority of exposures is accidental and occurs in children under the six years of age. The pediatric population is a very dynamic group because the physiologic processes that determine drug disposition undergo rapid changes as children grow, these pharmacokinetic properties, change as children mature with the most dramatic changes occurring in the first year of life. Most common pediatric poisoning in Egypt include insecticides, corrosives, hydrocarbons, food poisoning, analgesics, antihistamines, carbamazepines, phenol and oral contraceptive pills. Assessment of an acutely poisoned child involves the taking of an appropriate history, assessment of the level of consciousness, ventilation and circulation, a physical examination, and requesting appropriate toxicological and non-toxicological investigations. When a child presents with suspected poisoning, begin with an assessment of the airway, breathing and circulation. Activated charcoal is a universal antidote for the majority of poisons. Antidotes are playing an increasing role in therapy for pediatric poisonings. Poison prevention should continue as an integral part of anticipatory guidance activities of infant and child health care providers.

Impact of mono or combined interferon therapy on thyroid function in chronic hepatitis C virus adult patients

Egypt has the highest prevalence of antibodies to hepatitis C virus [HCV] in the world, estimated nationally at 14.7%. Numerous HCV prevalence studies in Egypt have published various estimates from different Egyptian communities, suggesting that Egypt, relative to the other nations of the world, might be experiencing intense ongoing HCV transmission. Interferon-alpha [IFN-alpha] monotherapy or combined therapy with ribavirin is the cornerstone therapeutic agent for chronic HCV infection. Treatment with IFN may cause thyroid dysfunction. Unfortunately, the clinical approach to this toxic effect is often carried out by personal judgment rather than by defined guidelines. Indeed, clinicians often reduce the dose or sometimes discontinue IFN-alpha treatment in those patients who develop thyroid dysfunction. This may reduce the therapeutic response to this drug. Hence, this study was undertaken to evaluate the impact of INF-alpha monotherapy or combined therapy with ribavirin on thyroid function in chronic HCV adult patients of both sexes in the period from January 2009 to August 2009. Sixty adult chronic HCV patients with normal thyroid function before the start of treatment with IFN-alpha - or IFN-alpha + ribavirin were selected for the study. Of them, 7 patients discontinued treatment, 1 patient died and 5 patients could not be followed during the study period. So the number of patients enrolled in the study after 6 months was 47. Clinical examination for thyroid dysfunction as well as thyroid function tests was then carried out. The study revealed that 17 patients [36.1%] developed abnormal thyroid dysfunction. This risk increased with female gender and in combined therapy with ribavirin. The incidence of hypothyroidism was more than hyperthyroidism particularly, in patients treated with combined therapy. Given the high prevalence of HCV disease in Egypt, it is essential that physicians treating patients with IFN-alpha be aware of the clinical spectrum of thyroid dysfunction, and test for thyroid function prior to starting IFN therapy. Careful thyroid surveillance throughout the treatment period is mandatory, especially in female patients and in those receiving combined therapy with ribavirin. Moreover, patients should be informed of this risk and should be advised to tell their physicians of any related symptoms