Cost-Effectiveness of HCV Core Antigen versus PCR for Monitoring Treatment Response in DAAS-Treated Egyptian Patients

PCR is currently the non-debatable proof for diagnosis of HCV infection as well as conclusion of treatment outcomes. HCV core antigen (HCVcAg) testing is a neglected, less expensive and less time consuming test that's presumed to achieve the same aims. The aim of this study is to find the cost-effectiveness of HCV core antigen testing in the monitoring of treatment response as an alternative to the gold-standard PCR test

Semen parameters on the intracytoplasmic sperm injection day: Predictive values and cutoff thresholds of success / 대한생식의학회지

Objective@#This study was conducted to investigate the relationship of semen parameters in samples used for intracytoplasmic sperm injection (ICSI) with fertilization and pregnancy rates in infertile couples. @*Methods@#In this prospective study of Infertile couples with male factor infertility that had undergone ICSI, fractions of the same semen samples obtained for microinjection (to ensure the best predictability) were evaluated to determine the semen parameters and sperm DNA fragmentation index (DFI) on the day of oocyte recovery. @*Results@#In total, 120 couples completed the study and were subdivided into fertilized (n=87) and non-fertilized couples (n=33). The fertilized couples were further classified into pregnant (n=48) and non-pregnant (n=39) couples. Compared to non-fertilized and non-pregnant couples, fertilized and pregnant couples showed statistically significantly higher sperm viability and percentage of normal sperm morphology, as well as significantly lower sperm DFI values. A receiver operating characteristic curve analysis of data from the 120 ICSI cycles showed that sperm viability, normal sperm morphology percentages, and sperm DFI were significant prognostic indicators of fertilization at cutoff values of 40%, 7%, and 46%, respectively. A sperm DFI of 46% showed sensitivity and specificity of 95% and 90%, respectively, for predicting fertilization, and no clinical pregnancies occurred in couples with a sperm DFI above 46%. @*Conclusion@#Semen parameters from the ICSI day sample, especially sperm viability, normal morphology, and DFI, had an impact on fertilization and pregnancy outcomes in ICSI cycles.

Knowledge, attitude and practice of long acting reversible hormonal contraception (LARHC) among women in urban upper Egypt

Background: The current study aims to assess the knowledge, attitude and practice of long acting reversible hormonal contraception (LARHC) among women in urban upper Egypt.Methods: A cross sectional study which included 902 married women, in the reproductive age, attending the outpatient clinics (Gynecology and family planning) of: 1-Assiut University Maternity Hospital, 2- Sohag University Hospital, and 3-Gehina General Hospital (MOH hospital) with current or previous use of any method of LARHC methods. A Questionnaire file was designed to assay knowledge attitude and practice of clients towards contraceptive methods. All data collected from clients reviewed separately to assess knowledge, attitude and practice of women towards contraceptive methods.Results: The most popular contraceptive method is COCs followed by IUD then DMPA. 99% of studied sample heard with good description about different types of LARHC. 54.9% of studied sample most popular/famous LARHC DMPA, most sources of information on LARHC were, Hospital, Relative/friends and health workers. 94.24% of the studied sample were in favor to use of LARHC, 94.2% of them agree to take a space between births, about 55.4% of them were health child and 61% comfortable lifestyle benefit from birth spacing, 33% of studied sample were maternal health, 68% of them were think/prefer to use implants, 64.5% of them didn’t pregnant while breastfeeding. 11% of sample women never used any contraception before and most reasons for not using contraception are fear of side effects, desire for more children, irregular sexual relationship, and husband opposition. Only 16.6 % of studied sample used LARHC before and most of them used DMPA, however 3 women who used DMPA get pregnant while using it.Conclusions: There is a good level of knowledge between upper Egypt women about LARHC methods.

Electrosurgical unipolar vessel sealing versus purohit technique in vaginal hysterectomy [a pilot randomized clinical trial]

Background: Vaginal hysterectomy should be performed in preference to abdominal hysterectomy, where possible as it has benefits; quicker return to normal activities, fewer complications, shorter operative time, less blood loss, and a shorter stay in hospital. Also, it is preferred to laparoscopic-assisted vaginal hysterectomy because of fewer bladder or ureteric damage as well as a shorter operating time and learning curve

Aim of the Work: To compare the between using unipolar electrocautery versus Purohit technique in vaginal hysterectomy as regards operative time

Patients and Methods: This pilot prospective randomized clinical trial was conducted at Ain Shams University Maternity and Women.s Hospital during the period from June 2016 to February 2018. This study included patients presenting to the outpatient gynecologic clinic of Ain Shams University Maternity and Women.s Hospital and planned to have vaginal hysterectomy for benign cause

Results: both total operative time and pedicle securing time were significantly longer in the Purohit technique group compared to the unipolar electrocautery group [P <0.001]

Conclusion: using unipolar electrocautery significantly reduces total operative time than using bipolar electrocautery without increasing rate of complications nor does it cause specific type of complications provided that special precautions are taken to avoid thermal effect on nearby structures

Recommendations: using unipolar electrocautery is recommended by well trained hands in suitable patient and should be offered for training by other surgeons of different levels to judge learning curve. Further studies with inclusion of patients having larger sizes of uteri using the same technique. Further settings with higher cautery up to 50W were found to be safe for further analysis

Autologous serum in dry eye disease

Background: The tear film overlays the ocular surface and provides the interface between the eye and the external environment. The tear film is essential for the nutrition and protection of the ocular surface and for clear vision as the tear film is the first refractive surface of the eye

Aim of the Work: the purpose of this study was to review the efficacy, complications and safety of using autologous serum in dry eye

Patients and Methods: thirty patients of moderate to severe dry eye selected from Ophthalmology Out-Patient Clinics, Al-Hussein University Hospitals. All patients were subjected to Schirmer 1 test, Tear break - up time [TBUT], and Fluorescein clearance test

Results: The mean value of Schirmer 1 test before the use of autologous serum was 2.83 mm +/- 0.83 SD while after use of autologous serum was 5.33 mm +/- 9.99 SD. The mean value of TBUT test before the use of autologous serum was 9.50 sec +/- 1.20 SD while after use of autologous serum was 9.433 sec +/- 1.52 SD. The mean value of FCT before the use of autologous serum was 100 % positive while after use of autologous serum was 76.7 % positive. The difference between before and after use of autologous is statistically significant as P-value < 0.001

Conclusion: this study revealed that autologous serum eye drops were found effective and safe in treatment of severe dry eye disease, as evidenced by improvement in subjective assessment of symptoms, Schirmer's 1teast, tear film break-up time [TBUT] and fluorescein clearance test [FCT]

Determination of delta-9-tetrahydrocannabinol content of cannabis seizures in Egypt

Objective To determine the delta-9-tetrahydrocannabinol (THC) content of cannabis seizures in Egypt. Methods Unheated and heated extracts of cannabis seizures were prepared from the dried flowering tops and leaves (marijuana) or from the resin (hashish) and subjected to analysis using high performance liquid chromatography (HPLC). Results The heated resin extract had the peak of THC in a relative ratio of 31.34%, while extracting the resin directly without heating contained only 18.34% of THC. On the other hand, marijuana showed minimum percentage of THC at 11.188% on heating and 9.55% without heating. Conclusions These results indicate the high potency of the abused cannabis plant in the illicit Egyptian market.

Determination of delta-9-tetrahydrocannabinol content of cannabis seizures in Egypt

OBJECTIVE@#To determine the delta-9-tetrahydrocannabinol (THC) content of cannabis seizures in Egypt.@*METHODS@#Unheated and heated extracts of cannabis seizures were prepared from the dried flowering tops and leaves (marijuana) or from the resin (hashish) and subjected to analysis using high performance liquid chromatography (HPLC).@*RESULTS@#The heated resin extract had the peak of THC in a relative ratio of 31.34%, while extracting the resin directly without heating contained only 18.34% of THC. On the other hand, marijuana showed minimum percentage of THC at 11.188% on heating and 9.55% without heating.@*CONCLUSIONS@#These results indicate the high potency of the abused cannabis plant in the illicit Egyptian market.

Production of antioxidant xylooligosaccharides from lignocellulosic materials using Bacillus amyloliquifaciens NRRL B-14393 xylanase.

The present study aimed to evaluate the enzymatic production of XOS, antioxidant activities together with total phenolic contents from different lignocellulosic materials and birchwoodxylan using both crude and pure forms of Bacillus amyloliquifaciens NRRL B-14393 xylanase respectively. The mode of action of the pure xylanase was studied by HPLC and the end products analysis of birchwoodxylan revealed that xylose, xylobiose and xylotriose were the only end products. The resulted XOS mixture exhibited potent antioxidant activity of 87.36 % and high total phenolic content of 182.88 mg GAE/ liter of extract. XOS were obtained from different alkali pretreated agricultural residues by the crude xylanase action with a yield in a range from 54.4% to85.5%.Maximum scavenging abilities and total phenolic contents of XOS mixtures of all the tested materials were determined. XOS mixtures of orange and mango peels revealed relatively higher antioxidant activities (96% and 76.84%, respectively) and total phenolic acid contents (156.32 and 133.74 mg GAE/ liter of extract, respectively) compared to the other XOS mixtures. In conclusion, Bacillus amyloliquifaciens NRRL B-14393 xylanase could be a promising source for production of XOS with high phenolic contents and antioxidant activities.

Etiological and prognostic values of procalcitonin in hospital-acquired pneumonia

Biological markers such as procalcitonin, may be helpful for the diagnosis of HAP. Procalcitonin has greater diagnostic accuracy than most commonly used clinical parameters and other biomarkers of infection, such as C-reactive protein and ESR. The aim of the study was to assess the etiological and prognostic values of procalcitonin in adult patients with hospital acquired pneumonia [HAP]. 15 Patients with a strong suspicion of hospital acquired pneumonia. The diagnosis of HAP depends on the clinical criteria of pulmonary infection and presence of radiological findings. Complete blood picture, sputum culture and sensitivity, ESR, CRP and PCT were obtained at admission and repeated after 2 weeks. PCT was determined with Elecsys BRAHMS PCT in serum >f studied patients. Serum PCT above 0.5 microg/L was considered highly positive for diagnosis of HAP. It was significantly higher at admission [2.72 +/- 1.72 microg/L] than after two weeks [1.0 +/- 1.91 microg/L]. There was a statistical significant decrease in serup levels of procalcitonin [P = 0.002] in response to antibiotic therapy. Also the PCX was significantly higher in patients with bad outcome [2.11-6.0 microg/L] than patients with good outcome [1.76 +/- 0.69 microg/L]. Procalcitonin was significantly higher among patients with pseudomonas [5.53 +/- 0.50 microg/L] and acinetobacter [2.67 +/- 0.49 microg/L] and lesser among patients with Escherichia coli [1.38 +/- 0.06 microg/L] and MRSA [1.09 +/- 0.13 microg/L]. Procalcitonin was a good etiological and prognostic marker in hospital acquired pneumonia. PCX is the most specific biomarker and has a number of advantages over previous markers

Clinical pulmonary infection score and C-reactive protein in the prediction of early ventilator associated pneumonia

The risk of ventilator-associated pneumonia [VAP] is highest early in the course of hospital stay. Most clinicians continue to rely on a clinical diagnosis of hospital-acquired pneumonia [HAP] because it is convenient. In an effort to improve the specificity of clinical diagnosis, the clinical pulmonary infection score [CPIS] was developed. Serum C-reactive protein [CRP] measurements in intensive care unit [ICU] patients enabled the early diagnosis of sepsis. The aim of this work was to evaluate the role of the clinical pulmonary infection score and C-reactive protein in the prediction of early ventilator associated pneumonia. Eighty patients recently were intubated and mechanically ventilated with no manifestations of infection; no infiltrates on chest X-ray for 48 h after intubation and had normal serum CRP at the first day of intubation. All patients were admitted to the intensive care unit in the Chest Department, Alexandria University Hospital and enrolled after obtaining informed consents. All patients were subjected to the following: full history taking, thorough clinical examination, laboratory investigations including total and differential white blood count, radiological evaluation, daily serum CRP assessment during the first 5 days of intubation and the calculation of CPIS at the onset of rising CRP. In this study, the age of all patients ranged from 34 years to 65 years with a mean age of 50.1 +/- 8.7 years. There were 44 male patients representing [55%]and 36 female patients representing [45%] of the study population. Serum CRP ranged from 0.8 to 3 mg/1 with a mean of 1.1 +/- 0.4 mg/1 on the first day of intubation and from 3.1 to 5 mg/1 with a mean of 4.2 +/- 0.4 mg/1 on the second day of intubation for all patients. On the third day of intubation, serum CRP ranged from 18 to 38 mg/1 with a mean of 27.0 +/- 4.7 mg/1 in 11 patients while on the fourth day of intubation serum CRP ranged from 32 to 59 mg/1 with a mean of 46.2 +/- 6.9 mg/1 in 12 patients. Lastly, serum CRP ranged from 50 to 66 mg/1 with a mean of 60.7 +/- 2.6 mg/1 on the fifth day of intubation in 9 patients. Therefore, serum CRP increased in 32 patients. CPIS of the studied patients at the onset of rising serum CRP ranged from 7 to 10 in 24 patients. In the first 5 days of intubation, 32 patients out of 80 patients had high CRP, those were 40% of the study population and 24 patients of those 32 patients had high CPIS; those were 30% of the study population and 75% of patients had high CRP. When the CPIS exceeded 6, there was an association with the presence of pneumonia which was confirmed by microbiological culture furthermore serum CRP is an easy, available and cheap test so daily serum CRP measurements to ICU patients enabled the early diagnosis of pneumonia and enhanced the value of the CPIS. Further studies of CPIS are needed with particular attention to how its variability might affect therapeutic choices

Diagnosis of exudative pleural effusion using ultrasound guided versus medical thoracoscopic pleural biopsy

Introduction: Medical thoracoscopy increases the diagnostic yield in patients with non-diagnosed pleural effusion when thoracocentesis and closed pleural biopsy [CPB] are non-diagnostic. Chest ultrasound [US] is a very useful imaging method for pleural diseases and the technique of ultra sound-guided cutting biopsy with a tru-cut needle has been well described

Aim of the work: The aim of this work was to diagnose exudative pleural effusion using ultrasound guided versus medical thoracoscopic pleural biopsy

Subjects and methods: Forty patients with, non-diagnosed exudative pleural effusion admitted to the chest department, Alexandria university hospital, were enrolled after obtaining informed consents. All patients were subjected to; full history taking, thorough clinical examination, laboratory investigations including prothrombin activity and INR, biochemical, pathological and microbiological evaluation of the pleural aspirate and radiological evaluation. Then the patients were divided [randomly] into 2 groups each containing 20 patients. Pleural biopsies were performed using medical rigid thoracoscopy on group 1 and ultrasound guided tru-cut pleural biopsy on group 2

Results: The mean age in-group I was 55.0 +/- 13.05 years and in-group II was 52.60 +/- 17.77 years. There was no statistically significant difference between the two groups regarding age, sex, smoking, marital status and past medical conditions. There was no statistically significant difference between the two groups regarding radiological findings. There was no statistically significant difference between the two groups regarding the pleural fluid analysis. There was no statistically significant difference between the two groups regarding the gross pleural findings. In group II non- specific pleurisy was found in 5 [25.0%] patients [by thoracoscopy 1 of them was finally diagnosed as metastatic deposits from adenocarcinoma of unknown primary, one was confirmed to be tuberculous pleurisy and the remaining 3 cases were confirmed to be non- specific pleurisy]. As regards complications in-group I, local wound infection occurred in 1 [5.0%] patient, and empyema occurred in 1 [5.0%] patient. In-group II, local wound infection occurred in 1 [5.0%] patient, and empyema occurred in 1 [5.0%] patient

Conclusion: It is better to use thoracoscopy in cases of undiagnosed exudative pleural effusion presented with a sufficient amount of pleural fluid to avoid lung injury while inserting the trocar. Whereas, ultrasound guided tru-cut pleural biopsy may be used in cases of undiagnosed exudative pleural effusion presented with thickened pleura but with an insufficient amount of pleural fluid

Effect of ageing on albino rat female prostate [paraurethral glands]: a histological, immunohistochemical and morphometric study

Introduction: The prostate is not a gland exclusive to males, also being an organ of the female genital system

Aim of the work: The aim of this study was to detect histological, immunohistochemical and morphometric changes associated with ageing in female paraurethral glands [PUGs]

Materials and methods: Forty female rats were divided into two groups: adult group and aged group; each group comprised 20 rats. PUGs of both groups were removed, paraffin sections were obtained and stained with H and E, Mallory trichrome, periodic acid schiff, anti-alpha smooth muscle actin and anti-Ki67 immunostains, and then studied morphometrically

Results: The adult gland was formed of two lobes located on both sides of the urethra and showed large and small acini with wide lumens that contained periodic acid schiff-positive secretions. The acini were lined by cubical and/or columnar epithelium of two types: secretory and basal cells. Also, a few collagen fibres, thick periacinar smooth muscle layers and a few Ki67-positive cells were observed. Aged gland showed disarrangement of acinar epithelium, with formation of alveolus-like structures. Stroma was more vascular, with the appearance of newly developed acini and inflammatory infiltrate. Statistically, aged gland showed a highly significant increase in the number of acini, height of acinar epithelium, area% of collagen and Ki67 immunoexpression. In addition, a highly significant decrease in the area of acini, and a significant decrease in the acinar nuclear area and thickness of periacinar smooth muscle layers were detected

Conclusion and recommendation: Ageing of female prostate [PUG] was associated with abnormal histological and morphometric changes similar to those occurring in male prostate and this could adversely affect the health and quality of women's life. Therefore, further studies are needed to elucidate processes that maintain homeostasis of this gland

Fiberoptic thoracoscopy in management of exudative pleural effusion

Exudative pleural effusion represents a common diagnostic task to the clinician. The two commonest causes of exudative pleural effusion are parapneumonic followed by malignant ones. However, obtaining a definite diagnosis is essential for proper management of the effusion. The aim of this work was to evaluate the role of the fiberoptic bronchoscope used as a thoracoscope in management of exudative pleural effusion. Eighty-four patients with exudative pleural effusion of undetermined etiology were enrolled in this study. All patients were subjected to full history taking, thorough clinical examination, pleural fluid aspiration and analysis, computed tomography of the chest and ultrasound examination of the pleural cavity. Under conscious sedation and local anaesthesia, fiberoptic thoracoscopy was then carried out using fiberoptic bronchoscope inserted through a rigid large siliconized chest tube. After drainage of the pleural fluid, the pleural cavity was carefully explored and multiple forceps biopsies were taken and sent for histopathological examination. Pleurodesis was then done using iodopovidone in patients with apparent pleural pathology. After lung expansion and pleural fluid drainage of less than 100 cc/day, the chest tube was removed. Successful histopathological diagnosis was achieved in all patients. It revealed that 63 [75%] cases had malignant pathology and 21 [25%] cases had inflammatory pathology. The malignant pathology was caused by: bronchogenic carcinoma in 28 [33.3%] cases, malignant mesothelioma in 2 [2.38%] cases and metastatic malignant deposits from other organs in 33 [39.28%] cases. The inflammatory pathology was tuberculosis in 16 [19%] cases and non-specific pleurisy in 5 [5.95%] cases. Pleurodesis was performed and was successful in all the patients. Two [2.38%] patients developed empyema after the procedure and they were successfully managed by intercostals tube drainage and anitibiotic therapy. Other complications encountered included local wound infection in 3 [3.57%] cases, subcutaneous emphysema in 3 [3.57%] cases and chest pain following pleurodesis in 15 [17.85%] cases. Thoracoscopy using the fibroptic bronchoscope is safe and effective. It is an alternative technique to rigid thoracoscopy with some advantages as it allows better exploration of the pleura. It is equally as efficient as the rigid thoracoscope and hardly more time consuming. With proper handling, there will not be any damage or abuse of the fibroptic bronchoscope

Clinical, parasitological and social studies on Wuchereria bancrofti in Egypt

This study was conducted on patients attending AlHussein University Hospital and Mansura University Hospitals. Sheets were filled out on each patient [age, residence, occupation, family similar condition, travelling, disease duration, symptoms suggesting acute dermatolymphangitis attacks, frequency and duration. They were 25 lymphoedema patients and 8 controls [17 males and 16 females] and subjected to clinical and parasitological examinations. According to residence, five patients were from Giza Governorate [18.18%], four from Dakahlia G. [12.12%], four from Gharbia G. [12.12%], five from Menoufia G. [15.15%], four from Sharkia G. [12.12%], two cases from Kafr Elsheikh G. [6.06%] and one patient from Assiut G. [3.03%]. In controls, 6 were from Al Hussein Cairo G. [15.15%], and two cases [6.06] from Al Abbassia. They were 48% farmers [10 male and 2 female]; 4% grocers [1 male]; 8% carpenters [2 male]; and 40% house wife [10 female]. According to lymphedema site: 3 cases [12%] were bilateral lower limbs lymphedema [2 female and 1 male], 13 cases [52%] had right lower limb lymphedema [6 female and 7 male], and 9 cases [36%] had left lower limb lymphedema [4 female and 5 male]. They were 18 [72%] with below knee extension of lymphedema [10 male and 8 female] and 7 [28%] above knee extension of lymphedema [3 male and 4 female]. Grade of lymphedema was one case [male] with grade II lymphedema [4%], 13 cases [52%] with grade III [7 male and 6 female] and 11 cases [44%] with grade IV [5 male and 6 female]. Duration of lymphedema was one case with grade II lymphedema in a period of 3 years, 13 cases with grade III lymphedema and the durations of lymphedema for these cases were [one case with 5 years duration, 3 cases were>6-9 years, 6 cases were>9-12 years and 3 cases were>12 years] and 11 cases with grade IV lymphedema and duration of lymphedema for these cases were [one case with 6 years duration, 2 cases were>6-9 years, 3 cases were>9-12 years and 5 cases were>12 years]

Nutritional adequacy in patients of the intensive care unit in Suez Canal University Hospital who are tube fed enterally

To assess the actual energy received by the patients of the intensive care unit in Suez Canal University hospital who are enterally fed compared to their estimated daily caloric requirement and to find out the causes of interruption of tube feeding. A descriptive study, to assess the adequacy of enteral tube nutrition intake and the factors that affect its delivery in the critically ill patients in Suez Canal university hospital, by monitoring the patients nutrition by Harris benedict equation [HBE] and laboratory investigations. The study was carried out in the general intensive care unit. All the patients receiving enteral nutrition were included with a target sample size of 92 patients. A date sheet was used to collect informations about the daily nutritional intake along with daily laboratory investigations including baseline values of blood glucose, potassium, phosphorus and blood gases, Urine analysis, CBC, triglycerides, creatinine, BUN, sodium, chloride, calcium, magnesium, coagulation, liver enzymes, billirubin, amylase, total protein, transferrin and transthyretin, twice weekly measurement of blood glucose, potassium, phosphorus and blood gases and once weekly measurement of CBC, triglycerides, creatinine, BUN, sodium, calcium, magnesium, coagulation, liver enzymes, billirubin, amylase, total protein, transferrin, transthyretin and urine analysis. Patients were followed up until enteral feeding withheld or death. Through following up the patients by measuring the daily caloric intake and laboratory investigations, the study showed that 67.4% of the patients were underfed and only 29.3% were adequately fed. The mean cause of feeding interruption was gastrointestinal factors [65.2%], such as vomiting and diarrhea, followed by intensive care unit factors [10.9%], such as surgical procedures and diagnostic procedures. Significant decrease in the values of BUN, total billirubin, total protein [T.protein], magnesium, PH and bicarbonate was found one week after starting enteral feeding. The majority of the included patients were found to be underfed. Gastrointestinal problems as diarrhea and vomiting played a major rule in unsuccessful delivery of adequate energy requirements to the patients

Relationship between therapeutic nursing modalities among cirrhotic patients and quality of life

Was to assess the relationship between therapeutic nursing modalities among cirrhotic patients and quality of life. Methods: sixty adult male and female liver cirrhotic patients, were selected randomly, free from any associated comorbid diseases as hepatic encephalopathy, congestive heart failure. The patients were interviewed in the medical unit, and instructed about the importance of educational sessions, they were divided into groups, compromising 5 to 7 patients. Matching was done for subjects within each group in relation to age, duration of the disease and educational level, and one close patient's relative attended in the educational sessions. Cirrhotic therapeutic nursing modalities sessions were carried out for the patients in groups in four sessions of one hour twice weekly during two weeks. Cognition about the-disease was assessed and quality of life was evaluated through knowledge assessment sheet and health promotion lifestyle profile before and after the educational sessions. A booklet was prepared in Arabic for each patient containing the main guidelines of the program. Results revealed that more than half of the study subjects were females > 40 years, and most [93.3%] of them were married, non-educated and living in rural areas. Findings revealed also deterioration in knowledge assessment scores and in all quality of life dimensions; self actualization, social, psychological, physical, nutrition, health responsibility of patient with cirrhosis before program in both sexes without any statistical differences. There were significant positive correlations between total knowledge and quality of life dimensions among the study groups treated by different nursing modalities after one and 3 month post educational program. As well, there were significantly better score of all items of nutrition for cirrhotic patients at immediate post program, and at 3 month post program than pre program and better scores of all items of selfcare for cirrhotic patients in post program. It is recommended that assessment of cirrhotic patients health related quality of life [HRQL] should be an essential part of nursing practice and an annual community survey must be done for screening of people who have virus C. Further research should be done to determine effect of application of an educational program about liver cirrhosis upon their Quality of life

Evaluation of serum fetuin-A: relationship with endothelial dysfunction in hemodialyzed patients

The aim of this study was to evaluate the association between serum fetuin-A concentrations and endothelial dysfunction in hemodialyzed [HD] patients. 85 patients on regular HD [55 males and 30 females] and 30 healthy controls [17 males and 13 females] were studied. We measurd serum fetuin-A by enzyme-linked immunosorbent assay. Assessment of endothelial dysfunction by measuring common carotid artery intima media thickness [CCA-IMT] and intima media thickness-inhomogeneity using high-resolution ultrasound. In addition, C-reactive protein [hsCRP], serum calcium, phosphate, intact parathyroid hormone [iPTH], albumin, total cholesterol, triglycerides, high density lipoprotein cholesterol [HDL-C], low density lipoprotein cholesterol [LDL -C] and fasting blood sugar were performed. Compared with controls, HD patients had a lower levels of serum fetuin - A, higher levels of CRP and 'iPTH, a greater CCA-IMT as well as CCA-IMT-inhomogeneity. Dialysis patients with cardiovascular disease [CVD] had a greater CCA-IMT and IMT-inhomogeneity compared with patients without CVD. IMT-inhomogeneity strongly correlated with IMT. In multiregression analysis, serum fetuin-A correlated with IMT-inhomogeneity but not with IMT, and hsCRP neither correlated with IMT-inhomogeneity nor with IMT. In conclusion, serum fetuin-A concentrations were decreased in HD patients and may be one of the contributing factors for the development of endothelial dysfunction in these patients

Evaluation of parenteral nutrition on the immune system of patients with polytrauma

Nutritional support for trauma and critically ill patients has been advocated to promote immune system recovery and to prevent as much tissue break down and nutritional deficit. The present study aiming to assessment of the parenteral nutrition on the immune system of patient with multiple trauma. Compare the effect of early parenteral nutritional and conventional hospital diet on the nutrition and immunology markers in trauma patients. A convenient sample of 40 severely traumatized patients within 8 hours after trauma they were enrolled sequentially into conventional [n = 20] and total parenteral nutrition [n = 20] groups [TPN]. Criteria for subject inclusion were, age 18-<45 years, Injury severity score [ISS] 20-40 score. Tools of data collection, four tools were utilized to collect data pertinent to the study. These tools were, nutritional assessment sheet, trauma scales and [APACHE] score [checklist], parenteral nutrition plans, evaluation tool which includes [Anthropometric measurement, Laboratory studies Immunological parameters]. Total parenteral nutritional has positive impact for trauma patients on anthropometric measurement, [weight loss, TSF and MAC] which was observed at the end of therapy [7th day.] for the conventional group while there were no changes for the same parameters in TPN group. As regard, laboratory tests, there were significantly increase in the values of total serum protein and albumin among patients of the TPN group after the end of therapy at [7th day] .As regard immune function, it was found that the mean values of [IL-10, IL-6, CD8] were significantly dropped in the TPN group after the end of therapy as compared to the admission. Also there were significantly increase in the values of complement C3, IGA, CD4, and CD4/CD8 ratio among patient of the TPN group at [7th day]. Establishment and implement of standardized protocol of parenteral nutrition support using nutritional screening and physical assessment forms, for the critically ill patients

Study of the relationship between helicobacter pylori infection and irritable bowel syndrome

Irritable bowel syndrome [IBS] can be diagnosed at any age but a new diagnosis of IBS should be made in patients older than 60 years of age because other diseases [colon cancer, diverttculitis, inflammatory bowel may have similar presenting symptoms. Research studies consistently show that women are two to three times more likely than men to be diagnosed with IBS, Over 40 years ago, it was recognized that a percentage of patients with irritable colon developed typical IBS symptoms after an acute infective enteritis [eg, postdysentery IBS]. The aim of the present work to study the relationship between helicobacter pylori and irritable bowel syndrome. The present study was conducted on 30 subjects, They were stratified into 2 groups: group I [IBS groups], they were twenty patients with symptoms suggestive of irritable bowel syndrome according to Rome criteria II, they were 6 males [30%] and 14 females [70%] and their ages were ranging from 18 to 50 years with a mean value of [36.5 +/- 13.2 years] and this group underwent upper endoscopy and colonoscopy and random biopsies were taken from gastric and colonic mucosa for histological examination. Group II [control group] included ten healthy volunteers with no symptoms suggestive of irritable bowel syndrome, they were [5] males and [5] females matched by age They were chosen from referrals to the endoscopy unit of Menoufiya University Hospital. An informed consent was obtained from all included subjects. There was statistically significant difference in the results of histopathological examination of biopsies taken from the colon. There is increase in inflammatory cell infiltration of mucosa of the colon of IBS patient than control groups [lymphocyte infiltration, plasma cell and eosinophit. Helicobacter pylori [HP] did not colonize the colon mucosa. There was no a statistically significant difference in the results of hisiopathological examination of biopsies taken from the gastric antrum of IBS patient and control group [inflammatory cell infiltration]. There was no statistically significant difference of presence of HP in the gastric mucosa of IBS patients and healthy control. No direct correlation between HP infection and IBS but there was intense inflammatory response in the presence of HP

Hepatocyte growth factor [HGF], HGF activator [HGFA] and c-met expression in synovial tissues in relation to disease activity in rheumatoid artheritis

We examined localization and mRNA expression of HGF, HGFA and c-Met in synovial tissues [ST] in rheumatoid arthritis [RA] in relation to disease activity to characterize its biologic function in RA. Immunohistochemical staining and RT-PCR for HGF, HGFA and c-Met were performed on ST specimens from 34 RA-patients and 20 osteoartheritis [OA] controls. Synovial fluid [SF] samples were taken from all RA and all OA for measuring HGF by ELISA technique. Immunohistochemical staining of RAST revealed that HGFA and c-Met were strongly expressed in fibroblasts, macrophages, endothelial cells and less on synovial lining cells, but HGF was expressed faintly in macrophages and fibroblasts. While, in OAST, HGFA and c-Met were detected in the same cells as RAST but in different distribution, but HGF was localized in vascular endothelial cells. RT-PCR showed HGF, HGFA and c-Met mRNA in all RAST and all OAST. HGF levels in SF samples were higher in RA patients [range 5.6-39.2 ng/ml and mean 26.3 +/- 1.2 ng/ml] than OA controls [range 4.2-37.5 ng/ml and mean 11.2 +/- 2.4 ng/ml], and the differences were statistically significant [P < 0.001]. Non significant correlation between HGF-SF levels and disease activity score [DAS] [P > 0.5]. HGFA, HGF and c-Met mRNA are expressed in ST in RA and OA. Lack of correlation between HGF-SF levels and DAS indicated that HGF played regulatory role in immunopathogenesis of RA