Epidemiological study on the impact of vaccination programs on antigenic relatedness, genetic characterization of highly pathogenic avian influenza H5N1

Two HPAI H5N1 viruses were isolated from vaccinated layer and broiler commercial poultry farms in Egypt at years 2011 and 2013; respectively. By phylogenetic analysis, the viruses fall into two genetically diverse clades: [i] A/chicken/Egypt/VRLCU67/2011 classified as a variant virus, clade 2.2.1.1; and [ii] A/chicken/Egypt/13VIR3729-4/2013 classified as a classic virus, clade 2.2.1. Cross HI-test confirmed that the reaction between the two viruses is weak; furthermore, it showed the antigenic diversity between viruses belong to different clades and antigenic groups. Antigenic relatedness was calculated between six AI antigens and their antisera representing the different clades and antigenic groups circulated in Egyptian field; including the A/chicken/Egypt/VRLCU67/2011 strain which showed very low R-values with the other viruses' groups; ranging from 17 % to zero. Results demonstrated the genetic and antigenic diversity of the variant viruses and how can the vaccine seed be a weak point in the vaccination program that could be broken by the drifted viruses antigenically distant from the vaccine strain

Histological study on the effect of vitamin C on ischemia reperfusion injury in the adult rat ovary

Ovarian torsion may cause serious complications such as infertility in young women. Conservative management includes detorsion and reperfusion of the twisted segment. However, it may have local and systemic consequences due to production of large amounts of reactive oxygen species during reperfusion of ovaries. The present work aimed to study the possible histological and immunohistochemical changes due to ischemia-reperfusion injury in rat ovaries and the possible protective effect of vitamin C as an antioxidant. A total of 32 albino rats were divided into four groups. Group I was the control sham-operated group [either sham operated only, or with vitamin C administration]. In group II rats, ovarian ischemia was induced by torsion of the right adnexa. In rats of group III, 4 h of ischemia followed by reperfusion was performed. In rats of group IV, 4 h of ischemia was followed by 50 mg/kg vitamin C administration, which was injected intravenously, and then reperfusion was performed. Except for the ischemia group, all other groups were subdivided into two subgroups from which the right ovaries were surgically removed either after 5 h or after 2 weeks of starting the experiment. From the ischemia group ovarian samples were taken after 5 h only. Specimens were processed for paraffin sections and stained with H and E and with an immunohistochemical stain for apoptotic marker p53. Image analysis and statistical analysis of the obtained results were carried out. Severe vascular congestion, edema, hemorrhage, and increased P53 immunoreaction were detected in the ovaries after ischemia, which became less marked after reperfusion and considerably improved with vitamin C administration, especially after 2 weeks. Vitamin C treatment can help in protecting the ovaries from ischemia-reperfusion injury after detorsion

[Corticosteroids and radiotherapy in the treatment of graves-ophthalmopathy]

Graves ophthalmopathy is a debilitating disease impairing the quality of life of affected individuals. The management of moderate-to-severe active Graves' ophthalmopathy is a major therapeutic challenge, and the treatment outcome is often unsatisfactory. We have carried out a retrospective study to assess the efficacy of combined orbital irradiation and systemic corticosteroids. Ten patients were included; all patients had received 20 Grays to the retrobulbar tissues in ten fractions, and oral or intravenous glucocorticoids. The main therapeutic outcome measures were the criteria of Donaldson and co-workers and a self-assessment evaluation. The quality of life outcome was also evaluated by the GO-QOL [Graves' ophthalmopathy quality of life] questionnaire. Seven patients [70%] demonstrated improvement in ocular parameters; the response was excellent in three cases, good in three cases and fair in one case. Three patients showed no response to the treatment. The self-assessment evaluation showed that 75% of patients were satisfied with the results of the treatment. Proptosis was the most responsive sign to radiation and steroids. A duration of the eye disease of more than 18 months was associated with less improvement and a higher failure of the treatment. Concerning the quality of life, the score for visual fonctionning was 88.2 +/- 18.2 after treatment, while the score for appearance was 63.3 +/- 23.3. In conclusion, a combination of orbital irradiation and systemic steroids is associated with 70% of favorable responses, but the quality of life is not restored in the same proportions and remains impaired after treatment

Verification of subclinical atherosclerosis by carotid doppler ultrasonography in behcet disease patients

Behcets disease [BD], is a unique systemic vasculitis, which affects almost all types and sizes of blood vessels. Although the exact pathogenesis of BD remains unclear, small vessel vasculitis accounts for a considerable portion of the pathogenic processes in BD. In addition, large venous or arterial lesions can occur in BD patients and vascular involvement may be seen in 25%. Vasculitis makes the prognosis of BD severe. Doppler ultrasonography may show carotid intima-media thickness [IMT] associated with atherosclerosis in BD which is an endothelial cell dysfunction [ECD] parameter and may partially explain the observed cardiovascular morbidity and mortality. The aim of the present work is to study the use of Doppler ultrasonography in the assessment of the carotid artery involvement regarding the IMT and plaque formation in patients with BD. Correlation with disease activity, clinical manifestations and laboratory investigations were considered. Assessment of the lipid profile of the patients and correlation with the findings of the Doppler ultrasonography was considered. Twenty patients, 15 males and 5 females, suffering from BD satisfying the new set of diagnostic criteria published by the International Study Group for Behcet's Disease in 1990, were included in the present study. They were recruited from the Rheumatology and Rehabilitation department as well as the outpatient clinic, Cairo University hospitals. Patients were taken consecutively, with a mean age of 36.75 +/- 8.57 years [ranged from 22 to 54 years] and mean disease duration of 9.23 +/- 5.83 years [range 1.5 to 20 years]. Twenty age and sex matched healthy volunteers served as controls with a mean age of 34.5 +/- 4.24 years were also included in the present study. Subjects with diabetes mellitus, hypertension or evidence of myocardial infarction were excluded from the study. Full history taking and clinical examination of all patients and investigations including lipid profile were performed for the control and the patients. Medications received by the patients were considered and patients receiving corticosteroids for management of their disease were not excluded. Disease activity was assessed using the Behcets disease current activity form [BDCAF] score. Carotid artery ultrasound scan for the right and left common carotid arteries, carotid bulb and the first 1.5 cm of the internal and external carotid arteries was carried out in the radiodiagnosis department, Cairo University. The IMT of the carotid artery was measured in both patients and control by ultrasonography. The age at disease onset was 27.53 +/- 6.46 years. Six of the patients were smokers. There was no significant correlation between the dose of corticosteroids or colchicine used by the BD patients and the IMT of the carotid artery. However, the dose of steroids significantly positively correlated with the level of low density lipoprotein [LDL] [p = 0.013]. The mean IMT of both right and left carotid arteries in the BD patients was 0.64 +/- 0.32 mm [0.68 +/- 0.38 mm and 0.6 +/- 0.24mm for the right and left IMT respectively]. The IMT of BD patients was significantly different from that in the control subjects [0.42 +/- 0.13 mm] [p = 0.003]. There was no significant difference between smoker and non smoker patients [p = 0.1]. Furthermore, there was no significant correlation between the IMT with the disease duration or BMI [p = 0.46 and 0.3 respectively].The IMT of the carotid artery showed a significant positive correlation with the urea level [p = 0.009] and creatinine [p = 0.013]. There was a tendancy towards a positive correlation between the IMT and the cholesterol level and a negative one with the HDL, however, there was a significant positive correlation with the serum triglycerides [p = 0.03]. There were positive sonographic findings in 3 out of 20 BD patients [15%] compared to the control [0%]. The three patients were two males who had autoimmune hepatitis and one female with HCV positive hepatomegaly. Atherosclerotic plaque was present in two. There was a significant positive correlation between the IMT of the carotid artery and the BDCAF score in BD patients [r = 0.481, p = 0.016]. The score significantly negatively correlated with the platelet count [p = 0.002] while there was no correlation with the cholesterol, triglycerides, low or high density lipoprotein. On comparing the IMT in BD patients according to the presence and absence of arthritis, CNS or eye involvement, there was no significant difference. One can conclude that there is a morphologic evidence of subclinical atherosclerosis in patients with BD. IMT was associated with triglycerides as well as urea and creatinine levels denoting that the renal function forms a possible risk of CVD in BD. The BDCAF is an easy tool that may significantly reflect the cardiovascular involvement in BD patients and may be important for clinical management

[Evaluation of silent period duration of masseter muscle before and after placement of an occlusal splint in persons with normal occlusion]

Silent period is defined as transient electromyographic activity following a stimulus of some kind during a sustained period of muscle contraction. The exact mechanism of this reflex and the factors that influence it are still unknown. One important unanswered question is the relationship between the length of muscle and duration of silent period. The aim of this study was to compare the silent period duration of masseter muscle before and after placement of an occlusal splint in the mouth. Twenty five persons with complete dentition [28 natural teeth with no prosthesis and class I occlusion, without signs and symptoms of muscle or TMJ dysfunction and without history of orthodontic treatment were chosen for this study. The mean age of subjects was 22.3 years. For each subject, a maxillary occlusal splint with 3mm thickness in premolar area was fabricated and adjusted. Silent duration was measured during maximum muscle activity using chin tap as stimulus. Silent period was evoked and measured 3 times and the mean of the measurements was used as individual SPD. The mean SPD taken without splint was 20.03 +/- 1 and 14.19 +/- 0.83 with splint. Pair Wise Comparison test with use of LSD test showed that the mean SPD with and without splint were significantly [P<0.05] different. The result of this study showed that placement of a splint shortens the SPD of masseter muscle, significantly. Therefore, it is suggested that SPD can be used as a Para clinical factor to evaluate the full mouth restorative treatments that probably change VD. It also shows that muscle and TMJ receptors have a more important role in SPD than periodontal receptors

Assessment of the role of blood group systems and three DNA loci [ALU TPA-25, Humfes / Fps and HuMf 13A1] in paternity testing in a sample of Egyptian population

A panel of 10 genetic markers has been applied for paternity testing in 51 Egyptian families. The panel included 7 blood group system [ABO, Rh, MNSs, Duffy, Lewis, Kell, and Kidd], and 3 DNA loci [Alu RPA - 25, HUMFES / FPS, and HUMF13A1]. The trio in each family consisted of the mother, the child, and the legal or alleged father. The families were studied as 3 groups of statistical significance: The 1st 40th family group in which paternity of legal fathers was tested despite the lack of any suspicion of paternity dispute [expected low probability of disputed paternity], the 41st - 51st family group in which paternity of legal fathers was tested due to strong suspicion paternity dispute [expected higher probability of disputed paternity], and the 1st - 51st family group in which paternity of 10 known foreign men [to represent alleged father with 100% true paternity dispute] was randomly tested in the 51 families of the study. The study included determination of blood groups by the agglutination method, and analysis of DNA loci by aggarose gel electrophoresis after DNA extraction and amplification by polymerase chain reation. Exclusion of paternity was concluded from the knowledge of modes of inheritance of the study markers, and probability of paternity [inclusion of paternity] was calculated from the studied gene freqencies after gene typing of the study population. Results of the study showed that the DNA loci were better than blood group systems in exclusion and inclusion of paternity, though both failed to exclude all the alleged fathers or to give reliable values of probability of paternity. The Lewis, Kell, and Kidd blood groups were nearly of no value in paternity testing whereas the polymorphic DNA loci [HUMFES / FPS and HUMF13A1] provided the best result. Some true disputed fathers were excluded by single markers only, raising the importance of such exclusion which should be considered seriously and cautiously and cautiously. Its reliabilityy should be scrutinized, abd it may be necessary to examine more markers. It has been concluded that the study panel of 10 genetic markers was not adequate in excluding or proving paternity for all test cases, and that the polymorphic markers provide better results in paternity testing. In a certain population, paternity testing should rely upon adequate number of the most valuable genetic markers, and regulatory rules regarding reliable paternity exclusion or inclusion or inclusion parameters are mandatory, as well as strict application of quality control parameters to the concerned laboratories

Early versus delayed laparoscopic cholecystectomy for the treatment of acute cholecystitis

Patients with a preoperative diagnosis of acute cholecystitis were prospectively allocated to treatment with early laparoscopic cholecystectomy within 24 hs of randomization or initial conservative treatment followed by delayed laparoscopic cholecystectomy 6-8 weeks later. There were 31 patients in the early group and 27 in the delayed group. There were no significant difference in conversion rate[early 19.4 percent versus delayed 22 percent], postoperative analgesic requirement [2 versus 1 dose]. Intra and postoperative complications. However, the early group has significantly longer operating time [112.5 versus 96.4 min, P=0.03] and shorter total hospital stay [3.7 versus 2.2 days, P<0.001]. The incidence of bacterial complications being markedly low, especially in the early group.These results indicate early laparoscopic cholecystectomy is safe and feasible for acute cholecystitis with the additional benefit of shorter total hospital stay and avoid the problems of failed conservative treatment and delayed surgery

saftey of laparoscopic cholecystectomy for cholelithiasis in sickle cell disease

As surgery in sickle cell patients is associated with high morbidity, this study aimed to establish the safety of minimally invasive surgery in this high-risk group. The study included 41 sickle cell patients underwent laparoscopic cholecystectomy [LC] for cholelithiasis, three patients had asymptomatic gallstones and preoperative gastroscopy and endoscopic retrograde cholangiography were performed in nine and eight patients, respectively. Twenty-six patients were given simple transfusions, while three received partial exchange transfusions. The mean operative time was 10 minutes and the conversion rate was 4.8%. There were 14.6% postoperative complications, the majority of which were respiratory and wound related and the median hospital stay was 2.5 days. Laparoscopic cholecystectomy is safe in patients with sickle cell hemoglobinopathy who are particularly at risk of developing pigmented gallstones. Therefore, the use of minimally invasive surgery is encouraged in any sickle cell patient undergoing operative intervention with the advantages of short postoperative analgesia requirement, shorter hospitalization and remarkable reductions in perioperative morbidity

Histopathological and immunohistochemical studies of skeletal muscle in mice experimentally infected with schistosoma mansoni

Histopathological, histochemical and immunohistochemical studies were carried out on the skeletal muscles of mice experimentally infected with Schistosoma mansoni throughout 20 weeks post infection. Histopathological changes were detected from the 13th week post- infection in spite of absence of Schistosoma mansoni eggs. There were definite enzymatic changes dehydrogenase, non-specific esterase and acid and alkaline phosphatases. These changes started from the 14th week post-infection. S. mansoni immune complex deposits were detected in the muscles from the 9th week post infection. Positive correlation was found between the degree of immune complex deposition and histopathological and histochemical changes. The study confirmed the role of immune complex in the pathogenesis of skeletal muscle lesion in Schistosoma mansoni infection [schistosomal myopathy]

Wedge resection alone or combined segmental phenolization for surgical correction of ingrowing toe nails

A retrospective analysis was undertaken of 194 patients treated surgically for ingrowing toenails. Each patient was randomly allocated to one of two treatment groups. There were 82 wedge resections and 112 wedge resection/segmental phenolization combination treatments. All patients were followed up for 6 months. The duration and intensity of postoperative pain was assessed and the recurrence rate monitored. Postoperative pain was less in wedge resection/segmental phenolization group [8.4 +/- 12.4 h] than in wedge resection group [31 +/- 36.7 h. P < 0.001]. There were 9 recurrences in the wedge resection group [11%] and none in the wedge resection/segmental phenolization group. The results in the wedge resection/segmental phenolization group were statistically significant when compared with the wedge resection group [P < 0.01]. It is concluded that the combination procedure gives better long-term results than wedge resection alone and allows excellent results to be achieved by all grades of surgeon

Submucous versus traditional haemorrhoidectomy [ligation and excision]

This study included 60 patients of both sexes complaining of symptomatic haemorrhoids [second, third degree and prolapsed piles]. These patients were divided into two groups: Group 1: included 30 patients were treated by submucosal ligation. Group 2: included 30 patients were treated by ligation-excision. Submucosal ligation was a time consuming operation [50 min.], compared with the time of ligation excision operation [20 min.], also the incidence of per-operative bleeding during submucosal ligation was high [23%] compared with that of ligation and excision [8%]. Post-operative pain was much reduced in submucosal ligation. Time required for healing in patients who underwent submucosal ligation was about 2 week, while that required for healing of wounds after ligation excision was about 5 weeks. Anal stenosis and stricture formation were less common in submucosal ligation [3%], their incidence in ligation and excision were [10%]. Sphincteric disturbance was relatively high in submucosal ligation [47%], as the study included a great number of females with a history of perineal tears. In conclusion, submucosal ligation is better in patients with 2nd and 3rd degrees of haemorrhoids

role of ultrasonography in the management of acute abdomen

The study comprised of 164 consecutive patients presenting with acute abdominal pain were assessed clinically and ultrasonographic examinations of 76 patients were performed. Of these, 54 [33%] patients would normally have had an immediate ultrasonographic scan requested; routine [within 24 h. of admission] ultrasonographic scan would have been requested in a further 22 [13%] patients. In 88 [54%] patients who were diagnosed as acute appendicitis, and ultrasonographic examination would not have been requested and appendicectomy was done for them. Ultrasonography altered the diagnosis in three patients. In the 1st patient, the diagnosis is altered from probable acute appendicitis to acute cholecystitis. In the 2nd patient, the diagnosis is altered from simple fractured rib [in car accident] to ruptured spleen with the fractured rib. In the 3rd patient, the diagnosis was changed from fracture femur and shock to multiple liver tears and retroperitoneal haematoma with the fracture femur. The study shows that immediate ultrasonographic examination of acute abdomen is helpful especially for patients with a history of trauma, for management and decision for urgent laparotomy and to exclude serious surgical pathology which required immediate intervention

Correlation between toxoplasma gondii antibodies in serum and aqueous humour in patients with suspected toxoplasma ocular lesions

Fifty cases with suspected toxoplasmic ocular were detected from Ophthalmology Department in Banha University Hospital. Samples from serum and aqueous humour were collected and examined by IFAT for detection of anti-Toxoplasma antibodies, and by single radial immune- diffusion for total IgG estimation. Eleven cases [22%] showed positive antibody titer in serum and aqueous humour. 3 cases showed positive aqueous humour antibody titer and 6 cases showed positive serum antibody titer. Eight cases [16%] showed aqueous humour antibody coefficient >/8, indicating conclusive proof that the lesion is caused by Toxoplasma organisms. High positivity rates were recorded in the age group below 20 years [36.3%] than between 20-60 years [25.6%] and in females [52%] than males [29%]

serodiagnosis of toxocariasis: a comparison of two antigens

Seventy eight subjects were examined serologically by ELISA for detection of antibodies against Toxocara embryonated egg antigen [TEE] and worm extract antigen [WEX]. The subjects were classified as suspected cases of having visceral larva migrains [VLM], cases with poliomyelitis, Ascaris lumbricoides and Strongyloides stercoralis infected cases and apparently healthy control cases. 38.7% of the examined cases were anti-Toxocara IgG positive using TEE-antigen, while only 22.6% were positive using WEX-antigen. Also, 12.9% and 9.7% of the examined cases were anti-Toxocara IgM positive, using both TEE- and WEX-antigens respectively. It was found that 70.8% and 53.3% of anti-Toxocara IgG positive cases had mild ELISA values using TEE- and WEX-antigens, respectively; while most of anti-Toxocara IgM positive cases had mild values

role of parasitic infection in the aetiology of phlyctenular eye disease

Stool and urine analysis of 150 cases of phlyctenular eye disease, revealed that 115 [76.67%] were positive for intestinal parasites. The most prevalent parasites were Hymenolepis nana [49.56%] followed by Ascaris lumbricoides [27.82%]. Eosinophilia [5.10%] was detected in 90 phlycten cases [60%], 80 of them [88.8%] had parasitic infection. Since H. nana can produce a type of tissue hypersensitivity, phlyctenular eye disease may be partly referred to such an infection

Effect of praziquantel of the tegument of schistosoma mansoni worms in experimentally infected mice

The in vivo effects of subcurative oral dose of praziquantel on the tegumental surface of S. mansoni worms were studied using transmission electron microscopy. A variety of tegumental changes were observed including: vacuolations, blebs, basal infolding, whorls of membranous material and disruption of tegumental surface. While the subtegumental changes were in the form of: swellings of parenchymal cells, vacuolations and loss of glycogen. These changes were more pronounced in males than in females and in adults than juveniles. Also, the changes after 24 hours post-treatment were more apparent than after 2 hours post-treatment

Diabetes mellitus with pregnancy Al-Zahraa experience

Eighty pregnant diabetic patients were included in this study. Patients were classified acording to Whites classification and gestational age on admission. Home and hospital management with or without insulin were resorted to, to maintain euglycemia. Maternal and foetal outcome were studied. The effect of parity and time of booking as well as class of diabetes and success of control are presented. Incriminating history was found in 75% of cases. Most obstetric complications occurred in class B diabetes especially in those coming after the 2[nd] trimester. Maternal and perinatal mortality and morbidity were reduced to levels comparable to international standards

HLA typing in patients of habitual abortion

Histocompatibility locus A [HLA] typing were performed by microcytotoxic method on 25 women with a history of recurrent spontaneous abortion, and compared with 330 age-matched healthy persons considered as normal control of the Egyptian citizens. There is an apparent increase in the antigen frequency in A[3] [24% in patients and 8.7% in control] but this increase is not significant. Accordingly there was no significant association between HLA antigens in patients as compared to antigen frequency in control group