Cognutuve and neurological complications of bacterial meningitis in adult patients: a hospital based study

Bacterial meningitis is associated with disabling sequelae in a significant proportion of patients. It is associated with high mortality, risk of neuropsychological sequelae and risk of cognitive impairment the purpose of this study is to assess cognitive and neurological complications in adult patients with bacterial meningitis. A total of 45 patients with bacterial meningitis and 16 patients with tuberculous meningitis were enrolled. They were subjected to full medical history taking and clinical examination, full neurological examination on admission and discharge. Mini mental state examination [MMSE] and Wechsler memory scale [WMS] were used to assess cognitive function. The results showed that the ischemic brain insult [87.88%] followed by cranial nerves affection [32.42%] were the commonest neurological complication detected on discharge. Cognitive impairment was detected in 53.66% of patients using MMSE.WMS showed that orientation, information and logical memory were the most common affected. Cognitive and neurological complications were not statistically related to age or etiology [P>0.05]. Longer duration until diagnosis [Beta = -.18, p <0.001], presence of intracranial complications [Beta = -.12, p <0.005], need for mechanical ventilation [Beta = -.79, p <0.001] and drug abuse [Beta = -0.11, p < 0.05] were significant predictors of worse outcome assessed by Glasgow outcome score

Serum interleukin-18: does it have a role in the diagnosis of hepatitis C virus related hepatocellular carcinoma?

Early diagnosis of hepatocellular carcinoma [HCC] is the only hope for cure. Although the role of alpha foetoprotein [AFP] in the diagnosis of advanced HCC is well recognised, at least one-third of cases will be missed unless another diagnostic tool is used. Increased levels of circulating interleukin-18 [IL-18] have been observed in patients with several cancer types and were described in patients with chronic hepatitis. The aim of this study is to assess the role of serum IL-18 level in the diagnosis of hepatitis C virus [HCV]-related HCC. A total of 75 subjects categorised into four groups, including 25 patients with HCV-related HCC and AFP above 200 ng/ml, 25 patients with HCV-related HCC and AFP below 200 ng/ml, 15 patients with HCV-related chronic liver disease and 10 healthy controls, were enrolled. HCC was diagnosed according to guidelines of the American Association for the Study of Liver Diseases. AFP and IL-18 were assessed in all subjects. AFP and IL-18 levels are significantly higher in patients with HCC than in disease control and healthy control subjects. IL-18 level is not correlating with the size or the number of hepatic focal lesions neither with the presence of lymphovascular invasion or abdominal lymphadenopathy. The best cut-off value of IL-18 for the diagnosis of HCC is 500 pg/ml with 84% sensitivity and 86.7% specificity and the area under receiver operating characteristic curve is 0.675. Serum IL-18 level is a suitable marker for the diagnosis of HCV-related HCC complementary to AFP, especially in cases with AFP level less than the diagnostic value

Liver metastases in Egyptian patients with colorectal cancer: incidence and clinico-pathological predictors

Carcinoma of the large bowel is the fourth commonest cancer worldwide. The most frequent site for metastasis is the liver. Overall 30% of patients develop liver metastasis during the course of their illness; of these, 23% to 47% are synchronous lesions. These data are based on western studies. No data are published on patients with colorectal cancer from Egypt. We aimed to assess the incidence of colorectal liver metastasis in Egyptian patients and to evaluate the differences in the clinico-pathological features and tumor behavior in patients with and without liver metastasis. One hundred forty eight patients were prospectively enrolled in the study. Patients were classified into metastatic group [n=78] and non metastatic group [n=70]. In the two groups macroscopic features compared including: tumor size [2 cm, 2-5 cm, and >5 cm], site of primary tumor, side of liver involved, clinical symptoms and liver profile. Carcinoembryonic antigen [CEA] and cancer antigen [CA19.9] levels were recorded. At microscopy, tumor differentiation, invasion and nodal status were evaluated. No difference was found in the distribution of the primary site and size of the tumor. Jaundice, hepatomegaly and ascites were significantly higher in patients with liver metastases. Patients with liver metastasis had higher levels of CEA, CA19.9, higher frequency of vascular invasion and nodal involvement

Maternal knowledge and practices in feeding infants and young children during diarrhea

An exploratory-descriptive design was conducted on 300 mothers with their infants and children under 5 years of age with diarrhea who were coming to the rehydration unit and outpatient clinic at Assiut University Hospital to identify their knowledge and practices related to feeding their infants and young children during diarrhea. Data was collected during the period from September 2000 until February 2001. A structured interview sheet was designed specifically to collect data. The study showed that the majority of mothers especially illiterate one did not have enough knowledge about diarrhea and also had poor practices about proper feeding care of child during diarrhea. Only 30/87[34.5%] of infants below 6 months were found to be exclusively breast-fed. During diarrhoal episodes 72/202 [35.64%] of illiterate mothers slopped feeding compared to 5/98 [5.1%] of educated mothers [P < 0.001]. Less than 68% of mothers identify at least one of the symptoms and signs of dehydration. Although mothers' awareness about ORS was high [100%], the ORS use rate was low 165/300 [55%] and only 36.33% of those mothers prepare it correctly. Mothers' knowledge about the etiology of diarrhea and the importance of infection in its causation was inadequate. The study recommended repeated nutritional education programs for mothers to correct the faulty practices during diarrheal episodes in their children. Education of mothers can be an important variable that affects their knowledge and practice about disease

Endothelin-1 and nitric oxide in children with renal hypertension

Plasma and urinary endothelin-1[ET-1] and nitrate [NOx] as an index of nitric oxide generation were measured in 27 hypertensive children with renoparenchymal diseases, 15 normotensive children with renoparenchymal diseases and 20 healthy control children of matched age and sex. The mean value of plasma ET-1 concentration was significantly higher in hypertensive children with renoparenchymal diseases than both normotensive renal diseased children and normotensive healthy controls. Significant positive correlation was found between ET-1 levels and mean blood pressure in hypertensive children with renal diseases. The mean value of 24 hours urinary excretion of ET-1 was significantly higher in normotensive children with renal diseases than normotensive healthy controls, but significantly lower than hypertensive children with renal diseases. Significant increase in the plasma levels of NOx was observed among hypertensive renal diseased children than normotensive renal diseased children and normotensive healthy controls. Significant positive correlation was found between the levels of plasma ET-1 and plasma NOx in hypertensive renal diseased children

Heterodyne synthesis: synthesis of fused thiopyrano [2,3-d] thiazole, [1] benzopyrano ['3,'4: 4,5] thiopyrano [2,3-d] thiazole and thiazolo [3,4-c] -triazine derivatives

The biological and medicinal activities of substituted thiazolidines have been well reviewed, besides, the use of thiopyrano derivatives as anti-malarial drugs has prompted us to synthesize compounds having both thiazolidine and thiopyrano moieties of expected biological activities. The reactions of the highly coloured 5- salicylidenethiazolidine -2, 4-dithione and acrylonitrile at room temperature, in acetic acid, afforded a colourless 1:1 adduct, as inferred from its analytical data, which may have any of the structures 2-5. structures 3-5 were ruled out based on the 1H NMR data of the adduct which can be readily interpreted in terms of 6- cyano-7-o-hydroxyphenyll-5, 6-dihydrothiopyrano [2,3-d] thiazolidine-2 thione. The region-chemical assignment was based on proton chemical shift, which is in agreement with the favourable interaction between the sulphur atom of the heterodyne component, >C=C-C=S, and the Beta carbon atom of the dienophile. On the other hand, when 1 was reached with either acrylonitrile and/or ethyl acrylate in refluxing acetic acid, one and the same product was obtained; a fused benzopyrano- ['3, '4: 4,5] thiopyrano [2,3-d] thiazole- 2-thioxo 6[H]- one [6] as inferred from its analytical and spectral data. The formation of 6 is assumed to proceed through cycloaddition followed by concomitant loss of ethanol. The reaction of 1 with N-phenylmaleimide, maleic anhydride and dimethyl acetylenedicarboxylate in acetic acid, afford the colourless 1:1 adducts 7, 8 and 9, respectively. The gross structures of compounds 7-9 were assigned on the vasis of their analytical and spectral data; the sterochemical assignment of 7 and 8 was a consequence of proton coupling constants. Subjecting the anhydride 8 to the action of aniline in benzene afforded the amide 10, which is readily dehydrated by the action of acetic acid containing anhydrous sodium acetate to afford 7. The behaviour of 1 toward the action of malononitrile has also been investigated. Thus, treatment of 1 with malononitrile, at room temperature, in absolute ethanol, and in the presence of triethylamine afforded the colourless adduct 11. The structure of 11 was based on its analytical and spectral data, besides its unambiguous synthesis, by the reaction between thiazolidine 2, 4- dithione and salicylidenemalononitrile. On the other hand, when the reaction of 1 with malononitrile was carried out in refluxing ethanol, a fused benzopyraro ['3, '4: 4,5] thiopyrano [2,3-d] thiazole - 2 thione derivative 12 was based on its analytical and spectral data; furthermore, compound 12 was found to be identical with the product obtained by refluxing 11 in absolute ethanol in the presence of thriethlamine. Attempts to S-alkylate the potassium salt of 1 by the action of methyl iodide, ethyl bromoacetate and/or phenacyl bromide were unsuccessful, and instead, one and the same product was isolated. Structure 13 was assigned for the product based on its analytical and IR data; besides, its alkaline hydrolysis afforded 3-meracaptocoumarin, proved to be identical via its S-benzyl derivative with an authentic sample [8]. The reaction of 1 phenylhdrazine at room temperature, effected saliclidene group cleavage, with the formation of 4- phenylhydrazono-2-thiazolidinethione[9] [14]. The raction of 14 with acetyl chloride afforded 4-N1- acetylphenylhydrazono-2-thiazolidinethione [15]. Subjecting 14 to the action of ethyl bromoacetate and phenacyl bromide, in refluxing ethanol, and in the presence of few drops of triethylamine, afforded the fused thiazole [3,4-c]- triazine derivatives 16 and 17, respectively. The structures of 15-17 were based on their analytical and spectral data; besides, the acid hydrolysis of 15 and 16 yielded 4-thiazolidinone-2-thione[10]. This is in analogy with the reported behaviour of 2-phenylhydrazono-4-thiazolidinone derivatives toward the action of the same reagents[11]