Prevalence of hearing impairment and its correlates among a group of hospitalized chronically ill elderly patients in Alexandria, Egypt

Background: Hearing impairment [HI] is one of the most common health problems among the elderly. The major risk factors for HI include aging, exposure to noise, chronic morbidities, and ototoxic drugs. Although the relation between HI and chronic morbidities among the elderly is well documented, it often receives minimal attention. The aim of this study was to determine the prevalence of HI and its correlates among a group of hospitalized chronically ill elderly patients in Alexandria, Egypt

Participants and methods: A descriptive cross-sectional study was carried out on 370 chronically ill elderly patients in the internal medicine wards of Alexandria Main University Hospital. A structured pre-coded interview schedule was used to collect data on sociodemographic characteristics and medical history. A questionnaire for screening for HI in the elderly was also used

Results: The majority of elderly patients [78.6%] complained of HI. HI was prevalent among all elderly patients aged 90 years and older. It was also more prevalent among women [82.2%], among single and divorced elderly patients [95.7 and 91.7%, respectively], among those who were illiterate or could only read and write [93.2%], among all skilled workers, and among housewives [82.2%]. HI was also most prevalent among elderly patients who lived alone [82.6%], hypertensive elders [87.6%], and elderly patients taking analgesics [85.4%]

Conclusion and recommendations: Hypertension and the intake of a number of medications were significantly associated with HI. It is recommended to use screening procedures for the identification of individuals with HI and to refer them for further audiologic evaluation

Neonatal late onset sepsis: the use of TNF-alpha as a marker for antibiotic sensitivity

Objectives: Early and accurate treatment of an infant with suspected sepsis is the gold for his survival. Cytokines are important proinflammatory mediators in the early phases of the sepsis syndrome. Recent investigations have demonstrated that some antibiotics, in addition to their antimicrobial effects, can interfere with cytokine production. This study was designed to determine the level of serum TNF-alpha in late neonatal septicemia [LOS] before and after antibiotic therapy to assess its role as a marker of success or failure of such therapy

Methods: Forty preterm neonates with culture proven LOS who were admitted to NICU, Pediatric Department, Tanta University Hospital during the period from January 2009 to January 2010 in addition to ten healthy full term and ten healthy preterm control neonates and 36 cases received final diagnosis of non-sepsis were included in this case control study. Selected neonates were classified into four groups according to the results of antibiogram. Group I: received ampicillin and cefotaxime and were sensitive to one or both of them. Group II: received ampicillin and cefotaxime and were resistant to them. Group III: received ampicillin and amikacin and were sensitive to one or both of them. Group IV: received ampicillin and amikacin and were resistant to them. The causative micro-organisms and their antibiograms were microbiologically determined with estimation of serum TNF- alpha using ELISA technique before and 24 hours and 72 hours after start of antibiotic treatment

Results: Forty neonates with laboratory confirmed LOS were enrolled in this study. klebsiella [42.5%] and coagulase negative staphylococci [25%] constituted the majority of the isolated organisms. LOS cases had significantly high serum level of TNF-alpha than preterm and fullterm controls as well as no-sepsis group [P<0.0001]. Only in group I and III, there was significant increase [P<0.0001 and P= 0.0001, respectively] in the levels of TNF-alpha after 24 hours of treatment as compared to TNF-alpha level before treatment, and significant decrease [P<0.0001] in TNF-alpha level after 72 hours of treatment as compared to 24 hours level

Conclusion: TNF-alpha is a powerful early predictor of LOS. Measurement of serum TNF- alpha during empiric treatment of neonatal sepsis could be a powerful indicator of appropriateness of antibiotic therapy. Therefore, increase of TNF - alpha level during initial treatment especially during the first day of treatment of neonatal sepsis may be taken as indication for sensitivity to initial antibiotics, even before sensitivity of microbiological causes to given antibiotics is known

Health related behavior of middle aged attenging out patient clinics in Alexandria

Aging is a lifelong process where early and mid-life events and behaviors have an important influence on the health and functions of individuals as they age. Adoption of a healthy lifestyle is important at all stages of life particularly the middle age. Physical activity, proper nutrition, social engagement avoiding risky behaviors as smoking, and practicing health seeking behavior can prevent diseases and functional decline at any age. Health related behaviors are affected by the wider range of factors as the environment in which elders live, their values, beliefs, traditions, and education. Also Knowledge about the benefits of healthy lifestyle is a crucial motivation to achieve successful active aging. This study aimed to assess the health related behaviors among the middle aged and evaluate their knowledge about the impact of health related behaviors upon successful active aging. The sample included 400 cases attending four outpatient clinics in Alexandria during the scheduled visits and fulfilling the inclusion criteria: age 50 to 60 years, and acceptance to participate in the study. Data was collected using a structured interview sheet to obtain information about the general characteristics of the elderly, assessment of their functional abilities, and knowledge and practice of health related behaviors. The results revealed that The total score of practicing and knowledge of health related behavior was bad among the majority of cases

Survivin: a novel negative regulator of apoptosis in normal, dysplastic and malignant epithelium

Survivin is a bifunctional protein that suppresses apoptosis and regulates cell division. In particular, deregulation of apoptosis resulting in aberrantly reduced cell death is thought to participate in cancer by facilitating the uprising of additional transforming mutations. The aim of this study was to investigate the surviyin expression in normal oral epithelium, oral dysplastic lesions verrucous carcinomas, oral squamous cell carcinomas and metastatic carcinomas. 35 samples for the previous different lesions were collected. Paraffin sections were immunohistochemically stained using comercially available anti-survivin antibody. Survivin expression was semi-quantitatively evaluated in different lesions. In normal oral mucosa, survivin was mildly detected in all cases and mainly located in basal cell layer, both nuclear and cytoplasmic staining could be detected. Survivin expression increased with the progress of the grade of dysplasia. In all studied cases of verrucous carcinoma, - survivin staining showed a heterogeneous distribution. In oral squamous cell carcinoma, the greatest expression of survivin positivity was found in well differentiated carcinoma. Less well differentiated tumors and cases of poorly differentiated carcinoma revealed a lower degree of positivity. Metastatic carcinoma revealed mild to moderate homogenous intensity. Areas of individual necrotic tumor cells did not stain positive for survivin. Analysis of the data presented here suggests that survivin expression is an early event during malignant transformation, thus over expression represents a hallmark of malignancy

Effect of pravastatin, a 3-hydroxy-3-methylglutaryl- coenzyme a reductase inhibitor, on apoptosis and proliferating cell nuclear-antigen [PCNA] in rat colon carcinogenesis

Abstract: Apoptosis plays a central role in tumor development and it has been hypothesized that lack/failure of apoptosis leads to the development of tumors, including colon tumors. Carcinogen treated rats develop foci of aberrant crypts in the colon [ACFs] that have been interpreted as preneoplastic lesions. The aim of the present study was to evaluate the effect of orally administered pravastatin [3- hydroxyl- 3- methylglutaryl- coenzyme A reductase inhibitor] on colon mucosal cholesterol level, apoptosis and the proliferating cell nuclear-antigen [PCNA] during induction and development of 1.2-dimethylhydrazine dihydrochloride [DMH] induced ACFs in the rat colon. The rats group I injected with 0.9% saline and served as negative control group, rats of groups [II-IV] were injected with DMH once a week for 4 weeks [between weeks 5 and 8 after the start of the experiment], group II served as a carcinogen control group without pravastatin treatment, group III pravastatin preventive group, received the pravastatin from the start of the experiment until 8 weeks before and during the carcinogen administration [before and during the initiation period], group IV pravastatin curative group were administered pravastatin for 10 weeks after the carcinogen administration [post initiation administration]. All animals were sacrificed under ether anesthesia at the end of week 18. Pravastatin administration significantly decrease colonic mucosal cholesterol level in both initiation and post initiation stages, reduced the number of ACF, induced apoptosis and have antiproliferative activity in both initiation and post initiation stages but the effect was only significant in group III

Conclusion: the results of the present study suggest that pravastatin is a cancer chemopreventive agent which may suppress DMH induction of lesions and their subsequent development via decreasing colon mucosal cholesterol, induction of apoptosis and antiproliferative action

Transcutaneous bilirubinometery: its role in the assessment of neonatal jaundice with comparable precision with serum bilirubin

Transcutaneous bilirubinometry [TCB] provides a noninvasive, cost effective screening method for significant neonatal jaundice. The aim of this study is to comment on the usefulness of the jaundice meter as a non invasive screening device for hyperbilirubinemia in neonatal intensive care units. The study included 40 neonates suspected on clinical grounds to have neonatal jaundice, admitted to the unit for either prematurity or other clinical conditions. Our results showed a correlation coefficient between total serum bilirubin and the mean of transcutaneous bilirubinometry of the forehead and sternum at 24 and 48 hours of appearance of jaundice to be 0.629 and 0.823 respectively with a significant P value of [0.07. Also, the correlation coefficient between assayed total serum bilirubin level and expectant serum bilirubin level at 24 and 48 hrs. of appearance of jaundice was 0.599 and 0.863 respectively with a significant P value of <0.01

Conclusion: transcutaneous bilirubinometry is a well-established screening method for neonatal jaundice, yet it has limitations of use due to the sensitivity of the method for defecting variation in melanin content of the skin. Also TCB monitoring should not be used to follow babies who have undergone exchange transfusions nor solely relied up to follow infants undergoing phototherapy