Polymorphism of toll like receptors 2 and 4 genes and the risk of bronchial asthma

Background: Bronchial asthma is one of the most common chronic inflammatory respiratory disorders affecting many people all over the world

Objectives: To study the association between single nucleotide polymorphism in genes of TLR2 and TLR4 and the risk of bronchial asthma

Methodology: This study was carried out on 40 patients suffering from bronchial asthma and 20 healthy subjects as a control group during the period from May 2014 to March 2015.The patients were chosen from the Chest Department of Benha University Hospital. Skin prick test [SPT] was done to assess atopic state. Blood samples were taken for detection of TLR gene polymorphism by Polymerase chain reaction -Restriction Fragment Length Polymorphism [PCR-RFLP]

Results: Statistical data for the genotypic frequencies in TLR2Arg753Gln revealed that the homozygous [GG] genotype has increased frequency among the controls [80%] as compared to the asthmatic patients [30%]The heterozygous [AG] genotype was more prevalent among the asthmatic patients [62.5%] as compared to the controls [15%] with OR =9.4, 95% CI [2.4-37.7] and significant P-value. Also, the homozygous mutant [AA] genotype has increased trend in the asthmatic patients [7.5%] than in the control subjects [5%], with OR = 0. 6, 95% CI [0.1-6.7] and non-significant P-value Statistical data for the genotypic frequencies in TLR4Asp299Glyrevealed that the homozygous [AA] genotype has increased frequency among the controls [70%] as compared to the asthmatics [20%]. The heterozygous [AG] genotype was more prevalent among the asthmatic patients [65%] as compared to the controls [30%] with OR =4.3, 95% CI [1.4-13.8] and significant P-value

Conclusion: The major allele in TLR 2 and 4 polymorphisms [GG genotype of TLR2 and AA genotype of TLR4] might be generally associated with a protective effect against bronchial asthma

Association between HCV induced mixed cryoglobulinemia and pulmonary affection: the role of TNF-alpha in the pathogenesis of pulmonary changes

Chronic hepatitis C virus [HCV] infection is associated with both pulmonary involvement and cryoglobulinemia. Therefore, this study was designed to investigate the relationship between pulmonary involvement and mixed cryoglobulinemia in chronic HCV infected patients and to investigate the role of TNF-alpha in the pathogenesis of pulmonary changes. After hospital ethics committee approval and formal patient consent were obtained, 100 patients with compensated hepatitis C virus infection as confirmed by PCR were recruited in this cross sectional study. Their demographic and laboratory data, abdominal ultrasound findings, pulmonary function tests [spirometry], arterial blood gas [ABG] parameters, TNF-alpha levels, and data from high-resolution chest CT were collected and analyzed using SPSS version 16, and a serum cryoglobulin assay was performed in all of the studied patients The prevalence of mixed cryoglobulinemia was 61.7% in the studied HCV patients. Pulmonary symptoms were observed in more than half of these patients. The most common complaint among the symptomatic patients was dyspnea [51.7%], followed by cough [43.3%]. Oxygen saturation [Spo[2] and Sao[2]%], and FEVi and FVC levels, were significantly decreased in the cryoglob-ulin positive patients compared to the cryoglobulin negative patients. A statistically significant correlation was found between the presence of cryoglobulins and FEV level, FVC level, serum albumin level, viremia level, thrombocytopenia and arterial blood gas parameters. No correlation was found between cryoglobulinemia and TNF-alpha level. The results of this study suggest that pulmonary involvement is common in patients with chronic HCV infection and mixed cryoglobulinemia. Cryoglobulinemia may lead to pulmonary involvement through vascular and interstitial deposition of cryoglobulins, which results in impaired gas exchange and airway affection

Human leukocyte antigen class I alleles can predict response to pegylated interferon/ribavirin therapy in chronic hepatitis C Egyptian patients

Racial differences and broad spectrum response to anti-hepatitis C [anti-HCV] therapy suggest a possible role for host genetic diversity in treatment outcomes. We aim to determine the association and predictive value of certain human leukocyte antigen [HLA] class I alleles with either susceptibility to viral clearance or persistence following pegylated interferon [Peg-IFN] plus ribavirin therapy in chronic hepatitis C [HCV] genotype 4 patients in Egypt. This study included 200 unrelated chronic HCV patients who received Peg-IFN plus ribavirin therapy [112 patients with sustained virological response [SVR] and 88 non-responders [NR]]. Serological testing of HLA class I antigens [HLA-A and HLA-B alleles] were performed by standard complement-dependent microlymphocytotoxicity assay. The frequency of HLA-A01 was significantly higher in SVR than in NR cases [OR: 0.51; 95% CI: 0.27-0.981; P = 0.042], while the frequency of alleles B38 [P = 0.011], B40 [P < 0.001] and B41 [P < 0.001] was significantly higher in NR cases [OR/95% CI: 7.05/ [1.39-18.01], 10.31/3.14-36.1. On logistic regression analysis, presence of the HLA-A01 allele was associated with SVR [OR: 0.50; 95% CI: 0.28-0.89; P = 0.02] and HLA-B38 can predict non response to therapy [OR: 7.92; 95% CI: 1.67-37.54; P = 0.009] with an overall accuracy of 60%.Severe ??brosis [OR: 3.035; 95% CI: 1.521-6.091; P = 0.002], high viremia [OR: 2.69; 95% CI: 1.11-6.53; P = 0.005] and steatosis [OR: 2.1; 95% CI: 1.002-3.90; P = 0.041] predicted no response with an overall accuracy of 81.8%. HLA-A01 and HLA-B38 alleles are associated with and may have a role in the outcome of response to Peg-IFN plus ribavirin therapy in Egyptian patients diagnosed with chronic HCV infection. The use of immunologic markers to predict the outcome of treatment may help pharmacogenetic personalization of treatment for HCV infection

Neoadjuvant capecitabine-based chemoradiotherapy followed by total mesorectal excision for locally advanced resectable rectal cancer

Twenty three patients with respectable clinical stages II and III cancer rectum entered the study. All patients received concurrent chemoradiotherapy [CRT] based on capecitabine orally at a dose of 825 mg/m2 twice a day throughout the concurrent radiotherapy [RT] course. A radiation dose of 45 Gy was given to the posterior part of the pelvis to include the tumor, the mesorectum, followed by a boost of 5.4 Gy limited to the tumor and corresponding mesorectum with a 2 cm margin. A total mesorectal excision [TME] surgery was performed after a rest period of 6-7 weeks from completion of the preoperative chemo-irradiation. Acute toxicities of concurrent chemo-radiotherapy were reversible and controllable. Grade 3 leucopenia was noted in one patient only. Acute cystitis, moderate grade, was developed in 3 patients. Neurological symptoms were noted in 3 patients. Bleeding during operation occurred in 8.7% of patients. One patient who showed clinical leakage failed conservative management and required surgical re-intervention. Downstaging rate for T-stage was 69.5% [16/23 patients]. This rate was higher for N-stage constituting 84.2% [16/ 19 patients as 4 patients were NO]. There was no increase in T- and/or N-stage [upstaging] recorded in this study. Complete pathological response was recorded in 2 patients only [8.7%]. Sphincter-conserving surgery was successfully performed in 2 of 7 patients who were considered for abdomino-perineal resection before chemo-irradiation [28.6%]. After a median follow up period of 24 months, overall survival rate was 90.9% [20/22]. Distant failure was higher than local recurrence [13.6% Vs 9.1% respectively]. In conclusion; preoperative concurrent capecitabine and radiotherapy is considered to be a safe procedure and well-tolerated in patients with clinical stages II and III resectable rectal cancer treated with TME surgery. Successful high rate of sphincter-sparing procedure to some patients with low cancer rectum is possible after preoperative concurrent capecitabine and radiotherapy. Preoperative concurrent capecitabine and radiotherapy may reduce recurrence and improve survival rates

Parasitological, haematological and biochemical studies on naturally infected goat with theileria species in Egypt

The prevalence of theileria infection was investigated in 65 goats with suspected symptoms of theilerioses from a private farm in Giza Governorate. In addition, a total of 51 blood samples were collected from apparently healthy goats from private farms and ruing slaughtering at El-Bassatine abattoir. The incidence of theileria infection in the farm was 86.1% while, the incidence in the apparently healthy goats was 43.1%. Ring form of theileria species was detected in infected erythrocytes. Macroschizonts and microshizonts were detected in the lymphocytes with different shapes of chromatin materials. Haematological studies revealed significant decline in haemoglobin concentration, packed cell volume and red blood cell count. Total leucocyte count showed significant leucopenia in diseased animals. Examination of serum revealed significant rises in levels of alanine aminotransferase, aspartate aminotransferase, alkaline phophatase, urea, creatinine and cholesterol. Concentration of serum total protein, albumin and globulin showed significant decrease in theileria infected animals as compared with the healthy control goats. Levels of serum iron, inorganic phosphorus, magnesium and calcium showed also significant decline as compared with healthy goats. No changes were observed in serum sodium and triglycerides levels of goats with theilerioses. Therefore, it is important to put in consideration the great economical losses caused by theilerioses in such important small ruminants

Microbial biofilms in relation to milk quality [with one table and 4 figures]

The attachment of bacteria with subsequent development of biofilms in food processing environments is a potential source of contamination that may lead to food spoilage or transmission of diseases. The present study was carried out in a buffalo dairy farm in Alexandria governorate for studying the biofilm of milking machine. A total of 192 swabs were taken from teatcups, milk jars, milk pipelines [rubber and stainless steel] and bulk tank milk [48 of each] as well as 30 bulk tank milk samples after using farm program, and after application of Iodophores and QACs. By application of Iodophores and QACs, total bacterial counts reduced by 29.03 and 53.37; 79.90 and 80.91; 31.87 and 62.89; 55.65 and 78.03 and 66.18 and 80.37%, respectively, While Coliforms were suppressed by 29.03 and 53.37; 79.90 and 80.91; 31.87 and 62.89; 55.65 and 78.03 and 66.18 and 80.37%, respectively. S. aureus forming biofilm in teatcups, milk pipelines, milk jars and tank milk was reduced by 28.22 and 23.08; 67.62 and 61.62; 93.04 and 86.83 and 87.30 and 84.24%., respectively. The reduction percentages for Enterococci counts of teatcups, milk pipelines, milk jars and tank milk and bulk tank milk after using Iodophores and QACs were 72.45 and 94.05; 74.67 and 92.13; 37.44 and 90.81; 80.25 and 95.99 and 75.46 and 79.37%, respectively. It could be concluded that QACs is more efficient on TBC, Coliforms and Enterococci counts, while Iodophores is more efficient on S. aureus. Both Iodophores and QACs are failed to overcome the microbial biofilm of milking machine

Biliary enteric anastomosis versus endoscopic biliary stenting in treatment of benign biliary strictures

Surgical repair has been the traditional method of treatment for benign biliary strictures giving good long-term results in most cases. Advances in interventional endoscopic techniques have established the important role of endoscopy in management of such conditions.This study compared the effectiveness of endoscopic and surgical managements of benign postoperative biliary strictures.Over the last 6 years, 31 patients were seen with diagnosis of benign biliary strictures. 21 patients had postcholecystectomy strictures and were included in this study Eleven of these patients were managed endoscopically with insertion of biliary stents and ten patients were treated surgically either by hepaticojejunostomy orcholedochojejunostomy. The mean follow up period was 28 + 11.5 months in the endoscopy group and 29 +/- 12.1 months in the surgery group. The results in both groups were evaluated by the short-term outcome involving morbidity, mortality and hospital stay, and the long-term outcome.Complications were more frequent in patients managed endoscopically than patients treated surgically[5 vs 2; p 0.21]. Duration of hospital stay was significantly longer in the surgery group than the endoscopy group [11.2 days vs 4.1 days; P<0.001]; even after considering repeated hospitalization for complications [11.4 daysvs 5.9 days; PO.001]. There was no hospital mortality in both groups. Surgery showed good long-term results in 70% of patients, fair results that required medical treatment in 20% of patients and poor results in one patient [10%]. Endoscopic management had good long-term results in 64% of patients, fair results in 18% of patients and poor results in 18% of patients. Overall, three patients [14%] showed poor results and were subjected to surgery for anastomotic stricture [one patient], restenosis after stent removal [another patient], or complete metal stent obstruction [the third patient].In conclusion, endoscopic biliary Stenting using plastic endoprosthesis in patients with benign biliary strictures has obtained good results and tolerable complications nearly equal to surgery. Endoscopic management is advised to be the first approach in such patients, and hepaticojejunostomy is indicated if endoscopic procedures fail or in case of recurrent stenosis. The use of metallic stents in benign biliary strictures has yet to be evaluated

Malunited distal radius fractures

In this prospective study, 64 malunited distal radial fractures were operated upon for the correction of the deformity and restoration of the normal anatomical relationship in the radiocarpal and distal radioulnar joint [DRUJ]. Postoperatively, the patients were involved in an intensive rehabilitation program till restoration of the maximum functional recovery. The patients were followed up for a minimum of 12 months. The final results were assessed both clinically and radiologically with correlation to the type of fracture and timing of the surgical intervention. Fifty-one patients in this series had excellent results, ten had good, three had fair, and none was rated as poor. The study revealed that thorough preoperative assessments of the plain X-rays, CT, and/or MRI and operative restoration of the normal anatomical relations are essential to achieve good results in these difficult cases

Markers of cardiovascular risk in premenopausal and postmenopausal smoking and non smoking women

The current work was carried out to study the effect of cigarette smoking, age and menopause on the levels of homocysteine, C-reactive protein and soluble intracellular adhesion molecules [sICAM-1] as markers of atherosclerosis and cardiovascular risk in women. The study was carried out on 100 women from the same socioeconomic state divided into two main groups according to their age and menopause. The first group included 50 premenopausal women with ages ranging from 25 to 45 years and this group was divided into two subdivisions according to cigarette smoking [25 nonsmoking women and 25 smoking women]. The second group included 50 postmenopausal women with ages ranging from 50 to 65 years divided into two subdivisions [25 postmenopausal nonsmoking women and 25 smoking women]. The biochemical parameters measured in the serum of all samples were fasting homocysteine, C-reactive protein and sICAM-1. The results showed that there was a significant increase in homocysteine, C- reactive protein and sICAM-1 in the premenopausal smoking, postmenopausal nonsmoking and postmenopausal smoking women in comparison with the premenopausal nonsmoking women

Estimation of tuberculosis incidence and mortality in Egypt using epidemiological models

To estimate tuberculosis incidence in Egypt, data were collected from national tuberculosis case notification records, vital registration statistics, tuberculin surveys and treatment outcomes. An important source of information was the national comprehensive tuberculin survey results, which estimated a 55.2% case detection rate and a 65.6% case notification rate. The data suggest that only two-thirds of actual cases are being identified and treated by the national programme. The figures for expected versus reported deaths from tuberculosis in Egypt in 1996 suggest underreporting to be almost 80%

Outcomes of pregnancies complicated by early vaginal bleeding

The association between early gestational bleeding and suboptimal pregnancy outcome was examined. Postpartum women were interviewed during January-October 1998 at the two main obstetric hospitals in Alexandria, Egypt. Of 1503 singleton deliveries, 10.6% reported bleeding; 63.5% and 36.5% during first and second trimesters respectively. Bleeding was more frequent among women of age >33 years, with history of low-birth-weight babies or previous miscarriage. Suboptimal outcomes occurred more often among women reporting bleeding than among those who never bled and the risk of such outcomes significantly increased with second trimester bleeding. Risk of a low-birth-weight baby, preterm delivery and perinatal death significantly decreased with increasing interpregnancy interval for women with first trimester or second trimester bleeding

use of medication in infants in Alexandria, Egypt

In Egypt, the determinants and rationale for drug use among infants have not been previously studied. We give an overview of the use of prescribed and non-prescribed medication over a 1-month period in infants in Alexandria, Egypt. In 89.6% of cases mothers stated that their infants had suffered some ailments which necessitated intervention; 27.5% used traditional therapies or non-prescribed medication and 72.5% sought medical advice. The non-prescribed medicines used were mainly antispasmodics and antipyretics. This study provides the first overview of the frequency of use of non-prescribed medication in infants and detected some indicators of irrational drug prescribing by physicians

Maternal haemoglobin and premature child delivery

The effect of anaemia [haemoglobin <11 g/dl] during pregnancy on preterm delivery was prospectively studied in 921 low-risk pregnancies. The association between anaemia and prematurity was measured at three different haemoglobin levels, early in pregnancy and during the third trimester. The risk of prematurity was higher with haemoglobin <9 g/dl in early pregnancy, followed by haemoglobin <10 g/dl during the same period; the least risk was recorded during the third trimester when haemoglobin was <10 g/dl. In multivariate logistic regression analysis, haemoglobin was the most important predictor of prematurity after controlling for other confounders. When applying the logistic predictive equation, a woman with all the significant risk factors included in the multivariate analysis had a 72% probability of giving birth to a preterm baby

Perilunate dislocations and fracture-dislocations

Perilunate dislocations [PLD] and fracture-dislocations [PLFD] are severe wrist injuries and most difficult to manage. The initial diagnosis is missed in many instances of these serious injuries that may compromise the outcome. We present our results in the management of nineteen cases of perilunate dislocations and fracture dislocations. This study demonstrates the prognosis with the different treatment techniques showing that good results can be expected by closed reduction, with or without internal fixation. The severest injuries with multiple fractures of the carpal bones as well as neglected and missed cases for longer than four weeks from injury gave the worst prognosis. We would like to stress on the importance of early diagnosis, immediate referral to a specialised hand surgeon for the definitive management and the important role of intensive physiotherapy for these major hand injuries

Ultrasonography in the diagnosis of acute appendicitis

During a 10 month period high resolution sonography was used in the evaluation of 80 patients with an equivocal clinical diagnosis of acute appendicitis. The sonographic findings were correlated with the surgical and pathological outcome in 53 cases and with clinical follow-up in the remainder. This technique was found to be accurate in the diagnosis of acute appeudicitis with a specificity of 95%, a sensitivity of 86% and accuracy of 91%. The predicitve value of a positive test was 93%, that of negative test was 89%. The results showed that high resoluion sonography is indicated to establish the diagnosis of acute appendicitis in patients with equivocal clinical findings

Self-esteem in a psychotherapeutic setting: a comparison of anxiety and depressive disorders

This study was conducted with the aim of assessment of features of self-esteem in patients undergoing psychotherapy for a variety of anxiety [N=43] and depressive [N=17] disorders. The method consisted of a semi-structured therapeutic situation evaluating the patients' concepts of themselves in terms of positive and negative traits or attributes. The requested self-evaluations included both qualitative and global quantitative dimensions. Reponses were subjected to content analysis as well as an assessment of the global quantitative evaluations. Results indicate that low or disturbed self-esteem may be equally significant in relation to anxiety as it is in relation to depression. Both anxiety and depressive disorders were associated with similar global impairment of self-esteem though differences may exist in some qualitative aspects

Social phobia in an Arabic culture: the impact of sociocultural factors

A relatively high frequency of cases presenting with social phobia has been observed among Saudi patients seeking psychiatric help. In this study an attempt was made to assess the possible role of some sociocultural factors in explaining this phenomenon. Two aspects were explored: 1- The possible impact of social change in terms of upward social mobility, urbanization and change of family structure. 2- The possible impact of the cultural patterns [cultural norms, traditions and customs] as reflected in the types of social contexts provoking social anxiety. The study was conducted on a group of social phobic patients [N=53]. A control group of other neurotic disorders [N=26] was utilized to assess the impact of social change. The results seem to provide evidence for a highly possible role of sociocultural factors in explaining the phenomenon of social phobia as observed in this culture. Implications related to the psychopathology of phobic disorders are discussed

Clinical profile of social phobia in Saudi patients

This study was conducted with the aim of investigating characteristics of the clinical profile of Social phobia as encountered in Saudi patients. A sample of 54 patients diagnosed as social phobia according to DSM-III-R criteria were subjected to a thorough clinical assessment including: 1-a semistructured interview exploring key aspects related to history, symptomatology and associated manifestations, and 2-a psychometric evaluation of possible associated personality features. Results show that the disorder in our patients tends to be generalized in form and chronic and persistent in course with no significant episodic fluctuations. Among associated manifestations depression is particularly prominent. Other manifestations include generalized anxiety, obsessive features, paranoid ideas and substance abuse. Personality assessment indicates prominent neurotic and socially introverted features. Results were discussed in the light of findings in some parallel late studies conducted mostly in the West

Perceived parental characteristics in social phobia compared with other neurotic disorders

This study was conducted with the aim of exploring parental characteristics or rearing attitudes as perceived by social phobic patients compared with patients suffering from other forms of neurotic disorders. A group of social phobic patients [N=53] and a control group of patients with other neurotic disorders [N=26] were subjected to a structured interview in which they were requested to rate their parents on a number of characteristics including severity, negligence, overprotection, overcriticism, conservatism and affection or love. Compared with the control group social phobic patients tended to rate their fathers significantly higher on conservatism and overcriticism. While ratings of mothers were not significantly different on any of the evaluated characteristics. On the other hand the comparison of fathers and mothers of social phobic patients indicated a significantly higher negative perception of fathers on most of the characteristics. There results point to the possibility that overconservative and overcritical parental influences have a significant differential pathogenic impact in relation to social phobia. They also imply that paternal rather than maternal characteristics are probably more influential in the genesis of this disorder. The possible relation of these findings to certain sociocultural variables was discussed