Some studies on the effect of protexin on immune status of cultured seabass fingerlings

The present study aimed to investigate the effect of different concentrations of protexin probiotic [Enterococcus faecium] on growth performance, differential leucocytes count, phagocytic activity, phagocytic index, serum total protein, albumin, globulin, Total bacterial count, Total enterobacteriaceae count and Total coliform count of intestinal microbial flora of seabass and disease resistance against challenge with Vibrio alginolyticus. Fish were separated in to four experimental groups of 0.0 g/kg feed [control], 0.1 g/kg feed, 0.2 g/kg feed, 0.3 g/kg feed of commercial probiotic protexin concentrate. Fish fed at 3% body weight per day. Results showed that protexin supplementation have significant improvement in growth performance, significantly increasing in lymphocytes, monocytes, phagocytic activity, phagocytic index, Serum total protein and globulin in all treated groups compared to control Contrary neutrophils and albumin/globulin ratio significantly decreased in all treated groups comparing to the control as well as decreasing in Total bacterial count, Total enterobacteriaceae count and Total coliform count of all treated groups comparing to the control. The mortality rates after challenging with Vibrio alginolyticus were significantly lower in all treated groups than the control. Results indicated that by increasing the concentration of the protexin probiotic results getting better in all examined parameters comparing to control. The present study clearly indicated that inclusion of 0.3gm / kg feed of protexin probiotic in fish diet for not less than 6th weeks can improve the immune status of seabass fingerlings to the favor of resistance to diseases

Monoclonal Antibody-Based Dipstick Assay: A Reliable Field Applicable Technique for Diagnosis of Schistosoma mansoni Infection Using Human Serum and Urine Samples

A field applicable diagnostic technique, the dipstick assay, was evaluated for its sensitivity and specificity in diagnosing human Schistosoma mansoni infection. A monoclonal antibody (mAb) against S. mansoni adult worm tegumental antigen (AWTA) was employed in dipstick and sandwich ELISA for detection of circulating schistosome antigen (CSA) in both serum and urine samples. Based on clinical and parasitological examinations, 60 S. mansoni-infected patients, 30 patients infected with parasites other than schistosomiasis, and 30 uninfected healthy individuals were selected. The sensitivity and specificity of dipstick assay in urine samples were 86.7% and 90.0%, respectively, compared to 90.0% sensitivity and 91.7% specificity of sandwich ELISA. In serum samples, the sensitivity and specificity were 88.3% and 91.7% for dipstick assay vs. 91.7% and 95.0% for sandwich ELISA, respectively. The diagnostic efficacy of dipstick assay in urine and serum samples was 88.3% and 90.0%, while it was 90.8% and 93.3% for sandwich ELISA, respectively. The diagnostic indices of dipstick assay and ELISA either in serum or in urine were statistically comparable (P>0.05). In conclusion, the dipstick assay offers an alternative simple, rapid, non-invasive technique in detecting CSA or complement to stool examinations especially in field studies.

Predictors of asymptomatic cardiac events and prognostic value of cardiac biomarkers in chronic kidney disease patients

Patients with chronic kidney disease [CKD] are at increased risk of cardiovascular events; cardiovascular disease is a leading cause of death in patients with chronic kidney disease; Circulating biomarkers play a major role in the early detection of cardiovascular disease in those patients. To clarify the prevalence of asymptomatic different cardiac events in CKD and to explore the degree of elevation of N- terminal-pro-B-type Natriuretic Peptide [NT-pro-BNP] in asymptomatic cardiac patients with varying degree of CKD and the relationship between the elevation of this biomarker and the occurrence of these cardiac complications. This case-control study included 40 CKD patients and 40 controls; patients were recruited from nephrology unit of internal medicine department; Assiut university hospital; known to have chronic kidney disease in different grades [grade I- grade V]. Resting transthoracic echocardiography [TTE] and plasma NT-pro-BNP concentrations were measured in patients who were asymptomatic for clinical evidence of any cardiac events, [n=40; mean age 47.63 +/- 17.93 years; 52.5%were males] as well as healthy volunteers n=40; mean age 42.00 +/- 13.25; 62% were males]. In addition, the correlation between plasma NT-pro-BNP concentration and parameters of echocardiography was examined. Increased prevalence of left ventricular hypertrophy [LVH] [70%]; left ventricular diastolic dysfunction [77.5%], left ventricular systolic dysfunction [17.5%] and coronary artery disease [27.5%] in CKD patients as well as serum NT-pro-BNP levels in the patients were significantly higher [6703.75 +/- 2947.68 pg/ml] than those in healthy volunteers [124.83 +/- 140.40 pg/ml] [p=0.000]. NT-pro-BNP level was higher also in patients who had hypertension [p=0.002]; anemia [p-0.004]; hypoalbuminamia [p=0.000];left ventricular hypertrophy [LVH] [7873. 57 +/- 2719. 31 pg/ml] [p = 0.000], diastolic dysfunction [7524. 52 +/- 2824.74 pg/ml] [p= 0.000]; systolic dysfunction [10371.43 +/- 2771.71] [p=0.000] and patients who had segmental wall motion abnormality [SWMA] [8709.0.9 +/- 3512.3.9] [p=0.000] and correlate Positively with C reactive protein [CRP] level [r-0.751 p=0.000]; left ventricular mass [LVM] [r=0.772 p=0.000] and left ventricular mass index [LVMI] [r=0.715 p=0.000] and negatively with ejection fraction [EF] by echocardiography [r=-0.483 p=0.000]. NT-pro-BNP level elevation in asymptomatic patients with CKD reflects underlying cardiac dysfunction, ischemic heart disease and hypertrophy independent of renal function

Fasciola gigantica Fatty Acid Binding Protein (FABP) as a Prophylactic Agent against Schistosoma mansoni Infection in CD1 Mice

Although schistosomicidal drugs and other control measures exist, the advent of an efficacious vaccine remains the most potentially powerful means for controlling this disease. In this study, native fatty acid binding protein (FABP) from Fasciola gigantica was purified from the adult worm's crude extract by saturation with ammonium sulphate followed by separation on DEAE-Sephadex A-50 anion exchange chromatography and gel filtration using Sephacryl HR-100, respectively. CD1 mice were immunized with the purified, native F. gigantica FABP in Freund's adjuvant and challenged subcutaneously with 120 Schistosoma mansoni cercariae. Immunization of CD1 mice with F. gigantica FABP has induced heterologous protection against S. mansoni, evidenced by the significant reduction in mean worm burden (72.3%), liver and intestinal egg counts (81.3% and 80.8%, respectively), and hepatic granuloma counts (42%). Also, it elicited mixed IgG1/IgG2b immune responses with predominant IgG1 isotype, suggesting that native F. gigantica FABP is mediated by a mixed Th1/Th2 response. However, it failed to induce any significant differences in the oogram pattern or in the mean granuloma diameter. This indicated that native F. gigantica FABP could be a promising vaccine candidate against S. mansoni infection.

Distribution pattern and physical mapping of ccc plasmid-mediated multidmg-resistance in some g-ve bacteria recovered from hospitals and haemodialysis units wastewater at AI-Madinah AI-Munawarah

Investigation of the presence and distribution pattern of plasmid-linked antibiotic resistance amongst Gram-negative bacterial strains recovered from wastewater of hospitals and haemodialysis units. Drawing up a physical map of the most frequently distributed plasmids. Representatives G-ve bacterial strains; 59 isolates, were chosen from a previous study for the same authors, as of the most resistant ones [resist more than 3 up to 9 antibiotics to > 100 micro g/ml.]. Miniprep protocol and gel electrophoresis technique were adopted for the detection and isolation of ccc plasmid DNA from the differentially-isolated G-ve bacteria. Restriction analysis using 11 DNA restriction enzymes and "Plasp" computer program against lambda phage DNA digested with Hind III, for physical mapping of the most distributed plasmid. Results revealed the presence of seven different plasmids, distributed as 1-3 different types of plasmids in 68% [4Oj59] of the strains; chosen as representatives of the most resistant ones [resist more than 3 up to 9 antibiotics to > 100 micro g/ml.]. The detected plasmid sizes were estimated against HindIII-digested lambda phage and found ranged from 36,844 to 2,027 bp. Preliminary physical mapping was constructed for the plasmid [23130 bp] that was the most distributed amongst more than 90% of the plasmid-bearing strains and was the only found singly. The isolated, characterized and the mapped plasmid [s], suggest the possibility of high rate of both vertical and horizontal distribution of these plasmids amongst the isolated G- ve bacterial Genera and species

Injection safety at primary health care level in south-western Saudi Arabia

In a study of injection safety in Abha health district, Saudi Arabia, data were collected from 47 physicians and 85 nurses at 24 primary health care centres, using an observation checklist and an interview questionnaire. All centres used individually packed disposable syringes and puncture-proof containers to collect used needles. Needlestick injury in the previous year was reported by 14.9% of physicians and 16.5% of nurses [0.21 and 0.38 injuries/person/year respectively]. Logistic regression analysis identified recapping the needle after use [physicians and nurses] and bending the needle before disposal [physicians] as significant risk factors for injury

Fasciola gigantica: parasitological and scanning electron microscopy study of the in vitro effects of ivermectin and/or artemethea

To evaluate the in vitro effects of different, concentrations of ivermectin and/or arteinether on Fasciola giganfica worms and to study the parasitological changes and tegumental alterations using scanning electron microscopy [SEM]. F. giganhica worms were incubated in vitro for 24 and 48 hrs with 3 concentrations of either ivermectin 01. artemether [10, 20 and 50 micro g/ml] or both in half the concentration of either of them [5, 10 and 25 micro g/ml]. Exposure of Fasciola worms to 25+25 micro g/ml of combined drug regimens or to 50 micro g/ml of either ivermectin or artemether for 48 hrs led to 100%, 41.7% and 75% worm killing which were accompanied by a significant reduction in egg laying capacity and significant increase in dead eggs which were maximally recorded in combined drug regimens. SEM of the flukes incubated for 48 hrs with combined drug regimens showed maximal tegumental disruption with swelling of the worm body, roughness, blebbing, sloughing and complete loss of spines. Disruption to the tegument of the flukes induced by artemether was more than that of ivermectin. Artemether alone or combined with ivermectin in half doses had potent fasciocidal activities. Besides, half doses of combined drug regimens had higher ovicidal effects than each drug alone, in vivo studies are recommended to furtherly explore the efficacy of combined regimens against Fasciola infection

Primary care physicians' knowledge and attitude towards prescribing medication for acute respiratory infection

This study was performed to assess primary care physicians' knowledge and attitude towards prescribing medications for acute respiratory infections [ARIs]. Aseer Region Primary Care Physicians. Cross sectional study. A cross sectional study using a self-administered, questionnaire carried out during March and April 2004, among all primary care physicians. Out of 320, 268 questionnaires were returned [response rate = 83.75%]. The mean rank of score in knowledge on ARIs was 16 [SD = 2.0] out of 21. More than 80% of respondents have heard about the National Protocol for ARIs [NP-ARIS]. One-third has attended a training course on the protocol, while a third did not want to attend such type of training. Of the 153 physicians who had copies of the protocol, 145 read it. However, only 85 physicians of those who read it comply with it. Physicians with experience more than 5 years in primary health care centres attended more training courses on the NP-ARIs [44% vs 20%, p = 0.01], had a positive attitude towards it [70% vs 60%, p = 0.04]. Those who were trained on the protocol, prescribed anti histamines and vitamin c less frequently [38% vs 60%, p = 0.04] and [38% vs 61%, p = 0.04] respectively. Over-prescribing for acute respiratory infections is a common behaviour among primary care physicians, despite their good knowledge of the health problem

Biochemical effects of chronic abuse of ergogenic aids in rats

To investigate the potential health risks associated with recommended or overdoses of amino acids mixture such as Power Mix [PM], Branched Chain Amino Acids [BCAAs] or Ceratine [Cr] supplementation as ergogenic aids for short or long-term rats. Male Sprague Dawley rats were assigned into two major groups; the first group was orally treated with the above mentioned supplements for six weeks [short-term], and the second group was treated similarly but for twelve weeks [long-term]. Each of the short- and long-term group was subdivided into seven subgroups which were treated as follows: PM [0.8 g/kg/day], PM [2.4 g/kg/day], BCAAs [0.2 g/kg/day]. BCAAs 0.6 g/kg/day], Cr [2 g/kg/day], Cr [6 g/kg/day] and controls [kept without treatment]. Plasma amino acids levels beside renal, thyroid, adrenal, and hepatic functions were estimated. Significant elevation in total amino acids concentration was found as result of feeding with the three dietary supplements. Results showed significant increase in serum creatinine level in rats ingested with these ergogenic aids except the low dose of PM given for short- or long-term. High doses of the three supplements given for both short- and long-term and low doses of BCAAs and Cr given for long-term caused significant elevation in serum uric acid level. Significant increase in serum NAG activity was observed among the three dietary supplements. Also, significant rise in serum AST and ALT activities was obtained after feeding the three dietary supplements except the low dose of PM given for short-term. Serum T3 level was significantly increased by feeding BCAAs or Cr in high doses for long-term. None of the three supplements exerted significant change in serum TSH and T4 levels. High doses of PM, BCAAs or Cr given for either short- or long-term caused significant increase in serum corticosterone and significant decrease in plasma ACTH levels. The three dietary supplements resulted in significant increase in cytosolic AST and ALT activities except the low dose of PM given for short- and long-term as well as low dose of BCAAs and Cr given for short-term. The three dietary supplement except low dose of PM fed for short-term, caused significant rise in mitochondrial AST activity. This study showed that supplementation of high-dose of PM, BCAAs or Cr given for long-term as ergogenic aids induced renal and hepatic damage as well hormonal disturbances

Effects of l-arginine and l-name on contractile function of rat intestine submitted to cold ischemic preservation

To investigate the protective effect of L-arginine, a nitric oxide [NO] donor, against cold ischemic preservation of rat intestine. Jejunal segments, excised from rats, were preserved in Ringer's lactate [RL] solution [1], RL containing L-arginine [2], RL containing L-NAME [3]; all segments were kept at 10°C for 4 hours. Comparisons were made with non preserved control segments immersed in Tyrode's solution. In vitro contractile function of jejunal segments, from all groups, was studied under basal condition and in response to acetyl choline and adrenaline. The contractile function, expressed as the contractile force and motility index, was insignificantly different in cold ischemic preserved jejunal segments from that of the controls. In both cold ischemic preserved and control segments, contraction force and motility index were augmented by acetyl choline and inhibited by adrenaline. Addition of L-arginine to the preservation medium significantly increased the basal contraction force and motility index. L-arginine did not modify the responses to acetyl choline, yet it attenuated the inhibitory effect of adrenaline on both the contraction force and motility index. Addition of L-NAME to the preservation medium did not modify either the basal contraction force or the motility index from those obtained from control or cold ischemic preserved segments, L-NAME significantly decreased the cholinergic responses when compared to those of the control, L-arginine and cold ischemic preserved groups. In response to adrenaline, L-NAME produced less inhibition than that exhibited by control or cold ischemic preserved segments; however, such inhibitory effect was less than that displayed by L-arginine under the same conditions. The augmented cholinergic response to addition of L-arginine, and its blunting by L-NAME, on rat jejunum, suggest that NO plays an important role in the motor activity of small bowel. This could be a result of improved autonomic cholinergic function and through augmenting neurotransmitter release

Enhanced coronary flow following experimental androgen deprivation by orchidectomy

Androgen deprivation is an effective treatment for patients with advanced prostate cancer. The present work was conducted to study the impact of testosterone deprivation on cardiac functions and coronary flow. Experimental androgen deprivation was induced in rats by orchidectomy, compared to sham-operated controls. Two weeks after operation, rats were subjected to measurements of body weight, plasma testosterone and ECG recording. Cardiac functions were studied on isolated perfused hearts in a Langendorff preparation, under basal conditions and following exposure to 30 minutes of global ischemia followed by another 30 minutes of reperfusion. The following parameters were assessed: heart rate [HR], peak tension [PT], time to peak tension [TPT], half relaxation time [HRT], and myocardial flow rate [MFR]. Absolute weights of different cardiac chambers and their relative weights were also determined. The orchidectoimzed [ORX] rats exhibited non significant changes in ECG parameters, significant increase in absolute weights of whole heart and left ventricle, associated with significant body weight gain. Hearts isolated from ORX rats displayed a significant increase in basal preischemic MFR compared to their matching controls. Upon isehemia reperfusion [I/R], MFR of hearts isolated from ORX rats was still higher compared to controls, After 30 minutes of reperfusion, hearts of control rats displayed non significant change in HR associated with significant decrease in MFR as compared to preisehemie values; while in hearts of ORX rats, HR was significantly decreased, and accompanied with non significant changes in MFR. The augmented MFR in response to I/R, in ORX rats,, was however associated with significant increase in TPT and HRT, indicating impaired ventricular contractility and delayed relaxation, respectively when compared to controls. Upon I/R, PT was preserved in ORX group, while it was deteriorated in the controls, as compared to the preischemia values. Expenmental androgen deprivation induced marked increase in coronary flow, possibly due to lack of the predominant vasoconstrietor effect of testosterone hormone

Rapid and reliable HP-TLC detection of opium and opium alkaloids; fluorescence densitometric assessment of morphine in serum

To propose a rapid reliable Thin Layer Chromatography [TLC] detection of opium and opium alkaloids in seizures and to develop a micro High Performance Thin Layer Chromatography [HP-TLC] method of assessment of morphine in serum using CAMAG-TLC scanner. 3 Opium samples were provided from the central Medico-Legal Laboratory, Ministry of Justice, Cairo, Egypt. They were subjected to TLC using the standard conditions. The blood samples were admitted to the Department of Narcotics and Poisons, National Research Center. The serum samples were hydrolyzed, extracted and dansylated. The dansyl derivatives were submitted to HP-TLC and measured by fluorescence densitometry using CAMAG-TLC scanner. TLC showed the major and minor opium alkaloids. The densitomatric fluorescence of morphine in serum revealed that the concentrations of morphine in 3 samples were 40, 50 of 66 ng/ml. Being sensitive and reliable the proposed method proved its applicability where possession or ingestion of opium is to be assessed

monoclonal antibody-based latex agglutination test for detection of circulating schistosomal antigens in human schistosomiasis maizsoni

Schistosomiasis is a major public health problem with a worldwide distribution, Diagnosis of this disease by simple and rapid immunoassays is a priority. The objective of the present study was to standardize and evaluate the latex agglutination test [LAT] as a simple test for the detection of circulating schistosomal antigen [CSA] in serum and urine samples of S. mansoni patients and compare it with ELISA. According to stool examination this study included, 52 S. mansoni infected patients, 20 other parasites infected patients and 20 negative control samples. A polystyrene latex [0.81 micro m] suspension was used as a carrier particle for anti-S. mansoni adult worm tegumental antigen monoclonal antibody [l2D/10F] in the test. The Latex particles sensitized with MAb were used for the detection of CSA in urine and serum samples. The sensitivity of LAT assay was 88.5% in urine and 86.6% in sera versus 90, 4% and 92.3% for ELISA. The specificity of LAT assay was 90% and 95% for urine and sera versus 85% and 95% for ELISA. The diagnostic efficacy of EAT was 89.1% and 90.2b for urine and serum samples, respectively versus 88% and 93.5% for ELISA. Moreover, a positive correlation was found between ova count in stool of S. mansoni infected patients and both the intensity of LAT and OD readings of ELISA in urine [r= 0.922; p< 0.001 and r= 0.865; p< 0.001, respectively] and in serum [r=0.847; p< 0.001 and r= 0.781; p< 0.001, respectively]. In conclusion, LAT is a suitable applicable diagnostic method in field survey especially when followed by ELISA as a confirmatory test in query false negative results. In the same time, more trials are required to increase the sensitivity and specificity of LAT to allow its use on a large scale in field surveys and as diagnostic kits for multiple parasitic infections

Evaluation of purified tegumental antigen of Fasciola adult worm In diagnosis of human fasciollash

This study was designed to develop a sandwich ELISA for detection of Fasciola antigens in stool and sera of fascioliasis patients as a better diagnostic alternative to routine parasitological methods. Anti-Fasciola antibodies were produced by immunization of rabbit with Fasciola purified tegumental antigen [PTA] obtained from worms collected from livers of cattle infected with Fasciola. Raised antibodies were then employed in sandwich ELISA for detection of Fasciola antigen in collected sera and stool samples. In this study sera and stool samples from 40 Fasciola infected patients, 30 patients infected with other parasites [Schistosoma, Hydatid and Ancklystoma] and 20 uninfected individuals were tested by sandwich ELISA for detection of Fasciola antigen. The sensitivity of coproantigen assay reached 90% for detection of Fasciola antigens in stool and 87.5% for detection of Fasciola antigen in sera of fascioliasis patients. The specificity of the assay was 94% for stool samples and 92% for sera of negative controls and patients harboring other parasites collectively. The diagnostic efficacy of the assay was 92.2% and 90% for stool and serum samples, respectively. Moreover, a positive correlation was found between ova count in stool of Fasciola infected patients and antigen levels in both sera and stool samples [r= 0.456, p< 0.01; r=0.532, p< 0.01]. In conclusion, our data demonstrated that the employment of rabbit anti-Fasciola IgG antibodies in sandwich ELISA for the detection of Fasciola coproantigen in stool provided a sensitive and specific tool for immunodiagnosis of Fasciola infection

DNA vaccination using schistosoma mansoni fimbrin gene on naive and infected praziquantel-treated mice

DNA immunization represents a promising vaccine strategy that has been reasonably successful, and will likely play a greater role in vaccine research development against Schistosoma mansoni [S. mansoni]. S. mansoni fimbrin [Smfim] gene which encodes a putative actin bundling tegumental and immunogenic protein has been cloned into the eukaiyotic expression vector pcDNAI/Amp and used for intra-muscular DNA vaccination of Swiss albino mice. Two experimental models were used to study its role on protection against S. mansoni infection in naive mice [model 1] and to explore its effect on infected praziquantel [PZQ]-treated mice [model 2] using different immunological, parasitological and histopathological parameters. In the first model, Smfim-vaccinated mice showed high anti-Smfim IgG titer and acquired a significant protection [43.2%; p< 0.01] with reduction of ova count in both hepatic and intestinal tissues [59.2% and 5 1.1% respectively, p< 0.01], significant reduction of granuloma count [24.1%; p< 0.01] and granuloma diameter [18.3%

Synergistic effect calcium channel blockers and praziquantel treatment in murine schistosomiasis

This work was conducted to study the potential drug interaction between calcium channel blockers [CCBs], commonly used as antihypertensives, and the antihelminthic agent praziquantel [PZQ] in Schistosoma mansoni infected mice. Two CCBs namely nifedipine and diltiazem were used either alone or in combination with PZQ, in full or reduced doses [500 mg/kg/day for 2 successive days or 250 mg/kg/day]. The experimental design included eight groups; infected-nifedipine treated [300 mg/kg for 3 weeks [wks]]; infected-nifedipine-PZQ treated; infected-diltiazem treated [300 mg/kg for 3 wks]; infected-diltiazem-PZQ treated; infected control and infected-PZQ treated. Eight wks postinfection [Pt] animals of all groups were sacrificed for subsequent parasitological, immunological and histopathological assessment. Data collected in this work revealed that treatment with nifedipine or diltiazem significantly reduced the egg production by adult schistosome worm as manifested by reduction in tissue egg load and decreased percent of immature ova in oogram pattern. This reduction was more in favor with nifedipine. The groups given the combined regimens of CCBs [nifedipine or diltiazem] and PZQ either in reduced [250 mg/kg/day] or full [500 mg/kg/ day] doses, showed more significant reduction in egg production in addition to high significant reduction in worm burden, as compared to infected control group. The number of granukima also decreased significantly in all treated groups; this could be due o decrease in egg production. The antischistosomal IgG level was increased significantly in PZQ-treated group and groups receiving combined regimens of CCBs and PZQ with different doses; while no significant change in the IgM levels was recorded among different studied groups. In conclusion administration of CCBs in the early phase of infection would inhibit egg production by parasitic worms, thus probably acting in synergy with PZQ and not interfering with its action. Further studies are needed to evaluate the possible use of lower doses of PZQ in combination with CCBs. The reported data of this work may be of value in endemic areas where schistosome infected patients could be suffering from other chronic diseases necessitating treatment with CCBs, as hypertension

Billiary atresia cases among attendants of Menoufiya National Liver Institute: [a retrospective study]

This study included 126 cases of neonatal cholestasis syndrome [NCS] from the attendants of Pediatric Department of the National Liver Institute, Menoufiya University from 1994 up to 2004 . They were divided into two groups: First group[1stGr.] included 58 biliary atresia [BA] cases [46%] and the second group [2ndGr.] included 68 [54%] were due to other causes of NCS . The etiology of NCS due to causes other than BA were as follows: 28 cases [22.22%] neonatal hepatitis, 11 cases [8.73%] septicemia, 8 cases [6.35%] paucity of intrahepatic bile ducts, 5 cases [3.97%] inspessated bile syndrome, 4 cases [3.17%] choledochal cyst, 2 cases [1.59%] Byler's disease, 2 cases [1.59%] galactosemia, 2 cases ? 1 antitrypsin deficiency [1.59%], 1 case [0.79%] Alagille syndrome, and 5 cases [3.97%] due to unknown causes. Onset of jaundice whether early or late does not differentiate cholestatic cases due to BA from other causes of NCS.Clay coloured [acholic] stools were more frequently detected in BA cases [77.6%] than 2ndGr. [27.9%] [p<0.05]. Triangular cord sign [Tc sign] and absence of and/or gall bladder abnormality were detected in significantly higher proportion of BA group more than the 2ndGr.[p<0.05]. By histopathological examination portal tract fibrosis, bile duct proliferation, bile plugs in portal ductules and preservation of hepatic lobular architecture were detected more frequently among BA cases than the other group, while interface hepatitis and giant cell detection were observed more frequently among 2ndGr. than BA cases [p < 0.05]. The mean of alkaline phosphatase and gamma glutamyl transpeptidase was found to be statistically higher among BA group than that of the 2ndGr. [p<0.05] . Kasai operation was done for only 20 cases of BA cases [34.5%] and the mean of age of patients at time of operation was 75 days +/- 17.8. Complications encountered in BA cases were recurrent cholangitis, ascites, itching, coagulopathy, hematemesis and end-stage liver failure in 48%, 50%, 41.7%, 39.6, 18.8% and 54.2% of cases respectively. In conclution, the results of the present study indicate that clinical evaluation by an experienced pediatric hepatologist and liver biopsy together with careful ultrasonographic evaluation are considered as the most reliable methods for early differentiation of BA from other causes of neonatal cholestasis. Management of BA cases will be improved by public and professional education to encourage early referral of infants with neonatal cholestasis [>14 days] to specilised liver centers for early diagnosis to facilitate initial surgery before 8 weeks of age

Primary health care emergency services in Abha district of southwestern Saudi Arabia

To study emergency services delivery in all 30 primary health care centres in Abha district of Asir region, Saudi Arabia, data were collected about equipment and facilities, physicians' practices and attitudes, and patients' utilization of and satisfaction with emergency services. Two centres had no devoted place for emergency services. Lack of some essential equipment and drugs was evident. The greatest continuing medical education need for doctors was the management of cardiovascular emergencies [72.3%]. Many doctors [40.4%] did not consider the majority of cases as true emergencies. Many patients [43.7%] used the centres for emergency services, the most common being trauma, burns and orthopaedics [47.8%]. Most patients were satisfied overall with emergency services [82.2%]

Generalized obesity, serum lipids and lipoproteins in adult males in a Semi-Urban community in the North of Jordan

To describe the relationship between generalized obseity with serum lipids and lipoproteins. Multi stage sampling technique was used to select the participants from Alsareeh area. A total of 400 apparently healthy adult males aged 30-50 years were invited to participate in the study, 103 non-obese, 100 overweight, 103 obese completed the study. A pilot tested interview questionnaire was designated in the study to collect dietary the history. Triglycerides, total cholesterol, and high density lipoprotein cholesterol were measured, whereas low density lipoprotein cholesterol and total cholesterol to high density lipoprotein cholesterol ratio were calculated. Adverse serum lipids and lipoproteins were categorized based on National Institute of Health [NIH, 1998]. Obesity was categorized into three groups as indicated by body mass index-C WHO [1997] for generalized obesity. There was an increase in the prevalence rate of adverse serum lipids and lipoproteins as BMI level increases. Their prevalence rate among overweight and obese subjects compared with non-obese subjects were 2.1-8.9 and 4.9-10.9 times respectively. Adjusted odds ratios of adverse serum lipids and lipoproteins after controlling for confounding factors among overweight and obese subject compared with non-obese were 5.08-6.27 [95%CI] and 11.59-13.8 [95%CI]respectively. The amount of body fat is a major risk factors on adverse serum lipids and lipoproteins which emphasizes the need for concentrated efforts to prevent and treat obesity rather than just its associated diseases

Phenotypic detection of metallo-beta-lactamases and extended spectrum beta-lactamases among gram negative bacterial clinical isolates

Detection of metallo-beta-lactamases [MBLs] and extended spectrum-beta-lactamases [ESBLs] among Gram negative bacilli [GNB] is crucial for the optimal treatment of patients and to control spread of resistance. However, NCCLS documents do not contain a method for detection of MBL producing isolates. Lack of sufficient reports from Egypt indicated the need for this study to determine the proportion of MBL producers among GNB isolated from clinical multi-drug resistant [MDR] pathogens. We also attempted to assess the efficiency of several phenotypic tests for the rapid and convenient detection of MBLs among Pseudomonas and Acinetobacter spp. The efficiency of testing ceftazidime [CAZ] resistant versus imipenem [IMP] resistant pathogens was also compared. A total of 70 CAZ intermediate/resistant GNB were identified and tested for antibiotic sensitivity by Vitek 2 Automated System [bioMérieux]. Screening for ESBLs was performed by Oxoid combined test [CD02] and confirmed by Vitek 2. The phenotypic detection of MBL production among Pseudomonas and Acinetobacter isolates was performed by modified Hodge test, EDTA-disk synergy test [EDST], IMP-EDTA combined disk test [CDT] and E-test MBL strips. Negative control strain [P. aeruginosa ATCC 27853] was included in the tests. Of the 70 GNB pathogens, 25[35.7%] were ESBL producers mainly Escherichia coli [E. coli] and Klebsiella pneumoniae [K. pneumoniae], while 8[11.4%] P. aeruginosa isolates were IMP resistant. Their MIC was 16ug/ml as confirmed by E-test. None of the Acinetobacters showed resistance to IMP. Isolates were considered as MBL producers when three of the phenotypic tests were positive. Both DST and CDT [7/8] were superior to Hodge and E-tests [4/8] for detection of MBL production. One IMP resistant isolate was negative by all tests suggesting non-MBL production. None of the IMP resistant isolates was an ESBL producer. In conclusion the majority of our IMP resistant P. aeruginosa isolates seemed to be MBL producers. Genetic confirmation and analysis of MBL producers is mandatory for positive isolates screened by phenotypic tests. Among the latter DST and CDT proved to be more rapid and convenient tests for their detection in the clinical laboratory. Testing IMP resistant rather than CAZ resistant isolates could reduce screening work for MBL detection. Colistin may be recommended for treatment of serious infections caused by MDR MBL positive P. aeruginosa