Insomnia among community dwelling elderly in Alexandria, Egypt

Insomnia is a common problem in the elderly population. Poor sleep quality is associated with decreased memory and concentration, increased risk of falls, cognitive decline, and higher rate of mortality. Inadequate sleep hygiene such as irregular sleep schedules, use of stimulants, and daytime naps may predispose to insomnia. The aim of this study was to determine the prevalence of insomnia among community dwelling elderly in Alexandria and to assess some of the risk factors and comorbid conditions related to insomnia. This is a cross-sectional study conducted among 380 elderly people taken from different clubs in Alexandria using a predesigned structured interview questionnaire. Data on sociodemographic characteristics, medical history, and personal and sleeping habits were collected. The Insomnia Severity Index was used to assess insomnia and the Depression Anxiety Stress Scale was used to measure depression, anxiety, and stress. One-third [33.4%] of the elderly suffered from insomnia. On logistic regression, the most independent factors that were significantly associated with insomnia were number of chronic diseases [odds ratio [OR] = 7.25 for having >5 diseases], being female [OR = 2.37], anxiety [OR=1.91], watching television in bed before sleeping [OR=1.90], depression [OR=1.74], nocturia [OR=1.13], and daily sunlight exposure [OR=0.57]. Insomnia is a common problem among the elderly in Alexandria. Female sex, chronic diseases, mental health problems, and bad sleep hygiene practice increase the risk for insomnia. Improving knowledge among the elderly about the prevalence and risk factors of insomnia could help the development of effective public health prevention and intervention programs for better sleep quality

Depression among a group of elders in Alexandria, Egypt

Depression is projected to be the leading cause of disease burden in older populations by the year 2020. The aim of this study was to assess the prevalence depression among a group of elders in Alexandria, Egypt and compare the characteristic of elders in 3 different settings. A descriptive, cross-sectional study was carried out among 100 people aged 60+ years in a government elderly home, an internal medicine ward in Alexandria Main University Hospital and a slum area In Alexandria. Based on the Geriatric Depression Scale [short form] the highest prevalence of scores that were suggestive or indicative of depression was among elders who were hospitalized [79.0%], had ophthalmic diseases [85.7%] or tumours [80.0%], had 2+ chronic morbidities [64.9%], were taking 4+ medications daily [83/3%], were more physically dependent and had had 2+ hospital admissions in the last 3 years [90.9%]. Modifiable factors that impact on depression need to be considered in developing interventions for improving mood states in the elderly

T-cell immunity in human chronic toxoplasmosis

Toxoplasmosis is a disease affecting 500 million people worldwide. The seroprevalence varies [from 5% to 90%], depending on geographical location, age, habit of eating raw meat or unwashed fruit and vegetables, and general level of hygiene. The incidence of infections is higher in warmer and humid climate and increases with age. The disease can be congenital or acquired. Cell response [TNF-alpha and IFN-gamma secreted by Th1 cells] and humoral response [IL-4, and IL-10 secreted by Th2 cells] were evaluated. This study assessed the effect of T. gondii on chosen indices of the immune response. The study involved 45 women infected with T. gondii [aged 18-42 years] proven have a chronic toxoplasmosis [IgG positive and IgM negative]. The control group consisted of 25 healthy women [aged 18-45 years] [IgG and IgM negative]. The results showed that patients infected with T. gondii had increased production of theTh-1 cytokines involved TNF-alpha and IFN-gamma that responsible for the cellular response compared to controls. Also, increased production of Th2 cytokines involved IL-4 and IL-10 that responsible for humoral response compared to controls

Nutritional assessment of institutionalized and free-living elderly in alexandria: a comparative study

Mini Nutritional Assessment [MNA] can identify malnourished elderly people and those at risk of malnutrition in short time and can guide optimal early nutritional intervention. To compare the nutritional status of institutionalized and free-living elderly in Alexandria. A cross-sectional study included fifty institutionalized elderly from two governmental elderly homes in Alexandria and fifty four free-living elderly from the community randomly selected . Data about socio-demographic characteristics, medical history and dietary habits were collected and nutritional assessment was carried out using dietary intake method, anthropometric measurements and the MNA tool. Based on body mass index [BMI] estimates, obesity and being at risk of overweight were prevalent among 32% and 18% of institutionalized elderly respectively; among 7.4% and 33.3%, of free-living ones respectively. Using MNA, malnutrition and being at risk of malnutrition were 12% and 40%, respectively among institutionalized elderly; 9.3% and 29.6%, respectively among free-living ones. Calcium and vitamins A and C intake were less than the requirements. Malnutrition and being at risk of it were prevalent among the elders in the two studied settings

Neuron specific enolase in infants and children with simple and complex febrile seizures

Febrile convulsions are the commonest acute neurological disorder of early childhood. Although febrile seizures seldom cause severe brain insult, it has been recently suggested that febrile seizures can cause hippocampal damage and subsequent mesial temporal lobe epilepsy. This study was conducted to evaluate the serum and CSF levels of neuron specific enolase [NSE] as a marker of neuronal damage and lactate dehydrogenase [LDH] as a marker of metabolic derangement in infants and children with simple febrile seizures [n = 12], complex febrile seizures [n =36], and epilepsy [n =12]. All cases were subjected to full history taking and physical examination. Simultaneous serum and CSF sampling were done on admission for assessment of serum and CSF NSE and LDH levels. Results showed that patients with complex febrile seizures had significantly higher levels of serum and CSF NSE and LDH than cases with simple febrile seizures, whereas they had significantly lower levels of serum and CSF NSE than cases with epilepsy. Correlation studies showed significant negative correlation between age of the patients and serum and CSF levels of NSE in patients with complex febrile seizures, while significant positive correlation was found between duration of seizures and serum levels of LDH and between number of seizures and serum NSE levels in cases with complex febrile seizures. It is concluded from this study that complex febrile seizures are more injurious to the neurons than cases with simple febrile seizures especially in younger age group. Prompt diagnosis and guided management is recommended in such cases. NSE maybe a useful test for assessment of neuronal damage after febrile seizures

study of some oxidants/antioxidants and trace elements in children with bronchial asthma

Asthma is a chronic inflammatory disorder of the airways involving variable airflow obstruction and increased airway responsiveness to a variety of stimuli. The rise in prevalence of asthma and allergic diseases among children is a matter of worldwide concern. Epidemiological evidence suggests that changes in diet, in particular reduced antioxidant intake have contributed to the increased asthma prevalence and severity and raises the possibility that dietary interventions may improve asthma. To evaluate the oxidants/antioxidants, and trace elements status in children with bronchial asthma this study was conducted on 39 asthmatic patients [mean age of 8.5 +/- 2.1 years] as well as 20 apparently healthy controls of matched age and sex recruited from Assiut Pediatric University hospital. Beside thorough history-taking, and meticulous clinical examination for all cases and controls, lung function tests and a chest x-ray were done for each asthmatic child. Fifteen patients had mild bronchial asthma, twelve had moderate, and twelve had severe asthma according to the National Asthma Education and Prevention program. The following investigations were done to all studied children: plasma lipid peroxide level expressed in terms of malondialdhyde [MDA]; red blood cell enzyme activity of each of glutathione peroxidase [GSH-Px], and superoxide dismutase [SOD]; plasma levels of vitamins [A, E, and C], zinc [Zn], copper [Cu], selenium [Se] and magnesium [Mg]. Asthmatic children showed significantly higher plasma level of MDA than controls. Red blood cell enzyme activity of each of GSH-Px, and SOD, also, plasma levels of vitamins A, and C, Zn, Se, and Mg showed significantly lower values in asthmatic children than controls. The changes observed in the studied parameters were more apparent in patients with severe asthma than those with mild degree. Significant positive correlations were observed between the values of forced expiratory volume 1 [FEV 1], and each of GSH-Px, SOD, and vitamin A, Zn, and Se, while significant negative correlation was found between FEV 1 and MDA. Also, significant negative correlations were detected between MDA, and each of GSH-Px, SOD, vitamin C and Zn. Oxidative stress and disturbed antioxidants and trace elements status are present in asthmatic children, and may have important consequences for the pathogenesis, and severity of asthma. Special attention must be given to the assessment of dietary intake of vitamins and trace elements. So, good dietetic intakes of high biological value protein, and supplements of vitamins, and trace elements are recommended as an adjuvant therapy. Long term prospective trials are recommended to determine whether modification of dietary intake will be beneficial in prevention, or reduction of the severity and or morbidity of the disease

Spinal nerve roots compression: the superadded diagnostic value of MR myelography

MR provided a new method for generating a myelogram like images of the thecal sac following the conventional MR imaging and based on suppressing background signal using heavily T2 weighted sequences. Forty two degenerative cases were included [group I]in our study [30 cases in the lumbar region, 12 cases in the cervical region and no degenerative cases in the dorsal region]. In addition 38 cases with non-degenerative spinal changes [group II] were included. All cases were examined by conventional multiplanar MRI and MR myelography for detection of the degree of disc prolapse and the compression of the thecal sac and nerve roots. MRI is very specific in determining the etiology of spinal cord compression using the T1,T2 and contrast enhanced sequences. The sensitivity of conventional MRI in the demonstration of the nerve roots compression in our study was 87% in cases with lumbar and cervical disc lesions, 100% in the non degenerative lumbar cases and 87%in non degenerative cervical cases and 75% in dorsal lesions. MR myelography is considered sensitive in 77% of lumbar non degenerative cases, 38% of dorsal non-degenerative cases and 75% in cervical non degenerative cases concerning the detection of the nerve roots compression. MRM allowed a better overall view of the thecal sac and spinal nerve root sleeves making it easier to diagnose spinal canal stenosis and disc herniation. MRM has the advantage of demonstration of the thecal sac and nerve root[s] distal to a complete block. As with conventional myelography, MRM alone can not identify and clearly the cause of nerve root compression and should only be performed as an adjunct to a conventional MR examination

New antimicrobial 9-[p-heterocyclo-substituted anilino]-tetrahydroacridines

The chemistry of tetrahydroacridines is of continuous interest, as they are associated with pharmacological activities[1-9]. Some members of this class of compounds are used as memory-enhancing agents for treating Alzheimer disease [1, 2] acetylcholine esterase inhibitors[3-5], DNA-binding agents[6], antimicrobial agents[7] and as amoebicides[7-9]. The present work deals with the synthesis of a new series of 9-[p-[4-aryl- 3-cyano-2-iminopyridin-6-yl] anilino]-1, 2, 3, 4-tetrahydroacridines [3] and their 2-oxo-[or thioxo]-pyridinylanilino derivatives 4 and 5, besides other related products 7-12 to be evaluated against bacteria and fungi. Synthesis was achieved by allowing 9-chloro-1, 2, 3, 4-tetrahydroacridine [1][10] to react with p-aminoacetophenone to give the 9-[p-acetylanilino] derivative 2. The one pot reaction of 2 with malononitrile, ammonium acetate and the appropriate aromatic aldehyde afforded the corresponding 9-[p-[4-aryl-3-cyano-2-iminopyridin-6-yl]-anilino]-1, 2, 3, 4-tetrahydroacridines [3a-e], respectively [Route a]. Similarly, reaction of 2 with ethyl cyanoacetate, ammonium acetate and the appropriate aromatic aldehyde in n-butanol afforded the corresponding 9-[p-[4-aryl-3-cyano-2[1H]-oxo-pyridin-6-yl] anilino]-1, 2, 3, 4-tetrahydroacridines [4a-d], respectively. On the other hand, the reaction of an ethanolic mixture of 2 with substituted arylmethylene cyanothioacetanilides [5][11, 12] in the presence of ammonium acetate gave the corresponding 3-cyano-4-arylpyridin-2[1H]-thiones [6a-d], respectively [Route a]. Also reaction of 1 with ethyl-p-aminobenzoate gave the corresponding ethyl-p-[1, 2, 3, 4-tetra-hydroacridin-9-yl] aminobenzoate [7] which upon reaction with hydrazine hydrate afforded the corresponding acid hydrazide 8. [Route b]. In addition, acetylation of 2 was accomplished by heating it with ethyl acetate in the presence of sodium metal to give p-[[1, 2, 3, 4-tetrahydroacridin-9-yl]amino]acetylacetophenone [9]. Bromination of 2 afforded 9-[p-bromo-acetyl anilino]-1, 2, 3, 4-tetrahydroacridine [10] which upon reaction with thiourea gave the corresponding 9-[p-[2-aminothiazol-4-yl]aniline-1, 2, 3, 4-tetrahydroacridine [11] was hydrobromide salt, while reaction of 10 with malononitrile afforded p-[1, 2, 3, 4-tetrahydroacridin-9-yl]amino-benzoylmethyl malononitrile [12] [Route c]

cilnical significance of ultrasound-guided lymph node biopsy and fine needle aspiration cytology [FNAC] in patients with abdominal lymphadenopathy

This study included 65 patients [32 males and 33 females] with enlarged abdominal lymph nodes [ALNs] detected by ultrasonography [US]. They underwent US-guided percutaneous ALN biopsy and fine needle aspiration cytology [FNAC] after initial clinical, laboratory, US and Doppler evaluation. Cases with very small [<1 cm] or highly vascular ALNs and those with bleeding tendency, marked obesity or tense ascites were excluded from the procedure. In all patients, both biopsy and FNAC were successful to obtain a sample without major complications. ALNs of different groups and locations were biopsied, the commonest were the para-aortic, coeliac and porta hepatic groups. A definite diagnosis was given by the percutaneous procedures in 58 cases. The diagnosis of other four cases was achieved by laparoscopic or surgical biopsies and the last three cases remained undiagnosed. It was concluded that US-guided biopsy and FNAC of ALNs are efficient methods in the diagnosis of both malignant and benign conditions. They require a perfect cytological and histopathological interpretation supplemented by the use of advanced histochemical techniques. The procedure is easy in experienced hands with no considerable complications

Decreased Helicobacter pylori-associated gastric epithelial proliferation by concurrent Schistosomal infection

Helicobacter pylori [H. pylori] injection is associated with increased gastric epithelial proliferation, the enhanced epithelial proliferation is important in developing gastric carcinoma. Some developing countries with a high prevalence of H. pylori infection have high gastric cancer rates, whereas in others, these rates are low. The progression of helicobacter-induced gastritis and gastric atrophy mediated by T-helper cell, type 1 [Th1] response may be modulated by concurrent parasitic infection. Pathogenic helminths of the genus Schistosoma cause T-helper cell, type 2 [Th2] response to parasite eggs. The Th2 response is usually associated with down regulation of Th1 cytokine synthesis. The aim of the present study was to assess whether concurrent Schistosoma mansoni infection with H. pylori has an effect on gastric mucosal injury in view of cell proliferation, apoptosis, pathological changes, nitric oxide and oxyradicals status. Between April 2001 and March 2002, 73 patients [13 child and 60 adults] were subjected to upper gastrointestinal endoscopy for dyspepsia and liver cirrhosis in the National Liver Institute, Menoufiya University. Four biopsy specimens were taken, two from the greater curvature of the antrum and two from the upper body of the stomach, biopsies were obtained from any lesion as well as from apparently healthy mucosa. One snap from each site was preserved in RNA later solution, then kept at -80°C till utilized for estimation of DNA-flow cytometric assay, reduced glutathion [GSH], catalase [CAT], superoxide dismutase [SOD], Nitric oxide [NO], and lipid peroxidation product- malondialdehyde [MDA]-. Diagnosis of bilharziasis was done by stool analysis, or by sigmoidoscopy and rectal snip. OF the 73 patients, 60 patients were cirrhotic [20 Child A, 34 B, 6 C], 48 were H. pylori-positive and 25 H. pylori negative. The mean age in H. pylori positive patients [46.31 +/- 10.7 years] was significantly less than in H. pylori - negative patients [52.8 +/- 7.2 years]. Infection with H. pylori alone correlated with increased DNA s-phase, proliferation activity and apoptosis [sub-G phase] [p 0.04, 0.03 and 0.04] respectively. Concurrent infection with schistosomiasis occurred in 34 patients and it significantly suppressed DNA 5-phase [P=0.001], proliferation activity [p<0.004], and apoptosis [sub-G phase], [p>0.05]. On contrast, concurrent infection had an adverse effect on liver cirrhosis with increased incidence of upper gastrointestinal bleeding. Schistosomal concurrent infection with H. pylori is associated with higher incidence of superficial gastritis, and may complicate liver cirrhosis with increased upper gastrointestinal bleeding. On the other hand, concurrent schistosomal infection may have a protective effect against the possible progression of H. pylori induced gastritis towards gastric carcinoma, by modulating the cytokine profile of the gastric mucosa with suppression of the proliferation activity. A detailed study of the cytokine expression in similar cases is recommended for unraveling the mystery of this phenomenon

Maturation phenotype of sertoli cells in testicular biopsies of infertile azoospeermic men

The involvement of abnormal Sertoli cell differentiation in different spermatogenic impairments has been studied by an immunohistochemical technique using cytokeratin-18 [CK-18] and anti-vimentin antibody. CK-18 is used as a marker for immature Sertoli cells as it is expressed only in Sertoli cells during prenatal and pre-pubertal differentiation and is normally lost at puberty. Forty two azoospermic men were included in the current study. These included 9 cases with obstructive azoospermia, 8 cases with pure [congenital] type of Sertoli cell only syndrome [SCOS], 12 with secondary type syndrome [SCOS], and 13 with spermatogenic maturation arrest. Vimentin was ubiquitous immunohistochemical marker associated with both normal and impaired spermatogenesis. CK-18 expression was associated with various stages of spermatogenic arrest an[l secondary type of Sertoli cell only syndrome [SCOS]. The expression of CK-18 may be a manifestation of de-differentiation of Sertoli cells or persistence of immature cells. Moreover, useful criteria to predict the absence of spermatozoa in cases of pure Sertoli-cell only syndrome can be obtained by a definite recognition of the typical histological patterns and refined by CK-18 immunostaining aid, especially in difficult cases

double J ureteric stent, is it still a faithful friend to urologists?

To assess the side effects and long term complications of double-J ureteric stents .The records of all patients who were stented by using double-J-Ureteric stents to relieve ureteric obstruction or in the course of endourological management of urolithiasis - were reviewed 50 patients with morbidity and complication due to the D.J. Stents [35 Males, 15 Females] were followed up with plain x-ray, ultrasound. 20 patients were found to complain of fever, symptoms of bladder irritability and flank pain, treated with antibiotics, analgesics and antispasmodics. 8 patients had migration of the stent, 6 with proximal migration, 2 with distal migration, 2 with spontaneous fragmentation of the stent, 20 patients had encrustations and stones formed around the double J stents and treated accordingly. The double J ureteric stents are of great importance and helpful to urologists but may have side effects and complications that may add to the patient's morbidity. So follow up regularly and early interference is mandatory to prevent these complications

Unresurfaced patella in total knee arthroplasty clinical results with conforming design

This is a prospective study of 21 patients [27 kness] underwent primary total knees arthroplasty without patellar resurfacing, using a conforming femoral design [profix components]. All patients had a diagnosis of osteoarthritis and followed for an average of 2.5 years. No major complications occurred and no patellar revision was required by the 2.5 years postoperative follow up. 89% of the cases were able to climb stairs without support. Two Knees [7%] had mild anterior knee pain with stair climbing only. Patellar tendon length was shorter in patients who had anterior knee pain than in patients who did not. There was no statistically significant correlation found between postoperative anterior knee pain and clinical score, decrease of patellar cartilage thickness, severity of patellar disease or patellar bone quality, indicating that unresurfacing of the patella in total knee arthroplasty with conforming femoral design has significant outcomes and avoid complications of resurfacing the patella

Extracorporeal shock wave lithotripsy for lower pole nephrolithiasis: Efficacy and variables that influence treatment outcome

We evaluated the efficacy of Extracorporeal Shock Wave Lithotripsy [ESWL] for treatment of lower pole caliceal stones. The study attempts to identify the relationship between the radiographic anatomy of the lower pole and the outcome of ESWL treatment for a solitary lower pole caliceal stones to help in selecting patients that are likely to benefit from that treatment. A total of 100 patients with solitary lower pole calculi [less than 2 cm.] underwent ESWL monotherapy using the Dornier Lithotriptor S machine. Pretreatment intravenous urography [IVU] was done to determine the stone size and lower pole measurements which include; the lower pole infundibular length. The lower pole infundibular width and the lower pole infundibulopelvic angle. Clinical and radiographic follow-up was done every month for 6 months after ESWL treatment. Sixty-four patients [64%] were stone-free 6 months after starting ESWL treatment, eighteen patients [18%] showed improvement as decreased stone size and another eighteen patients [18%] failed ESWL treatment. Significant variables that influenced treatment outcome include, stone size and type: the number of ESWL sessions and the radiographic anatomy of the lower pole. A short and broad lower pole infundibulum were very important favorable factors that improved the stone clearance after ESWL. Also a wide infundibulopelvic angle significantly improves the stone free rate after ESWL.ESWL is the initial treatment of choice for lower pole calculi smaller than 2cm. The spatial anatomy of the lower pole as defined by the lower pole infundibulopelvic angle, infundibular length and infundibular width, has a significant role in stone free rates after ESWL

Risk factors for coronary artery disease among young Egyptian [under 35 years]

Despite impressive strides in diagnosis and management over the last three decades, coronary artery disease continues to be a major public health problem. We observed that the incidence of coronary artery disease is increasing among young patients [below 35 years of age]. To study the pattern of risk factors for CAD among young Egyptians. 50 patients under 35 years of age were included in the study. Another 50 healthy persons matched by age and sex were included in the study as a control group. Patients were selected from the CCU unit of the NHI. Full history taking, complete general and local examination of the heart was done, resting twelve leads ECG, clinical exercise testing, lipid profile, blood sugar, uric acid, liver and kidney function, echocardiography and thallium stress test was done to all patients. Also psychiatric assessment questionnaire was taken from them to determine the type of personality, exposure to stress and for determining the social, economic status and exposure to pollution. 50 patients under 35 years of age were included in the study, they were 40 males [80%] and 10 females [20%]. Their age ranged between 23 to 34 years with a mean of 29.67 +/- 4.86 years. 20 patients [40%] had ant. MI, 15 patients [30%] had inf. MI, 10 patients had extensive ant. MI and 5 patients had non-Q wave MI. The age of the controls ranged between 21 to 35 years with a mean of 28.5 +/- 5.45. 8 of them [16%] were diabetic, 12 [24%] were hypertensive, dyslipidemia was found in 24 [48%] of them, 14 [28%] were smokers and 14 [28%] had +ve family history for CAD. Type A personality was found in 37 patients [74%], 30 patients [60%] were exposed to psychosocial stress. 39 patients [78%] were living in polluted areas [near factories and in crowded areas]. Exposure to pollution, type of personality, and exposure to psychosocial stress was found to be the most prevalent risk factors for coronary artery disease among young Egyptians. So, attention should be paid to these risk factors especially pollution and extensive studies should be done to find out the role of pollution in CAD

study of urinary tract infection following diagnostic urologic endoscopic procedures in Alexandria

To study the incidence and possible sources of post-cystoscopy infection. Two hundred patients [140 males and 60 females] were studied during the period from April 1998 and December 1998. They underwent diagnostic cystoscopy in the Urology Department [144] and in the Outpatient Clinic of the Main University Hospital [56], Alexandria Faculty of Medicine. Urine samples were collected pre [200] and post-cystoscopy [123] in the first follow up visit within a week. In addition, swabs from the cystoscope, samples from the Cidex, rinsing water, lubricant gel and glycine were cultured .Urine samples were infected in 48.5% of cases prior to cystoscopy and in 69.9% of cases after cystoscopy. These included all the catheterized patients, 30% and 16.26% respectively. With the exclusion of the catheterized patients, infection rates were 26.43% and 64.08% respectively. Comparing the isolates cultured in both instances, 61.02% of patients who were followed caught new isolate infection. Cystoscopes were infected in 21.5% of occasions. Samples taken from Cidex, rinsing water, lubricant gel and glycine were sterile in only 38.73%, 50.79%, 17.46% and in 4.76% of cases respectively. The infection may be less likely to happen if the procedure was carried early in the day, during the first day of Cidex preparation and using the lubricant gel tube for the first time. The reported post-cystoscopy infection rate is unacceptably high. Every effort has to be done to overcome this problem. Several recommendations are proposed. The added expenses are expected to be much less than that caused by infection caused in the cystoscopy room

Determination of antibodies to the fragments A and B of diphtheria toxin

Anúindirect ELISA to determine the fraction of anti diphtheria toxoid [DTd] antibody [Ab] reactive with fraction A [FA] and fraction B [FB] of the toxoid is described. In principle, the binding of [DTd] adsorbed onto ELI SA-plates to the corresponding antibodies [Abs] was specifically blocked with horse F [ab]2 to either FA or FB of diphtheria toxin [DT]. The unblocked antigenic determinants of the DTd were used for determination of the corresponding Abs in sera from immunized humans and guinea pigs. The results revealed a high correlation between the levels of Abs to the DTd, FA and FB of the toxoid in sera from immunized hosts. In addition, it demonstrates that the use of DT-based immunotoxin alters the ratio of anti-FA/anti-FB. The developed ELI SA is reliable for monitoring of the levels of Abs to the toxic entity of the DT-based immunotoxins